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Role of endoscopy in acute gastrointestinal bleeding in real clinical practice:An evidence-based review 预览
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作者 Kyoungwon Jung Won Moon 《世界胃肠内镜杂志:英文版(电子版)》 2019年第2期68-83,共16页
Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding,and guidelines for gastrointestinal bleeding are divided into two separate sections,they may not be distinguished fro... Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding,and guidelines for gastrointestinal bleeding are divided into two separate sections,they may not be distinguished from each other in clinical practice.Most patients are first observed with signs of bleeding such as hematemesis,melena,and hematochezia.When a patient with these symptoms presents to the emergency room,endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation.Especially,in cases of variceal bleeding,it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes.In cases of suspected lower gastrointestinal bleeding,full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis.The therapeutic aspect of endoscopy,using the mechanical method alone or injection with a certain modality rather than injection alone,can increase the success rate of bleeding control.Therefore,it is important to consider the origin of bleeding and how to approach it.In this article,we aim to review the role of endoscopy in diagnosis,treatment,and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting. 展开更多
关键词 ENDOSCOPY GASTROINTESTINAL BLEEDING Endoscopic BLEEDING control EMERGENCY BOWEL preparation BEDSIDE ENDOSCOPY Second-look ENDOSCOPY
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丙泊酚用于无痛胃肠镜的镇痛效果评定及安全性分析 预览
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作者 吕亚丽 《河北医学》 CAS 2019年第6期979-982,共4页
目的:分析丙泊酚用于无痛胃肠镜诊疗术的临床应用效果及安全性。方法:选择要进行肠镜检查的100例患者,将之简单随机分组分为观察组和对照组。观察组采用无痛胃肠镜诊疗术,在进行胃肠镜检查和治疗前,给予患者丙泊酚用于麻醉镇痛;对照组... 目的:分析丙泊酚用于无痛胃肠镜诊疗术的临床应用效果及安全性。方法:选择要进行肠镜检查的100例患者,将之简单随机分组分为观察组和对照组。观察组采用无痛胃肠镜诊疗术,在进行胃肠镜检查和治疗前,给予患者丙泊酚用于麻醉镇痛;对照组患者直接进行胃肠镜检查和治疗。比较分析患者的生命体征,包括了血氧饱和度(SpO2)和心率(HR)等,并比较两组患者术后的疗效。结果:对于观察组患者,HR、SpO2在进行诊断检查前后没有发生明显的变化,组内无差异(P>0.05);而对于对照组患者,HR在进行肠镜检查前后有着较为明显的波动,但SpO2的变化较平稳,组内比较差异显著(P<0.05)。观察组患者治疗后总有效率为98%,明显高于对照组76%;观察组患者胃肠镜诊治前非常紧张人数所占比例12%,明显低于对照组,与对照组相比,观察组患者的心理状态相对更好;观察组相较对照组,在进行检查时患者出现不良反应率相对较低(P<0.05)。结论:与常规的胃肠镜手术相比,无痛胃肠镜诊疗有着明显的优势,其不仅能够有效的减轻患者的疼痛,同时有着较好的适应性,另外也具有不良反应少的优势,检查过程中对患者HR、SpO2等无明显影响,安全性高,且患者对操作的满意度高,值得在临床上广泛应用。 展开更多
关键词 胃肠镜 无痛胃肠镜诊疗术 丙泊酚
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基于消化道黏膜象进行中医辨证的思考
