炎症性肠病(inflammatory bowel disease,IBD)是一组非特异性肠道炎症性疾病,营养不良是IBD常见并发症,影响儿童和青少年的生长发育,严重影响疾病预后和患者的生活质量,对IBD患者应常规进行营养筛查和评估,选择合适的工具能够为精准的早期营养干预争取时间,使患者从中收益.本文就炎症性肠病营养筛查评估工具的研究进展做一综述.

溃疡性结肠炎(UC)在我国的发病率、患病率呈增长趋势,而阑尾周围炎是溃疡性结肠炎内镜下的"跳跃性"病变,更多见于远端溃疡性结肠炎患者.UC患者与合并阑尾周围炎(PAI)患者的内镜下表现基本一致,联合内镜及病变周围组织活检可以提高诊断准确率,能更准确界定UC范围.在识别UC合并PAI时,生命早期实行阑尾切除术可能会受益,但对疾病的严重程度和手术治疗效果影响不明显.同时,合并PAI对于UC的预后的影响有限,二者的关系需进一步深入研究.

结肠憩室是指结肠黏膜经肠壁肌层缺损处向外形成囊状突出的病理结构。结肠憩室在欧美等发达国家发病率高，而随着亚洲国家人群生活方式及饮食习惯的逐步西方化，人口老龄化及结肠镜检查的普及，该病发病率也在增长。该病大部分患者临床症状非特异，易出现漏诊或延误诊断。本文报道1例隐匿型升结肠憩室穿孔，分析其临床特征、辅助检查及诊治经过，以期为临床医师提供诊治思路。

对于智慧课堂而言,其作为信息化教学顺利开展的基础,因此,怎样充分使用PAD(presentation-assimilation-discussion,PAD)实施教学,作为智慧课堂的主要任务之一,也是一个重要的课题.通过对医学生诊断学课间实习课引入PAD教学实施两周的调研,根据相关的研究表明,首先,高校的教师使用PAD进行教学已经被广大师生认可,教师也能够熟练使用PAD进行教学.其次,在教学的过程中,PAD课堂可充分发挥其有效的作用,主要表现在以下几个方面:PAD课堂体现的是教学过程中师生间权利和责任的对分,与以往的课堂相比,在相应的教学过程中,老师起着引导的作用,学生是对知识进行探索的主体,对分课堂在一定程度上,能够激发学生的主动性,从而使教师能够更加热情的进行教学,学生能够更加积极主动的接受教师所传授的各种知识,这样一来,可以确保学习效率,使互动形式多样化,保证课堂的活跃程度.

目的:探讨Dieulafoy病并活动性出血的内镜下诊断及治疗的临床效果.方法:回顾性分析我院2010-01～2018-12确诊Dieulafoy病并出血的病例临床资料,总结临床表现,内镜下表现,治疗方法及治疗效果进行分析总结.结果:在内镜下止血成功率为100％,内镜下止血是处理Dieulafoy病伴出血的治疗的首选方法,内镜下治疗方法多种,以钛夹止血为主.结论:内镜检查是及时确诊及治疗Dieulafoy的有效方法,内镜下治疗安全,创伤小,费用低,效果佳.

本研究目的是为了证实地塞米松对结肠癌LoVo细胞增殖的抑制作用,并阐明其中的分子机制.LoVo细胞经不同浓度梯度地塞米松干预,再加入TGF-β1受体抑制剂SB431542阻断TGF-β1信号传导途径,通过MTS分析各组细胞增殖情况,借助Hoechst 33342和Annexin V/PI染色法检测细胞凋亡率;结合Westem blotting对TGF-β1、Smad2和caspase-3蛋白表达情况的检测结果,分析地塞米松诱导结肠癌LoVo细胞凋亡的作用机理.LoVo细胞在1.0 mmol/L和10.0 mmol/L地塞米松干预48 h后,细胞增殖率与对照组相比分别降低32％ (p＜0.01)和47％(p＜0.001),2组细胞凋亡率分别为28％和36％(p＜0.001).Western blotting结果显示,与对照组相比,地塞米松以浓度依赖性方式显著上调LoVo细胞TGF-β1、Smad2和Cleaved-caspase-3蛋白水平(p＜0.01),而TGF-β1受体抑制剂SB431542明显下调TGF-β1、Smad2和Cleaved-capase-3蛋白表达(p＜0.05).流式细胞术检测结果表明,SB431542+地塞米松干预组与地塞米松处理组LoVo细胞凋亡率分别为8％和23％ (p＜0.001).地塞米松可显著诱导LoVo细胞凋亡,而SB431542能够挽救这一过程,这表明,地塞米松通过TGF-β1/Smad2通路诱导LoVo细胞凋亡.

