消化系统疾病诊治与组织病理诊断密切相关,高效、规范获取组织样本是关键,对此2021年欧洲胃肠内镜学会制定了消化道及肝胰腺胆道的内镜下组织活检的指南,分为上消化道（含肝、胰腺、胆道）和下消化道两部分,提供了规范活检的指导及建议。笔者对指南就上消化道内镜下组织活检的部分内容进行解读,解读内容为个人观点。

The diagnosis and treatment of digestive system diseases are closely related to histopathological diagnosis．Efficient and standardized acquisition of tissue samples plays a key role．In 2021,European Society of Gastrointestinal Endoscopy（ESGE）had developed guidelines for endoscopic tissue biopsy of the digestive tract and hepatopancreatic biliary tract,which divided into upper gastrointestinal tract（including liver,pancreas,biliary tract）and lower gastrointestinal tract．This guideline provided guidance and recommendations for standardizing biopsies．We interprets some of the contents of the guideline on tissue biopsy under endoscopy of the upper gastrointestinal tract,which are personal opinions．

目的 上消化道出血发作急、变化快,具有较高的危险性,本研究目的在于分析急性上消化道出血患者的临床特征及危险因素,为临床诊治提供参考。方法 将2019年1月—2021年2月年我院的242例疑似急性上消化道出血患者作为研究对象,收集患者的年龄、性别、是否有长期抽烟史、饮酒史,是否有合并症以及并发症等一般资料,运用单因素分析其临床特征,运用多因素Logistic回归分析其独立危险因素。结果 患者年龄、长期饮酒史、消化性溃疡、门脉高压、急性胃黏膜病变、服用阿司匹林(ASA药物)、Hp感染等临床特征与急性上消化道出血具有相关性,与患者的性别、长期抽烟史不具有相关性;年龄、消化性溃疡、门脉高压、服用ASA药物、Hp感染是急性上消化道出血的危险性因素。结论 急性上消化道出血病势程度较重,死亡率高,出血需及时针对性治疗;对于急性上消化道出血高危患者,严密监测病情变化,评估其风险系数。

Objective Upper gastrointestinal bleeding has a high risk because of its rapid change. The purpose of this study is to analyze the clinical characteristics and risk factors of patients with acute upper gastrointestinal bleeding, so as to provide reference for clinical diagnosis and treatment. Methods A total of 242 patients with suspected acute upper gastrointestinal bleeding in our hospital from January 2019 to February 2021 were selected as the research objects. The general data such as patients' age, gender, whether they had a long-term history of smoking or drinking, whether they had complications and data of complications were collected. The clinical characteristics were analyzed by univariate analysis, and the independent risk factors were analyzed by multivariate Logistic regression analysis. Results Age, long-term drinking history, peptic ulcer, portal hypertension, acute gastric mucosal lesions, taking aspirin (ASA drugs), Hp infection and other clinical characteristics were correlated with acute upper gastrointestinal bleeding, but gender and long-term smoking history were not. Age, peptic ulcer, portal hypertension, taking ASA drugs and Hp infection were the risk factors of acute upper gastrointestinal bleeding. Conclusion The acute upper gastrointestinal bleeding is a serious disease, with high mortality, and the bleeding needs timely targeted treatment. For patients with high-risk acute upper gastrointestinal bleeding, closely monitor the changes of the disease and evaluate the risk coefficient are needed.

目的 探讨无痛镇静在胃镜下上消化道异物取出术中的应用价值。方法 回顾分析2017年5月1日—2020年5月1日在东莞东华医院消化内镜中心接受内镜下上消化道异物取出术患者,对其临床资料进行分析,总结比较在无痛镇静下和普通胃镜下上消化道异物取出术两组患者的诊疗效果。结果 共357例患者,行胃镜下异物取出术共372次,其中无痛镇静组99例,普通组273例,其中15例患者在普通胃镜下异物取出术失败改为无痛镇静下胃镜取出术成功取出,最终10人异物未取出转外科或上级医院;在无痛镇静下行胃镜上消化道异物取出术比普通胃镜下异物取出术成功率高(P＜0.05),黏膜损伤、出血、穿孔等并发症少(P＜0.05),人均费用低(P＜0.05);无痛镇静后患者血氧饱和度、血压下降(P＜0.05),心率升高(P＜0.05),其中老年人影响明显(P＜0.05),但不影响患者内镜操作,氟马西尼催醒后心率、血氧饱和度、血压恢复正常(P＞0.05)。结论 在无痛镇静下行胃镜上消化道异物取术安全、有效、成功率高、医疗费用少,患者易于接受的好方法,值得推广。

