关键词： 肠疾病   结肠镜检查   老年人  

摘要： 目的探讨老年患者结肠镜检查的临床特点。方法选取2015年2月—2016年2月在广东省人民医院行结肠镜检查的老年患者2 314例,根据是否存在消化道出血分为出血组(n=681)和非出血组(n=1 633)。分析老年患者的结直肠病变类型和检出率,并比较两组患者的结直肠病变差异。结果 2 314例老年患者的阳性检出率为81.7%(1 891/2 314),其中结直肠息肉、结直肠癌、结肠憩室、溃疡糜烂性病变的检出率分别为50.9%(1 179/2 314)、16.1%(373/2 314)、12.4%(286/2 314)、5.5%(127/2 314),出血组患者的结直肠癌检出率为47.0%(320/681)。出血组患者的阳性检出率(95.6%,651/681)高于非出血组(75.9%,1 240/1 633),差异有统计学意义(P<0.001)。与非出血组比较,出血组患者男性比例高,结直肠癌、溃疡糜烂性病变、血管畸变检出率高,结直肠息肉检出率低,差异有统计学意义(P<0.001);两组患者结肠憩室、结直肠黑变病检出率比较,差异无统计学意义(P>0.05)。结论结直肠息肉和结直肠癌是老年患者结肠镜检查中较为常见的阳性病变,且结直肠癌可能是导致老年患者下消化道出血的重要病因。

关键词： 256层螺旋CT   小肠造影扫描   小肠疾病   临床诊断   特征性表现  

摘要： 目的评价256层螺旋CT小肠造影扫描技术(MDCTE)对小肠疾病的诊断作用。方法给予300例临床怀疑小肠疾病患者MDCTE检查,将MDCTE检查结果与临床诊断进行对比分析。结果 300例行MDCTE检查的患者,244例诊断为小肠病变,与临床诊断一致。56例患者MDCTE诊断为阴性,其中符合40例,漏诊11例,误诊5例。MDCTE诊断小肠疾病的灵敏度为93.8%(244/260),准确率为94.7%(284/300);阳性预测值为100.0%,阴性预测值为71.4%。结论 MDCTE诊断小肠疾病具有特征性表现,对小肠疾病的诊治具有重要意义。

关键词： 256层螺旋CT小肠造影扫描   小肠疾病   临床诊断   特征性表现  

摘要： 目的评价256层螺旋CT小肠造影扫描技术对小肠疾病的诊断作用。方法给予2015年1月—2017年1月300例临床怀疑小肠疾病患者256层螺旋CT小肠造影扫描,观察患者病变的位置、形态、大小、转移及周围侵犯情况,将256层螺旋CT小肠造影扫描结果与临床诊断进行对比分析。结果 300例行256层螺旋CT小肠造影扫描检查的患者,244例诊断为小肠病变,与临床诊断一致。56例患者256层螺旋CT小肠造影扫描诊断为阴性,其中符合40例,漏诊11例,误诊5例。256层螺旋CT小肠造影扫描诊断小肠疾病的灵敏度为93.8%(244/260),准确率为94.7%(284/300);阳性预测值为100%,阴性预测值为71.4%。结论 256层螺旋CT小肠造影扫描诊断小肠肿瘤、炎症、梗阻等疾病具有特征性表现,对小肠疾病的诊治具有重要意义,临床推广价值极好。

关键词： Crohn’s disease   Diet   Environment   Smoking   Ulcerative colitis  

摘要： Purpose of Review: Environmental factors may influence predisposition to develop inflammatory bowel diseases (Crohn’s disease, ulcerative colitis) or alter its natural history by modification of both the host immune response and intestinal microbial composition. The purpose of this review is to translate such evidence into clinical practice by a focus on interventional studies that have modified such environmental influences to improve disease outcomes. Recent Findings: Several environmental influences have been identified in the recent literature including tobacco use, diet, antibiotics, vitamin D deficiency, stress, appendectomy, and oral contraceptive use. Some risk factors have similar influences on both Crohn’s disease and ulcerative colitis while others are disease-specific or have divergent effects. Summary: Emerging epidemiologic evidence has confirmed the association of many of these factors with incident disease using prospective data. In addition, laboratory data has supported their mechanistic plausibility and relevance to intestinal inflammation. © 2017, Springer Science+Business Media New York.