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作者 邓芳芳 曹淼 张文兴 《中华中医药杂志》 CAS CSCD 北大核心 2019年第3期1108-1110,共3页
望诊是中医诊断的主要方法之一。已有的中医望诊集中于体表可见部位,如面部、舌部等。近来年消化内镜不断发展使消化道内部的黏膜象望诊已逐渐可能。文章通过分析认为基于消化道黏膜象进行中医诊断已经可行:消化道黏膜象的获取方法简单... 望诊是中医诊断的主要方法之一。已有的中医望诊集中于体表可见部位,如面部、舌部等。近来年消化内镜不断发展使消化道内部的黏膜象望诊已逐渐可能。文章通过分析认为基于消化道黏膜象进行中医诊断已经可行:消化道黏膜象的获取方法简单且图像标准;消化道黏膜象中医诊断符合中医原理,与舌诊有共通性;消化道黏膜象中医诊断对消化道疾病诊断有独特优势,对临床辨证有巨大实用价值。充分利用消化道黏膜象进行中医诊断应改变已有的'司外揣内'的思维模式,通过以'内'为主,'内外'结合达到准确辨证、提高疗效的目的。 展开更多
关键词 望诊 黏膜象 辨证论治 中西医结合 消化内镜
Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopan-creatography in the United States 预览
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作者 Mitchell S Cappell David M Friedel 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第27期3468-3483,共16页
Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly stee... Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competency. This work advocates for mandatory, national 展开更多
关键词 Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY Privileges CREDENTIALING Gastroenterology FELLOWSHIP TRAINING Advanced gastrointestinal endoscopy TRAINING Certification Standards
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胃肠镜检查零预约下失约原因分析及对策 预览
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作者 王盈盈 夏梦雪 +4 位作者 宋丹丹 白桦娟 冯双 吴慧银 邱晓珏 《中华胃肠内镜电子杂志》 2019年第2期73-76,共4页
目的了解和分析胃肠镜检查失约原因及特点,进一步完善预约制度。方法本研究选取2018年5月28日至6月6日经解放军总医院消化内镜中心预约胃肠镜检查的3001例患者数据,从中筛选出208例失约患者信息,并对失约患者进行电话回访及记录失约原... 目的了解和分析胃肠镜检查失约原因及特点,进一步完善预约制度。方法本研究选取2018年5月28日至6月6日经解放军总医院消化内镜中心预约胃肠镜检查的3001例患者数据,从中筛选出208例失约患者信息,并对失约患者进行电话回访及记录失约原因。统计并比较不同年龄组、不同性别、不同地区患者的失约率。对失约原因进行统计分析。结果筛选出的208例失约患者,占总预约胃肠镜检查人数的6.9%。208例失约患者中,因身体原因失约占23.6%;因忙/有事失约分别占12.0%、11.5%;因其他检查时间长、术前检查多而失约分别占10.1%、8.7%;已在外院完成检查的患者占5.7%;已预约但是不想检查的患者占5.3%。结论建议加强失约约束及特殊人群健康宣教,增加取消预约渠道及检查提醒功能来减少失约。 展开更多
关键词 胃肠镜检查 失约 零预约 原因分析
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消化道出血内镜下治疗
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作者 欧阳红娟 游洁玉 《中国小儿急救医学》 CAS 2019年第4期253-256,共4页
消化道出血是内科急症,且病因多样,主要临床表现为呕血、黑便、不明原因贫血,急性大出血时,如未及时治疗可导致急性休克,甚至死亡。当患者有活动性出血表现时,单纯药物治疗不能达到止血效果,如果不对患者进行及时有效内镜治疗,其生命安... 消化道出血是内科急症,且病因多样,主要临床表现为呕血、黑便、不明原因贫血,急性大出血时,如未及时治疗可导致急性休克,甚至死亡。当患者有活动性出血表现时,单纯药物治疗不能达到止血效果,如果不对患者进行及时有效内镜治疗,其生命安全将会受到严重的威胁。内镜检查可对消化道出血诊断并进行止血治疗,具有简便快捷、创伤小、见效快等优点。随着内镜技术的发展,消化道出血的手术率和病死率明显下降。 展开更多
关键词 消化道出血 内镜 治疗
共聚焦显微内镜对消化道黏膜病变诊断偏差的原因分析 预览
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作者 吴巍 郭滟 +3 位作者 袁菲 费晓春 吴云林 王立夫 《胃肠病学和肝病学杂志》 CAS 2019年第1期19-23,共5页
