Association of plant-based diets with the risk of upper gastrointestinal tract cancers:A systematic review and meta-analysis

Background:Diets rich in red or processed meat have been linked to an increased risk of cancers within the digestive system.It has been suggested that a plant-based diet may have protective effects against digestive system cancers.This study aimed to determine the association between plant-based diets and upper gastrointestinal tract cancers(UGTC).Methods:We conducted a systematic review and meta-analysis of observational studies.We searched the PubMed,Medline,Embase,and Web of Science databases for articles published up to September 30,2023.We pooled the risk ratios(RR)with the corresponding 95%confi-dence intervals(CI)using fixed or random-effects models.Results:Our meta-analysis included 16 studies(30 results).The data revealed a strong inverse association between a high intake of plant-based diets and UGTC(RR=0.60,95%CI=0.49-0.72),specifically gastric cancer(GC,RR=0.53,95%CI=0.42-0.67)and esophageal can-cer(EC,RR=0.63,95%CI=0.42-0.96).This relationship was not significant for gastric cardia cancer(GCA)or esophagogastric junctional cancer(EGJC,RR=0.76,95%CI=0.47-1.22).A subgroup analysis showed the association was significant in studies from Asia and Europe,as well as in studies utilizing indices such as a vegetarian diet,Mediterranean diet,the plant-based diet index,and principal component analy-sis(PCA)dietary patterns.There was no indication of publication bias among the analyzed studies.Conclusions:This meta-analysis highlights the potential health benefits of plant-based diets in preventing UGTC,particularly regarding esophageal squamous cell carcinoma(ESCC)and GC.Nevertheless,additional research is required to validate these results and explore the un-derlying mechanisms.

Prognostic value of T cell immunoglobulin and mucin-domain containing-3 expression in upper gastrointestinal tract tumors:A meta-analysis

BACKGROUND There is a lack of robust prognostic markers for upper gastrointestinal(GI)tract cancers,including esophageal,gastric,and esophagogastric junction cancers.T cell immunoglobulin and mucin-domain containing-3(TIM3)plays a key immunomodulatory role and is linked to the prognosis of various cancers.However,the significance of TIM3 in upper GI tract tumors is still uncertain.AIM To investigate the prognostic value of TIM3 expression in upper GI tract tumors.METHODS A literature search was conducted on the PubMed,Embase,and Web of Science databases for relevant studies published until June 2023.After screening and quality assessment,studies that met the criteria were included in the metaanalysis.Statistical methods were used for the pooled analysis to assess the association of TIM3 expression in upper GI tract tumors with the prognosis and clinicopathological parameters.The results were reported with the hazard ratio(HR)and 95%confidence interval(CI).RESULTS Nine studies involving 2556 patients with upper GI tract cancer were included.High TIM3 expression was associated with a worse prognosis in upper GI tract cancer(HR:1.17,95%CI:1.01-1.36).Positive expression of TIM3 in gastric cancer was correlated with the T and N stage,but the difference was not statistically significant.However,TIM3 overexpression was significantly correlated with the TNM stage(odds ratio:1.21,95%CI:0.63-2.33;P<0.05).TIM3 expression showed no association with the other clinicopathological parameters.CONCLUSION High expression of TIM3 in the upper GI tract cancer is associated with a worse prognosis and advanced T or N stages,indicating its potential value as a prognostic biomarker.These findings may provide a basis for the personalized treatment of upper GI tract cancers.

