Objective To explore the value of Sedative/analgesic and narcotic in the savary dilator in the treatment of esophageal stenosis. Methods 45 cases of patients were divided into 3 groups: Pharyngeal sur-face anesthesia group; conscious sedation and intravenous anesthesia, Observation Group 3 patients with adverse reactions, as well as pre-treatment, treatment, treatment of blood pressure, respiration, heart rate and oxygen satu-ration changes. Results Pharyngeal surface anesthesia group Significant stress、cough、 extubation act, and other adverse reactions, Intraoperative breathing, heart rate and blood pressure increased significantly (P<0.05), but in the normal range, Oxygen saturation did not change much; Sedation group significantly reduced side effects,patients in breathing,heart rate and blood pressure than before no significant changes occur hypoxemia 2; intra-venous anesthesia group, patients with intraoperative tolerance, and less adverse reactions; but the average intra-operative Blood pressure was significantly lower than before (P<0.05); breathing, heart rate than the pre-oper-ative has been slow, but the difference was not statistically significant (P>0.05), hypoxemia occurred in 4 ca-ses. Conclusion In the endoscopic treatment, a reasonable choice of sedation/anesthesia and analgesic tech-nique will help improve patient compliance and tolerance,To make treatment more economic, safety, comfort.

目的:探讨汕头地区居民食管病发病情况及预防治疗策略.方法:回顾性分析1476例经内镜诊断为食管病患者的胃镜、病理、影像学及手术治疗等资料.结果:1476例食管病患者中发生食管癌714例,食管炎445例,食管静脉曲张120例,食管良性狭窄85例,食管黏膜撕裂症46例,食管异物34例,食管憩室23例,食管息肉6例,食管贲门失弛缓症3例,保守治疗840例,内镜治疗124例,手术治疗512例.食管癌患者随访218例,其中手术152例、非手术66例,其1、3年期死亡率分别为40%、90%和95%、100%.食管炎患者康复150例,死亡10例.结论:食管病主要以食管癌与食管炎为主,且食管癌在本地区的发病率较高,增强居民预防食管病的意识,可降低疾病的发生.

Objective: To investigate the causes of duodenal stasis disease.Method: Patients with duodenal stasis disease were examined by single or multiple ways,such as barium study,selective superior mesenteric artery visualization, electron microscope or CT.Result: The main etiopathogenisis of the duodenal stasis is functional dyspepsia(FD).Conclusion: Functional disorder causes the duodenal stasis disease.

目的 探讨大肠癌患者手术前后血清肿瘤相关抗原199(cancer antigen 199,CA199)和癌胚抗原(CEA)变化及其临床价值.方法 应用化学发光免疫分析法测定大肠癌患者术前和术后0～3个月血清CA199和CEA值,并对测定结果进行统计分析.结果 (1)血清CA199和CEA在大肠癌根治术或姑息术术后表达水平均明显下降(P＜0.05),实行根治术的表达率显著下降(P＜0.05),而实行姑息术的表达率下降不明显(P＞0.05).(2)血清CA199和CEA在大肠癌管状腺癌和黏液腺癌术后的表达水平均明显下降(P＜0.05),而乳突状腺癌下降不明显(P＞0.05);管状腺癌术后的表达率明显下降(P＜0.05),乳突状腺癌术后的表达率下降不明显(P＞0.05),黏液腺癌术后仅CEA表达率有明显下降(P＜0.05).(3)血清CA199和CEA在A期、B期大肠癌术后的表达水平和表达率均明显下降(P＜0.05),CA199在C期、D期术后表达水平和表达率的变化不同步,而CEA的变化则趋于一致;不同Dukes分期大肠癌CA199和CEA表达水平有显著差异(P＜0.05),二者表达水平随分期进展而上升,但表达率递增并不明显(P＞0.05).(4)大肠癌术前CA199与CEA二者联合检测的敏感度显著高于CA199单项(P＜0.05),与CEA单项比较,虽敏感度有所上升,但幅度不明显(P＞0.05);大肠癌术后CA199和CEA联检的敏感度与单项检测差异无统计学意义(P＞0.05).结论 大肠癌患者手术前后血清CA199和CEA的变化有一定的规律和特点,运用好这些规律和特点有助于判断临床分期、病理类型和选择恰当的手术方式;有助于评估手术效果和预测首程化疗疗效,为判断预后、及早发现术后复发患者提供参考依据.

