地佐辛联合丙泊酚用于无痛肠镜诊疗的临床观察

目的：观察地佐辛联合丙泊酚用于无痛肠镜诊疗的有效性和安全性。方法：90例患者随机分为三组：地佐辛组（D组）、芬太尼组（F组）和丙泊酚组（P组）,观察患者给药前（T0）、插镜时（T1）、停药时（T2）和睁眼时（T3）的收缩压（SBP）、舒张压（DBP）、心率（HR）和血氧饱和度（SpO2）;手术时间及术中丙泊酚的用药总量、苏醒时间和离院时间;停药后20 min内Ramsay评分;术中和术后的不良反应,术后患者和术者的满意度。结果：D组的血流动力学指标比F组和P组稳定;P组的丙泊酚用量明显大于F组和D组（P〈0.01）;P组的苏醒时间长于F组（p〈0.05）和D组（P〈0.01）,且离院时间也明显长于F组和D组;停药10 min时,D组的Ramsay评分小于P组（P〈0.05）,停药15 min时,D组和F组的Ramsay评分均小于P组（P〈0.05）。结论：地佐辛联合丙泊酚用于无痛胃肠镜诊疗更安全有效,值得临床推广。     

腹腔镜监控肠镜下（LMCP）息肉摘除术对比常规肠镜下息肉切除的随机对照临床研究

目的:探讨腹腔镜监控下的肠息肉摘除术(LMCP)治疗效果,比较LMCP肠息肉摘除术对比常规肠镜下息肉切除的临床治疗效果及预后情况。方法:将符合条件的所有手术患者随机分为两组,每组各41例,其中试验组使用腹腔镜监控下结肠镜息肉摘除术,对照组单纯使用肠镜行息肉切除术。所有病人均观察并记录其预后情况。结果:研究共纳入82例病人,男53例,女29例,平均年龄70岁。息肉平均大小为2.0 cm。所有患者术后无并发症。试验组和对照组的第一次通便时间分别为13.2 h和24.5h,统计学具有显著性差异P<0.001,风险比为1.81,95%置信区间为[1.13-3.00]。试验组和对照组的总住院天数分别为4.5天和8.0天,统计学具有显著性差异P<0.001,风险比为4.15,置信区间95%CI为[2.40-7.18]。结论:LMCP术对病人具有显著的获益,可以避免不必要的并发症,手术操作更安全。因此,LMCP是一种安全有效的方法,并且创伤更小,住院周期更短,是息肉切除术首选的方法。     

重症急性胰腺炎患者血清IL-6水平与内毒素移位及肠黏膜紧密连接蛋白表达关系的研究(英文)

目的:大量研究表明重症急性胰腺炎(SAP)患者血清中高浓度IL-6和肠黏膜低表达的紧密连接蛋白可促进内毒素移位的发生。本文主要研究重症胰腺炎患者血清IL-6水平对内毒素移位和肠黏膜紧密连接蛋白表达的影响。方法:50例重症胰腺炎患者,其中12例在患病早期因结肠受累合并腹胀,对12例结肠受累患者应用结肠镜行结肠灌洗进行腹腔减压,同时取结肠黏膜进行活组织检查。所有病人在治疗的第3天,第7天,第10天,第14天抽取外周静脉血。40例健康志愿者作为对照组。应用ELISA方法检测血清IL-6水平,鲎试验(LAL)方法检测血清内毒素含量,应用免疫荧光和Western blotting方法检测肠黏膜紧密连接蛋白表达水平。结果:SAP患者血清IL-6和内毒素含量明显高于健康对照组,而结肠黏膜紧密连接蛋白表达低于对照组;在临床治疗过程中,早期SAP患者血清IL-6和内毒素水平高于晚期(P值均0.05)。SAP早期血清高浓度的IL-6与结肠黏膜紧密连接蛋白的低表达具有相关性,差异有统计学意义(r=0.735,P0.05)。结论:血清IL-6水平可作为早期评价重症急性胰腺炎严重程度的一项指标,IL-6水平与重症急性胰腺炎临床病程有相关性,可能导致肠道内毒素移位。     

