Objective To explore the microsurgical treatment strategies for patients with carotid artery stenosis complicated by tortuosity.Methods A retrospective study was conducted on 9 patients with carotid artery stenosis and tortuosity who underwent microsurgical treatment in the Department of Neurosurgery,the Second People's Hospital of Liaocheng,from June 2019 to August 2023.Patient demographics and clinical data,including sex,age,initial admission diagnosis,clinical symptoms,risk factors for carotid artery stenosis(hypertension,diabetes,hyperlipidemia,smoking,drinking),pre-operative and contralateral vascular imaging were collected.According to the type of vascular tortuosity,three surgical methods were employed:(1)For"C"-shaped tortuosity of the internal carotid artery(ICA),the ICA was divided obliquely at the carotid bifurcation,and eversion carotid endarterectomy was performed.Then ICA was opened longitudinally along its medial side,the common carotid artery(CCA)was extended proximally along its lateral border.The ICA was end-to-side anastomosis anastomosed to the CCA.(2)For coiling of the ICA,the ICA was divided obliquely at the carotid bifurcation and eversion carotid endarterectomy was completed.The redundant segment of the ICA origin was resected,and an end-to-side anastomosis between the ICA and CCA was performed.(3)For cases of kinking of both the ICA and external carotid artery(ECA),or kinking of the CCA,the technique was performed by transection of the CCA,and then eversion carotid endarterectomy was performed,and part of the CCA was resected.After downward mobilization of the ICA and ECA,an end-to-end anastomosis of the CCA was carried out.Postoperatively,all patients underwent neck CT angiography(CTA)and duplex ultrasound examination within 1-3d to assess carotid patency,tortuosity improvement,and hemodynamic changes.Surgical success was defined as residual stenosis ≤30％,improved tortuosity,and no occurrence of stroke within 1-3d after surgery.Postoperative complications,including stroke,myocardial infarction,hoarseness,surgical site bleeding,swelling,and poor wound healing,were also observed.Follow-up carotid ultrasound was performed at 1,6,and 12 months to monitor for restenosis(peak systolic velocity＞220 cm/s or＞70％reduction in vessel diameter).Results Among the 9 patients,4 were males and 5 were females;the age ranged from 61 to 74 years,with an average of(67±4)years.3 cases had asymptomatic severe stenosis,3 cases had symptomatic moderate stenosis,and 3 cases had symptomatic severe stenosis.There were 9 cases of previous hypertension,5 cases of diabetes,6 cases of hyperlipidemia,4 cases of coronary heart disease,5 cases of smoking,and 4 cases of drinking.There were 5 cases of ICA"C"-shaped tortuosity,2 cases of coiling of the ICA,1 case of both ICA and ECA tortuosity,and 1 case CCA tortuosity.All 9 patients successfully underwent surgery.Postoperative neck CTA within 1-3 d demonstrated patency of the operated carotid artery and improvement in vascular tortuosity in all cases,with duplex ultrasound showing favorable hemodynamic status.No postoperative complications were observed.Follow-up at 1,6,and 12 months revealed no restenosis in any of the patients.Conclusions Microsurgical surgery is an effective method for treating carotid artery stenosis complicated by tortuosity.Detailed preoperative evaluation and selection of appropriate surgical techniques are essential.This study is a single-center study with a small sample size,and the findings require further validation through multi-center,large-scale research.