Multiple primary malignant tumors of upper gastrointestinal tract:A novel role of ^(18)F-FDG PET/CT

AIM: To evaluate the capacity of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detecting multiple primary cancer of upper gastrointestinal (UGI) tract. METHODS: Fifteen patients (12 without cancer histories and 3 with histories of upper GI tract cancer) were investigated due to the suspicion of primary cancer of UGI tract on X-ray barium meal and CT scan. Subsequent whole body 18F-FDG PET/CT scan was carried out for initial staging or restaging. All the patients were fi nally confi rmed by endoscopic biopsy or surgery. The detection rate of multiple primary malignant cancers was calculated based on 18F-FDG PET/CT and endoscopic examinations.RESULTS: 18F-FDG PET/CT scan was positive in 32 suspicious lesions, 30/32 were true positive primary lesions, and 2/32 were false positive. In 15 suspicious lesions with negative 18F-FDG PET/CT scan, 12/15 were true negative and 3/15 were false negative. Among the 15 patients, 12 patients had 29 primary synchronous tumors confirmed by pathology, including 8 cases of esophageal cancers accompanied with gastric cancer and 4 of hypopharynx cancers with esophageal cancer. The other 3 patients had 4 new primary metachronous tumors, which were multiple primary esophageal cancers. PET/CT imaging detected local lymph node metastases in 11 patients. Both local lymph node metastases and distant metastases were detected in 4 patients. On a per-primary lesion basis, the sensitivity, specificity, accuracy, negative predictive value and positive predictive value of 18F-FDG PET/CT for detecting multiple primary cancer of UGI tract were 90.9%, 85.7%, 89.4%, 80% and 93.7%, respectively. CONCLUSION: The whole body 18F-FDG PET/CT may play an important role in evaluating the multiple primary malignant tumors of UGI tract cancer.

Clinical features of upper gastrointestinal serrated lesions: An endoscopy database analysis of 98746 patients

AIM To analyse the clinical features of patients with the serrated lesions in the upper gastrointestinal tract(UPGI) tract.METHODS Patients who underwent routine esophagogastroduodenoscopy(EGD) at the Digestive Endoscopy Centre of General Hospital, Tianjin Medical University between january 2011 and December 2015 were consecutively recruited. Patients with UPGI serrated lesions were consecutively identified. The patients' demographics and histopathology were recorded. The colorectal findings for patients who underwent colonoscopy simultaneously or within six months were also extracted from the colonoscopy database. In addition, we analyseddifferences in colorectal neoplasia detection between the study patients and randomly selected patients matched for age and gender who did not exhibit serrated lesions and who also underwent colonoscopy in the same period.RESULTS A total of 21 patients out of 98746 patients(0.02%) who underwent EGD were confirmed to have serrated lesions with predominantly crenated, sawtooth-like configurations. The mean age of the 21 patients was(55.3 ± 17.2) years, and 11 patients were male(52.4%). In terms of the locations of the serrated lesions, 17 were found in the stomach(including 3 in the cardia, 9 in the corpus and 5 in the antrum), 3 were found in the duodenum, and 1 was found in the esophagus. Serrated lesions were found in different mucosal lesions, with 14 lesions were detected in polyps(8 hyperplastic polyps and 6 serrated adenomas with low grade dysplasia), 3 detected in Ménétrier gastropathy, 3 detected in an area of inflammation or ulcer, and 1 detected in the intramucosal carcinoma of the duodenum. In addition, colonoscopy data were available for 18 patients, and a significantly higher colorectal adenoma detection rate was observed in the UPGI serrated lesions group than in the randomly selected age- and gender-matched group without serrated lesions who also underwent colonoscopy in the same period(38.9% vs 11.1%, OR = 5.091, 95%CI: 1.534-16.890, P = 0.010). The detection rate of advanced adenoma was also higher in the UPGI serrated lesions group(22.2% vs 4.2%, OR = 6.571, 95%CI: 1.322-32.660, P = 0.028).CONCLUSION Serrated lesions in the UPGI were detected in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is recommended for the detection of concurrent colorectal adenoma for these patients.

