目的 探讨内镜下黏膜切除(EMR)术与高频电切术治疗结肠息肉的临床效果,并分析其病理检查结果.方法 选取2018年1月至2020年7月来我院进行电子肠镜检查且确诊为结肠息肉、需要住院治疗的230例患者,按治疗方案的不同将其分为A组(80例,高频电切术)和B组(150例,EMR术).分析结肠息肉的内镜下表现及病理检查结果,并比较EMR术与高频电切术治疗结肠息肉对患者并发症、复发及术后恢复情况的影响.结果 230例患者的412枚息肉全部被切除,切除率为100.00％.B组的残留率、复发率均低于A组,排气时间、进食时间及排便时间均短于A组,差异具有统计学意义(P<0.05).230例结肠息肉患者中,多发息肉、山田分型I、Ⅱ型最多,且多发于乙状结肠与直肠,病理分型中腺瘤性息肉最多.结论 经内镜诊断结肠息肉患者,可清晰观察到息肉的内镜表现及术后病理检查结果,与高频电切术相比,EMR术具有临床效果好、创伤小、术后恢复快、息肉残留率及复发率低等特点,值得临床广泛推广应用.

目的 观察二甲硅油联合复方聚乙二醇电解质散在结肠镜镜检查中的效果,从而为患者选择更有效的肠道准备方法.方法 选择2018年8月—2020年8月于本院行结肠镜检查术的216例患者,随机分为对照组和观察组,每组108例,对照组给予聚乙二醇电解质散冲服,观察组在对照组的基础上加用二甲硅油口服,比较2组患者肠镜检查时间、生理盐水冲洗量、肠道清洁度、肠道内气泡量、息肉检出率、不良反应情况.结果 观察组患者肠道检查时间(14.10±0.95)min,短于对照组的(16.99±1.87)min(t=14.240,P＜0.01);观察组生理盐水冲洗量(124.493±8.54)mL,少于对照组的(271.77±6.42)mL(t=143.214,P＜0.01).观察组肠道泡沫分级优良率79.63％,高于对照组的64.81％(x2=5.908,P=0.015);2组患者肠道清洁良好率(93.52％ vs 92.59％)差异无统计学意义(x2=0.072,P=0.789).2组息肉总检出率(51.85％ vs 42.59％)差异无统计学意义(x2=1.858,P=0.173),但观察组息肉直径≤0.5 cm检出率14.81％,高于对照组的6.48％(x2=3.941,P=0.047);观察组不良反应发生率8.33％,低于对照组的15.74％,但差异无统计学意义(x2=2.798,P=0.094).结论 二甲硅油联合复方聚乙二醇电解质散,可有效减少肠道气泡残留、避免反复冲洗从而降低肠镜检查时间,提高了肠道内微小息肉的检出率.

目的 探讨TGF-β1及其信号通路在胃息肉中的表达及与胃息肉癌变之间的相关性.方法 选取徐州市肿瘤医院2012年1月～2014年11月间接受胃镜检查发现为胃息肉及胃癌的住院患者为试验对象,其中胃息肉30例,胃癌30例,慢性胃炎20例,进行胃镜下活检,胃息肉均行EMR治疗,胃癌患者行常规胃大部切除术,术前未行常规放化疗,采用SP免疫组织化学染色法检测不同病变中的TGF-β1、Smad 3的表达水平,结合临床对检查指标进行分析.结果 Smad 3在胃癌组的表达最低,与正常胃组织组及胃息肉组比较差异有统计学意义(P<0.05),TGF-β1在胃癌组的表达高于正常胃组织组及胃息肉组(P<0.05),TGF-β1的高表达多见于低分化,有淋巴结转移及Ⅲ-Ⅳ期的胃癌组中.Smad 3胃息肉中的表达低于正常胃组织组(P<0.05),TGF-β1在胃息肉组中的表达高于正常胃组织组(P<0.05).TGF-β1与Smad 3之间的表达呈负相关性.TGF-β1、Smad 3在胃癌中的表达和年龄及性别无关.结论 不同类型胃息肉中的TGF-β1、Smad 3蛋白的表达水平不同,TGF-β1、Smad 3蛋白的表达可作为胃息肉癌变风险预测的临床诊断指标.

