Context: Pancreas divisum (PD), the most common congenital anatomic variation of the pancreatic ductal system, is still rare in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for patients with symptomatic PD. However, even by experienced endoscopists, the procedure of ERCP can fail in 3% to 10% of cases. Traditionally, if we fail in cannulation we have no choice but to rely on surgery. Case Report: The 2 case reports of PD in this study with cannulation were both unsuccessful, fortunately, the use of endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP was eventually successful in treatment. Conclusions: Using endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP is safe and effective for the treatment of the patients of difficult minor papilla cannulation in patients of PD, and can be used as a remedy for minor papilla cannulation failure.

目的 观察针刺足三里治疗急性胰腺炎的临床疗效.方法 将2016年10月—2018年6月收治的急性胰腺炎患者96例作为研究对象,按随机数字表法将其分为治疗组与对照组各48例,2组均行西医常规治疗,治疗组在此基础上加用针刺足三里.观察2组治疗前、治疗后3d、治疗后7d腹痛腹胀情况;记录首次排气或排便时间及住院时间;记录治疗前、治疗后3d、治疗后7d血淀粉酶(B-AMY)、白细胞计数(WBC)、超敏C反应蛋白(CRP)等实验室指标情况.结果 治疗3 d后2组CRP均呈上升趋势,治疗7 d后均出现下降,治疗组下降更明显,其余各项指标治疗组均优于对照组,P<0.05.结论 针刺足三里辅助治疗急性胰腺炎的疗效优于单纯西医常规治疗,值得临床推广.

Objective To investigate the relationship between general clinical characteristics,different stages of adenomas,metabolic syndrome (MetS) factors of patients with colorectal adenoma (CRA) and cyclooxygenase-2 (COX-2)expression in colonic mucosa.Methods Samples of normal mucosa in left colon from 51 CRA patients(CRA group) and 8 patients(control group,without CRA or any MetS factors) were collected.The expression of COX-2 in colonic mucosa was detected by immunohistochemnistry (IHC).COX-2 IHC staining scores and percentages of samples identified as COX-2 positive in epithelial layer,together with numbers of lamina propria COX-2 positive cells were assessed.The relationship between these 3 indexes and general clinical characteristics such as sex,age,smoking history,alcohol history,history of gallbladder removal,history of gastrointestinal neoplasms,and family history of colorectal neoplasms,were analyzed.CRA patients were divided into two groups based on whether they were with advanced adenomas or MetS factors,and two groups were compared with each other.Results No general clinical characteristics were significantly associated with COX-2 expression in colonic normal mucosa(P＞0.05).Numbers of lamina propria COX-2 positive cells in patients with advanced adenomas were significantly higher than control group (P＜ 0.05).All 3 indexes above-mentioned in CRA patients with MetS factors were significantly higher than those without any MetS factors (P＜0.01).Conclusion COX-2 expression in colonic mucosa of patients with CRA is significantly associated with MetS factors.

目的:探讨胶囊内镜检查前肠道准备中采用乳果糖联合复方聚乙二醇电解质散的应用价值.方法:选取收治的行胶囊内镜检查的患者,随机分为A组和B组各20例,A组采用复方聚乙二醇电解质散行肠道准备,B组在A组的基础上联用采用乳果糖行肠道准备,比较两组患者肠道清洁情况及患者耐受情况.结果:A组肠道清洁度优良率为60.0%,B组为80.0%.B组清洁度优良率显著高于A组,差异有统计学意义(P<0.05).A组患者耐受度优良率和B组相同,均为95.0%.结论:采用胶囊内镜检查前采用乳果糖联合复方聚乙二醇电解质散行肠道准备,具有较好的清洁度,安全耐受性好,是较理想的胶囊内镜术前准备方法.