Colonoscopy screening and surveillance disparities during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has increased barriers to accessing preventive healthcare. This study identifies populations disproportionately underrepresented in screening and surveillance colonoscopies during the COVID-19 pandemic.MethodsIn this single-center cohort study, colonoscopy procedures were reviewed during 6-month intervals before the pandemic (July 1, 2019 - December 31, 2019) and during the pandemic (July 1, 2020 - December 31, 2020 and January 1, 2021 - June 30, 2021). 7095 patients were categorized based on procedure indication, demographics, Charlson Comorbidity Index and Social Vulnerability Index (SVI). Statistics performed using VassarStats.Results2387 (2019) colonoscopies pre-pandemic and 2585 (2020) and 2123 (2021) during the pandemic were identified. There was a decrease in colonoscopies performed during months when COVID-19 cases peaked. The total number of average CRC risk patients presenting for first colonoscopy declined during the pandemic: 232 (10 %) pre-pandemic to 190 (7 %) in 2020, 145 (7 %) in 2021 (p < 0.001). Fewer of these patients presented from highly vulnerable communities, SVI > 0.8, during the pandemic, 39 in 2019 vs 16 in 2020 and 22 in 2021. Of all screening and surveillance patients, fewer presented from communities with SVI > 0.8 during the pandemic, 106 in 2019 versus 67 in 2020 and 77 in 2021.ConclusionIt is important to address the decline in CRC preventive care during this pandemic among average CRC risk first-time screeners and vulnerable community patients. An emphasis on addressing social determinants of health and establishing patients in gastroenterology clinics is imperative to promote future health in these populations.     

结肠息肉镜下特征、病理分型及癌变规律分析

目的:探讨结肠息肉镜下特征、病理类型及血清学特点与癌变的相关性。方法:收集我院2011年6月~2013年6月肠镜证实的640名结肠息肉患者资料。对年龄、性别、息肉特征(部位、大小、数量、分型、病理等)分析,并将息肉者癌胚抗原与健康人比较。结果:检出息肉1144枚;年龄在41岁~60岁的占52.9%;发生在乙状结肠和直肠的占47.3%;多发及多部位息肉比例为56.9%和46.9%;腺瘤样息肉占87%;随年龄、息肉体积增加,癌变率增加;无蒂息肉癌变率高于有蒂息肉;两组血清癌胚抗原值差异有统计学意义。结论:结肠息肉多发生在乙状结肠和直肠;以腺瘤息肉为主;癌变与年龄、腺瘤大小、形态、病理类型有关。癌胚抗原可能在腺瘤样息肉的筛查及监测癌变存在意义。     

口服磷酸钠盐用于结肠癌术后老年患者结肠镜检查前肠道准备的 效果观察

目的:评价口服磷酸钠盐用于结肠癌术后老年患者结肠镜检查前肠道准备的有效性、安全性及耐受性.方法:选取2011年9月1日至2011年12月31日间共116例行结肠镜检查的结肠癌术后老年患者,随机分组纳入试验组例和对照组,试验组口服磷酸钠盐进行肠道准备,对照组口服硫酸镁制剂.结肠镜检查术者单盲评价肠道准备的清洁度;患者在肠镜检查当日及检查结束1周后评价肠道准备的耐受度.并记录不良反应(安全性).结果:试验组肠道准备的总满意率为82.1％(46/56),对照组为90.0％(54/60),两组之间无明显差异(P＞0.05).检查当10.7％的试验组患者和38.3％的对照组患者认为肠道准备过程难以耐受(P=0.001).检查结束1周后7.1％的试验组患者和23.3％的对照组患者认为肠道准备过程难以耐受(P=0.003).两组之间不良反应无显著性差异.结论:磷酸钠盐用于结肠癌术后老年患者的肠道准备,清洁效果和不良反应情况与硫酸镁制剂相似,但患者的耐受性却显著提高.     

传统结肠镜检查法的应用现状

自20世纪六十年代末结肠镜检査术问世以来,无论是其操作手法还是器械改革均得到飞速发展,并广泛应用于临床,使直视病灶、实现活检及治疗成为可能。虽然,结肠镜检查为结直肠疾病的诊断及治疗带来了巨大的帮助并成为结直肠癌诊断的金标准,但其局限性也日渐明显。作为一种侵入性操作,结肠镜检查无法避免的腹部疼痛、难以预知的并发症、无法保证的成功率以及可能存在的漏诊率限制了其临床应用不仅在一定程度上降低了患者的依从性,增加了操作的困难度,且使一部分具有操作指征的患者错失早期诊断及治疗的最佳时机。本文简要阐述了传统注气式结肠镜检查法的一般特点并总结了其应用现状,以期为今后传统注气式结肠镜检查法的合理化应用提供一定的参考依据。     