目的分析共聚焦显微内镜(confocal laser endomicroscopy,CLE)诊断胃肠道黏膜病变出现偏差的原因。方法统计2009年6月至2018年9月在上海交通大学医学院附属瑞金医院消化内科接受CLE检查的患者。检查过程中静脉注射质量浓度为100 g/L的... 目的分析共聚焦显微内镜(confocal laser endomicroscopy,CLE)诊断胃肠道黏膜病变出现偏差的原因。方法统计2009年6月至2018年9月在上海交通大学医学院附属瑞金医院消化内科接受CLE检查的患者。检查过程中静脉注射质量浓度为100 g/L的荧光素钠作为荧光剂。采用四级诊断标准(炎症/化生性病变、低级别上皮内瘤变、高级别上皮内瘤变、癌)对CLE图像进行实时诊断,根据手术病理或随访结果作为最终诊断,并将最终诊断与CLE实时诊断作对比。回顾患者的内镜和共聚焦影像资料,分析诊断偏差的原因。结果总计540例患者纳入研究,扫描病灶总数613处。与最终病理结果相比,CLE诊断准确率为87.9%(539/613)。在诊断偏差的74处病变中,CLE诊断偏轻40处,诊断偏重34处。CLE诊断偏差的原因主要包括以下情形:病变程度解读误差(45/74,60.8%);白光内镜可见确切病变但CLE未见典型阳性表现(16/74,21.6%);难以鉴别炎症与淋巴瘤(3/74,4.0%);检查过程中白光内镜未见病灶(1/74,1.4%);操作者观察欠仔细或诊断经验不足(9/74,12.2%)。活动期炎症、重度糜烂、坏死组织、荧光素钠明显外渗、图像解读误差是造成CLE诊断程度偏差的常见原因,探头贴合不良、异型细胞散在浸润常导致CLE诊断偏轻,而腺体异型性重于腺上皮细胞、异型腺体浅表、活检未能取材于最典型部位常导致CLE诊断偏重。结论CLE诊断偏差的原因涵盖多个方面。通过增进内镜医师的操作技能、诊断能力,控制荧光素钠剂量,增进与病理医师之间的交流互动,可改善CLE的临床诊断效能。 展开更多
关键词 消化道 癌前病变 内镜 共聚焦显微内镜 诊断
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基于层次分析法与维修数据的消化内镜失效元件分析
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作者 王守镜 廖先珍 +3 位作者 王梦婷 龚敏 谢延媛 徐忠 《华西医学》 CAS 2019年第6期625-631,共7页
目的探究与消化内镜维修成本和停机时间相关的主要失效元件。方法采用层次分析法,对四川大学华西医院2010年1月-2019年4月消化内镜的维修数据进行处理和分析。结果涉及110条消化内镜,大修理322次,小修理364次,共更换1 651件失效元件,其... 目的探究与消化内镜维修成本和停机时间相关的主要失效元件。方法采用层次分析法,对四川大学华西医院2010年1月-2019年4月消化内镜的维修数据进行处理和分析。结果涉及110条消化内镜,大修理322次,小修理364次,共更换1 651件失效元件,其中更换失效元件数量前3名为按钮(380件,23.02%)、插入管(223件,13.51%)和镜片(179件,10.84%)。造成大修理维修成本高和停机时间长的主要失效元件为光电耦合器(F=849.702,P<0.001;F=9.525,P=0.002)和导光束(F=8.190,P=0.005;F=6.384,P=0.012),影响小修理维修成本的失效元件为镜片(F=25.464,P<0.001)和角度钢丝(F=5.652,P=0.018),延长小修理维修时间的失效元件是镜片(F=10.384,P=0.001)和电气接口(F=4.816,P=0.029)。结论对维修数据定量分析有利于客观分析维修成本和停机时间的主要失效元件。 展开更多
关键词 消化内镜 层次分析法 失效元件 维修数据
胃肠镜检查护理中应用PDCA模式的研究 预览
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作者 姚俊 《中国继续医学教育》 2019年第18期155-157,共3页
目的探讨分析在胃肠镜检查中实施PDCA模式后对护理风险控制的效果。方法对2017年1月—2018年3月内在我院接受胃肠镜检查的患者60例作为研究对象。按护理模式差异分为两组。对照组患者采用常规护理,观察组患者采用PDCA模式;对比、分析两... 目的探讨分析在胃肠镜检查中实施PDCA模式后对护理风险控制的效果。方法对2017年1月—2018年3月内在我院接受胃肠镜检查的患者60例作为研究对象。按护理模式差异分为两组。对照组患者采用常规护理,观察组患者采用PDCA模式;对比、分析两组患者的护理风险控制效果,观察组护理工作质量以及患者护理满意度。结果对照组患者的护理风险事件发生率为20.0%,观察组为3.3%;观察组实施PDCA模式后护理工作质量明显上升。观察组护理满意度为96.7%;对照组为80.0%;上述数据对比,差异具有统计学意义(P<0.05)。结论在胃肠镜检查中实施PDCA模式效果显著,在明显降低护理风险事件发生率的同时提高护理满意度。 展开更多
关键词 PDCA模式 常规护理 胃肠镜检查 护理风险控制 应用效果 对比分析
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Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects 预览
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作者 Diogo Turiani Hourneaux de Moura Bruna Furia Buzetti Hourneaux de Moura +5 位作者 Michael A Manfredi Kelly E Hathorn Ahmad N Bazarbashi Igor Braga Ribeiro Eduardo Guimaraes Hourneaux de Moura Christopher C Thompson 《世界胃肠内镜杂志:英文版(电子版)》 2019年第5期329-344,共16页
