关键词： 胃肠超声造影   胃十二指肠疾病   诊断符合  

摘要： 目的探讨胃肠超声造影技术对胃十二指肠疾病的临床诊断价值。方法选取90例经病理结果确诊为胃十二指肠疾病的患者作为研究对象,所有患者均接受胃肠超声造影和胃镜检查,以病理结果作为金标准,分析比较胃肠超声造影和胃镜检查的诊断符合率。结果 90例患者经胃肠超声造影检出胃炎59例、胃溃疡7例、十二指肠溃疡8例、十二指肠炎症5例、胃息肉2例、胃癌9例,胃镜检出胃炎61例、胃溃疡5例、十二指肠溃疡6例、十二指肠炎症5例、胃息肉2例、胃癌11例,病理结果显示胃炎63例、胃溃疡6例、十二指肠溃疡5例、十二指肠炎症4例、胃息肉2例、胃癌10例;胃肠超声造影的诊断符合率为88.9%(80/90),胃镜检查的诊断符合率为91.1%(82/90),胃肠超声造影与胃镜检查的诊断符合率比较,差异无统计学意义(P>0.05)。结论胃肠超声造影诊断胃十二指肠疾病的符合率较高,患者接受度较高,可作为临床诊断首选。

关键词： 肛肠疾病术后   隔姜灸   穴位贴敷   胃肠道反应   满意度  

摘要： 目的:探讨穴位贴敷联合隔姜灸治疗肛肠疾病术后胃肠道反应的临床疗效。方法:选择2016年3月～2017年6月本院采用腰硬联合麻醉的肛肠病术后患者140例,随机分为治疗组和对照组各70例,对照组给予常规的对症治疗和护理措施,治疗组在对照组干预措施的基础上,加用穴位贴敷联合隔姜灸进行治疗,比较两组患者干预前后恶心、呕吐、腹胀等胃肠道反应的情况以及治疗的满意度。结果:治疗后两组患者的恶心、呕吐、腹胀等症状均有改善,但治疗组的疗效和满意度均显著优于对照组(P<0.05)。结论:肛肠疾病术后应用传统中医特色护理技术穴位贴敷结合隔姜灸疗法,可改善术后患者恶心、呕吐、腹胀等症状,提高患者对治疗的满意度,为临床治疗肛肠疾病术后消化道反应提供一个新的护理方法。

关键词： Dysplasia   Histopathology   Ileal pouch   Inflammatory bowel disease   Neoplasia   Pouchoscopy   Surveillance  

摘要： Purpose of Review: Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure after proctocolectomy in patients with inflammatory bowel disease who require colectomy. The ileal pouch is susceptible to a variety of adverse outcomes including mechanical insult, ischemia, and infectious agents. There is also a risk for developing low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even adenocarcinoma in the pouch. The purpose of this review is to highlight risk factors, clinical presentation, surveillance, and treatment of pouch neoplasia. Recent Findings: Patients with pre-colectomy colitis-associated neoplasia are at high risk for developing pouch neoplasia. Other purported risk factors include the presence of family history of colorectal cancer, the presence of concurrent primary sclerosing cholangitis, chronic pouchitis, cuffitis, or Crohn’s disease of the pouch. Pouch adenocarcinoma tends to have a poor prognosis. Summary: It is recommended to have a combined clinical, endoscopic, and histologic approach in diagnosis and management. Surveillance and management algorithms of pouch neoplasia are proposed, based on the risk stratification. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.

关键词： 良性肛肠疾病   尿潴留   预后因素  

摘要： 目的探讨良性肛肠疾病患者术后急性尿潴留的预后因素。方法回顾性分析2016年6月～2018年6月455例良性肛肠疾病的临床资料,31例(6. 8%)术后发生急性尿潴留,对患者年龄、性别、BMI、ASA分级、术前合并症、手术方式、手术范围、麻醉方法、手术时间、液体入量、出血量和术后镇痛补救情况等进行单因素分析,多因素logistic回归分析良性肛肠疾病患者术后急性尿潴留的预后因素。结果单因素分析显示年龄、性别、ASA分级、术前合并糖尿病、麻醉方法、手术范围、液体入量和术后镇痛补救有统计学差异(P <0. 05)。多因素logistic回归分析显示年龄≥76岁(OR=7. 002,95%CI:1. 181～41. 532,P=0. 032)、性别(OR=10. 322,95%CI:1. 633～65. 232,P=0. 013)、ASA分级(OR=4. 134,95%CI:1. 080～15. 823,P=0. 038)、糖尿病(OR=13. 715,95%CI:2. 032～92. 558,P=0. 007)、手术范围(OR=4. 546,95%CI:1. 681～12. 296,P=0. 003)、麻醉方法(OR=3. 241,95%CI:1. 558～6. 741,P=0. 002)和术后镇痛补救(OR=7. 289,95%CI:1. 479～35. 914,P=0. 015)是良性肛肠疾病患者术后发生急性尿潴留的独立预后因素。结论年龄、性别、糖尿病、手术范围、麻醉方法和术后镇痛补救是良性肛肠疾病患者术后发生急性尿潴留的预后因素,针对预后因素进行干预可能减少术后急性尿潴留的发生。

