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Objective The objective of this study was to review the current clinical applications and impact of intraoperative imaging on endoscopic sinonasal and skull base procedures in adult and pediatric patients.Methods The PubMed database was searched for articles related to the use of image guidance in otolaryngology using the search terms "image guidance otolaryngology".This was supplemented by the authors′ experience utilizing image guidance in nearly 3000 endoscopic sinus and skull base procedures.Results The literature demonstrates that intraoperative image guidance has utility in primary and revision endoscopic sinus surgery,as well as endoscopic surgery of the skull base.Image guidance also has applications in pediatric endoscopic surgery,such as pediatric sinus surgery and repair of choanal atresia.Conclusions Intraoperative image guidance,when combined with a thorough knowledge of paranasal sinus and skull base anatomy and technical proficiency,can provide improved safety when performing otolaryngologic procedures from endoscopic sinus surgery to endoscopic skull base surgery.While not a substitute for knowledge of anatomy,the increased availability and usability of image guidance systems make them a useful tool in the armamentarium of the otolaryngologist/head and neck surgeon and neurosurgeon.
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AIM To evluate the curative effect of metal clips combining with microwave in treating large, pedicellatedgastrointestinal polyps by endoscopy.METHODS Ten patients with pedicellated gastrointestinal polyps were treated with metal clips (OlympusMD-850) combining with microwave by endoscopy. Among them, gastric polyps were found in 6 cases (6polyps), colonic polyps in 4 cases(4 polyps), 9 polyps were 1.5 cm - 2 cm in size, the other one was morethan 2 cm, the diameter of pedicel was 1 cm to 1.5 cm. All patients were repeatedly examined withendoscopy to observe the curative effect at 5 to 10 days and one month after treatment.RESULTS All the 10 polyps were eradicated, 2- 4 metal clips were placed in one polyp, the succeedingcurative rate was 100%. No hemorrhage, perforation and other complications occurred.CONCLUSION The curative effect of metal clips combining with microwave in treating large, pedicellatedgastrointestinal polyps by endoscopy is reliable and safe.
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AIM Endoscopic ultrasonography (EUS) guided pancreatic pseudocysts drainage is an ideal therapeuticprocedure. We perform it in just one step by using the self-made drainage stent.ETHODS We made an aperture at the tip of the needle outer sheath, and tied the outer sheath with theself-made stent by suture. EUS-guided pancreatic pseudocysts drainage was performed in five patients. Nopatient had visible endosmotic bulge on the gastrointestinal wall. Mean pseudocyst diameter was 4.5 cm(pancreatic head 1, body 2, tail 4). We determined the optimal site for puncture and advanced the needlyand stent into cyst. Taking out the needle made the stent separated from the sheath.RESULTS No hemorrhage happened among these patients. One patient suffering from fever up to 40℃recovered within two days after operation. All the cysts diminished insige after 7 days and resolvedcompletely after 6.8 weeks in average. Cyst resolution was accompanied by symptomatic improvement in allpatients. During a follow-up of 6 months no cyst recurred.CONCLUSION EUS-guided drainage of pseudocysts is a safe and effective procedure, which performs thejust in one process and diminishes the patients' distness.
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INTRODUCTION It has now been almost 20 years since the initial descriptions of a heretofore unrecognized disorder afflicting homosexual men and manifesting as Pneumocystis carinii pneumonia and Kaposi′s sarcoma. With the identification of the human immunodeficiency virus (HIV) as the etiology of this syndrome, there has been exponential growth in our understanding of this devastating immune disorder. During the first decade of the acquired immunodeficiency syndrome (AIDS), there was an explosion of cases in the United States and Africa.
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INTRODUCTIONEsophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].
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影像引导下的内镜技术在肺外周结节诊断中的价值
肺外周结节的确诊对患者进行何种治疗有着重要的影响,不仅能使肺癌患者得到及时治疗,而且也可阻止对良性疾病进行不必要的手术.因此选择何种方法诊断肺外周结节尤为重要.
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浅谈消化内镜与内镜外科
内镜一词的英文为"endoscopy",源于希腊语,系由"endo"(内在的、里面的)与动词"skopein"(观察)组合而成."endoscopy"原意为窥视人体深部腔道的一种方法,后也用于指代检查所用的器械而沿用至今.自1805年德国Bozzini利用蜡烛光作光源,用一根细铁管进行泌尿道检查以来,医学内镜有了飞速发展[1].
