An elderly woman with persistent abdominal pain and bloating was diagnosed with obstructive sigmoid colon cancer on computed tomography (CT) ([Fig. 1]). Because of a low oxygen saturation value caused by secondary aspiration pneumonia she was admitted to the intensive care unit; therefore transfer to a fluoroscopy-equipped operating room was inappropriate.

目的 探讨经口胆道镜(peroral cholangioscopy,POCS)联合胆管腔内超声(intraductal ultrasonography,IDUS)在胆道狭窄病变诊治中的诊断价值.方法 回顾性分析我中心2019年9月至2022年10月共收治的39例胆道狭窄患者,以引进使用POCS的时间为界,分为IDUS组(21例)和POCS+IDUS组(18例),全部患者均经内镜逆行胰胆管造影术(ERCP)成功插管并应用IDUS于病灶处扫查,IDUS组予透视下活检,POCS+IDUS组予直视观察并精准活检.通过活检或手术病理证实,或随访疾病进展,综合判断良恶性质.结果 IDUS组对胆管恶性狭窄诊断的敏感性为53.33％(8/15)、准确率为 57.14％(12/21);POCS+IDUS组分别为 92.86％(13/14)、88.89％(16/18),后者均高于前者,差异有统计学意义(P=0.035,P=0.037).两组均无术后急性重症胰腺炎、穿孔及与操作相关的死亡.结论 POCS具备清晰的视觉影像,且可精准活检提供病理诊断;IDUS对胆管壁及周围组织的扫查,可以明确恶性狭窄侵犯范围.两者联合应用能极大提高诊断准确率,并为外科患者管理及手术方案选择提供依据.

Objective:To explore the application value of the new gastric cancer screening scoring system for risk populations in the island of Fujian province.Methods:From April to June 2019, gastric cancer screening was performed on the population of Nanri Island, Putian City, Fujian Province, and epidemiological data of all subjects were prospectively collected. Participants underwent gastroscopy based on gastric cancer risk stratification of the new scoring system. Suspected positive cases further received magnifying endoscopy and biopsy. Additional endoscopic procedures and other surgical treatments were conducted. The detection rates of gastric cancer and precancerous lesions in each group of gastric cancer risk stratification were compared, and the Chi-square test was used for statistical analysis.Results:A total of 1 423 subjects were included, and 19 cases (1.34%) of gastric cancer were detected. The detection rates of gastric cancer were 0.88% (9/1 025) in the low-risk group, 1.76% (6/341) in the medium-risk group, and 7.02% (4/57) in the high-risk group. Paired comparison between the low-risk group and the high-risk group showed significant difference ( χ2=12.364, P=0.003). There was no significant difference between the low-risk group and medium-risk group, or between the medium-risk group and high-risk group ( P>0.05). Among all participants, 87 (6.11%) cases of gastric precancerous lesions were identified. The detection rates of precancerous lesions in the low-risk, medium-risk, and high-risk groups were 6.24% (64/1 025), 5.87% (20/341), and 5.26% (3/57) respectively, with no significant difference among the three groups ( P>0.05) .Conclusion:During gastric cancer screening, the novel gastric cancer screening scoring system helps to stratify gastric cancer risk for population in the islands of Fujian province, serving as a foundation for subsequent detailed endoscopy.

目的 探讨"省县医院"共建模式对基层医院消化道早癌诊疗水平的影响.方法 回顾性分析2019年5月至2021年6月在仙游县总医院消化内镜科接受胃镜检查、活检病理提示早期食管癌(early esophageal cancer,EEC)和早期胃癌(early gastric cancer,EGC)患者的临床资料,根据共建帮扶时间,分为共建前组和共建后组,比较共建前后EEC及EGC的检出情况、内镜治疗及并发症发生情况.结果 共入组71例上消化道早癌病例,其中共建前组19例,共建后组52例.共建前组完成胃镜11 021例,19例早癌,349例进展期癌,上消化道早癌检出率为0.17％(19/11 021),早诊率为5.44％(19/349);共建后组完成11 148例胃镜,52例患者,359例进展期癌,上消化道早癌检出率为0.47％(52/11 148),早诊率为14.5％(52/359).两组上消化道早癌检出率及早诊率差异均有统计学意义(均P=0.000).共建前组无消化道早癌内镜治疗病例,共建后组共有24例早癌患者行内镜治疗,均无出血、穿孔及狭窄等并发症发生.结论 "省县医院"的共建帮扶模式,可显著提高下层医院的上消化道早癌诊疗水平.

