贲门失弛缓症(achalasia of cardidia,AC)是一种原发性食管动力障碍性疾病,其诊断的主要依据包括临床症状、食管造影、食管动力学检查及上消化道内镜检查,食管高分辨率测压是金标准.随着新技术的兴起,AC的诊断方式更加丰富,三维建模或...贲门失弛缓症(achalasia of cardidia,AC)是一种原发性食管动力障碍性疾病,其诊断的主要依据包括临床症状、食管造影、食管动力学检查及上消化道内镜检查,食管高分辨率测压是金标准.随着新技术的兴起,AC的诊断方式更加丰富,三维建模或许可以促进AC的早期发现,内镜下功能性腔内成像探针可以提高诊断的准确率.常用的治疗方法有内镜下球囊扩张、腹腔镜Heller肌切开术、经口内镜下肌切开术(peroral endoscopic myotomy,POEM)等.POEM已成为目前应用最广泛的治疗方法,大幅提高了AC的临床治疗成功率.本文旨在结合近年来的研究进展,对AC的诊断和治疗进行综述.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)-related cirrhosis is mainly caused by NAFLD by causing inflammation which leads to fibrosis.The role of leptin in NAFLD-related cirrhosis has been rarely reported.CA...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)-related cirrhosis is mainly caused by NAFLD by causing inflammation which leads to fibrosis.The role of leptin in NAFLD-related cirrhosis has been rarely reported.CASE SUMMARY This study presents the case of a 65-year-old male patient who was referred to The First Affiliated Hospital of Guangxi University of Chinese Medicine,Guangxi,Chi-na,for diagnosis and treatment for liver cirrhosis.Initially,the cause of liver cirrhosis was unknown.After radiology,laboratory examination,pathological results and analysis of the patient’s signs and symptoms,the case was finally diagnosed with final NAFLD-related cirrhosis.Although this study reports a single case,the findings might expand the understanding of leptin’s role in NAFLD-related cirrhosis and might provide a basis for the clinical diagnostic criteria,pathological features and treatment of NAFLD-related cirrhosis.CONCLUSION Although the occurrence of marasmus NAFLD-related cirrhosis is rare,it needs to be distinguished from other liver diseases,including viral hepatitis,drug-induced liver disease,Wilson’s disease and autoimmune liver disease.Aggressive treatment is needed to prevent the progression of NAFLD-related cirrhosis.展开更多
文摘贲门失弛缓症(achalasia of cardidia,AC)是一种原发性食管动力障碍性疾病,其诊断的主要依据包括临床症状、食管造影、食管动力学检查及上消化道内镜检查,食管高分辨率测压是金标准.随着新技术的兴起,AC的诊断方式更加丰富,三维建模或许可以促进AC的早期发现,内镜下功能性腔内成像探针可以提高诊断的准确率.常用的治疗方法有内镜下球囊扩张、腹腔镜Heller肌切开术、经口内镜下肌切开术(peroral endoscopic myotomy,POEM)等.POEM已成为目前应用最广泛的治疗方法,大幅提高了AC的临床治疗成功率.本文旨在结合近年来的研究进展,对AC的诊断和治疗进行综述.
文摘背景早期食管病变在无明显转移或浸润时均可以首选内镜下治疗,尤其是内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),然而术后非治愈性切除、复发或转移等不良事件的发生是不可避免的,可能需要追加手术或放化疗等辅助治疗.目的分析ESD治疗早期食管病变后需要追加手术或放化疗的危险因素,并探讨治愈性切除对追加辅助治疗的影响.方法回顾性分析本中心因T1期食管癌及癌前病变行ESD者,随访患者术后复发、转移以及辅助治疗的情况,并建立辅助治疗人群选择的预测模型.结果患者年龄、病灶环周比例、镜下大小与ESD术后非治愈性切除相关(P<0.05),而且环周比例>2/3(OR=7.958,P=0.007)是独立危险因素.治愈性/非治愈性切除者中分别有2例/10例追加了手术或放化疗,即不论是否为治愈性切除均有辅助治疗者.年龄、环周比例、病灶抬举情况、分化情况、脉管侵袭、浸润深度等与ESD术后需要辅助治疗相关(P<0.05),年龄≥70岁(OR=4.210,P=0.049)、病灶抬举不良(OR=18.171,P=0.047)、浸润至SM2层(OR=38.781,P=0.012)是独立危险因素.列线图模型的曲线下面积为0.864(95%CI:0.766-0.962),特异度和灵敏度分别为95.8%和75.0%,校准曲线、决策曲线、Hosmer and Lemeshow检验(χ^(2)=1.5954,P=0.991)等显示该模型预测价值尚可.结论T1期食管癌及癌前病变者在ESD术后不能仅靠病理为非治愈性而追加手术或放化疗,而应结合患者情况、内镜表现及术后病理等综合评估.
基金Supported by Guangxi Provincial Natural Science Foundation of China,No.2022GXNSFBA035485 and No.2022GXNSFAA035460Basic Ability Improvement Project of Young and Middle-aged Teachers in Guangxi Colleges and Universities,No.2019KY0313+1 种基金the National Natural Science Foundation of China,No.81760845 and No.81403382Innovation Project of Guangxi Graduate Education,No.YCSW2021220 and No.YCXJ2021056。
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)-related cirrhosis is mainly caused by NAFLD by causing inflammation which leads to fibrosis.The role of leptin in NAFLD-related cirrhosis has been rarely reported.CASE SUMMARY This study presents the case of a 65-year-old male patient who was referred to The First Affiliated Hospital of Guangxi University of Chinese Medicine,Guangxi,Chi-na,for diagnosis and treatment for liver cirrhosis.Initially,the cause of liver cirrhosis was unknown.After radiology,laboratory examination,pathological results and analysis of the patient’s signs and symptoms,the case was finally diagnosed with final NAFLD-related cirrhosis.Although this study reports a single case,the findings might expand the understanding of leptin’s role in NAFLD-related cirrhosis and might provide a basis for the clinical diagnostic criteria,pathological features and treatment of NAFLD-related cirrhosis.CONCLUSION Although the occurrence of marasmus NAFLD-related cirrhosis is rare,it needs to be distinguished from other liver diseases,including viral hepatitis,drug-induced liver disease,Wilson’s disease and autoimmune liver disease.Aggressive treatment is needed to prevent the progression of NAFLD-related cirrhosis.