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胃肠吻合术的研究进展(摘译)
内镜在胃癌全胃切除术中的意义Significance of intraoperative endoscopy in total gastrectomy for gastric cancer.[日本]/Nishikawa K…//Surg Endosc.2010 Oct;24(10):2633-2636.背景吻合口缺损是胃肠手术中手术并发症的主要原因之一.本研究的目的是评价内镜在食道空肠吻合术中检测吻合口缺损中的有效性.
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经皮椎间孔入路全内镜技术治疗腰椎间盘突出症
一、前言
腰椎间盘突出症是一种常见病、多发病,手术治疗方法可以分为传统开放手术和微创手术两大类。近些年来,微创脊柱外科以其创伤小、恢复快等优点,取得了快速的发展进步,在腰椎间盘突出症的治疗中获得了显著疗效。其中经皮内镜椎间盘摘除技术是目前创伤小的镜下椎间盘摘除术式。经皮内镜技术通过带工作通道的硬杆状内窥镜在生理盐水持续灌洗下进行,可在直视下对病变椎间盘进行操作,因其操作全程在内窥镜下完成,故又称为全内镜技术。根据经皮穿刺入路不同,该技术分为经皮椎间孔入路全内镜下腰椎间盘摘除术(transforaminalpercutaneousendoscopiclumberdiscectomy,TF-PELD)和经皮椎板间入路全内镜下腰椎间盘摘除术(interlaminarpercutaneousendoscopiclumberdiscectomy,IL-PELD)。其中TF-PELD技术开展早,近年来随着微创理念和器械革新的不断推动,该技术的适应证和临床需求逐渐扩大,为更好地掌握和推广该项技术,现就其技术操作及相关临床问题综述如下。 -
虚拟内镜技术在消化系统疾病诊断中的应用
CT或磁共振虚拟内镜(virtual endoscopy,VE)技术是近年医学影像学重要进展之一.这项技术可以三维立体地显示鼻腔、喉管、气管、支气管、胃肠道、输尿管、膀胱、血管等器官腔内表面的改变,作为内镜检查的重要补充手段,并在某些领域使常规内镜的地位受到挑战.
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微创时代三镜联合治疗困难肝外胆管结石
腹腔镜、胆道镜和十二指肠镜三镜联合治疗胆外胆管结石的观点,近年来在国内外逐步得到认可[1-4].具有创伤小、适用于部分单镜或双镜无法成功取石的病例的特点.近年来,作者在三镜联合治疗肝外胆管结石方面进行了一些临床实践和探索,有以下粗浅的认识:对于单纯使用十二指肠镜取石未成功者,可采用三镜联合疗法,前期行内镜下鼻胆管引流( endoscopic naso-biliary drainage,ENBD ),择期行腹腔镜下胆总管或胆囊管切开探查术、联合胆道镜取石术,往往可获得较为满意的临床疗效.
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小儿消化道出血急症内镜应用
小儿消化道出血由于胃肠管道局部病变不同,年龄组不同,其出血原因有所不同,但现有研究表明,儿童消化道出血以应激性溃疡、细菌性胃肠炎、溃疡病/胃炎、肠息肉、肠套叠、坏死性小肠结肠炎、结肠炎性病变、血管病变、过敏性紫癜、梅克尔憩室、肠重复畸形、痔、寄生虫病等较为多见.
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电视气管内镜在气管支气管异物取出术中的应用
我科自2010年1月至2009年1月共收治临床诊断为支气管异物患儿385例,其中有282例采用电视气管支气管内镜法取出异物,现总结如下.
