Ablation of Barrett's esophagus using the second-generation argon plasma coagulation

Objective To investigate the efficacy and safety of the second-generation argon plasma coagulation (VIO APC) in ablation of Barrett's esophagus. Methods Eighteen patients with Barrett's esophagus (12 males, median age of 55 years, median length of 2.1 cm,1 low-grade dysplasia, 13 cases of short segment Barrett's esophagus) received VIO APC, which was performed at a power setting of 40W and argon gas flow at 1. 5-2. 0 L/min, "forced" mode, in 1-3 sessions (mean 1.3). All the patients received treatment with high-dose proton pump inhibitors. The main complaints before ablation were upper abdominal pain in 12 patients (66%), sour regurgitation in 14 patients (77%), and dysphagia or odynophagia in 7 patients (38%). Two patients (11%) had esophageal hiatal hernia. Results The percentage of patients in whom ablation was endoscopically achieved proximal to the gastroesophageal junction was 77. 8%(14/18), and histologically achieved in 66. 7% (12/18). Berried glands were observed in 2 patients who had achieved endoscopic ablation, the areas of Barrett's mucosa were reduced by more than 60% in the other 4 patients. After treatment, 4 patients had transient retrosternal pain and 3 patients had mild epigastric discomfort. One patient had small amounts of hemorrhage during the process, and it ceased after norepinephrine and thrombosin were administered through endoscope biopsy channel. No esophageal stricture or other severe adverse events was observed. During 11.8 (4-15) months' follow-up, the patients who had achieved the complete ablation had no evidence of relapse of Barrett's esophagus. Conclusion VIO APC with a relatively low power setting can effectively ablate the Barrett's mucosa with special intestinal metaplasia when standard APC has been done. No severe adverse events were observed. Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium.     

不同药物对反流性食管炎黏膜保护作用的实验研究

目的　用不同药物对混合反流大鼠模型进行干预 ,观察混合反流对大鼠食管黏膜的损伤及西沙比利、萘丁美酮和铝碳酸镁对黏膜的保护作用。方法　健康SD大鼠 16 8只 ,随机分为 4组 :阳性对照组 (Y组 ) ,西沙比利干预组 (P组 ) ,萘丁美酮干预组 (R组 ) ,铝碳酸镁干预组 (D组 )。分别于术后 2 2、2 8、35、4 0周观察食管黏膜的大体和病理变化。结果　术后不同时间Y组的损伤程度均重于其他 3组 (P <0 .0 5 ) ;且Y组Barrett食管 (BE)、重度不典型增生和食管腺癌 (EAC)的发生率均高于其他 3组。P组的损伤程度高于R、D组 (P <0 .0 5 ) ,但BE、重度不典型增生和EAC的发生与R、D组无统计学差异 (P >0 .0 5 )。结论　长期严重的反流性食管炎 (RE)可导致BE、重度不典型增生和EAC ;西沙比利、萘丁美酮和铝碳酸镁对食管黏膜均有一定的保护作用 ,可减少BE、重度不典型增生和EAC的发生 ,但萘丁美酮和铝碳酸镁的效果要优于西沙比利。     

胆汁反流与食管黏膜上皮损伤的研究进展

尽管十二指肠胃食管反流的研究已有100多年历史,但不明点仍很多。本文复习文献并结合我们的研究成果,就胆汁对食管黏膜的损伤,包括损伤的可能机制、食管内胆汁反流的诊断、治疗等方面作以介绍,重点对胆汁在Barrett食管和食管腺癌发生中的作用及其防治作了阐述。     

Ⅰ型胶原蛋白基因在反流性食管炎、Barrett食管及食管腺癌中的表达

目的探讨反流性食管炎、Barrett食管及食管腺癌黏膜组织中Ⅰ型胶原蛋白(COL1A1)基因mRNA的表达水平及意义。方法经胃镜取材,采用荧光定量PCR方法检测反流性食管炎、Barrett食管、食管腺癌组织中COL1A1基因mRNA的表达水平。结果 COL1A1mRNA在正常组和反流性食管炎阴性组食管黏膜中呈低表达(0.154±0.119,0.152±0.105),在Barrett食管与食管腺癌食管黏膜中呈明显的高表达(0.396±0.170,0.726±0.561)。并且在从正常→反流性食管炎→Barrett食管→食管腺癌的发生、发展过程中,COL1A1mRNA的表达呈现渐进性增强,并与病期有关。结论 COL1A1基因的异常表达与反流性食管炎、Barrett食管和食管腺癌的发生、发展密切相关;COL1A1mRNA的表达水平可用作监测Barrett食管和食管腺癌早期发生及干预治疗效果的有用指标。     

