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Issues and controversies in esophageal inlet patch 预览
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作者 Adriana Ciocalteu Petrica Popa +1 位作者 Mircea Ionescu Dan Ionut Gheonea 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第30期4061-4073,共13页
The proximal esophagus is rarely examined,and its inspection is often inadequate.Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus,a r... The proximal esophagus is rarely examined,and its inspection is often inadequate.Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus,a region in which their prevalence is likely underestimated.Various studies have reported correlations between these esophageal marks with different issues such as Barrett’s esophagus,but these findings remain controversial.Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance.Unfortunately,the limited clinical data and statistical analyses make reaching any conclusions difficult.It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms,diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers.Due to its potential underdiagnosis,there are no consensus guidelines for the management and follow up of inlet patches.This review focuses on questions that were raised from published literature on esophageal inlet patches in adults. 展开更多
关键词 INLET PATCH Ectopic GASTRIC MUCOSA Heterotopic GASTRIC MUCOSA ESOPHAGEAL cancer Narrow band imaging Optical chromoendoscopy Cervical ESOPHAGUS Functional dyspepsia Barrett’s ESOPHAGUS Helicobacter pylori
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孤立性食管静脉瘤223例临床内镜分析 预览
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作者 周燕 白飞虎 +6 位作者 虎金朋 牛敏 杨珍 莫丽蓉 杨金芳 朱亚萍 张雪 《中华消化病与影像杂志(电子版)》 2019年第3期103-104,共2页
目的通过分析内镜诊断为食管孤立性静脉瘤223例患者的临床内镜特点,以加深内镜医师对该病的认识,减少对该病的误诊。方法对2013年6月至2018年1月宁夏回族自治区人民医院消化内镜中心通过胃镜诊断的食管孤立性静脉瘤进行分析。结果期间... 目的通过分析内镜诊断为食管孤立性静脉瘤223例患者的临床内镜特点,以加深内镜医师对该病的认识,减少对该病的误诊。方法对2013年6月至2018年1月宁夏回族自治区人民医院消化内镜中心通过胃镜诊断的食管孤立性静脉瘤进行分析。结果期间共完成胃镜诊断48 861例,其中食管孤立性静脉瘤223例,检出率为0.46%,其中5例因出血行内镜下食管静脉瘤硬化术。结论:食管孤立性静脉瘤属良性病变,增长速度缓慢,一般无特殊处理,若发生出血,内镜下注射聚桂醇硬化治疗为可行有效的方法。 展开更多
关键词 内镜 食管 静脉瘤 出血
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22例纽扣式电池食管异物患儿治疗效果分析 预览
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作者 王萍 李赟 +1 位作者 罗欣友 余甜甜 《临床小儿外科杂志》 CAS 2019年第6期467-471,共5页
目的总结儿童纽扣式电池食管异物患儿的临床特征、并发症及治疗措施,为制定儿童食管异物规范化诊疗方案提供依据。方法回顾性收集2013年1月至2019年1月由湖南省儿童医院收治的22例纽扣式电池食管异物患儿作为研究对象,其中男童12例,女... 目的总结儿童纽扣式电池食管异物患儿的临床特征、并发症及治疗措施,为制定儿童食管异物规范化诊疗方案提供依据。方法回顾性收集2013年1月至2019年1月由湖南省儿童医院收治的22例纽扣式电池食管异物患儿作为研究对象,其中男童12例,女童10例,中位年龄30.5个月。19例(86.36%)发生吞咽困难,17例(77.27%)发生呕吐,5例(22.73%)发生流涎,1例(4.55%)发生恶心。病史2 h至6个月,异物滞留时间<6 h 6例,6~24 h 5例,24~48 h 3例,≥48 h 8例。异物崁顿在食管上段者14例,食管中段者3例,食管下段者5例。结果22例患儿中19例(86.36%)治愈出院,2例(9.09%)好转出院,1例(4.55%)死亡。21例(95.45%)发生食管黏膜糜烂,12例(54.55%)发生食管周围炎,3例(13.64%)发生食管穿孔(食管气管瘘),2例(9.09%)发生食管狭窄,1例(4.55%)发生大出血。纽扣式电池食管异物所致并发症发生率最高是食管黏膜糜烂,其次是食管周围炎、食管穿孔、食管狭窄、大出血。3例食管穿孔中有1例经增强营养及控制感染后自然愈合,1例于胸外科予食管穿孔修补术后痊愈出院,1例合并食管穿孔及食管气管瘘发生大出血死亡。食管气管瘘2例中有1例于外院行胃造瘘及食管旷置术,1例食管气管瘘患儿尚在随访观察中;食管狭窄2例已行食管扩张术,其中1例疗效欠佳尚在随访观察中;结论纽扣式电池食管异物的常见并发症是食管黏膜糜烂、食管周围炎,更为严重者可以发生食管穿孔、食管狭窄,甚至大出血死亡。对于该类患儿应尽快就医、尽早手术、采用正确有效的护理措施、加强病情观察、定期随访,这样可降低并发症发生率,有效改善其预后。 展开更多
