目的:观察内镜下息肉勒除器冷切除术治疗大肠小息肉的临床效果.方法:选取2020年1月-2021年6月粤北人民医院消化内科收治的大肠小息肉患者150例作为研究对象,采用随机数字表法分为冷圈套组、活检钳除组及电切组,每组50例.三组患者均在内镜下实施息肉切除手术.冷圈套组采用息肉勒除器冷切除息肉;活检钳除组采用活检钳切除息肉;电切组采用高频电凝电切设备切除息肉.比较三组患者息肉的位置、大小、数量,手术时间,治疗费用,术中出血率,术后两周出血率,手术并发穿孔率,结肠息肉的完整切除率及标本回收率.结果:三组患者在息肉的位置、大小、数量方面相比,差异均无统计学意义(P>0.05).电切组的手术时间长于冷圈套组和活检钳除组、治疗费用高于冷圈套组和活检钳除组(P<0.05);冷圈套组、活检钳除组手术时间、治疗费用相比,差异均无统计学意义(P>0.05).电切组术后两周出血率高于冷圈套组和活检钳除组(P<0.05);三组患者术中出血率相比,差异无统计学意义(P>0.05);三组患者均未出现肠穿孔.冷圈套组、电切组结肠息肉完整切除率均高于活检钳除组(P<0.05);冷圈套组和电切组结肠息肉完整切除率相比,差异无统计学意义(P>0.05);三组标本回收率相比,差异无统计学意义(P>0.05).结论:对于6～9 mm的大肠小息肉,选择息肉勒除器冷圈切除,手术时间短、并发症较少且有利于标本的获取,值得在各级医院推广.

Objective To explore the clinical effect of endoscopy hemostatic forceps versus and epinephrine injection used in combination with metal clip for treatment of acute bleeding from duodenal ulcer. Method A total of 100 patients with duodenal ulcer bleeding admitted to Yuebei People''s Hospital from January 2020 to June 2021 were randomLy divided into Hemostatic forceps group and injection group, with 50 cases in each group. The Hemostatic forceps group was treated with electrocoagulation combined with metal clip, and the injection group was treated with epinephrine injection combined with metal clip. The consumption time of hemostatic operation, hemostatic rate, rebleeding rate, surgical transfer rate and interventional surgery rate, and complication rate were compared between the two groups. Result The hemostatic rate was 100％ in both groups. The rate of rebleeding was 4％ (2/50) and the surgical transfer and interventional surgery rate was 2％ (1/50) in the Hemostatic forceps group, and 6％ (3/50) and 4％ (2/50) in the injection group. There was no significant difference between the two groups. The operation time of endoscopic hemostasis in the injection group (12.28±2.62 min) was significantly shorter than that in the Hemostatic forceps group (17.36±3.00 min) (P ＜ 0.05). The total incidence of adverse events in the injection group was 14％, which was significantly lower than that in the Hemostatic forceps group (34％) (P ＜ 0.05). Conclusion Both endoscopic hemostatic forceps combined with metal clip or injection of epinephrine combined with metal clip can achieve good hemostatic effect in patients with acute bleeding from duodenal ulcer. However, under the same circumstances, the operation time of the latter in emergency hemostasis is faster and the complications are less, which is worthy of clinical promotion.

目的 探讨自拟柴术苡乌汤治疗腹泻型肠易激综合征(IBS-D)肝郁脾虚证的疗效.方法 选取2020年12月至2022年9月达州市中西医结合医院、达州市通川区中医院、达州市达川区中医医院共102例肝郁脾虚型IBS-D患者,随机分为观察组与对照组,每组各51例患者,对照组给予匹维溴铵片,观察组给予自拟柴术苡乌汤,两组均持续治疗4周,比较两组中医证候疗效、中医症候积分、腹泻与腹痛应答率、IBS-SSS积分、Th1型细胞因子[干扰素-γ(IFN-γ)、白细胞介素(IL-2)]和Th2型细胞因子(IL-4、IL-10)表达以及不良反应和复发情况.结果 观察组临床治疗有效率94.12％高于对照组78.43％(P<0.05);观察组治疗后中医症候积分低于对照组(P<0.05);观察组治疗2周、治疗4周腹泻应答率为52.94％、82.35％、腹痛应答率为56.86％、86.27％分别高于对照组35.29％、62.75％、37.25％、66.67％(P<0.05);观察组治疗后IBS-SSS积分低于对照组(P<0.05);观察组治疗后Th1细胞因子IL-2、IFN-γ水平低于对照组,Th2细胞因子IL-4、IL-10水平高于对照组(P<0.05);观察组疗程结束后3个月复发率6.25％低于对照组22.50％(P<0.05).结论 自拟柴术苡乌汤可有效减轻IBS-D患者腹痛、腹泻、腹胀症状,纠正Th 1/Th2平衡,降低疾病复发率.

