超声内镜与胃镜在胃间质瘤临床诊断的对比分析

目的探讨超声内镜和胃镜在胃间质瘤的临床诊断价值。方法选取我院2013年1月~2014年11月初步诊断为胃间质瘤患者350例,其中行超声内镜检查175例,行胃镜检查175例,两组均行镜下病理活检,并比较两组检查结果的阳性率与病理结果之间的诊断符合率。结果超声内镜诊断阳性率为100%(175/175),胃镜诊断阳性率为97.14%(170/175),与病理结果的符合率为超声内镜的诊断符合率97.14%(170/175),高于胃镜诊断符合率的94.29%(165/175),但两者差异无统计学意义(P0.05)。结论超声内镜及胃镜诊断胃间质瘤各有特点,超声内镜诊断率高可作为胃间质瘤的术前首选检查。     

Randomized Prospective Comparison of Two Protocols for Head-up Tilt Testing in Patients with Normal Heart and Recurrent Unexplained Syncope

BackgroundThis randomized study was aimed to compare the diagnostic value of two head-up tilt testing protocols using sublingual nitroglycerin for provocation in patients with recurrent unexplained syncope and normal heart.MethodsThe patients with normal findings in physical examination, electrocardiography and echocardiography were randomly submitted to one of upright tilt test protocols. The only difference between two protocols was that nitroglycerin was administered after a five minute resting phase in supine position during protocol B. We also considered eighty normal persons as the control group.ResultsOut of 290 patients that underwent tilt testing, 132 patients were in group A versus 158 patients in group B. Both groups had an identical distribution of clinical characteristics. Tilt test was positive in 79 patients in group A (25 in passive phase, 54 in active phase) versus 96 patients in group B (43 in passive phase, 53 in active phase). There was no significant difference between results in two groups (P value = 0.127). Forty cases were tested with protocol A and forty underwent tilt testing with protocol B. Tilt test was positive in 4 cases with protocol A versus 3 cases in protocol B. The positive rates of tilt testing with protocol A was 60% while it was 61% in protocol B. The specificity of testing with protocol A was 90% and it was 92.5% in protocol B.ConclusionsAccording to our data, adding a period of rest and returning to supine position before nitroglycerin administration had no additional diagnostic yield.     

IAA、ICA及GADA联合检测对糖尿病分型的诊断价值

目的:探讨胰岛素自身抗体(IAA)、胰岛细胞抗体(ICA)及谷氨酸脱羧酶抗体(GADA)联合检测对糖尿病分型的诊断价值。方法:选择2015年6月~2016年6月在我院进行诊治的1型糖尿病患者30例为A组,2型糖尿病患者60例为B组,同期在我院进行体检健康者50例为C组,采用酶联免疫吸附法(ELISA)检测三组的IAA、ICA及GADA,比较三组的阳性检出率。结果:A组空腹血糖为(10.12±3.68)mmol/L,B组空腹血糖为(11.23±3.26)mmol/L,A组和B组的空腹血糖均明显高于C组(4.35±1.42mmol/L)(P0.05),但A组和B组的空腹血糖相比无明显差异(P0.05);A组和B组的IAA、ICA及GADA单独和联合检测的阳性率均明显高于C组(P0.05),且A组的IAA、ICA及GADA单独和联合检测的阳性率明显高于B组(P0.05);IAA、ICA及GADA联合检测对1型和2型糖尿病的敏感性和特异性均明显高于单独检测(P0.05)。结论:IAA、ICA及GADA联合检测对糖尿病分型具有较高的临床诊断价值。     

