目的:观察内镜下息肉勒除器冷切除术治疗大肠小息肉的临床效果.方法:选取2020年1月-2021年6月粤北人民医院消化内科收治的大肠小息肉患者150例作为研究对象,采用随机数字表法分为冷圈套组、活检钳除组及电切组,每组50例.三组患者均在内镜下实施息肉切除手术.冷圈套组采用息肉勒除器冷切除息肉;活检钳除组采用活检钳切除息肉;电切组采用高频电凝电切设备切除息肉.比较三组患者息肉的位置、大小、数量,手术时间,治疗费用,术中出血率,术后两周出血率,手术并发穿孔率,结肠息肉的完整切除率及标本回收率.结果:三组患者在息肉的位置、大小、数量方面相比,差异均无统计学意义(P>0.05).电切组的手术时间长于冷圈套组和活检钳除组、治疗费用高于冷圈套组和活检钳除组(P<0.05);冷圈套组、活检钳除组手术时间、治疗费用相比,差异均无统计学意义(P>0.05).电切组术后两周出血率高于冷圈套组和活检钳除组(P<0.05);三组患者术中出血率相比,差异无统计学意义(P>0.05);三组患者均未出现肠穿孔.冷圈套组、电切组结肠息肉完整切除率均高于活检钳除组(P<0.05);冷圈套组和电切组结肠息肉完整切除率相比,差异无统计学意义(P>0.05);三组标本回收率相比,差异无统计学意义(P>0.05).结论:对于6～9 mm的大肠小息肉,选择息肉勒除器冷圈切除,手术时间短、并发症较少且有利于标本的获取,值得在各级医院推广.

目的:分析消化内镜治疗胃十二指肠溃疡出血患者的方法与效果.方法:选取本院2016年1月～2020年12月54例接受治疗的胃十二指肠溃疡出血患者为研究对象,随机分为27例观察组和27例对照组,对照组用常规药物注射止血治疗,观察组用消化内镜治疗,对比研究两组不同方法的治疗相关指标、临床治疗总有效率、并发症发生率.结果:观察组的输血量、出血量、止血时间、住院时间均少于对照组,观察组治疗效果总有效率96.30％比对照组77.78％高(P<0.05).结论:经消化内镜下氩气刀治疗胃十二指肠溃疡出血安全有效,可以缩减出血量和治疗时间,提高治疗效果,同时还降低了并发症发生率,其治愈疗效有临床价值.

目的:探究内镜下套扎和组织胶注射治疗食管及胃底静脉曲张的临床价值.方法:选取本院收治的60例展开内镜下套扎治疗的食管静脉曲张患者为本次观察对象,其中21例伴有胃底静脉曲张患者在展开内镜下套扎治疗后施行组织胶注射治疗.60例纳入时间自2020年1月—2020年12月.治疗后随访3个月以评估其临床治疗效果及安全性.结果:参与本次研究的60例食管及胃底静脉曲张患者成功止血率100.00％,早期再出血率1.67％,晚期在出血率6.67％,消除率55.00％,缓解率35.00％,并发溃疡出血率1.67％,发热发生率1.67％,未见菌血症及狭窄情况.结论:内镜下套扎和组织胶注射治疗食管及胃底静脉曲张疗效明显且安全性高.

目的 对比分析金属自膨胀式支架(SEMS)经内镜(ERCP)与经皮肝穿(PTCD)植入治疗胆管恶性梗阻疗效.方法 对2007年1月至2017年12月粤北人民医院经内镜或经皮肝穿植入SEMS的50例胆管恶性梗阻患者进行回顾性分析.其中ERCP组28例,PTCD组22例.对比两种支架植入成功率、30 d内病死率、术前及术后5~7 d肝功能的差异、术后1周生活质量、术后近期并发症等指标.结果ERCP组与PTCD组相比,支架植入成功率、30 d内病死率差异无统计学意义(P>0.05),2例经ERCP失败改PTCD植入成功.两组术前5~7 d肝功能指标(TBil、DBil、AST、ALT、AKP、GGT)差异无统计学意义(P>0.05);术后均较术前显著降低(P<0.01).两组术后近期并发症发生率无统计学意义(P>0.05).ERCP组术后1周生活质量与术前比较有显著改善(P<0.01),且优于PTCD组(P<0.01).结论 经内镜与经皮肝穿植入SEMS解除胆管恶性梗阻的疗效、30 d病死率和术后并发症相当, 但ERCP组术后1周生活质量优于PTCD组.

Objective To explore the effects of anti-H.pylori treatment to the negative conversion rate of H.pylori DNA and the activity of PLA2 in the bile of patients with gallstone. Methods Among the 60 patients with cholelithiasis undergoing ERCP bile duct lithotomy+endoscopic nasobiliary drainage (ENBD), or T tube drainage for surgical bile duct lithotomy, the patients who were positive for 14C breath test and biliary H.pylori DNA were randomly divided into two groups, 30 cases each. The treatment group(Group A) was treated with quadruple therapy of anti H.pylori, control group(group B) was treated with proton pump inhibitors;The nega-tive rate of H.pylori DNA and the decrease of PLA2 activity were compared between the two groups. Result The negative rate of H.pylori DNA in group A was higher than that in group B(P<0.05);there was no differ-ence in PLA2 activity before drainage in group A and group B on the first day of drainage. All the activity of PLA2 decreased at eighth days after drainage;but the activity of PLA2 in group A was lower than that in group B (P<0.01). Conclusion The Anti-H.pylori treatment can improve the H.pylori DNA negative conversion rate and decrease the activity of PLA2 in bile with cholelithiasis.

INTRODUCTION:Colorectal cancer is one of the common malignant tumors in humans, and the incidence rate is gradually increasing year by year. Survivin and CD44v3 are ideal targets for gene therapy due to their overexpression in colorectal cells. Studies show that downregulation of survivin could promote apoptosis and depress proliferation, and reduction of CD44v3 expression could inhibit tumor invasive capacity. It is difficult to achieve satisfactory curative effect.OBJECTIVE:In this study, we use survivin and CD44v3 short hairpin RNAs (shRNA) combined transfection into colorectal cancer cell line SW480 to investigate its effects on the cell apoptosis, proliferation and invasiveness.METHODS:ShRNA plasmids targeting survivin and CD44v3 were singly or co-transfected into SW480 cells.RESULTS:The co-transfection group exhibited the most significant inhibitory effect on cell growth (P < 0.05) and the highest apoptosis rate (P < 0.05). In addition, the invasive capacity in the co-transfected group was the least. The tumor inhibition rate of the cotransfected group in xenograft tumor mice was significantly higher than other groups (P < 0.05). Moreover, the microvessel density of the co-transfected group was significantly decreased compared with other groups (P < 0.05).CONCLUSION:These results suggest combined transfection of survivin shRNA and CD44v3 shRNA may produce a synergistic effect on gene therapy in colorectal cancer.

目的:探讨联合转染Survivin短发夹RNA(short hairpin RNA,shRNA)和CD44v3 shRNA对结直肠癌SW480细胞增殖和侵袭能力的影响.为结直肠癌的基因治疗提供实验依据.方法:设计并构建能够稳定转录shRNA并干扰Survivin和CD44v3分子表达的质粒,将其单独及联合转染结直肠癌SW480细胞后,分阴性对照组、空白质粒对照组,Survivin组、CD44v3组和共转染组.Western blot检测转染后Survivin和CD44v3蛋白表达的变化,流式细胞仪及MTT法检测细胞凋亡和细胞增殖的变化.Transwell小室检测细胞迁移能力的改变.结果:测序证明表达载体构建成功,共转染组Survivin和CD44v3的蛋白表达抑制率分别为84.2%±0.3%和77.3%±0.1%,与单独转染组相比差异有统计学意义(P<0.05).转染120 h后,共转染组、Survivin组和CD44v3组细胞生长抑制率分别为44.3%±0.1%、21.5%±0.2%、26.4%±0.2%,共转染组抑制效果最明显(P<0.05),总凋亡率分别为37.6%±2.3%、20.0%±0.4%、21.6%±1.6%.共转染组凋亡率最高(P<0.05),小室穿膜细胞数分别为66.12个±4.04个,89.35个±3.06个、93.53个±5.13个,共转染组与各组差异显著(P<0.05).结论:Survivin shRNA和CD44v3 shRNA可分别下调Survivin和CD44v3蛋白的表达,抑制结直肠癌细胞的增殖,促进其凋亡,减弱其迁移能力,而两者的联合转染能进一步抑制细胞的生长增殖,减弱细胞的侵袭能力.