目的 探讨小探头超声(MPS)辅助内镜下放射状切开术(ERI)治疗难治性上消化道瘢痕性狭窄的有效性和安全性.方法 收集2017年11月-2020年1月因上消化道狭窄行MPS评估并行ERI治疗的患者30例,分析患者治疗前和治疗后狭窄改善程度及手术并发症情况,评估其疗效及安全性.结果 30例患者均完成MPS评估后再行ERI,平均操作时间(15.34±2.75)min,所有患者均未出现穿孔和出血等并发症,术前吞咽困难评分为(2.87±0.51)分,术后出院时降至(0.87±0.43)分,术前与术后出院时相比,差异有统计学意义(P<0.05),术后3和6个月吞咽困难评分分别为(0.90±0.80)和(1.03±0.49)分,与术后出院时比较,差异无统计学意义(P>0.05).结论 MPS辅助ERI治疗上消化道瘢痕性狭窄安全、有效,值得临床推广应用.

目的 对比研究内镜下橡皮圈套扎术(ERBL)与经典外科手术吻合器痔上黏膜环切钉合术(PPH)治疗痔疮的临床疗效.方法 选取2018年1月-2020年1月在淮安市第二人民医院消化内科及胃肠外科住院,分别行ERBL及PPH的Ⅱ度和Ⅲ度痔疮患者各40例.观察组为ERBL手术患者,对照组为PPH手术患者,比较两组患者的手术时间、术中出血量、术后住院天数、术后早期和晚期并发症以及治疗效果.同时比较ERBL组套扎环数量与套扎早期和晚期并发症的相关性.结果 ERBL组手术时间及术后住院时间明显短于PPH组,术中出血量明显少于PPH组,差异有统计学意义(均P=0.000);ERBL组术后早期并发症中疼痛及里急后重的发生率明显低于PPH组(P=0.004和P=0.044);两组患者治疗总有效率比较,差异无统计学意义(χ2=0.26,P=0.608).不同套扎环数量与ERBL术后早期及晚期并发症的发生无明显相关性(P>0.05).结论 ERBL及PPH治疗痔疮的总有效率相仿,但EBRL组手术时间及术后住院天数明显短于PPH组,术中出血量明显少于PPH组,且不同套扎环数量对ERBL术后早期及晚期并发症的发生无明显影响,ERBL用于治疗痔疮安全、有效,可应用于临床.

目的 研究新型辅助技术圈套器联合棉线在内镜黏膜下剥离上消化道早癌病变中的应用研究.方法 回顾性研究2016年6月-2019年2月在该院内镜中心接受治疗的上消化道早癌患者40例,分为对照组和改良牵引组,每组各20例.对照组采用传统的内镜黏膜下剥离术(ESD),改良牵引组使用圈套器联合棉线牵引辅助行ESD,分别从手术完整切除率、手术时间、术中及术后并发症、术后平均住院天数等方面进行对比.结果 术前两组患者在年龄、性别构成、肿瘤部位及直径等方面差异均无统计学意义(P>0.05).两组上消化道早癌患者完整切除率为100％.对照组手术时间为(73.95±13.04)min,改良牵引组为(50.95±12.62)min,改良牵引组手术时间明显短于对照组,差异有统计学意义(t=4.74,P<0.01).对照组有2例发生术中出血、2例术后发生迟发性出血及穿孔,均通过内镜下处理好转出院.对照组住院时间为(10.21±3.74)d,改良牵引组为(6.05±2.56)d,改良牵引组住院时间明显短于对照组,差异有统计学意义(t=9.15,P<0.01).所有标本术后病理底切缘及侧切缘均为阴性.40例患者术后随访至截稿时均未复发,无术后食管胃狭窄等远期并发症.结论 圈套器联合棉线牵引辅助装置能给ESD操作者提供良好的手术视野,在缩短手术时间的同时,降低并发症的发生风险,而且该装置组合简便,能作为ESD治疗黏膜病变过程中的一个有效辅助装置.

Objective To analyze the relationship between serum asymmetric dimethylarginine (ADMA) and initial acute coronary syndrome (ACS) after taking a proton pump inhibitor (PPI). Methods From January 2017 to October 2018, we enrolled 140 patients with initial ACS and 70 healthy subjects. Among them, 70 patients were included in a PPI group (administration of PPI+ initial ACS), 70 patients in an ACS group (non-PPI+ initial ACS), and 70 healthy subjects (non-PPI+ non-ACS) in a control group. Serum ADMA concentration was measured by enzyme linked immunosorbent assay, and cholesterol and triglyceride were measured routinely. General demographic information, biochemical indicators, and ADMA levels were compared by one-way ANOVA, nonparametric test, and chi-square test. Mann-Whitney U test was used for comparison between groups. Spearman correlation analysis was used to analyze the relationship between serum ADMA level and traditional risk factors of acute coronary syndrome. Multivariate logistic regression analysis was used to investigate the risk factors for ACS. Results Serum ADMA levels in the PPI group and the ACS group were both significantly higher than that in the control group (Z=-9.585, -4.793, P 0.05). Logistic regression analysis showed that serum ADMA level was an independent risk factor for patients with initial ACS (β=0.017, OR=1.017, P<0.001). Conclusions Serum ADMA levels in patients with initial ACS after taking proton pump inhibitors are significantly higher than those in initial ACS patients without taking proton pump inhibitors. Serum ADMA levels in patients with initial ACS are significantly higher than those in healthy controls. Elevated serum ADMA is an independent risk factor for initial ACS. Key words: Asymmetric dimethylarginine; Proton pump inhibitor; Acute coronary syndrome