无痛胃肠镜与常规胃肠镜在消化道疾病诊治中的临床对比分析

目的:探究并分析无痛胃肠镜与常规胃肠镜在消化道疾病诊治中的临床应用价值。方法:于2014年5月~2015年5期间,选择我院收治的胃肠消化道疾病患者64例为研究对象,根据患者对胃肠镜检测方式的选择,将其分为研究组(33例)和对照组(31例)。研究组患者给予无痛胃肠镜检查,对照组给予常规胃肠镜检查,观察并记录两组患者胃肠镜检查前后血氧饱和度(SpO_2)、心率及血压的变化,内镜操作过程中咽喉反射发生率、不良反应的发生率,术后内镜检查效果评价及患者对操作的满意度。结果:研究组胃肠镜检查效果显著优于对照组,且研究组优良率显著高于对照组(P0.05);研究组患者在胃肠镜检查前后心率、血压及SpO_2均未出现明显变化(P0.05),而对照组患者在内镜查前后心率、血压均出现明显变化,术中心率、血压均明显高于术前和术后(P0.05);研究组患者出现咽喉反射及不良反应发生率均显著低于对照组,对操作满意度显著高于对照组(P0.05)。结论:无痛胃肠镜与常规胃肠镜相比,患者适应性更好、疼痛轻、不良反应少、安全性高,且患者对操作的满意度高。     

不同术式经皮椎间孔镜治疗腰椎间盘突出症的疗效分析

目的:探讨不同术式经皮椎间孔镜治疗腰椎间盘突出症的疗效。方法:选取我院2013年9月~2015年7月我院收治的采用经皮椎间孔镜治疗的腰椎间盘突出症患者159例,根据不同手术方式进行分组,其中采用YESS手术的36例患者作为YESS组,采用TESSYS手术的76例患者作为TESSYS组,采用BEIS手术(即改良的TESSYS手术)的47例患者作为BEIS组。于术前、术后1天、3个月、6个月、12个月对所有患者进行视觉疼痛模拟评分(VAS)和改良的MacNab疗效评定。结果:三组的手术时间、术中出血量、住院时间比较差异有统计学意义(P0.05),BEIS组和TESSYS组的手术时间、术中出血量高于YESS组,且BEIS组手术时间、术中出血量高于TESSYS组,BEIS组的住院时间高于YESS组和TESSYS组,差异均有统计学意义(P0.05)。三组患者术后各时期VAS评分均较术前降低(P0.05),但三组间术前、术后不同时期VAS评分整体比较均无统计学差异(P0.05)。三组优良率整体比较,差异无统计学意义(P0.05)。结论:不同术式经皮椎间孔镜治疗腰椎间盘突出症的疗效相当,可以有效减轻术后患者的疼痛,但是三种术式的手术时间、术中出血量、住院时间有所差异,临床上针对不同类型的腰椎间盘突出症应采用不同术式,以获得更确切的疗效。     

四联疗法和序贯疗法治疗服用非甾体类消炎药人群幽门螺杆菌感染的临 床对照研究

目的:对比四联疗法和序贯疗法对根除服用非甾体类消炎药(NSAID)人群幽门螺杆菌(Hp),改善其消化道不良症状及促进消化性溃疡愈合的临床效果。方法:对有消化不良症状的服用非甾体类消炎药物患者行胃镜检查、快速尿激酶及13C呼气试验检查,将155例幽门螺杆菌阳性合并有慢性胃炎或消化性溃疡患者作为研究对象,随机分为两组,A组采用四联疗法,B组采用序贯疗法。A组予雷贝拉唑+克拉霉素+阿莫西林+枸橼酸铋钾治疗10天;B组前5天予雷贝拉唑+阿莫西林,后5天予雷贝拉唑+克拉霉素+甲硝唑。治疗结束后,予雷贝拉唑和胃黏膜保护剂治疗8周。停药4周后,复查胃镜、13C呼气试验,观察和比较两组Hp根除率、消化不良症状缓解率及溃疡愈合率。结果:A、B两组Hp根除率分别为(ITT分析:86.7%和81.9%;PP分析:87.8%和84.3%);症状缓解率为(81.9%对79.2%);胃溃疡愈合率为(68.8%对66.7%),十二指肠球部溃疡的愈合率为(68.2%对70.0%),两组患者间Hp根除率、症状缓解率及溃疡愈合率比较均未见明显统计学差异(P>0.05)。四联疗法组和序贯疗法组不良反应的发生率分别为4.9%和4.3%。两组比较无明显差异(P>0.05)。结论:四联疗法和序贯疗法对长期服用非甾体类消炎药物人群的Hp根除疗效、消化不良症状的缓解及促进溃疡愈合的治疗作用均无明显差异。     