A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is ... A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a firstline approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects. 展开更多
关键词 GASTROINTESTINAL Endoscopy ENDOSCOPIC vacuum THERAPY Negative pressure THERAPY FISTULA LEAK PERFORATION Defect
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流程化护理干预对胃肠镜检查术患者负性心理的影响观察 预览
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作者 李燕 谢娟 巫丽莎 《实用临床护理学电子杂志》 2019年第11期2-3,共2页
目的观察流程化护理干预对胃肠镜检查术患者负性心理的影响。方法选取胃肠镜检查术患者一共90例作为本文研究内容中的选取对象,收取时间(2015年2月1日-2016年2月5日),电脑随机分为观察组一组(45例胃肠镜检查术患者)、对照组一组(45例胃... 目的观察流程化护理干预对胃肠镜检查术患者负性心理的影响。方法选取胃肠镜检查术患者一共90例作为本文研究内容中的选取对象,收取时间(2015年2月1日-2016年2月5日),电脑随机分为观察组一组(45例胃肠镜检查术患者)、对照组一组(45例胃肠镜检查术患者),分别实施流程化护理干预以及常规护理。结果观察组患者的焦虑评分和抑郁评分与对照组患者具有差异(P<0.05)。结论通过对胃肠镜检查术患者实施流程化护理干预,取得显著效果。 展开更多
关键词 流程化护理干预 胃肠镜检查术 负性心理 影响
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麻醉胃镜检查中低氧血症的危险因素分析 预览
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作者 封莉莉 丁文霞 +5 位作者 孙媛媛 张莹莹 袁宁平 张丽君 韩文军 席惠君 《世界华人消化杂志》 CAS 2019年第7期427-434,共8页
背景麻醉胃镜检查已经作为一种常规胃镜检查方式在国内开展.低氧血症仍然是麻醉胃镜检查中发生率较高的不良事件,但国外就其发生率的报道情况相差较大(<1%至85%),国内缺乏相关高质量报道.丙泊酚作为用于门诊患者麻醉胃镜检查的镇静药... 背景麻醉胃镜检查已经作为一种常规胃镜检查方式在国内开展.低氧血症仍然是麻醉胃镜检查中发生率较高的不良事件,但国外就其发生率的报道情况相差较大(<1%至85%),国内缺乏相关高质量报道.丙泊酚作为用于门诊患者麻醉胃镜检查的镇静药物,其安全、有效性已经得到认可,《中国消化内镜诊疗镇静/麻醉的专家共识意见》(2014年)推荐使用,国外仍然有对其安全性的质疑,本研究中,我们将其作为门诊患者胃镜检查的镇静药物使用,观察其对低氧血症发生率的影响.目的观察麻醉胃镜检查中低氧血症的发生率,并分析其危险因素.方法纳入上海长海医院消化内镜中心2018-09-01/2018-11-30经麻醉医师施行丙泊酚镇静的门诊麻醉胃镜检查患者,共计580例.观察患者在检查过程中有无低氧血症,记为发生低氧血症(110例)和未发生低氧血症(470例)两组,记录两组患者的基本信息、麻醉过程和内镜操作相关信息.结果单因素分析发现打鼾史、活检、年龄、体重指数、腹围、内镜操作时间、丙泊酚的量、患者ASA分级、内镜医师分级在两组间存在差异(P <0.05).多因素Logistic回归分析,发现年龄(>75岁, OR值8.955, 95%CI: 2.070-38.746)和丙泊酚用量(>197 mg,OR值2.360, 95%CI: 1.320-4.219)是低氧血症的独立危险因素.结论对高龄患者(特别是>75岁患者)和需要较大量丙泊酚(特别是>197 mg)镇静的患者需要加以主动干预,以预防低氧血症的发生. 展开更多
关键词 麻醉/镇静 胃镜 低氧血症 危险因素
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Duodenal variceal bleeding with large spontaneous portosystemic shunt treated with transjugular intrahepatic portosystemic shunt and embolization: A case report 预览
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作者 Rohit Anand Saad Emhmed Ali +1 位作者 Driss Raissi Wesam M Frandah 《世界放射学杂志:英文版(电子版)》 2019年第8期110-115,共6页
BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is ... BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part od duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of spontaneous portosystemic shunt (SPSS) was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. CASE SUMMARY A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. A computed tomography (CT) angiogram was performed and showed an enlarged cluster of venous collaterals around the distal duodenum. He underwent TIPS placement. He had another episode of melena three days later. Push enteroscopy with injection sclerotherapy into the duodenal varices was performed with no success. A repeat CT angiogram showed occluded TIPS shunt. Therefore, a TIPS revision was performed and there was an extensive portal venous thrombosis with a large shunt between the inferior mesenteric vein and left renal vein via the left gonadal vein. Thrombectomy and TIPS shunt balloon angioplasty was performed, followed by embolization of the portosystemic. The melena was resolved, and patient was discharged with arranged hepatology follow up. CONCLUSION It importance to look and embolize the SPSS shunts in patients with early TIPS dysfunction and recurrent duodenal variceal bleeding. 展开更多
关键词 Portasystemic SHUNT Gastrointestinal HEMORRHAGE Liver cirrhosis DUODENUM Endoscopy ANGIOPLASTY Case report
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Truth lies below: A case report and literature review of typical appearing polyps yet with an atypical diagnosis 预览
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作者 Aaron Fisher Edward Yousif Marc Piper 《世界胃肠内镜杂志:英文版(电子版)》 2019年第1期54-59,共6页
BACKGROUND Enteropathy associated T-cell lymphoma (EATL) is a rare form of peripheral Tcell lymphoma and makes up less than 5% of gastrointestinal lymphomas. EATL can be divided into type 1 which is associated with ce... BACKGROUND Enteropathy associated T-cell lymphoma (EATL) is a rare form of peripheral Tcell lymphoma and makes up less than 5% of gastrointestinal lymphomas. EATL can be divided into type 1 which is associated with celiac disease, and monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), formally type 2, which is not associated with celiac disease. CASE SUMMARY We present a 60-year-old African American female, without celiac disease, who presented with abdominal pain, diarrhea, and 30 lb. weight loss over a 3 month period. She was subsequently diagnosed with EATL throughout her entire gastrointestinal tract. She is currently undergoing chemotherapy with EOCH (Etoposide, Oncovin, Cyclophosphamide, and Hydroxydaunorubicin). EATL is most common in the Asian and Hispanic population yet the incidence in African Americans is uncertain and emphasizes the rarity of this case. A literature review was included to further emphasize similarities and differences between our case and previously reported cases of MEITL. CONCLUSION The patient was diagnosed with EATL, immunochemical testing was not conclusive for MEITL however was suggestive of the disease. 展开更多
