目的 分析细支气管腺瘤(bronchiolar adenoma,BA)患者的影像学表现和病理学特征.方法 回顾性分析首都医科大学宣武医院2019年1月-2020年9月接受手术治疗的11例BA患者的临床资料,其中男5例、女6例,年龄40～73(62.40±10.50)岁.分析术前胸部CT的影像学特征、术中快速冰冻病理诊断情况、术后病理分型、细胞生长方式、细胞核增殖指数Ki-67等.结果 平均术前观察时间(381.10±278.28)d,影像学病变最大径5～27(10.27±6.34)mm.表现为不规则形态的异质性磨玻璃样病变8例(72.7％),纯磨玻璃样病变3例(27.3％);有血管征象10例(90.9％),空泡征8例(72.7％),支气管征1例(9.1％),胸膜征3例(27.3％),毛刺/分叶征9例(81.8％).术式包括亚肺叶切除10例和肺叶切除1例.术中冰冻病理明确诊断为BA的有5例(45.5％).术后病理分型包括8例远端型BA和3例近端型BA,病灶最大径为4～20(8.18±5.06)mm.8例(72.7％)病灶在显微镜下可观察到特征性的双层细胞结构,10例(90.9％)病变组织显示甲状腺转录因子1表达;9例(81.8％)病灶显示NapsinA腔内细胞表达;病灶组织Ki-67指数为1％～5％(3.22％±1.72％).结论 病理学特征及影像学表现明确了 BA是肿瘤性病变的前提,但对BA是良性或惰性肿瘤的认定,还需要更多的临床资料及分子病理学研究证据.

目的 探讨仁青芒觉胶囊联合雷贝拉唑治疗胃溃疡的临床疗效.方法 选取 2020年 3 月—2023 年2 月首都医科大学附属北京康复医院收治的 91 例胃溃疡患者,按随机数字表法将所有患者分为对照组(45 例)和治疗组(46 例).对照组晨服雷贝拉唑钠肠溶片,20 mg/次,1 次/d.治疗组在对照组基础上口服仁青芒觉胶囊,4 粒/次,1 次/d.两组疗程均为6 周.观察两组临床疗效,比较治疗前后两组主要症状积分、溃疡愈合率和幽门螺杆菌(Hp)根除率、36 项健康调查简表(SF-36)评分及血清胃泌素(GAS)、胃动素(MTL)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)水平.结果 治疗后,治疗组总有效率是 95.65%,较对照组的 80.00%显著提高(P＜0.05).治疗后,两组中上腹痛、反酸、嗳气、脘腹胀满积分及其总积分均较治疗前显著降低(P＜0.05);且治疗后,治疗组主要症状积分显著低于对照组(P＜0.05).治疗后,治疗组溃疡愈合率、Hp根除率分别为 73.91%、89.13%,均显著高于对照组的 51.11%、71.11%(P＜0.05).治疗后,两组SF-36 中生理健康评分、心理健康评分及量表总分均显著增加(P＜0.05);且治疗后,治疗组 SF-36 评分高于对照组(P＜0.05).治疗后,两组GAS、MTL、TNF-α、TGF-β1 水平均较治疗前显著下降(P＜0.05);且治疗后,治疗组血清GAS、MTL、TNF-α、TGF-β1 水平均显著低于对照组(P＜0.05).结论 仁青芒觉胶囊联合雷贝拉唑治疗胃溃疡可获得确切疗效,能安全有效地缓解患者主要症状,调节胃肠激素,抑制炎症反应,促进溃疡愈合及Hp清除,改善生活质量,值得临床推广应用.