目的:分析消化内镜治疗胃十二指肠溃疡出血患者的方法与效果.方法:选取本院2016年1月～2020年12月54例接受治疗的胃十二指肠溃疡出血患者为研究对象,随机分为27例观察组和27例对照组,对照组用常规药物注射止血治疗,观察组用消化内镜治疗,对比研究两组不同方法的治疗相关指标、临床治疗总有效率、并发症发生率.结果:观察组的输血量、出血量、止血时间、住院时间均少于对照组,观察组治疗效果总有效率96.30％比对照组77.78％高(P<0.05).结论:经消化内镜下氩气刀治疗胃十二指肠溃疡出血安全有效,可以缩减出血量和治疗时间,提高治疗效果,同时还降低了并发症发生率,其治愈疗效有临床价值.

目的 探讨影响慢性乙型肝炎患者并发肝衰竭死亡的危险因素.方法 回顾性分析2019年1月至2021年2月在广东省韶关市粤北人民医院接受诊治的140例慢性乙型肝炎并发肝衰竭患者的临床资料,按照患者接受内科综合治疗后是否存活分为生存组(治疗后临床症状好转,n=77)、死亡组(治疗后无效死亡,n=63).比较两组患者各项临床资料,采用单因素和多因素Logistic回归分析影响乙型病毒性肝炎患者并发肝衰竭死亡的危险因素.结果 本研究经单因素分析结果显示,病程、血氨水平、CTP评分、MELD评分、血钠水平、年龄、碱性磷酸酶水平、转氨酶水平、血清胆红素水平、凝血酶原时间、肝性脑病、肝肾综合征、消化道出血的发生对乙型病毒性肝炎患者并发肝衰竭死亡有一定影响(均P<0.05).经进一步多因素分析结果显示,高龄、高碱性磷酸酶水平、高转氨酶水平、高血清胆红素水平、凝血酶原时间延长、肝性脑病、肝肾综合征、消化道出血的发生是影响乙型病毒性肝炎患者并发肝衰竭死亡的独立危险因素(OR=1.347、1.029、1.654、1.352、1.274、0.081、16.415、0.937,均P<0.05).结论 高龄、高碱性磷酸酶水平、高转氨酶水平、高血清总胆红素水平、凝血酶原时间延长、肝性脑病、肝肾综合征、消化道出血的发生是影响乙型病毒性肝炎患者并发肝衰竭死亡的独立危险因素.

目的:对于肝硬化失代偿期的治疗,分析恩替卡韦与保肝药物合用的治疗效果.方法:本次研究对象共58例,是我院收治的肝硬化失代偿期患者,选取时间段为2018年1月至2020年12月.根据治疗方法不同进行分组,分为对照组(保肝药物治疗)和实验组(恩替卡韦+保肝药物治疗),每组29例.结果:两组治疗前后经影像学检查发现,同治疗前相比,治疗后患者的脾静脉内径、脾脏厚度、门静脉内径均有显著降低,但实验组更明显(P<0.05);与治疗前相比,治疗后总胆红素(TBiL)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平降低,但实验组低于对照组(P<0.05).结论:在保肝药物治疗的基础上应用恩替卡韦治疗肝硬化失代偿期,疗效肯定,能有效改善患者的肝功能,利于改善患者预后.

