目的 探讨透明帽辅助单人结肠镜检查在结肠镜检查困难患者中的临床应用.方法 对有便秘或腹部手术史的行结肠镜检查的388例患者,按照入组顺序分为奇数组及偶数组,奇数组采用常规单人结肠镜检查法,偶数组采用透明帽辅助单人结肠镜检查法.比较2种检查方法 的成功率、平均到达回盲部时间、进入回肠末端成功率及时间、息肉检出率、平均疼痛评分及并发症情况.结果 透明帽辅助结肠镜检查法操作成功率较高、平均到达回盲部时间、进入回肠末端时间少于常规结肠镜检查法,结果 分别为(91％ vs.79％,P=0.001)、[(7.4±1.8) min vs.(10.7±2.5) min,P=0.01]、[(15.2±4.0) s vs.(26.3 ±7.3)s,P=0.001],但2组进入回肠末端成功率比较差异无统计学意义(92％ vs.90％,P=0.43);平均疼痛评分透明帽辅助组为(4.4±0.8)分,常规检查组为(5.8±1.3)分,比较差异有统计学意义(P=0.02).2组息肉检出率比较有差别,透明帽辅助组高于常规组(50％ vs.31％,P=0.001),2组均未出现严重并发症.结论 对有便秘或腹部手术史的患者,透明帽辅助结肠镜操作法安全、有效,对患者造成痛苦更小.

Objective To investigate the effect of short transparent cap-assisted colonoscopy for endoscopic primary operator. Methods A total of 1200 patients who underwent colonscopic in Shantou Chaonan Minsheng Hospital were divided into regular colonoscopy or short transparent cap-assisted colonoscopy in order. The two methods were compared by success rate ,cecal intuba-tion time,the success rate and time of terminal ileum intubation,poly detection rate,pain score and the occurrence of complication. Results The success rate of colonoscopy of short transparent cap-assisted colonoscopy and regular colonoscopy were 94% and 89%(P=0.00),the average cecal intubation time were 8min and 12min (P=0.00),the success rate of terminal ileum intubation were 87% and 81% (P=0.00),the time of terminal ileum intubation were 24 sec and 31 sec (P=0.02),the average pain score were 4.2 and 4.9 (P=0.01) and the polyp detection rate were 27%and 21% (P=0.01). No complication is observed. Conclusion The short transparent cap-assisted colonoscopy is an examination with easier,more effective and less painful for endoscopic primary operator.

OBJECTIVE:To explore the effects of cyclooxygenase-2 (COX-2) and its inhibitor valdecoxib in liver fibrosis.METHODS:Hepatic fibrosis was induced by carbon tetrachloride for 8 weeks in wild-type and COX-2 knockout mice. And the levels of hyaluronic acid (HA), collagen IV(IV-C), procollagen III(PCIII) and α-smooth muscle actin (α-SMA ) were determined. Cyclin D and cyclin E were measured in hepatic satellite cell (HSC) after a treatment of valdecoxib for 24 h or not.RESULTS:HA, IV-C, PCIII and α-SMA all had significant difference in 3 groups (control group:(180 ± 13) µg/L, (56 ± 9) µg/L, (39 ± 13) µg/L, 2.49% ± 0.24% in control, F = 78.52, 61.30, 41.96, 28.15, all P < 0.05) . HA, IV-C and α-SMA in wild-type liver fibrosis mice were higher than those in knockout counterparts ((413 ± 60) vs (308 ± 42) µg/L, (96 ± 13) vs (74 ± 10 ) µg/L, 8.99% ± 0.81% vs 4.72% ± 0.50%, all P < 0.01). But PCIII were similar between two groups ((82 ± 12) vs (72 ± 15) µg/L, P = 0.06). Wild-type mice expressed higher levels of cyclin D and cyclin E than those of knockout mice (0.96 ± 0.15 vs 0.76 ± 0.10, 0.94 ± 0.13 vs 0.82 ± 0.09, P = 0.02, 0.04). The rates of cyclin D and cyclin E were 0.40 ± 0.06 and 0.38 ± 0.05, 0.35 ± 0.04 and 0.37 ± 0.06 respectively after a treatment of valdecoxib. And both deceased in hepatic satellite cell of wild-type and knockout mice (both P < 0.01) versus those without valdecoxib.CONCLUSIONS:COX-2 increases the activation and proliferation of HSC leading to liver fibrosis. And its inhibitor may depress liver fibrosis by decreasing the expressions of cyclin D and cyclin E in COX-2 dependent and(or) independent way.

目的 探讨乳头括约肌小切开联合大气囊扩张术在肝外胆管大结石内镜治疗中的安全性及有效性.方法 87例肝外胆管结石直径≥1.0 cm患者采用奇偶数法分为两组,奇数组43例接受乳头括约肌小切开联合大气囊扩张术取石治疗,偶数组44例接受乳头括约肌切开取石治疗,比较两组间结石取净率、取石次数、机械碎石率、结石嵌顿率、操作时间及早期并发症发生情况.结果 观察组4例出现高淀粉酶血症,3例出现轻症急性胰腺炎,并发症发生率为16.3％(7/43);对照组中,有3例出现高淀粉酶血症,2例出现轻症急性胰腺炎,3例出血,并发症发生率为18.2％(8/44),差异无显著性(P＞0.05),但出血率比较差异有显著性(P＜0.05).观察组结石取净率、结石嵌顿率、机械碎石率、二次取石率、操作时间分别为97.7％(42/43)、0％(0/43)、4.6％(2/43)、0％(0/43)及(35.2±5.2)min;对照组对应为97.7％(43/44)、6.8％(3/44)、18.1％(8/44)、13.6％(6/44)及(45.1±4.0)min,除结石取净率比较差异无显著性(P＞0.05),其他4项比较差异均有显著性(P＜0.05).结论 乳头括约肌小切开联合大气囊扩张术在肝外胆管大结石内镜治疗中安全有效,操作简便.

