BorrmannⅣ型胃癌超声内镜诊断价值的研究

目的：评价超声内镜(EUS)对BorrmannⅣ型胃癌的诊断效果。材科与方法：138例胃癌病例术前均经内镜和病理活检检查。其中36例胃镜疑为BorrmannⅣ型胃癌的病例术前同时做了EUS检查，结果与术后外科病理诊断进行对照。结果：胃镜检出的138例胃癌中，BorrmannI型、Ⅰ型、Ⅱ型和Ⅲ型胃癌内镜活检多能明确诊断，第1次活检确诊率达88．5％以上。再次内镜活检取材，97．4％以上的病例能确诊。36例内镜可疑为BorrmannⅣ型胃癌首次活检14例(38．9％)为粘膜炎症反应，未见癌瘤细胞。虽经再次活检，仍有12例(33．3％)未能获得明确诊断。该型胃癌在EUS下声像图常有特征性的变化．表现为大部分或全胃壁弥漫性全层增厚，粘膜下层尤明显．回声减弱。增厚的胃壁并无明显结构紊乱．其层次尚可辨认。根据这一特征．36例内镜疑诊为该型的胃癌病变均行EUS检查．均作出了正确的诊断．确诊率达100%．结论：EUS能显示BorrmannⅣ型胃癌特征性的变化．用于该型胃癌的诊断，优于内镜及活检检查。     

内镜智能分光比色技术对大肠肿瘤性病变的诊断价值

目的探讨内镜智能分光比色技术（HCE）在诊断大肠肿瘤性病变的价值。方法581例患者进行常规内镜检查，其中197例入选。分别采用常规放大技术、HCE放大技术及染色放大技术对病变进行腺管开口分型及毛细血管形态观察，并与病理学诊断相比较。结果在197例病人中发现新生性病变398个，其中常规放大内镜下发现病变361个（90．8％），FICE放大模式下发现病变393（98．7％）。HCE放大内镜对肿瘤性及非肿瘤性判断符合率为90．2％（359／398），高于染色放大内镜82．4％（328／398）（P=0．001）。结论HCE放大内镜对大肠肿瘤性及非肿瘤性病变诊断的符合率高于普通放大内镜及染色放大内镜．有利于发现平坦型病变。     

超声内镜对常规内镜活检阴性胃壁增厚病变的诊断价值

目的评价超声内镜对常规内镜活检阴性胃壁增厚病变的诊断价值。方法回顾性分析57例常规内镜活检阴性胃壁增厚病变行超声内镜检查患者的诊断结果和随访情况,以手术病理和随访结果为最终诊断,统计内镜超声检查术（EUS）的诊断符合率以及内镜超声引导下细针穿刺抽吸术（EUS—FNA）、内镜超声定位下活检的阳性发现率。结果57例最终诊断为胃癌19例、胃淋巴瘤10例、不典型增生1例、Menetrier’s病1例、炎性改变26例。EUS对胃癌的诊断符合率为53．8％（14／26）,对胃淋巴瘤的诊断符合率为50．0％（10／20）;EUS．FNA阳性发现率为47．4％（9／19）;内镜超声定位下活检阳性发现率为66．7％（20／30）。结论EUS结合EUS—FNA尚不能作为鉴别诊断常规内镜活检阴性胃壁增厚病变病因的金标准,但超声内镜对诊断有一定帮助。     

如何通过内镜活检提高大肠淋巴瘤的诊断水平

大肠淋巴瘤临床表现并无特异性,肠镜检查虽多能发现黏膜病变,但由于组织病理学上多有明显的炎症背景,与炎症浸润的淋巴细胞难以区分。肠镜下溃疡病变为淋巴瘤的常见表现,但由于内镜活检取材局限,常常误诊为克罗恩病或肠结核,不易获得明确诊断。本文从肠道淋巴瘤发生的病理学基础入手,介绍了肠道淋巴瘤内镜下的常见表现和临床诊断线索,强调可疑病变需要大块黏膜剥离活检,借助淋巴瘤的单克隆起源特性,通过病理形态和免疫组化的结合,正确诊断肠道淋巴瘤,从而提高内镜诊断大肠淋巴瘤的水平。     