目的 探索在胸部薄层CT(thin-section CT,TSCT)表现为肺纯磨玻璃结节(pure ground-glass opacity,p-GGO)患者的影像学特征对术后病理预判的可能性.方法 对笔者医院2019年1月 ～2020年6月行胸腔镜手术治疗的451例p-GGO患者的临床资料进行回顾性分析,依据TSCT扫描所表现的p-GGO内部特征将p-GGO分为Ⅰ型p-GGO和Ⅱ型p-GGO.结果 451例患者中包括Ⅰ型p-GGO 188例(41.7％),Ⅱ型p-GGO 263例(58.3％).与Ⅱ型p-GGO比较,Ⅰ型p-GGO病变最大径度(8.86±5.10mm vs 11.24±5.80mm,F=8.247,P=0.004)、径度增大和密度增高的平均时间(30.50±14.30个月vs 9.74±16.40个月,F=6.945,P=0.009)、边缘分叶或毛刺征(P=0.000)、胸膜征(P=0.001)、血管征(P=0.009)等影像学表现的差异有统计学意义.Ⅰ型p-GGO组中的浸润前期病变例数(n=123)明显多于Ⅱ型p-GGO组(n=63),而微浸润期病变例数(20例vs 86例)和浸润期病变例数(17例vs 86例)明显少于Ⅱ型p-GGO组(P=0.000),且Ⅱ型p-GGO组中有更多的病例发生局部浸润(P=0.000).结论 p-GGO在TSCT所表现的内部特征有助于对早期肺癌病理特性的预判.

To determine whether oxidative stress and inflammation are associated with constipation by examining the expression of the main producers of reactive oxygen species, nicotinamide adenine dinucleotide phosphate (NADPH) oxidases, and pro-inflammatory cytokines in the colon of patients with chronic functional constipation. The colonic biopsies were collected from 32 patients with chronic functional constipation and 30 healthy subjects who underwent colonoscopy. Colonic mucosal histology was observed. Interleukin (IL)-1β, IL-6, IL-8 messenger RNA (mRNA), and 4 members of NADPH oxidase (NOX1, NOX2, DUOX2, and NOX4) protein and mRNA were assessed by immunohistochemistry, western blotting, and reverse transcription polymerase chain reaction. The tissues from both patients and healthy subjects showed normal histological structure without increase of inflammatory cells. NOX1 protein and mRNA levels were significantly increased compared to controls (P < .05). DUOX2 protein, but not mRNA, was increased by 2-fold compared to controls (P < .05). The levels of NOX2 and NOX4 protein and mRNA demonstrated no significant difference between patients and control subjects. The levels of IL-1β and IL-6 mRNA were significantly higher in constipation patients (P < .05), while IL-8 mRNA level was no different between the 2 groups. NADPH oxidase and pro-inflammatory cytokine might be involved in the pathogeneses of chronic functional constipation.

目的 探索SIX1和SIX4蛋白在结肠腺瘤性息肉中的表达及意义.方法 利用组织芯片及组织切片,通过免疫组化检测结肠腺瘤性息肉组织、结肠癌组织及癌旁组织中SIX1和SIX4蛋白的表达情况,分析结肠腺瘤性息肉中SIX1和SIX4蛋白表达的意义.结果 结肠腺瘤性息肉组织中SIX1、SIX4蛋白表达低于结肠癌组织,高于癌旁组织,差异有统计学意义(P<0.05);SIX1、SIX4蛋白表达在结肠腺瘤性息肉内定位于结肠上皮细胞质及细胞膜.结论 SIX1和SIX4可能在结肠腺瘤性息肉发生过程中发挥作用,检测SIX1和SIX4蛋白表达有助于结肠癌的早期诊断.

目的 分析单孔胸腔镜治疗老年肺磨玻璃结节(ground-glass opacity,GGO)患者的临床资料及病理结果.方法 对笔者医院2017年1月～2019年12月行单孔胸腔镜手术治疗、年龄>60岁的老年GGO患者281例的临床资料进行回顾性研究.结果 281患者的平均年龄为67.00±5.30岁,其中男性患者83例(29.5％),女性患者198例(70.5％).190例(67.6％)伴有高血压、糖尿病、吸烟、冠心病、COPD等.胸部CT扫描发现,GGO最大径均值为13.31±7.50mm.平均观察时间为13.48±23.30个月.术式为肺叶切除术88例(31.3％)、亚肺叶切除术193例(68.7％).手术平均用时为162.61±63.50min,平均术中出血量为53.68±29.60ml.51例(17.6％)术后出现心脑血管、肝功能损害等术后并发症,无围术期死亡病例.术后病理报告:30例(10.7％)为良性GGO病变、75例(26.7％)为浸润前期病变、65例(23.1％)为微浸润腺癌、111例(39.5％)为浸润期肺腺癌.平均住院日为10.93±3.60天.男性患者(P=0.024)、肺叶切除术式(P=0.000)、影像学表现为Ⅲ ～Ⅳ型GGO的患者(P=0.036)、浸润期病变患者(P=0.009)是超过平均住院日的主要因素.结论 具备Ⅱ型GGO以上特征或最大径10mm以上的GGO是预判老年早期肺癌的重要影像学特征.单孔胸腔镜下的亚肺叶切除是治疗以GGO为影像学表现的老年早期肺癌患者首选的治疗手段.

