Objective:To evaluate the efficacy and safety of endoscopic treatment for patients with anastomotic varices(AV)and explore the optimal treatment.Methods:Eight patients with AV were enrolled. These patients were diagnosed by endoscopy from 2006 to 2020 in our center. Clinical features, endoscopic findings, treatment methods, adverse events and follow-up data were analyzed retrospectively.Results:Of the 8 patients, 4 had cavernous transformation in portal vein, and 1with liver cirrhosis. Hematemesis and melena were the most common initial symptom. During endoscopic examination, active bleeding in 2 cases and positive red color signs in other 3 cases were found. Five patients received endoscopic treatment. Three cases were treated with endoscopic cyanoacrolate injection (ECI), one with endoscopic injection sclerotherapy (EIS), and one with endoscopic variceal ligation(EVL). Immediate hemostasis rate was 100% post-endoscopic treatment for anastomotic variceal bleeding . Five-day treatment failure ratio was 20% . Six-week mortality after endoscopic treatment for anastomotic variceal bleeding was 0. The only adverse event was fever in one patient. During the follow-up period, one rebleeding case died of failure of conservative treatment for rebleeding.Conclusions:AV bleeding is rare and has the characteristics of difficult diagnosis, large volume of bleeding, difficult hemostasis, and poor prognosis. Endoscopic treatment of AV bleeding is feasible, safe, and effective. The recurrent bleeding rate of this disease is not satisfied, endoscope follow-up should be emphasized. If rebleeding occurring, endoscopic treatment or interventional treatment should still be used.

Objective:To analyze the application effect of intensified health education in endoscopic treatment of esophageal varices in the elderly.Methods:From March 2022 to December 2022, 96 elderly patients with esophageal varices over the age of 60 who were admitted to the Department of Gastroenterology at the First Medical Center of the General Hospital of the People's Liberation Army and required endoscopic treatment were selected as the study subjects. Among them, 48 elderly patients selected in the first five months were selected as the control group, and 48 elderly patients selected in the next five months were selected as the enhancement group.The control group was given routine health education, while the reinforcement group was provided with intensified education and intervention based on the control group′s education. To compare the cooperation degree and nursing service satisfaction of the two groups of patients in general endoscopic treatment.Results:The cooperation degree of the enhanced group during endoscopic treatment was better than that of the control group (P<0.05); The evaluation of nursing service satisfaction was significantly improved compared to the control group (P<0.05).Conclusion:Intensive health education can effectively improve the cooperation degree of elderly patients in the process of conventional endoscopic treatment, and improve nursing service satisfaction.

目的 分析总结经内镜下金属钛夹治疗残留和/或复发性细小的食管静脉曲张的可行性和临床疗效.方法 将2012年2月至2013年7月于中国人民解放军总医院因食管静脉曲张套扎或硬化治疗后出现残留血管以及复发的较为细小的静脉(直径为0.3～0.5cm)病例按照预先经过SPSS 13.0软件进行的简单随机分组分为钛夹治疗组(简称钛夹组)和硬化治疗组(简称硬化组),进行安全性和有效性对比,并对所有钛夹治疗病例进行为期10年的长期随访,分析总结钛夹夹闭治疗后食管静脉曲张消失情况、钛夹应用技巧,以及术后并发症情况、术后住院时间及长期疗效进行对比.结果 钛夹组静脉曲张消失率为93.3％,硬化组静脉曲张消失率为86.7％,两组差异无统计学意义(P>0.05).钛夹组治疗次数显著少于硬化组[(1.13±0.35)次vs.(1.67±0.82)次,P<0.05].钛夹组住院日显著少于硬化组[(9.3±2.4)d vs.(14.3±5.9)d,P<0.05].钛夹组术后并发症发生率显著低于硬化组(P<0.05).钛夹组术后无一例使用抗生素;硬化组术后均使用抗生素3d预防感染.首次行钛夹治疗后1个月、3个月、6个月、9个月的静脉曲张消失率分别为97.4％、97.2％、93.3％、90.9％.结论 内镜下金属钛夹夹闭治疗残留和/或复发性细小的食管静脉曲张操作简单、安全,均可达到较好效果,以短期疗效为著,并发症发生率低且可减少抗生素的使用.治疗后3个月及6个月进行胃镜复查,此后根据胃镜检查结果适当调整复查时间.

目的 分析并总结胰十二指肠术后消化道少见部位静脉曲张(吻合口静脉曲张)破裂出血内镜下组织胶注射治疗的临床特点.方法 回顾性分析我院2011年9月至2021年9月十年间胰十二指肠术后消化道少见部位静脉曲张破裂出血内镜下治疗病例及近十年文献报道中吻合口静脉曲张病例,总结其临床特点、内镜诊断及内镜下组织胶治疗的价值.结果 4212例内镜下考虑或确诊为消化道静脉曲张病例中,有9例为胰十二指肠切除术后病例,其中7例因消化道出血行胃镜检查,共检出3例为胰十二指肠切除术后合并消化道吻合口静脉曲张.该3例患者既往均无基础肝病,表现为不同程度的消化道出血.胃镜检查均发现同时合并有食管和(或)胃底静脉曲张,均接受内镜下组织胶注射治疗,内镜下止血效果显著.吻合口静脉曲张内镜治疗组复发率较高,介入治疗组并发症发生率较高,两组有效性及安全性差异无统计学意义(P>0.05).结论 胰十二指肠切除术后出现消化道出血时,应警惕吻合口少见部位静脉曲张的发生,行胃镜检查时应尽量对所有吻合口进行探查,内镜下组织胶注射治疗是此类静脉曲张出血的有效治疗方法.该病复发出血率较高,应强调内镜随访,发现新发或具有出血风险曲张静脉时仍需重复内镜下治疗.在查明曲张静脉的引流静脉和门静脉高压原因后,进一步选择针对性治疗,以减少曲张静脉复发出血.

With the development of tissue engineering and regenerative medicine, it is much desired to establish bioimaging techniques to monitor the real-time regeneration efficacy in vivo in a non-invasive way. Herein, we tried magnetic resonance imaging (MRI) to evaluate knee cartilage regeneration after implanting a biomaterial scaffold seeded with chondrocytes, namely, matrix-induced autologous chondrocyte implantation (MACI). After summary of the T2 mapping and the T1-related delayed gadolinium-enhanced MRI imaging of cartilage (dGEMRIC) in vitro and in vivo in the literature, these two MRI techniques were tried clinically. In this study, 18 patients were followed up for 1year. It was found that there was a significant difference between the regeneration site and the neighboring normal site (control), and the difference gradually diminished with regeneration time up to 1 year according to both the quantitative T1 and T2 MRI methods. We further established the correlation between the quantitative evaluation of MRI and the clinical Lysholm scores for the first time. Hence, the MRI technique was confirmed to be a feasible semi-quantitative yet non-invasive way to evaluate the in vivo regeneration of knee articular cartilage.

目的 通过磁共振T2 mapping和磁共振软骨延迟增强成像(dGEMRIC)评估膝关节再生软骨的修复过程.资料与方法 对13例患者的20处再生软骨在基质诱导的自体软骨细胞移植术(MACI)后1、3、6、12个月进行磁共振T2 mapping和dGEMRIC检查,测量再生软骨和邻近正常软骨的T2值和纵向弛豫率差(ΔR1)值,比较术后各时间点再生软骨和正常软骨T2值和ΔR1值的差异,观察再生软骨T2值和ΔR1值在术后1、3、6、12个月的动态变化.结果 再生软骨区T2值和ΔR1值在MACI术后1、3、6、12个月呈逐渐下降趋势,且差异有统计学意义(P<0.01).MACI术后1、3、6个月,再生软骨T2值和ΔR1值高于正常软骨(P均<0.01).术后12个月,再生软骨的T2值和ΔR1值与正常软骨比较,差异无统计学意义(P均>0.05).结论 磁共振T2 mapping和dGEMRIC能作为评价再生软骨生物特性的有效方法,为临床软骨移植工作的疗效评价提供依据.