关键词 食管 异物 治疗效果 儿童
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经食道超声引导心内膜临时起搏导线放置的效果观察 预览
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作者 俞建国 曹俏玮 +2 位作者 杨日辉 赵红炜 王庆 《现代医药卫生》 2019年第18期2813-2814,2817共3页
目的探讨经食道超声(TEE)引导下心内膜临时起搏导线放置的效果及安全性。方法选取2018年7月至2019年1月该院收治需放置临时起搏器的胸腔镜心脏手术患者20例,双腔气管插管全身麻醉后在右颈内静脉置入鞘管和上腔引流管,左颈内静脉置入三... 目的探讨经食道超声(TEE)引导下心内膜临时起搏导线放置的效果及安全性。方法选取2018年7月至2019年1月该院收治需放置临时起搏器的胸腔镜心脏手术患者20例,双腔气管插管全身麻醉后在右颈内静脉置入鞘管和上腔引流管,左颈内静脉置入三腔中心静脉导管,然后借助TEE从鞘管内放置心内膜临时起搏导线。结果20例患者均能成功放置心内膜起搏导线,其中14例一次性将心内膜起搏导线的前端放置在右室心尖部,4例放置了2次,2例需将导线退回到套袋内重新塑形后才能顺利放置。20例患者放置时间为156~501s,平均(276.9±85.1)s,总成功率为100%,未出现明显并发症。结论TEE引导下心内膜临时起搏导线放置具有明视、效果确切、安全性高等特点,大大减少了心内膜临时起搏导线的放置时间和并发症,值得在临床上推广应用。 展开更多
关键词 超声检查 食管 胸腔镜 心脏外科手术 心内膜临时起搏导线
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Advanced imaging in surveillance of Barrett’s esophagus:Is the juice worth the squeeze? 预览
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作者 Sara A Cerrone Arvind J Trindade 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第25期3108-3115,共8页
Esophageal cancer is on the rise.The known precursor lesion is Barrett’s esophagus(BE).Patients with dysplasia are at higher risk of developing esophageal cancer.Currently the gold standard for surveillance endoscopy... Esophageal cancer is on the rise.The known precursor lesion is Barrett’s esophagus(BE).Patients with dysplasia are at higher risk of developing esophageal cancer.Currently the gold standard for surveillance endoscopy involves taking targeted biopsies of abnormal areas as well as random biopsies every 1-2 cm of the length of the Barrett’s.Unfortunately studies have shown that this surveillance can miss dysplasia and cancer.Advanced imaging technologies have been developed that may help detect dysplasia in BE.This opinion review discusses advanced imaging in BE surveillance endoscopy and its utility in clinical practice. 展开更多
关键词 Barrett’s ESOPHAGUS Advanced imaging CHROMOENDOSCOPY ENDOMICROSCOPY
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Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location 预览
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作者 Fabian Emura Rene Gomez-Esquivel +4 位作者 Carlos Rodriguez-Reyes Petros Benias Javier Preciado Michael Wallace Luis Giraldo-Cadavid 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第4期498-508,共11页
AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.METHODS Distance from the incisors and radial orientation were estimated for t... AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination.A sub-study was also performed using white light followed by endoscopic ultrasound(EUS)in 25 consecutive patients to confirm the findings.The scope orientation throughout the exam was maintained at the natural axis,where the left esophageal quadrant corresponds to the area between 6 and 9 o'clock.When an anatomical landmark was identified,it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined.The