目的 评估超声内镜检查术(EUS)诊断消化道黏膜下病变(SML)的临床价值.方法 回顾性分析2020年1月-2021年12月该院消化内科使用EUS诊断,并经组织病理学证实为SML患者的病例资料.结果 共有142例消化道SML患者进行了EUS检查.其中,135例为实体瘤,7例为壁外压迫.实体瘤中,EUS诊断黏膜层病变14例,黏膜肌层病变20例,黏膜下层病变62例,固有肌层病变39例,其诊断准确率分别为:100.0%、100.0%、95.0%和89.7%.EUS诊断平滑肌瘤30例(21.1%),间质瘤29例(20.4%),神经内分泌肿瘤25例(17.6%),异位胰腺15例(10.6%),息肉14例(9.9%),脂肪瘤11例(7.7%),囊肿9例(6.3%),壁外压迫7例(4.9%),颗粒细胞瘤2例(1.4%).107例行内镜治疗或手术切除后送病检,99例病理与EUS诊断相符,EUS总体诊断准确率为92.5%.结论 EUS对消化道SML诊断的准确性与病变的起源有关,起源于黏膜层与黏膜肌层的诊断准确性最高,在鉴别壁内病变与壁外压迫方面,也具有较好的诊断价值.EUS在一定程度上可以判断SML的性质,有助于确定病变的治疗方式.

目的 基于一次性胃部细胞无创采样器采集胃液标本进行幽门螺杆菌耐药基因检测,指导幽门螺杆菌个体化治疗,探讨此技术的临床应用价值.方法 选取2021年5月至2022年5月北京大学深圳医院收治的根治失败2次或以上的难治性幽门螺杆菌感染患者50例,使用一次性胃部细胞无创采样器采集胃液,通过荧光定量PCR法检测抗生素耐药基因,根据耐药结果给予患者制订基于铋剂四联根除治疗方案,疗程14d,治疗结束至少4周后复查尿素呼气试验,确定幽门螺杆菌是否被成功根除.结果 在50例送检样本中,检测幽门螺杆菌阳性者为43例.43例个体化治疗患者根除成功41例,幽门螺杆菌感染根除率意向性分析为95.35%(95%CI为84.19%～99.43%),遵循方案分析为97.62%(95%CI为87.43%～99.94%),均显著优于标准铋剂四联疗法(P＜0.001).结论 基于一次性胃部细胞无创采样器采集胃液标本进行幽门螺杆菌耐药基因检测技术指导的个体化治疗在顽固性幽门螺杆菌感染患者中取得比较理想的临床效果,具有较好的应用价值.

目的 研究伴有和未伴有高级别上皮内瘤变的肠道绒毛状腺瘤的生物学特征.方法 分析北京大学深圳医院2017年12月27日至2021年04月21日消化内镜室收治的经病理诊断为大肠绒毛状腺瘤及伴高级别上皮内瘤变的绒毛状腺瘤患者的临床资料.结果 88例绒毛状腺瘤患者中,有男性53例(60.2％),女性35例(39.8％),平均年龄为(57.75±13.36)岁;117例合并高级别瘤变绒毛状患者中,共有男性68例(58.1％),女性49例(60.2％),平均年龄为(60.02±11.75)岁.不同病理类型腺瘤的好发部位,均以直肠和乙状结肠为主.高级别上皮内瘤变发生、生长部位可能与绒毛状腺瘤长径有关.长径越大,高级别内瘤变的发生比例越高;长径<20mm组的高级别上皮内瘤变在乙状结肠的发生比例最高;长径≥20mm组的高级别上皮内瘤变更多见于直肠,且随长径增加,在直肠的分布比例逐渐上升.绒毛状腺瘤的生长部位、腺瘤长径与年龄有关.年龄≥58岁时,长径≥20mm的绒毛状腺瘤发生比例增多;年龄≥60岁时,绒毛状腺瘤在直肠发生比例上升,在乙状结肠发生比例下降.结论 伴有和未伴有高级别上皮内瘤变肠道绒毛状腺瘤均多见于直肠及乙状结肠.绒毛状腺瘤及高级别上皮内瘤变的生物学特征可能与腺瘤的长径和年龄有一定相关.