通过对建国以来分阶段开展的3次国人死亡原因的回顾调查和国家癌症中心最新发布的我国癌症数据报告的分析,可以看到恶性肿瘤是影响我国人民生命健康的重要疾病,肺癌是首要的危险因素;同时也看到我国政府在不同发展时期应对恶性肿瘤所制定的一系列防控策略的科学性和有效性,明确把"早诊早治"作为防治肺癌等恶性肿瘤的重要策略.我国的肺癌外科在建国后进入了一个新的发展时期,学术水平和技术能力在20世纪90年代已接近或达到国际水平,部分领域已经处于国际领先水平.胸部螺旋CT扫描的应用使早期肺癌诊断成为可能;液体活检联合常规血清肿瘤标志物检测有助于提高早期肺癌的正确诊断率;胸腔镜技术的应用是胸外科领域发展的里程碑,也使早期肺癌患者的微创外科治疗成为现实.在提高早期肺癌患者生存率的同时,提高了患者生存质量.

目的探讨白介素（IL）-17A和IL-18在慢性功能性便秘患者结肠黏膜内表达情况,分析这两种白介素在慢性功能性便秘发病机制中的作用。方法选择2 0 1 8年10月至2 0 1 9年6月在河南科技大学第一附属医院消化内镜中心进行肠镜检查的32例慢性功能性便秘患者作为试验组,并选取同期30例健康体检者作为对照组;两组研究对象在结肠镜检查过程中取乙状结肠黏膜活检,进行HE染色观察组织形态学、实时定量聚合酶链式反应（PCR）检测IL-17A和IL-18 mRNA表达情况,并应用酶联免疫吸附测定（ELISA）方法测定IL-17A和IL-18蛋白水平,比较这两种炎症因子mRNA和蛋白在两组结肠黏膜的表达差异。结果试验组与对照组结肠黏膜组织形态学均无异常改变,试验组患者结肠黏膜内未发现慢性炎症细胞（如淋巴细胞、浆细胞等）浸润增加。试验组结肠黏膜组织中IL-17A mRNA、IL-17A蛋白表达水平高于对照组,差异有统计学意义（P＜0.05）;而IL-18 mRNA和蛋白表达两组间比较,差异无统计学意义（P＞0.05）。结论 IL-17A在慢性功能性便秘结肠黏膜组织中表达升高,IL-17A可能参与功能性便秘的发病机制或病理过程。

