NBI及AFE在喉癌早期诊断中的应用

研究表明,喉癌的早期诊断、及时治疗不仅可以提高治愈率,而且也减少了患者的手术创伤和经济负担。积极开展喉癌的早期诊断研究具有重要的临床和社会意义。发现早期喉癌常规方法主要有电子喉镜、纤维喉镜、颈部CT及MRI检查,但并不能明显有效提高早期诊断率。而窄带成像(narrow band imaging,NBI)及自体荧光内镜(autofluorescence endoscopy AFE)是近几年用于喉癌早期诊断的两种新颖的内镜技术。NBI是一种通过变窄光波的波长,使粘膜上皮内乳头样毛细血管袢及粘膜下静脉的结构形成鲜明的对比,从而提高组织表面细微结构的对比度,便于发现病灶。而AFE技术是一种利用自发荧光聚集于病变组织的某个区域产生的差异强度,来区别正常组织与肿瘤性病变,从而用于肿瘤的早期诊断及识别癌前病变。因此,对NBI及AFE的进一步研究及认识对喉癌早期诊断提供非常重要的临床应用价值。     

行胶囊内镜检查67 例患者临床结果分析

目的:评价胶囊内镜在小肠疾病中的诊断价值,总结胶囊内镜临床应用策略。方法:回顾性分析上海市第一人民医院胃肠镜室2009年7月-2011年4月67例行胶囊内镜检查患者的检查结果,结合其中32名患者双气囊小肠镜检查结果及手术病理,分析胶囊内镜在小肠疾病的检出率,诊断率和不良事件发生率,总结胶囊内镜检查时的注意事项。结果:1例胶囊内镜操作失败,66例受检者检出率80.3%,诊断率为66.7%,发现病变中血管病变为主要诊断,占62.1%,其次为肠道占位(息肉、肿瘤)为14.6%,克罗恩病占10.9%,所有患者均未出现严重不良事件。结论:胶囊内镜在小肠疾病检查中安全,无创,诊断率较高,临床胶囊内镜检查时建议充分肠道准备,实时监控及结合双气囊小肠镜检查。     

上消化道粘膜下肿瘤的内镜下诊断及治疗进展

上消化道粘膜下肿瘤(SMTs)临床较为常见,是一类来源于非粘膜层的肿物,有良恶性之分,良性多见。因其表面覆盖正常粘膜组织,常规的内镜下活检只取到粘膜层,难以深达粘膜下层,肿瘤性质难以判定,因此既往多随访观察,肿瘤在短时间内增大或出现明显的临床症状时才予以外科手术治疗。近年来,由于超声胃镜(EUS)技术的发展,SMTs的诊断不仅可以定位,还可以定性。随着内镜下粘膜切除术(EMR)、内镜下粘膜剥离术(ESD)、经口内镜粘膜下隧道肿瘤切除术(STER)等内镜下微创治疗技术的发展,不仅可获得足够的病理标本更加准确的诊断SMTs,还可以安全、高效的切除病变、避免了外科手术的创伤、减轻了经济负担,本文就内镜下对于SMTs的诊断、微创切除SMTs的方法及相关并发症的处理等予以综述。     

激光共聚焦显微内镜在大肠疾病诊断中的应用现状及进展

激光共聚焦显微内镜(confoeal laser endomicroscopy,CLE)是20世纪80年代发展起来的一种新的内镜成像技术,它的出现把一些疾病的内镜诊断与组织学诊断科学地结合起来,能够在内镜检查同时完成组织学诊断,这种新的诊断方法是内镜影像技术的一次革命性飞跃.本文就CLE在大肠疾病诊断中的临床应用现状作一综述,总结CLE在大肠疾病诊断中的优势及实用价值.     

