8 892例腔镜前患者传染性标志物检测分析

[目的]了解患者腔镜前血液乙型肝炎表面抗原（HBsAg）、丙型肝炎抗体（抗-HCV）、艾滋病抗体（抗-HIV1/2）的感染情况,为避免传染性疾病通过腔镜而交叉传播。[方法]对8 892例腔镜检查者进行HBsAg、抗-HCV、抗-HIV1/2胶体金快速检测并对阳性结果用酶联免疫（ELISA）方法复查验证。[结果]8 892例腔镜前HBsAg、抗-HCV、HIV的阳性率分别为5.15%、2.8%、0.11%;抗-HIV 1/2试验阳性者10例。[结论]对于快速检测血液传染性标志物的可疑结果用ELISA方法验证后是可靠的,对腔镜前患者的血液进行传染性标志物的检测具有重要的意义。     

Biomechanical change of lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction report of 23 cases

Objective： To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion （TLIF） and unilateral pedicle screw fixation by X-Tube system. Methods： Five human lumbar cadaveric functional spine units（FSU） were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion （posterior lumbar interbody fusion） and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results： There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 （65.2%）, good in 6 （26.1%） and fair in 2 （8.7%）. The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion： The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgi     

内镜下微波治疗疣状胃炎的临床疗效观察

目的:探讨内镜下微波治疗疣状胃炎的疗效和临床价值。方法:经内镜活检孔插入微波导线,电极头紧贴病灶进行凝固治疗至病灶"熨平",术后控制饮食并口服药物2~3周,4~8周后复查胃镜观察疗效[1]。结果:112例病人一次性治愈者107例,5例经2次治疗完全治愈。治愈率100%,无并发症发生。结论:内镜下微波治疗疣状胃炎疗效显著,安全性高,操作便捷,是当前治疗疣状胃炎较为理想的一种方法。     

Dieulafoy病内镜下钛夹止血的临床观察(附16例报道)

目的 观察Dieulafoy病内镜下钛夹止血的临床效果. 方法 对16例Dieulafoy病患者在内镜下确诊后即行钛夹止血. 结果 所有病例均在内镜下钛夹止血,一次成功.平均随访300天,无一例复发. 结论 内镜下钛夹止血治疗Dieulafoy病疗效确切,组织损伤小,复发率低,值得开展.     

Endoscopic decontamination: an audit and practical review

A comprehensive audit of endoscopic decontamination practices throughout a 1200-bedded teaching hospital trust was undertaken, prior to a review of the current policy and consideration of alternative disinfectants. Pharmacy records of glutaraldehyde usage, occupational health staff survey data of glutaraldehyde exposure, discussions with all departments where endoscopy might be conducted and information from all companies supplying endoscopes and allied equipment were reviewed. In total, 56 endoscopes were found to be in use in 16 areas of the Trust. In the main designated endoscopy units, compliance with the established policy was generally good, but in other areas, equipment which could tolerate autoclaving was being disinfected with chemical sterilants; some units were still using endoscopes which were not fully immersible and there was widespread use of disinfectant troughs, rather than automated washer-disinfectors. In most cases, this was because staff were concerned about endoscopy equipment passing to a central processing department with potential delays and losses. An updated Trust-wide endoscopy policy, using glutaraldehyde and incorporating the current British Thoracic Society, British Gastroenterological Society and British Urological Society guidelines, has now been implemented. The issues around this and alternative disinfectants are discussed.     

功能性内窥镜鼻窦手术在老年患者的应用

目的 探讨功能性内窥镜鼻窦手术在老年慢性鼻窦炎、鼻息肉患者的应用及其疗效。方法 总结74例≥岁老年慢性鼻窦炎、鼻息肉患者行功能性内窥镜手术的临床资料,以同期行相同手术的199例59岁以下患者为对照组。结果 老年组与对照组手术治愈率分别为79．5％和77．9％。结论 功能性内窥镜鼻窦手术同样适合于老年患者,可望提高老年患者的生存质量。     

神经内镜治疗感染性脑积水10例报告

目的探讨运用神经内镜方法治疗合并脑室内感染性脑积水的疗效。方法采用神经内镜新技术,对10例合并脑室内感染性脑积水患者进行治疗,在结合抗生素冲洗液冲洗的同时,分别行第三脑室底脚间池造瘘术、透明隔造瘘术、脉络丛凝固术及内镜引导下脑室外引流术。结果脑积水及炎症控制9例,死亡1例。结论神经内镜技术辅助治疗合并脑室内感染性脑积水患者能明显缩短病程,提高治愈率。     

内窥镜手术结合干扰素治疗小儿喉乳头状瘤的临床观察

目的了解内窥镜手术结合α-干扰素治疗小儿喉乳头状瘤的临床价值。方法38例在支撑喉镜下用内窥镜进行喉乳头状瘤手术(术中用咬除或吸割器切除肿瘤),手术创面液氮冷冻处理,术后定期皮下注射α-干扰素;同期支撑喉镜下仅作喉乳状瘤单纯切除20例。对所治病例的临床资料进行分析。结果应用内窥镜手术,术中可清晰显示喉腔内病灶的部位,同时能处理气管内的病灶,术后连续皮下注射α-干扰素随诊1.5-2.5年,2年治愈率达70.3%;支撑喉镜下单纯肿瘤切除者,2年治愈率为38.1%,二组疗效差异有显著意义(P<0.05)。结论内窥镜手术及术时创面液氮处理配合术后应用α-干扰素,使小儿喉乳头状瘤治愈率比既往手术治愈率有较大提高。     

中西医结合治疗中老年鼻出血的疗效观察

目的：探讨用中西医结合的方法治疗中老年鼻出血的优点．方法：132例患者分为两组，对照组用传统的鼻腔填塞止血加西药治疗，治疗组在内窥镜下射频止血加中药治疗．结果：治疗组疗程短，痛苦小．结论：中西医结合治疗中老年鼻出血的方法是有效而安全的，值得临床推广。     

内镜下气囊扩张术治疗贲门失弛缓症

目的探讨內镜直视下气囊扩张术治疗贲门失弛缓症的效果?椒ā《?04例经多种药物治疗不佳的贲门失弛缓症患者行內镜直视下气囊扩张术,术后定期随访。结果扩张术成功率100%,104例患者治疗后吞咽困难得到明显缓解。随访3个月症状缓解率为95.2%,6个月时为93.3%。术中发生食管穿孔1例,经外科手术治愈。结论内镜下气囊扩张术治疗贲门失弛缓症属微创性治疗,并发症少,病人易接受,安全,近期疗效满意。