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期刊信息/Journal information
中华消化内镜杂志
中华医学会南京分会
中华消化内镜杂志

中华医学会南京分会

李兆申

月刊

1007-5232

xhnj@xhnj.com

025-83472831

210003

江苏省南京市紫竹林3号南京医学会

中华消化内镜杂志/Journal Chinese Journal of Digestive EndoscopyCSCD北大核心CSTPCD
查看更多>>1996年8月创刊，中华医学会主办。本刊原刊名《内镜》杂志。办刊宗旨是：贯彻党和国家的卫生工作方针、政策，注重理论与实际相结合，普及与提高相结合，报道国内外消化内镜学的最新进展，努力推动和促进我国消化内镜技术水平不断提高。《中华消化内镜杂志》主要报道内容包括食管镜、胃镜、十二指肠镜、胆囊镜和大肠镜、小肠镜、乙状结肠镜等领先的科研成果，及其设备、技术在国内外的进展，以及临床诊断和治疗经验等。目前的主要栏目有：论著、短篇论著、基础研究、临床报道、技术交流、特殊病例报道及内镜并发症等。读者对象为从事医疗、教学、科研等工作的消化系疾病及消化内镜工作者。
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    上消化道内镜人工智能系统临床应用专家共识（2023，武汉）

    于红刚王洛伟许文立唐涌进...
    85-96页
    查看更多>>摘要：食管胃十二指肠内镜（esophagogastroduodenoscope，EGD）是诊断上消化道肿瘤、癌前病变及危急重疾病的有效工具。人工智能技术在EGD的质量控制和辅助诊断中起到了重要作用，但目前国内外尚无EGD人工智能系统应用的相关共识。2023年中华医学会消化内镜学分会组织全国领域内权威专家讨论，结合国内外最新循证医学证据，形成EGD人工智能系统临床应用专家共识，旨在为临床医师应用EGD人工智能时提供合理的决策依据。本共识包括人工智能在胃镜盲区监测、食管异常病灶识别、食管癌浸润深度预测、食管胃静脉曲张分级、胃异常病灶识别等方面的13条推荐意见陈述，以及EGD人工智能系统临床应用要求。 The esophagogastroduodenoscope (EGD) is an effective tool for diagnosing upper gastrointestinal tumors, precancerous lesions and critical emergency diseases. Artificial intelligence (AI) technology plays a significant role in the quality control and auxiliary diagnosis of EGD. However, currently there is no consensus on the application of EGD AI system at home or abroad. In 2023, organizing discussions among nationwide authoritative experts in the field, and combining the latest evidence-based medical evidence at home and abroad, Digestive Endoscopology Branch of Chinese Medical Association has formulated an expert consensus on the clinical application of EGD AI system, in order to provide clinicians with a reasonable decision-making basis when using EGD AI. This consensus consists of 13 recommendations including blind spot monitoring under gastroscopy, esophageal abnormal lesion identification, prediction of esophageal cancer infiltration depth, grading of esophageal gastric varices, identification of gastric abnormal lesions, and clinical application requirements for EGD AI system.

    人工智能食管胃十二指肠内镜中国专家共识

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    混合型胃癌的预后与内镜治疗策略

    申沐穹丁强刘梅唐涌进...
    97-101页
    查看更多>>摘要：胃癌具有较高的死亡率和组织学多样性，混合型胃癌可能具有更强的侵袭性和更差的预后。内镜黏膜下剥离术具有创伤小、并发症少、治疗费用低等优势，近年来在胃癌治疗领域的应用不断增多。就目前主流组织学分型方式下混合型胃癌的定义、预后及内镜治疗相关研究进行总结。

    胃肿瘤混合型内镜黏膜下剥离术预后治疗

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    胃“爬行型”腺癌研究进展

    宋世义王雷常廷民朱悦...
    101-103页
    查看更多>>摘要：胃“爬行型”腺癌是早期胃癌的一种特殊类型，组织病理学上表现为在胃固有腺增殖带附近出现不规则腺体融合且呈现水平扩展趋势，但细胞异型性低。因腺管横行扩张融合似牵手状，又名“牵手癌”。由于病变在增殖带水平进展，表面覆盖非癌上皮，导致病变与正常黏膜对比度差，内镜诊断有一定难度。就现有文献对胃“爬行型”腺癌相关研究进展进行阐述，以期提高临床医师对该病的认知。