放大染色内镜对结节性胃炎、胃粘膜相关组织淋巴瘤的诊断

目的:探讨放大染色内镜对结节性胃炎、胃粘膜相关组织淋巴瘤诊断的可行性。方法:选择哈尔滨医科大学第四临床医学院2007年5月～2010年7月诊断的结节性胃炎、疑诊胃粘膜相关组织淋巴瘤患者,观察临床、内镜、病理表现、幽门螺杆菌感染情况和根除治疗的效果。并应用日本FUJINON EG-590ZW型放大内镜对患者进行检查,观察根除幽门螺杆菌前后结节性胃炎、胃粘膜相关组织淋巴瘤的改变。结果:纳入分析的100例成人患者,男25例,女75例,年龄19～68岁,平均年龄39.2岁。主要临床表现为上腹痛和消化不良症状。内镜下表现为胃窦部为主,可扩展至胃体部的色泽均匀的结节样或颗粒样改变。病理检查显示胃窦部活检标本中有伴生发中心的淋巴滤泡增生。所有患者均有幽门螺杆菌感染,经根除治疗后,症状缓解率达92.0%。结论:结节性胃炎、胃粘膜相关组织淋巴瘤发生与幽门螺杆菌感染相关,放大染色内镜对结节性胃炎有诊断意义。     

放大染色内镜对结节性胃炎、胃粘膜相关组织淋巴瘤的诊断

目的：探讨放大染色内镜对结节性胃炎、胃粘膜相关组织淋巴瘤诊断的可行性。方法：选择哈尔滨医科大学第四临床医学院2007年5月～2010年7月诊断的结节性胃炎、疑诊胃粘膜相关组织淋巴瘤患者,观察临床、内镜、病理表现、幽门螺杆菌感染情况和根除治疗的效果。并应用日本FUJINONEG-590ZW型放大内镜对患者进行检查,观察根除幽门螺杆菌前后结节性胃炎、胃粘膜相关组织淋巴瘤的改变。结果：纳入分析的100例成人患者,男25例,女75例,年龄19-68岁,平均年龄39．2岁。主要临床表现为上腹痛和消化不良症状。内镜下表现为胃窦部为主,可扩展至胃体部的色泽均匀的结节样或颗粒样改变。病理检查显示胃窦部活检标本中有伴生发中心的淋巴滤泡增生。所有患者均有幽门螺杆菌感染,经根除治疗后,症状缓解率达92．0％。结论：结节性胃炎、胃粘膜相关组织淋巴瘤发生与幽门螺杆菌感染相关,放大染色内镜对结节性胃炎有诊断意义。     

肺癌早期诊断的研究进展

大多数肺癌患者在确诊时已属中晚期,5年生存率极低,早期诊断是改善其预后和提高生存率的关键。目前常用的肺癌早期诊断方法包括影像学、内镜和分子生物学技术等。除传统的X线胸片、磁共振（Magnetic Resonance Imaging,MRI）、正电子发射断层显像（Positron Emission Tomography-Computed Tomography,PET-CT）等方法外,近年来逐步应用的高分辨CT（High-ResolutionComputed Tomography,HRCT）、低剂量CT（Low Dose Computed Tomography,LDCT）、自荧光纤维支气管镜（AutomaticFluorescence Bronchoscopy,AFB）、超声支气管内镜（Endo-Bronchial Ultra-Sound,EBUS）、荧光共聚焦显微镜支气管镜（FiberedConfocal Fluorescence Microscopy,FCFM）、细胞内镜（Endocytoscopy,EC）、电磁导航支气管镜（Electromagnetic NavigationBronchoscopy,ENB）、经支气管针吸活检术（Transbronchial Needle Aspiration,TBNA）、呼出气体分析和肿瘤标记物联合检测等,对于肺癌的早期诊断起到了重要作用,明显改善预后。本文就肺癌早期诊断的研究进展进行综述。     

