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.

认识篇 何谓肥胖症 “每逢佳节胖三斤”,很快就到一年一度的春节了.人们在假期不是回家过节就是出门旅游,不论哪种情况都会把瘦身减肥抛到脑后.难得回家一次,尤其是节假日,父母一定做了满满一桌子好吃的,当然要大快朵颐;好不容易出来玩一趟,当地的美食,恨不得从头吃到尾.吃着吃着就长胖了几斤.节后如何快速瘦身?先来客观认识一下肥胖症,找到肥胖的克星.

[目的]采用荆花胃康胶丸联合铋剂四联治疗幽门螺杆菌(Helicobacter pylor,Hp)阳性慢性胃炎初治患者,观察Hp根除率、临床症状改善情况以及用药安全性,探讨中西药联合对Hp感染的根除率以及Hp阳性慢性胃炎的疗效.[方法]采用前瞻性随机对照多中心临床研究,对象为4个中心经胃镜检查确诊为慢性胃炎并伴有Hp感染的初治患者,采用分层区组随机化分为4个治疗组:A组,艾司奥美拉唑20 mg+胶体果胶铋200 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,疗程10 d;B组,荆花胃康胶丸240 mg+艾司奥美拉唑20 mg+胶体果胶铋200 mg+阿莫西林1 000 mg+呋喃唑酮100mg,疗程10 d;C1组:荆花胃康胶丸240 mg,前14 d;艾司奥美拉唑20 mg+胶体果胶铋200 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,后10d,总疗程24 d;C2组:艾司奥美拉唑20 mg+胶体果胶铋200 mg+阿莫西林1 000 mg+呋喃唑酮100mg,前10 d;荆花胃康胶丸240 mg,后14 d,总疗程24 d;各组服药均为2次/d.治疗结束后评估4组患者Hp根除率、临床症状改善情况和药物不良反应发生情况.治疗结束停药至少28 d后以13.14 C-尿素呼气试验结果判断Hp是否根除.[结果]共纳入471例患者,A、B、C1、C2组分别入组1 24、11 4、114、119例.4组Hp根除率ITT分析结果分别为82.3％(102/124)、86.0％(98/114)、78.9％(90/114)、79.8％(95/119),组间比较差异无统计学意义(P=0.518);PP分析结果分别为87.9％(102/116)、90.7％(98/108)、86.5％(90/104)、85.6％(95/111),B组根除率高于其他治疗组,但组间比较差异无统计学意义(P =0.677).各组根除Hp治疗后症状均获明显改善(P＜0.01),其中B组症状改善明显优于A组(P=0.007).共有32例患者出现不良反应,其中A组10例(8.1％),B组7例(6.1％),C1组6例(5.3％),C2组9例(7.6％),组间差异无统计学意义(P =0.819).[结论]荆花胃康胶丸联合铋剂四联同时服用Hp根除率较高,且症状改善明显优于铋剂四联.中西药联合治疗Hp阳性慢性胃炎具有一定优势,值得进一步研究.

Objective To study the effect of curcuma and pseudo-ginseng on chronic atrophic gastritis. Methods 201 patients with chronic atrophic gastritis were enrolled into this randomized controlled, multi-center and open study. And these patients were randomly divided into three groups numbered as group A, B and C. All the patients took 5 milli grams of folic acid three times a day. Besides, the pa-tients in group A and group B took 1 gram of curcuma granule and 1 . 5 grams of pseudo-ginseng powder twice a day respectively. The patients with Helicobacter pylori ( Hp) infection were treated with amoxicil-lin 1 . 0 g bid+ furazolidone 0 . 1 g bid+ pectic bismuth 0 . 2 bid+ esomeprazole 20 mg bid before taking the medicine above. After 6 months, they were retested by gastroscopy with pathohistological examination of which the results including dysplasia, atrophy, intestinal metaplasia, acute and chronic inflammation were compared with that of the previous tests. Results More patients with gastric mucosal dysplasia in group A got improved than group C ( P<0 . 05 ) while no statistic difference was observed between group B and group C(P>0. 05). The improvement rate of gastric mucosal atrophy was higher in group A than group C (P<0. 05) while no statistic difference was observed between group B and group C(P>0. 05). And there were more patients aggravated in group B than in group A ( P<0 . 05 ) . 3 ) There was no statis-tical difference of intestinal metaplasia and inflammation among three groups ( all the P>0 . 05 ) . Con-clusion The single herb curcuma could reverse gastric mucosal atrophy in a certain extent.

