人工智能在内镜诊断上消化道早癌领域的研究进展

随着深度学习算法的不断开发,人工智能在内镜辅助诊断中的应用也备受关注。上消化道肿瘤因其早期不易被发现的特点成为内镜医师镜下诊断的难题,而计算机辅助诊断等新技术有望实现对上消化道早期恶性病变及其相关危险因素的识别及诊断。本文阐述了目前人工智能在内镜诊断上消化道早癌领域的应用情况和发展前景。     

内镜治疗90岁及以上老年人胆总管结石患者的临床护理研究

目的 探讨经内镜十二指肠乳头括约肌切开术(EST)及胆道塑料支架置入(ERBD)治疗90岁及以上患者胆总管结石的疗效、安全性及护理.方法 对32例90岁及以上老年人患者完善术前准备,在密切监护下行EST及ERBD治疗胆总管结石的临床资料进行回顾性分析.结果 EST 1次取石成功27例;1次取出部分结石3例,经行内镜下鼻胆管引流,5d后再次取石成功;成功率为93.8％.1例因结石大,碎石失败后行ERBD,6个月后结石变小,取出胆管结石;1例因乳头旁巨大憩室插管未成功而致取石失败.32例患者中并发出血1例(3.1％),未发生肠穿孔、胰腺炎等并发症和死亡.结论 内镜行EST及ERBD治疗90岁及以上老年人胆总管结石安全、有效,具有创伤小、并发症少,操作灵活、简便等优点,护士完善的术前准备、准确迅速的术中配合和监护,精心的术后护理是治疗成功的重要条件.     

上颌第二乳磨牙近中颊根第二根管的临床研究

探讨上颌第二乳磨牙近颊第二根管（MB2）的特征及临床治疗方法。选取患牙髓炎或根尖周炎的上颌第二乳磨牙95颗,拍摄术前及根充后 X 线片,采用耳鼻喉内窥镜观察测量髓室底各根管口位置关系;术中采用10号锉结合17％EDTA 凝胶探查根管,手动器械进行根管预备,螺旋输送器导入 Vitapex 糊剂充填根管。在95颗上颌第二乳磨牙中,有14颗存在 MB2,发现率为14．7％,MB2位于 MB-P 根管口之间假想连线的近中。     

呼吸运动周期中成人上呼吸道形态的动态观察

目的 观察正常人和阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syncirome，OSAS)患者在呼吸运动周期中上呼吸道的形态学变化，比较正常人和OSAS患者间的差别。方法 经PSG确诊的OSAS患者共34人，年龄性别相近的正常成年人30人，以纤维内窥镜观察清醒平静呼吸时上呼吸道的形态变化，对受试者上呼吸道吸气和呼气时的形态分别拍照，利用计算机图像测量分析技术计算吸气和呼气之间上呼吸道形态学改变的幅度，比较正常人和OSAS患者间的差别。结果 正常人和OSAS患者，均表现为吸气时上呼吸道横截面积明显缩小，吸气中期达到最小，呼气开始则横截面积增大，呼气中期达到最大。OSAS患者在呼气和吸气间的改变幅度明显大于正常对照组，左右径的改变幅度大于前后径。软腭后区的改变幅度大于舌后区。结论 呼吸运动周期中上呼吸道的形态存在周期性的变化，OSAS患者的变化幅度明显大于正常对照者，这种较大的变化幅度是OSAS患者睡眠中发生上呼吸道阻塞的基础。     

内镜辅助尺神经前置术治疗肘管综合征的疗效随访

目的 探讨内镜辅助下尺神经松解皮下前置治疗肘管综合征的临床疗效. 方法 2008年2月至2010年6月,共收治肘管综合征患者44例,均行尺神经松解皮下前置术治疗,其中行开放性肘管切开手术28例,内镜下手术16例.对比两组手术时间、术后用药情况、创口瘢痕长度、术后住院时间.术后随访1 ～ 12个月,观察术后工作恢复时间并评价尺神经功能. 结果 内镜组平均手术时间(67.20±19.69)min,术后瘢痕长(1.50±0.58)cm,术后止痛药使用率6.3％,术后平均住院时间(2.40±1.42)d,平均恢复工作时间(14.60±4.69)d;开放组平均手术时间(62.80±11.06)min,术后瘢痕长(8.70±1.42)cm,术后止痛药使用率42.8％,平均住院时间(5.70±2.53)d,平均恢复工作时间(29.40±8.75)d,两组差异均有统计学意义(均为P＜ 0.05).按中华手外科学会周围神经功能评定标准,术后12个月,尺神经功能评分:开放组优良率82.14％,内镜组优良率81.25％,差异无统计学意义(P＞0.05). 结论 内镜组具有皮肤切口小、组织创伤轻、并发症少、术后疼痛轻,早期恢复日常工作等优点,且能获得与开放肘管切开尺神经松解皮下前置术相同的疗效.     