reference points to obtain the distances and radial orientation were as follows:the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium.With the video processor system set to moderate insufflation,measurements were obtained at the end of the patients'air expiration.RESULTS The left main bronchus and left atrium esophageal landmarks were identified using white light in 99%and 100%of subjects at a mean distance of 25.8 cm(SD 2.3),and 31.4 cm(SD 2.4)from the incisors,respectively.The left main bronchus landmark was found to be a tubular,concave,non-pulsatile,esophageal external compression,occupying approximately 1/4 of the circumference.The left atrium landmark was identified as a round,convex,pulsatile,esophageal external compression,occupying approximately 1/4 of the circumference.Both landmarks were identified using white light on the anterior esophageal quadrant.In the substudy,the left main bronchus was identified in 24(92%)patients at 25.4 cm(SD 2.1)and 26.7 cm(SD 1.9)from the incisors,by white light and EUS,respectively.The left atrium was recognized in all patients at 30.5 cm(SD 1.9),and 31.6 cm(SD 2.3)from the incisors,by both white light and EUS,respectively.EUS confirmed that the landmarks correspond 展开更多
关键词 Esophagus Natural landmark RADIAL ORIENTATION Longitudinal ORIENTATION Four-quadrants LEFT main BRONCHUS LEFT atrium
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食管神经内分泌癌107例的临床及病理特点分析
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作者 孟宇 练延帮 +4 位作者 李珊珊 勾贺 王亚梦 陈洁 宋敏 《中华消化杂志》 CAS CSCD 北大核心 2019年第8期533-538,共6页
目的探讨食管神经内分泌癌(ENEC)患者的临床表现及病理特点。方法纳入2011年1月至2018年11月郑州大学第一附属医院经病理复诊为ENEC的107例患者,分析其临床表现、肿瘤的部位、肿瘤大小、临床病理分型和免疫组织化学标志物情况。计量资... 目的探讨食管神经内分泌癌(ENEC)患者的临床表现及病理特点。方法纳入2011年1月至2018年11月郑州大学第一附属医院经病理复诊为ENEC的107例患者,分析其临床表现、肿瘤的部位、肿瘤大小、临床病理分型和免疫组织化学标志物情况。计量资料采用统计描述,分类资料采用卡方检验。结果107例ENEC患者中,首发症状以进食梗噎最常见,占63.6%(68/107);其次为胸背疼痛,占13.1%(14/107)。60.7%(65/107)的患者经内镜活组织检查确诊,39.3%(42/107)的患者经手术病理确诊。肿瘤位于食管胸上段相对较少,占13.1%(14/107);位于胸中段和胸下段分别占45.8%(49/107)和41.1%(44/107)。肿瘤长径为0.7~9.0 cm,中位数为2.5 cm,其中≤2.5 cm者占57.0%(61/107),>2.5 cm者占43.0%(46/107)。107例患者中,溃疡型50例(46.7%),髓质型32例(29.9%),蕈伞型16例(15.0%),隆起型9例(8.4%)。107例患者中,纯神经内分泌癌(P-NEC) 96例(其中小细胞型95例,大细胞型1例),占89.7%;混合性神经内分泌癌(M-NEC)11例(其中小细胞癌鳞状细胞癌混合型9例,小细胞癌腺癌混合型2例),占10.3%。突触素阳性率为99.0%(104/105),CD56阳性率为98.0%(100/102),嗜铬粒蛋白A(CgA)阳性率为31.5%(17/54),Ki-67为>90%~100%占47.7%(51/107)。肿瘤最大径>2.5 cm的P-NEC占42.1(45/107),M-NEC占0.9%(1/107),P-NEC组的肿瘤最大径大于M-NEC组,差异有统计学意义(χ^2=4.311,P=0.038)。结论ENEC是一种临床表现不特异且有高度侵袭性的恶性肿瘤,确诊主要靠组织病理及免疫组织化学检查。 展开更多
关键词 神经内分泌 食管 免疫组织化学 病理学 临床
食管黏膜下血肿的多层螺旋CT诊断
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作者 黄日升 陈杰云 +1 位作者 陈向荣 杨子江 《临床放射学杂志》 CSCD 北大核心 2019年第4期630-634,共5页
目的分析食管黏膜下血肿的CT表现,提高对该病的认识。方法回顾性分析16例食管黏膜下血肿患者的临床及影像资料,总结其CT表现特征。结果病灶部位:食管上段1例,食管颈段+胸上段2例,食管颈段+胸中上段1例,食管胸中下段4例,食管颈段+胸上中... 目的分析食管黏膜下血肿的CT表现,提高对该病的认识。方法回顾性分析16例食管黏膜下血肿患者的临床及影像资料,总结其CT表现特征。结果病灶部位:食管上段1例,食管颈段+胸上段2例,食管颈段+胸中上段1例,食管胸中下段4例,食管颈段+胸上中下段8例。食管管壁增厚的形态:结节状增厚1例,同心圆状增厚2例,偏心性增厚10例,同心圆状+偏心性增厚3例;3例病灶内见气泡影;病变段管腔闭塞或呈圆形、新月形、斑点状气体影,适度扩张者病灶腔内缘一般光滑;4例累及胸中下段者其上方食管扩张不明显,管腔扩张程度与病灶的厚度不成比例。除1例合并纵隔血肿外,其余15例病灶外缘清楚。平扫呈高密度(CT值为35~69 HU),高于自身胸主动脉密度,增强扫描无强化。其中5例伴有胸腔积液,1例伴有纵隔血肿。结论 CT能很好的显示食管黏膜下血肿的特征,可作为诊断及随访的首选方法。 展开更多