目的 探讨C反应蛋白与清蛋白比值(CAR)对重症急性胰腺炎预后的预测价值.方法 选取2017年11月～2019年11月在我院住院的105例重症急性胰腺炎患者进行回顾性分析,依据临床预后分为存活组91例及死亡组14例.入院24h内采血送检,比较两组的C反应蛋白(CRP)、清蛋白(ALB)水平及CAR.结果 重症急性胰腺炎存活组和死亡组年龄、性别、ALB水平差异均无统计学意义(P>0.05).存活组的CRP和CAR低于死亡组,差异有统计学意义(P<0.05).二元Logistic回归分析结果提示CRP(OR=1.024,95％CI:1.002～1.046)和CAR(OR=1.785,95％CI:1.149～2.773)是重症急性胰腺炎预后不良的独立危险因素.ROC曲线结果提示CAR曲线下面积(AUC)最大(AUC=0.730,P=0.06),当取最佳界值为3.95时,其对应的灵敏性和特异性分别为57.1％和65.9％.结论 入院24h内CAR是重症急性胰腺炎预后的独立危险因素,对重症急性胰腺炎的预后具有较好的预测效能.

目的:观察奥曲肽与奥美拉唑联合胃镜治疗肝硬化合并上消化道出血的临床效果.方法:抽取58例肝硬化伴食道静脉曲张破裂出血患者开展研究,对其临床资料进行回顾性分析,以治疗方案作为分组依据,将其分为对照组、治疗组,每组29例.对照组治疗奥曲肽联合奥美拉唑治疗,治疗组奥曲肽联合奥美拉唑治疗基础上,联合胃镜进行治疗.对比两组的治疗总有效率、症状好转时间及止血时间、临床观察指标等情况.结果:治疗组的总有效率高于对照组,差异有统计学意义(P<0.05);治疗组患者症状好转时间及止血时间短于对照组,差异有统计学意义(P<0.05);治疗组患者临床观察指标优于对照组,差异有统计学意义(P<0.05).结论:对肝硬化合并上消化道出血患者采用奥曲肽联合奥美拉唑治疗基础上加用胃镜进行治疗,可提高治疗有效率,不仅缩短症状好转时间及止血时间,还可以优化临床观察指标,临床值得进一步推广.

[目的]通过改良清洁灌肠操作流程提高肠镜检查的效果与老年病人对清洁灌肠的自评舒适度.[方法]将2017年11月—2018年12月在老年病科、中医科、消化内科住院的120例老年病人(年龄≥65岁)随机分为观察组和对照组各60例,对照组清洁灌肠的操作流程参照第5版《基础护理学》,观察组采用改良清洁灌肠操作流程,清洁灌肠的插入深度为15～25 cm、溶液为100 mL开塞露溶解在35～36℃1000 mL生理盐水中、体位为旋转体位.比较两种操作流程对老年病人清洁灌肠效果的影响,观察两组病人Boston肠道准备量表评分、灌肠液保留时间、灌肠次数、舒适度自评分、灌肠液外漏情况.[结果]两组病人Boston评分表、舒适度评分、灌肠液保留时间、灌肠次数、灌肠液外漏情况比较差异有统计学意义(P<0.01).观察组效果优于对照组.[结论]改良后的清洁灌肠操作流程可提高老年病人灌肠的清洁度,延长灌肠液保留时间,减少灌肠次数与灌肠液外漏,提高老年病人清洁灌肠的舒适度.

Objective: Use the comparison between the optimum combination of FICE wave length adding magnifying endoscope and the result of pathology ,in order to diagnose correctly and treat the colorec-tal eminence lesions in time .Method:By magnifying colonoscopy routine examination , record location , mor-phology, by the different combination of FICE wave length (RGB),Observe micro gland mucosal surfaces of the tube shape and microvascular morphology ,record the optimum wavelength combination ,magnify he lesions 40-200 times.Results: The use of the optimum combination of FICE wavelength adding magnifying endo-scope answers for rate of above 90%of histopathological diagnosis .Conclusion:Using the optimum combina-tion of FICE wavelength adding magnifying endoscope can identify the colonic mucosal neoplastic and non ne -oplastic lesions instantly ,advise the treatment of the corresponding microscopic or operation ,improve the sen-sitivity of diagnosis and treatment of early colorectal cancer and accuracy .