    胃肿瘤胃爬行型腺癌临床特点内镜特点病理特点

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    混合型早期胃癌临床病理特征及内镜治疗预后评估

    卢林芝聂蓬张志鎰秦天燕...
    104-110页
    查看更多>>摘要：目的 探讨组织学分型为混合型的早期胃癌临床病理特征，同时分析内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗早期胃癌的预后。 方法 收集2011年1月至2020年3月在甘肃省武威肿瘤医院行ESD治疗的早期胃癌患者的临床资料，采用描述性统计方法分析混合型早期胃癌患者临床病理特征，采用logistic回归模型分析ESD治疗早期胃癌的临床效果及影响因素，采用Kaplan-Meier方法估计生存率，log-rank检验进行生存率的比较。 结果 本研究共纳入269例患者（280个病灶），其中男216例（80.30%），女53例（19.70%），年龄为（60.43±8.01）岁；混合型早期胃癌病灶25个（8.93%），分化型早期胃癌248个（88.57%），未分化型早期胃癌7个（2.50%）。相较于分化型和未分化型，混合型早期胃癌的病变部位以胃上1/3为主［64.00%（16/25）、40.73%（101/248）比0.00%（0/7），χ2=10.211，P=0.006］，病变大小≤2 cm占比较小［52.00%（13/25）、80.65%（200/248）比85.71%（6/7），χ2=11.173，P=0.004］，浸润深度黏膜内较少［52.00%（13/25）、85.48%（212/248）比57.14%（4/7），χ2=20.019，P<0.001］，垂直切缘阳性比例相对较高［20.00%（5/25）、2.82%（7/248）比0.00%（0/7），χ2=16.657，P<0.001］，侵犯脉管比例高于分化型癌低于未分化型癌［36.00%（9/25）、2.42%（6/248）比42.86%（3/7），χ2=58.413，P<0.001］，完全切除率较低［76.00%（19/25）、93.15%（231/248）比100.00%（7/7），χ2=9.497，P=0.009］，治愈性切除率低于分化型早期胃癌但高于未分化型早期胃癌［48.00%（12/25）、89.52%（222/248）比42.86%（3/7），χ2=39.757，P<0.001］，eCura C2级比例高于分化型癌低于未分化型癌［48.00%（12/25）、5.65%（14/248）比57.14%（4/7），χ2=58.766，P<0.001］。多因素分析结果显示，病变越大（P=0.004，OR=0.539，95%CI：0.354~0.822）为治愈性切除的危险因素；相较于黏膜下深层浸润，浸润至黏膜层（P=0.001，OR=51.799，95%CI：5.535~84.768）和黏膜下浅层（P<0.001，OR=29.301，95%CI：24.694~73.972）是治愈性切除的保护因素；相对于混合型早期胃癌，分化型早期胃癌（P=0.024，OR=3.947，95%CI：1.195~13.032）是治愈性切除的保护因素，未分化型早期胃癌（P=0.443，OR=0.424，95%CI：0.048~3.788）治愈性切除风险与混合型差异无统计学意义。随访期间死亡7例，总体生存时间为（114.42±0.97）个月，五年生存率为97.10%。不同分化程度的早期胃癌患者生存率差异无统计学意义（χ2=0.434，P=0.805）；是否治愈性切除的早期胃癌患者生存率差异有统计学意义（χ2=4.081，P=0.043）。 结论 混合型早期胃癌患者切缘阳性率高、脉管浸润常见、实现治愈性切除的情况较分化型早期胃癌低，因此，在处理混合型早期胃癌的过程中要更加严谨。早期胃癌ESD治疗后远期生存预后较好。 Objective To investigate the clinicopathological characteristics of early gastric cancer with mixed histological staging, and to analyze the prognostic effect of endoscopic submucosal dissection (ESD) for early gastric cancer. Methods Clinical data of early gastric cancer patients treated with ESD in Gansu Wuwei Cancer Hospital from January 2011 to March 2020 were collected, and clinicopathological characteristics of patients with mixed-type early gastric cancer were analyzed by descriptive statistical methods. The clinical effects and influencing factors of ESD on early gastric cancer were analyzed by logistic regression. Kaplan-Meier was used to estimate the survival rate, and log-rank test was used to compare the survival rate. Results A total of 269 patients (280 lesions) were included in this study, including 216 males (80.30%) and 53 females (19.70%), with age of 60.43±8.01 years. There were 25 lesions (8.93%) of mixed early gastric cancer, 248 lesions (88.57%) of differentiated early gastric cancer, and 7 lesions (2.50%) of undifferentiated early gastric cancer. Compared with differentiated