Objective To explore the microsurgical treatment strategies for patients with carotid artery stenosis complicated by tortuosity.Methods A retrospective study was conducted on 9 patients with carotid artery stenosis and tortuosity who underwent microsurgical treatment in the Department of Neurosurgery,the Second People's Hospital of Liaocheng,from June 2019 to August 2023.Patient demographics and clinical data,including sex,age,initial admission diagnosis,clinical symptoms,risk factors for carotid artery stenosis(hypertension,diabetes,hyperlipidemia,smoking,drinking),pre-operative and contralateral vascular imaging were collected.According to the type of vascular tortuosity,three surgical methods were employed:(1)For"C"-shaped tortuosity of the internal carotid artery(ICA),the ICA was divided obliquely at the carotid bifurcation,and eversion carotid endarterectomy was performed.Then ICA was opened longitudinally along its medial side,the common carotid artery(CCA)was extended proximally along its lateral border.The ICA was end-to-side anastomosis anastomosed to the CCA.(2)For coiling of the ICA,the ICA was divided obliquely at the carotid bifurcation and eversion carotid endarterectomy was completed.The redundant segment of the ICA origin was resected,and an end-to-side anastomosis between the ICA and CCA was performed.(3)For cases of kinking of both the ICA and external carotid artery(ECA),or kinking of the CCA,the technique was performed by transection of the CCA,and then eversion carotid endarterectomy was performed,and part of the CCA was resected.After downward mobilization of the ICA and ECA,an end-to-end anastomosis of the CCA was carried out.Postoperatively,all patients underwent neck CT angiography(CTA)and duplex ultrasound examination within 1-3d to assess carotid patency,tortuosity improvement,and hemodynamic changes.Surgical success was defined as residual stenosis ≤30％,improved tortuosity,and no occurrence of stroke within 1-3d after surgery.Postoperative complications,including stroke,myocardial infarction,hoarseness,surgical site bleeding,swelling,and poor wound healing,were also observed.Follow-up carotid ultrasound was performed at 1,6,and 12 months to monitor for restenosis(peak systolic velocity＞220 cm/s or＞70％reduction in vessel diameter).Results Among the 9 patients,4 were males and 5 were females;the age ranged from 61 to 74 years,with an average of(67±4)years.3 cases had asymptomatic severe stenosis,3 cases had symptomatic moderate stenosis,and 3 cases had symptomatic severe stenosis.There were 9 cases of previous hypertension,5 cases of diabetes,6 cases of hyperlipidemia,4 cases of coronary heart disease,5 cases of smoking,and 4 cases of drinking.There were 5 cases of ICA"C"-shaped tortuosity,2 cases of coiling of the ICA,1 case of both ICA and ECA tortuosity,and 1 case CCA tortuosity.All 9 patients successfully underwent surgery.Postoperative neck CTA within 1-3 d demonstrated patency of the operated carotid artery and improvement in vascular tortuosity in all cases,with duplex ultrasound showing favorable hemodynamic status.No postoperative complications were observed.Follow-up at 1,6,and 12 months revealed no restenosis in any of the patients.Conclusions Microsurgical surgery is an effective method for treating carotid artery stenosis complicated by tortuosity.Detailed preoperative evaluation and selection of appropriate surgical techniques are essential.This study is a single-center study with a small sample size,and the findings require further validation through multi-center,large-scale research.

Objective:To describe the clinical characteristics of patients with autoimmune gastritis (AIG), and to further explore the clinical differences between AIG patients with positive Helicobacter pylori ( H. pylori) and with negative H. pylori, and to reveal the significance of H. pylori in AIG patients. Methods:From January 1, 2020 to December 31, 2023, 112 patients visited Taizhou Hospital of Zhejiang Province who underwent endoscopy examinations and AIG-related antibody tests were retrospectively enrolled. Among them, 34 cases were complicated with H. pylori infection ( H. pylori-positive group) and 78 cases were not complicated with H. pylori infection ( H. pylori-negative group). Anemia status, the positive rates of AIG antibodies including anti-parietal cell antibody (PCA) and intrinsic factor antibody (IFA), gastric function markers such as gastrin-17, pepsinogen Ⅰ (PGⅠ) and the ratio of PGⅠ to PG Ⅱ, vitamin B12 and folic acid levels, as well as the manifestations under gastroscopy, thyroid function indicators, and results of thyroid ultrasound examination were comparatively analyzed between H. pylori-positive group and H. pylori-negative group. Independent samples t-test, Mann-Whitney U test, and chi-square test were used for statistical analysis. Results:Among the 112 patients with AIG, 30 cases were males and 82 cases were females, with the age of (59.3±10.1) years old. Twenty-three (20.5%) AIG patients were complicated with iron deficiency anemia and 13 (11.6%) AIG patients were complicated with megaloblastic anemia. The proportion of patients complicated with megaloblastic anemia of H. pylori-positive group was higher than that of H. pylori-negative group (23.5%, 8/34 vs. 6.4%, 5/78), and the difference was statistically significant ( χ2=5.20, P=0.023). The positive rates of PCA, IFA, thyroid peroxidase antibody, and thyroglobulin antibody were 98.2% (110/112), 27.5% (28/102), 75.0% (24/32), and 62.5% (20/32), respectively. The gastrin-17 level of 94.2% (97/103) AIG patients was more than 5 times the normal upper limit; and the vitamin B12 level of 24.4% (22/90) AIG patients decreased. There were 84.0% (42/50) of AIG patients complicated with thyroid nodules or echo changes under ultrasound, and 18.8% (12/64) of AIG patients had thyroid function changes. In addition to reverse atrophy under endoscopy, yellow-white turbid mucus was found in 51.8% (58/112) AIG patients, 51 cases (45.5%) combined with proliferative polyps, 8 cases (7.1%) combined with gastric neuroendocrine tumors and 7 cases (6.2%) combined with gastric adenoma or adenocarcinoma. The proportion of patients with adenoma or adenocarcinoma in H. pylori-positive group was higher than that of H. pylori-negative group (14.7%, 5/34 vs. 2.6%, 2/78), and the difference was statistically significant ( χ2=4.07, P=0.044). Conclusions:When unexplained anemia occurs clinically, inverse atrophy or gastric neuroendocrine tumors presented under endoscopy, positive gastric autoantibodies detected, the diagnosis of AIG should be considered. The eradication of H. pylori still remains as the key to the treatment of AIG patients.