Diagnostic value of diffuse and peripheral lung lesions by transbronchial lung biopsy

Objective To evaluate the diagnostic value of transbronchial lung biopsy (TBLB) via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions. Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions. Results Eighty-nine final diagnosis cases via TBLB only once, the diagnostic rate of double lung diffuse lesions was the highest, [51.06% (24/47)], local non-nodule lesions, nodule lesions, cavity lesions were 33.33%(23/69), 29.91%(35/117), and 28.57%(4/14), respectively. Among 24 diagnostic cases of double lung diffuse lesions, there were 6 cases of pneumonia of pulmonary tuberculosis, 9 cases of lung carcinoma, 7 cases of adenecarcinoma; 6 cases of pneumonia, 2 cases of fungous infection, and 1 case of lung hemosiderusis. The diagnostic yield about 58 cases of local lesions was low, among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%. In 89 cases of peripheral lung lesions with histological diagnosis, lung carcinoma and pulmonary tuberculosis were frequent diseases, which accounted for 86.52%. Conclusion TBLB is a reliable, safe, effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.     

食管内外气体造影CT的临床实验研究

食管癌的最佳治疗计划需要确定诊断的准确资料，食管内外气体造影电子计算机Ｘ线断层摄影（ＣＴＩＥＩＥ）可同时显示食管粘膜病变及食管肿瘤外侵与周围组织器官的直接征象，故提供的临床资料明显优于Ｘ线、ＣＴ平扫及有关检查。ＣＴＩＥＩＥ动物实验及临床研究证实无生理、病理性损害，未出现任何并发症。作者认为，该方法操作简便安全，在食管癌的诊治和评价预后方面具有一定的实用价值。     

成年国人内镜下食管长度的研究

目的探讨国人食管与身高、坐高、性别及年龄的相关性。方法应用前视式胃镜在直视下经食管内腔测量了613例(男378例,女235例)食管上口(咽部)至食管末端(齿状线最近侧缘)的长度。结果成年男性食管平均长度为(24.8±2.1)cm,成年女性食管平均长度为(22.8±1.9)cm,男、女性食管长度存在显著性差异(P<0.01)。同时发现,男女性食管长度与身高、坐高呈直线相关关系。但各年龄组间食管长度无显著性差异(P>0.05)。结论食管长度受多因素影响,其中身高和坐高是影响食管长度的最重要的两个因素。     

EFFECT OF PREOPERATIVE CHEMOTHERAPY ON METASTASIZED LYMPH NODES IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA

Recent advances in surgical teChniques and pe-rioperative management have significantly im-proved the resect rate, long-term survival and op-erative mortality of patients with esophageal can-cer. However, treatment of surgery only does notimprove the extremely poor prognosis of the pa-tients with local advanced squamous cell carcino-ma[lj. Multimodal therapy is needed to improve theprognosis for patients with locally advancedesophageal cancer. Most investigators have foundthat adjuvant treatme…     

食管癌和宫颈癌组织中p53蛋白过度表达及其与放疗敏感性的关系

用免疫组化法对 52例宫颈癌和食管癌标本中 p53基因蛋白过度表达进行研究 ,并探讨其与近期放疗效果的关系。结果显示 ,p53蛋白在宫颈癌和食管癌中过度表达分别为 35.4 8%和 52 .38% ,p53蛋白过度表达率在高分化鳞癌中较中低分化者低 (P <0 .0 5) ,且与病期无关 (P >0 .0 5)。在宫颈鳞癌 ,p53蛋白过度表达者近期放疗效果较差 (P <0 .0 5) ,食管鳞癌 p53过度表达与放疗效果无明显关系。提示 p53基因与放射敏感性有关 ,但不是唯一因素。     

西安地区12年间胃镜检出上消化道癌症分析

目的探讨西安地区内镜检出并经病理证实的上消化道癌症的临床流行病学特点。方法选择1991年1月至2002年12月于西安市三所大型医院进行胃镜检查并经病理确诊的上消化道癌症患者,对其临床、病理、内镜及流行病学特征进行分析。结果12年来上消化道癌症总检出率为8.13%,其中食管癌检出率3.42%,贲门癌检出率1.44%,非贲门部胃癌检出率3.26%,十二指肠癌检出率0.01%。12年来食管癌和胃癌的检出率虽有一些波动,但呈明显下降趋势(P=0.000),贲门癌呈现出较为平缓的上升趋势(P=0.000)。贲门癌的男女性别比为6.29∶1,远较胃癌和食管癌为高(2.92∶1和3.09∶1,P=0.000)。食管鳞癌和腺癌构成无明显变化(P=0.562),食管腺癌没有明显的升高趋势(P=0.557)。结论西安地区食管癌居上消化道癌症之首;12年来胃癌、食管癌的检出率明显下降,贲门癌的检出率呈明显升高趋势;贲门癌为不同于食管癌和胃癌的独立疾病。     