CT引导下经皮肺活检的临床应用

目的探讨CT引导下经皮肺穿刺活检对肺部周围型病变的诊断价值。方法对痰细胞学阴性及纤维支气管镜不能确诊的58例肺部周围型病变患者，在胸部CT定位下，用活检针经皮肺穿刺活检取材，行病理学诊断。结果58例患者的诊断阳性率为94．8％（55／58），阴性率5．2％（3／58），术后气胸7例，小量咯血2例。结论CT引导下经皮肺穿刺活检是一种安全的检查手段，对周围型肺部病变具有较高的诊断价值。     

共聚焦激光显微内镜对胃非隆起型病变的诊断价值

目的探讨共聚焦激光显微内镜检查（CLE）对胃非隆起性病变良、恶性的鉴别诊断价值。方法对37例常规内镜发现的胃非隆起型病变患者行CLE检查。静脉注射荧光素钠后对病变区域进行观察,然后进行靶向活检。对CLE或靶向活检病理诊断为恶性病变者进行内镜或手术治疗,术后对整块标本进行病理学检查;对良性患者予规范药物治疗并每隔3个月复查胃镜,直至病变愈合。结果CLE诊断癌性病变11例,良性病变26例。靶向活检病理证实CLE诊断的11例癌变者中10例为癌,1例为良性;26例良性者中1例为癌,余皆为良性。共12例接受切除治疗（3例内镜治疗,9例外科手术）,术后病理学证实与靶向活检病理诊断完全一致。良性者随访中未发现有恶变,经平均3．16（3．58±1．20）个月的内镜随访,病变均愈合。CLE对胃非隆起性病变癌变诊断的灵敏度、特异度和准确度分别为90．9％、96．2％和90．9％,阳性预测值和阴性预测值分别为90．9％和96．2％;CLE与组织学检查的Kappa值为0．871。结论CLE对胃非隆起型病变具有较高的诊断价值,将有望替代活检病理做出实时组织学诊断。     

计算机量化分析诊断大肠肿瘤

为探讨计算机量化分析诊断大肠肿瘤性病变的可能性，５２例内镜下活检标本被应用自动图象测定及流式细胞光度分析的方法进行核形态、核仁形成区及细胞增殖活性的定量分析。结果显示随着病变恶性程度的增高，核形态及核仁形成区各项参数值明显增大（Ｐ＜０．０１）、细胞增殖活性也增强。通过病例回代验证，所建立的核形态、核仁形成区及细胞增殖活性三种判别函数对其病变判别的符合率分别为９６％、９２％、６７％。上述结果为提高大肠肿瘤内镜活检的确诊率提供了新的模式。     

形似良性病变的早期胃癌的临床研究

目的总结形似良性病变早期胃癌临床特点，提高早期胃癌的诊断水平。方法回顾分析2001～2006年我院经手术切除和病理检查证实，且内镜下形态改变类似良性病变的早期胃癌25例。结果25例患者平均年龄为（58．59±9．35）岁，男女患病率无显著差异（P〉0．05）。21例（86．00％）患者有不同程度的临床症状。分化型癌19例，未分化型癌6例。黏膜内癌19例，黏膜下癌6例，均无淋巴结及远处转移。在内镜检查时发现可疑恶性病灶者18例，7例为内镜诊断良性病变由活检病理意外发现，漏诊率28％。有22例次接受色素染色后放大内镜、内镜荧光早期胃癌诊断仪（ISF）、智能电子分光内镜（FICE）检查等内镜精检，内镜精检和常规内镜检查的首次活检阳性率分别为81．8％和52．00％。大体形态以平坦型和凹陷型为主，内镜表现与良性息肉或炎性增生；局部黏膜发红或退色；局部黏膜粗糙或颗粒样或糜烂及良性溃疡相似。结论形似良性病灶早期胃癌易误认为良性病变，常规内镜首次活检阳性率低，应进行内镜精检并积极随访复查，避免延误诊断和治疗。     

大肠粘膜腺管开口对粘膜病变的诊断价值

目的：探讨放大内镜结合腺管开口分型在诊断大肠粘膜病变性质的临床应用价值。方法：放大内镜检查中，发现病变后，对病灶喷洒靓胭脂，采用放大内镜观察病灶粘膜腺管开口形态，按Kudo分型作病灶性质判断 ，并与切除或活检组织作病理学比较。结果：在194处病灶中，放大内镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤和大肠癌的病理符合率分别为100.0％、93.3％、90.9％、100.0％，总病理符合率为96.1％。结论：放大内镜对判断大肠病变性质有较高的病理符合率，使我们能够区分肿瘤与非肿瘤，良性与恶性肿瘤，预测癌的浸润深度，决定合适的治疗方式，具有较高的临床应用价值。     