[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.

目的 探讨缺血性肠炎的临床特点.方法 回顾性分析23例缺血性肠炎患者的临床资料.结果 23例患者均出现不同程度的急性腹痛,便血21例,腹泻12例,腹胀9例,不全肠梗阻2例.肠镜下有特征性表现,以左半结肠为主的黏膜糜烂、溃疡形成,经过内科早期积极干预,22例痊愈,1例转外科手术治疗.结论 有基础疾病患者,临床出现突发剧烈腹痛,腹泻,而后出现血便,应考虑缺血性肠炎的可能,早期诊断、正确治疗是本病预后的关键.

[Purpose] To investigate the clinical value of Helicobacter pylori infection in patients with gastric diseases. [Methods] A total of 439 cases of gastric disease pathologically proven form Jan, 2009 to Dec,2012 were analyzed,including 163 cases with chronic superficial gastritis,64 cases with chronic atrophy gastritis,47 cases with gastroesophageal reflux disease,79 cases with gastric ulcer,54 cases with duodenal ulcer,12 cases with gastric atypical hyperplasia and 20 cases with gastric cancer. Helicobacter pylori infection was detected by(14)C-breath test and rapid urease. [Results] Of 439 cases with gastric disease,219 cases was Hp positive with Hp infection rate of 49.89%. The Hp infection rate in gastric cancer was higher than that in chronic gastritis(65.00% vs 43.17%,χ2=3.850,P=0.043),and that in gastroesophageal reflux disease(65.00% vs 34.04%,χ2= 5.477,P=0.019),but was not significant difference with gastric-duodenal ulcer(65.00% vs 63.91%, χ2=0.009,P=0.925). Hp infection rate increased with age increasing in age less than 60 years old. [Conclusion] Gastric Helicobacter pylori infection is closely related to duodenal ulcer,gastric atypical hyperplasia and gastric cancer. Helicobacter pylori is a high risk factor for gastric cancer. Helicobacter pylori eradication might reduce the risk for gastric cancer.

目的研究参苓白术散与得舒特、培菲康联合应用治疗腹泻型肠易激综合征(IBS)的疗效。方法将105例患者随机分为实验组、中药对照组、西药对照组各35例。西药对照组用得舒特、培菲康,中药对照组用参苓白术散,实验组则联用参苓白术散和以上2种西药。结果实验组12周总的症状改善88.6%,中药对照组68.6%,西药对照组80.0%。实验组症状改善情况显著优于其他2组(P<0.05)。实验组分别与西药组、中药组停药4周后总症状严重程度比较P=0.036,差异均有统计学意义(P<0.05)。结论参苓白术散联合得舒特、培菲康治疗可明显改善腹泻型IBS患者症状,减少得舒特、培菲康停药后反跳,以达到远期巩固疗效的目的。

目的评价推进式电子小肠镜临床应用的适应证、检查范围和临床价值. 方法对多项检查阴性、疑诊小肠病变的41例患者行推进式电子小肠镜检查,采用双人操作法. 结果 41例中成功完成检查者40例.小肠镜前端可达到Treitz韧带下30～100cm,发现十二指肠、空肠病变12例(占29.3%),食管、胃病变8例.未发生与操作相关的严重并发症. 结论推进式电子小肠镜是一种安全、可靠的十二指肠和上段空肠疾病的检查手段.

目的评价推进式电子小肠镜检查拟小肠疾病的临床诊断价值及其安全性.方法采用双人操作推进式插入法,不辅以外套管,循腔进镜,适当滑进,反复勾拉进退.结果15例拟小肠疾病患者中14例越过屈氏韧带下50～100cm,平均插达屈氏韧带下80cm;另1例因十二指肠末端梗阻拟新生物,肠镜不能扩张未能进镜.总插镜成功率100%,病变检出率为66.7%.无严重并发症发生.结论推进式电子小肠镜检查应作为检查十二指肠降部、水平部及上段空肠病变的首选方法.