关键词 食管 血肿 体层摄影术 X线计算机
食管原发性小细胞神经内分泌癌22例临床病理分析
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作者 张惠娟 周胜理 +2 位作者 赵兰芳 石梦林 李健 《中华肿瘤防治杂志》 CAS 北大核心 2019年第16期1200-1207,共8页
目的食管原发性小细胞神经内分泌癌(small cell neuroendocrine carcinoma,SCNEC)是一种少见且预后差的恶性肿瘤,确诊主要依据病理学.本研究分析食管原发性SCNEC临床病理和免疫组化特征,并探讨其诊治要点.方法收集2014-01-29-2018-03-2... 目的食管原发性小细胞神经内分泌癌(small cell neuroendocrine carcinoma,SCNEC)是一种少见且预后差的恶性肿瘤,确诊主要依据病理学.本研究分析食管原发性SCNEC临床病理和免疫组化特征,并探讨其诊治要点.方法收集2014-01-29-2018-03-23河南省人民医院经病理确诊的食管SCNEC患者22例,回顾性分析其临床病理、影像学表现、胃镜表现、组织学特征及治疗结局.结果22例食管SCNEC患者中,内镜主要表现为不规则新生物,表面伴有糜烂或溃疡(86.4%,19/22).11例为局限期,其中5例未发生淋巴结和远处转移;11例为广泛期,均发生远处器官转移或远处淋巴结转移,肝脏(81.8%,9/11)是最常见的远处转移器官.22例患者1、3年生存率分别为52.8%和16.6%,局限期和广泛期患者中位生存时间分别为29.0和5.0个月,差异有统计学意义,χ^2=6.643,P=0.01.22例患者免疫组化显示,CgA阳性6例(27.3%),Syn阳性22例(100.0%)和CD56阳性22例(100.0%),11例(50.0%)c-kit染色阳性,其中9例(81.8%,9/11)同时表现为p53蛋白表达异常;3例c-kit和p53表达阴性,但CK20阳性.结论食管SC-NEC呈侵袭性生长,易发生转移,预后差.免疫组化染色有助于食管SCNEC诊断.c-kit和p53免疫反应为食管SC-NEC生物学行为提供新见解. 展开更多
关键词 神经内分泌癌 小细胞癌 食管 免疫组化 预后
Resection of early esophageal neoplasms:The pendulum swings from surgical to endoscopic management 预览
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作者 Vedha Sanghi Hina Amin +1 位作者 Madhusudhan R Sanaka Prashanthi N Thota 《世界胃肠内镜杂志:英文版(电子版)》 2019年第10期491-503,共13页
Esophageal cancer is a highly lethal disease and is the sixth leading cause of cancer related mortality in the world.The standard treatment is esophagectomy which is associated with significant morbidity and mortality... Esophageal cancer is a highly lethal disease and is the sixth leading cause of cancer related mortality in the world.The standard treatment is esophagectomy which is associated with significant morbidity and mortality.This led to development of minimally invasive,organ sparing endoscopic therapies which have comparable outcomes to esophagectomy in early cancer.These include endoscopic mucosal resection and endoscopic submucosal dissection.In early squamous cell cancer,endoscopic submucosal dissection is preferred as it is associated with cause specific 5-year survival rates of 100%for M1 and M2 tumors and 85%for M3 and SM1 tumors and low recurrence rates.In early adenocarcinoma,endoscopic resection of visible abnormalities is followed by ablation of the remaining flat Barrett’s mucosa to prevent recurrences.Radiofrequency ablation is the most widely used ablation modality with others being cryotherapy and argon plasma coagulation.Focal endoscopic mucosal resection followed by radiofrequency ablation leads to eradication of neoplasia in 93.4%of patients and eradication of intestinal metaplasia in 73.1%of patients.Innovative techniques such as submucosal tunneling with endoscopic resection are developed for management of submucosal tumors of the esophagus.This review includes a discussion of various endoscopic techniques and their clinical outcomes in early squamous cell cancer,adenocarcinoma and submucosal tumors.An overview of comparison between esophagectomy and endoscopic therapy are also presented. 展开更多