三项血清学检查联合应用对老年菌血症早期诊断的价值

目的 探讨C-反应蛋白（CRP）、降钙素原（PCT）和血清样淀粉蛋白A（SAA）对于老年菌血症早期诊断的价值。方法 选择2016年12月至2018年11月我院收治的老年感染患者140例（年龄≥65岁）为研究对象,按血培养结果分为菌血症患者（60例）和非菌血症患者（80例）;选择同期健康体检者60例（年龄≥65岁）为对照组,测定全部研究对象血清CRP、PCT和SAA水平及阳性率。结果 与对照组比较,菌血症和非菌血症患者血清CRP、PCT和SAA水平均显著升高（P<0.05）;且菌血症患者这3项指标水平高于非菌血症者（P<0.05）。在单项检测中,PCT的敏感性和特异性最高。3项联合检测的诊断价值高于单项检测。由G－菌引起的菌血症患者这3项指标水平高于G+菌菌血症患者（P<0.05）。结论 血清CRP、PCT和SAA这3项指标对老年菌血症的早期诊断具有一定价值。     

上消化道造影和CT扫描诊断胃部肿瘤的应用价值比较

目的:比较上消化道造影和CT扫描诊断胃部肿瘤的临床应用价值。方法:选取我院胃外科收治的胃部肿瘤82例,随机分为两组,其中对照组41例,采用上消化道造影技术诊断;实验组41例,采用螺旋CT扫描,进行胃部肿瘤诊断。对比两组检查方式的诊断结果与病理诊断的符合率。结果:1进行螺旋CT扫描诊断与病理诊断符合率(95.12%,39/41)明显高于上消化道造影技术诊断符合率(80.49%,33/41),差异有统计学意义(P0.05);2淋巴结转移的敏感性和特异性比较中,螺旋CT明显高于上消化道造影技术,差异有统计学意义(P0.05)。结论:上消化道造影和CT扫描在诊断胃部肿瘤的临床应用中,上消化道造影技术是早期胃部肿瘤的首选检查方法,但是螺旋CT对胃部肿瘤正确诊断率要高,螺旋CT对淋巴结转移的敏感性和特异性较高,能够给确定胃部肿瘤分期提供依据,值得临床推广。     

螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值

目的:探讨螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。方法:选取2014年1月至2016年1月期间来我院就诊的60例急性脑梗死患者作为观察组,另选同期来我院就诊的非急性脑梗死患者60例作为对照组。两组患者均进行螺旋CT头颈部血管成像检查,比较两组患者的颈动脉狭窄程度及各段血管斑块分布情况,并根据检查结果评价螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。结果:观察组轻度狭窄与中度狭窄检出率均显著高于对照组(P0.05),重度狭窄与闭塞检出率与对照组比较无统计学差异(P0.05),观察组总检出狭窄率高于对照组(P0.05)。观察组与对照组在颈动脉分叉处、颈总动脉、颈内动脉及颈外动脉均有斑块检出,观察组斑块总检出率为69.4%,显著高于对照组的41.2%(P0.05)。结论:临床上应用128层螺旋CT头颈部血管成像技术对急性脑梗死患者颈动脉狭窄情况可进行有效评估,该方法对患者轻、中度狭窄以及双侧颈动脉斑块检出率更高,在临床诊断及预后防治中具有应用推广价值。     

内镜与药物治疗肝硬化伴食管静脉曲张破裂出血的疗效比较

目的:比较内镜与药物治疗肝硬化伴食管静脉曲张破裂出血(EVB)的疗效。方法:选择2012年1月-2013年8月我院收治的肝硬化伴EVB患者70例,依据随机数字表法将所有患者分为对照组和观察组,各35例。两组患者入院后均给予纠正贫血、扩充血容量治疗,观察组待患者病情稳定后,在咽部麻醉下行内镜下食管静脉曲张套扎疗法(EVL),对照组患者应用生长抑素3mg+50 m L生理盐水泵入,兰索拉唑40 mg+100 m L生理盐水静脉滴注治疗。比较两种治疗方法的临床总有效率、复发率以及不良反应发生率。结果:观察组治疗总有效率91.43%,显著高于对照组71.43%(P0.05);观察组的出血复发率仅为5.71%,低于对照组的22.86%(P0.05);观察组食管溃疡、发热和胸骨后疼痛发生率均低于对照组,但差异未见统计学意义(均P0.05)。结论:EVL治疗肝硬化伴EVB疗效显著,减少复发率和不良发应发生率,效果优于单纯药物治疗,值得在临床上推广。     