目的 探讨对接技术在消化道重建术后行常规内窥镜逆行胰胆管造影(ERCP)治疗困难患者中的应用价值.方法 回顾性分析我中心2014年10月至2022年4月收治的消化道重建术后行内窥镜逆行胰胆管造影(ERCP)的169例患者资料,其中行常规ERCP治疗失败的21例,采用对接技术治疗.结果 21例采用对接技术治疗的患者中,16例经通过经皮经肝胆管引流(PTCD)与ERCP对接成功(PE-RV),1例经超声内镜穿刺胆管(EUS-BD)与ERCP对接成功(EUS-RV),对接成功率达80.9％.4例失败,2例因输入襻肠管冗长扭曲呈锐角,1例输入襻肠管缺血挛缩致肠腔狭窄,致内镜无法到达盲端;另1例因外科手术损伤胆管中段,纤维化而致严重狭窄,未能顺利对接,改行腹腔镜下胆肠吻合术.术后不良反应发生率为23.5％,包括2例胰腺炎,1例胆管炎,1例腹痛,均予保守治疗后缓解.结论 对接技术是一种对消化道重建术后行常规ERCP治疗失败患者安全、有效的补救方法,可提高消化道重建术后ERCP治疗的成功率.

目的 探究十二指肠球部严重狭窄合并胆总管开口异位患者的内镜逆行胰胆管造影(ERCP)诊疗方案.方法 回顾性分析我院收治的十二指肠球部严重狭窄合并胆总管异位开口患者10例的临床资料,其中十二指肠乳头异位3例,确诊胆管-十二指肠瘘7例,分析两类异常胆管开口在成因、临床症状方面的差异,并比较内镜下的诊断、ERCP治疗的技术难点.结果 患者均合并胆总管结石,4例合并胆总管末端狭窄,3例有胆囊切除术史.患者均出现上腹疼,其中7例伴发热,7例出现梗阻性黄疸.患者均插管成功,行胆管造影检查,术后并发轻症急性胰腺炎1例,无出血和穿孔等其他并发症.3例十二指肠乳头异位患者中1例患者行球部狭窄球囊扩张术后,经乳头括约肌切开取石成功.7例胆管-十二指肠瘘患者经瘘口插管并成功取石.结论 十二指肠球部狭窄易合并十二指肠乳头异位或胆管-十二指肠瘘,两者都存在胆管开口异位情况.通过异位开口部位、形态、周围黏膜特征,准确辨别是何类胆管开口异位,采取应对措施以提高ERCP的成功率和减少并发症,并为可能的外科手术提供明确诊断,合理地选择术式.

Objective:To evaluate the efficacy and safety of budesonide viscous suspension (BVS) in preventing extensive esophageal stenosis after endoscopic submucosal dissection(ESD).Methods:Data of 62 cases of early esophageal neoplasms or precancerous lesions receiving ESD whose postoperative mucosal defects were more than half the circumference of the esophageal lumen at Fujian Provincial Hospital from October 2014 to December 2018 were retrospectively studied. The patients were divided into the BVS group who received BVS therapy (n=24) and the control group who received no intervention (n=38). The incidence of postoperative stenosis, the number of bougie dilation procedures and complications were compared between the two groups. Risk factors for postoperative stricture were analyzed by logistic regression.Results:The incidence of postoperative stenosis [16.7% (4/24) VS 47.3% (18/38), P=0.005], the number of bougie dilation procedures (1.50±0.58 VS 2.70±1.09, P=0.039) in the BVS group were significantly lower than those in the control group. No serious adverse events such as perforation or massive hemorrhage related to BVS were observed in the BVS group. Multivariate logistic regression analysis showed circumferential extension ≥3/4 ( OR=37.970, 95% CI: 6.338-227.482) and non-intervention with BVS( OR=20.962, 95% CI: 3.374-130.243) were the independent risk factors for esophageal stricture after ESD. Conclusion:Administration of BVS is an effective and safe method to reduce the incidence of stenosis and the number of bougie dilation procedures for extensive esophageal stenosis after ESD.