目的:探讨血清胃泌素-17(Gastrin-17)、胃蛋白酶原I(pepsiongen,PGI)、胃蛋白酶原II(pepsiongen PGII)联合幽门螺杆菌(Helicobacter pylori,Hp)检测对胃癌筛查的临床价值.方法:2018-03～2018-08期间在内蒙古医科大学附属医院消化内科因上腹部不适住院的病人纳入临床研究,入选病人在行胃镜检查前用ELISA方法检测空腹血清G-17、PGI、PGII及C14呼气试验检测Hp,根据胃镜和病理诊断结果,评估G-17、PGI、PGII、Hp对胃癌筛查的价值.结果:按照入选排除标准连续纳入72例病人,包括慢性非萎缩性胃炎40例,慢性萎缩性胃炎22例,胃癌10例,与慢性非萎缩性胃炎、慢性萎缩性胃炎组相比,胃癌组血清G-17、PGII水平较高,Hp阳性率较高,PGI在组间差异无统计学意义.结论:血清G-17、PGII水平升高和Hp感染可提示胃癌风险.血清胃功能三项联合Hp诊断胃癌临床价值较高.可应用于人群早期胃癌筛查,从而提高胃癌的早期诊断率.

淋巴瘤是一组高度异质性疾病,其临床特征及病理学亚型分布具有明显的地域差异.我们对哈尔滨医科大学附属肿瘤医院8年间诊治的2 093例淋巴瘤进行回顾性分析,并结合文献进行讨论,旨在了解本地区淋巴瘤的临床病理类型及分布特点.

目的：探讨胃镜直视下取出上消化道异物的方法与疗效。方法选择我院消化内镜中心诊治的92例上消化道异物患者的临床资料，分析治疗过程及疗效。结果92例上消化道异物患者中，有84例通过内镜顺利钳取成功，成功率91.3%，异物滞留常见部位是食道其次是胃。1例患者因异物两端刺入食道上段黏膜较深，游离困难，转胸外科手术治疗。4例患者因配合差，内镜下未取出，1例患者异物滞留时间长，术前胸部CT提示纵膈气体影，考虑食道穿孔可能，转胸外科就诊。1例患者体检示腹腔有异物影，内镜下观察至十二指肠降段，未发现异物。1例患者食道中段异物取出后，未遵医嘱擅自乘车回家，后因消化道出血死亡。术后的吞咽痛均显著改善。结论胃镜直视下取出上消化道异物是简便快速有效的方法，操作相对安全、患者可耐受、无需静脉麻醉，且方法较易掌握、成功率高。

目的：探讨结肠黑变病的临床特点、内镜下表现以及与年龄、性别、结肠炎症、息肉及肿瘤的关系。方法选取2013年6月至2014年6月在我院消化内镜中心肠镜检查确诊的114例结肠黑变病临床资料及内镜下表现进行回顾性分析。结果114例患者中中年组发病率较高，青年组发病有增高趋势，女性发病率高于男性；有腹部手术史4例（3.50%）；便秘患者93例（81.57%）；服用泻药患者102例（89.47%）；不服用泻药但排便周期长9例（7.89%）；合并结肠慢性炎11例（9.64%）；合并增生性息肉2例（1.75%）；合并绒毛管状腺瘤2例（1.75%）；腺瘤性息肉53例（46.49%），其中管状腺瘤高级别内瘤变2例（1.75%）；合并结肠癌4例（3.50%）。结论结肠黑变病以结肠黏膜色素沉着为特征的非炎性良性可逆性病变，慢性便秘和长期服用泻药与结肠黑变病的发生有关，同时伴发息肉的发病率较高，可能与结肠肿瘤发生有一定相关性。

类癌是一种少见的特殊类型恶性肿瘤，以消化道最为常见，本文对近年来消化道类癌的临床表现、诊断及内镜下治疗进展作一评述，以利于提高相关知识和临床诊治水平。

Primary peritoneal carcinoma incidence is low,its has obscure symptoms,and easy to be misdiagnosed.In this article,diagnosis and treatment process of one case of primary peritoneal carcinoma was analyzed,in odder to improve the clinical diagnosis and treatment level.

目的探讨食管恶性狭窄支架置入的方法及疗效。方法选择我院消化内镜中心2008年6月至2012年12月对52例无手术适应证的晚期食管癌采用内镜下预扩张、记忆合金支架置入治疗,术后观察临床疗效和并发症。结果所有患者均在消化内镜中心完成,无需X线透视,支架放置成功率98.3%,支架定位准确,术后的吞咽困难均显著改善,无严重并发症出现。结论放置记忆合金食管支架是治疗食道恶性狭窄安全有效的方法,且较易掌握,近期疗效显著,可提高患者的生存质量。

目的:比较胃得安胶囊与常规三联用药(质子泵抑制剂+两种抗生素)治疗Hp相关性慢性胃炎的疗效.结果:治疗组Hp根除率为81.1％(43/53),对照组为67.6％(25/37),两组比较有显著差异(p=0.023)；治疗组对胃痛、嗳气、反酸及上腹憋胀症状改善有显著疗效(p=0.015),未见明显副反应.结论:胃得安胶囊四联疗法根除Hp效果肯定,是治疗有明显上消化道症状的Hp相关性慢性胃炎的有效方法.