Objective To explore the application value of painless gastroscope in the removal of foreign body in upper gastrointestinal tract. Methods The study involved patients who visited at the department of endoscopy center at Hospital (Dongguan, China). Retrospective analysis of patients undergoing endoscopic removal of foreign bodies in the upper gastrointestinal tract from May 1, 2017 to May 1, 2020. We analyzed the patients' clinical data and compared the diagnosis and treatment effect between the painless gastroscope group and normal gastroscopy group. Results A total of 357 patients were included, 372 times of removal of foreign body under gastroscope were conducted. A total of 99 cases in painless gastroscope group were treated by painless gastroscope with painless sedation, 273 cases in normal gastroscopy group were treated by normal gastroscopy, among them, 15 cases were failed to removal the foreign body treated by normal gastroscopy, and turned into the painless sedation gastroscopy. Finally, 10 patients with foreign bodies were not removed and transferred to surgical department or higher level hospitals. In the treatment of endoscopic foreign body removal, the success rate of painless gastroscope group was higher (P<0.05), the complication incidence of mucosal injury, bleeding and perforation and cost per capita were lower than that of normal gastroscopy(P<0.05). Following painless sedation, the blood oxygen saturation, blood pressure dropped (P<0.05) and heart rate increased (P<0.05), the effect of the sedatives on the elderly was the most obvious (P<0.05), but it did not affect the patient's endoscopic operation, and the heart rate, blood oxygen saturation and blood pressure (P>0.05) after awakening. Conclusion Painless gastroscope in the removal of foreign body in upper gastrointestinal tract is safe, effective high success rate, less medical cost, and easy for patients to accept, it should be widely applied.

目的 分析上消化道早癌与癌前病变内镜下治疗的效果。方法 将2017年10月—2020年10月接诊且行传统外科手术治疗的75例上消化道早癌与癌前病变患者作为对照组,将同期接诊且行内镜黏膜下剥离术(ESD)治疗的75例上消化道早癌与癌前病变患者作为观察组,对组间围手术期指标、生活质量、疼痛评分、病灶切除情况、治疗效果、并发症发生率展开分析。结果 (1)观察组术中出血量(17.66±2.25)mL、手术用时(96.79±9.25)min、住院时间(10.95±1.88)d、治疗费用(1.74±0.41)万元均少于对照组(87.73±5.63)mL、(190.52±10.68)min、(22.75±2.69)d、(4.96±0.37)万元(P<0.05);(2)组间生活质量、疼痛评分在术前无差异(P>0.05);观察组生活质量、疼痛评分在术后优于对照组(P<0.05);(3)观察组治愈性切除率(98.67%)、整块完整切除率(100.00%)与对照组(96.00%、98.67%)无差异(P>0.05);(4)观察组总有效率(96.00%)与对照组(97.33%)无明显差异(P>0.05);(5)观察组发生2例并发症(2.67%),对照组发生11例并发症(14.67%,P<0.05)。结论 对上消化道早癌与癌前病变患者行ESD治疗,疗效显著,可以减少并发症,减轻疼痛感与经济压力,改善生活质量,值得推广。

Objective To analyze the effect of endoscopic treatment of early upper gastrointestinal cancer and precancerous lesions. Methods From October 2017 to October 2020, 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by traditional surgery were selected as the control group, and 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by endoscopic submucosal dissection (ESD) were selected as the observation group. The therapeutic effect and the incidence of complications were analyzed. Results (1) The intraoperative blood loss was (17.66±2.25) mL, operation time was (96.79±9.25) min, hospitalization time was (10.95±1.88) d, treatment cost was(17.4±4.1)thousand yuan in the observation group, which were less than those in the control group [(87.73±5.63) mL, (190.52±10.68) min, (22.75±2.69) d, (49.6±3.7) thousand yuan, (P＜0.05)]. (2) There were no significant differences in quality of life and pain score between groups before operation. The quality of life and pain score of the observation group were better than those of the control group after operation (P<0.05). (3) The curative resection rate (98.67%) and complete resection rate (100.00%) of the observation group were not significantly different from those of the control group (96.00% and 98.67%,P＞0.05); (4) The total effective rate (96.00%) of the observation group was not significantly different from that of the control group (97.33%,P＞0.05); (5) The total effective rate of the observation group was significantly higher than that of the control group (97.33%). There were 2 cases of complications in the observation group (2.67%), and 11 cases in the control group (14.67%, P<0.05). Conclusion ESD treatment for patients with early upper gastrointestinal cancer and precancerous lesions has significant effect, can reduce complications, relieve pain and economic stress, and improve the quality of life, which is worthy of promotion.