Uptake and outcomes of small intestinal and urinary tract cancer surveillance in Lynch syndrome

BACKGROUND Lynch syndrome(LS)is a hereditary cancer predisposition syndrome associated with increased risk of multiple cancers.While colorectal cancer surveillance decreases mortality in LS and is recommended by guidelines,there is lack of evidence for the efficacy of surveillance for extra-colonic cancers associated with LS,including small intestinal cancer(SIC)and urinary tract cancer(UTC).Given the limited evidence,guidelines do not consistently recommend surveillance for SIC and UTC,and it remains unclear how often individuals will choose to undergo and follow through with extra-colonic surveillance recommendations.AIM To study factors associated with SIC and UTC surveillance uptake and outcomes in LS.METHODS This is an IRB-approved retrospective analysis of individuals with LS seen at a tertiary care referral center.Included individuals had a pathogenic or likely pathogenic variant in MLH1,MSH2,MSH6,PMS2,or EPCAM,or were a confirmed obligate carrier,and had at least one documented visit to our center.Information regarding SIC and UTC surveillance was captured for each individual,and detailed personal and family history was obtained for individuals who had an initial LS management visit in our center’s dedicated high-risk LS clinic between January 1,2017 and October 29,2020.During these initial management visits,all patients had in-depth discussions of SIC and UTC surveillance with 1 of 3 providers experienced in LS management to promote informed decision-making about whether to pursue SIC and/or UTC surveillance.Statistical analysis using Pearson’s chi-squared test and Wilcoxon rank-sum test was completed to understand the factors associated with pursuit and completion of SIC and UTC surveillance,and a P value below 0.05 was deemed statistically significant.RESULTS Of 317 individuals with LS,86(27%)underwent a total of 105 SIC surveillance examinations,with 5 leading to additional work-up and no SICs diagnosed.Additionally,99(31%)patients underwent a total of 303 UTC surveillance examinations,with 19 requiring further evaluation and 1 UTC identified.Of 155 individuals who had an initial LS management visit between January 1,2017 and October 29,2020,63(41%)chose to undergo SIC surveillance and 58(37%)chose to undergo UTC surveillance.However,only 26(41%)and 32(55%)of those who initially chose to undergo SIC or UTC surveillance,respectively,successfully completed their surveillance examinations.Individuals with a pathogenic variant in MSH2 or EPCAM were more likely to initially choose to undergo SIC surveillance(P=0.034),and older individuals were more likely to complete SIC surveillance(P=0.007).Choosing to pursue UTC surveillance was more frequent among older individuals(P=0.018),and females more frequently completed UTC surveillance(P=0.002).Personal history of cancer and family history of SIC or UTC were not significantly associated with electing nor completing surveillance.Lastly,the provider discussing SIC/UTC surveillance was significantly associated with subsequent surveillance choices.CONCLUSION Pursuing and completing SIC/UTC surveillance in LS is influenced by several factors,however broad incorporation in LS management is likely unhelpful due to low yield and frequent false positive results.

认知行为干预对上消化道早癌行内镜下黏膜剥离术患者的效果研究

目的探讨基于人文关怀理念的认知行为干预对上消化道早癌患者疼痛、心理和康复效果的影响。方法选择196例上消化道早期癌症行内镜下黏膜剥离术(ESD)患者,随机分为对照组和观察组,每组98例。对照组给予上消化道早癌ESD知识宣教,观察组在此基础上给予基于人文关怀理念的认知行为干预。比较2组康复情况、疼痛视觉模拟评分法(VAS)评分、焦虑自评量表(SAS)评分、一般自我效能感量表(GSES)评分、术后并发症。结果观察组的术后肛门排气时间、术后首次排便时间和术后住院时间为(24.67±8.25)h、(43.90±10.27)h、(9.38±2.02)d,分别短于对照组的(27.83±9.40)h、(50.03±12.85)h、(10.26±2.37)d;手术24、48、72 h后观察组VAS评分为(2.63±0.67)、(1.84±0.52)、(1.33±0.38)分,分别低于对照组的(2.89±0.70)、(2.06±0.58)、(1.47±0.42)分;观察组干预后SAS评分为(38.73±7.40)分,低于对照组的(42.05±8.01)分;观察组干预后的GSES评分为(31.53±6.27)分,高于对照组的(29.28±5.96)分,差异均有统计学意义(P<0.05)。2组总并发症发生率比较,差异无统计学意义(P>0.05)。结论对上消化道早癌患者实施基于人文关怀理念的认知行为干预可减轻疼痛和焦虑情绪,促进患者快速康复。