Upper gastrointestinal endoscopy: its effects on patient management.

Out of 95 patients referred for upper gastrointestinal endoscopy after a barium-meal examination, 44 underwent a change in management. Some changes were minor but in 12 patients a decision on surgery was required. Seven of these patients were among a group of 13 for whom the referring consultant would have recommended laparotomy had endoscopy not been available, while the other five were subjected to an unplanned laparotomy. These findings support the practice of performing endoscopy on patients whose symptoms are not fully explained by barium-meal examination, especially patients aged over 45. In such cases the procedure also seems to be cost-effective.     

腹腔镜下直肠癌根治术在治疗老年患者中的临床研究

目的:探讨老年直肠癌患者行腹腔镜微创手术的治疗效果。方法:回顾性分析了2008年7月至2011年1月本院收治的91例老年直肠癌患者,按治疗方式分为腹腔镜组39例和开腹组52例,术后随访3年,比较分析两组患者围手术期、手术并发症及预后情况。结果:腹腔镜组患者的术中出血量、肠功能恢复时间、术后发热请况及住院时间均优于开腹组(P0.05);腹腔镜组并发症发生率为2.6%,低于开腹组的21.1%(P0.05);腹腔镜组局部复发率、远处转移率及死亡率与开腹组比较均无统计学差异(P0.05)。结论:老年直肠癌患者行腹腔镜手术与开腹手术效果相当,且安全、微创,但远期疗效尚需进一步研究证明。     

MRI和螺旋CT增强在肝脏占位性病变诊断中的价值比较

目的:对比分析MRI和螺旋CT增强在肝脏占位性病变诊断中的价值。方法:以2012年7月-2016年5月我院收治的临床考虑为肝脏占位性病变70例患者为研究对象,将70例患者根据入组先后顺序分为两组,35例行增强CT扫描,35例行动态增强MRI扫描,比较两组患者的病理诊断结果、病灶个数及直径、增强CT及MRI的诊断结果和检查过程中的不良反应及耐受性。结果:CT增强组和MRI增强组的肝脏占位性病变的病理诊断、病变类型、分布及病灶个数(71 vs 70)、病灶直径(2.25±2.01 cm vs2.19±1.98 cm)比较差异均无统计学意义(P0.05);以病理诊断结果为金标准,MRI增强组的总诊断符合率为85.71%,CT增强组的总诊断符合率为77.14%,MRI增强组的总诊断符合率高于CT增强组,但差异无统计学意义(P0.05);CT增强组共发生2例不良反应,均为轻度恶心,MRI增强组未出现造影剂不良反应,CT增强组的不良反应发生率(5.71%vs 0.00%)及视觉模拟评分法(VAS)评分(1.25 0.96分vs 0.71 0.56分)均显著高于MRI增强组(P0.05)。结论:CT增强和MRI增强扫描对于肝脏占位性病变的诊断均具有较高的临床价值,其中MRI增强扫描的安全性和耐受性更高,临床医师可根据患者的经济状态、身体状态等因素的综合评估,选择合适的检查手段,必要时可两者联合检查,以提高诊断的准确性。     