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鼻内镜下泪囊鼻腔造孔术应用体会
鼻内镜下泪囊鼻腔造孔术因面部无瘢痕,且能同时处理鼻腔鼻窦病变,已广泛应用于临床慢性泪囊炎鼻泪管阻塞的手术治疗,并且取得了良好的疗效~([1-4]).但是由于造孔狭窄、鼻腔粘连和肉芽增生影响临床治愈率~([1-4]),故该手术方式需要进一步完善.笔者通过使用内镜检查眼科医生外径路泪囊鼻腔吻合术鼻腔造口位置,结合本研究第一作者内镜下泪囊鼻腔造孔术经验,采取中鼻甲腋~([5])重建,泪囊和鼻泪管完全向鼻腔开放,大限度地扩大泪囊造孔,该方法充分利用鼻腔黏膜瓣和泪囊鼻泪管联合瓣覆盖裸露骨质,并能有效防止造孔狭窄、鼻腔粘连和肉芽增生,且不需要泪囊置管和黏膜银夹固定~([3-4]),现报道如下.
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双气囊小肠镜治疗胶囊内镜小肠滞留1例
胶囊内镜(capsule endoscopy,CE)滞留为CE使用中的较少见但较严重并发症之一,今年我科在双气囊小肠镜(doubleballoonenteroscopy,DBE)下成功取出小肠内滞留CE 1例,避免了患者手术治疗的痛苦及并发症的发生.本例患者有以下特点:(1)患者年龄较小,仅11岁;(2)CE滞留位置深;(3)滞留时间较长,为42d.现将该病例报道如下,并文献复习.
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Objective:To analyze the clinicopathologic characteristics and prognostic factors of small gastrointestinal stromal tumor (GIST) of the stomach.
Methods:A total of 31 small gastric GIST patients, including 10 males and 21 females, with a median age of 58 years (37-81 years), who underwent surgery at any time from 1999 to 2012 were included in this study. The clinical records of the patients were analyzed retrospectively.
Results:Abdominal discomfort and pain (10 cases, 32.3%, respectively) were the two most common complaints among the patients. All patients received surgery, 11 received gastric wedge resection, 11 received subtotal gastrectomy, 5 received laparoscopic gastric wedge resection, and 4 received endoscopic submucosal dissection. No severe adverse complication was observed. A total of 29 patients (93.5%) were followed up. During the follow-up, 2 patients were found to exhibit tumor recurrence, and 1 patient had liver metastases. One patient died of tumor progression, while another died of another malignant tumor. Median progression free survival (PFS) time was 120.3 months, and median overall survival (OS) time was 130.4 months.
Conclusion:Small gastric GIST has better prognosis. Surgery is the best choice for therapy. Micro-invasive procedures are safe and effective for elective patients. Tumor necrosis, tumor bleeding, and muscle invasion are potential prognostic factors of small gastric GIST. -
内镜中心工作流程和安全管理探讨
随着国民经济的增长和人们健康意识的不断增加,内镜检查作为疾病诊疗技术之一,已很普遍,胃肠镜检查越来越多地被人们列入健康体检的内容.因此,我院内镜中心也大限度地为病人提供便捷、方便的服务.在此过程中为确保病人安全,实施有效的护理安全管理尤为重要.
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内镜下钛夹联合尼龙绳治疗医源性肠穿孔1例
结肠镜检查及治疗是临床用于大肠疾病诊断和治疗的重要手段之一,是目前临床实践中诊治大肠疾病的有效手段,较为普及,然而结肠镜检查属于侵入性检查,对人体会造成一定程度的影响,尤其肠穿孔及出血是较为严重的并发症.我中心对肠镜医源性穿孔实施内镜下钛夹联合尼龙圈治疗,疗效满意.现报告如下.
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早期胃癌胃镜下诊断方法的进展
早期胃癌(early gastric cancer,EGC)是指局限于胃黏膜层或黏膜下层的癌,不管其面积多大和有无淋巴结的转移.与进展期胃癌相比,早期胃癌具有非常高的治疗价值和非常好的治疗效果.早期胃癌的治愈率可超过90%,而进展期胃癌的5年存活率只有30%左右.因此,胃癌的早期诊断非常重要.
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内镜下黏膜切除与高频电凝切除治疗结肠息肉并发症的比较
随着内镜微创治疗技术的发展,内镜下高频电切除术早已成为结肠息肉的首选治疗措施,内镜下黏膜切除是近年来为了诊断和治疗胃肠道的扁平隆起性病变,在内镜下高频电切基础上发展起来的一种新切除技术.本文通过对传统的高频电凝切除及内镜下黏膜切除治疗结肠息肉并发症进行比较, 以评价两种方法在内镜治疗中的应用价值.