UPF3B促进上消化道恶性肿瘤细胞增殖

目的探讨UPF3B对上消化道恶性肿瘤细胞增殖的影响。方法通过qRT-PCR和Western Blot技术验证胃癌和食管癌细胞中UPF3B的敲低和过表达效率;CCK-8、EdU、平板克隆形成实验评估细胞的增殖能力。结果在胃癌和食管癌细胞中通过siRNA敲低UPF3B的表达水平,UPF3B的mRNA和蛋白表达水平显著降低,且有统计学意义(P<0.001),CCK8、EdU、平板克隆形成实验结果表明敲低UPF3B抑制胃癌和食管癌细胞的增殖;在胃癌和食管癌细胞中转染UPF3B过表达质粒上调UPF3B的表达水平,UPF3B的mRNA和蛋白表达水平显著升高,且有统计学意义(P<0.001),CCK8、EdU、平板克隆形成实验结果表明过表达UPF3B促进胃癌和食管癌细胞的增殖。结论UPF3B促进上消化道恶性肿瘤细胞增殖。

提高上消化道早癌筛查率的研究进展

对上消化道早癌筛查现状、影响筛查的因素、提高筛查率的方法进行综述,以期为今后护理人员提高上消化道早癌筛查率提供参考。

多环套扎黏膜切除术治疗消化道早癌及病变的综述

选择正确有效、创伤小、恢复快的治疗方法是治疗消化道早癌及黏膜病变关键。过去,只要确诊了癌、癌前病变或者黏膜下病变,无论病变大小、分期,大多采取外科手术的方法切除病变。外科手术对患者来说创伤大、恢复慢、花费高,器官功能受损,使得患者生活质量下降。随着医学不断地发展进步,内镜下微创手术正在以飞速发展的趋势逐渐取代部分外科手术。针对部分消化道早癌,癌前病变及黏膜下病变,内镜下微创手术完全可以达到彻底切除病变和治愈的目的。本文介绍内镜下多环套扎黏膜切除术治疗早期食管癌、食管及结直肠的癌前病变及食管的黏膜下病变的现状和展望。

2007—2021年山东省汶上县上消化道癌筛查结果分析

目的分析2007—2021年汶上县癌症早诊早治项目中上消化道癌筛查结果。方法在县域内采用整群随机抽样的方法选取发病率和病死率较高的乡或村40~69岁人群作为目标人群。采用高危因素问卷调查的方法选出高危人群后进行内镜检查和活检病理,计算出阳性率、早诊率、治疗率等指标。结果2007—2021年共完成内镜检查27784人次,活检病理检查19173人次。检出上消化道肿瘤患者353例,检出率为1.27%,其中有272例为早癌病例,早诊率为77.05%。按年度分析2007—2014年度和2015—2021年度活检率变化比较,差异有统计学意义(χ^(2)=202.27,P<0.05)。2007—2014年和2015—2021年检出率变化,差异有统计学意义(χ^(2)=34.44,P<0.05),2018—2021年筛查阳性率在2.10%以上,超过了国家项目组设定的目标检出率(2.00%)。2007—2014年和2015—2021年治疗率比较,差异有统计学意义(P<0.05)。2007—2014年和2015—2021年早诊率比较,差异无统计学意义(P>0.05)。结论通过问卷调查评估出高危人群后“采用上消化道内镜+病理学检查”的筛查手段可高效检出上消化道癌及癌前病变,对提高地区癌症患者生存率有现实意义。