关键词： INFLAMMATORY bowel diseases   T cells  

摘要： Inflammatory bowel disease (IBD) is an expanding autoimmune disease afflicting millions that remains difficult to treat due to the accumulation of multiple immunological changes. BT-11 is an investigational new drug for IBD that is orally active, gut restricted, and targets the lanthionine synthetase C-like 2 immunometabolic pathway. CD25(+) FOXP3(+) CD4(+) T cells are increased locally within the colon of BT-11 treated mice in Citrobacter rodentium and IL-10(-/-) mouse models of colitis. The maintained efficacy of BT-11 in the absence of IL-10 combined with the loss of efficacy when direct cell cell interactions are prevented suggest that the regulatory T cell (Treg) related elements of suppression are cell contact mediated. When PD-1 is inhibited, both in vitro and in vivo, the efficacy of BT-11 is reduced, validating this assertion. The depletion of CD25+ cells in vivo abrogated the retention of therapeutic efficacy postdiscontinuation of treatment, indicating that Tregs are implicated in the maintenance of tolerance mediated by BT-11. Furthermore, the involvement of CD25 suggested a role of BT-11 in IL-2 signaling. Cotreatment with BT-11 and IL-2 greatly enhances the differentiation of CD25(+) FOXP3(+) cells from naive CD4(+) T cells relative to either alone. BT-11 enhances phosphorylation of STATS, providing a direct linkage to the regulation of FOXP3 transcription. Notably, when STATS is inhibited, the effects of BT-11 on the differentiation of Tregs are blocked. BT-11 effectively enhances the IL-2/STATS signaling axis to induce the differentiation and stability of CD25(+) FOXP3(+) cells in the gastrointestinal mucosa to support immunoregulation and immunological tolerance in IBD.

关键词： 肛肠疾病   疼痛   中药熏洗   坐浴  

摘要： [目的]探讨便时温水坐浴联合便后中药熏洗坐浴对减轻肛肠疾病术后疼痛的效果。[方法]采用随机对照方法将纳入的80例研究对象分为干预组和对照组,每组40例,对照组给予中药熏洗坐浴,干预组在对照组的基础上给予便时温水坐浴。干预2周后两组病人疼痛程度评定并测量两组病人水肿消退时间及创面愈合时间。[结果]干预2周后两组病人的疼痛程度进行比较,差异有统计学意义(P<0.05);水肿消退时间比较差异有统计学意义(P<0.05),而创面愈合时间比较差异无统计学意义(P>0.05)。[结论]便时温水坐浴联合便后中药熏洗在一定程度上能有效减轻病人的疼痛程度,缩短肛门伤口水肿消退时间。但本研究还不能说明便时温水坐浴联合便后中药熏洗坐浴能促进伤口愈合。

关键词： 功能性胃肠疾病   心理分析   抗抑郁治疗   临床疗效  

摘要： 目的分析功能性胃肠疾病的心理分析和抗抑郁治疗的临床疗效。方法 2016年1月至2017年12月,于我院收治的功能性胃肠疾病患者中选取150例,将其归为观察组,再选取我院同时期50例健康体检者为对照组,所有患者均采用SCL-9(症状自评表)、SDS(抑郁自评量表)进行评估,并采取不同方式对患者进行治疗,对其治疗效果进行分析。结果观察组抑郁发生率为85.33%,相较于对照组的10%更高,P <0.05;治疗前,观察组SCL-9各因子评分均高于对照组,P <0.05;丙组患者临床治疗总有效率为98%,高于甲(76%)、乙(80%)两组,差异存在统计学意义,P <0.05。结论功能性胃肠疾病和精神心理因素存在一定相关性,除了对患者进行常规治疗外,还要针对各种心理因素,对患者进行针对性的心理治疗,以此来促使临床疗效提高。