关键词 Esophageal cancer SUBMUCOSAL tumors SUBMUCOSAL tunneling Barrett’s esophagus DYSPLASIA Adenocarcinoma ENDOSCOPIC therapy Radiofrequency ablation ENDOSCOPIC MUCOSAL RESECTION
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原发性食管恶性黑色素瘤1例并文献复习 预览
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作者 李静 《中国民康医学》 2019年第12期129-130,共2页
目的:探讨食管原发性恶性黑色素瘤(PMME)的临床特点及诊疗效果。方法:以1例PMME患者为研究对象,结合文献资料对该疾病的临床特点、诊治和预后情况进行探讨分析。结果:该患者术后病理结果最终确诊为PMME,出院后行化疗联合干扰素治疗和树... 目的:探讨食管原发性恶性黑色素瘤(PMME)的临床特点及诊疗效果。方法:以1例PMME患者为研究对象,结合文献资料对该疾病的临床特点、诊治和预后情况进行探讨分析。结果:该患者术后病理结果最终确诊为PMME,出院后行化疗联合干扰素治疗和树突状细胞(DCs)生物治疗,目前术后随访已5个月,患者仍健在。结论:PMME极为罕见,其诊断主要依赖于内镜下活检及病理免疫组化检查;治疗上仍是以手术为主的综合治疗,因其易发生淋巴及血行转移,故预后不理想。 展开更多
关键词 食管 原发性 黑色素瘤 免疫治疗
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Endoscopic management of esophageal cancer 预览
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作者 Osman Ahmed Jaffer A Ajani Jeffrey H Lee 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第10期830-841,共12页
Esophageal cancer(EC)generally consists of squamous cell carcinoma(which arise from squamous epithelium)and adenocarcinoma(which arise from columnar epithelium).Due to the increased recognition of risk factors associa... Esophageal cancer(EC)generally consists of squamous cell carcinoma(which arise from squamous epithelium)and adenocarcinoma(which arise from columnar epithelium).Due to the increased recognition of risk factors associated with EC and the development of screening programs,there has been an increase in the diagnosis of early EC.Early EC is amenable to curative therapy by endoscopy,which can be performed by either endoscopic resection or endoscopic ablation.Endoscopic resection consists of either endoscopic mucosal resection(preferred in cases of adenocarcinoma)or endoscopic submucosal dissection(preferred in cases of squamous cell carcinoma).Endoscopic ablation can be performed by either radiofrequency ablation,cryotherapy,argon plasma coagulation or photodynamic therapy,amongst others.Endoscopy can also assist in the management of complications post-esophageal surgery,such as anastomotic leaks and perforations.Finally,there is a growing role for endoscopy to manage end-of-life palliative symptoms,especially dysphagia.The growing use of esophageal stents,debulking therapy and dilation can assist in improving a patient’s quality of life.In this review,we examine the multiple roles of endoscopy in the management of patients with EC. 展开更多
关键词 ESOPHAGEAL cancer ENDOSCOPY RESECTION Ablation STENT Barrett’s ESOPHAGUS
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主动脉—食管瘘消化道大出血1例综合护理 预览
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作者 沈秀红 梁虹 +6 位作者 尹先琳 高琳琳 林清金 柯燕芍 连娴静 彭建扬 宋聪华 《中外医疗》 2019年第10期130-132,共3页
目的总结1例主动脉—食管瘘消化道大出血的护理经验。方法要点包括急性消化道大出血护理体会、主动脉—食管瘘抢救过程护理配合、主动脉覆膜支架系统置入术后护理观察,同时对患者及家属进行健康指导。结果该例患者抢救成功,经住院65d天... 目的总结1例主动脉—食管瘘消化道大出血的护理经验。方法要点包括急性消化道大出血护理体会、主动脉—食管瘘抢救过程护理配合、主动脉覆膜支架系统置入术后护理观察,同时对患者及家属进行健康指导。结果该例患者抢救成功,经住院65d天后康复出院。结论主动脉—食管瘘为罕见病,对其进行归纳总结有助于此类疾病护理水平的提高。 展开更多