Objective To evaluate the safety and effectiveness of conscious sedation and intravenous anesthesia used to endoscopic retrograde cholangio pancreatiography (ERCP) in treatment of extrahepatic bile duct stones.Methods A total of 100 cases of extrahepatic bile duct stones patients in treatment of ERCP were encoded by the group order,50 cases of odd used intravenous anesthesia (intravenous anesthesia group),intravenous injection of propofol; 50 cases of even used conscious sedation (conscious sedation group),muscle injection of diazepam and pethidine.Intraoperative reaction (extubation behavior,own postural changes),changes in vital signs,operating time,the success rate of stone and complication were observed in two groups.Results The incidence of intraoperative extubation behavior and own postural changes in conscious sedation group were significantly higher than those in intravenous anesthesia group [24％ (12/50) vs.2％ (1/50),18％ (9/50) vs.0],and the differences were statistically significant (P ＜ 0.01).The heart rate and mean artery pressure in two groups were decreased at 5 minutes after administration than that before operation,and the difference was statistically significant (P ＜ 0.05),but there was no statistical significance at 10 min after entering the mirror and postoperative awake compared with before operation (P ＞ 0.05).Pulse oxygen saturation between two groups had no statistical significance (P ＞0.05).The success rate of stone in two groups were 98％ (49/50).Operating time in intravenous anesthesia group was obviously shorter than that in conscious sedation group [(38.2 ± 6.3) min vs.(49.1 ± 9.9) min] (P ＜ 0.01).The complications between two groups had no statistical significance (P ＞ 0.05).Conclusion Conscious sedation and intravenous anesthesia can be used to ERCP in treatment of extrahepatic bile duct stones,but intravenous anesthesia can obviously reduce patients discomfort,shorten the operation time.

目的 探讨肠易激综合征(IBS)与心率变异性(HRV)的相关性,为诊断、治疗提供新的手段.方法 收集肠易激综合征患者80例进行心率变异性分析,并与正常人30例对照分析.结果 观察组病例较对照组SDNN降低,差异有显著性意义.结论 肠易激综合征患者大部分存在自主神经功能紊乱,主要表现为迷走神经功能增强.

目的 探讨和评价内镜治疗大肠息肉早期癌变的疗效及预后.方法 对我院1993年6月至2003年6月期间经内镜确诊的大肠息肉早期癌变患者,按治疗方法的不同分为内镜治疗组和外科手术治疗组,对两组的临床资料、治疗方法和随访结果进行回顾性分析.结果 64例大肠息肉早期癌变中,内镜治疗34例,外科手术治疗30例(包括1例内镜治疗后追加手术者).内镜治疗组癌灶完全切除率为97.1%,无出血及穿孔并发症发生.外科手术治疗组有1例病理证实癌组织浸润达黏膜下深层,无远处转移.内镜治疗组经3个月～5年的随访,2例死于心脑等疾病外,无一例肿瘤复发.比较两组黏膜和黏膜下层早期癌变的临床资料、随访结果和5年生存率,内镜治疗组的疗效与手术治疗组相似(P>0.05).结论 大肠息肉早期癌变,特别是黏膜层早期癌变,内镜治疗的疗效和随访结果与手术治疗相似,而且内镜治疗操作简便、安全、创伤小,患者易接受,恢复较快,费用较低,值得推广.

目的探讨抗抑郁药联合认知治疗对肠易激综合征(irritable bowel syndrome,IBS)患者疗效的影响。方法IBS患者60例,随机分为2组,每组30例,对照组常规对症治疗,观察组在对照组基础上应用认知疗法对患者进行心理治疗,结合口服小剂量盐酸帕罗西丁(20mg/d)治疗12周,12周末后观察IBS患者临床症状改善程度,应用抑郁自评量表(SDS)和焦虑自评量表(SAS)评分测量治疗前后抑郁量评分及焦虑量评分。结果观察组治疗后临床症状改善程度显著大于对照组(P<0.05),焦虑抑郁评分明显低于对照组(P<0.01)。结论小剂量抗抑郁药联合认知疗法是治疗IBS的有效手段,是改善患者临床症状及生活质量的有效途径。

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。

目的探讨小肠原发性肿瘤的临床特点,拓宽不明原因消化道出血的诊断思路,提高诊治水平。方法回顾性总结1983年8月到2005年12月间本院收治,最后经手术及病理诊断的69例原发性小肠肿瘤的临床资料。结果本组69例中,良性31例,恶性38例;良性以平滑肌瘤为多,约占80.6%(25/31),其余为息肉及腺瘤等;恶性以腺癌为主,占81.5%(31/38),其余为平滑肌肉瘤、腺泡状软组织肉瘤、恶性淋巴瘤、间质瘤等。本组病例术前确诊仅12例,占17.4%。本组病例十二指肠肿瘤9例,占13%;空肠肿瘤32例,占46.4%;回肠肿瘤28例,占40.6%。小肠肿瘤临床表现以消化道出血、腹痛、腹胀、呕吐、肠梗阻、腹部肿块为主。结论小肠肿瘤缺乏特异性临床表现,诊断较为困难,目前缺乏价廉、易行、普及、特异的诊断手段,必要时考虑手术探查及术中内镜协助诊断治疗。

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.