Objective]To investigate the clinical features of heterotopic gastric mucosa in the upper esophagus(HGMUE)diagnosed by narrow band imaging(NBI)endoscopy.[Methods]The clinical manifesta‐tions ,endoscopic features and the histological characteristics of HGM UE patients in the Wuhan central hospital from 2013 to 2014 were retrospectively analyzed.[Results]Total 113 cases were diagnosed HG‐MUE by NBI endoscopy in 4 719 patients.The detection rate of HGMUE was 2.39%.Some patients had the clinical symptoms of retrosternal pain ,heartburn ,dysphagia ,globus sensation ,hoarseness ,et al.The pa‐thology of tissues was gastric epithelium.Fundic‐type gastric mucosa(68.14% )constituted the most com‐mon histology.[Conclusion]The use of NBI endoscopy can improve the detection rate of HGMUE which may help the secondary step of clinical treatment.

were no significant differences in the detection rate of recto-sigmoid colon,mid colon,right colon and total detection of polyps among the 3 groups (P >0.05).Conclusion 4-L split-dose PEG is better than the oth-er 2 regimens in the colon cleansing quality,so it can better reach the intestinal cleaning standards before enteroscopy,which is a more suitable regimen for bowel preparation.

胆汁淤积是指任何病因引起胆汁分泌排泄功能障碍，进而所致的一系列的病理和临床表现。胆汁淤积可发生于胆汁分泌排泄过程中任何部位，根据发生部位分为肝内胆汁淤积和肝外胆汁淤积。肝外胆管发生机械性梗阻，胆管的扩张往往先于黄疸出现，直到胆管内的压力高于肝细胞分泌压的失代偿阶段才出现黄疸，即肝外胆汁淤积性黄疸，原称梗阻性黄疸，主要由胆、胰、十二指肠乳头及其周围病变和毗邻脏器肿瘤侵犯所致。结石、寄生虫、粘蛋白分泌物、假性囊肿等阻塞或压迫胆道，肿瘤侵犯、炎症、手术损伤、肝移植术后胆道并发症、十二指肠乳头病变、胆胰管先天性畸形、胆胰汇合异常等因素会阻塞胆管，引起黄疸，常导致感染、内毒素血症、肝功能损害、营养不良、肝纤维化、甚至肝硬化，临床表现为肝胆组织损害和全身各系统发生一系列病理生理变化症候群。本文就肝外胆汁淤积性黄疸对机体损伤、临床诊断及治疗进行笔谈。

Objective To explore the levels of protein tyrosine phosphatase nonreceptor type 22.6(PTPN22.6)mRNA in peripheral blood mononuclear cells(PBMCs)of Crohn’s disease(CD)pa-tients,and investigate its correlation with C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR).Methods Levels of PTPN22.6 mRNA in PBMCs of 50 CD patients and 35 controls were detec-ted by real-time PCR,and levels of CRP and ESR were determined by rate nephelometry and automatic ESR Analyzer SRS 100 /II,respectively.Results Levels of PTPN22.6 mRNA expression were higher in CD patients than those in healthy controls(P <0.05).Of CD patients,compared with inactive cases,lev-els of PTPN22.6 mRNA expression increased in active cases(P <0.05);and levels of PTPN22.6 mRNA expression were significantly associated with the levels of CRP and ESR(r =0.356,P <0.01;r =0.512, P <0.01,respectively);compared with cases without stenosis,penetration or cases with penetration,cases with obstruction had significantly higher levels of PTPN22.6 mRNA(P =0.018;P <0.05,respectively). Conclusion PTPN22.6 mRNA expression levels increase in CD patients;high levels of PTPN22.6 mRNA are associated with the status of disease activity,CRP or ESR levels,and illness behavior.It sug-gests that PTPN22.6 could play a considerable role in pathogenesis of CD.