窄带成像-放大内镜在上消化道早期癌及癌前病变筛查中的应用研究

目的探究窄带成像-放大内镜(NBI-ME)在上消化道早期癌及癌前病变筛查中应用。方法选取2021年7月至2023年7月在许昌北海医院治疗的68例疑似为上消化道早期癌及癌前病变的患者,所有患者均接受常规内镜、NBI-ME检查,以病理结果作为金标准,分析诊断效能。结果68例疑似消化道早期癌及癌前病变患者经病理检查后,提示良性病变为8例,癌前病变22例、消化道早期癌18例、进展癌20例。NBI-ME诊断准确率、特异性为97.06%、100.00%,高于常规内镜(80.88%、62.50%),差异有统计学意义(P<0.05);NBI-ME敏感性(96.67%)高于常规内镜(83.33%),差异无统计学意义(P>0.05);良性病变与肿瘤病变在NBI-ME镜下特征表现中,分界线、黏膜微血管、黏膜表面腺管、腺管密度增加及黏膜微血管密度增加存在差异,且差异有统计学意义(P<0.05);NBI-ME检查病变轮廓、消化道黏膜、微血管形态清晰程度高于常规内镜,差异有统计学意义(P<0.05)。结论NBI-ME用于上消化道早期癌及癌前病变筛查中具有较高诊断效能,特异度高,同时能提供清晰的图像以供于临床医师诊断,为临床诊断及治疗提供指导依据。

Application of an artificial intelligence system for endoscopic diagnosis of superficial esophageal squamous cell carcinoma

BACKGROUND Upper gastrointestinal endoscopy is critical for esophageal squamous cell carcinoma(ESCC)detection;however,endoscopists require long-term training to avoid missing superficial lesions.AIM To develop a deep learning computer-assisted diagnosis(CAD)system for endoscopic detection of superficial ESCC and investigate its application value.METHODS We configured the CAD system for white-light and narrow-band imaging modes based on the YOLO v5 algorithm.A total of 4447 images from 837 patients and 1695 images from 323 patients were included in the training and testing datasets,respectively.Two experts and two non-expert endoscopists reviewed the testing dataset independently and with computer assistance.The diagnostic performance was evaluated in terms of the area under the receiver operating characteristic curve,accuracy,sensitivity,and specificity.RESULTS The area under the receiver operating characteristics curve,accuracy,sensitivity,and specificity of the CAD system were 0.982[95%confidence interval(CI):0.969-0.994],92.9%(95%CI:89.5%-95.2%),91.9%(95%CI:87.4%-94.9%),and 94.7%(95%CI:89.0%-97.6%),respectively.The accuracy of CAD was significantly higher than that of non-expert endoscopists(78.3%,P<0.001 compared with CAD)and comparable to that of expert endoscopists(91.0%,P=0.129 compared with CAD).After referring to the CAD results,the accuracy of the non-expert endoscopists significantly improved(88.2%vs 78.3%,P<0.001).Lesions with Paris classification type 0-IIb were more likely to be inaccurately identified by the CAD system.CONCLUSION The diagnostic performance of the CAD system is promising and may assist in improving detectability,particularly for inexperienced endoscopists.

内镜-病理复原解析结合传统授课的教学模式在上消化道早癌内镜诊断培训中的应用价值

目的 探讨内镜-病理复原解析结合传统授课的教学模式在上消化道早癌内镜诊断培训中的应用价值。方法 选取我院消化内镜中心进修医生(学员)54名,以随机数字表法将其分为对照组(27名,传统授课)和观察组(27名,传统授课+内镜-病理复原解析)。比较两组的应用效果。结果 两组学员培训前、后的理论知识成绩及培训前的基础胃肠镜操作成绩比较,差异无统计学意义(P>0.05)。两组培训后的精查胃镜操作成绩及对浸润深度的诊断符合率比较,差异无统计学意义(P>0.05);观察组学员对病变性质、分化程度的诊断符合率高于对照组(P<0.05)。观察组的教学满意度、个人自信度、学习兴趣评分均高于对照组(P<0.05)。结论内镜-病理复原解析结合传统授课的教学模式能够有效提高学员的上消化道早癌的内镜诊断能力,更好地激发其主动学习的积极性。