大肠非霍奇金淋巴瘤的内镜诊断分析

目的探讨原发性大肠非霍奇金淋巴瘤(NHL)的内镜表现,以提高对原发性大肠非霍奇金淋巴瘤的诊断率。方法回顾性分析近6年来我院经手术及病理证实的8例原发性大肠NHL临床和内镜资料。结果病变部位位于盲肠者占62.5%。内镜下表现为弥漫型3例,溃疡型4例,息肉型1例。电子结肠镜检查结合病理组织活检诊断阳性率达87.5%。结论本病好发于盲肠,多为单发病灶。本组病例中内镜下病灶形态表现以溃疡型多见。结肠镜检查联合内镜下活检、免疫组织化学检查有助于提高对大肠NHL内镜诊断阳性率。     

Endoscopic Surveillance for Cancer in Chronic Ulcerative Colitis

Severe epithelial dysplasia in multiple colonoscopic biopsy specimens may help identify those patients with chronic ulcerating colitis (CUC) at highest risk for developing colonic cancer. This retrospective analysis of 75 patients with longstanding CUC studied by colonoscopy and biopsy disclosed 11 patients with cancer. Four of these cancers were detected by surveillance colonoscopy and seven were detected by diagnostic colonoscopy. There was a high correlation between the presence of dysplasia and cancer in the patients. Cancer was found in five of seven patients who underwent operation after colonoscopic biopsies showed severe dysplasia. No cancers were found at operation in 15 patients whose colonoscopic biopsy specimens were free of dysplasia. Dysplasia can be consistently identified. A reviewing pathologist agreed with the initial biopsy diagnosis in 59 of 64 cases (92%) and with the colectomy diagnosis in 18 of 21 (86%). Colonoscopy with multiple biopsy specimens is a valuable surveillance technic. Patients without dysplasia on biopsy should have continued surveillance.     

"肠型恶组"诊断的再评价

目的 进一步认识与重视误诊为肠型恶组-同结肠T细胞恶性淋巴瘤的临床表现、病理学特点及内镜分型。方法 临床病例结合内镜、病理学、免疫组化及文献报道，进行分析与讨论。结果 肠型恶组与回结肠T细胞恶性淋巴瘤两者的临床症状(依次为腹痛、腹块、血便或黑便及发热与腹泻等)及病理学表现(恶性细胞形态多样化，可呈组织细胞样、异型淋巴样细胞或巨核异型细胞表现)缺乏特异性，诊断往往较困难，并且预后不良。结肠镜表现分蕈状、溃疡蕈状、浸润、溃疡浸润及溃疡等5型。结论 旧称的肠型恶组，实际上大部分为大细胞性淋巴瘤；其中原发性回结肠真正的组织细胞性淋巴瘤罕见。临床上易与溃结等炎症性肠道疾病或其它恶性肿瘤混淆。结肠镜联合活检及免疫组化分析是作出正确诊断的重要方法。     

Endoscopic diagnosis of colonic tuberculosis

BACKGROUND: GI tuberculosis is a diagnostic challenge, particularly in the absence of evidence of pulmonary infection. It may mimic many other abdominal diseases such as other infectious processes, tumors, and Crohn's disease. In the absence of positive laboratory and radiologic tests, the diagnosis is often established definitively by obtaining a surgical specimen. Colonoscopy, however, has been used successfully to diagnose the disease and thus avoid the morbidity and mortality associated with exploratory laparotomy. METHODS: An evaluation was conducted of colonoscopic features in 10 patients with colonic tuberculosis. OBSERVATIONS: In all cases there was ileocecal involvement; total colonic involvement was found in only 1 case. The colonoscopic appearance included the following: ulcerated lesions, sessile firm polyps, masses, and small diverticula, ranging from 3 to 5 mm in diameter. In 5 of our patients the diagnosis was confirmed bacteriologically, in 3 with endoscopic biopsy material, and in 2 by sputum examination. In all cases antituberculous therapy produced remarkable symptom and endoscopic improvement. CONCLUSION: This report highlights the importance of colonoscopy in the diagnosis of tuberculous involvement of the GI tract.     

