直肠重复畸形临床罕见,其缺乏特异性临床表现,甚至可能终身不出现症状,能在术前作出正确诊断的不多,相关报道也较少.直肠重复畸形患者多以急腹症就诊,常合并肠道特异性或非特异性感染或血吸虫感染等,可发生出血、坏死、梗阻甚至恶变.既往以外科手术为主要治疗方式,随着内镜技术的发展,内镜下微创治疗逐渐成为新型的、可部分替代外科手术的治疗方式之一.现报告1例经结肠镜下内镜黏膜下剥离术治疗的直肠重复畸形患者.

目的 分析结核性腹膜炎(tuberculosis peritonitis,TBP)的临床特点和实验室检查,探讨各种诊断方法在TBP诊断中的应用.方法回顾分析116例以腹水待查入院并得到确诊的TBP病例,对其临床特点、实验室检查及诊断方法进行总结分析.结果各项检查的阳性率分别为PPD 53.5%(38/71),TB-Ab 15.4%(2/13),CA125 92.4%(61/66),CEA 29.1%(23/79),CA199 1.7%(1/60),ADA 83.3%(20/24),腹膜活检 47.6%(10/21),腹腔镜80%(4/5),剖腹探查100%(10/10).各种诊断方法诊断的例数所占比例分别为诊断性治疗 77.6%(90/116),淋巴结活检 1.7%(2/116),腹膜活检8.6%(10/116),腹腔镜3.4%(4/116),剖腹探查 8.6%(10/116).结论诊断性治疗是TBP确诊的主要方法.腹膜活检、腹腔镜及剖腹探查对TBP诊断的阳性率高,在有适应证的前提下应适时、及早进行.

Objective To evaluate the technical feasibility and safety of transvaginal appendectomy by endoscopy in canine models.Methods Six female dogs weighing between 12-15 kg underwent transvaginal appendectomy by endoscopy.A small incision at posterior fornix of the vagina was made endoscopically by a needle knife and then dilated by a balloon dilator.After the endoscope entered the peritoneal cavity,the appendicular artery was clipped and the appendix was dissociated,and then the free appendix was ligated by an endoloop near root and removed by snare cutting.The appendix was then removed through the vaginal port.Finally,the vaginal incision was closed by clipping and endolooping.Two weeks after the procedure,the animals were sacrificed for anatomic investigation.Results Endoscopic transvaginal appendectomy was successfully performed in all animals with a mean operating time of (94.2±41.8) min.Complicated bleeding occurred in 1 dog and rectal burn in another during the operation.All the experimental animals survived the post operative period for 2 weeks without any complications.Post mortem examination revealed that the wound and vaginal incision healed well.Conclusion Transvaginal appendectomy by endoscopy is safe and feasible in a canine model,while further study and progression of appropriate accessories are needed for future clinical use.

Objective To assess the feasibility and safety of adjustable loop-based purse-string technique in gastrotomy closure of natural orifice translumenal endoscopic surgery (NOTES).Methods Ten healthy female dogs were used in this study.Transgastric NOTES peritoneal exploration was performed in 5 groups (2 dogs in each) via various sites of the stomach ( greater curvature of the antrum; greater and lesser curvature of the body; anterior and posterior wall of the body).The gastric incision was then closed by using loop-based purse-string technique.Healing of the incision and intra-peritoneal infection were checked by endoscopy,necropsy,bacterial culture and histological examination 2 weeks later.Results The performance of NOTES peritoneal exploration and closure with purse-string technique was successful in ten dogs without significant complications.The mean operation time of closure was 7.3 ± 1.8 min.Minor bleeding occurred in 2 dogs (20％) during the incision of greater curvature of the antrum and body,which was controlled by electrocoagulation.Culture of the ascitic fluid and necropsy revealed no sign of abdominal infection or other complications except for adhesion in 1 dog ( 10％ ).The intact incision was confirmed by endoscopic,postmortem and histological examination,which suggested complete healing of the incision.Conclusion It is easy and safe to use loop-based purse-string technique for closure of multi-regional NOTES gastrotomy.This technology may be used for the repair of gastric ulcer perforation theoretically.

>多年来内科医生一直在寻求一种更加微创的方法来诊断和治疗疾病,经自然腔道内镜外科手术(natural orificetransluminal endoscopic surgery,NOTE)的出现为消化内科医生尤其是内镜医生带来了新的希望。NOTE同时具备了腹腔镜手术和内镜手术的优点,并且无瘢痕、创伤小、术后疼痛轻,把微创的理念推进到一个新的高度。一、NOTES的历史回顾及国内外现状NOTE是指软式内镜通过胃肠、泌尿生殖等自然腔道实施胸、腹、盆腔操作的微创手术。2006年美国胃肠内镜学会

<正>经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)是以软式内镜为治疗工具,不经皮肤切口,而是经阴道口、阴道、结直肠等自然腔道对腹腔疾病进行治疗的微创外科治疗方法。自Wilk〔1〕提出NOTES概念及Kalloo等〔2〕发表经胃内镜动物腹腔探查的实验报告后,

>"白色胆汁"是胆道系统中的一种无色或白色液体,于1911年被Kausch最先描述,白色胆汁主要与缺乏胆红素及胆盐有关。尽管ERCP术中发现的白色胆汁病例并不少见,但国外报道不多,到目前为止国内也少见相关报道。为此,我们收集了近1年来出现的13例白色胆汁患者的病例

美丽筒线虫寄生于反刍动物及其他哺乳类动物的口腔与食管黏膜和黏膜下层,偶尔寄生于人体引起美丽筒线虫病.现将1例寄生于食管黏膜的美丽筒线虫病报道如下. 患者男,29岁.因上腹胀痛伴反酸、烧心1年就诊. 体检:发育正常,营养好.

目的:探讨溃疡性结肠炎临床治疗措施。方法:对经肠镜检查等确诊的86例患者,随机分为治疗组43例给予常规治疗,对照组43例采用常规治疗并加康复新液灌肠、美常安(枯草杆菌、肠球菌二联活菌肠溶胶囊)口服,疗程均为8周,治疗结束后复查肠镜和评定疗效。结果:两组总有效率比较,差异有统计学意义,P<0.05。结论:采用柳氮磺吡啶(SASP)联合康复新液、微生态治疗溃疡性结肠炎疗效较佳,值得临床推广。

随着甲状腺功能检查的普及,人们对非甲状腺疾病引起的甲状腺功能异常认识越来越深刻,肝硬化引起的甲状腺功能异常已经引起重视.笔者总结56例肝硬化患者,发现39例(69.6%)甲状腺功能测值低于正常标准.现报道如下:

下消化道出血是指Treitz韧带远端的小肠和大肠出血,临床上较为常见.其出血病因繁多,分类各异.明确其病因对临床正确诊治下消化道出血起着决定性的指导作用.现将我院1997年1月至2003年4月收治的经结肠镜检查的120例非痔下消化道出血病例分析如下: