目的:探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)和内镜黏膜下剥离术(endoscopic submucosal dissec-tion,ESD)治疗早期结直肠癌的临床效果及安全性.方法:回顾性分析 2015年 5月至 2021年 12月在福建省立医院南院行内镜治疗的早期结直肠癌患者的资料.根据治疗方法不同,分为EMR和ESD两组,比较两组患者手术时间、整块切除率、完全切除率、并发症发生率及复发率.结果:共纳入 167例患者,其中EMR组 74例,ESD组 93例.ESD组的手术时间均长于EMR组(P<0.05).病变直径≥20 mm时,ESD组病灶整块切除率、完全切除率高于EMR组(P<0.05);病变直径<20 mm时,EMR组和ESD组病灶整块切除率及完全切除率差异无统计学意义(P>0.05).在EMR组中,病变直径≥20 mm的整块切除率和完全切除率均低于病变直径<20 mm(P<0.05).ESD组术后并发症发生率高于EMR组(P<0.05).ESD组术后复发率低于EMR组,差异无统计学意义(P>0.05).结论:EMR在直径<20 mm的病灶中疗效显著.而在直径≥20 mm的病灶中,ESD能获得更高的切除率及更好的临床疗效.

BACKGROUND Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the “gold standard” for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate. AIM To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation. METHODS We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies. RESULTS A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs (P < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms (P > 0.05). CONCLUSION Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.

目的 探讨经口内镜下肌切开术治疗贲门失弛症的临床疗效.方法 回顾性分析本院2010年8月至2017年12月确诊为贲门失弛症并于本科室行经口内镜下肌切开术(per-oral endoscopic myotomy,POEM)手术的48例患者的临床资料,根据有无既往诊疗史将患者分为2组,无既往诊疗史组34例,有既往诊疗史组14例,分析2组患者术后以及随访过程中并发症发生情况及临床疗效.结果 48例患者POEM手术均顺利完成.肌切开长度4～11 cm,随访时间3～88个月,术前Eckardt评分3～11分,平均(7.54±1.76)分,术后Eckardt评分0～5分,平均(1.67±1.31)分,较术前明显降低(P<0.05),3个月后4例Eckardt评分>3分,其中1例行第二次POEM手术,随访至目前(61个月)Eckardt评分<3分.术后并发症发生率20.8％(10/48),无一例与手术相关死亡病例,所有并发症经对症、保守治疗后痊愈,无一例追加外科手术.2组患者在并发症的发生率以及疗效上的差异无统计学意义.结论 POEM手术并发症的发生以及疗效与既往诊疗史无关,是一种治疗贲门失弛症安全、有效的手术方式,且有较好的远期疗效.

在普通胃镜下,通常对胃黏膜明显隆起或凹陷的病变较易识别,而胃黏膜平坦型病变在普通白光下仅表现为浅表隆起、凹陷或黏膜色泽改变,是胃黏膜病变中较易漏诊的特殊类型.本研究对194例胃黏膜平坦型病变患者的胃镜检查结果和病理资料进行分析,以期加强对胃黏膜平坦型病变的认识,提高早期胃癌和癌前病变的发现率和诊断率.

目的 评估普通窄带成像在组织病理中性粒细胞浸润预测幽门螺杆菌感染黏膜活检中的临床应用价值.方法 随机观察324例胃镜检查患者,以尿素酶方法诊断H.pylori感染,胃镜普通窄带成像判别胃体黏膜分型,利用配对卡方检验及Kappa检验行统计学分析.结果 胃体黏膜糜烂组:中性粒细胞浸润预测H.pylori感染的灵敏度、特异度、阳性预测值和阴性预测值分别为(100%,90%,98.87%,100%,P>0.05,Kappa值=0.942);胃体黏膜非糜烂组:①非萎缩肠化黏膜病理中性粒细胞浸润检出率100%;②萎缩黏膜及肠化黏膜病理均未见中性粒细胞浸润.结论 NBI糜烂胃体黏膜及非萎缩肠化黏膜中性粒细胞浸润预测H.pylori感染具有较高参考价值;NBI肠化或萎缩胃体黏膜中性粒细胞浸润预测H.pylori感染参考价值低.