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991.
皮圈结扎与金属夹子治疗上消化道Dieulafoy病变出血的临床对比研究 总被引:2,自引:0,他引:2
目的:比较内镜下皮圈结扎(EBL)与金属夹子(EHP)治疗Dieulafoy病变出血的疗效及安全性。方法:2004年2月至2006年10月共有34例上消化道Dieulafoy病变出血患者入选本研究,其中22例病灶位于胃部,10例位于胃肠吻合口,2例位于十二指肠球部。将患者随机分成EBL组(n=16)和EHP组(n=18),分别采用EBL或EHP治疗,并对两组治疗结果进行比较。结果:EBL组与EHP组达到止血平均所需的皮圈戓金属夹子个数相似;两组早期止血率、再出血率、转外科手术率、并发症发生率、平均输血量及平均住院时间差异均无统计学意义(均P>0.05)。结论:本组小样本的临床研究提示,EBL与EHP治疗上消化道Dieulafoy病变出血在临床疗效与安全性方面无明显差异。 相似文献
992.
目的观察内镜微创治疗尿道狭窄或闭锁的疗效。方法经尿道输尿管硬镜下或尿道膀胱镜下或电切镜下,或者多镜联合下,采用等离子棒状电极或钬激光行尿道内切开,酌情加用尿道瘢痕电切术治疗尿道狭窄或闭锁46例,对其手术疗效及操作要点进行回顾性分析和总结。结果42例一次手术成功,3例行2次腔内手术,1例手术失败。术后1-6周后拔出尿管,排尿通畅,尿线粗,最大尿流率由术前1.6-9.5mL/s升至18-31.5mL/s。42例随访8月-3年,平均32个月,36例排尿通畅,6例行尿道扩张2-6次后排尿良好。结论内镜微创治疗尿道狭窄或闭锁,损伤小,并发症少,成功率高,可作为治疗尿道狭窄或闭锁的首选方式。 相似文献
993.
Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans 总被引:2,自引:1,他引:1
Narula VK Happel LC Volt K Bergman S Roland JC Dettorre R Renton DB Reavis KM Needleman BJ Mikami DJ Ellison EC Melvin WS Hazey JW 《Surgical endoscopy》2009,23(6):1331-1336
Introduction Natural orifice translumenal endoscopic surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the
peritoneum via a natural orifice. One important requirement of this technique is the need to minimize the risk of clinically
significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in ten patients
who underwent diagnostic transgastric endoscopic peritoneoscopy.
Methods Patients participating in this trial were scheduled to undergo diagnostic laparoscopy for evaluation of presumed pancreatic
cancer. Findings at diagnostic laparoscopy were compared with those of diagnostic transgastric endoscopic peritoneoscopy,
using an orally placed gastroscope, blinding the endoscopist to the laparoscopic findings. We performed no gastric decontamination.
Diagnostic findings, operative times, and clinical course were recorded. Gastroscope and peritoneal fluid aspirates were obtained
prior to and after the gastrotomy. Each sample was sent for bacterial colony counts, culture, and identification of species.
Results Ten patients, with an average age of 63.7 years, have completed the protocol. All patients underwent diagnostic laparoscopy
followed by successful transgastric access and diagnostic peritoneoscopy. The average time for laparoscopy was 7.2 min, compared
with 18 min for transgastric instrumentation. Bacterial sampling was obtained in all ten patients. The average number of colony-forming
units (CFU) in the gastroscope aspirate was 132.1 CFU/ml, peritoneal aspirates prior to creation of a gastrotomy showed 160.4 CFU/ml,
and peritoneal sampling after gastrotomy had an average of 642.1 CFU/ml. There was no contamination of the peritoneal cavity
with species isolated from the gastroscope aspirate. No infectious complications or leaks were noted at 30-day follow-up.
Conclusions There was no clinically significant contamination of the peritoneal cavity from the gastroscope after transgastric endoscopic
instrumentation in humans. Transgastric instrumentation does contaminate the abdominal cavity but, the pathogens do not mount
a clinically significant response in terms of either the species or the bacterial load. 相似文献
994.