Colonoscopic surveillance of first-degree relatives of colorectal cancer patients in a faecal occult blood screening programme

Background: In some Italian areas, colonoscopic surveillance of first-degree relatives (FDRs) of colorectal cancer (CRC) patients is provided as a part of local population-based faecal occult blood test (FOBT) screening programmes. The objective of the present study was to assess the feasibility and early results of this surveillance model. Methods: Data from district screening centres were used to evaluate the process of identification and selection of eligible FDRs (residence in the Emilia-Romagna Region, age 40–75 years, no recent colonoscopy) of screen-detected CRC patients and the detected prevalence of disease. The probability for an FDR to undergo colonoscopy and to be diagnosed with CRC and advanced adenoma was estimated using the Kaplan–Meier method. The sex- and age-standardised ratio of detected prevalence to that expected based on results from a colonoscopy screening study of the Italian general population was estimated. Results: Between 2005 and 2011, 9319 FDRs of 2437 screen-detected CRC patients (3.8 per patient) were identified and contacted. Their likelihood of being eligible for, and accepting, colonoscopy was 0.11 (95% confidence interval: 0.11–0.12). Among the 926 subjects undergoing colonoscopy, the prevalence of previous negative screening FOBT was 63%. Eleven CRCs (1.2%) and 100 advanced adenomas (10.8%) were detected. The standardised ratio of detected prevalence to that expected was 0.91 (95% confidence interval: 0.19–2.66) for CRC and 1.48 (1.04–2.05) for advanced adenoma. Conclusions: The procedure of selection of FDRs was extremely ineffective. Due to previous negative screening tests, the prevalence of disease was less than expected. A population-based FOBT screening programme is a highly unsuitable setting for the provision of surveillance to FDRs of CRC patients.     

Near-infrared autofluorescence spectroscopy for in vivo identification of hyperplastic and adenomatous polyps in the colon

This study reports the implementation of an endoscope-based near-infrared (NIR) autofluorescence (AF) spectroscopy technique for in vivo differentiation of normal, hyperplastic and adenomatous colonic polyps during clinical colonoscopic examination. A total of 198 in vivo NIR AF spectra in the range of 810–1050 nm were acquired from colonic tissues (normal (n = 116); hyperplastic (n = 48); and adenomatous polyps (n = 34)) of 96 patients undergoing colonoscopic screening. Significant differences (p < 0.001, one-way analysis of variance (ANOVA)) in in vivo NIR AF intensity among normal, hyperplastic, and adenomatous polyps are observed. Multivariate statistical techniques, including principal components analysis (PCA) and linear discriminate analysis (LDA) together with the leave-one tissue site-out, cross-validation, were used to develop diagnostic algorithms for distinguishing adenomatous polyps from normal and hyperplastic colonic polyps based on NIR AF spectral features. The PCA–LDA modeling on in vivo colonic NIR AF dataset yields diagnostic sensitivities of 83.6%, 77.1%, and 88.2%; and specificities of 96.3%, 88.0%, and 92.1%, respectively, for classification of normal, hyperplastic and adenomatous colonic polyps. This work suggests that NIR AF spectroscopy associated with PCA–LDA algorithms has potential for in vivo diagnosis and detection of colonic precancer at colonoscopy.     

结直肠疾病临床特点的趋势分析

目的:通过分析患者的临床资料,探讨结直肠疾病的临床特点,为临床诊断和治疗提供参考。方法:回顾性分析我院肠镜室2012年5月-2013年4月(A)及2005年5月-2006年4月(B)两个时间段经电子肠镜检查的人群的性别、年龄及结直肠疾病的检出、息肉及癌的病变部位及病理类型情况。结果:两时间段结直肠器质性疾病发病率均较高,且A时间段比B时间段结直肠器质性疾病发病率升高(57.68%:45.13%),结直肠息肉及炎发病率升高(35.09%:19.76%和21.90%:14.45%),腺瘤性息肉比率升高(76.84%:68.33%),左半结肠息肉及癌的比率降低(60.88%:72.27%和60.00%:77.55%)。结论:结直肠疾病的发病人群分布发生改变,发病率呈逐年升高趋势。结直肠息肉的病理分型、发生部位及结直肠癌的发生部位有显著变化。