关键词： 多层螺旋CT   小肠疾病   造影技术   应用研究  

摘要： 目的:研讨在小肠疾病的临床影像学诊断中采用MDCT小肠造影技术的实际效果。方法:选取自2017年5月—2018年6月于本院普外科就诊的怀疑小肠病变的120例患者作为本次研究的受试者,所有受试者术前均予以MDCTE平扫加增强扫描,并将其影像学结果与手术后结果进行对照。结果:本研究120例受试者中,有42例由MDCTE诊断为小肠病变,且其结果符合临床的最终确诊。此外,剩余78例患者诊断为阴性,63例符合指标,10例出现漏诊,5例出现误诊。将数据输入统计学软件予以分析后可知,在对小肠疾病的诊断中,MDCTE的敏感度为73.68%(42/57),其特异度为100%(42/42),正确率为87.5%(42+63)/120)。此外,其阳性预测值为100%(42/42),阴性预测值为80.76%(63/78)。结论:临床上在小肠病变中有许多常见的疾病如小肠肿瘤、小肠炎症以及肠梗阻等其在MDCTE的表现具有显著的特征,临床医生在诊断该类疾病时,可极大的参考MDCTE的做出的诊断,并与患者临床的其他症状体征相结合,以提高小肠疾病的诊断正确性。

关键词： 复方阿嗪米特   莫沙必利   胃肠疾病相关性消化不良  

摘要： 目的 :研究用复方阿嗪米特联合莫沙必利对老年胃肠疾病相关性消化不良患者进行治疗的临床效果。方法 :从2016年4月至2017年10月期间在唐山市丰润区人民医院就诊的老年胃肠疾病相关性消化不良患者中选取78例患者为研究对象。将其随机分为对照组和观察组。对对照组患者单用莫沙必利进行治疗,对观察组患者用复方阿嗪米特联合莫沙必利进行治疗。用药4周后,对比两组患者的临床疗效和消化不良症状的改善情况。结果 :用药4周后观察组患者消化不良症状的总积分低于对照组患者,其治疗的总有效率高于对照组患者,P <0.05。结论 :用复方阿嗪米特联合莫沙必利对老年胃肠疾病相关性消化不良患者进行治疗可显著改善其消化不良的症状,提高其临床疗效。

关键词： Inflammatory bowel disease   Colorectal carcinoma   IBD-associated dysplasia   Villous hypermucinous change   Serrated change/dysplasia  

摘要： Background: Patients with inflammatory bowel disease (IBD) - ulcerative colitis (UC) and Crohn's disease (CD) have an elevated risk of developing colorectal carcinoma (CRC). Major risk factor in IBD patients is the continuous chronic inflammation leading to development of dysplasia and carcinoma. Nevertheless, other types of non-conventional but suspicious mucosal changes serrated change/dysplasia, NOS and villous hypermucinous change, have also been reported in IBD patients. Preneoplastic potential of these lesions is still not well elucidated. Aims: The aim of this study was identification of IBD-associated CRCs focusing on finding related precursor lesions in the surgical specimen or in archival biopsy samples followed by a detailed morphological, immunohistochemical and molecular evaluation. For the purpose of the study the mucosal lesions were divided into conventional IBD-associated dysplasia and non-conventional lesions that were merged under a provisory term of putative preneoplastic lesions (PPL). Methods: A total of 309 consecutive IBD colectomy specimens diagnosed during a 10-year period were reviewed. Detailed morphological evaluation, immunohistochemical analysis of mismatch repair (MMR) proteins, p53 and O-6-methylguanine DNA methyltransferase (MGMT) expression and molecular analysis for KRAS, NRAS and BRAF gene mutation were performed in the retrieved CRC cases as well as in the detected dysplasia and PPLs of these patients. Results: We identified 11 cases of morphologically heterogenous IBD-associated CRCs, occurring in 5 males and 6 females, aged 26-79 years (mean 44 years). A total of 22 mucosal lesions were revealed in 8 CRC patients comprising conventional IBD-associated dysplasia (4 lesions), PPLs as serrated change/dysplasia NOS (11 lesions), villous hypermucinous change (5 lesions), and two true serrated lesions (one sessile serrated adenoma and one traditional serrated adenoma). More than one type of lesion was found in 6 patients. Seven CRC