目的 探讨胃腺癌中HMGA2、Twist的表达及其与上皮间质转化相关因子E-cadherin和Vimentin的关系.方法 应用免疫组织化学方法检测80例胃腺癌标本以及20例正常胃组织中HMGA2、Twist、E-cadherin和Vimentin的表达,分析其与临床病理资料之间的关系.结果 80例胃腺癌组织中,HMGA2、Twist、E-cadherin和Vimentin表达的阳性率分别为65%、68.75%、26.25%和67.5%,HMGA2和Twist的表达呈正相关(P＜0.05),HMGA2与Twist的表达均与淋巴结转移及肿瘤临床分期有统计学意义(P＜0.05),而且HMGA2和Twist的表达均与E-cadherin低表达(P＜0.05)和Vimentin高表达(P＜0.05)存在相关性.结论 HMGA2与Twist在胃腺癌组织中的高表达与EMT的发生密切相关,通过促进胃腺癌组织上皮表型向间质表型转化进而促进侵袭转移.

Objective:To investigate the effect of propranolol plus isosorbide 5-mononitrate on portal hypertension and to test the effectiveness in the prevention of variceal rebleeding in patients with hepatic cirrhosis.Methods:Analysis performed on the clinical data of 60 cases with hepatic cirrhosis were randomly divided into two groups,Portal blood flow and splenic blood flow were assessed at baseline,4 weeks after treatment.Results:After 4 weeks treatment,the indexes of portal blood flow were drop stably,the inner diameter of splenic vein was obvious decreased(P0.05).The actuarial probability of rebleeding 4 weeks after randomization was lower in the therapy group and the difference was significant(P0.05).Conclusion:propranolo plus isosorbide-5-mononitrate can cause a significant decrease in portal blood flow,improves the efficacy in the prevention of variceal rebleeding in hepatic cirrhotic patients.

<正>重症急性胰腺炎(severe acute pancreatitis,SAP)是多种病因导致胰酶在胰腺内被激活后引起胰腺组织自身消化、水肿、出血甚至坏死的炎症反应,常继发感染、腹膜炎和休克等多种并发症,病死率20%～40%。SAP时,机体

Objective:To observe the efficacy,clinical benefit response,time to no progress and adverse effect of XELOX and OLF for the preoperated patients with advanced gastric cancer.Methods: XELOX group: capecitabine 1000 mg/m2/d,twice a day,po for 14days,oxaliplatin 130 mg/m2,intravenous infusion d1,every three weeks.OLF group: Oxaliplatin 130 mg/m2,intravenous infusion d1,calcium folinate200 mg/m2,intravenous infusion 1-5d,5-fluorouracil 500 mg/m2,intravenous infusion 1-5d,every three weeks.Results: The median time to progress(mTTP) in the XELOX group was 6 months,and mTTP in the OLF group was 5 months,the survival of one year rate was 44.0%(11/25).All the patients were safety.Conclusions: The XELOX and OLF is effective in the treatment of patients with advanced gastric cancer under the same conditions.XELOX programs may be more convenient,and may be more advantage in the re-treated patients.

Peutz-Jeghers综合征(PJS),又称黑斑息肉综合征,即黑色素斑-肠息肉综合征,是一类少见的胃肠道错构瘤性多发性息肉综合征,我科从2008～2009年共收治患者2例,现结合文献对其发病情况、诊断、治疗及预后报道如下.

Objective:To observe the short-term efficency,clinical benefit response and toxicity of implanting fluorouracil sustained-release drug delivery compared with intra-abdominal peritoneal perfusion heat fluorouracil chemotherapy in the patients with terncinal gastric cancer and malignant ascites.Methods:30 cases of patients with confirmed terminal gastric adenocarcinoma with ascites by histopathology were divided into two groups randomly that were intraperitoneal implantation of sustained-release drug delivery fluorouracil group(IISRDF) and perfusion chemotherapy group(PC).IISRDF group was implanted the sustained-release drug delivery fluorouracil as the dose of 500mg/m2,and repeated treatment was administered in forteehth day.PC group was intraperitoneal injection of the 5-FU 1g which was dissolved in the 10% glucose injection 500mL and heated to the temperature of 45℃.Repeated treatment was administered in the seventh day and forteenth day.The curative effect were evaluated between two grortgs after two cycles.Results:The total effective rate of IISRDF group and PC group were 66.7% and 64.2%,respectively.There was no significant difference(P0.05).Clinical benefit rate was 73.37%(11/15) and 71.4%(10/14),repectively.There also was no significant difference between the two groups(P0.05).Comparison of hematological toxicity between the two groups was not significant(P 0.05).Non-hematological toxicity,such as diarrhea,renal dysfunction,peripheral neuritis and the incidence of oral mucositis was no significant difference(P 0.05),but the incidence of nausea / vomiting and liver dysfunction had a significant difference(P0.05) between two groups.Conclusion:Both methods of treating terminal gastric cancer with malignant ascites are effective.There is no significant difference in the improvement of the life quality between two groups.Tolerable side effects can be endured and safety is good,but the incidence of nausea / vomiting and liver dysfunction of IISRDF group is lower than the PC group.