上消化道早癌筛查结果和相关因素分析

目的分析2020年1月至2021年12月期间上消化道早癌筛查结果和相关影响因素。方法收集2020年1月至2021年12月期间进行上消化道内镜检查的患者,分为上消化道癌阳性和阴性两组,分析相关影响因素包括:人口学特征、既往疾病史、无痛胃镜、口服去泡剂、胃镜彩图量、正规培训;进一步探讨上消化道癌发病的影响因素。结果2020年1月至2021年12月在宣城市人民医院进行上消化道内镜检查17820例,发现食管、贲门、胃癌分别为87、32、116例。早期食管、贲门、胃早癌发现56、27、89例;上消化道早癌阳性和阴性两组在文化程度、吸烟饮酒史、腌制食品、油炸食品、萎缩性胃炎、低级别上皮内瘤变、无痛胃镜、标准胃镜彩图、焦虑方面差异有统计学意义。两组在性别、年龄、新鲜水果、热烫食品、豆制品、油炸食品、口服去泡剂、正规培训、抑郁方面差异无统计学意义。经多因素非条件Logistic回归分析,饮酒、萎缩性胃炎、腌制食物、低级别上皮内瘤变是影响上消化道癌发病的独立危险因素。结论上消化道早癌的发病可能与文化程度、吸烟、饮酒、腌制食品、萎缩性胃炎、低级别上皮内瘤变、无痛胃镜、标准胃镜彩图、焦虑因素有关,饮酒、萎缩性胃炎、腌制食物、低级别上皮内瘤变是影响上消化道癌发病的独立危险因素。

上消化道癌及癌前病变高危人群预测模型研究

目的分析上消化道癌及癌前病变的危险因素,构建上消化道癌高危人群预测模型,识别上消化道癌高危群体。方法选取2020年6月至2021年12月参加山西省阳城县“农村上消化道癌早诊早治项目”中的40~69岁人群,根据纳入和排除标准筛选后按7∶3随机分为训练集(n=1997)和验证集(n=852),分别用于模型的训练和验证。采用χ2检验进行单因素分析,P<0.2的因素进行最优子集变量筛选,选择赤池信息(akaike information criterion,AIC)最低的变量组合构建logistic回归模型并建立评分量表。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)并根据曲线下面积(area under curve,AUC)评估模型区分度,Hosmer-Lemeshow(H-L)检验和校准曲线评估模型校准度,临床决策曲线(decision curve analysis,DCA)评估临床适用性。结果建立基于年龄、性别、吸烟、热烫饮食摄入、肿瘤家族史5项危险因素的上消化道癌及癌前病变logistic回归预测模型,训练集和验证集AUC分别为0.759(95%CI:0.688~0.830)和0.743(95%CI:0.606~0.880),校准曲线结合H-L检验证明该模型具有较好的校准度(P>0.05)。根据logistic回归模型建立评分模型,分值范围0~27分,分值越高发病风险越高。评分模型训练集和验证集的AUC分别为0.760(95%CI:0.690~0.829)和0.748(95%CI:0.612~0.884),校准曲线结合H-L检验证明该模型具有较好的校准度(P>0.05)。DCA表明该模型具有良好的临床适用性。结论基于年龄、性别、吸烟、热烫饮食摄入、肿瘤家族史等5个危险因素构成的上消化道癌及癌前病变高危人群预测模型和评分模型具有较好的预测价值,有助于上消化道癌人群筛查。

浙江省2019年至2021年上消化道癌机会性筛查结果分析

目的:综合分析浙江省2019年至2021年上消化道癌机会性筛查结果,为上消化道癌机会性筛查及早诊早治工作的开展提供指导。方法:从国家项目数据管理平台导出浙江省2019年至2021年上消化道癌机会性筛查的资料,计算活检率、上消化道肿瘤性病变检出率、上消化道癌早诊率,采用χ2检验及趋势χ2检验比较不同组间率的差异。结果:2019年至2021年共247055例受检者纳入上消化道癌机会性筛查,其中233624例进行活检组织病理学检查。上消化道肿瘤性病变的检出率随年龄增加而上升(P<0.001),且男性显著高于女性(均P<0.001)。在检出率的比较中,采用无痛胃镜组的上消化道肿瘤性病变检出率低于未采用无痛胃镜组,而采用染色组的高于未采用染色组,HP阳性组的高于HP阴性组(均P<0.001)。结论:严格依据国家推行的方案,可以扩大上消化道癌筛查和早诊早治覆盖范围,对于提高上消化道病变检出率具有重要意义,但仍需进一步普及癌症知识,提高上消化道癌早诊率。