and undifferentiated early gastric cancer, the lesion site of mixed early gastric cancer was mainly located in the upper 1/3 of the stomach [64.00% (16/25), 40.73% (101/248) VS 0.00% (0/7), χ2=10.211, P=0.006], the proportion of the lesion size ≤2 cm was relatively small [52.00% (13/25), 80.65% (200/248) VS 85.71% (6/7), χ2=11.173, P=0.004], and the proportion of infiltration depth in the mucosa was lower [52.00% (13/25), 85.48% (212/248) VS 57.14% (4/7), χ2=20.019, P<0.001], the proportion of positive vertical resection margin was relatively high [20.00% (5/25), 2.82% (7/248) VS 0.00% (0/7),χ2=16.657, P<0.001], the proportion of vascular invasion was higher than that of differentiated carcinoma but lower than that of undifferentiated carcinoma [36.00% (9/25), 2.42% (6/248) VS 42.86% (3/7),χ2=58.413, P<0.001], the complete resection rate was lower [76.00% (19/25), 93.15% (231/248) VS 100.00% (7/7),χ2=9.497, P=0.009], the curative resection rate was lower than that of differentiated early gastric cancer, but higher than that of undifferentiated early gastric cancer [48.00% (12/25), 89.52% (222/248) VS 42.86% (3/7), χ2=39.757, P<0.001], and the proportion of eCura grade C2 was higher than that of differentiated cancer, but lower than that of undifferentiated cancer [48.00% (12/25), 5.65% (14/248) VS 57.14% (4/7),χ2=58.766, P<0.001]. The results of multivariate analysis showed that the larger lesions (P=0.004, OR=0.539, 95%CI: 0.354-0.822) was the risk factor for curative resection. In terms of infiltration depth, mucosal (P=0.001, OR=51.799, 95%CI: 5.535-84.768) and submucosal 1 (P<0.001,OR=29.301, 95%CI: 24.694-73.972) were protective factors for curative resection compared with submucosal 2. In terms of differentiation degree, compared with mixed type, differentiated type (P=0.024, OR=3.947, 95%CI: 1.195-13.032) was the protective factor for curative resection, while undifferentiated type (P=0.443, OR=0.424, 95%CI: 0.048-3.788) showed no difference between curative resection and mixed type. During the follow-up, 7 patients died. The overall survival time was 114.42±0.97 months, and the 5-year survival rate was 97.10%. There was no significant difference in the survival rate of early gastric cancer patients with different degrees of differentiation (χ2=0.434, P=0.805). The survival rate of early gastric cancer patients with or without curative resection was significantly different (χ2=4.081, P=0.043). Conclusion Mixed early gastric cancer patients show high margin positive rate, vascular infiltration, and less curative resection than differentiated early gastric cancer. Therefore, the process of treating mixed early gastric cancer should be more rigorous. The long-term survival prognosis of early gastric cancer after ESD treatment is promising.