Transorbital neuroendoscopic surgery for the treatment of skull base lesions

Transorbital neuroendoscopic surgery (TONES) is a relatively new technique that not only allows access to the contents of the orbit but also the intracranial compartment, including the anterior cranial fossa, middle fossa and lateral cavernous sinus. In this study, we aimed to retrospectively review the largest experience to our knowledge with regards to surgical outcomes of skull base pathologies treated with a TONES procedure. Forty patients (aged 3–89 years) underwent 45 TONES procedures between the years of 2006–2013. Pathologies were cerebrospinal fluid leak repair (n = 16), traumatic fracture (n = 8), tumor (n = 11), meningoencephalocele (n = 5), hematoma (n = 1), and infection (n = 4). Three patients had a persistent complication at 3 months, including a case each of enophthalmos (unnoticed by patient), epiphora (delayed presentation at 2 months requiring dacryocystorhinostomy), and ptosis (improved at 1 year). Surgical success was achieved in all patients. Of special import, there were no cases of visual decline, diplopia, or stroke. There was no mortality. To our knowledge this is the first study and largest experience of TONES (level 4 evidence) to detail outcomes with respect to skull base pathologies. Our results indicate that TONES procedures can be performed with minimal morbidity. Further studies are needed to assess equivalency with craniotomy based approaches though this initial report is encouraging.     

神经内镜微创手术与开颅血肿清除术治疗高血压脑出血疗效比较

目的 探讨神经内镜微创手术与开颅血肿清除术治疗高血压脑出血的疗效。方法 连续收集同一术者手术病例120例,分成开颅手术组和神经内镜手术组,每组60例。通过手术时间、血肿清除率、术后GCS、NICU滞留时间、术后并发症的出现和术后3个月GOS,比较两组手术疗效。结果 所有120名患者接受持续随访,随访时间大于3个月。内镜手术组和开颅组2组病例术前临床资料无明显差异(P0.05);手术时间内镜组为(1.5±0.4)h,开颅组为(3.9±0.6)h(P0.01);血肿清除率内镜组为95.84%±2.72%,开颅组为87.48%±7.84%(P0.01);术后第1、3、7天GCS评分内镜组分别为:10(6,12),12(8,13),13(10,13),开颅组分别为6(5,9),7(5,11),8(5,12()P均0.01);NICU滞留时间内镜组为(3.55±4.21)d,开颅组为(9.10±4.72)d(P0.01);术后并发症内镜组无颅内感染病例,坠积性肺炎5例;开颅组颅内感染6例,坠积性肺炎41例,内镜组优于开颅组(P均0.05);术后3个月GOS评分,内镜组3(3,4),开颅组2(2,3)(P0.01)。结论 神经内镜手术治疗高血压脑出血具有微创高效的特点,是治疗脑出血的有效方式,多个方面优于开颅血肿清除术,值得临床推广。     

Concept,Design and Development of Innovative Endoscope Holder System for Endoscopic Otolaryngological Surgeries

Endoscopic surgeries have gained popularity not only in ENT but also in other surgical faculties. Endoscopic approach for sinus surgeries and otologic surgeries is well known. However, the major disadvantage of endoscopic aided surgeries as against microscope aided surgeries is thought to be the effective reduction in the working hands as the non-dominant hand of the surgeon is utilized for holding the endoscope. This urged the need for development of the endoscopic holder so as to allow both the hands of the surgeon for surgical manipulation.

Electronic supplementary material

The online version of this article (doi:10.1007/s12070-014-0738-y) contains supplementary material, which is available to authorized users.     

PTGBD穿刺引流与腹腔镜胆囊切除术联合治疗危重胆囊炎的临床疗效分析

目的：分析PTGBD穿刺引流与腹腔镜胆囊切除术联合治疗危重胆囊炎的临床疗效。方法选取2013年1月—2014年12月间该院收治的危重胆囊炎患者共102例,根据手术方式不同分为PTGBD与LC联合组和急诊LC组。比较两组手术时间、手术出血量、腹腔引流量、腹腔引流引流时间、住院天数、费用、及患者满意度等。结果急诊LC组患者手术中出血量、腹腔引流时间以及肛门排气时间明显多于PTGDB联合LC组,差异有统计学意义（P＜0.05）;急诊LC组患者并发症发生率远高于PTGDB联合LC组,且患者的满意率也明显低于PTGDB联合LC组,差异有统计学意义（P＜0.05）。结论PTGBD联合LC术式是目前治疗危重胆囊炎最为有效的治疗手段,值得临床推广应用。     

Primary endoscopic stapedotomy using 3 mm nasal endoscope: Audiologic and clinical outcomes

ObjectiveTo report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes.Materials and methodsThirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope (Karl Storz). At 6 months follow-up, the patients were evaluated for intraoperative findings, postoperative hearing outcomes and complications.ResultsCanaloplasty was performed in 2 (6.66%) patients, and no curettage of the canal wall was required in 12 (40%) patients. Transposition of the chorda tympani nerve was conducted in 11 (36.66%) patients. The average duration of surgery was 36 min (range 31–65 min). The air-bone gap (ABG) was 35 dB (range 24–50 dB) preoperatively and 14.63 dB (range 9–20 dB) postoperatively (p = 0.00). At 6 months follow-up, <20 dB ABG was achieved in 93.33% of the patients. No major intraoperative/postoperative complications were detected.ConclusionA 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes. It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.