Objective:Obesity has become a serious global health concern. A number of studies suggest that chronic diarrhea is frequent in obese people. We performed a systematic review and meta-analysis to assess the prevalence of chronic diarrhea in obese adults.Methods:We systematically searched PubMed, Embase, and Web of Science for studies from inception through October 15, 2022.We included population-based or obese patient-based studies that could calculate the prevalence of diarrhea. Two researchers independently determined study eligibility, extracted data, and assessed quality.Data were pooled using a random effects model.Results:Overall, 8 studies with 19, 701 respondents were assessed, including 11, 820 overweight and obese individuals.The pooled chronic diarrhea rate was 23.02% (95%CI: 17.47%, 28.57%) in people with a BMI≥ 25 kg/m2.The prevalence of diarrhea in the obese group (23.79%, 95%CI: 16.29%, 31.29%) was higher than that in the overweight group (18.82%, 95%CI: 13.02%, 24.62%), but it was not statistically significant (P=0.30).Conclusions:Chronic diarrhea is quite common in obese populations.With the increasing number of obese people, and the coexistence of obesity and chronic diarrhea deserves extra attention.

Objective:To evaluate the safety and efficacy of 3% lauromacrogol solution for the ablation of animal cystic tumor models, and to explore the practicability of the model for the simulation of pancreatic cystic tumor.Methods:Endometriosis cyst models were established in the abdominal cavity of thirty female mature SD rats by autologous transplantation.After 4 weeks of feeding, the cysts successfully modeled were randomly divided into two groups, injected with 3% lauromacrogol solution or normal saline, respectively.After 4 weeks of feeding, the abdominal cavity was opened to observe the ablation of cysts, and specimens were collected for pathological examination.Results:A total of 34 cysts were collected. In terms of morphology, cysts in the normal saline group remained hemispherical before and after ablation, while cysts in the 3% lauromacrogol solution group showed flat scar after the ablation.In terms of pathology, almost no single layer columnar epithelial cells were ablated in the normal saline group, while all the single layer columnar epithelial cells were ablated in the 3% lauromacrogol solution group, and the lamina propria was intact in both groups. Statistical analysis of the ablation efficiency of the two groups showed that 3% lauromacrogol solution had significant ablation effect.Conclusion:The ablation of endometriosis cyst in rats with 3% lauromacrogol solution is safe and effective, preliminary indicating that 3% lauromacrogol solution can be used for endoscopic ultrasound guided lauromacrogol ablation.This model can simulate pancreatic cystic tumors to some extent.

囊性病变多在常规体检中发现，一般无需处置，有癌变风险或在随访过程中体积增大产生症状的病变可行聚桂醇消融术进行治疗。本文对消化系统囊性病变聚桂醇消融术的适应证与禁忌证、消融方法、有效性及安全性进行了整理与分析。

Objective:To evaluate the efficacy and safety of the second session of endoscopic ultrasound-guided lauromacrogol ablation (EUS-LA) for pancreatic cystic neoplasms (PCNs).Methods:A total of 74 patients with suspected of PCNs who underwent EUS-LA in the First Medical Center of Chinese PLA General Hospital from April 2015 to December 2020 were enrolled in the study. Fifteen of them underwent the second ablation. The efficiency of EUS-LA was determined based on the change of lesion volume during the imaging follow-up, categorized into complete resolution (CR), partial resolution (PR) and stable disease (SD). The safety was determined by the complication incidence.Results:Among the 15 patients undergoing the second EUS-LA, there were 9 males and 6 females with age of 51.5±17.6 years. Thirteen patients completed imaging follow-up after the second EUS-LA, CR was achieved in 8 patients, PR in 2 patients and 3 in SD. The CR rate increased from 0 after the first ablation to 8/13 after the second ablation ( P=0.002). The median cyst diameter decreased from 22.0 mm before the second ablation to 15.0 mm after the second ablation ( Z=-2.666, P=0.008) and the median cyst volume reduced from 2 419.7 mm 3 to 1 099.5 mm 3 ( Z=-2.134, P=0.033). The complication incidence of the second ablation was 2/15, similar to that of the first ablation. Conclusion:The second ablation is effective and safe without increasing the complication incidence in patients without achieving CR after the first EUS-LA.

目的 探讨直视下超级微创光动力疗法(photodynamic therapy,PDT)治疗胰腺导管内乳头状黏液肿瘤的临床疗效.方法 胰腺导管内乳头状黏液肿瘤(intraductal papillary mucinous neoplasm,IPMN)患者1例,采用肿瘤靶向层析光动力疗法新理念设计的临床方案,在静脉注射光敏剂血卟啉注射液1.5 mg/Kg后48 h,通过胆胰内镜置入发光长度为3 cm柱形光纤对胰管尾部和部分中部进行照射,激光波长532 nm,功率密度80 mW/cm2,照射时间为10 min,能量密度48 J/cm2.激光照射结束后撤出光纤,再次超选胰管成功,沿导丝置入7F单猪尾塑料胰管支架.结果 PDT治疗后即刻受照的病变区局部可见黏膜水肿、色略苍白、肿瘤内血管呈暗紫色,术中无出血.PDT术后第1天患者淀粉酶为1 345 U/L、脂肪酶为5 697 U/L,PDT术后第6天,淀粉酶、脂肪酶达到正常,术后患者无发热、恶心、呕吐,无腹胀、腹痛等不良反应发生.PDT术后第3天和第6天,CT检查结果胰腺形态及密度均未见异常.术后2个月行胆胰内镜可见胰尾部病变完全消失,胰管中部病变仅剩约1/4周乳头状结构,较治疗前环周占位明显改善.结论 直视下超级微创PDT治疗胰腺导管内IPMN具有良好的安全性和有效性.