    胃肿瘤早期胃癌混合型内镜黏膜下剥离术预后

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    胃癌风险相关分期的活检策略优化

    兰雅迪许倩倩许昌芹贾如真...
    111-116页
    查看更多>>摘要：目的 探讨萎缩及肠化分期与胃癌发生风险的相关性并优化活检策略。 方法 回顾性收集自2020年11月至2022年10月在山东省立医院接受内镜检查并进行五点活检的患者资料。比较胃癌与非胃癌患者基线资料、不同部位萎缩及肠化情况，通过logistic回归分析可操作的与胃癌风险联系的胃炎评估（operative link for gastritis assessment，OLGA）和可操作的与胃癌风险联系的肠化生评估（operative link for gastric intestinal metaplasia assessment，OLGIM）分期系统与胃癌的相关性。计算Kendall tau相关系数比较不同活检方案（两点、三点及四点）与标准五点活检进行OLGA和OLGIM分期的一致性。进一步绘制受试者工作特征曲线比较不同活检方案对OLGA和OLGIM Ⅲ~Ⅳ期的诊断效能。 结果 共122例患者纳入数据分析，年龄（61.0±10.0）岁。多因素logistic回归分析显示OLGA分期与胃癌发生无关（P=0.788），OLGIM Ⅲ~Ⅳ期与胃癌发生相关（P=0.006，OR=3.39，95%CI：1.41~8.17）。萎缩、肠化在胃窦小弯［56.6%（69/122）和66.4%（81/122）］和胃角［57.4%（70/122）和52.5%（64/122）］的发生率较高，程度也较重，在胃体大弯发生率［2.5%（3/122）和5.7%（7/122）］较低，程度也较轻。四点和三点活检与标准五点活检进行OLGA及OLGIM分期时一致性较高，其中包括胃窦小弯、胃体小弯及胃角的三点活检一致性相当高，相关系数分别为0.969和0.987。 结论 OLGIM Ⅲ~Ⅳ期增加胃癌发生的风险。建议同时对胃窦小弯、胃体小弯及胃角三点活检，以筛查和监测萎缩或肠化。 Objective To investigate the correlation of atrophy and intestinal metaplasia (IM) stage with gastric cancer and to optimize biopsy strategy. Methods Data of patients who underwent endoscopy and five-point biopsy at Shandong Provincial Hospital between November 2020 and October 2022 were collected. The baseline characteristics of gastric cancer and non-gastric cancer patients, as well as the occurrence and severity of atrophy and IM in different areas were compared. Logistic regression analysis was used to evaluate the correlation of operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) staging with gastric cancer. The Kendall tau correlation coefficient was used to compare the consistency of different biopsy strategies (two-point, three-point, and four-point) with the standard five-point biopsy in OLGA and OLGIM staging. Receiver operating characteristic (ROC) curve analysis was further performed to compare the diagnostic performance of different biopsy strategies in identifying the OLGA and OLGIM Ⅲ-Ⅳ stage. Results A total of 122 patients were included in the analysis, with age of 61.0±10.0 years. Multivariate analysis showed that OLGA staging was not associated with gastric cancer (P=0.788), while OLGIM Ⅲ-Ⅳ staging was significantly correlated with gastric cancer (P=0.006, OR=3.39, 95%CI: 1.41-8.17). The occurrence of atrophy and IM were higher in lesser curvature of the antrum [56.6% (69/122) and 66.4% (81/122)] and incisura angularis [57.4% (70/122) and 52.5% (64/122)], with higher severity, while lower in greater curvature of the corpus [2.5% (3/122) and 5.7% (7/122)], with lower severity. The consistency of four-point and three-point biopsies with standard five-point biopsy in OLGA and OLGIM staging was high. The consistency of three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus was exceptionally high among them, with correlation coefficients of 0.969 and 0.987, respectively. Conclusion OLGIM Ⅲ-Ⅳ stages increase the risk of gastric cancer. Three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus are recommended for the screening and monitoring of atrophy or IM.

    胃肿瘤活检萎缩肠化风险分期

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    内镜黏膜下剥离术治疗环周食管表浅癌的疗效及安全性分析