关键词： 肛肠疾病   术后尿潴留   原因   护理对策  

摘要： 目的探讨肛肠疾病术后尿潴留的原因以及护理对策。方法 45例肛肠疾病术后尿潴留患者,术后对患者行排尿诱导,并且采取积极的护理措施,对护理前后患者的健康感觉以及生活满足感进行对比分析。结果 45例肛肠疾病术后尿潴留的发生原因:心理因素20例,前列腺增生2例,麻醉效果差8例,术后疼痛15例。45例患者中,2例因前列腺增生,行导尿治疗;6例采取开塞露刺激顺利排尿;37例患者在行护理之后正常排尿,并且顺利出院。护理前患者的健康感觉(89.45±2.15)、生活满足感(15.45±3.05)分,均低于护理后的(118.05±3.15)、(28.65±3.45)分,差异均具有统计学意义(P<0.05)。结论肛肠疾病术后尿潴留的原因有很多,主要有心理因素、前列腺增生、麻醉效果以及术后疼痛等因素的影响,但是积极有效的护理干预能够帮助患者减轻疼痛,顺利排尿,进而提升患者的生存质量。

关键词： 功能性胃肠疾病   中医药治疗   常规治疗   临床疗效  

摘要： 目的探讨采用中医药疗法与西医疗法治疗功能性胃肠疾病患者的临床效果比较。方法选取2015年1月至2016年1月鞍山市长大医院收治的238例功能性胃肠疾病患者作为研究对象,随机分为研究组和对照组,每组119例。对照组患者给予马来酸曲美布汀,研究组患者则在对照组基础上加用中医、中药疗法进行治疗,比较两组患者治疗效果、不良反应发生情况及生命质量。结果治疗后,研究组患者治疗的总有效率明显高于对照组,不良反应发生率明显低于对照组,差异均有统计学意义(均P<0.05);研究组患者中医脾胃系疾病PRO量表(SSD-PRO)总分为(89±6)分,明显高于对照组的(64±4)分,差异有统计学意义(P<0.05);研究组患者不适/疼痛、形色精力、消化、排便、心理、医疗、独立性及社会关系评分均明显高于对照组,差异均有统计学意义(均P<0.05)。结论杜宇功能性胃肠疾病患者采用中医、中药疗法治疗临床效果显著,能够有效提高生命质量,减少不良反应发生。

关键词： Diet   IBD pathogenesis   IBD therapy   Inflammatory bowel disease  

摘要： Purpose of Review: Diet may play both a causal and therapeutic role for inflammatory bowel disease (IBD). Physicians caring for patients with IBD are often asked to make dietary recommendations. However, there are no well-established guidelines on the use of diet as a treatment of IBD. In this review, we describe the evidence supporting diet as a potential cause for IBD, patient-perceived symptoms based on diet, current research on various diets as a treatment for IBD, and areas of future research. Recent Findings: New studies in murine models suggest that dietary emulsifiers may trigger the gut inflammatory cascade. New studies of restriction diets in patients have shown a relationship between dietary intake, symptoms, and bowel inflammation. Summary: Until several ongoing clinical trials are completed, a reasonable approach to dietary recommendations for patients with IBD is to propose a well-balanced, healthy (low-fat, low-sugar) diet prepared from fresh ingredients, such as the Mediterranean diet, with exclusions of self-identified foods that worsen or trigger IBD-related symptoms. © 2017, Springer Science+Business Media New York.

关键词： Antibodies to drug   Biologic therapy   Crohn’s disease   Inflammatory bowel disease   Therapeutic drug monitoring   Trough level   Ulcerative colitis  

摘要： Purpose of Review: Biological medications are effective in inflammatory bowel disease (IBD) but adverse events, cost, and loss of response make their use challenging. Therapeutic drug monitoring (TDM) allows clinicians to more safely, effectively, and efficiently use medications. The purpose of this article is to review and summarize the most recent literature pertaining to TDM in IBD. Recent Findings: Measurement of biological drug trough levels predicts ongoing patient response and can be used to titrate the medication to be more effective and efficient. Antibodies against the medications predict loss of response and adverse events. Using both parameters can predict response to subsequent biologicals. Newer biologicals show similar characteristics to those more commonly used. Management protocols using drug and antibody levels optimize medication use and may be cost-effective. Summary: Recent evidence suggests benefit to TDM of biologicals in IBD. © 2017, Springer Science+Business Media New York.

关键词： LYMPHOGRANULOMA venereum   HIV-positive persons   MEN who have sex with men   DISEASES   ANTIRETROVIRAL agents   ULCERS   CASE studies   THERAPEUTIC use  

摘要： The article presents a case study of a 48-year-old HIV-positive MSM on antiretroviral therapy presented with bilateral inguinal lymphadenopathy. It mentions that colonoscopic examination revealed several white ulcers on bowel mucosa in the proximal rectum. It further reveals diagnosis of lymphogranuloma venereum (LGV) proctocolitis mimicking inflammatory bowel disease (IBD) in the HIV-positive MSM.