重症急性胰腺炎(Severe acute pancreatitis, SAP)临床过程凶险,发展变化快、并发症多,病死率高.本文回顾分析了1999年1月～2002年5月本院诊治的30例病人资料,现报告如下.

目的:探讨经内镜下食管静脉曲张破裂出血注射硬化剂与结扎的治疗.方法:经内镜下给曲张的食管静脉注射硬化剂,或将曲张的食管静脉用结扎器结扎.结果:急诊止血4例,48例曲张程度减轻,10例曲张静脉红色症消失,2例术后出现轻度门高压性胃病,2例术后腹水量增加,一例术后20天死于再次大出血.结论:安全、并发症少,止血及预防再出血效果明显.

目的观察内镜下连续皮圈套扎术治疗食管曲张静脉的近期疗效.方法应用 Microvasiv Speed- band套扎器,对 9例病人作了 10次治疗,术前半小时均应用降门脉压力药物,术后常规应用止酸剂 losec20mg qd半个月,另继续应用心得安或加消心痛或加安体舒通以达到降门脉压力.结果 9例病人共 42条曲张静脉治疗后均有明显减轻,其中 7例因大出血入院病人套扎后 6个月内未再出血,收到良好的近期效果.结论内镜下连续皮圈套扎术治疗食管曲张静脉破裂出血和防止近期内再出血有着非常良好的效果,治疗前后均需应用降门脉压力药物,可以防止术后因门脉高压性胃病加重导致的出血 .

例1 患者男性，21岁，因左上腹部疼痛10d，在当地医院诊断为急性胰腺炎，经过禁食、抗炎、解痉等处理后症状无明显好转，于1999年10月10日转我院。既往身体健康。查血淀粉酶……

胰腺癌的临床表现隐匿,早期缺乏特异性症状,易被医师误诊、漏诊,难以早期诊断,一旦临床确诊,大多已属晚期,失去手术机会.近10年来,我院共收治胰腺癌80例,为提高对胰腺癌早期的认识,及早进行必要的影像学检查作出早期诊断,改善预后,现将胰腺癌的早期首发症状分析讨论如下.

近年来我院在600例电子结肠镜(简称内镜)检查中,结合活检和手术病理诊断,检出大肠癌60例,检出率为10%.本文探讨电子结肠镜诊断价值和大肠癌的危险因素. 1 临床资料 1.1 一般资料本组男32例,女28例,男女之比为1.14:1.年龄25～91岁,平均50.5岁,中位年龄54岁,40岁以上者占67%.主要临床表现:便血66.6%,腹痛18.4%,腹泻8%,腹块7%.从出现症状到内镜确诊时间自数天到3年不等,其中6个月内者34例,占56.7%.钡灌肠造影检查19例,其中诊断大肠癌或大肠癌可能者15例,与内镜符合率为78%;2例钡灌肠诊断慢性结肠炎,另2例钡灌肠未发现病变.

目的观察生长抑素及奥曲肽对食管胃底静脉内张破裂大出血(EGVB)的疗效.方法 90例肝硬化EGVB病人随机分成3组:生长抑素组用施他宁(14肽生长抑素)250ug iv后以250ug/h的速度持续静脉滴注5天.奥曲肽组用善宁(八肽生长素)0.1mg jv后以25ug/h的速度持续静脉滴注5天;垂体后叶素组用垂体后叶素0.3u/min的速度持续静脉滴注5天.3组的年龄、性别、肝功能分级、出血量、输血量等方面均无统计学差异.结果生长抑素组止血率为80.0%(24/30),死亡率6.67%(2/30).奥曲肽组止血率76.67%(23/30),死亡率13.33%(4/30),垂体后叶素组止血率53.33%(16/30),死亡率36.67%(11/30).结论施他宁及善宁治疗肝硬化EGVB的疗效均明显好于垂体后叶素,而善宁因其价格明显低于施他宁可作为首选治疗药物,施他宁则因止血速度快而可根据病人的经济条件选择作为前期使用的药物.

我院于1994年1月～1997年4月应用奥曲肽治疗23例食管胃底曲张静脉破裂出血病人,与应用垂体后叶素联用酚妥拉明治疗相似病人22例进行对比研究,报告如下.