关键词 ENTEROPATHY associated T-CELL LYMPHOMA Monomorphic epitheliotropic intestinal T-CELL LYMPHOMA Peripheral T-CELL LYMPHOMA Gastrointestinal LYMPHOMA Endoscopy Case report LITERATURE review
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模拟器在胃肠内窥镜培训中的应用 预览
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作者 李茉 徐洪雨 《胃肠病学和肝病学杂志》 CAS 2019年第8期955-958,共4页
基于模拟器的胃肠内窥镜培训在过去几十年里被广泛地研究并获得了认可,已经验证了几种类型的模拟器,如机械模拟器、虚拟现实(VR)模拟器、离体和体内模型,并且证实了在早期训练中使用模拟器可以缩短学习曲线,快速掌握各种操作手法和技巧... 基于模拟器的胃肠内窥镜培训在过去几十年里被广泛地研究并获得了认可,已经验证了几种类型的模拟器,如机械模拟器、虚拟现实(VR)模拟器、离体和体内模型,并且证实了在早期训练中使用模拟器可以缩短学习曲线,快速掌握各种操作手法和技巧。通常机械模拟器和VR模拟器用于初级内镜培训,离体和体内模型用于高级的内镜培训(如ERCP、EUS等)。而用于更多常规干预治疗如息肉切除术、EMR、支架置入和止血的验证模型还很稀缺,应鼓励这些领域的发展。 展开更多
关键词 胃肠道内窥镜 模拟器培训 计算机模拟
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Diagnosis and therapeutic strategies for small bowel vascular lesions 预览
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作者 Eiji Sakai Ken Ohata +1 位作者 Atsushi Nakajima Nobuyuki Matsuhashi 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第22期2720-2733,共14页
Small bowel vascular lesions, including angioectasia (AE), Dieulafoy’s lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be ... Small bowel vascular lesions, including angioectasia (AE), Dieulafoy’s lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be venous lesions, they usually manifest as a chronic, well-compensated condition. Subsequent to video capsule endoscopy, deep enteroscopy can be applied to control active bleeding or to improve anemia necessitating blood transfusion. Despite the initial treatment efficacy of argon plasma coagulation (APC), many patients experience re-bleeding, probably because of recurrent or missed AEs. Pharmacological treatments can be considered for patients who have not responded well to other types of treatment or in whom endoscopy is contraindicated. Meanwhile, a conservative approach with iron supplementation remains an option for patients with mild anemia. DL and AVM are considered to be arterial lesions;therefore, these lesions frequently cause acute life-threatening hemorrhage. Mechanical hemostasis using endoclips is recommended to treat DLs, considering the high re-bleeding rate after primary APC cauterization. Meanwhile, most small bowel AVMs are large and susceptible to re-bleeding therefore, they usually require surgical resection. To achieve optimal diagnostic and therapeutic approaches for each type of small bowel lesion, the differences in their epidemiology, pathology and clinical presentation must be understood. 展开更多
