目的 分析Peutz-Jeghers综合征临床特点，以提高诊治水平。 方法 2008年11月-2010年1月对8例Peutz-Jeghers综合征的临床资料进行回顾性分析。 结果 男女各4例，年龄13～41岁，病程20 d～40年。8例均有黑斑和息肉，5例有明确的家族史。首发表现以腹痛为主，轻度抑郁表现2例，并发肠套叠2例，结肠癌1例。病理报告：错构瘤4例。外科手术治疗1例，结肠镜治疗6例，保守治疗1例。 结论 Peutz-Jeghers综合征易并发抑郁症、肠套叠和恶性肿瘤，患者需心理治疗和遗传咨询，肠镜下息肉切除是主要手段。
Objective To evaluate the difference of oral sodium phosphate (NaP) and polyethylene glycol-electrolyte lavage solution (PEG-ELS) in the aspects of cleansing efficacy, tolerance, and safety in clinical practice, so as to provide evidence for clinical practice. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed according the handbook of the Cochrane Collaboration. RCTs were identified from The Cochrane Library(Issue1,2004) MEDLINE(1980-2004), EMBASE(1984-2004),and CBM(1978-2004).Handsearching was also performed .RCTs comparing the two methods were selected .Tow reviewers independently assessed the quality of included trials and extracted data independently .Results Eighteen trials involving 3668 patients were included .Sub-group analysis was performed. Nap tablet had higher rate of adequate cleansing quality (RR1.08,95%CI1.02 to 1.05,p=0.01).Two-day ,divided-dose oral Nap was superior in the rate of adequate cleansing quality (RR1.27,95%CI1.06 to 1.52,p=0.009). .The. rate of adequate cleansing quality in right colon of Nap was lower than PEG-ELS(RR0.79,95%CI 0.64 to 0.98,p=0.03).The rate of abdominal cramps (RR 0.84,95%CI 0.72 to 0.99),the rate of abdominal fullness (RR 0.48,95%CI 0.26 to 0.89),the rate of nausea (RR 0.65,95%CI 0.56 to 0.76)and the percentage of patients who didn’t finished their prescribed regimen (RR 0.23,95%CI0.14 to 0.36)in Nap group were lower (plt;0.05).Conclusions Compared with PEG-ELS,Nap is superior in cleansing efficacy , patients’ tolerance ,safety and economy . It is possible to promote the use of Nap in clinical practice in China .
ObjectiveTo systematically evaluate the efficacy and safety of computer-aided detection (CADe) and conventional colonoscopy in identifying colorectal adenomas and polyps. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) comparing the effectiveness and safety of CADe assisted colonoscopy and conventional colonoscopy in detecting colorectal tumors from 2014 to April 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was performed by RevMan 5.3 software. ResultsA total of 9 RCTs were included, with a total of 6 393 patients. Compared with conventional colonoscopy, the CADe system significantly improved the adenoma detection rate (ADR) (RR=1.22, 95%CI 1.10 to 1.35, P<0.01) and polyp detection rate (PDR) (RR=1.19, 95%CI 1.04 to 1.36, P=0.01). It also reduced the missed diagnosis rate (AMR) of adenomas (RR=0.48, 95%CI 0.34 to 0.67, P<0.01) and the missed diagnosis rate (PMR) of polyps (RR=0.39, 95%CI 0.25 to 0.59, P<0.01). The PDR of proximal polyps significantly increased, while the PDR of ≤5 mm polyps slightly increased, but the PDR of >10mm and pedunculated polyps significantly decreased. The AMR of the cecum, transverse colon, descending colon, and sigmoid colon was significantly reduced. There was no statistically significant difference in the withdrawal time between the two groups. Conclusion The CADe system can increase the detection rate of adenomas and polyps, and reduce the missed diagnosis rate. The detection rate of polyps is related to their location, size, and shape, while the missed diagnosis rate of adenomas is related to their location.