高频超声及钼靶X线检查在乳腺癌诊断中的应用价值

目的评价单一高频超声、钼靶X线及联合应用钼靶、超声对乳腺癌的诊断价值。方法选择2009年4月至2012年4月在我院确诊的318例女性乳腺癌患者,其中104例仅行高频超声检查,98例仅行钼靶X线检查,两者联合应用者116例。结果钼靶X线诊断符合率为78.6%,误诊率11.2%,漏诊率10.2%;单独高频超声诊断符合率为80.7%,误诊率10.6%,漏诊率8.7%;联合应用超声、钼靶X线诊断符合率为93.1%,误诊率4.3%,漏诊率2.6%。单独应用高频超声或钼靶X线检查与联合诊断的检出率及漏诊率有统计学差异,误诊率无统计学差异。结论钼靶X线与超声检查各有优势,二者联合应用具有良好的诊断互补性,能明显提高乳腺癌的检出率和准确率,降低误诊率和漏诊率。     

77例乳癌针吸细胞学检查与病理组织学检查的对照分析

<正> 应用针吸细胞学检查在临床上诊断乳房包块已获得了普遍的重视和肯定。目前已逐渐广泛应用于乳腺癌诊断。我们在临床实际工作中,应甩此方法已近十年,为了提高细胞学诊断水平,现就77例乳癌针吸细胞学检查和切除标本组织学检查进行对照分析如下。资料与方法 1973年1月—1982年12月我科对乳腺肿块应用针吸细胞学检查共125例,其中20例临床和细胞学不怀疑恶性病变;5例乳腺增生病,细胞学检查显示轻度上皮增生;23例细胞学诊     

陈旧性寰枢椎脱位合并延脊髓受压手术治疗(附32例报告)

1971年～1989年,我院手术治疗陈旧性寰枢椎脱位合并延脊髓受压32例。诊断主要依据X线检查及其测量。术后随访平均6年。优良率达87.5%。本文讨论了寰枢椎脱位的原因、有关手术操作方法和疗效。提高疗效的关键是在受压延脊髓发生不改逆改变之前早期诊断和手术治疗。     

食管癌贲门癌切除经食管床食管胃吻合术58例报告

对58例食管癌、贲门癌患者行肿瘤切除后经食管床食管胃吻合术，术后效果良好，无1例发生吻合口瘘及心肺并发症，认为该本式使胃代食管更接近食管的解剖和生理，减轻了胸腔胃对心肺功能的影响，利于吻合口的愈合。     

Diagnosis and excision of breast multi-focal lesions by ultrasound-guided vacuum-assisted biopsy: a comparative evaluation

Objective To compare and evaluate the efficacy of diagnosis and excision for appropriately selected breast multi-focal lesions and solitary lesion by ultrasound-guided vacuum-assisted biopsy (UGVAB). Methods Among 392 appropriately selected patients, 187 patients with multi-focal lesions and 205 patients with solitary lesion were treated by the 8-gauge UGVAB from May 2007 to June 2009. All lesions were removed as completely as possible. The patients with benign pathology underwent physical and ultrasound examinations at one week and 6 months after procedure. Results During the procedure, only three patients had vasovagal syncope and twenty others complained of other intraoperative discomfort. An accurate pathological diagnosis was obtained in all lesions. There was no apparent false-negative result among the 696 lesions with benign pathology at a follow-up of 6 months after procedure. The rates of malignant or premalignant pathology, postoperative complications and residual lesions in patients with multi-focal lesions were higher than those in patients with solitary lesion. If each lesion was considered as a subject of study, there was no significant difference between the two groups. Conclusion UGVAB is an effective method for diagnosis and excision of appropriately selected breast multi-focal lesions and can be used routinely.     