关键词 ANGIODYSPLASIA Angioectasia Dieulafoy's lesion ARTERIOVENOUS MALFORMATION Obscure gastrointestinal bleeding Video capsule endoscopy Deep ENTEROSCOPY Argon plasm coagulation
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2004-2017年中国消化内镜清洗消毒管理现状的Meta分析
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作者 郭玉婷 费春楠 +3 位作者 刘军 纪学悦 刘贺 宋佳 《中华医院感染学杂志》 CAS CSCD 北大核心 2019年第3期459-464,472共7页
目的评估我国医院消化内镜清洗消毒管理现状,为规范洗消流程及提升消毒质量提供数据支持。方法检索中国知网、维普、万方和PubMed数据库,收集2004年4月-2017年12月关于我国各地区医院消化内镜洗消管理现状的文献。严格按照纳入与排除标... 目的评估我国医院消化内镜清洗消毒管理现状,为规范洗消流程及提升消毒质量提供数据支持。方法检索中国知网、维普、万方和PubMed数据库,收集2004年4月-2017年12月关于我国各地区医院消化内镜洗消管理现状的文献。严格按照纳入与排除标准筛选文献、提取资料,采用STATA 12.0软件进行Meta分析。结果最终纳入10篇文献,共431家医院。Meta分析:进行医院级别亚组分析,单独内镜洗消间配置率2级医院0.858 (95%CI:0.751~0.965)高于3级医院0.783(95%CI:0.619~0.948)(P<0.001);内镜洗消间通风良好3级医院0.917 (95%CI:0.862~0.972)高于2级医院0.875 (95%CI:0.806~0.944)(P<0.001);全自动内镜洗消机配置率3级医院0.364 (95%CI:0.179~0.549)高于2级医院0.054(95%CI:0.011~0.097)(P<0.001,P=0.014)。多酶洗液一镜一换3级医院0.729 (95%CI:0.528~0.930)高于2级医院0.551 (95%CI:0.339~0.763)(P<0.001);内镜储藏柜配置率3级医院0.968 (95%CI:0.923~1.012)高于2级医院0.950 (95%CI:0.900~0.999)(P<0.001);消毒剂浓度监测率3级医院0.733 (95%CI:0.396~1.071)高于2级医院0.604(95%CI:0.023~1.185)(P<0.001,P=0.041)。结论我国调查医院消化内镜的洗消过程基本符合规范,但仍存在全自动设备紧缺及感染控制不到位的问题,需建立内镜洗消效果的质量保证和监管体系。 展开更多
关键词 消化内镜 清洗 消毒 现状
消化内镜微创治疗老年胆石症的护理要点 预览
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作者 刘榕华 《中西医结合护理(中英文)》 2019年第6期134-136,共3页
本文回顾了53例老年胆石症患者的临床资料。患者均接受内镜下乳头括约肌切开术(EST)+内镜下乳头柱状气囊扩张术(EPBD)行消化内镜微创治疗。完善术前检查,预防性使用奥曲肽预防术后高淀粉酶血症和胰腺炎,术中加强监测,术后给予生命体征... 本文回顾了53例老年胆石症患者的临床资料。患者均接受内镜下乳头括约肌切开术(EST)+内镜下乳头柱状气囊扩张术(EPBD)行消化内镜微创治疗。完善术前检查,预防性使用奥曲肽预防术后高淀粉酶血症和胰腺炎,术中加强监测,术后给予生命体征、血糖监测,营养支持,体位护理,管道护理,术后并发症预防,出院指导及健康教育。 展开更多
关键词 老年患者 胆石症 消化内镜 微创治疗 风险防控 安全护理 胰腺炎
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Crohn’s disease of esophagus,stomach and duodenum 预览
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作者 Andréa Maia Pimentel Raquel Rocha Genoile Oliveira Santana 《世界胃肠药理与治疗学杂志:英文版(电子版)》 2019年第2期35-49,共15页