    窦晓坛吴建海周婷郭慧敏...
    117-120页
    查看更多>>摘要：目的 评价内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗环周食管表浅癌的疗效及安全性。 方法 2015年1月至2019年12月间，因环周食管表浅鳞癌在南京大学医学院附属鼓楼医院行ESD治疗的74例连续病例纳入回顾性分析，主要观察ESD操作成功率、治愈性切除率、并发症发生情况以及追加治疗情况。 结果 1例患者中转外科手术，其余73例顺利完成ESD治疗，ESD操作成功率为98.6%。ESD术后病理提示39例达治愈性切除，ESD治愈性切除率为53.4%（39/73）。15例（20.5%）发生术中肌层损伤，1例（1.4%）发生术中穿孔，2例（2.7%）发生迟发性出血，1例（1.4%）发生迟发性穿孔。有11例失访，其余62例获得随访资料，随访时间（36.4±19.0）个月，其中12例追加外科手术，5例追加放化疗。在未行手术且获得随访资料的57例患者中，有49例发生ESD术后食管狭窄，ESD术后食管狭窄发生率为86.0%。 结论 ESD治疗环周食管表浅癌总体安全，但术中易发生肌层损伤，且治愈性切除率不高，术后食管狭窄发生率高，追加外科手术比例高。 Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for circular superficial esophageal cancer. Methods A retrospective analysis was conducted on 74 consecutive cases of circular superficial esophageal squamous cell carcinoma treated with ESD at Nanjing Drum Tower Hospital from January 2015 to December 2019. The success rate of ESD, curative resection rate, incidence of complications, and additional treatment were mainly observed. Results One case was transferred to surgery, and the remaining 73 cases successfully completed ESD treatment. The success rate of ESD was 98.6%. Postoperative pathology of ESD revealed that 39 cases achieved curative resection, with a curative resection rate of 53.4% (39/73). Intraoperative muscle layer injury occurred in 15 cases (20.5%), and intraoperative perforation occurred in 1 case (1.4%). Two cases (2.7%) experienced delayed bleeding, and one case (1.4%) experienced delayed perforation. Eleven cases were lost to follow-up, and the remaining 62 cases received follow-up for 36.4±19.0 months. Among the follow-up cases, 12 underwent additional surgery and 5 cases additional chemotherapy and radiotherapy. Among the 57 patients with follow-up data who did not underwent surgery, 49 developed esophageal stenosis after ESD, with an incidence rate of 86.0%. Conclusion ESD for circular superficial esophageal cancer is generally safe, but it is prone to muscle layer injury during the operation, with a low curative resection rate, a high incidence of postoperative esophageal stenosis, and a high proportion of additional surgical procedures.

    食管肿瘤食管表浅癌环周病变内镜黏膜下剥离术食管狭窄

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    超声内镜引导下肝脏穿刺活检术在肝移植受者中的应用价值

    饶伟李倩刘佳田秋菊...
    121-126页
    查看更多>>摘要：目的 评估超声内镜引导下肝脏穿刺活检术（endoscopic ultrasound-guided liver biopsy，EUS-LB）在肝移植受者病理诊断中的应用价值。 方法 采用回顾性队列研究设计，在2021年12月至2022年3月间于青岛大学附属医院器官移植中心肝脏病中心因肝功能异常或需要评估肝纤维化程度行EUS-LB的肝移植受者中，选取EUS-LB由同一位内镜医师完成，且标本由同一位病理科医师读片并出具报告的总计12例病例纳入EUS-LB组；在器官移植中心肝脏病中心同期行经皮肝脏穿刺活检术（percutaneous liver biopsy，PLB）的肝移植受者中，选取PLB由同一位肝病内科医师完成，且标本系由EUS-LB组同一位病理科医师读片并出具报告的总计23例病例纳入PLB组。对比2组肝脏组织获取情况和术后不良事件发生情况。 结果 2组患者均穿刺1~2次。EUS-LB组肝脏组织条的中位总长度明显长于PLB组（61 mm比17 mm，Z=11.362，P=0.002），最长组织条长度稍长于PLB组［（17.6±6.9）mm比（13.7±3.5）mm，t=2.382，P=0.086］，肝脏组织条数目明显多于PLB组［（4.8±2.1）条比（2.3±1.2）条，t=9.271，P=0.001］，完整汇管区数目明显多于PLB组［（11.3±4.6）个比（6.2±3.3）个，t=8.457，P=0.003］。腹痛是2组术后的唯一不良事件，且EUS-LB组术后腹痛发生率明显低于PLB组［8.3%（1/12）比43.5%（10/23），χ2=4.893，P=0.036］。 结论 EUS-LB是一种安全有效并且更舒适化的肝脏穿刺活检方法，相比PLB，EUS-LB可以获得更长的组织条和更多的汇管区，并且发生术后疼痛的患者更少，值得临床推广。 Objective To investigate the application of endoscopic ultrasound-guided liver biopsy (EUS-LB) to liver transplant recipients. Methods In this retrospective cohort study, a total of 12 liver transplant recipients who underwent EUS-LB by the same endoscopist and specimens were diagnosed and reported by the same pathologist due to abnormal liver function or need to be evaluated for graft fibrosis in the Organ Transplantation Center of the Affiliated Hospital of Qingdao University were enrolled into the EUS-LB group from December 2021 to March 2022, meanwhile, a total of 23 patients whose PLB was completed by the same hepatologist and specimens were diagnosed by the same pathologist during the same period were enrolled in the PLB group. Acquisition of liver specimens and postoperative adverse events of the two groups were compared. Results Patients in both groups were punctured 1-2 times on average, and the median total length of liver specimens in the EUS-LB group was significantly longer than that in the PLB group (61 mm VS 17 mm, Z=11.362, P=0.002). There was no significant difference in the length of the longest liver specimens between the two groups (17.6±6.9 mm VS 13.7±3.5 mm, t=2.382, P=0.086), while the number of liver specimens in the EUS-LB group was more than that in the PLB group (4.8±2.1 VS 2.3±1.2, t=9.271, P=0.001). The number of complete portal tracts was 11.3±4.6 in the EUS-LB group and 6.2±3.3 in the PLB group (t=8.457, P=0.003). Abdominal pain was the only postoperative adverse event, and only 1 patient in the EUS-LB group had postoperative abdominal pain, which was fewer than that in the PLB group [8.3% (1/12) VS 43.5% (10/23), χ2=4.893, P=0.036]. Conclusion Compared with PLB, EUS-LB delivers longer liver biopsy specimens with more complete portal tracts in liver transplant recipients, and fewer recipients complain about postoperative pain in EUS-LB group. Therefore, EUS-LB is a safer, more effective and more comfortable liver biopsy method.