目的 探讨腹腔镜术中联合结肠镜治疗结直肠小占位病变的可行性和临床应用价值。方法对我院2006年12月至2009年5月期间23例行腹腔镜联合结肠镜手术的结直肠小占位病变患者的临床资料进行回顾性分析。结果 所有患者均在腹腔镜下完成手术，无中转开腹。 手术时间80～200 min，平均140 min; 出血80~120 ml，平均100 ml。 9例息肉病变行局灶切除，术中经快速冰冻切片病理证实4例早期癌及10例不典型增生均行相应肠段切除。 术后1例出现轻度肺炎，经积极抗炎对症治疗后痊愈，其余患者恢复良好。 所有患者术后第1天即离床活动，住院时间5～10 d，平均7 d。结论 腹腔镜术中联合结肠镜治疗结直肠占位是安全可行的，有助于结直肠病灶及切缘的准确定位，可缩短手术时间，值得临床进一步推广应用。
ObjectiveTo understand the prevalence of anorectal diseases in the elderly in the community, and to evaluate the role of electronic rectosigmoidoscope in the screening of anorectal diseases.MethodThe resident population aged 60–74 in the Xichang’an Street Area of Xicheng District of Beijing were collected to complete the initial screening by filling in the risk factor assessment questionnaire, and who were classified as the high-risk with positive initial screening were admitted to the diagnostic re-screening by electronic rectosigmoidoscope.ResultsThere were 4 782 screening subjects, while 4 347 people actually participated in the initial screening, and 2 997 people were positive (positive rate was 68.9%). Among them, 2 312 participated in the electronic rectosigmoidoscope screening, and the compliance rate was 77.1%. A total of 2 275 patients with various anorectal diseases were detected by electronic rectosigmoidoscope, 1 311 (56.7%) of whom were hemorrhoids, 458 (19.8%) were rectal polyps, 154 (6.7%) were anal papillary hypertrophy, 147 (6.4%) were proctitis, 103 (4.4%) were anal fissure, 52 (2.2%) were anal fistula , 33 (1.4%) were rectal melanoma , and 17 (0.7%) were suspected rectal cancer. The detection rates of rectal polyps, proctitis, and anal fistula in the men were higher than those in the women (P<0.05), while the detection rates of hemorrhoids, anal papilla hypertrophy, anal fissure, and rectal melanosis in the women were higher than those in the men (P<0.05).ConclusionsAs a screening tool, electronic rectosigmoidoscope has the characteristics of simple operation, good compliance of the subject, and high compliance rate for re-screening. It is suitable for large-scale screening of anorectal diseases for elderly residents in the community.
Objective To investigate the method of the treatment on cholecystolithiasis combined with calculus of common bile duct (CBD) by laparoscopy with combination of choledochoscope and duodenoscope and its significances. Methods Forty-two patients with cholecystolithiasis combined with calculus of CBD were treated by laparoscopy with combination of choledochoscope and duodenoscope from Jan. 2007 to Dec. 2008 in this hospital. Under general anesthesia, laparoscopic cholecystectomy was performed first, then the anterior wall of CBD was opened, calculus of CBD was treated by choledochoscope and duodenoscope intraoperatively. Then primary suture of the CBD was performed under laparoscope and nasobiliary drainage duct was placed. Results One case was converted to laparotomy, 41 cases succeeded and left hospital after being taken off the nasobiliary drainage duct in 5-7 d. No case died, no bile leakage, no bleeding or perforation of upper digestive tract, and no acute pancreatitis happened after operation. Conclusion Laparoscopy with combination of choledochoscope and duodenoscope treating cholecystolithiasis combined with calculus of CBD is a safe, effective and quickly recovering method with less sufferings and trauma.
目的评价胆道镜和十二指肠镜在治疗T管拔除后胆瘘中的应用价值。方法对我院2000年5月至2004年12月期间9例采用胆道镜或十二指肠镜下鼻胆管引流（ENBD）治疗T管拔除后胆瘘患者的资料进行回顾性分析。结果本组病例采用胆道镜和十二指肠镜治疗均获成功，无并发症。结论胆道镜和十二指肠镜治疗T管拔除后胆瘘临床疗效可靠，有推广价值。
ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.
ObjectiveTo systematically review the diagnostic value of capsule endoscopy and enteroscopy in small intestinal diseases.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect studies on the diagnosis of intestinal diseases by capsule endoscopy and enteroscopy from inception to August 31st, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Meta-analysis was then performed by using RevMan 5.3 and Meta-DiSc software.ResultsA total of 20 studies were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for capsule endoscopy were 0.86 (95%CI 0.83 to 0.87), 0.81 (95%CI 0.78 to 0.84), 117.07 (95%CI 37.98 to 360.92), 7.20 (95%CI 2.81 to 18.45), 0.11 (95%CI 0.06 to 0.21), and those for enteroscopy were 0.89 (95%CI 0.87 to 0.90), 0.91 (95%CI 0.89 to 0.93), 196.99 (95%CI 72.63 to 534.26), 13.26 (95%CI 5.00 to 35.14), 0.12 (95%CI 0.07 to 0.21). The areas under the working characteristic curve (SROC) of capsule endoscopy and enteroscopy were 0.9692 and 0.9783, respectively.ConclusionsBoth capsule endoscopy and enteroscopy have high specificity and sensitivity in the diagnosis of small intestinal diseases, and enteroscopy has higher clinical value in the diagnosis of some small intestinal diseases than capsule endoscopy. Due to limited quantity and quality of the included studies, the above conclusions are required to be verified by more high-quality studies.