Nieuwenhuis DH Draaisma WA Verberne GH van Overbeeke AJ Consten EC 《Surgical endoscopy》2009,23(1):80-86
Background The transanal endoscopic operation (TEO) has proved to be an effective alternative to conventional surgery for the treatment
of rectal lesions. The TEO procedure offers reduced morbidity, faster recovery and equivalent oncologic outcome. Currently,
two instrument sets are available: one with three-dimensional (Wolf) and one with two-dimensional (Storz) optic capacities.
The three-dimensional (3D) instrument set is considered the golden standard. Although the advantages of TEO are imposing,
the procedure with the 3D armamentarium has certain technical and financial drawbacks. This study therefore aimed to compare
results for the TEO 2D alternative with recently published results for 3D TEO.
Methods All consecutive patients with benign or malignant pT1 or pT2 rectal lesions undergoing TEO were prospectively followed. All
procedures were performed with the 2D armamentarium using standard endoscopic instruments, a rectoscope (diameter, 4 cm; working
length, 7.5–15 cm), and 5-mm Ligasure and Ultracision. Operating times, complications, hospital stay, and oncologic outcome
were gathered and compared with published data.
Results Between 2004 and 2006, 31 patients with a median age of 75 years (range, 33–87 years) underwent 31 TEOs for a total of 36
rectal lesions (29 tubulovillous adenomas and 7 adenocarcinomas). The median distance of the lesion from the anal verge was
7.5 cm (range, 5–15 cm). The median lesion diameter was 2.3 cm (range, 0.5–5.0 cm). The locations of the lesions were as follows:
18 on the dorsal, 5 on the ventral, and 5 on the lateral rectal wall. The median operating time was 55 min (range, 25–165 min),
compared with 105 min reported in the literature. All the lesions except one could be radically excised. No intraoperative
complications occurred. Postoperative complications occurred for three patients, all due to hemorrhage. The median hospital
stay was 3 days (range, 1–21 days). During a median follow-up period of 15 months (range, 1–35 months), two recurrences took
place.
Conclusion The study findings showed that for rectal tumors located up to 15 cm from the anal verge with a maximal diameter of 5 cm,
TEO using standard laparoscopic instruments with a 2D view is feasible and provides results comparable with those associated
with a 3D view and dedicated instruments. Furthermore, the 2D procedure can be performed with improved ergonomics due to movable
monitors and is considerably less expensive. 相似文献
995.
94例输尿管狭窄内切开术护理 总被引:2,自引:0,他引:2
目的 探讨经尿道及经皮肾穿刺造瘘输尿管狭窄内切开的护理及注意事项.方法 回顾总结94例输尿管狭窄患者行腔内内切开术的围手术期护理.其中先天性肾盂输尿管交界处狭窄75例,体外震波碎石术后狭窄11例,输尿管镜术后狭窄8例.行经尿道输尿管镜内切开患者65例,经皮肾穿刺造瘘内切开29例.自制电极内切开58例,钬激光内切开26例.结果 82例患者恢复良好,未再形成狭窄,7例患者再次行内切开治愈,5例患者行开放整形术.43例患者术后出现胃肠道不良反应.结论 经尿道及经皮穿刺造瘘行狭窄内切开是治疗输尿管狭窄的有效治疗手段,加强术前、术后相关护理措施至关重要.在术后护理中要特别注意并发症的观察和尿管、肾造瘘管的护理. 相似文献
996.
Guerrieri M Baldarelli M Organetti L Grillo Ruggeri F Mantello G Bartolacci S Lezoche E 《Surgical endoscopy》2008,22(9):2030-2035
Background Local therapy for early rectal cancer is a valid alternative to the classical radical operation, which has a higher morbidity
and mortality rate. The use of high-dose preoperative radiation appears to enhance the options for sphincter-saving surgery
even for T2–T3 rectal cancer patients with effective local control. The authors report their experience with transanal endoscopic
microsurgery (TEM) used to manage selected cases of distal rectal cancer without evidence of nodal or distant metastasis (N0–M0).
Methods The study enrolled 196 patients with rectal cancer (51 T1, 84 T2, and 61 T3). All the patients staged preoperatively as T2
and T3 underwent preoperative high-dose radiotherapy, and since 1997, patients younger than 70 years in good general condition
also have undergone preoperative chemotherapy.
Results Minor complications were observed in 17 patients (8.6%) and major complications in only 3 patients (1.5%). The definitive
histology was 33 pT0 (17%), 73 pT1 (37%), 66 pT2 (34%), and 24 pT3 (12%). Eight patients (5 pT2 and 3 pT3) experienced local
recurrence (4.1%). The rectal cancer-specific survival rate at the end of the follow-up period was 100% for pT1, 90% for pT2,
and 77% for pT3 patients.