关键词 食管 动脉瘤 消化道出血 介入 护理
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三腔两囊管在新生儿H型气管-食管瘘诊断中的应用 预览
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作者 邓科委 吴晓宇 +1 位作者 于西萍 罗立倩 《延安大学学报:医学科学版》 2019年第3期49-52,共4页
目的探索三腔二囊管在新生儿H型气管-食管瘘诊断中临床应用价值。方法选取西北妇女儿童医院近3年9例高度怀疑H型气管-食管瘘患儿作为研究对象,应用三腔二囊管对食管上下两端封堵后向食管内注入造影剂形成正压的条件下,在X线透视下监测... 目的探索三腔二囊管在新生儿H型气管-食管瘘诊断中临床应用价值。方法选取西北妇女儿童医院近3年9例高度怀疑H型气管-食管瘘患儿作为研究对象,应用三腔二囊管对食管上下两端封堵后向食管内注入造影剂形成正压的条件下,在X线透视下监测是否有造影剂通过瘘道进入气管,评估三腔二囊管对H型气管-食管瘘的诊断价值。结果借助三腔二囊管对高度怀疑H型气管-食管瘘的患儿进行食管造影,食管充盈赢显影良好,未发现有造影剂通过瘘道进入气管X线征象,排除H型气管-食管瘘存在。结论对高度怀疑H型气管-食管瘘患儿应用三腔二囊管进行食管造影对明确诊断有一定应用价值,简单可行、直观可靠。 展开更多
关键词 三腔两囊管 食管 造影 新生儿 H型气管-食管瘘
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110例食管神经内分泌肿瘤临床分析
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作者 宋丽杰 陶爽 +7 位作者 王博 杨闽洁 翟雪佳 陶伟丽 连妤瑾 余旭旭 樊青霞 李文才 《中华实用诊断与治疗杂志》 2019年第6期562-565,共4页
目的探讨食管神经内分泌肿瘤的临床特征、治疗模式、化疗方案及预后。方法回顾性分析110例食管神经内分泌肿瘤患者的临床资料。结果 110例食管神经内分泌肿瘤患者,其中食管小细胞癌90例(81.8%),食管鳞状细胞癌或腺癌伴神经内分泌分化20... 目的探讨食管神经内分泌肿瘤的临床特征、治疗模式、化疗方案及预后。方法回顾性分析110例食管神经内分泌肿瘤患者的临床资料。结果 110例食管神经内分泌肿瘤患者,其中食管小细胞癌90例(81.8%),食管鳞状细胞癌或腺癌伴神经内分泌分化20例;患者以吞咽困难或胸骨后疼痛为主要首发症状,病变主要位于食管中下段;手术是治疗局限期食管小细胞癌的主要方法,广泛期患者以化疗为主,多采用EP方案;食管鳞癌或腺癌伴神经内分泌分化患者以手术联合术后辅助化疗为主;Kaplan-Meier生存分析显示,食管鳞癌或腺癌伴神经内分泌分化患者1、3、5 a生存率(75.0%、41.7%、25.0%)高于食管小细胞癌患者(55.6%、4.4%、2.2%)(P<0.05);食管小细胞癌局限期手术患者1、3、5 a生存率(72.0%、8.0%、4.0%)高于非手术患者(33.3%、0、0)(P<0.05),广泛期化疗患者1 a生存率(50.0%)高于非化疗患者(0)(P<0.05)。结论食管小细胞癌为食管神经内分泌肿瘤常见类型,预后差,局限期首选手术治疗,广泛期首选化疗;食管鳞癌或腺癌伴神经内分泌分化是神经内分泌肿瘤的少见类型,治疗以手术联合化疗为主,与食管小细胞癌相比,其预后较好。 展开更多
关键词 神经内分泌肿瘤 小细胞癌 食管
经食管黏膜下隧道内镜治疗大面积食管黏膜病变的价值 预览
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作者 乔晓 梁凤 +2 位作者 叶彬 刘树青 韩成艳 《中华消化病与影像杂志(电子版)》 2019年第2期61-64,共4页
目的,探讨经食管黏膜下隧道内镜治疗大面积食管黏膜病变的应用价值。方法,徐州医科大学附属淮安医院2015年1月至2017年7月经胃镜及病理诊断大面积食管高级别上皮内瘤变18例,采用随机数字表法分为传统内镜黏膜下剥离术(endoscopic submuc... 目的,探讨经食管黏膜下隧道内镜治疗大面积食管黏膜病变的应用价值。方法,徐州医科大学附属淮安医院2015年1月至2017年7月经胃镜及病理诊断大面积食管高级别上皮内瘤变18例,采用随机数字表法分为传统内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)法及经食管黏膜下隧道法切除病变,对比及随访观察治疗效果。结果,隧道组均于术中一次性完整剥离切除,一次性整块切除率均为100%,经典ESD组1例圈套器辅助分片切除,一次性整块切除率均为88.9%,术后病理结果提示所有切除标本的侧切缘和基底切缘无肿瘤累及。病变切除的平均直径隧道组为(7.5±3.2)cm,经典ESD组为(8.3±1.4)cm,2组在病变切除面积差异无统计学意义( P >0.05);平均手术时间隧道组为(50.4±28.0)min,经典ESD组为手术时间(82.5±29.7)min,2组在一次性整块切除率、平均手术时间方面,差异有统计学意义( P <0.05)。隧道技术组术中无1例皮下气肿;剥离过程无环形肌受伤害;经典ESD组术中出现纵隔、皮下气肿2例,其中小穿孔的1例应用钛夹缝合,术后3 d气肿均自行消失,术后24 h内出现发热1例,伴有白细胞升高,抗炎对症处理后第2天完全缓解,差异有统计学意义( P <0.05)。结论,内镜经食管黏膜下隧道技术是大面积食管黏膜病变切除安全有效的方法,能有效降低内镜下病变切除的难度,缩短手术时间,减少并发症发生。 展开更多
关键词 食管 高级别上皮内瘤变 内镜经食管黏膜下隧道技术 内镜黏膜下剥离术
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强直性脊柱炎颈胸段后凸畸形截骨术后食管长度变化的CT测量及临床意义
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作者 轩文彬 钱邦平 +4 位作者 乔木 黄季晨 邱勇 王斌 俞杨 《中华医学杂志》 CAS CSCD 北大核心 2019年第29期2276-2281,共6页