Objective:To describe the clinical characteristics of patients with autoimmune gastritis (AIG), and to further explore the clinical differences between AIG patients with positive Helicobacter pylori ( H. pylori) and with negative H. pylori, and to reveal the significance of H. pylori in AIG patients. Methods:From January 1, 2020 to December 31, 2023, 112 patients visited Taizhou Hospital of Zhejiang Province who underwent endoscopy examinations and AIG-related antibody tests were retrospectively enrolled. Among them, 34 cases were complicated with H. pylori infection ( H. pylori-positive group) and 78 cases were not complicated with H. pylori infection ( H. pylori-negative group). Anemia status, the positive rates of AIG antibodies including anti-parietal cell antibody (PCA) and intrinsic factor antibody (IFA), gastric function markers such as gastrin-17, pepsinogen Ⅰ (PGⅠ) and the ratio of PGⅠ to PG Ⅱ, vitamin B12 and folic acid levels, as well as the manifestations under gastroscopy, thyroid function indicators, and results of thyroid ultrasound examination were comparatively analyzed between H. pylori-positive group and H. pylori-negative group. Independent samples t-test, Mann-Whitney U test, and chi-square test were used for statistical analysis. Results:Among the 112 patients with AIG, 30 cases were males and 82 cases were females, with the age of (59.3±10.1) years old. Twenty-three (20.5%) AIG patients were complicated with iron deficiency anemia and 13 (11.6%) AIG patients were complicated with megaloblastic anemia. The proportion of patients complicated with megaloblastic anemia of H. pylori-positive group was higher than that of H. pylori-negative group (23.5%, 8/34 vs. 6.4%, 5/78), and the difference was statistically significant ( χ2=5.20, P=0.023). The positive rates of PCA, IFA, thyroid peroxidase antibody, and thyroglobulin antibody were 98.2% (110/112), 27.5% (28/102), 75.0% (24/32), and 62.5% (20/32), respectively. The gastrin-17 level of 94.2% (97/103) AIG patients was more than 5 times the normal upper limit; and the vitamin B12 level of 24.4% (22/90) AIG patients decreased. There were 84.0% (42/50) of AIG patients complicated with thyroid nodules or echo changes under ultrasound, and 18.8% (12/64) of AIG patients had thyroid function changes. In addition to reverse atrophy under endoscopy, yellow-white turbid mucus was found in 51.8% (58/112) AIG patients, 51 cases (45.5%) combined with proliferative polyps, 8 cases (7.1%) combined with gastric neuroendocrine tumors and 7 cases (6.2%) combined with gastric adenoma or adenocarcinoma. The proportion of patients with adenoma or adenocarcinoma in H. pylori-positive group was higher than that of H. pylori-negative group (14.7%, 5/34 vs. 2.6%, 2/78), and the difference was statistically significant ( χ2=4.07, P=0.044). Conclusions:When unexplained anemia occurs clinically, inverse atrophy or gastric neuroendocrine tumors presented under endoscopy, positive gastric autoantibodies detected, the diagnosis of AIG should be considered. The eradication of H. pylori still remains as the key to the treatment of AIG patients.