Conclusions Patients with T1 cancer and favorable histologic features may undergo local excision alone, whereas those with T2 and T3 rectal
cancer require preoperative radiochemotherapy. The results in the authors’ experience after TEM appear not to be substantially
different in terms of local recurrence and survival rate from those described for conventional surgery. 相似文献
997.
Background: The management of recurrent choledocholithiasis today remains as challenging as in the pre‐endoscopic era. Between 2 and 7% of affected patients have historically required surgical intervention for the treatment of recurrent or retained choledocholithiasis and of these, as many as 24% develop biliary complications. To avoid surgery, repeated endoscopic management of the problem has been suggested. In this study, we evaluate our policy of repeated endoscopic management of recurrent primary bile duct stones. Methods: This study examined a cohort of nine patients identified from a prospective database with recurrent choledocholithiasis. Demographic, clinical and investigative details were recorded and data were analysed. Complications were determined from a review of the patient’s file. Results: There were nine patients and 66 procedures were carried out. Mean age at time of first endoscopy was 70.1 years (36–91 years). Three patients were of male sex (33.3%). The mean number of endoscopies carried out per patient was 7.3 (3‐13). Failure to completely clear the duct occurred in 36.4% of all endoscopies. There were no periprocedural complications. Conclusion: Repeated endoscopic stone extraction by endoscopic retrograde cholangiopancreatography when required is a safe policy. However, this technique will only provide temporary relief from primary duct stones and repeated endoscopic treatment, again safe, will be required. 相似文献
998.
Background: Two recent meta‐analyses suggest that operative common bile duct (CBD) exploration (laparoscopic or open) may be superior to endoscopic retrograde cholangiopancreatography (ERCP) for the management of choledocholithiasis when the gall bladder is in situ. Much of the published work regarding laparoscopic exploration comes from enthusiasts of the technique and may not be transferable to other institutions. In our institution, both hepatobiliary and general surgeons carry out cholecystectomy, with differing levels of expertise in laparoscopic bile duct exploration. ERCP and laparoscopic antegrade transampullary endobiliary stents are available. We reviewed the management of choledocholithiasis in this setting. Methods: A retrospective review of all patients undergoing cholecystectomy during 2004 and 2005 at John Hunter and Belmont Hospitals (Newcastle, Australia) was conducted. Results: The overall incidence of choledocholithiasis was 10.3% (70 of 681). Fifty patients underwent preoperative ERCP, with choledocholithiasis confirmed in only 24 patients (therapeutic rate 30%). Thirty‐one patients underwent CBD exploration with 100% clearance through an open approach (12 patients) and 58% clearance through a laparoscopic approach (11 of 19 patients). Hepatobiliary surgeons carried out 22 of 31 CBD explorations (clearance rate 82%) and placed 13 transampullary antegrade endobiliary stents. In comparison, general surgeons carried out nine CBD explorations (clearance rate 56%) and placed only four antegrade stents. Conclusion: This series suggests that preoperative ERCP is significantly overutilized, laparoscopic CBD exploration is less successful than open CBD exploration and that antegrade transampullary intraoperative endobiliary stenting is underutilized by non‐hepatobiliary surgeons. 相似文献
999.
Agaba AE Sarmah SS Victor Babu BA Agaba PO Ajayi O Fayaz M Ramanand B 《Annals of the Royal College of Surgeons of England》2007,89(6):W1-W5
INTRODUCTION
Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut.PATIENT AND METHODS
A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation.RESULTS
Due to migration of the retained flange, the patient developed small bowel obstruction.CONCLUSIONS
Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange. 相似文献1000.
黄永辉 《中华消化内镜杂志》2023,40(2):85-93
我国逐步进入老龄化社会,很多老年患者因疾病无法进食,导致生活质量急剧下降。经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)对于营养物质的供给具有不可替代的优势。中华医学会消化内镜学分会老年内镜协作组组织本协作组专家,参考最新研究进展,通过集体讨论与投票等方式,共同制定本共识。本共识就PEG的适应证、禁忌证、术前准备、操作规范、并发症等共列有11条陈述建议。 相似文献