Objective To compare the sedative effects of three combined anesthesia methods in the treatment of esophageal varices under gastroscope and the impact of them on the respiration and circulation. Methods 90 patients undergoing the anesthesia for the treatment of esophageal varices under gastroscope were selected and divided into three groups single-blindly and randomly with 30 patients in each. Group I was first given intravenous injection of fentanyl, then propofol (1~2mg/kg);Group II was first giv-en intravenous injection of fentanyl, then etomidate (0.2~0.3mg/kg);Group III was first given intravenous injection of fentanyl, then intravenous injection of propofol and etomidate mixture (dose ratio 7:1). Three groups of patients were given 2% lidocaine 5ml for pharyngeal surface anesthesia, and given fentanyl 0.5~1ug/kg, the total dose did not exceed 50ug, then started to put into the gas-troscope when the eyelash reflex disappeared. The intraoperative degree of sedation, amnesia and postanaesthetic recovery time, the HR, MAP and pulse oxygen saturation (SpO2) before injection of the drugs, before and after putting into the gastroscope and at the postanaesthetic recovery, and the postoperative nausea and vomiting of the patients were observed. Results There were no sta-tistically significant differences in the changes of blood pressure before and after injection of drugs and during the examination be-tween group II and group III (P>0.05). The blood pressure of group I dropped about 15%~30% after injection of drugs, compared with that before the injection, there was a statistically significant difference (P<0.05). 100% of the patients in the three groups had no response when the gastroscope was put into and no body movement and bucking during the operation. 5 cases (16%) in groupⅡwhile no patients in group I and group III had postoperative nausea and vomiting. All the patients in the three groups had no memory of the inspection process. All the patients in group I and group III but in group Ⅱexcept 10% of the patients due to nau-sea and vomiting were satisfied with the inspection and treatment. Conclusion For esophageal varices, the treatment under gastro-scope with fentanyl and propofol and etomidate anesthesia after pharyngeal surface anesthesia is safe, effective, simple and feasi-ble.

目的 探讨内镜智能分光比色技术和缺氧诱导因子-1α (HIF-1α)的表达在大肠息肉样病变中的诊断价值.方法 通过内镜智能分光比色技术对大肠息肉样病变进行黏膜表面细微腺管开口形态分型及微血管形态观察,同时用免疫组织化学法检测病变组织HIF-1α的表达.结果 炎症性息肉和癌性息肉的腺管开口形态分型及微血管分型形态比较,差异有统计学意义(P＜0.05);癌性息肉HIF-1α的表达强度明显高于炎症性息肉HIF-1α的表达强度,差异有统计学意义(P＜0.05);不同腺管开口分型及微血管分型形态的大肠息肉HIF-1α的表达强度比较,差异有统计学意义(P＜0.05).结论 内镜智能分光比色技术能够清楚观察大肠息肉患者的膜表面微细结构及微血管形态,有利于息肉样病变患者疾病的早期诊断,HIF-1α在肿瘤性息肉患者组织中的高表达有利于结肠早期癌的发现.

Objective To explore early postoperative rebleeding risk factors of cirrhosis esophageal variceal ligation ( EVL) . Methods Eighty patients treated with EVL were divided into observation group ( 20 patients with postoperative rebleeding) and control group ( 60 patients without postoperative rebleeding) . Clinical data of both groups were compared and analyzed so as to explore early postoperative rebleeding risk factors. Results Early rebleeding incidence of 80 patients was 25% ,in which 3 patients died from improper diet. Esophageal varix rupture was the cause of early rebleeding. Portal vein thrombosis,liver function grade of Child-Pugh,hemoglobin,prothrombin time which were analyzed by Logistic retrospective analysis were independent risk factors ( P < 0. 01) . Among the grades of early postoperative bleeding in liver function,grade C ( OR = 65. 0) had obvious influence,the others were prothrombin time ( OR = 33. 5) ,hemoglobin ( OR = 22. 6) and portal hypertension( OR = 8. 6) . Conclusion According to the patient’s organism and rebleeding risk factors,EVL combined with non selective β-receptor blocker which has reduced rebleeding and complication rate can prolong the life of patients.