    肝移植超声内镜引导下肝脏穿刺活检术经皮肝脏穿刺活检术湿法

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    IgG4相关自身免疫性胰腺炎临床及超声内镜特征分析

    孙红翼柴宁莉李金平李惠凯...
    127-130页
    查看更多>>摘要：目的 分析弥漫型与局灶型IgG4相关自身免疫性胰腺炎（IgG4-related autoimmune pancreatitis，IgG4-AIP）的临床及超声内镜检查（endoscopic ultrasonography，EUS）结果差异。 方法 回顾性收集2011年9月至2022年4月于解放军总医院行EUS并临床诊断为IgG4-AIP的患者资料，对一般临床资料、EUS特征、术后病理等相关资料进行描述，获得特征差异。 结果 χ 2 χ 2 χ 2 χ 2 共纳入40例患者，年龄（60.03±10.87）岁，男性多见（85.0%，34/40）。所有患者行EUS，其中28例患者行EUS引导下细针穿刺。40例患者中，29例（72.5%）为弥漫型，11例（27.5%）为局灶型。弥漫型患者中腹痛［65.5%（19/29）比18.2%（2/11），=5.393，P=0.020］和胆管壁增厚［51.7%（15/29）比9.1%（1/11），=4.394，P=0.036］更多见，局灶型患者中主胰管扩张［45.5%（5/11）比10.3%（3/29），=4.146，P=0.042］更多见，且病灶位置以胰头最常见（90.9%，10/11）。两组在慢性胰腺炎实质改变上差异无统计学意义［34.5%（10/29）比27.3%（3/11），=0.003，P=0.955］。 结论 弥漫型和局灶型AIP在腹痛及胆胰管病变中具有一定差异，慢性胰腺炎特征在两组中均未见高水平表达，这对临床实践中的AIP分型有提示作用。 Objective To analyze the differences in clinical and endoscopic ultrasonography (EUS) findings between diffuse and focal IgG4-related autoimmune pancreatitis (IgG4-AIP). Methods Data of patients diagnosed as having IgG4-AIP who underwent EUS at Chinese PLA General Hospital from September 2011 to April 2022 were retrospectively collected. General clinical data, EUS features, and postoperative pathology were analyzed for characteristic differences. Results χ 2 χ 2 χ 2 χ 2 A total of 40 patients were included in the study, 60.03±10.87 years old, a higher proportion of males (85.0%, 34/40). All patients underwent EUS, and 28 underwent EUS-guided fine-needle aspiration. Among the 40 patients, 29 (72.5%) had diffuse type and 11 (27.5%) had focal type. Abdominal pain [65.5% (19/29) VS 18.2% (2/11), =5.393, P=0.020] and thickening of the bile duct wall [51.7% (15/29) VS 9.1% (1/11), =4.394, P=0.036] were more common in the diffuse type, while main pancreatic duct dilation [45.5% (5/11) VS 10.3% (3/29), =4.146, P=0.042] was more common in the focal type, with the lesion most commonly located in the pancreatic head (90.9%, 10/11). There was no significant difference in the presence of chronic pancreatitis parenchymal changes between the two groups [34.5% (10/29) VS 27.3% (3/11), =0.003, P=0.955]. Conclusion There are certain differences in abdominal pain and biliary and pancreatic duct lesions between diffuse and focal AIP. The high expression of chronic pancreatitis characteristics is not observed in either group, which provides clues for the classification of AIP in clinical practice.