目的探讨强直性脊柱炎(AS)颈胸段后凸畸形患者行C7经椎弓根椎体截骨(PSO)后食管长度变化及临床意义。方法回顾性分析2014年12月至2018年11月在南京鼓楼医院接受C7PSO治疗的8例男性AS患者,接受手术时年龄26~49岁,平均(35±7)岁。颈... 目的探讨强直性脊柱炎(AS)颈胸段后凸畸形患者行C7经椎弓根椎体截骨(PSO)后食管长度变化及临床意义。方法回顾性分析2014年12月至2018年11月在南京鼓楼医院接受C7PSO治疗的8例男性AS患者,接受手术时年龄26~49岁,平均(35±7)岁。颈椎侧位X线片上测量术前、术后颈胸段后凸Cobb角、颈胸段矢状面偏移(C2-T1SVA)和固定节段角度(AFL),外观照片上测量颏眉角(CBVA),CT矢状面重建上测量术前、术后截骨椎前缘高度(AHOV)及部分食管长度(食管起始处至下固定椎下终板之间食管长度)。收集Oswestry功能障碍指数(ODI)与颈椎功能障碍指数(NDI)评估患者生存质量,疼痛数字评分表(NRS)评估患者疼痛情况。结果8例患者均获得随访,随访时长3~51个月,平均(15±9)个月。8例患者颈胸段后凸Cobb角平均矫正35.9°±7.3°,C2-T1SVA平均矫正(44.7±11.6)mm,AFL平均矫正32.0°±4.8°,CBVA平均矫正38.1°±11.5°,AHOV平均减少(5.6±1.6)mm,部分食管长度平均延长(15.3±1.6)mm。ODI术前、末次随访分别为(17±14)分、(13±10)分;NDI术前、末次随访分别为(18±15)分、(10±6)分;NRS评分术前为(4.8±2.4)分,末次随访改善至(1.0±1.2)分。食管长度变化与颈胸段后凸Cobb角、C2-T1SVA、AFL、CBVA矫正值存在线性相关(r=0.84、0.83、0.83、0.73,均P<0.05)。结论AS颈胸段后凸畸形患者C7PSO术后食管较术前延长;食管长度变化与矫形效果参数密切相关;手术方案设计时要充分考虑截骨矫形术对食管长度的影响,避免引起相关并发症。 展开更多
关键词 脊柱炎 强直性 颈椎 脊柱后凸 截骨术 食管
Clinical outcomes and safety of high-resolution manometry guided superficial partial circular muscle myotomy in per-oral endoscopic myotomy for Jackhammer esophagus:Two cases report 预览
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作者 Youn I Choi Kyoung Oh Kim +3 位作者 Dong Kyun Park Jun-Won Chung Yoon Jae Kim Kwang An Kwon 《世界临床病例杂志》 2019年第16期2322-2329,共8页
BACKGROUND Jack hammer esophagus is a relatively rare disease and to date,there is no dramatic treatment option.Recently,conventional per-oral endoscopic myotomy (POEM) have expanded their area into Jackhammer esophag... BACKGROUND Jack hammer esophagus is a relatively rare disease and to date,there is no dramatic treatment option.Recently,conventional per-oral endoscopic myotomy (POEM) have expanded their area into Jackhammer esophagus.However,several complications such as post procedure motility disorders (e.g.,passage disturbance) are issues after POEM.To overcome these issues,we here introduced high-resolution manometry (HRM)-guided superficial partial circular muscle myotomy,which involves cutting only the superficial layer of the esophageal circular muscle.CASE SUMMARY We report two cases of patients with Jackhammer esophagus who were treated with HRM-guided extremely superficial partial circular muscle myotomy during POEM.Case 1 was a 53-year-old female with medication-refractory odynophagia and case 2 was a 47-year-old man who presented with chest pain.They were diagnosed with Jackhammer esophagus using HRM,and the hypercontractile segments of the esophagus were identified.HRM-guided extremely superficial partial circular muscle myotomy was performed while preserving the lower esophageal sphincter.Therefore,the circular and longitudinal muscle layers are preserved but hypercontractile movements are reduced,even after POEM.Patients’ clinical symptoms dramatically improved right after POEM,and 6-mo follow-up HRM revealed completely resolved status.During a 1-year follow-up period,patients were still in good health and remained symptom free.CONCLUSION HRM-guided superficial partial circular muscle myotomy may be a promising alternative to conventional POEM for treating Jackhammer esophagus with improved efficacy. 展开更多
关键词 Jackhammer ESOPHAGUS Hypercontractile PARTIAL CIRCULAR MUSCLE MYOTOMY Case REPORT
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38例颈部外伤诊治体会 预览
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作者 于洋 杨志超 +4 位作者 董维刚 马瑞霞 柳萍 朱金源 康向飞 《宁夏医科大学学报》 2019年第4期416-419,共4页