100例胃肠道疾病患者,平均分为无痛组和对照组各50例,无痛组采用无痛胃镜联合结肠镜对患者进行检查,常规组单纯应用胃镜进行检查。结果无痛组检查时间明显短于常规组;检查过程中不良反应明显少于常规组。应用无痛胃肠镜联合结肠镜对胃肠道疾病患者的临床效果非常明显。

Objective: To investigate the diagnosis and treatment for children-intestinal angioma.Method: Exploratory laparotomy was performed for 30 cases of children with repeated hemorrhage of digestive tract during which hemorrhage foci were observed under gastroscope after enterostomy.The foci of intestinal angioma was removed.Result: The foci of 15 cases were located in jejunum,10 were in ileum and 5 were extensive angiomain jejunum,ileum and colon.29 cases were cured and discharged.Intestinal hemorrhage was occurred again and surgery was performed for only one case.Conclusion: It is difficult to diagnose children-intestinal angioma after operation.It is easy to remove normal intestinal canal during exploratory laparotomy observed by naked eyes.Observation combined by naked eyes and gastroscope after fistulization can make sure where the foci were and curative effect is satisfied.

目的:对86例患儿的电子胃镜检查及临床表现进行了分析,旨在引起临床医师对小儿胃炎、消化性溃疡的重视,从而提高诊断率,尽早减轻患儿痛苦。方法:回顾性分析86例患儿电子胃镜检查的临床资料。结果:慢性胃炎44例,十二指肠溃疡22例,胃溃疡3例,胃肿瘤2例。对69例确诊患儿予H2受体拮抗剂、铋剂、抗幽门螺杆菌(HP)治疗,治愈56例,好转13例。结论:小儿慢性胃炎检出率最高,达51.2%,其次为十二指肠溃疡;小儿消化性溃疡临床表现不典型,合并上消化道出血多见,故对于不明原因贫血、黑便、腹痛、腹胀患儿,应争取电子胃镜检查,以明确诊断;对向胃腔内生长的肿瘤,电子胃镜能早期诊断,并可取活体组织作病理检查,有极重要的临床意义;小儿消化道炎症和/或溃疡一旦确诊,即予铋剂、克拉霉素和/或H2受体拮抗剂治疗,可取得显著疗效。

胆管结石历来以外科手术为主,但效果并非十分理想,很多复杂的肝内胆管结石、胆总管结石术后残留率高达30%～96%,手术越做越大,效果仍不满意.由于内镜技术的发展,胆道治疗内镜术已达到了一个临床能够接受的成熟水平,而胆道镜下液电碎石术则进一步提高了镜下碎石的效果和结石取净率.

Objective: To investigate the diagnosis and therapy of repiratory tract foreign body foreinfants. Method: Retrospective analysis of diagnosis and treatment was made in 30 cases of infants’ respiratory foreign body for last 4 years. Result: From 6 months to 5 years of age ( male:female = 2.3:1), 24 cases were vegetality foreign body ( 80%), 3 cases were chemical foreign body ( 10%) and 3 cases were animal foreign body ( 10%) whose operations were performed by trachea cannula and artifical ventilation under bronechoscope. Rate of success was 100% and there were no asphyxia and cardiopulmonary arrest complication. Conclusion: For infants under 5 years of age, especially under 3 years old, it is necessary to perform operation by trachea cannula and artificial ventilation under bronechoscope for respiratory foreign body because it can supply abundant oxygen and good respiratory situation. It can also shorten the time of examination and treatment and avoid glottial edema, asphyxia and cardiopulmonary arrest complication.

目的:探讨小肠双对比造影检查的有效方法.方法:72例受检者被随机分成2组;试验组(36例)应用研制的小肠造影导管,在胃镜直视下钳夹导管头端并送达十二指肠水平部,头端气囊充气固定导管,退出胃镜后,经导管灌注适量稀钡胶浆及空气行小肠双对比造影.对照组(36例)采用改进的F9心导管在透视下插管.结果:实验组插管成功35例(成功率97.1%),对照组插管成功27例(成功率75%).结论:研制专用的小肠造影导管并经胃镜引导插管行小肠双对比造影检查,其成功率明显高于普通插管方法.

小儿小肠血管瘤在临床上多见,仅占胃肠道出血原因的3-5%,常见的症状是反复的消化道出血,无其他特征性症状体征,术前诊断困难,常规肉眼剖腹探查手术,易盲目切除肠管,用肠管造瘘胃镜导引与肉眼观察相结合的方法,进行手术30例,疗效满意,现总结并分析如下.