患者男,43岁,无消化道不适症状,于2019年6月21日因“健康体检”在解放军总医院第一医学中心消化内镜中心行无痛胃镜检查.既往饮酒20年,平均每天饮白酒(53度)约600 g,近5年有所减少,每日饮白酒250 ～300 g.常规麻醉后进镜观察,见胃体黏膜粗糙,集合细静脉的规则排列(RAC)征阴性,小弯侧黏膜充血明显,弥漫性发红(图1),胃角、胃窦黏膜充血、水肿,伴渗出、片状红斑(图2、3),内镜下稍吸气观察胃体小弯与两侧黏膜存在明显分界线,喷洒靛胭脂后观察胃体小弯黏膜着色少,可见颗粒样改变(图4、5),胃角、胃窦胃小区结构增大,伴凹陷性糜烂(图6).分别于胃体小弯、胃角、胃窦小弯各取活检1块.病理诊断结果:胃(体小弯)表浅体型黏膜慢性炎伴急性炎及幽门螺杆菌感染,部分腺体肠化、增生;胃(角)幽门型黏膜慢性炎伴急性炎及幽门螺杆菌感染,部分腺体肠化、增生;胃(窦小弯)幽门型黏膜慢性炎伴急性炎,部分腺体肠化、增生,可见幽门螺杆菌感染.

目的 胰岛素瘤是最常见的胰腺神经内分泌肿瘤,因其临床表现多样,导致诊断困难.影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用,拥有较高的敏感性和特异性.本研究拟通过明确胰岛素瘤的解剖分布特点,以期有助于提高影像学的诊断准确率和降低漏诊率,尤其是在教育和培训实践中对于EUS的学习者更具有指导价值.方法 回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料,检索方法采取搜索术后病理诊断为“胰岛素瘤”的病例,通过查阅病例的方法,提取出胰岛素瘤的大小和解剖分布等数据,进一步分析其特点.结果 共检索到确诊为胰岛素瘤的患者116例,其中,男45例、女71例,年龄13 ～ 76岁,平均年龄(44.4±14.85)岁.胰岛素瘤单发110例(94.8％)、多发6例(5.2％).位置分布:头颈部46例(39.7％),单发45例、多发1例;体尾部68例(58.6％),单发65例、多发3例;全胰腺多发2例(1.7％).病变大小特点:最大径0.4～3.4 cm,平均大小(1.53±0.58)cm.≤1 cm 29例、＞1 cm而≤1.5 cm41例、＞1.5 cm而≤2.0 cm28例,≤3 cm 15例,＞3 cm3例.年龄与肿瘤的大小相关,≤44岁患者肿瘤平均大小为(1.36 ±0.51)cm、＞44岁患者肿瘤平均大小为(1.70±0.60)cm,P＜0.05.头颈部的肿瘤大于体尾部的肿瘤,头颈部肿瘤平均大小(1.66±0.63) cm,体尾部(1.42±0.52)cm,P＜0.05.结论 胰岛素瘤在胰腺体尾部较头颈部更好发;绝大多数单发,但可以全胰腺多发;多数小于1.5 cm,肿瘤的大小与患者年龄和肿瘤的解剖分布相关.

目的 通过临床大样本研究,进一步明确内镜下射频消融术(RFA)治疗胃低级别上皮内瘤变(LGIN)的有效性及安全性.方法 回顾性选择2014年10月至2019年12月经解放军总医院消化内镜中心术前筛查的175例患者证实为胃LGIN的255例病变纳入研究,并进行内镜下RFA,关注其围手术期并发症发生情况,术后采用Wong-Baker面部表情量表进行疼痛评分,并追踪其复查随访结果.结果 255例病变均成功完成内镜下RFA,术中无明显并发症发生;术后3个月、6个月、1年、2年、3年的治愈率分别为91.3％、90.8％、89.4％、88.2％、86.5％,术后腹痛为主要并发症.结论 内镜下RFA是治疗胃LGIN的一种安全有效、操作简便、可门诊治疗的新方法,具有良好的临床应用前景.

内镜粘膜下剥离术(ESD)以其在适应证内可以达到对消化道浅表肿瘤的完整性切除和根治性治疗已成为治疗消化道浅表肿瘤的标准手段,确定适宜的ESD围手术期治疗方案及术前合理备血对降低ESD并发症、提高患者治疗期间的生活质量有着重要意义.

Objective: To investigate characteristic clinical features,therapeutic methods and outcomes of adenoid cystic carcinoma(ACC) from the maxillary sinuses.Methods: 31 ACC patients were reviewed and analyzed,including diagnosis,treatment methods and outcomes.Results: 31 patients represented different clinical behavior,and most of them were classified as T4,advanced stage.Operation with concomitant radiation therapy was taken for treatment.27 cases acquired follow-up and the survival rates of 5 and 10 years were 78.6% and 43.0%,respectively.Conclusion: Advanced stage and unfavorable nature of ACC in this cohort resulted in poor outcome.Efforts should be directed to minimize the delay in diagnosis at the primary care level.