Crohn’s disease with involvement of the esophagus,stomach and duodenum has a prevalence of 0.5%to 4%in symptomatic adult patients,but some studies have shown that these results may be underestimated,since upper gastr... Crohn’s disease with involvement of the esophagus,stomach and duodenum has a prevalence of 0.5%to 4%in symptomatic adult patients,but some studies have shown that these results may be underestimated,since upper gastrointestinal endoscopy is not performed routinely in the initial evaluation of the disease in adult patients,as it is in the pediatric population.In general,involvement of the upper gastrointestinal tract in Crohn’s disease occurs concomitantly with involvement of the lower gastrointestinal tract.The diagnosis depends on clinical,endoscopic,histological and radiological evaluation.The presence of aphthoid ulcers,longitudinal ulcers,bamboo-joint-like appearance,stenoses and fistulas are endoscopic findings suggestive of the disease,and it is important to exclude the presence of Helicobacter pylori infection.The primary histological findings,which facilitate the diagnosis,are the presence of a chronic inflammatory process with a predominance of lymphoplasmacytic cells and active focal gastritis.The presence of epithelioid granuloma,although less frequent,is highly suggestive of the disease in the absence of chronic granulomatous disease.Treatment should include the use of proton pump inhibitors associated with corticosteroids,immunomodulators and biological therapy according to the severity of the disease. 展开更多
关键词 Crohn’s disease UPPER gastrointestinal tract UPPER digestive endoscopy ESOPHAGUS STOMACH DUODENUM Chronic GASTRITIS Focal GASTRITIS EPITHELIOID granuloma
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治疗性护理对消化道出血患者内镜下止血效果的影响观察
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作者 李琴 程春生 +2 位作者 张岖 周南征 贺诗荃 《中国误诊学杂志》 CAS 2019年第2期84-87,共4页
目的评价治疗性护理对消化道出血患者内镜下止血效果的影响。方法选取深圳市南山区人民医院2016年6月至2017年11月期间收治的120例消化道出血患者作为研究对象,均接受内镜下止血治疗,根据随机对照原则将其分为两组。对照组60例,接受常... 目的评价治疗性护理对消化道出血患者内镜下止血效果的影响。方法选取深圳市南山区人民医院2016年6月至2017年11月期间收治的120例消化道出血患者作为研究对象,均接受内镜下止血治疗,根据随机对照原则将其分为两组。对照组60例,接受常规护理干预;观察组60例,实施常规护理+治疗性护理干预。对比两组止血效果、临床相关指标,并观察干预前后心理状态、消化道出血危险性评分变化。结果观察组72 h再出血量[(42.87±7.93)ml比(216.93±31.53)ml,t=41.470,P=0.000],72 h再出血率(3.33%比20.00%,χ~2=8.086,P=0.005)均显著低于对照组,且一次性止血成功率(93.33%比75.00%,χ~2=7.566,P=0.006)显著高于对照组,差异均有统计学意义。24 h再出血率两组比较,差异无统计学意义。观察组干预前HADS量表评分与对照组相比,差异无统计学意义(P>0.05);观察组干预后HADS量表中抑郁评分[(4.53±1.18)分比(6.09±1.54)分,P<0.001]、焦虑评分[(4.28±1.22)分比(6.42±1.29)分,P<0.001]均显著低于对照组,差异均有统计学意义。观察组干预前BRS评分与对照组相比,差异无统计学意义(P>0.05);观察组干预后BRS评分<6分比例(78.33%比53.33%,P=0.004)显著高于对照组,差异有统计学意义。结论消化道出血患者内镜下止血治疗同时辅以治疗性护理干预有助于提高止血效果,降低再出血风险及出血量,缩短整体治疗时间,减轻患者负性情绪。 展开更多
关键词 消化道出血 内镜 治疗性护理 止血效果 心理状态
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