Lung cancer is a leading cause of cancer mortality worldwide. As the incidence of lung cancer increases in recent years, the number of patients diagnosed with synchronous multiple primary lung cancers (SMPLC) is also rising. SMPLC diagnosis is often made based on the clinical course, imaging findings, and histologic and molecular features. Standard lobectomy is the main therapeutic modality for SMPLC. Because maximum retention of lung function is essential, sublobectomy is also a commonly used surgical strategy when appropriate. The question is how to optimize the sequence of lobectomy and sublobectomy for patients with SMPLC. Thoracoscope lobectomy for the primary lesion plus sublobectomy for the secondary lesions is the most commonly used approach. Here we present a case of SMPLC with sublobectomy followed by lobectomy.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) in some cases can be diagnosed as esophageal varices (EV). DLG1-AS1 promotes cervical cancer, while its function is other malignancies remains unknown. Our aim for this study is to study the role of DLG1-AS1 in esophageal squamous cell carcinoma. METHODS: Plasma levels of DLG1-AS1 in 66 early stage ESCC patients, 60 EV patients and 60 healthy controls were measured by RT-qPCR. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of DLG1-AS1 for early stage ESCC. Relationship between miR-145 and DLG1-AS1 was analyzed by overexpression experiments. Proliferation of cells was determined by CCK-8 assay. RESULTS: DLG1-AS1 was upregulated in ESCC, but not in EV patients compared with healthy control. DLG1-AS1 overexpression distinguished ESCC patients from healthy controls and EV patients. Plasma miR-145 was inversely correlated with DLG1-AS1 in ESCC patients. Moreover, DLG1-AS1 overexpression resulted in the downregulation of miR-145, while miR-145 mimic transfection did not significantly alter DLG1-AS1. Overexpression of DLG1-AS1 mediated the promoted, while overexpression of miR-145 resulted in inhibited proliferation of ESCC cells. The role of DLG1-AS1 overexpression was inhibited by miR-145 mimic transfection. CONCLUSION: Therefore, DLG1-AS1 may promote ESCC under the repression of miR-145.

To investigate the relationship between platelet to lymphocyte ratio PLR and prognosis in patients with small cell lung cancer SCLC .Methods Clinical data including platelet and lymphocyte counts of 165 patients with SCLC admitted to our hospital from June 2008 to June 2018 were collected and retrospectively analyzed and their survival were followed up. The optimal cut-off value of PLR was determined with time-dependent receiver operating curve ROC curve analysis in SPSS 22.0 statistical software.The overall survival OS and progression-free survival PFS of high PLR and low PLR groups were evaluated with Kaplan-Meier analysis respectively and Multivariate Cox regression models were applied to evaluate the independent prognostic significance of PLR.Results ROC curve analysis showed that PLR ＝189 was optimal cut-off value.One hundred and twenty cases were found in the low PLR <189 group and 45 cases fell in the high PLR ≥189 group.The progression-free survival of patients with low PLR was higher than that of high PLR 8.6 months vs 6 months P＝0.016 .The overall survival of patients with low PLR was higher than that of high PLR 13.8 months vs 12.1 months P＝0.016 .COX multivariate regression analysis showed that radiotherapy can be used as an independent prognostic factor for both PFS and OS in patients with SCLC HR＝0.488 95%CI＝0.303～0.787 P＝0.003 HR＝0.314 95%CI＝0.190～0.519 P＝0.000.PLR level can be used as an independent prognostic factor for PFS in patients with SCLC HR＝1.538 95%CI＝1.040～2.274 P＝0.031 but not as an independent prognostic factor for OS HR＝1.323 95%CI ＝0.883 ～1.982 P ＝0.175 .Conclusion PLR can reflect the prognosis of patients with SCLC but it cannot be used as an independent prognostic factor.

[目的]探讨白光下胃镜所见发红黏膜与早期胃癌及癌前病变的关系.[方法]回顾比较80例白光下胃镜所见发红黏膜病理结果与其未发红黏膜病理结果.[结果]80例中9例拒绝活检,45例发红黏膜在胃窦,13例在胃体,8例在胃角,3例在窦体交界,2例在胃底,未发红黏膜均取自同一患者发红黏膜旁.发红黏膜病理结果为低级别上皮内瘤变7例,高级别上皮内瘤变2例,腺癌1例,炎症61例,未发红黏膜病理结果为低级别上皮内瘤变1例,炎症70例.[结论]胃镜下发红黏膜癌前病变和癌变率高,需要重视.

