鼻内镜下或间接喉镜下微波热凝术治疗声带息肉声带小结

目的探讨间接喉镜下或鼻内镜下微波热凝治疗声带息肉或小结的效果。方法对321例在间接喉镜或鼻内镜下微波热凝治疗声带息肉或小结病例资料进行分析。结果321例患者均一次手术成功。术后随诊3个月～一年以上的321例患者,治愈率92%,好转率8%。无效率为0。术中和术后未发生并发症。结论间接喉镜下或鼻内镜下微波热凝治疗声带息肉声带小结,具有操作安全、方便、不出血、快捷、简单、治愈率高等优点。     

ANALYSIS OF BURIED BUMPER SYNDROME AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY DUE TO USE OF A BUTTON‐TYPE KIT

Background: Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Along with the widespread use of the button‐type kit, BBS is encountered frequently. Methods: In the present study, we examined causes and treatments for BBS among 1400 patients who had undergone PEG. Results: The causes of BBS after PEG were classified into two categories: early causes consisted of wound infection, inappropriate size of kit and severe lordosis, while late causes were inappropriate exchange of kit, rough management or weight gain. The treatments for BBS could be determined by the degree of wound infection, fistula and burial of the bumper. Conclusion: We prepared a flowchart for replacement, by which BBS can be managed safely and quickly without surgical or endoscopic intervention.     

ENDOSCOPIC OBSERVATION OF MUCOSAL SPREAD LESION OF CHOLANGIOCARCINOMA USING PERORAL CHOLANGIOSCOPY WITH NARROW BAND IMAGING

A 69‐year‐old man was admitted to Toho University Omori Medical Center complaining of icterus. Abdominal computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were suspicious of cholangioma of inferior bile duct. Peroral cholangioscopy using narrow band imaging (NBI) was performed and it was possible to diagnose the mucosal spread lesions of cholangioma. Histological findings reflected the endoscopic findings. Mucosal spread lesions of cholangiocarcinoma were successfully diagnosed using the CHF‐B260 for NBI.     

Percutaneous endoscopic gastrostomy–a user's perspective

Sixteen patients receiving percutaneous endoscopic gastrostomy (PEG) feeding following a period of nasogastric (NG) feeding were investigated to assess acceptance and identify problems by means of a questionnaire. PEG was considered to be superior to NG feeding in terms of tolerance and cosmetic acceptance by 81% and 88% of participants respectively ( P < 0.001). Pain was an infrequent problem. Interruptions to feeding were consideed to be more common with NG feeding by 50% of participants; 38% considered interruptions equally common with both PEG and NG, and 12% considered interruptions more common with PEG feeding ( P = NS). The time for care was equivalent for both methods. Seventy-five percent considered PEG to have made a valuable contribution to enteral feeding. Leakage was however considered to be more frequent in PEG feeding by 81% of participants (compared to 12% who considered leakage to be more common with NG feeding; P < 0.001) and leakage was more frequent at die junctions in the catheter rather than from the stoma. Thirty-one percent of patients with PEG had needed systemic antibiotics for stomal infections. All patients with both PEG and NG feeding needed professional help. Sixty-two percent needed professional help more frequently with PEG than with NG feeding (compared to 19% who considered that the NG tube needed professional help more frequently; P <0.05). We conclude that leakage and infections are major problems in PEG enteral feeding.     

ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL

After removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.     

中下段颈椎的应力松弛特性及前、后路手术对其的影响

目的 研究中下段颈椎的应力松弛特性，并评估椎间盘切除植骨术与椎板切开术对其影响。方法 6例新鲜尸体完整颈椎及手术后颈椎，在模拟生理状态下进行屈曲及伸展位的应力松弛实验。结果 在恒应变条件下，绘制术前及不同术式后的中下段颈椎的应力松弛函数及曲线；术后的中下段颈椎的应力和初始化应力比值G(t)比术前明显增大，前路椎间盘切除植骨术后的G(t)值比椎板切开术大，两者均有统计学意义。结论 在恒应变条件下，颈椎具有快速应力松弛敏感性，屈曲位比伸展位大。椎板成形术及颈椎前路椎间盘切除植骨术都使颈椎的应力松弛能力减弱，前路椎间盘切除植骨术的影响更大。     

单侧听力耳鼓室成形术的临床探讨

目的分析单侧听耳患者的鼓室成形术,了解手术方法和手术疗效。方法对9耳慢性化脓性中耳炎胆脂瘤型进行了乳突根治术加鼓室成形术,对37耳慢性化脓性中耳炎单纯型和中耳炎后遗症进行鼓室成形术,并比较术后效果。手术后3个月~1年之间进行术后听力评价。结果46耳单侧听力耳术前言语频率气导平均听阈为60.2±23.1dB HL,骨导听阈35.7±17.0dB HL;手术后的平均气导听阈为51.3±22.6dB HL,骨导听阈为36.3±10.6dB HL。鼓室成形术后疗效评定:37耳外耳道宽敞,人工鼓膜完整,血运好,近正常鼓膜色泽;纯音测听500~2000Hz平均气导听力改善23例(62.16%,23/37),听力不变13例(35.14%,13/37),听力恶化(下降10dB以上)1例(2.70%,1/37)。乳突根治术加鼓室成形术后疗效评定:9耳术腔干洁,人工鼓膜完整,血运好,近正常鼓膜色;纯音测听500~2000Hz平均气导听力改善5例(56.56%,5/9),听力不变4例(44.44%,4/9)。结论各型慢性化脓性中耳炎都可作为单侧听力耳的手术适应症。手术时只要注意手术技巧,认真仔细,一般不会造成手术后骨导听力的下降。术后干耳和保持原有听力是手术的最终目的。     

MRCP与ERCP对低位梗阻性黄疸诊断价值的比较

目的 评价磁共振胰胆管造影术(MRCP)和内窥镜逆行胰胆管造影(ERCP)在低位梗阻性黄疸中的诊断价值.方法 将78例经B型超声证实为低位梗阻性黄疸的病人随机分为2组(均无禁忌证),其中1组40例行MRCP检查,另1组38例行ERCP检查.通过对比检查后并发症、淀粉酶、脂肪酶以及诊断准确度来比较两者的诊断价值.结果 ERCP术后病人的并发症发病率明显高于行MRCP检查的病人(P＜0.01),ERCP检查后病人的淀粉酶和脂肪酶水平高于MRCP术后的病人(P＜0.05),两者诊断准确度经比较无差异(P＞0.05).结论 对低位梗阻性黄疸病人的诊断应首选MRCP,需作进一步确诊时再选用ERCP.     

CASE OF FASCIOLIASIS: EXTRACTION WITH ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY

Fascioliasis is a worldwide zoonotic infection with fasciola hepatica and fasciola gigantica. The zoonoses are particularly endemic in sheep‐raising countries and are also endemic in Turkey. Clinical features of fascioliasis relate to the stage and intensity of infection. Fasciola hepatica infection comprises two stages: hepatic and biliary, with different signs and symptoms. Cholestatic symptoms may be sudden, but, in some cases, they may be preceded by a long period of fever, eosinophilia and vague gastrointestinal symptoms. We reported a case with fever and upper‐quadrant abdominal pain since 3 months that comes from an area endemic for fasciola hepatica, with suspected imaging about fasciola hepatica in common bile duct on ultrasonography. After that, fasciola hepatica was extracted with endoscopic retrograde cholangiography.