Objective:To explore the strategies and complications of the submucosal tunneling endoscopic resection (STER) in the treatment of esophageal duplicated cyst (EDC).Methods:From January 2013 to December 2019, at Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected. The clinical featured, computed tomography (CT) findings, endoscopic findings, postoperative efficacy, complications and pathological results after operation were summarized.Results:Among the 11 patients, there were 6 males and 5 females, the age ranged from 13 to 67 years, and the mean age was (43.0±18.2) years. One case presented with swallowing obstruction, 1 case with belching, 4 cases with upper abdominal pain, and the remaining 5 cases had no specific clinical symptoms. Under endoscopy, the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity, which were soft to touch. Under endoscopic ultrasonography, they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria. The results of CT scan of 9 patients showed round low-density cystic masses, among them 7 cases showed mild enhancement. The maximum diameter of the cysts was 1.5 to 4.4 cm, with mean maximum diameter being (2.8±0.8) cm, and the maximum diameter of most patients (7 cases) were 2 to 3 cm. The other two patients showed only slightly thickened esophageal wall on CT. Five lesions occurred in the horizontal mediastinum of the lower esophagus. All the 11 patients underwent STER operation successfully, among them 6 patients received simple STER and the cysts were completely resected, and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall. The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts. The median follow-up time (range) of 11 patients was 42 months (12-86 months). Ten patients recovered well after the operation, and local recurrence, malignant transformation or metastasis were not found. One case had recurrence, and was treated with STER and cauterization with argon ion for residual cyst wall and cured. No complications such as bleeding, fistula, mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions:STER is a minimally invasive, safe and effective treatment for EDC, and may be a new treatment for EDC.

Objective To explore the pathologic features and distribution characteristics of upper gastrointestinal submucosal tumors (SMT).Methods From January 2013 to December 2017,at Department of Gastroenterology of Taizhou Hospital Affiliated to Wenzhou Medical University,clinical data of 1 182 hospitalized patients with 1 237 upper gastrointestinal SMT who underwent endoscopic therapy and diagnosed by pathology and immunohistochemistry was retrospectively analyzed including the pathological types,tumor of locations,endoscopic findings,layer of origin and tumor size.Results There were 473 esophageal SMT,including 387(81.8％) leiomyomas,located in the mucosal muscularis or muscularis propria;and 59(12.5％)cysts located in the submucosa or mucosal muscularis.There were 138(29.2％) lesions,159(33.6％) lesions and 176(37.2％) lesions in the upper,middle and lower esophagus respectively,and the most common type was leiomyoma.A total of 723 tumors were gastric SMT,among them 284 (39.3％) lesions were gastrointestinal stromal tumors (GIST) and 273(37.8％) lesions were leiomyomas,and all located in the muscularis propria.A total of 69(9.5％) lesions located at cardia,the common types were leiomyoma (55 lesions,79.7％) and GIST (nine lesions,13.0％).A total of 239 (33.1％) lesions located at gastric fundus,the common types were GIST (152 lesions,63.6％) and leiomyoma (79 lesions,33.1％).A total of 280 (38.7％) lesions located at gastric body,the common types were leiomyoma (138 lesions,49.3％) and GIST (111 lesions,39.6％).A total of 127 (17.6％) lesions located at gastric antrum,the common types were heterotopic pancrease (71 lesions,55.9％) and lipoma (26 lesions,20.5％),and all were located in the submucosa,some involved the muscularis propria.There were six (0.8％) lesions at gastric angle,and two (0.3％) at gastrointestinal anastomosis.Forty-one lesions were duodenal SMT,among them 23(56.1％) located at duodenal bulb,the common types were cyst (10 lesions,43.5％),lipoma (five lesions,21.7％) and heterotopic pancrease (five lesions,21.7％).A total of 18(43.9％) lesions located at descending duodenum,the common types were lipoma (nine lesions,50.0％) and cyst (five lesions,27.8％),and all lesions located in the submucosa.Conclusions The most common type of SMT in the esophagus and cardia is leiomyoma,however the SMT in gastric fundus and body are mostly leiomyomas and GIST,while in gastric antrum,most SMT are heterotopic pancreases and lipomas.In duodenal bulb and descending duodenum,the common types of SMT are cyst and lipoma.