Objective To investigate the value of Helicobacter pylori (HP),blood carcinoembryonic antigen (CEA),carbohydrate antigens 72-4 (CA72-4) and CA24-2 in the screening of gastric cancer.Methods The contents of HP,blood CEA,CA72-4 and CA24-2 in 50 healthy controls,45 patients with benign gastric lesions mnd 70 patients with gastric cancer were detected.According to the number of positive cases,the positive rate of single detection and the positive rate of combined detection were calculated.Sensitivity,specificity,and accuracy of serum tumor markers were calculated according to HP single and combined detection.Results The positive rate of each individual detection and 4 joint detection in gastric cancer group was significantly different from that in the benign lesion group and the normal control group (P ＜0.01).The positive rate of 4 joint detection in gastric cancer group was 89.25％,and the difference was statistically significant (P ＜0.01).There was no significant difference in the positive rate of the single test and the 4 joint detection in benign stomach group and normal control group (P ＞ 0.05).The sensitivity,specificity and accuracy of HP,blood CEA,CA72-4,CA24-2 joint detection were significantly higher than single detection (P ＜ 0.05).Conclusions Joint detection was significandy better than single detection,and can significantly improve the detection rate of gastric cancer.

目的:探讨在胃癌筛查中,以胃泌素17(G-17)、胃蛋白酶(PG)血清学阳性诊断临界值作为判断标准的应用价值.方法:选取我院接诊的胃癌患者54例及同期健康人60例,取空腹外周静脉全血,收集上清液行G-17、PGⅠ、PGⅡ血清学检测;根据2015年"中国早期胃癌筛查方案"中所拟定的血清学界值标准对入组对象进行分组,并分析各组胃癌检出率以及G-17和PG的筛查灵敏度和特异度.结果:胃癌组PGⅠ、PGⅡ低于浅表性胃炎和萎缩性胃炎组,胃癌组G-17高于浅表性胃炎组,萎缩性胃炎组PGⅠ、PGⅡ、G17均低于浅表性胃炎组(P<0.05);经ROC曲线分析,PGⅠ筛查胃癌ROC曲线下面积为0.894,最佳界值为PGⅠ<74ng/ml,灵敏度和特异度分别为85.7%和75%;PGⅡ筛查胃癌的ROC曲线下面积为0.766,最佳界值为PGⅡ<4ng/ml,其灵敏度和特异度分别为89%和62.5%.114例(54例胃癌,60例非胃癌)入组对象分为4组,A组胃癌检出率为7.14%,B组胃癌检出率为60.87%,C组胃癌检出率为38.89%,D组胃癌检出率为76.47%;采用Bonferroni法比较,A组与B、C、D组胃癌检出率比较均有显著差异(P<0.05);B、C、D 3组胃癌检出率比较无显著差异(P>0.05)以G-17为诊断界限值,灵敏度最高为70.6%;以PG为诊断界限值,特异度最低为79.7%;以G-17联合PG为诊断界限值,灵敏度最低为34.0%,特异度最高为94.1%.结论:在胃癌筛查中,运用G-17联合PG作为诊断界限值,其非胃癌患者检出率较高,胃癌漏诊率较高.

Objective To investigate the clinical and pathological features of colonic polyp canceration and related risk factors of colon polyps,and explore clinicopathologic features and major risk factors of the canceration of polyps of colon polyps.Methods Totally 80 patients with colon polyps including 6 cases of cancerations and 20 patients with colon cancers were selected from Xuzhou Tumor Hospital Admissions.Those patients were divided into 74 cases of non cancer group and 26 cases of cancer group.The clinical data,the detection index and the statistical analysis were performed.Results The clinical features of patients included 51 cases of multiple polyps,30 cases of fatty liver,13 cases of fecal occult blood positive,and 30 patients with colonoscopy.There were 218 polyps,191 data intact,and 6 cases showed cancer (3.14％).Inflammatory polyps mainly occurred in rectum,cecum,and significant risk other than the colon.Tubular adenoma occurred mainly in the transverse colon.Sigmoid colon cancer colon polyps of the highest risk showed OR =2.30 (P ＜ 0.05).The cancer risk from high to low was from tubular villous adenoma to villous adenoma hair (P ＜0.01),and no difference in tubular adenoma cancer risk (P ＞0.05).There was no difference between the indexes of the canceration group and the non cancerous group (P ＞ 0.05).The single factor analysis showed pathological type,and the lesion were the main risk factors of malignant colonic polyps (P ＜ 0.05).Multi-factor regression analysis showed WBC,pathological type,and the lesion were the main risk factors of malignant colonic polyps (P ＜ 0.05).Conclusions The colonic polyps in male have higher incidence with fatty liver,hypertension and other pathological features,and are mainly tubular adenomas,inflammatory and hyperplastic polyps,with different lesions,pathological types occur and different cancer risk.