消化道早癌患者内镜黏膜下剥离术后迟发性出血的危险因素分析

目的 分析消化道早癌患者内镜黏膜下剥离术(ESD)后迟发性出血的危险因素。方法 回顾性分析2020年5月—2023年2月泰州市人民医院收治的625例消化道早癌患者,其中胃癌257例,食管癌368例。所有患者行ESD,记录消化道早期患者ESD术后迟发性出血情况。胃癌患者根据ESD术后是否发生迟发性出血分为胃癌未发生组与胃癌发生组,食管癌患者根据ESD术后是否发生迟发性出血分为食管癌未发生组与食管癌发生组。比较胃癌发生组与胃癌未发生组患者临床资料,食管癌发生组与食管癌未发生组患者临床资料,采用多因素逐步Logistic回归模型分析ESD术后发生迟发性出血的影响因素。结果 257例胃癌患者中,ESD术后迟发性出血27例,迟发性出血发生率为10.51%;368例食管癌患者中,ESD术后迟发性出血23例,迟发性出血发生率为6.25%。胃癌发生组病灶部位为胃体、病灶直径≥20 mm、黏膜下有粗大血管、黏膜下有纤维化、手术时间≥60 min、长期服用抗凝药物占比高于胃癌未发生组(P <0.05),胃癌发生组病灶深度为黏膜层占比低于胃癌未发生组(P <0.05)。多因素逐步Logistic回归分析结果显示:黏膜下有粗大血管[OR=3.838(95%CI:1.687,8.731)]、黏膜下有纤维化[OR=3.511(95%CI:1.544,7.988)]、手术时间≥60 min [OR=2.821(95%CI:1.240,6.417)]、长期使用抗凝药物[OR=4.415(95%CI:1.941,10.043)]为胃癌患者ESD术后发生迟发性出血的影响因素(P <0.05)。食管癌发生组黏膜深度为黏膜下层、切片直径≥40 mm、切除管径大小为环周、黏膜下有粗大血管、黏膜下有纤维化、手术时间≥60 min、长期服用抗凝血药物占比高于食管癌未发生组(P <0.05)。多因素逐步Logistic回归分析结果显示:黏膜下有粗大血管[OR=3.056(95%CI:1.343,6.951)]、手术时间≥60 min [OR=3.607(95%CI:1.586,8.206)]、长期使用抗凝药物[OR=4.104(95%CI:1.804,9.336)]为食管癌患者ESD术后发生迟发性出血的影响因素(P <0.05)。结论 黏膜下有粗大血管、手术时间≥60 min、长期使用抗凝药物的消化道早癌患者ESD术后迟发性出血风险更高。

