目的 探讨内镜下结肠息肉冷切除术(CSP)治疗微小结肠息肉的效果.方法 回顾性分析内镜下CSP术治疗的86例微小结肠息肉患者的临床资料.结果 本组患者均顺利完成手术,平均手术时间(16.33±5.28)min,其中14例用时＜10min,18例＞20min.15例CSP术后追加活检咬除残余息肉组织,完整切除率82.6％(71/86);53例CSP术后使用钛夹封闭创面,部分多发息肉患者使用多枚钛夹.大多数创面出血1～2 min内自行停止,冲洗后无活动性出血.平均住院(3.63±0.74)d,无一例出现术后出血及穿孔等并发症.结论 内镜下CSP术是治疗微小结肠息肉的重要手段,息肉完整切除率高,并发症发生率低,值得临床推广应用.

小肠疾病种类很多,如感染性炎症(细菌、病毒、寄生虫等)、克罗恩病、肿瘤或血管病变等,其检查手段虽然很多,但都有其局限性[1].随着内镜技术的快速发展,胶囊内镜(CE)开始应用于临床,可获得整个小肠的影像学资料,但存在一定的盲区,易漏诊,发生胶囊嵌顿,具有一定的限制[2,3].双气囊小肠镜(DBE),其具有视野广、图像清晰的特点,并可进行活检、黏膜染色标记病变部位等特点,目前已成为小肠疾病诊断与治疗的重要手段[4].目前,学者们对DBE和CE的应用效果争论较大,且DBE在宁波市医院内的开展应用少见报道.本研究通过比较DBE和CE对小肠疾病的诊断价值,观察DBE的检查效果,为临床诊治提供有效的手段.

目的 观察酪酸梭菌活菌与匹维溴铵联合治疗腹泻型肠易激综合征的临床效果.方法 收集90例腹泻型肠易激综合征患者,按随机数字表法将其分为两组,对照组45例患者应用匹维溴铵治疗,观察组45例患者应用酪酸梭菌活菌联合匹维溴铵治疗.比较两组治疗前后症状评分、血清CRP水平、HAMD评分及HAMA评分.结果 患者治疗前腹泻评分、腹痛评价及症状总积分差异均无统计学意义(均P＞ 0.05).治疗后两组腹泻评分、腹痛评价及症状总积分均较治疗前降低,且观察组治疗后腹泻评分、腹痛评价及症状总积分均低于对照组,差异均有统计学意义(均P＜ 0.05).观察组临床总有效率高于对照组,差异有统计学意义(P＜0.05).两组患者治疗前血清CRP水平、HAMD评分、HAMA评分差异均无统计学意义(均P＞0.05).观察组治疗后血清CRP水平、HAMD评分、HAMA评分均低于对照组,差异均有统计学意义(均P＜0.05).结论 酪酸梭菌活菌与匹维溴铵联合治疗腹泻型肠易激综合征效果较明显,能有效缓解患者临床症状,减轻炎症反应,改善焦虑、抑郁情绪,值得临床推广应用.

大肠广基息肉是一种肠道病变,其在临床具有极高的发病率, 主要是源于人体结肠和直肠黏膜上皮层的赘生物,该疾病具有复发率高、发病隐匿等特点,给临床治疗增加了困难[1]. 近年来,随着我国人们饮食习惯的改变,进而导致我国大肠广基息肉患者不断增加,若治疗不及时,易影响其日常饮食和身心健康. 研究显示,多数大肠癌主要是由于大肠息肉中的腺瘤性息肉所致,因此,一旦发现大肠息肉,应及时将其切除,避免其发生病变. 目前临床上对于该疾病主要采用常规黏膜切除术治疗,但其具有复发率高、并发症多、安全性差等不足,导致其使用受到限制[2,3]. 本院对内镜下黏膜切除术治疗大肠广基息肉患者的临床疗效进行分析(2016年1月至2017年12月),并总结分析结果报告如下.

肝性脑病是终末期肝病常见的并发症之一,现代治疗方法多种多样,其中灌肠较为普遍.本文中笔者通过对肝性脑病灌肠治疗应用进行总结,以期对目前研究中相关评价指标、保留时间、灌肠液浓度等问题进行探讨.

[Objective]To observe the effect of Radix Curcumae and Notoginseng combined with folic acid on gastric precancerous lesion by clinical case study.[Methods]Ninety-six patients with premalignant gastric lesions(atrophy,intestinal metaplasia and low grade atypical hyperplasia)confirmed by gastroscopy and pathology were randomly divided into three groups.Radix Curcumae Group:received Radix Curcumae Granule and folic acid for treatment;Notoginseng Group:received Notoginseng Powder and folic acid for treatment;Folic Acid Group:received folic acid for treatment.All the patients received continuous treatment for 6 months.The symptom changes,drug combination during the treatment were noted.After treatment,all the patients underwent grastroscopy and pathology examination.The score changes of symptom and pathology were compared before and after treatment.[Results]Eighty-four patients finished 6 months treatment.The symptom scores of all three groups after treatment were significant decreased(P＜0.05).The symptom scores of Radix Curcumae group and Notoginseng group were lower than Folic Acid Group,while there was no statistical significance(P＞0.05).After treatment,the score of atypical hyperplasia,atrophy and intestinal metaplasia of all three groups were significantly decreased(P＜0.05).The score of atrophy,intestinal pathological in Radix Curcumae group and Notoginseng group were decreased greater than folic acid group,while the difference was not statistically significant(P＞0.05).No significant change of the inflammation score and activeness score in all of the three groups before and after treatment(P＞0.05).[Conclusion]Radix Curcumae and Notoginseng combined with folic acid are effective for patients with premalignant gastric lesions and can significantly reverse gland atrophy,intestinal metaplasia and low grade atypical hyperplasia in certain degree.

Aim: To discuss the clinical value of endoscopic submucosal dissection (ESD) for treating upper gastrointestinal lesions. Methods: A total of 52 patients who underwent ESD between May 2012 and May 2013 were retrospectively analyzed to assess the feasibility, safety and efficacy of ESD for treating upper gastrointestinal lesions. Results: Among 52 patients, 4 had esophageal lesions, 48 had gastric lesions. Postoperative pathology revealed that 40 were mucosal lesions, including esophageal papilloma (n = 2), cardiac hyperplastic polyps (n = 9), cardiac adenoma (n = 3), early gastric cancer (n = 2), high grade intraepithelial neoplasia (n = 3), low grade intraepithelial neoplasia (n = 5), gastric antral adenomatous polyps (n = 9), hyperplastic polyps (n = 5), and intestinal metaplasia (n = 2); and 12 were submucosal lesions, including esophageal leiomyoma (n = 1), esophageal gastrointestinal stromal tumor (n = 1), gastric heterotopic pancreas (n = 7), gastric body gastrointestinal stromal tumor (n = 2), and lipoma (n = 1). All the lesions were completely resected and were confirmed by pathologic examination. No severe bleeding occurred. Perforation occurred in two cases but was safely managed by conservative treatment. Conclusion: ESD is a safe, effective and recommendable treatment for upper gastrointestinal lesions. It can not only resect the lesions completely, but also provide accurate pathologic information. ? 2014 Baishideng Publishing Group Co., Limited. Allrights reserved.

反流性食管炎(reflux esophagitis, RE)是指胃十二指肠内容物反流入食管,引起食管组织损伤,临床上以反酸、烧心、胸骨后疼痛等为主要特征.内镜检查是有效的诊断方法,以往临床上对反流性食管炎不够重视,对于检出率的报道较少.本研究通过对本院胃镜诊断RE患者资料的回顾性分析来总结和探讨RE的特点.