Routine and blind histological diagnoses on colonoscopic biopsies compared to clinical-colonoscopic observations in patients without and with colitis.

Of the 110 patients examined, complete agreement was found between the blind and routine histological studies in the sections from 69 patients (63%), between the blind histological study and that of colonoscopy in 66 patients (60%), and between the routine histological diagnoses and those of colonoscopy in 73 patients (66%). The diagnosis of a normal colonic mucosa was made by blind study on colonoscopic biopsies in 32 patients, by the routine one in 36 patients, and by clinical-colonoscopic examination in 40 cases, the percentage of agreement with the colonoscopic diagnosis being 68 and 72, respectively. The diagnosis of unspecific non-ulcerative colitis was made by the blind histological study in 43 patients, by the routine histological examination in 58 cases, and by colonoscopy in 41 patients. The percentage of agreement between the histological studies and the clinical-colonoscopic diagnoses was 61 and 78, respectively. A diagnosis of ulcerative colitis was made by the blind histological study in 35 patients, by the routine histological examination in 16, and by colonoscopy in 27 cases. The percentages of agreement between the histological studies and the diagnoses by clinical-colonoscopic examination were 82 and 59, respectively. The differences in symptomatology between groups were small, except for a high occurrence of diarrhoea and blood in stool in ceses with ulcerative colitis, as evaluated by blind histological study. The findings stress the importance of following defined criteria for histological examination.     

Dysplasia and cancer complicating strictures in ulcerative colitis

Previous studies have found a widely variable prevalence of dysplasia and cancer in colonic strictures in patients with ulcerative colitis. Consequently, therapeutic recommendations are conflicting. To better assess the prevalence, we reviewed the clinical and pathological findings in all 27 patients with ulcerative colitis complicated by stricture who were entered into our Inflammatory Bowel Disease Registry. A true stricture was defined as a persistant localized narrowing of the colon found on air-contrast barium enema or on colonoscopy. Upon careful review, 12 of 27 patients were found to have transient colonic spasm, not a stricture, and were excluded. The remaining 15 patients with true strictures represented 3.2% of all ulcerative colitis patients in the registry. Strictures were identified at 13.3± 9.9 years following the diagnosis of ulcerative colitis. Eleven patients had multiple strictures that were principally located in the left colon. Of the 15 patients, 11 had dysplasia and two had cancer found on colonoscopic biopsy. Ultimately, six patients had carcinoma found at colonoscopy or colectomy (three modified Dukes' stage A, one stage B, and two stage D). All cancers were at the site of a stricture. These findings indicate that a true colonic stricture in ulcerative colitis is frequently associated with dysplasia and cancer, which can be diagnosed with colonoscopic biopsy. A stricture should be considered a strong risk factor for cancer, requiring intensive colonscopic surveillance. If dysplasia is discovered, or if the stricture cannot be adequately biopsied, consideration should be given to total colectomy.Research supported by the David and Reva Logan Gastrointestinal Clinical Research Center and the Gastrointestinal Research Foundation Junior Board.     

Colonoscopic study of 50 patients with colonic tuberculosis.

Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%). A nodular mucosa with areas of ulceration was the usual colonoscopic finding. Ileocaecal disease was found in 16, ileocaecal and contiguous ascending colon disease in 14, segmental colonic tuberculosis in 13, ileocaecal disease and non-confluent involvement of another part of the colon in five, and pancolitis in two patients. This report emphasises that colonoscopy is a useful procedure for diagnosing colonic tuberculosis and that segmental colonic tuberculosis is not uncommon.     

Percutaneous sonography-guided fine needle aspiration biopsy of colonoscopic biopsy-negative colonic lesions.