目的 利用可视化基因芯片检测技术检测结果指导幽门螺杆菌"个体化"治疗,评价其优越性.方法 244例初诊幽门螺旋杆菌感染患者的胃黏膜组织,检测组织标本中幽门螺旋杆菌gyrA基因上喹诺酮耐药相关的Asn87(N87K)、Asp91(D91G/Y/N)突变位点和23s rRNA基因上克拉霉素耐药相关的A2142G、A2143G突变位点,以及人CYP2C19上与PPI代谢相关的等位基因2C19*2、2C19*3突变位点.根据检测结果喹诺酮和克拉霉素的敏感性分为敏感及耐药;PPI药物代谢活性分为强代谢型(EM)、中代谢型(IM)和弱代谢型(PM);结合检测结果给予幽门螺杆菌"个体化"四联根除治疗,并统计根除率.结果 244例中检出63例对抗生素耐药,耐药率25.80％(63/244),其中左氧氟沙星和克拉霉素耐药率耐药率2.86％(7/244)和20.49％(50/244),两者双重耐药率2.45％(6/244).244例中检出CYP2C19代谢类型有242例(99.18％),其中 EM、IM、PM、分别占40.08％(97/242)、58.26％(141/242)和 1.65％(4/242).242例检测结果阳性患者根据检测结果给予幽门螺杆菌个体化的"四联"治疗,240例完成治疗,初次根除率达到91.67％.EM、IM、PM的根除率分别为89.58％、92.86％和100％,差异无统计学意义(P＞0.05).结论 可视化基因芯片技术能够同时提供准确的CYP2C19代谢类型和克拉霉素、左氧氟沙星耐药情况,指导临床用药,具有较好的临床应用价值.

Background Helicobacter pylori eradication with therapies employing a proton pump inhibitor (PPI) and antimicrobial agents is mainly achieved via bacterial susceptibility to antimicrobial agents and the magnitude of acid secretion inhibition. However, annual eradication rates have greatly declined in Mainland China, and therefore, tailored H. pylori eradication regimens that inhibit acid secretion and employ optimal antimicrobial agents determined based on gene clip testing may improve eradication rates. This study was aimed at evaluating the efficacy of tailored H. pylori eradication therapy guided by visual gene clip testing for antibiotic resistance and PPI metabolism genotypes. Methods This prospective study included 244 patients (141 men and 103 women aged 20–79 years) receiving initial treatment for H. pylori infection. Visual gene clip testing using gastric mucosal specimens was performed to detect antibiotic resistance to clarithromycin conferred by the A2142G and A2143G point mutations of the H. pylori 23S rRNA gene and to levofloxacin conferred by the Asn87 and Asp91 point mutations of the H. pylori gyrA gene. Patients received a 14-day bismuth quadruple therapy regimen guided by testing for antibiotic resistance and CYP2C19 polymorphisms, and primary H. pylori eradication was assessed at least 4 weeks after therapy. Results H. pylori strains were successfully isolated from the gastric mucosa tissues of 244 patients. Antibiotic resistant isolates were identified in 63 patients, with clarithromycin resistance observed in 50 patients, levofloxacin resistance in 7 patients, and dual resistance in 6 patients. The PPI metabolic genotype of CYP2C19 was detected in 242 of 244 cases, and 97 cases were categorized as extensive metabolizers, 141 as intermediate metabolizers, and 4 as poor metabolizers. Among the 242 patients who received tailored therapy, the H. pylori eradication rate was 90.9% (95% confidence interval 87.3%~94.6%) in the intention-to-treat analysis and 96.9% (95% confidence interval 94.7%~99.2%) in the per protocol analysis. Conclusions Tailored therapy for H. pylori infection guided by determination of antibiotic resistance and CYP2C19 polymorphism using visual gene chip technology may provide high clinical effectiveness as initial H. pylori eradication therapy.