目的 观察联合鳖甲煎丸治疗对于非酒精性脂肪性肝病(NAFLD)肝纤维化的疗效.方法 263例NAFLD肝纤维化患者随机分为治疗组(n=131)和对照组(n=132),两组均常规给予护肝治疗,治疗组加用鳖甲煎丸治疗,疗程为24周,以患者肝脏生化、血脂、肝纤维化指标及肝脏硬度情况变化,评价肝纤维化改善疗效.结果 与对照组比较,治疗组治疗后肝功能(除γ-GT)、血脂、肝纤维化以及肝脏硬度各项指标均显著降低(P＜0.05).结论 联合应用鳖甲煎丸治疗,对NAFLD所致的肝纤维化具有良好的改善作用.

目的 探索内镜黏膜下剥离术治疗上消化道固有肌层肿瘤的可行性、疗效和安全性.方法 经胃镜和内镜超声、CT证实上消化道固有肌层肿瘤35例,其中食管15例,胃20例.行内镜黏膜下剥离术,若出现较大的穿孔或操作困难则改为胃镜联合腹腔镜治疗.结果 35例病灶全部成功进行内镜黏膜下剥离术,未发生严重并发症.操作时间45～240 min,平均82.4 min.术后病理诊断食管平滑肌瘤14例,食管间质瘤1例,胃平滑肌瘤6例,胃间质瘤14例.病灶直径0.8～4.2 cm,平均1.9 cm.术中发生穿孔3例,2例用金属夹成功封闭,1例行腹腔镜下穿孔修补术.结论 内镜黏膜下剥离切除术治疗消化道固有肌层肿瘤是微创、有效并且安全的治疗方法.

目的:探讨在无痛胃镜下行高频电凝电切术治疗胃息肉的临床疗效.方法:对213例无痛胃镜下行高频电凝电切术治疗胃息肉的患者,评估其治疗效果和满意率.结果:无痛胃镜可使患者在安全、无痛苦情况下顺利完成整个检查及治疗过程,无并发症和麻醉意外发生.结论:无痛胃镜下行高频电凝电切术治疗胃息肉,具有无痛、安全、高效、无不良反应等优点,可明显减轻患者的痛苦,治疗效果满意.

Objective To explore the application effects of endoscopic nasojejunal feeding tube placement in elderly critically ill patients. Methods From January 2009 to August 2012,100 elderly critically ill patients admitted to ICU of this hospital were divided randomly into groups EN,PN,50 in each. PN group were given intravenous nutrition,EN group under-went endoscopic nasojejunal feeding tube placement for enteral nutrition. Hemoglobin,serum albumin,prealbumin and CRP levels,weight,nitrogen balance,acute physiology and chronic health evaluation systemⅡ( APACHEⅡ) scores,complica-tions were observed before treatment and on days 7,14 after treatment. ResUlts There was no significant difference in the above mentioned indicators between 2 groups before treatment(P>0. 05). The prealbumin level was higher in EN group than in PN group on days 7 after treatment(P<0. 05),and hemoglobin,serum albumin,prealbumin higher on days 14 after treatment (P<0. 05). Body weight,nitrogen balance were higher,serum CRP lower in EN group than in PN group on days 7,14 after treatment(P<0. 05). APACHEⅡ scores were lower in EN group than in PN group on days 14 after treatment(P<0. 05). Six patients had phlebitis in PN group(12%),4 had abdominal distension and 3 had diarrhea in EN group(8%,6%,re-spectively) at the beginning of treatment. After adjusted input velocity concentration and temperature are spontaneously. Con-clUsion Endoscopic nasojejunal feeding tube placement,safe and effective,helps improve nutritional status and immunity in elderly critically ill patients.