Objective:To determine the safety and long-term efficacy of endoscopic ultrasonography-guided lauromacrogol ablation (EUS-LA) for treatment of pancreatic cystic neoplasms (PCNs) with a larger population.Methods:From April 2015 to April 2019, 255 patients suspected of PCNs were enrolled in the First Medical Center of Chinese PLA General Hospital in the study, and 57 patients underwent EUS-LA. The effectiveness of EUS-LA was determined based on imaging volume changes. The occurrence of complications was observed and recorded.Results:Among the 57 patients who underwent EUS-LA, 38 were female and 19 were male, with the mean age of 52.0±14.6 years. The cysts were located in the head/uncinate of the pancreas in 33 patients and in the body/tail of the pancreas in 24 patients. A total of 50 patients were followed up by imaging examinations. After treated by EUS-LA, the cyst median volume sharply reduced from 11 434.1 mm 3 to 639.4 mm 3 ( Z=-5.556, P<0.01), and the median diameter decreased from 32.0 mm to 12.0 mm ( Z=-6.161, P<0.01). Postoperative imaging showed a complete resolution in 24 patients (48.0%), partial resolution in 14 patients (28.0%), and persistent cyst in 12 patients (24.0%). The total number of ablation was 69, and there were 12 patients undergoing a second ablation. The adverse events rate was 4.3% (3/69). Among the 34 patients followed up for 12 months or more, complete resolution was observed in 18 patients (52.9%), partial resolution in 9 (26.5%), and persistent cyst in 7 (20.6%). Conclusion:EUS-LA is effective and safe for the treatment of PCNs. Its effectiveness is stable after more than 12 months′ follow-up.

BACKGROUND:Esophageal granular cell tumors (GCTs) are rare tumors. Differences in reports on the clinical features of GCTs in the esophagus and some controversies about the diagnostic strategy for esophageal GCTs exist.OBJECTIVES:We aimed to investigate the clinical features and diagnosis of esophageal GCTs. Additionally, we sought to determine the prevalence of gastroesophageal reflux disease and reflux esophagitis in patients with esophageal GCTs.METHODS:We retrospectively studied the clinical features, endoscopic features, and management of 22 patients with esophageal GCTs.RESULTS:Esophageal GCTs were more common in men than in women with a ratio of 1.2:1 and were predominantly found in the distal esophagus. Ten patients with esophageal GCTs had regurgitation and/or heartburn symptoms, and eight patients were confirmed to have reflux esophagitis by endoscopy. All esophageal GCTs were protuberant lesions covered by normal esophageal epithelium. The endoscopic morphology of esophageal GCTs was diverse. On endoscopic ultrasonography, these tumors appeared as homogeneous or inhomogeneous hypoechoic lesions with clear borders originating from the submucosal or mucosal layer. Eleven patients underwent endoscopic forceps biopsy at the first endoscopy, and only six patients were correctly diagnosed by pathology. Nevertheless, the 18 lesions treated with endoscopic resection were all correctly diagnosed without complications, and no patients developed recurrence during the follow-up period.CONCLUSIONS:The occurrence of esophageal GCTs may be related to esophageal inflammation. As a method for obtaining an accurate pathological diagnosis and for treatment, endoscopic resection should be offered as the primary option for patients with esophageal GCTs.

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.

Background and Aims To determine the value of contrast-enhanced endoscopic ultrasound (CE-EUS) for differentiation of pancreatic cystic neoplasms (PCNs). Methods From April 2015 to December 2017, 82 patients were enrolled in this study. All patients were confirmed to have PCNs by surgical pathology. Prior to surgery, all patients underwent fundamental B-mode EUS (FB-EUS) and CE-EUS, 65 of whom underwent computed tomography (CT) and 71 of whom underwent magnetic resonance imaging (MRI). The enhanced mode data of PCNs were recorded. The diagnostic accuracy of CE-EUS in classifying PCNs was compared with that of CT, MRI and FB-EUS. The ability of CE-EUS to identify PCNs was evaluated by comparing the enhanced mode of PCNs. Results There was a significant difference between benign and malignant lesions in enhanced mode ( P = 0.017). The enhanced modes of benign lesions were mostly type II and type III, while those of malignant lesions were type 0, type I, and type IV. The sensitivity, specificity, and accuracy of type 0, type I, and type IV enhanced mode as the diagnostic criterion for malignant lesions were 80%, 65.3%, and 67.1%, respectively. CE-EUS demonstrated greater accuracy in identifying PCNs than did CT, MRI, and FB-EUS (CE-EUS vs. CT: 92.3% vs. 76.9%; CE-EUS vs. MRI: 93.0% vs. 78.9%; CE-EUS vs. FB-EUS: 92.7% vs. 84.2%). Conclusion Compared with CT, MRI, and FB-EUS, CE-EUS is better at differentiating PCNs. CE-EUS is expected to be another important imaging technique for the diagnosis of PCNs.