目的 探讨炎症性肠病(IBD)专病门诊在提高溃疡性结肠炎患者临床疗效中的应用价值.方法 选取2015年1月至2018年12月北京大学深圳医院IBD专病门诊就诊的54例溃疡性结肠炎患者纳入研究,对比入组患者初次来我院消化科IBD门诊前和我院IBD专病门诊就诊1年后的临床疗效及院外复发率,对比IBD专病门诊就前后肠道症状评分及实验室检查结果 [血小板记数(PLT)、C反应蛋白(CRP)、血沉(ESR)]变化,最后对比IBD专病门诊就诊前后疾病复发情况.结果 患者到我院IBD专病门诊就诊治疗的总有效率显著高于IBD专病门诊就诊前的总有效率,差异有统计学意义(P<0.05).患者到我院IBD专病门诊就诊后Mayo评分排便次数、便血、内镜发现、医师总体评分及Mayo总分显著低于IBD专病门诊就诊前评分,差异有统计学意义(P<0.05).患者IBD门诊就诊后血清h-CRP、血沉水平显著低于IBD专病门诊就诊前,差异有统计学意义(P<0.05);PLT水平均低于IBD门诊就诊前,但差异无统计学意义(P>0.05).IBD专病门诊就诊后1年的复发率18.52％,显著低于就诊前1年的复发率68.52％,差异有统计学意义P<0.05).结论 IBD专病门诊能够提高溃疡性结肠炎患者的临床治疗效果,降低院外复发率,值得临床应用.

目的:探讨深圳市幽门螺杆菌感染患者细胞色素P450 2C19 (CYP2C19)基因多态性的分布频率,提高该地区幽门螺杆菌的清除率.方法:采用多重PCR及可视化基因芯片技术对244例初诊于北京大学深圳医院的幽门螺杆菌感染患者的胃黏膜组织进行检测,测定内容为组织标本中人细胞色素P450与质子泵抑制剂代谢相关的等位基因2C19*2、2C19*3突变位点,检测结果根据药物代谢活性分为强代谢型、中代谢型和弱代谢型.结果:本研究共检测到CYP2C19强代谢型患者占39.7％(97例),中代谢型患者占57.7％(141例),弱代谢型患者占1.6％(4例),未检出的患者占0.8％(2例).通过x2检验发现,不同年龄及性别的患者其CYP2C19的代谢型差异无统计学意义(P＞0.05).结论:北京大学深圳医院就诊的幽门螺杆菌感染患者中CYP2C19的代谢型以强代谢型和中代谢型为主,在行幽门螺杆菌根除治疗的过程中要注意个体差异及精准化治疗.

[目的]了解本院检测的质子泵抑制剂(PPI)代谢相关的CYPC219基因多态性、幽门螺杆菌(Hp)对克拉霉素和左氧氟沙星的耐药情况及相关耐药基因突变特征,检验可视化基因检测芯片的临床应用价值,为临床Hp个体化治疗提供理论依据.[方法]收集2016～2017年北京大学深圳医院感染Hp患者的胃黏膜标本244例,提取胃黏膜DNA,通过Hp感染个体化治疗检测试剂盒(基因芯片法)对个体CYP2 C19代谢类型、克拉霉素及左氧氟沙星耐药基因片段进行检测.[结果]244例样本中有181例对2种抗生素均敏感(74.18％),63例对至少1种抗生素耐药,耐药率25.82％(63/244).耐药患者中有50例对克拉霉素耐药,耐药率20.49％(50/244),7例对左氧氟沙星耐药,耐药率2.86％(7/244),6例对克拉霉素和左氧氟沙星双重耐药,耐药率2.45％(6/244).244例样本中242例检出个体CYP2 C19基因代谢类型(99.18％),97例野生型(39.75％),141例杂合子型(57.78％),4例突变型(1.63％),另有2例未检出(0.8％).[结论]与传统检测手段相比,可视化基因芯片技术能够同时提供准确的CYP2 C19代谢类型和克拉霉素、左氧氟沙星耐药情况,指导临床针对性地选择药物进行Hp个体化用药,不仅能够提高Hp根除的成功率,同时减少抗生素滥用带来的不良反应和资源浪费,在临床中具有很好的应用前景.