    胰腺炎自身免疫性IgG4相关自身免疫性胰腺炎临床特征超声内镜

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    门诊患者结直肠癌肠镜筛查依从性的相关影响因素研究

    谭雪娇彭昕秦健李加学...
    131-136页
    查看更多>>摘要：目的 探讨影响门诊患者结直肠癌肠镜筛查依从性的独立危险因素。 方法 纳入2022年1月至2022年6月在新疆7个地州内7家三级医院消化内科门诊就诊的40~74岁患者，结合患者就诊情况对符合肠镜检查条件的患者提出筛查建议，并通过问卷收集信息。先采用χ2检验比较依从与未依从肠镜筛查建议患者的特征差异，再采用多因素logistic回归模型（逐步回归：向前，有条件）分析与结肠镜筛查依从性相关的独立危险因素。 结果 从7个中心共获取463份有效问卷，依从肠镜检查建议者427例（92.2%）、未依从肠镜检查建议者36例（7.8%）。χ2检验发现，两类人群在性别构成、年龄分布、文化程度构成、肠息肉主观认知构成、有无结直肠息肉个人史、有无结直肠癌家族史、有无结直肠息肉家族史、有无腹痛或腹胀症状以及有无大便习惯或性状改变方面差异均有统计学意义（P<0.05）。多因素logistic回归分析发现，40~49岁人群（P=0.005，OR=0.141，95%CI：0.036~0.549）、50~59岁人群（P=0.039，OR=0.257，95%CI：0.071~0.932）肠镜检查依从性均明显差于60~74岁人群；中学文化程度人群（P=0.011，OR=3.121，95%CI：1.304~7.473）、本专科及以上文化程度人群（P=0.016，OR=3.544，95%CI：1.270~9.890）肠镜检查依从性均明显好于小学及以下文化程度人群；有结直肠息肉个人史人群肠镜检查依从性明显好于无结直肠息肉个人史人群（P=0.015，OR=12.288，95%CI：1.629~92.719）；有结直肠癌家族史人群肠镜检查依从性明显好于无结直肠癌家族史人群（P=0.038，OR=8.506，95%CI：1.124~64.351）；有大便习惯或性状改变人群肠镜检查依从性明显好于无大便习惯或性状改变人群（P=0.039，OR=4.794，95%CI：1.085~21.192）。 结论 新疆7个地州内7家三级医院门诊患者肠镜筛查依从性与患者年龄、文化程度、结直肠息肉个人史、直肠癌家族史以及大便习惯或性状改变密切相关。年龄在40~59岁、文化程度较低、既往无息肉病史或结直肠癌家族史、无大便习惯或性状改变是影响门诊患者结直肠癌肠镜筛查依从性的独立危险因素。 Objective To explore the influencing factors for compliance to colonoscopy screening for colorectal cancer in outpatients. Methods Patients aged 40-74 years who visited the outpatient gastroenterology department of 7 tertiary hospitals in 7 regions of Xinjiang from January 2022 to June 2022 were enrolled. Recommendations for colonoscopy screening were made according to the patient's medical conditions, and the questionnaire was used to collect information. The Chi-square test was used to compare the differences of compliant and non-compliant patients. Multivariate logistic regression was used to analyze the influencing factors of compliance to colonoscopy screening. Results A total of 463 valid questionnaires were obtained from 7 centers, in which, 427 outpatients (92.2%) followed the recommendation for colonoscopy screening, and 36 (7.8%) did not. Chi-square test results showed that there were statistically significant differences between the two groups in gender, age, education, subjective cognition of intestinal polyps, personal history of colorectal polyps, family history of colorectal cancer, family history of colorectal polyps, abdominal pain or distension, and defecation habit or stool changes (P<0.05). The results of multivariate regression analysis showed that the screening compliance of patients aged 40-49 years (P=0.005, OR=0.141, 95%CI: 0.036-0.549) and 50-59 years (P=0.039, OR=0.257, 95%CI: 0.071-0.932) was lower than that of patients aged 60-74 years. The screening compliance of patients with high school education (P=0.011, OR=3.121, 95%CI: 1.304-7.473) and college education or above (P=0.016, OR=3.544, 95%CI: 1.270-9.890) was higher than those with primary school education and below. Patients with personal history of colorectal polyps (P=0.015, OR=12.288, 95%CI: 1.629-92.719), family history of colorectal cancer (P=0.038, OR=8.506, 95%CI: 1.124-64.351) and changes in defecation habit or stool trait (P=0.039, OR=4.794, 95%CI: 1.085-21.192) also had higher compliance. Conclusion Age, educational level, personal history of colorectal polyps, and family history of colorectal cancer are related to colonoscopy screening compliance in outpatients of 7 tertiary hospitals in 7 regions of Xinjiang. The independent risk factors affecting compliance to colorectal cancer screening in outpatients are age of 40-59 years, lower educational level, no previous history of polyps or family history of colorectal cancer, and no defecation habit or stool changes.