TOA FOR RESECTION OF BULBAR CERVICAL VENTRAL COMPRESSION LESION

Ｉｔｉｓｗｅｌｌｋｎｏｗｎｂｙｎｅｕｒｏｓｕｒｇｉｓｔｓａｎｄｏｒｔｈｏｐｅｄｉｓｔｓｔｈａｔｂｕｌｂａｒ－ｃｅｒｖｉｃａｌｄｏｒｓａｌｃｏｍｐｒｅｓｓｉｏｎｌｅｓｉｏｎｓｃａｎｂｅｒｅｓｅｃｔｅｄｖｉａｐｏｓｔｅｒｉｏｒａｐｐｒｏａｃｈｅｓ，ｂｕｔｉｔｉｓｄｉｆｆｉｃｕｌｔｔｏｒｅｓｅｃｔｔｈｅｖｅｎｔｒａｌｃｏｍｐｒｅｓｓｉｏｎｌｅｓｉｏｎｓ．Ｗｉｔｈｔｈｅｉｍｐｒｏｖｅｍｅｎｔｏｆｉｍａｇｅ，ｍｉｃｒｏｓｕｒｇｉｃａｌｔｅｃｈｎｉｑｕｅａｎｄｉｎｓｔｒｕｍｅｎｔｓ，ｔｈｅｒｅｓｅｃｔｉｏｎ…     

内镜检测成年国人活体食管长度初步研究

用前视式胃镜在直视下经食管内腔测门齿至齿状线的最近侧距离间接得知食管长度,结果认为成人门齿距食管末端齿状线缘的平均长度:男性为41.08 cm±2.03 cm,女性为38.24 cm±2.08 cm,两者有显著差异(P<0.0005)。身高与门齿距齿状线间的长度有直线相关关系,得出由身高推测食管长度的公式男女分别为:y(男)=O.161x-1.19(cm);y(女)=0.162x-2.4(cm)。发现男性随着年龄的增长门齿距齿状线间的距离长度有所延长。     

萘丁美酮在混合反流模型干预治疗中的作用

目的探讨萘丁美酮在混合反流模型干预治疗中的作用。方法健康SD大鼠100只,随机分为反流模型组(Y组,46只)、萘丁美酮组(R组,46只)和正常对照组(C组,8只)。分别观察Y组、R组术后5、17、28、40周及C组40周时食管黏膜的病理改变,检测环氧合酶-2(COX-2)、增殖细胞核抗原(PCNA)、细胞周期蛋白D1(CD1)的表达情况。结果①R组不同时段的损伤积分和Barrett食管(BE)的发生率均低于Y组。②Y组COX-2、PCNA及CD1从正常→反流性食管炎(RE)→BE→食管腺癌(EAC)的阳性表达率和表达程度逐渐增强。③R组不同时段COX-2、PCNA、CD1的表达均低于Y组,且COX-2表达程度和阳性表达率与Y组相比均有统计学意义(P<0.05);R组40周PCNA的表达程度及阳性表达率与Y组相比有统计学差异(P<0.05)。结论COX-2、PCNA和CD1基因的高表达参与了从RE→BE→EAC的发展过程,是BE、EAC发生、发展的早期分子事件。萘丁美酮可影响COX-2、PCNA和CD1的表达,减轻炎症的程度并减缓病程的进展,降低BE和重度不典型增生的发生率,抑制腺癌的发生。     

超声显像在肾肿瘤影像诊断中的作用

报告了我院1986年～1993年临床拟诊断为肾肿瘤,且均行过手术及病理检查的106例患者的各项影像检查诊断结果。诊断正确率:B型超声93.33％(84/90),CT 94.73％(36/38);磁共振成像93.75％(15/16);肾分泌造影82.41％(75/91);肾动脉造影71.43％(5/7);同位素肾动态显像62.50％(25/40)。初步探讨了B超在肾肿瘤诊断中的作用。     

结核蛋白芯片对肺结核及肺外结核的诊断价值

目的通过临床诊断和医学检验报告,评价了结核蛋白芯片在肺结核及肺外结核中的辅助诊断作用。方法应用蛋白芯片对107例肺结核患者及134例肺外结核患者进行结核菌蛋白16ku、38ku和脂阿拉伯甘露糖(LAM)的相应抗体的检测。结果①结核蛋白芯片对结核病的诊断有辅助诊断的价值。②联合三项蛋白芯片抗体指标(16ku蛋白、38ku蛋白、LAM)进行辅助诊断肺结核的价值大于辅助诊断肺外结核的价值,其中肺结核组结核蛋白芯片阳性率为66.4%,肺外结核组阳性率35.8%。③在结核病中三项蛋白芯片抗体指标灵敏性依次为LAM、38ku蛋白、16ku蛋白。④联合蛋白芯片指标灵敏性高于单一蛋白芯片指标。⑤16ku+LAM与16ku+38ku+LAM有近似相同的诊断价值。结论结核蛋白芯片对于检测肺结核和肺外结核有一定的辅助诊断价值。