目的：探讨幽门螺杆菌（helicobacter pylori，HP）感染与胃镜下不同胃炎类型及病理之间的关系。方法：2010年1月至2012年12月在我院行胃镜检查诊断的5638例患者连续性行胃镜下黏膜活检，对其内镜和病理表现进行分型分级，并检测患者的HP感染情况，分析HP感染与胃镜下不同胃炎类型及病理之间的关系。结果：所有5638例患者中浅表性胃炎、糜烂性胃炎及萎缩性胃炎的HP阳性率分别为51．00％、72．89％及77．22％；糜烂性胃炎及萎缩性胃炎患者与浅表性胃炎患者比较均有显著差异（P＜0．01）。在病理检查中度炎症反应程度的患者HP感染率明显高于轻度炎症反应患者（P＜0．01）；重度炎症反应程度的患者HP感染率明显高于中度炎症反应患者（P＜0．01）。在病理检查有活动性炎症的患者HP感染阳性率为86．79％，而无活动性炎症的患者HP感染率为53．18％，有显著统计学差异（P＜0．01）。在病理检查有肠上皮化生患者及有上皮类瘤变患者中HP感染阳性率分别为84．86％及89．80％，而无肠上皮化生及无上皮类瘤变患者的HP感染率为分别为48．08％及56．92％，比较均有显著差异（P＜0．01）。结论：HP感染可加重胃黏膜的炎症反应，同时促进慢性胃炎向萎缩性胃炎、肠上皮化生、上皮内瘤变发展。

Objective To investigate the effect of Octreotide on pancreatic head carcinoma patients with obstructive jaundice who underwent endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement.Methods Niney-nine patients hospitalized in Department of Gastroenterology of Wuhan Central Hospital from Jan 2006 to Dec 2011 were included in this study.All the patients were diagnosed as pancreatic head carcinoma with obstructive jaundice.The patients were randomly divided into the Octreotide treatment group and the control group.Both groups underwent ERCP with pancreatic duct stent placement for malignant biliary obstruction.The patients in Octreotide treatment group were injected with subcutaneous Octreotide at a dose of 0.1 mg twice per day for more than 90 day till death.The changes of serum total bilirubin before and after treatment were compared.The improvement of symptoms of nausea,vomiting,abdominal pain,diarrhea and anorexia was compared.The complication rates and survival were also determined.Results Postoperative recurrence of jaundice was observed in six patients in control group,and the cause may be stent occlusion,and 3 of the 6 patients underwent a second ERCP and stent placement,then jaundice was relieved,the other 3 patients did not receive a second ERCP.The serum bilirubin level in the remaining 45 patients returned to basically normal value (below 2 times of the normal value).The prevalence of nausea,vomiting,abdominal pain,diarrhea and anorexia in the 2 groups was not statistically different before treatment,and after treatment the prevalence of symptoms in the 2 groups was significantly decreased except for diarrhea.The decrease in Octreotide treatment group was more obvious than that in control group,and the difference between the two groups was statistically significant (P ＜ 0.01).In the control group,post-ERCP pancreatitis occurred in three patients,and all were cured after treatment.There was no post-ERCP pancreatitis occurred in the Octreotide treatment group.Minor pain at the injection site was noted in three patients in the Octreotide treatment group.Pain was relieved after changing the injection site.The survival was significantly longer in the Octreotide group than that in control group [(14.4 ± 8.7) months vs (7.3 ± 5.3) months,P ＜ 0.05),and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Octreotide can improve the quality of life and increase the survival of patients with pancreatic head carcinoma who undergo ERCP with pancreatic duct stent placement.

Growing evidence has supported that metabolic syndrome (MS) could be an important risk factor of colorectal tumorigenesis. Multifactorial mechanisms could take part in the relationship between MS and colorectal neoplasms, such as inflammation of colonic mucosa, injury of mucosal barrier function and alteration of the microbiome. In spite of unclear mechanisms of action, MS components and related diseases have significant roles in prevention and fundamental research of colorectal neoplasms.

目的 探讨内镜下胆道支架置入治疗复杂型肝门部恶性梗阻中的临床应用价值.方法 2007年2月-2011年2月,经确诊为肝门部恶性胆道梗阻患者43例,应用胆道支架引流术,观察操作成功率、生存期等评价指标.结果 该组引流有效率86.0％(37/43),Bismuth Ⅲ型中Ⅲa型引流有效率92.9％(13/14),Ⅲb型90.5％(19/21),Bismuth Ⅳ型引流有效率62.5％(5/8),并发症发生率为7.0％.随访的34例患者的支架平均通畅时间及中位生存时间分别为(141.2±86.3)和194 d.结论 胆道支架置入术治疗复杂型肝门部恶性梗阻所致梗阻性黄疸疗效确切,安全性高,提高患者的生存质量,延长其生存期.