目的:利用基因芯片检测技术检测幽门螺旋杆菌(Hp)对抗菌药物的耐药性,分析深圳地区Hp耐药状况,为该地区临床根除Hp合理选择抗菌药物提供依据.方法:采用基因芯片检测技术对2015年2月至2017年2月北京大学深圳医院收治的244例合并Hp感染患者的胃黏膜组织进行克拉霉素、左氧氟沙星的耐药性检测,观察不同性别、不同年龄段患者对克拉霉素、左氧氟沙星的耐药情况.结果:共纳入感染Hp的患者244例(男性141例,女性103例),对克拉霉素耐药者有56例,耐药率为22.9％,对左氧氟沙星耐药者有13人,耐药率为5.3％,对克拉霉素、左氧氟沙星双重耐药者有5人,耐药率为2.0％,男女性患者对克拉霉素耐药率比较,差异无统计学意义(P＞0.05).按年龄段分组的耐药率显示,30岁以上年龄组的抗茵药物耐药率逐渐增加(17.6％、24.3％、39.1％),60岁以后年龄组的耐药率则呈下降趋势(13.5％、2.7％).结论:深圳地区对克拉霉素的耐药性较高,与国内平均水平相近,对左氧氟沙星的耐药性较低,明显低于国内平均水平,本研究为该地区合理选用抗菌药物根除Hp提供了理论依据.

Objective To investigate the expression of 5-hydroxytryptamine ( 5-HT ) in non-erosive reflux disease ( NERD) with poor effection and good effection of proton pump inhibitor ( PPI ) . Methods Sixty patients of NERD were divided into poor effection of PPI group (21 patients) , good effection of PPI group (39 patients) and 10 volunteers as the normal control group, esophageal mucous membrane biopsy were obtained by gastroscopy. The expression of mast cells was determined by immunohistochemistry technique, the expressions of 5-HT4 receptor and serotonin transporter (SERT) were determined by Western blotting. Results The mast cell expression rate was (17. 05 ± 2. 13)% in poor effection of PPI group and (18. 37 ± 3. 86)% in good effection of PPI group (with no statistical difference), higher than that in the normal control group (3. 94 ± 2. 13)% (P<0. 05). The 5-HT4 receptor (5-HT4R) protein absorbance ratio by Western blotting were 1. 08 ± 0. 17, 0. 96 ± 0. 15 and 1. 10 ± 0. 18 in poor effection of PPI group, good effection of PPI group and normal control group, respectively, with no statistical difference (P>0. 05). The SERT protein absor-bance ratio:poor effection of PPI group (1. 22 ± 0. 20) > good effection of PPI group (0. 63 ± 0. 14) >normal control group (0. 21 ± 0. 09) (P<0. 05). Conclusion The up-regulation of SERT protein expression might be involved in the pathogenesis of NERD with poor effection of PPI.