BACKGROUND: Pre-operative tissue diagnosis with colonoscopy is not always possible in patients with colonic lesions. OBJECTIVE: To study the usefulness and efficacy of percutaneous ultrasound-guided aspiration biopsy of colonic lesions. METHODS: Fifty consecutive patients with colonic lesions in whom colonoscopic brush cytology and biopsy were either negative or the lesion was not accessible on colonoscopy on two attempts, underwent percutaneous ultrasound-guided fine-needle aspiration biopsy. The results were compared with surgical findings. RESULTS: Fine-needle aspiration biopsy revealed adenocarcinoma in 40 patients; one had lymphoma, 2 had tuberculosis, 2 had abscess and 5 patients had negative aspiration. Forty-eight patients (excluding 2 with tuberculosis) underwent laparotomy and the diagnoses on aspiration biopsy were confirmed. Of the 5 negative aspirations, 3 had adenocarcinoma, one had tuberculosis and one intussusception. Thus, we had sensitivity of 91.8%, specificity of 100%, predictive value of positive results 100%, predictive value of negative results 20%, and percentage of false negative results 8.1%. Two patients developed complications--hemorrhage into the peritoneum and sepsis due to perforation at the site of aspiration; both survived after surgery. CONCLUSION: Percutaneous ultrasound-guided aspiration biopsy may be attempted for diagnosis of colonic lesions in situations where it may be the only means of obtaining a cytological diagnosis before surgery.     

The diagnosis of colitis by colonoscopy with biopsy and X-ray examination. A blind comparative study.

The examinations were performed in 40 outpatients, of whom 21 were women. From the rectal and colonic mucosa 185 biopsies were obtained. The X-ray examination was performed within one week from the colonoscopy, using a conventional barium enema. A complete agreement between the colonoscopic diagnosis and that of the directed biopsy was found in 33 cases (80 per cent), and minor disagreements in 3 cases. A complete agreement between the colonoscopic and X-ray diagnoses was obtained in 22 patients (55 per cent), and minor disagreements in 16 cases, most of whom showed "unspecific" non-ulcerative colitis. In 3 cases with ulcerative colitis a normal colon was found by X-ray. A higher percentage of cases showed decreased haustration by X-ray examination than by colonoscopy, whereas a fairly equal percentage of ulceration was detected by the two methods. Erosions, mucus covering, oedema, vascular injection, and bleedings were not detected by X-ray examination.     

Comparison between stool examination, serology and large bowel biopsy in diagnosing Schistosoma mansoni

This report evaluates the diagnostic method in 167 patients with colonic schistosomiasis. These patients formed a part of a large number of patients who had sigmoidoscopy or colonoscopy for various gastrointestinal problems. During sigmoidoscopy or colonoscopy examination, typical intestinal Schistosomia lesions could be seen and at the same time several biopsies could be taken. Stool examination showed Schistosoma mansoni ova in only 19 patients (11.37%) of the 167 patients whose colonic biopsies were positive for Schistosoma mansoni. Serological tests were carried out in 115 of these patients and 88 patients (52.69%) had a titre of 64 or more. This study shows that endoscopic colonic biopsy is a better method than stool examination and serological tests in the diagnosis of intestinal or hepatosplenic schistosomiasis.     

Validity of early colonoscopy for the treatment of adenomas missed by initial endoscopic examination.

OBJECTIVE: To determine whether the features of adenomas identified in a first endoscopic examination may predict the presence of polyps with advanced pathological features that may have gone unnoticed and whether early colonoscopy may benefit these patients. MATERIAL AND METHODS: We examined 133 patients with diagnosis of colonic adenomas who had undergone complete colonoscopy and endoscopic polypectomy. All of them underwent colonoscopic follow-up at 3 years. Seventy nine patients underwent colonoscopic follow-up both at 6 months and at 3 years, while 54 patients underwent just colonoscopic follow-up at 3 years and 47 just at 6 months. RESULTS: Fifteen per cent of the patients analyzed developed polyps with pathological features after 6 months. The size and histological analysis of the polyps detected in the initial colonoscopic examination did not affect these results (p < 0.05). The number of polyps was statistically significant: patients with 3 or more polyps in the initial colonoscopic examination presented more polyps with pathological features after six months (25.8 versus 5.8%, p = 0002). This follow-up examination at 3 years did not reveal a higher occurrence of polyps with pathological features in any of the two groups of patients, namely, those who had undergone early colonoscopy and those who had not. CONCLUSIONS: Patients with multiple polyps have greater probability of developing synchronous polyps with some pathological features which may have gone unnoticed. Since early examination has not shown to provide a benefit for these patients, the first follow-up colonoscopy should be performed at 3 years, particularly if the initial colonoscopy is negative.