Background/Aims: To explore the correlations between endoscopic gastric mucosal lesions and pathological gastric intraepithelial neoplasia (GIN), and to investigate outcomes of gastric intraepithelial neoplasia after treatments. Methodology: Biopsies of 18,566 Chinese patients undergoing diagnostic gastroscopy were included. Among them, 130 patients were given various treatments, including medication, endoscopic treatment and surgery. Results: There were 433 patients with GIN by initial pathological diagnosis. Among them, 367 low-grade GIN and 66 high-grade GIN, 348 cases accompanied with chronic gastritis, and 85 cases accompanied with localized foci. Eighty cases of Hp-positive patients with low-grade GIN were given anti-Hp therapy. Our results showed that 45 cases of intraepithelial neoplasia disappeared when chronic inflammation left, and 33 cases were given the original diagnoses and two cases developed into high-grade GIN. Surgery was then performed, after which one case was confirmed to have early gastric carcinoma, and the other was diagnosed as advanced gastric carcinoma. Pathological examinations were carried out undergoing EMR or ESD treatment for 18 patients with localized foci accompanied with low-grade GIN. Results showed four cases of chronic inflammation, 11 cases with original diagnoses maintained, and three cases of high-grade GIN. Conclusions: GIN occurred frequently in patients with more severe pathological inflammations under endoscope, which also had certain correlations with intestinal metaplasia. After treatment, parts of low-grade GIN could be reserved. The effect of endoscopic resection on localized foci accompanied with low-grade GIN was affirmative. However, the limitation of endoscopic biopsy should be fully understood.

目的观察利巴韦林对急性戊型肝炎的抗病毒作用。方法选择急性戊型肝炎患者62例,其中治疗组32例,对照组30例。两组均使用腺苷蛋氨酸及异甘草酸镁护肝治疗,治疗组加用利巴韦林静滴治疗。结果治疗组比对照组转氨酶及黄疸下降明显,住院天数缩短,费用减少。两者具有显著统计学差异(P<0.05)。结论利巴韦林可以促进急性戊肝的恢复,缩短住院时间。

Objective:To investigate the-1123G/C in the promoter and+788G/A in exon 10polymorphisms of protein tyrosine phosphatase nonreceptor type 22(PTPN22)gene on disease susceptibility and phenotype of ulcerative colitis(UC),and explore the expression of PTPN22 mRNA in colonic biopsies of UC.Methods:A total of 105UC patients and 200healthy controls were genotyped for-1123G/C and+788G/A of the PTPN22 gene polymorphisms using a method of polymerase chain reaction based restriction fragment length polymorphism.PTPN22 mRNA expression in colonic biopsies of UC patients and controls was determined by quantitative PCR.Results: The frequencies of C allele andCC + CGgenotype were higher in UC patients than in healthy controls(42.4%vs 32.5%,P =0.016,OR=1.53,95%CI:1.08-2.16;67.6%vs 51.5%,P =0.009,OR=1.93,95%CI:1.18-3.16),and associated with extensive colitis(P=0.035).In UC patients,PTPN22 mRNA expression levels were elevated in active disease compared with inactive disease(P=0.005).There was no association of PTPN22 mRNA expression levels with-1123G/C polymorphism in UC patients.The distribution of+788G/A allele and genotype frequencies did not differ between UC patients and the healthy controls.Conclusion:Our study showed the potential association between PTPN22-1123G/C polymorphism and UC in central China.PTPN22 mRNA expression levels were highly expressed in colonic biopsies of active UC.It suggests that PTPN22 may plays an important role in pathogenesis of UC.