目的探讨结肠黑变病(melanosiscoli,MC)的病因、发病机制、内镜特点及病理改变。方法对本院10余年来确诊为MC的资料完整的23例病例进行分析讨论。结果在对7200例门诊及住院患者结肠镜的检查中,检出MC23例,检出率0.32%。结论MC与服用泻药有关,尤其与蒽醌类泻药有关[1～2],且MC常伴发结肠息肉,对便秘病人尽量不用蒽醌类泻药,一旦发现MC,应定期做结肠镜检查。

Purpose To research the change of serum level of CA199 and CEA pre and post-operation in the patients with colon cancer, and there clinical meaning. Methods The serim level of CA199 and CEA in 50 cases of clinical diag .osed patients of colon cancer and 50 cases of normal volunteer were detected by full-auto-immunochemical analyzer. Results The serum level of CA199 and CEA of the patients pre-operation were higher than of normal volunteer (P0. 01), and they decreased abruptly after operation. There were a significance difference between pre-radical-operation and post-radical-operation (P0. 05), and there were no significance difference in the cases of palliative operation (P0. 05). Conclusion The serum level of CA199 and CEA in colon caner patients increase pre-operation, and decreased abruptly after radical operation.

目的探讨Dieulafoy病的诊治,加强对本病的认识,提高上消化道出血的治愈率,降低病死率.方法对526例上消化道出血进行回顾性临床分析,经急诊胃镜诊断Dieulafoy病8例,全部行外科手术治疗.结果8例患者均出血凶猛,有2例为血管侧壁破裂,6例为血管横断破裂.经外科手术治疗后,全部患者均治愈出院.结论Dieulafoy病是黏膜下血管畸形病灶,易受各种病因损害造成破裂出血,内科治疗或内镜治疗往往难以达到效果,外科切除最为彻底,可以达到根治目的.

目的探讨进展期胃癌患者手术前后血清CEA、CA199水平变化对其预后的临床价值.方法采用全自动化学发光免疫分析法,测定进展期胃癌患者血清CEA、CA199含量变化及手术切除对其的影响.结果胃癌术前CEA、CA199均高于非肿瘤对照组(P＜0.05),行胃癌根治术后CEA、CA199水平较术前明显下降(P＜0.05),而姑息手术前后CEA、CA199变化不大(P＞0.05).结论血清CEA、CA199的表达与肿瘤的存在与否相关,且与胃癌的浸润及转移过程密切相关.观察胃癌患者血清CEA、CA199含量及其变化,对病情估计及预后判断具有一定的指导意义.

目的探讨内镜下黏膜切除术(EMR)对早期胃癌的治愈率,减轻患者外科手术痛苦,提高生活质量.方法 11例患者根据病变的形态及部位的不同,病变呈隆起的,单纯用息肉切除法进行,对于扁平隆起型、凹陷型的,则需用黏膜切除法进行.结果 11例早期胃癌患者中,EMR术后全部均进行病理组织检查,证明均未浸润肌层,术后定期随访1～36个月,未发现复发,无并发症,治疗效果满意.结论早期胃癌行黏膜切除术,既经济又减轻患者外科手术的痛苦,并可以达到治愈的效果.

目的:探讨微探头超声内镜(MPS)对食管癌的诊断价值.方法:食管癌病人30例,MPS检查作术前TN分期,并与手术后病理结果对照.结果:27例手术病人中,MPS对1例局限于粘膜层及2例局限于粘膜下层的早期癌均作出准确判断,对于进展期癌,癌肿浸润深度诊断准确率为81.5%,食管邻近的纵隔淋巴结转移判断敏感性为88.9%,特异性为77.8%.结论:MPS能对早期食管癌作出准确诊断,对于进展期癌能较准确地进行术前分期,可作为手术可切除性预测和预后估计的重要依据.

目的:探讨超声内镜检查技术.方法:对44例食管疾病采用微探头超声内镜检查.结果:提出食管疾病超声内镜检查时,超声介质最好采用脱气水,以水囊法为宜,注水量20～30 ml,病人取坐位或半坐卧位,可获得较高质量图像.对于局限于粘膜层或粘膜下层的早期癌,使用20 MHz频率探头能作出准确判断;而对于进展期癌或其它食管疾病,则宜采用12 MHz或15 MHz频率探头.结论:超声内镜检查可提高对食管疾病的准确诊断率.

应用微型探头超声内镜(MPS)对30例癌病人进行检查,结果显示:MPS能对局限于粘膜层抑或粘膜下层的早期癌做出准确诊断.对于进展期癌,癌肿浸润深度诊断准确率为81.5%,食管邻近的纵隔淋巴结转移判断的敏感性为88.9%,特异性为77.8%,并能准确诊断有无胸主动脉等纵隔重要脏器受累,可成为手术可切除预测和预后估计的重要检查方法.