目的为总结颈部外伤有效的诊治方法。方法回顾性分析38例颈部外伤患者临床资料,分析总结其致病原因、治疗方法及预后处理。结果38例患者中,1例术前死亡,1例术后咽漏形成经保守治疗效果不佳后自动放弃出院,其余36例均Ⅰ期愈合(含复合伤),... 目的为总结颈部外伤有效的诊治方法。方法回顾性分析38例颈部外伤患者临床资料,分析总结其致病原因、治疗方法及预后处理。结果38例患者中,1例术前死亡,1例术后咽漏形成经保守治疗效果不佳后自动放弃出院,其余36例均Ⅰ期愈合(含复合伤),2例喉腔放置喉膜,1个月后取出,随访半年均未产生喉狭窄。结论颈部外伤术前需要对患者病情准确的判断,抢救生命放在首位,尽可能恢复喉的生理功能,防止并发症发生,同时需多学科共同合作综合治疗。 展开更多
关键词 颈部 外伤 气管 食管 开放性损伤
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Clinical characteristics of young patients with early Barrett’s neoplasia 预览
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作者 Yugo Iwaya Yuto Shimamura +8 位作者 Kenichi Goda Enrique Rodríguez de Santiago John Gerard Coneys Jeffrey D Mosko Gabor Kandel Paul Kortan Gary May Norman Marcon Christopher Teshima 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第24期3069-3078,共10页
BACKGROUND Esophageal adenocarcinoma(EAC)and high-grade dysplasia(HGD)may appear in young patients with Barrett's esophagus(BE).However,characteristics of Barrett's-related neoplasia in this younger population... BACKGROUND Esophageal adenocarcinoma(EAC)and high-grade dysplasia(HGD)may appear in young patients with Barrett's esophagus(BE).However,characteristics of Barrett's-related neoplasia in this younger population remain unknown.AIM To identify clinical characteristics that differ between young and old patients with early-stage Barrett's-related neoplasia.METHODS We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC(pT1)and HGD at a tertiary-referral center between 2001 and 2017.Baseline characteristics,drug and risk factor exposures,clinicopathological staging of EAC/HGD and treatment outcomes[complete eradication of neoplasia(CE-N),complete eradication of intestinal metaplasia(CE-IM),recurrence of neoplasia and recurrence of intestinal metaplasia]were retrieved.Multivariate analyses were performed to identify factors that differed significantly between older and younger(≤50 years)patients.RESULTS We identified 450 patients with T1 EAC and HGD(74%and 26%,respectively);45(10%)were≤50 years.Compared to the older group,young patients were more likely to present with ongoing gastroesophageal reflux disease(GERD)symptoms(55%vs 38%,P=0.04)and to be obese(body mass index>30,48%vs 32%,P=0.04).Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms[odds ratio(OR)2.00,95%confidence interval(CI)1.04-3.85,P=0.04]and to be obese(OR 2.06,95%CI 1.07-3.98,P=0.03)whereas the young group was less likely to have a smoking history(OR 0.39,95%CI 0.20-0.75,P<0.01)compared to the old group.However,there were no significant differences regarding tumor histology,CE-N,CE-IM,recurrence of neoplasia and recurrence of intestinal metaplasia(mean follow-up,44.3 mo).CONCLUSION While guidelines recommend BE screening in patients>50 years of age,younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms. 展开更多
关键词 Barrett's Esophagus GASTROESOPHAGEAL REFLUX disease Obesity Esophageal adenocarcinoma HIGH-GRADE DYSPLASIA Guideline Young patient
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