电针结合红外线照射对反复着床失败患者子宫内膜容受性、胚胎移植及妊娠情况的影响

目的:观察电针结合红外线照射对反复着床失败(RIF)患者子宫内膜容受性、胚胎移植及妊娠情况的影响。方法:选取102例于2015年5月-2018年5月在我院行复苏胚胎移植的RIF患者,按照随机数字表法将患者分为电针结合红外线照射治疗组(A组,38例)、安慰针刺组(B组,34例)及空白对照组(C组,30例)。比较三组治疗前后血清雌二醇、孕酮水平,于治疗前后检测子宫内膜容受性超声学指标,包括子宫内膜厚度、内膜容积、血管血流指数(VFI)、内膜血流指数(FI)、阻力指数(RI),比较三组胚胎移植及妊娠情况。结果:三组治疗前后血清雌二醇、孕酮水平比较无统计学差异(P0.05)。治疗后A组子宫内膜厚度、内膜容积大于治疗前及B组、C组,VFI、FI高于治疗前及B组、C组,RI低于治疗前及B组、C组(P0.05)。三组移植胚胎数、生化妊娠率、临床妊娠率比较无统计学差异(P0.05),A组胚胎着床率高于B组、C组(P0.05)。结论:电针结合红外线照射治疗RIF患者可以改善子宫内膜容受性,提高胚胎着床率。     

Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial

A prospective randomised trial was performed to assess the efficacy of endoscopic injection of adrenaline for actively bleeding ulcers. Emergency endoscopy in 961 patients admitted for upper gastrointestinal haemorrhage identified 68 patients with actively bleeding ulcers. These 68 patients were randomised to receive either endoscopic injection of adrenaline or no endoscopic treatment. After endoscopy both groups were managed in an identical manner, and strict criteria for emergency operation were adhered to in both groups. Bleeding was initially controlled in all 34 patients assigned to the treatment group. Significantly fewer patients in the treatment group than in the control group needed emergency operations (five v 14, respectively). In addition, in the treatment group the median transfusion requirement was significantly less (three v five units of blood) and the median hospital stay shorter (six v eight days). No complications were observed with the injection of adrenaline, and the rate of healing of ulcers in those attending for endoscopy six weeks after discharge was similar in both groups (81% (17 out of 21 patients) in the treatment group v 79% (11 out of 14) in the control group).Injection of adrenaline is effective in stopping bleeding from actively bleeding ulcers.     

实时三维超声输卵管造影与X线造影诊断不孕症患者输卵管病变的价值比较

目的:比较实时三维超声输卵管造影与X线造影检查诊断女性不孕症患者输卵管病变的临床应用价值。方法:选择2014年3月至2016年12月我院诊治的不孕症患者60例作为研究对象,所有患者都于月经干净后3-7 d同时随机实施实时三维超声输卵管造影与X线造影检查,观察并记录造影图像质量与诊断结果,比较两种方法的诊断效果。结果:实时三维超声输卵管造影与X线造影的图像质量优良率分别为98.3%和86.7%,实时三维超声输卵管造影的图像质量明显高于X线造影(P0.05)。实时三维超声输卵管造影与X线造影诊断不孕症患者输卵管不通畅率分别为56.7%和46.7%,实时三维超声输卵管造影组显著高于X线造影组(P0.05)。输卵管通畅性评价金标准腹腔镜下通液术诊断发现输卵管不通畅35例,在此基础上实时三维超声输卵管造影与X线造影检查不孕症的敏感性分别为97.1%和80.0%,特异性均为100.0%,超声诊断的敏感性明显高于X线(P0.05)。结论:相对于X线造影,实时三维超声输卵管造影检查不孕症患者输卵管病变的图像质量更好,有利于疾病的判断,对输卵管通畅度判断更精确,利于后期治疗及疾病预防,还可提高诊断敏感性。     