消化内镜检查及消化内镜黏膜下剥离术对消化道早癌的诊治效果观察

目的探讨消化道早癌诊治中消化内镜检查及消化内镜黏膜下剥离术的应用效果。方法49例消化道早癌患者,按诊治方法不同分为参照组(24例)和研究组(25例)。参照组患者接受白光内镜检查及开腹或开胸手术治疗,研究组患者接受消化内镜检查及消化内镜黏膜下剥离术治疗。对比两组患者影像学图像质量评分、手术情况、治疗效果及并发症发生情况。结果研究组患者毛细血管影像评分(3.74±0.23)分、形态影像评分(3.32±0.44)分、胃小凹影像评分(3.69±0.33)分均高于参照组的(2.46±0.28)、(2.32±0.35)、(2.76±0.39)分,差异有统计学意义(P<0.05)。研究组患者手术时间(64.93±7.67)min、住院时间(3.53±0.72)d均短于参照组的(79.34±8.58)min、(8.34±1.26)d,术中出血量(48.25±4.35)ml少于参照组的(67.32±5.19)ml,差异有统计学意义(P<0.05)。研究组患者治疗有效率96.00%与参照组的95.83%对比,差异无统计学意义(P>0.05);研究组并发症发生率0低于参照组的16.67%,差异有统计学意义(P<0.05)。结论消化道早癌诊治中应用消化内镜检查及消化内镜黏膜下剥离术,可提升诊断中影像学质量,在保证良好治疗效果基础上减轻手术创伤、减少并发症。

内镜下黏膜切除术与内镜黏膜下剥离术治疗上消化道早期癌的效果比较

目的 比较内镜下黏膜切除术(EMR)与内镜黏膜下剥离术(ESD)治疗上消化道早期癌的效果。方法 选择2019年1月至2020年12月我院收治的56例上消化道早期癌患者为研究对象,根据手术方式不同将其分为对照组(28例,EMR)和试验组(28例,ESD)。比较两组的治疗效果。结果 试验组的手术时间长于对照组(P<0.05);两组的术中出血量、术中穿孔率、≤20 mm病灶完全切除率、整块切除率、复发率比较,差异无统计学意义(P>0.05)。术后24 h,试验组的轻度疼痛占比高于对照组(P<0.05)。术后1周,两组的血管内皮生长因子A(VEGFA)、血管内皮生长因子B(VEGFB)、血管内皮生长因子C(VEGFC)、嗜铬粒蛋白A(CgA)水平均较术前降低,且试验组低于对照组(P<0.05)。试验组的并发症总发生率低于对照组(P<0.05)。术后6个月,两组的社会功能、认知功能、躯体功能、角色功能、情绪功能评分均较术前升高,且试验组高于对照组(P<0.05)。结论 EMR和ESD均在上消化道早期癌治疗中有一定效果,但后者效果更显著,能减轻患者疼痛,降低VEGFA、VEGFB、VEGFC、CgA水平,且并发症较少,利于患者早日康复。

腹腔镜近端胃切除双通道吻合术治疗早期胃上部癌的疗效及对营养状况和生存状况的影响

目的 探讨腹腔镜近端胃切除双通道吻合术治疗早期胃上部癌的疗效及对患者营养状况和生存状况的影响。方法 选择2018年1月至2022年1月咸阳市第一人民医院收治的80例早期胃上部癌患者作为研究对象,按照随机数表法分为观察组与对照组各40例,对照组患者使用全胃切除术治疗,观察组患者使用腹腔镜近端胃切除双通道吻合术治疗。比较两组患者围术期情况,术前、术后6个月的血清白蛋白、总蛋白、血红蛋白水平,并比较术后并发症发生率,记录两组随访至2022年8月1日时的生存率。结果 两组患者的手术时间、术中出血量、淋巴结清扫数量、肛门排气时间、住院时间比较差异均无统计学意义(P>0.05);术后6个月,观察组患者的血清白蛋白、总蛋白、血红蛋白水平为(57.29±5.13) g/L、(66.52±5.81) g/L、(120.02±11.84) g/L,明显高于对照组的(43.05±4.33) g/L、(50.73±5.81) g/L、(108.12±8.10) g/L,差异均有统计学意义(P<0.05);观察组患者术后并发症总发生率为12.50%,明显低于对照组的32.50%,差异有统计学意义(P<0.05);两组患者均随访至2022年8月1日,观察组失访2例、对照组失访3例,观察组和对照组患者的生存率分别为94.74%、91.89%,差异无统计学意义(P>0.05)。结论 腹腔镜近端胃切除双通道吻合术有助于改善早期胃上部癌患者术后的营养状况,降低并发症,但对生存状况的改善效果不明显。