目的:探讨用复方嗜酸乳杆菌片和谷氨酰胺颗粒治疗腹泻型肠易激综合征的临床效果.方法:选取我院在2013年6月至2015年11月期间收治的72例腹泻型肠易激综合征患者作为研究对象.按照随机方案将这72例患者分成试验组(36例)和参照组(36例).为参照组患者应用常规疗法进行治疗,在此基础上,为试验组患者加用复方嗜酸乳杆菌片和谷氨酰胺颗粒进行治疗.治疗结束后,对比两组患者治疗的效果、乳杆菌的水平、肠球菌的水平、酵母样真菌的水平和不良反应的发生率.结果:在进行治疗前,两组患者乳杆菌的水平、肠球菌的水平和酵母样真菌的水平相比差异无统计学意义(P>0.05).在治疗结束后,与参照组患者相比,试验组患者乳杆菌的水平更高,其肠球菌的水平和酵母样真菌的水平更低,差异有统计学意义(P<0.05).与参照组患者相比,试验组患者治疗的有效率更高,治疗后其不良反应的发生率更低,差异有统计学意义(P<0.05).结论:用复方嗜酸乳杆菌片和谷氨酰胺颗粒治疗腹泻型肠易激综合征的临床疗效确切,可有效地缓解患者的临床症状,恢复其肠道菌群的平衡,且安全性较高.

Objective To investigate the influence of blocking PI3-K/Akt signaling pathway by specific inhibitor LY294002 on the chemotherapy effect of SGC7901 human gastric carcinoma cell line. Methods The human gastric carcinoma cell line SGC7901 was treated with 5-FU,DDP,or ADM respectively,and then compared to a combination of those drugs individually with LY294002.The effect of the growth of SGC7901 cells was detected by MTT assay.The apoptosis and the cell cycle progression of the tumor cells were analyzed by flow cytometry.The expression of P-Akt was determined by Western blot. Results The growth of gastric carcinoma cell line SGC7901 was inhibited by 5-FU,DDP,and ADM.The inhibition was related to the dose of the drug.As compared with the negative control group,the inhibition and the apoptosis ratio increased when applied a combination of those drugs individually with LY294002(P0.05).The gastric carcinoma cell was arrested in G0/G1 phase and reduced in S phase.Western blot detection showed that the expression of P-Akt decreased to different degrees with the combination of two agents compared with negative control group,and the difference was statistically significant(P0.05). Conclusions The phosphorylation inhibitor LY294002 can significantly enhance the sensitivity to chemotherapeutic agent.Inhibition of the PI3-K/AKT signaling pathway could have a synergistic effect in gastric cancer treatments.

Objective To explore mechanism of PI3K/Akt signaling pathway in SGC7901 human gastric carcinoma cell line.Methods LY294002 was added into the culture media of SGC7901 human gastric carcinoma cells.Cell viability was measured by MTT assay.Cell apoptosis was detected by flow cytometry.The expression of the P-Akt signaling pathway components was determined by western blot.Results The growth and proliferation of gastric carcinoma cells decreased significantly after LY294002 treatment(P0.05),the percentage of apoptosis increased significantly(P0.05).Western blot analysis showed that protein expression of P-Akt in SGC7901 cells decreased significantly.Conclusions PI3K/Akt signaling pathway plays an important role in the progression of gastric carcinoma cell.Blocking PI3K/Akt signal pathway inhibits the proliferation and promotes the apoptosis of gastric carcinoma cells.