    结肠镜检查结直肠癌门诊患者依从性影响因素

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    内镜逆行胰胆管造影术在儿童胰胆管合流异常中的诊疗价值

    聂双朱浩沈珊珊李雯...
    137-141页
    查看更多>>摘要：目的 探讨内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）在儿童胰胆管合流异常（pancreaticobiliary maljunction，PBM）诊治中的安全性和有效性。 方法 收集2012年11月至2022年9月在南京大学医学院附属鼓楼医院消化科行ERCP诊治的年龄≤14岁的40例PBM患儿资料，回顾性总结PBM分型、ERCP诊治情况、不良事件发生率及转归情况。 结果 19例PBM患儿为胰管汇入胆管（P-B）型，17例为胆管汇入胰管（B-P）型，4例为复杂型。40例PBM患儿共行50次治疗性ERCP，其中48次操作成功，1次ERCP插管失败，后改行1次辅助对接的内镜逆行胰管造影术。术后无出血、穿孔、死亡等严重并发症。34例（85%）患儿得到随访，其中14例进一步行外科手术，20例继续内科保守治疗，恢复均可。 结论 ERCP是儿童确诊PBM的金标准，也是一种安全有效的治疗手段。 Objective To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis and treatment of pediatric pancreaticobiliary maljunction (PBM). Methods Data of 40 pediatric patients under 14 with PBM diagnosed and treated by ERCP at Department of Gastroenterology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from November 2012 to September 2022 were collected. PBM types, ERCP-related diagnosis and treatment, adverse events and prognosis were retrospectively analyzed. Results Nineteen cases were P-B type (joining of common bile duct with pancreatic duct), 17 were B-P type (joining of pancreatic duct with common bile duct), and 4 were complex type. Forty children with PBM underwent 50 ERCP-related operations, among which 48 procedures succeeded. One case failed during cannulation of ERCP, replaced by rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP) afterwards. There were no serious postoperative adverse events such as bleeding, perforation or death. Thirty-four patients (85%) were followed up successfully, among which 14 underwent further surgery and 20 continued conservative treatment. Conclusion ERCP is the golden standard to diagnose pediatric PBM, and it is also safe and effective treatment for PBM.

    儿童胰胆管造影术,内窥镜逆行胰胆管合流异常内镜治疗

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