色素内镜联合CRP和TRF在青海地区早期食管癌患者的诊断价值

摘要 目的：探讨色素内镜联合C反应蛋白(C-reactive protein,CRP)和转铁蛋白(Transferrin,TRF)在青海地区早期食管癌患者的诊断价值。方法：2018年6月至2020年3月选择在本院进行食管癌筛查的青海地区患者250例,所有患者都给予色素内镜检查,同时给予血浆CRP和TRF检查并判断诊断价值。结果：在250例患者中,病理诊断为原位癌28例,高级别上皮内瘤变10例,低级别上皮内瘤变12例,慢性炎症200例;其中早期食管癌38例。卢戈液色素内镜显示不染色47例,淡染色95例,浓染色108例。早期食管癌患者的血浆CRP值都高于非早期食管癌患者,TRF值低于(P<0.05)。Pearson相关性分析显示早期食管癌与色素内镜卢戈液不染色、CRP、TRF值存在相关性(P<0.05)。色素内镜联合CRP和TRF在青海地区早期食管癌的诊断敏感性与特异性分别为97.4 %和100.0 %。结论：色素内镜联合CRP和TRF在青海地区早期食管癌患者诊断中的应用具有很好的敏感性与特异性,能有效预测早期食管癌发生情况,对早期诊治早期食管癌具有一定的指导意义。     

内镜下逆行胰胆管造影术的护理

内镜下逆行性胰胆管造影术（endoscopic retrograde cholangiopancreatography,简称ERCP）是近10年来逐渐发展的一项医疗新技术,该术通过十二指肠镜将造影剂从导管注入胰管和胆管使其显影。适用于疑有胆道、胰腺疾病和疑难性腹痛等患者的诊断及进一步的治疗,具有安全、有效、痛苦少等优点,是当前辅助诊断和治疗胰胆管疾病的一种重要的方法之一。随着消化内镜性能的不断改进和插管造影技术的提高,还可以在诊断的基础上进行其他相关的内镜治疗,如内镜下十二指肠乳头括约肌切开术（EST）、内镜鼻胆引流术（ENDB）等。我科自1998年7月开展此项技术,取得了良好的效果,现将护理总结如下。     

超声内镜对消化道隆起性病变的诊断价值

目的:探讨超声内镜(EUS)对消化道隆起性病变的诊断价值。方法:回顾性分析2013年2月到2017年6月于我院行EUS检查并经内镜下黏膜剥离术(ESD)、内镜粘膜切除术(EMR)或超声内镜引导下细针穿刺(EUS-FNA)获取诊断的293例有消化道隆起性病变的患者,分析病变的超声特点,对比病变的诊断结果。结果:在293例患者中,270例超声诊断与最终诊断相符,EUS诊断消化道隆起性病变的准确性为92.3%。在多种隆起性病变中,以平滑肌瘤(30.7%)及间质瘤(32.4%)最多见,超声对平滑肌瘤及间质瘤的诊断准确性分别为87.8%、95.8%。结论:EUS对消化道隆起性病变是一种有效的、准确的初步诊断方法。     

胃镜对咽喉部恶性病变诊断的临床应用价值

目的:探讨胃镜在对于咽喉部恶性疾病诊断的临床应用价值。方法:对2013年11月至2014年9月因声音嘶哑或咽部异物感或吞咽困难为主诉就诊的患者,给予电子喉镜或间接喉镜检查,以在喉镜下发现咽喉部肿物或喉镜下发现黏膜异常增生不能明确判定病灶性质的12例患者为研究对象。继而给予窄带成像(Narrow-band imaging,NBI)及放大胃镜检查,对病灶进行性质及病变范围的判定。病理结果作为金标准,比较喉镜及胃镜两种方式对咽喉恶性病灶的正确诊断率。结果:12例患者中共发现15处病灶,其中炎性反应5处,单纯性鳞状上皮增生3处,鳞状细胞癌6处,神经纤维瘤1处。喉镜对病灶的正确诊断率是40.0%(6/15),NBI放大胃镜对病灶的正确诊断率是93.3%(14/15),两者差异有统计学意义(x~2=9.60,P=0.005)。结论:NBI放大胃镜对咽喉部肿瘤诊断正确率高于普通喉镜,充分证明了胃镜在咽喉部恶性疾病的诊断方面的临床价值。在行胃镜检查时,同时对咽喉部进行仔细观察检查是十分必要的。     

Comparison of High Resolution Magnifying Endoscopy and Standard Videoendoscopy for the Diagnosis of Helicobacter pylori Gastritis in Routine Clinical Practice: A Prospective Study