Introduction: EUS-guided lauromacrogol ablation has proven to safe and efficacious; however, its long-term effectiveness remains unknown. This study aimed to further determine the effectiveness of lauromacrogol ablation with long-term follow-up and to determine the most appropriate time when re-ablation should be performed. Methods: Forty-two patients undergoing EUS-guided ablation using lauromacrogol alone among 222 patients suspected of having PCNs were enrolled prospectively from April 2014 to June 2018. Ultimately, we studied 26 patients with at least 12 months of follow-up. Imaging was obtained at 3 months after ablation, after an interval of 6 months and every year thereafter. The effectiveness of ablation was determined based on volume changes. Results: The study group included 17 females and 9 males, with an overall mean age of 54.7 years. Cysts were located in the head/uncinate of the pancreas in 19 patients (73.1%) and in the body/tail of the pancreas in 7 patients (26.9%). The median volume of cysts sharply reduced from 11088.2 mm3 to 509.20 mm3 (P<0.001) and the mean diameter decreased from 34.1 mm to 12.9 mm (P<0.001). Postoperative imaging showed complete resolution (CR) in 14 patients (53.8%), PR in 6 patients (23.1%), and PC in 6 (23.1%). The adverse events (AEs) rate was 9.1% (3/33). Conclusion: EUS-guided lauromacrogol ablation is effective (providing a 53.8% rate of CR) and safe (an AEs rate of 9.1%). Re-ablation is recommended at about 5 months after ablation if the cyst is larger than 10.0 mm in diameter.89_A Figure 1. CT before EUS-guided ablation with lauromacrogol, showing a 37.0 mm round cyst in the uncinate89_B Figure 2. Follow-up CT at 22 months after the first ablation, showing the cyst disappearing89_C Figure 3. The trend of volume change during the 12-month follow-up time after excluding 7 patients underwent 2 times ablation

目的 隐匿性乳腺癌(occult breast cancer,OBC)是一种少见类型的乳腺癌,OBC发病率较低,缺乏大样本的临床研究,因而在诊断和治疗上存在较多争议.本研究回顾性分析9例OBC患者的临床资料,探讨OBC的诊断、治疗及预后.方法 选取解放军总医院2013-08-27-2015-01-23收治的OBC患者9例.患者均为女性,平均年龄50.7岁,中位年龄52岁.本组均因腋下无痛性肿块而就诊,穿刺病理确诊为淋巴结转移性腺癌.6例行乳腺癌改良根治术,3例行腋窝淋巴结清除术.结果 9例患者术后病理均确诊为OBC,3例经全乳连续切片发现原发癌灶.TNM分期:T0N1M05例,T0N2M01例,T0N3M03例.全组9例均获随访,随访时间为11～28个月.除1例死亡外均无瘤生存至今,未见局部复发和远处转移.结论 OBC是乳腺癌的一种特殊类型,发病隐匿,但预后好.以腋下无痛性肿物而就诊的中老年女性应考虑OBC的可能.穿刺病理结合免疫组化可以帮助确诊.乳腺MR是术前筛查乳腺内原发灶的最敏感方法.治疗应以手术为主,术后加做全身的辅助综合治疗.

OBJECTIVE:To estimate zonal variation of GAG content in reparative cartilage after matrix associated autologous chondrocyte implantation (MACI) using delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC).METHODS:Seven patients (14 cartilage defects) undergoing MACI were recruited for examination with dGEMRIC at 3, 6, and 12 months after the procedure to calculate global and zonal longitudinal relaxivity (Δ R1) of the normal cartilage and reparative cartilage.RESULTS:The mean Δ R1 values of normal cartilage were significantly lower than those of reparative cartilage after MACI. A significant decrease was noted in the mean Δ R1 values from the deep layer to the superficial layer in the reparative cartilage at the 3 examinations. The Δ R1 values of the reparative cartilage showed no significant variation between 3 months and 6 months, but a significant decrease in the Δ R1 values occurred at 12 months.CONCLUSIONS:dGEMRIC is feasible to assess cartilage repair noninvasively following MACI.