目的：通过光学显微镜(简称光镜)对非糜烂性反流病(NERD)患者食管鳞状上皮细胞间隙增宽(DIS)进行研究，探讨食管鳞状上皮细胞间隙的变化情况及意义。方法NERD患者(25例， NERD组)和正常对照者(20例，正常对照组)作为研究对象行胃镜检查，并在食管远端齿状线上方2 cm处取一块黏膜组织，常规HE染色，在光镜下观察上皮细胞间隙情况并采集图像进行测量。结果NERD组食管鳞状上皮细胞的平均细胞间隙、最小细胞间隙、最大细胞间隙均大于正常对照组，差异有统计学意义(P<0.01)。结论光镜测量可作为研究NERD食管鳞状上皮细胞间隙增宽的一种简单、实用方法，对探讨细胞间隙增宽在NERD发病机制和临床诊断中的意义具有重要作用。

Objective To analyze the clinical pathological characteristics of colorectal neuroendocrine neoplasm,and to explore its diag-nosis and rational treatment of this kind of neoplasm. Methods The clinical and pathological data of 33 patients with rectal neuroendocrine neo-plasm underwent endoscopic resection etc during January 2010 to December 2013 in this hospital were analyzed,in order . to know the effectiveness of endoscopic resection and surgical removal of rectal neuroendocrine neoplasm. Results The common clinical manifestations of this tumor were abdominal pain and abdominal distention. The endoscopic ultrasonography(EUS)of these patients showed the size of lesions mostly were 2 cm or less,with low homogeneous echoes and clear margin. The treatment for these lesions was mainly by endoscopic resection or surgical resection. Conclusion In order to raise the rate of early diagnosis of this kind of rectal tumor,the application of EUS and immuno - histochemical examina-tion is helpful in diagnosis of rectal neuroendocrine neoplasm and avoid misdiagnosis. The endoscopic resection or surgical resection is the main procedure for treatment of this disease.

Objective To evaluate the endoscopic and clinical manifestations of abdominal type allergic purpura in adult patients as the evidences of reaching early diagnosis.Methods The clinical and endoscopic manifestations of 32 patients with abdominal type allergic purpura were analyzed retrospectively.Results All the patients complained of paroxysmal abdominal colic.50% patients complained of vomiting,31.2% patients had hematochezia,25% patients had haematemesis, the occult blood test was positive in all patients. Purpura was found in 2-10 days after the presentation of abdominal pain. The clinic misdiagnosis rates were 78.1%. Duodenal and ileum had more severe mucous lesions,but the esophageal mucosa in all patients were norma1. Endoscopy found hyperaemia,edema,bleeding spots,erosion and ulcer in gastroenterologic mucosa. ConclusionFamiliar with the clinical and endoscopic characteristics of adult henoch-schonlen purpura with gastrointestinal involvement is essential for the early diagnosis of the disease.

目的探讨内镜在急性消化道大出血行急诊剖腹探查术中的应用价值。方法回顾性分析2005年始我科配合急诊手术治疗26例消化道大出血患者的临床资料,评估术中内镜价值。结果26例均查出出血部位,25例为单一出血灶,1例有2处血管畸形;术中平均内镜检查时间15min。所有患者均根据术中内镜诊断进行了相关手术治疗,术中无死亡病例,术后随访3个月无再出血,1例死于多脏器功能衰竭。结论对不明原因消化道大出血患者,术中内镜检查是安全有效的手段。

Objective: To investigate the clinical features of fungal esophagitis.Method: The clinical data of 60 patients with fungal esophagitis diagnosed in May 2007 to Nov.2010.Result: The distribution range of disease was most in middle and lower segments of the esophagus,accounting for 83.34%,the other for the whole upper esophagus and accounted for 16.66%.Severity of symptoms associated with endoscopy was not absolute,and the results of microscopic examination and pathological results were basically consistent,at the same time were associated with a variety of complications.Conclusion: The incidence of fungal esophagitis increase year by year,the clinical manifestations and complications variate,causing more and more attention.