目的:观察活动期溃疡性结肠炎(Ulcerative colitis,UC)患者凝血指标变化,探讨其临床指导价值.方法:自我院2014年3月—2016年10月活动期UC患者中选取172例(A组),同期缓解期UC患者选取90例(B组)、50名健康体检者(NC组).检测各组受试者血小板计数(PLT)、平均血小板体积(MPV)、凝血酶原时间(PT)等凝血指标;此外,按照活动期UC患者病情活动度,分别纳入轻度组(n=63)、中度组(n=41)、重度组(n=68),对各组凝血指标进行比较,并计算凝血指标与活动期UC患者疾病活动指数(CAI)、Baron内镜评分的相关性,总结凝血指标变化在活动期UC病情严重程度评估的临床价值.结果:活动期UC组PLT、FIB、D-D高于其他2组,其MPV、PT低于其他2组;活动期UC组、B组PT低于NC组,差异有统计学意义(P<0.05).随着患者病情活动度的加剧,其PLT、D-D逐渐上升,MPV逐渐下降;其轻度组FIB低于中度组、重度组,差异有统计学意义(P<0.05).Pearson相关性分析提示,PLT、D-D与CAI指数、Baron内镜评分呈正相关,MPV与CAI指数、Baron内镜评分呈负相关(P<0.05).结论:检测活动期UC患者PLT、D-D及MPV变化能够为病情活动度及严重程度的判断提供一定参考.

[目的]探讨十二指肠间质瘤的临床特点及诊治方法.[方法]回顾性分析近13年来我院确诊的16例十二指肠间质瘤患者的临床资料.[结果]本组中女性患者占75％;≥60岁者占68.75％,＜60岁者占31.25％;发病部位以十二指肠降部较多见(62.5％);呕血、黑便或便血为常见临床表现(75％).本组患者均行手术治疗.6例术后服用甲磺酸伊马替尼400 mg/d治疗.[结论]十二指肠间质瘤好发于老年人,十二指肠降部为好发部位,上消化道出血是常见临床表现.内镜和CT检查是主要的辅助检查手段.外科手术为首选治疗方法.

目的 评价肠内免疫营养联合微生态制剂对进展期胃癌术后辅助化疗患者营养状态、血液学毒性,消化道反应和免疫功能的影响.方法 将2013年1月至2015年9月首都医科大学附属北康医院收治的76例进展期胃癌术后辅助化疗患者随机分为肠内免疫营养组(E组,27例)、肠内免疫营养联合微生态制剂组(E+P组,25例)及对照组(C组,24例).观察各组患者化疗前后的营养状态、血液学毒性,消化道反应和T细胞亚群的变化.结果 与化疗前相比,对照组化疗后体重降低,PA和TF均显著降低(P＜0.05),化疗后E组和E+P组体重较化疗前无明显变化(P＞0.05),前白蛋白(PA)和转铁蛋白(TF)显著高于对照组(P＜0 05),E组与E+P组的PA和TF两组间无明显差异(P＞005).对照组有11例(45.8％)出现Ⅲ度血液学毒性,而E组出现3例(11.1％),E+P组仅出现2例(8.0％),差异有统计学意义(P＜0.05);E组和E+P组中消化道反应的发生明显少于对照组(P＜0.05),其中E+P组优于E组(P＜0.05).对照组患者化疗前后辅助性T细胞(CD4+)和CD4+/CD8+比值明显下降(P＜0.05),E组及E+P组反而上升(P＜0.05),E组及E+P组间差异无统计学意义(P＞0 05).结论 肠内免疫营养可减轻化疗引发的毒副反应,改善患者的营养状态,增强机体的免疫功能.肠内免疫营养联合微生态制剂可进一步减轻化疗过程中的消化道反应,提高患者治疗期间的生存质量.