Background: It has been shown that standard endoscopic features often labeled as gastritis has a poor correlation with histopathology. Recently, high resolution magnifying endoscopy has been reported to be an effective method to diagnose gastritis. The aim of the present study was to compare standard endoscopy with magnifying endoscopy for the diagnosis of Helicobacter pylori gastritis, and to determine whether gastritis can be diagnosed based on findings at magnification endoscopy. Materials and Methods: A total of 129 patients were enrolled into the study. Erythema, erosions, prominent area gastrica, nodularity, and regular arrangement of collecting venules (RAC) were investigated by standard endoscopy. Standard endoscopy was followed by magnifying endoscopy in all patients, and repeated in 55 patients after indigo carmine spraying. Results: None of the standard endoscopic features showed a sensitivity of more than 70% for H. pylori gastritis, except RAC pattern analysis. Absence of a corporal RAC pattern had 85.7% sensitivity and 82.8% specificity for predicting H. pylori infection. Under magnification, the sensitivity and specificity of regular corporal pattern (regular collecting and capillary vascular structures with gastric pits resembling pinholes) for predicting normal histology were 90.3% and 93.9%, respectively. Loss of collecting venules, or both collecting and capillary structures was correlated with chronic inflammation and activity. With the progression of mucosal atrophy, irregular collecting venules became visible. The values for irregularly arranged antral ridge pattern for the prediction of antral gastritis were 89.3% and 65.2%, respectively. Indigo carmine staining increased sensitivity and specificity up to 97.6% and 100% for corporal gastritis, and up to 88.4% and 75.0% for antral gastritis, respectively. Indigo carmine staining significantly increases the detection of intestinal metaplasia. Conclusions: High resolution magnifying is superior to standard endoscopy for the diagnosis of H. pylori gastritis, and identification of specific histopathologic features such as atrophy and intestinal metaplasia seems possible.     

Diagnosis of Helicobacter pylori Infection

When an endoscopy is performed, it now becomes easier to observe indirect evidence of the presence of a Helicobacter pylori infection, given the progress of new methods including magnifying narrow band imaging or confocal laser endomicroscopy. Out of the biopsy-based tests, the novel original method proposed concerned culture in a broth medium with or without antibiotics and ELISA detection of H. pylori. New stool antigen tests are still appearing with no major improvement in comparison with the monoclonal-based tests already on the market. The combination of pepsinogen detection to H. pylori serology is now more and more evaluated to detect preneoplastic lesions.     

窄带成像技术联合放大内镜在早期胃癌诊断中的价值

目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy,NBI-ME)在早期胃癌诊断中价值。方法:115例早期胃癌患者行NBI-ME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查。所有患者接受内镜下治疗,术后行病理活检。分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率。结果:115例患者纳入本研究,最终术后切除病理示低级别上皮内瘤变(low-grade neoplasia,LGIN)16例,高级别上皮内瘤变(high-grade neoplasia,HGIN)30例,分化型胃癌59例,未分化型胃癌10例。NBI-ME诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为98.0%、81.3%、97.0%、86.7%、95.7%,内镜活检的对应值分别为82.8%、87.5%、97.6%、45.2%、83.5%。NBI-ME诊断早期胃癌的敏感度及准确率均明显高于内镜活检(P0.05)。结论:NBI-ME对早期胃癌具有较高诊断价值。     

An ultra-low-power image compressor for capsule endoscope

Background  

Gastrointestinal (GI) endoscopy has been popularly applied for the diagnosis of diseases of the alimentary canal including Crohn's Disease, Celiac disease and other malabsorption disorders, benign and malignant tumors of the small intestine, vascular disorders and medication related small bowel injury. The wireless capsule endoscope has been successfully utilized to diagnose diseases of the small intestine and alleviate the discomfort and pain of patients. However, the resolution of demosaicked image is still low, and some interesting spots may be unintentionally omitted. Especially, the images will be severely distorted when physicians zoom images in for detailed diagnosis. Increasing resolution may cause significant power consumption in RF transmitter; hence, image compression is necessary for saving the power dissipation of RF transmitter. To overcome this drawback, we have been developing a new capsule endoscope, called GICam.     