同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的疗效对比研究

摘要 目的：探讨同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的临床疗效。方法：回顾性分析本院2017年1月至2019年10月期间收治的76例慢性泪囊炎合并慢性鼻-鼻窦炎患者的临床资料,根据手术方式分为A组和B组,各38例。A组行分期手术（鼻腔鼻窦病变处理控制鼻腔鼻窦炎症后再行鼻内镜下泪囊鼻腔造孔术）。B组行同期手术（处理鼻腔鼻窦病变后立即行鼻内镜下泪囊鼻腔造孔术）,比较两组围术期指标、临床疗效、术后并发症发生情况,采用慢性泪囊炎生活质量量表（DQOLS）评价患者术前和术后6个月时的生活质量。结果：B组总有效率为94.74 %（36/38）,A组总有效率为92.11 %（35/38）,两组总有效率比较无明显差异（P>0.05）;B组术后并发症总发生率为13.16 %（5/38）,与A组的10.53 %（4/38）比较无明显差异（P>0.05）。两组患者术后6个月时的DQOLS各维度评分和总分均较术前升高（P<0.05）,但组间比较差异均无统计学意义（P>0.05）。B组患者住院总费用少于A组,住院时间、手术时间均短于A组（P<0.05）,两组术中出血量比较无明显差异（P>0.05）。结论：同期手术与分期手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎患者具有相当的临床疗效和安全性,且对患者生活质量的改善程度亦无明显差异,但前者能够缩短手术时间、住院时间及减少住院费用。     

360例肺癌患者血清TSGH检测的临床分析

目的探讨肿瘤特异性生长因子(TSGF)在肺癌患者中检测的诊断价值。方法采用TSGF检测试剂对360例确诊肺癌患者、170例肺部良性病患者和30例正常人的血清进行TSGF检测分析。结果360例肺癌患者,检出恶性TSGF,阳性315例,占87.5%;170例肺部良性疾病,阳性24例,占14.1%;30例正常人,阳性0例。其中,肺癌组与各组相比较,差异具有统计学意义。肺癌组的TSGF阳性率明显高于其他各组(P0.01)。结论检测血清TSGF可辅助肺癌的诊断,在正常人体检筛查肺癌中具有一定的价值。     

Causes of iron deficiency anemia in an adult inpatient population. Effect of diagnostic workup on etiologic distribution

The causes of iron deficiency anemia in a population of adults admitted to two Jerusalem hospitals within a period of 7 years were examined. About one half of the 262 patients with iron deficiency anemia were over 70 years old. The ratio of males to females exclusive of young females with menorrhagia was 1:1.8. Despite the combined use of various diagnostic procedures, no definite cause of iron deficiency anemia could be established in 34% of patients. Benign gastrointestinal lesions were found in about one half of the cases in both hospitals. The prevalence of GI neoplasms in hospital B with a more intensive use of endoscopic procedures was significantly higher than in hospital A (18% vs 5%, p less than 0.001). The relative usefulness of barium contrast vs endoscopic studies is illustrated by the fact that 22 diagnoses established by endoscopy were missed by barium studies, whereas only 2 of those established by barium studies were not visualized by endoscopy. A particularly high risk group were anemic males aged 50 to 69 years in whom the prevalence of GI neoplasms was 30%. These data indicate that reliance on traditional contrast radioscopy may result in misdiagnosis of a high proportion of gastrointestinal neoplasms.     

Open access fibresigmoidoscopy: a comparative audit of efficacy

A total of 541 open access referrals for fibresigmoidoscopy over five years were compared with 495 hospital initiated procedures during the same period. The number of open access fibresigmoidoscopies doubled during the five years but diagnostic yield remained unchanged at about 40% and was similar to that of the hospital initiated procedures. Colorectal carcinoma was seen in 64 open access patients compared with 47 hospital referred patients, the proportion of Dukes''s type A lesions being similar (34%) in both groups. Polyps, colitis, and diverticular disease were equally common in open access and hospital referred patients. Fibresigmoidoscopy failed to detect disease in only 12 patients (1·2%) and the procedure was unsatisfactory in only 54. Referral was considered justified in 475 (88%) open access patients, and only 54 (17%) patients with normal appearances at endoscopy required further investigations.Diagnostic yields were low (19%; 30/156 cases) in open access patients under 40 and in patients with abdominal pain, constipation, or abdominal pain with constipation (0-17%). Most of these young patients presumably suffer from the irritable bowel syndrome and do not justify fibresigmoidoscopy. In contrast, there was a high diagnostic yield (90-100%) in patients of all ages referred for diarrhoea and rectal bleeding, altered blood from the rectum, and rectal bleeding associated with abdominal pain.Open access fibresigmoidoscopy is an effective service that should be freely available to general practitioners.