目的探讨消化道类癌的临床特点、诊治及预后.方法 回顾性分析北京大学深圳医院2004～2010年收治的43例消化道类癌患者临床资料.结果 发病部位以直肠最多见(76.7%),其次为胃(18.6%).内镜下大多直径≤1.0 cm.免疫组织化学检查突触素(SYN)阳性率为100.0%(36/36),神经元特异性烯醇酶(NSE)阳性率为69.2%(9/13),嗜铬粒蛋白A(CGA)阳性率为55.6%(20/36).2例合并其他恶性肿瘤,部分合并萎缩性胃炎伴肠化、胃黄色素瘤、大肠息肉和结肠黑变病.治疗方法主要是内镜切除和外科手术切除.21例随访3个月至5年,局部复发3例(14.3%),均无死亡.结论 消化道类癌以直肠部位最多见,大多直径≤1.0 cm,可合并其他恶性肿瘤及良性病变,免疫组织化学有助于提高诊断,内镜切除和外科手术是主要治疗手段,预后大多良好.

目的 观察反流性食管炎、Barrett食管、食管腺癌的PCNA、Ki-67、bcl-2的表达.方法 免疫组化法测定反流性食管炎、Barrett食管、食管腺癌及正常对照组的PCNA、Ki-67、bcl-2的表达.结果 食管腺癌组的PCNA、Ki-67、bcl-2表达高于反流性食管炎、Barrett食管、正常对照组(P<0.01);反流性食管炎组及Barrett食管组的PCNA、Ki-67表达分别高于正常对照组(P<0.01),但bcl-2表达与正常对照组相比无明显统计学差异.结论 联合监测PCNA、Ki-67、bcl-2的表达有助于判断食管细胞的增殖活性和肿瘤恶性倾向.

目的:探讨活检钳钳除法治疗上消化道小息肉样病变的疗效和安全性.方法:回顾性分析北京大学深圳医院2000-2009年电子胃镜检查发现上消化道小息肉样病变（直径≤0.5cm）并行活检钳钳除病例治疗和随访资料,并与同期高频电切除病例资料（病变直径≤2.0cm）对比,比较两种治疗方法的并发症和病变复发情况.结果:入选病例共91例.活检钳钳除组56例,单发息肉样病变48例,多发8例,共计68枚病变.高频电切除组35例,单发息肉样病变23例,多发12例,共计54枚病变.所有研究病例内镜治疗后均无上消化道出血、穿孔等并发症,两组并发症发生率均为0.0%,无显著性差异.半年以后的随访和胃镜复查中两组均各有1例复发,两组复发率分别为1.5%、1.9%,无显著性差异.结论:活检钳钳除法治疗上消化道小息肉样病变的疗效和并发症与高频电切除法相比无显著性差异.活检钳钳除法可彻底摘除上消化道小息肉样病变,临床疗效肯定,安全实用,是治疗上消化道小息肉样病变的有效手段.

患者女,44岁,因左上腹包块10 d人院.患者入院10 d前无意中触及左上腹一鸡蛋大小包块,有触痛,到我院门诊,行CT检查,疑结肠癌收住院.半个月来食欲差,进食后感腹部稍胀痛,无恶心呕吐,大便黑色,不成形,2～3次/d.体检:左上腹稍隆,可扪及一大小约12 cm×10 cm包块,边界欠清,触痛,活动度差,肝脾未触及,Murphy征阴性,移动性浊音阴性。

患者男,38岁,因反复上腹隐痛伴黑便15年再发1d入院。平时无反酸烧心、胸闷胸痛,无恶心呕吐、吞咽困难,既往无特殊病史。体查：血压120／70mmHg,心率78次／min,神清,轻度贫血貌,心肺听诊正常,腹平软,无压痛反跳痛,肝脾未触及。血常规：WBC6．97×10^9／L,HB109g／L．Pu246×10^9／L。大便潜血阳性。入院后查14C—UBT阳性。胃镜检查见十二指肠球腔变形,大弯侧见大小约0．5cm×0．6cm深凹溃疡,覆白苔,周边黏膜充血水肿；距门齿约29cm处食管右侧壁见一憩室,开口大小约1．5cm×2．0cm,