Percutaneous Aortic Valve Replacement: Emerging Tractability for Sufficient Intracardiac Resection of the Aortic Valve

OBJECTIVE:: The feasibility of endovascular resection of highly calcified aortic valves has already been demonstrated by our group. Different endovascular and intracardiac tractability methods were applied. In this study, these technologies were analyzed comparing the tractability, the resection time, and the lesions in the surrounding tissue. METHODS:: All aortic valve resections (seven human hearts and 21 porcine hearts) were performed using a Thulium:YAG laser (continuous wave, wavelength of 2.01 μm, 20 watts power rating). In the first resection system, the laser fiber was controlled by a free in-lying flexible endoscope (? 2.5 mm, length of 600 mm). The distal part of the endoscope (40 mm) was moved in one plane by proximal manual control (three degrees of freedom). The resection system was separated into defined rooms assigning one room for one tool. The fiber was controlled by the above-mentioned endoscope (*) (three degrees of freedom). The third resection system was a mechanical microactuator carrying the laser fiber (three degrees of freedom). The fourth resection system contains a rotatable inlay with defined rooms and a newly designed nitinol (NiTi) microactuator that controlled the laser fiber (four degrees of freedom). The resection time per leaflet was measured in minutes. Gross anatomy and histology in the surrounding tissue were evaluated. RESULTS:: The resection time in approaches 1, 2, 3, and 4 was 5.5 ± 2.3 minutes, 7.4 ± 2.7 minutes, ± 6.6 minutes, and2.3 ± 1.2 minutes, respectively. The gross anatomy and histology of collateral damages revealed only superficial lesions of the surrounding tissue. The amount of lesions and the resection time were lower in the fourth approach with four degrees of freedom. CONCLUSIONS:: This analysis demonstrated that a precise tractability with four degrees of freedom is necessary for a faster and safer endovascular resection of the aortic valve. The analysis will help to optimize the ongoing development of the endovascular and intracardiac resection technology.     

常见消化道黏膜下肿物的临床特点及治疗方法

目的:探讨常见消化道黏膜下肿物(submucosal tumors,SMTs)的临床特点、治疗方式及安全性。方法:选择2014年5月至2016年3月在哈医大一院经内镜切除的并经病理及免疫组化明确诊断的消化道粘膜下肿物的患者共49例。所有患者术后3个月、6个月及12个月后随诊复查胃镜。统计每种肿物的患者临床症状,各种黏膜下肿物的性别分布、大小,及在消化道的分布。计算超声内镜的诊断率,总结病理结果。结果:49例患者中,间质瘤25例,类癌9例,平滑肌瘤8例,异位胰腺4例,脂肪瘤2例,颗粒细胞瘤1例。间质瘤分布以胃底、胃体多见。类癌以直肠最多见,胃内也可见。平滑肌瘤多分布于食管,也可见于胃。异位胰腺多分布于胃窦。通过内镜黏膜下挖除术(Endoscopic submucosal excavation,ESE)切除42例,粘膜下隧道切除术(Submucosal tunneling endoscopic resection,STER)切除4例,还有3例行内镜下黏膜切除(Endoscopic Mucosal Resection,EMR)。所有患者术后均无迟发性出血、严重感染及死亡病例发生。随访3-22个月,所有患者均无复发。结论:黏膜下肿物在内镜及超声内镜各有特点。超声内镜对黏膜下肿物的诊断与治疗具有重要的指导意义。双镜联合使SMTs的内镜下各种治疗方式(EMR、ESE、STER)更有安全保障,使患者受益最大。     

光学相干层析成像技术在内窥镜中的应用

光学相干层析成像(optical coherence tomography,OCT)技术是继X射线成像、核磁共振成像、超声成像等之后的一种新型的成像技术,其可光纤化的特点使得它易于医用电子内窥镜相结合。OCT内窥镜技术可实现对人体内部器官的高速率、高分辨率、无损伤、实时成像。主要介绍了OCT技术的种类、基本原理以及包括探测深度和纵向分辨率等的参数;简述了OCT内窥镜的发展历史以及最新成果,重点分析了光源对OCT内窥镜的影响。总结了OCT内窥镜的主要应用。