目的 探讨内镜下圈套器切除术治疗结直肠小息肉的优选术式.方法 从2017年8月-2018年2月接受结肠镜检查的患者中筛选90例患者,随机分为3组:间接冷圈套切除术(CSP)组30例(42枚息肉)、直接CSP组30例(41枚息肉)和热圈套切除术(HSP)组30例(54枚息肉).间接CSP组采用黏膜下注射0.9％ NaCl溶液抬举息肉后圈套器机械勒除息肉,直接CSP组采用圈套器机械勒除息肉,HSP组采用黏膜下注射0.9％ NaCl溶液抬举息肉后圈套器高频电切除息肉.观察并对比3种手术方式的即刻出血发生率、迟发出血发生率、穿孔发生率、息肉切除时间、息肉完整切除率等.结果 间接CSP组、直接CSP组和HSP组即刻出血发生率分别为43.3％(13/30)、46.7％(14/30)、16.7％(5/30),3组间两两比较差异均有统计学意义(P值均＜0.05),直接CSP组即刻出血发生率最高.间接CSP组和直接CSP组均未发生迟发出血,HSP组迟发出血的发生率为10.0％(3/30),HSP组的迟发出血率显著高于其他两组(P值均＜0.05).间接CSP组内镜下息肉完整切除率为88.1％(37/42),直接CSP组为92.7％(38/41),HSP组为100.0％(54/54),HSP组的完整切除率显著高于其他两组(P值均＜0.05).结论 HSP具有较好的完整切除率,但有迟发出血的风险,CSP即刻出血风险较大.

目的 探讨注气结肠镜与注水结肠镜检查的舒适度及操作性.方法 选取2016年6-9月在北部战区总医院内窥镜科接受结肠镜检查的240例患者,将其随机分为注气结肠镜检查组和注水结肠镜检查组,比较两组患者一般情况,记录检查的达盲率、时间、腹痛评分,随访腹痛、腹胀及再次检查是否选择无痛结肠镜意愿.结果 注气组与注水组在一般情况、进镜成功率、进镜深度、检查后腹痛情况、再次检查选择无痛结肠镜等方面差异无统计学意义(P＞0.05);注气组疼痛评分明显高于注水组(P=0.001),注水组的进镜时间、退镜时间及操作总时间明显高于注气组(P＜0.001,P=0.013,P＜0.001),检查后1h腹胀程度注气组明显高于注水组(P＜0.001),检查后6h腹胀程度两组间差异无统计学意义(P＞0.05).结论 注水结肠镜检查可明显减轻患者腹痛和检查后腹胀不适感,但其操作时间较注气法延长.

Objective To investigate the therapeutic effect of endoscopic plastic stent and metal stent placement in relieving obstructive jaundice in patients with pancreatic cancer,and to analyse the cost effectiveness.Methods A retrospective review was performed on the clinical data of 102 pancreatic cancer patients with obstructive jaundice in General Hospital of Northern Theater Command between January 2013 to January 2014.The patients were divided into plastic stent group (n =26) and metal stent group (n =76)based on the type of biliary stent placed under endoscopy.The complication and short-term therapeutic effect were compared between two groups.The number of endoscopic stent placement,treatment interval,hospitalization cost and median survival time were recorded.Results The levels of alanine aminotransferase (ALT) and total bilirubin (TBiL) in the two groups 5-7 days after endotherapy were significantly lower than those before treatment,but the difference was not statistically significant between the two groups (P ＜0.05).No severe complication was observed.The average number of treatments in the metal stent group was significantly lower than that in the plastic stent group (1.7 times vs 2.9 times),and the treatment interval was significantly longer[(271.7 ± 42.3) d vs (113.4 ± 38.2) d].The difference above between these two groups was statistically significant (P＜0.05).However,there was no significant difference on the average total hospitalization cost (84227.2 yuan vs 86906.8 yuan) or median survival time (15.6 months vs 13.1 months)between these two groups.Conclusions Primary placement of metal biliary stents for obstructive jaundice in adult patients with metastatic pancreatic carcinoma was cost-effective than plastic stents,and their effects were comparable.

Objective 　To analyze the factors associated with additional surgery after endoscopic resection of colorectal lesions. Methods 　Seventy-seven cases of colorectal lesions treated with endoscopic resection and additional surgery in General Hospital of Northern Theater Command from January 2012 to December 2017 were included in this study. According to the pathological changes, lymph node hyperplasia or vascular invasion, these patients were divided into positive group (n=13) and negative group (n=64). The general condition, lesion characteristics, complete resection rate and lifting sign were compared between the two groups. Univariate and multivariate logistic regression analyses were performed for risk factors for additional surgery. Results 　There were no significant differences in the general condition, lesion characteristics, and endoscopic adverse events between the two groups. Compared with the negative group, the rate of resection of the lesion in the positive group was significantly reduced (χ2=17.936, P＜0.001), and the proportion of poor elevation significantly increased (χ2=28.643, P＜0.001). Logistics univariate analysis showed that en bloc resection (OR=0.08, 95%CI 0.02-0.34, P<0.001), as a protective factor, led to a decrease in risk of positive results; while the inadequate lifting sign (OR=13.78, 95%CI 4.32-43.97, P<0.001), as a risk factor, led to an increase in risk of positive results. Logistics multivariate analysis also showed that the en bloc resection (OR=0.13, 95%CI 0.08- 0.31, P<0.001) could reduce the risk of positive results and was an independent protective factor; while the inadequate lifting sign (OR=10.62, 95%CI 4.59-31.71, P<0.001) increased the risk of positive results, which was a risk factor. Conclusions 　Surgery is recommended for endoscopic treatment of postoperative cases with poorly lifting and multiple resections. DOI: 10.11855/j.issn.0577-7402.2019.07.15