Objective To explore the efficacy of millimeter wave physiotherapy combined with nedaplatin chemotherapy in treatment of patients with malignant peritoneal effusion and bone marrow suppression. Methods 72 patients with malignant peritoneal effusion during June 2013 to June 2015 in this hospital were randomly divided into cisplatin group(24 cases),nedaplatin perfusion group(23 cases)and nedaplatin combined millimeter wave physiotherapy group(25 cases). The therapeutic efficacy and incidence of adverse reactions were compared among these three groups. Results The rates of efficacy in patients of cisplatin perfusion group and nedaplatin perfusion group were 54. 17% and 56. 52% re-spectively,and the difference between these two groups was significant( P < 0. 05). The effective rate of nedaplatin combined millimeter wave treatment group was 88. 00% ,it was much higher than that of other two groups,and the difference was significant( P < 0. 05). The difference in inhibition rates of 0 degree of bone marrow suppression,I - II degree of bone marrow suppression and III - IV degree of bone marrow inhibition in cisplatin perfusion group and nedaplatinum thermal perfusion group was not significant( P > 0. 05). The suppression rate of 0 degree bone mar-row in nedaplatin combined with millimeter wave treatment group was much higher than that of other two groups,and its occurrence rate of III or IV degree myelosuppression was far lower than that of other two groups,the difference was significant( P < 0. 05). Conclusion The application of nedaplatin chemotherapeutic hyperthermic intraperitoneal perfusion combined with millimeter wave treatment has significant efficacy in treatment&nbsp;of patients with malignant ascites;it can effectively reduce the bone marrow suppression,hence it has certain value for clinical application.

Objective To explore the endoscopic and clinical characteristics for colonic diverticula patients.Methods One hundred and thirty-six colonic diverticula patients diagnosed by endoscope were studied retrospectively.Results Detectable rate of colonic diverticula was the highest in the elderly patients,the rates were 62.50%,36.76% and 0.74% in the old-aged,middle-aged and the youth patients respectively.The right colon was the most disease position(80.15%).There were 48 cases and 88 cases for single and multi diverticula.The colonic polyp was most in accompanying symptom.Conclusion The disease summit of colonic diverticulum is in older-aged patients,and the disease is more likely to locate in right colon and the most are multi-diverticula,the colonic polyp is most in accompanying symptom.

Objective To summarize the diagnostic and therapeutic experiences of primary duodenal carcinoma(PDC). Methods The clinical data of 35 cases of primary duodenal carcinoma patients in Xuanwu hospital were analyzed retrospectively. Results The primary tumor sites were located in duodenal bulb 6 cases,descending duodenum 26 cases,duodenal levelin 3 cases.Pathological analysis revealed 8 cases of papillary adenocarcinoma,23 cases of tubular adenocarcinoma,2 cases of mucinous adenocarcinoma,1 case of carcinoid tumor and 1 case malignant stromal tumor.Confirmed rates of gastroscopy,upper gastrointestinal barium,CT,ultrasound,MRCP were 77.4%,52.4%,46.7%,10.3% and 6.9%,respectively.Pancreatoduodenectomy were performed in 22 cases,duodenal ampulla resection and mammillaplasty in 6 cases,gastrojejunostomy in 3 cases,simple tumor resection in 1 cases,palliative by-pass surgery in 2 cases. Conclusion The sites of primary duodenal carcinoma are more in descendant duodenum,especially papilla around.The pathology is main adenocarcinoma.The preferred diagnosis of PDC is endoscopy,followed by duodenal gas double-contrast barium enema.Surgical resection,especially pancreaticoduodenectomy is the most common and reliable method of treatment for PDC.

原发性十二指肠腺癌是临床少见疾病,而在小肠癌中占较大比例。本病起病较隐匿,临床缺乏典型症状和体征,早期诊断困难,极易误诊、漏诊。近年来,随着内镜检查的广泛普及、各种影像技术的迅速发展以及对本病认识的提高,本病的诊断正确率有所增加。我院2001年1月至2007年12月间共诊治原发性十二指肠癌35例,其中经内镜检查诊断为十二指肠癌的有24例。现对35例临床资料进行回顾分析,以提高本病的诊断水平。

The clinical data of 32 cases with gastric bezoar confirmed by endoscopy was analyzed retrospectively.The patients were treated under gastroscope by means of penta-claw grasping forceps,polypectomy snare,or multipoint injection of 5% Sodium Bicarbonate solution.We found that all 32 patients had tannic acid-rich-food,and food types were the major affecting factors for gastric bezoar.All bezoars were broken into pieces,28 and 4 cases were negative endoscopy in 1 and 2 weeks respectively,without complications.It is one of most effective and safe manipulation of gastric bezoar with injection of 5% Sodium Bicarbonate solution,combination with the forceps and snare.