食管内镜下黏膜下剥离术的围手术期护理

目的通过对食管内镜下黏膜下剥离术（ESD）围手术期患者护理经验的回顾,总结针对此类患者的护理体会。方法采用术前指导、术中配合、术后护理的护理程序对接受ESD治疗的33例患者的围手术期护理进行总结。结果本组33例患者从术前平稳过渡到接受手术,患者术后均恢复良好,无护理并发症发生。结论食管ESD可提高病变黏膜完整切除率,但风险大,因此作为一项新技术,做好患者围手术期护理是至关重要的,它可减轻患者术前焦虑,帮助患者顺利度过手术的不同时期。     

耳穴压豆在行消化道内镜下黏膜剥离术患者中的应用

目的 探讨耳穴压豆在行消化道内镜下黏膜剥离术患者中的应用效果。方法 选取2018年1～11月在我科行择期消化道ESD术的患者200例,采用随机数字表法将其分为观察组和对照组,每组100例。对照组采用常规护理方法,观察组在对照组基础上实施耳穴压豆治疗。结果 观察组焦虑、疼痛评分、腹胀发生率均低于对照组(t=-6.085,P<0.001;t=-2.986,P=0.004;χ²=5.531,P=0.019) ,恶心呕吐程度轻于对照组(Z=-5.216, P<0.001)。结论 耳穴压豆可有效缓解ESD患者术后疼痛、恶心呕吐和腹胀,值得临床应用与推广。     

Vonoprazan vs lansoprazole for the treatment of artificial gastric ulcer after endoscopic submucosal dissection: a prospective randomized comparative study

Vonoprazan is a potent inhibitor of gastric acid secretion and may have better response than proton pump inhibitors (PPIs) in the treatment of endoscopic submucosal dissection induced artificial ulcers. However, reported outcomes remain controversial. In this study, we conducted a prospective, randomized comparative trial to evaluate healing effects of vonoprazan and lansoprazole on endoscopic submucosal dissection (ESD)-induced ulcers. We enrolled 216 patients who underwent endoscopic submucosal dissection for early gastric neoplasms. They were randomly divided into vonoprazan (20 mg/day) and lansoprazole (30 mg/day) groups. The primary endpoint was the reduction rate of ulcer and complete healing (scar) ratio of ESD-induced ulcers at 4 and 8 weeks. Finally, 101 patients of the vonoprazan group and 95 patients of the lansoprazole group were included in the analysis. There were no significant differences in the reduction rate between the vonoprazan and lansoprazole groups at either timepoint (4 weeks, 94.0 vs 93.4%; 8 weeks, 99.8 vs 99.9%, respectively). The complete healing ratio at 4 and 8 weeks did not differ significantly between the vonoprazan and lansoprazole groups (4 weeks, 11.9 vs 12.6%; 8 weeks, 87.1 vs 86.3%, respectively). In the anti-H. pylori-antibody negative or positive patients, there were no significant differences in the reduction rate and complete healing ratio between the vonoprazan and lansoprazole groups. Regardless of treatment choice, the overall complete healing ratio at 8 weeks was significantly higher in the anti-H. pylori-antibody negative patients than the positive patients (p = 0.006). The healing effects of vonoprazan on ESD-induced ulcers were comparative to those of lansoprazole.     

金属钛夹在内镜黏膜下剥离术中的应用与护理配合

目的探讨金属钛夹在内镜黏膜下剥离术中的应用与护理配合。方法对87例消化道病变患者施行内镜下剥离术中金属钛夹的选择、应用和护理配合进行回顾性总结。结果 85例患者剥离成功。术中67例使用金属钛夹止血,26例使用金属钛夹作创面缝合,3例术中发现穿孔予金属钛夹夹闭穿孔部位,均在1周左右出院。结论金属钛夹在内镜黏膜下剥离术中的止血和缝合创面的作用极大地提高了手术的安全性,护士熟悉金属钛夹的型号、性能,实现医护完美配合对手术成功有重要意义。     

Endoscopic papillary balloon dilation for difficult common bile duct stones: Our experience

AIM: To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) performed for common bile duct (CBD) stones.METHODS: From a computer database, we retrospectively analyzed the data relating to EBD performed in patients at the gastrointestinal unit of the Sandro Pertini Hospital of Rome (small center with low case volume) who underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD from January 1, 2010 to February 29, 2012. All patients had a proven diagnosis of CBD stones studied with echography, RMN-cholangiography and, when necessary, with computed tomography of the abdomen (for example, in cases with pace-makers). Prophylactic therapies, with gabexate mesilate 24 h before the procedure and with an antibiotic (ceftriaxone 2 g) 1 h before, were administered in all patients. The duodenum was intubated with a side-viewing endoscope under deep sedation with intravenous midazolam and propofol. The patients were placed in the supine position in almost all cases. EBD of the ampulla was performed under endoscopic and fluoroscopic guidance with a balloon through the scope (Hercules, wireguided balloon^®, Cook Ireland Ltd. and CRE^®, Microvasive, Boston Scientific Co., Natick, MA, United States).RESULTS: A total of 14 patients (9 female, 5 male; mean age of 73 years; range 57-82 years) were enrolled in the study, in whom a total of 15 EBDs were performed. All patients underwent minor endoscopic sphincterotomy (ES) prior to the EBD. The size of balloon insufflation depended on stone size and CBD dilation and this was performed until it reached 16 mm in diameter. EBD was performed under endoscopic and fluoroscopic guidance. The balloon was gradually filled with diluted contrast agent and was maintained inflated in position for 45 to 60 s before deflation and removal. The need for precutting the major papilla was 21.4%. In one patient (an 81-year-old), EBD was performed in a Billroth II. Periampullary diverticula were found only in a 74-year-old female. The adverse event related to the procedures (ERCP + ES) was only an intra procedural bleeding (6.6%) that occurred after ES and was treated immediately with adrenaline sclerotherapy. No postoperative complications were reported.CONCLUSION: With the current endoscopic techniques, very few patients with choledocholithiasis require surgery. EBD is an efficacious and safe procedure.     

Radiation exposure in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic papillotomy

Radiation exposure was studied in 327 patients undergoing endoscopic retrograde cholangiopancreatography, or endoscopic papillotomy taking into account fluoroscopy time and incident area exposure. The mean fluoroscopy time was 238±152 seconds and the incident area exposure 3,730±2,790 R×cm².These results were compared with standard exposures in upper GI series and colon examinations as found in the literature.