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1.
内窥镜与腹腔镜联合治疗胆囊结石合并胆总管结石   总被引:10,自引:2,他引:8  
目的:评价内窥镜与腹腔镜联合治疗胆囊结石合并胆总管结石的临床效果。方法:对44例胆囊结石合并有胆总管结石。并经逆行胰胆管造影(ERCP),确认胆总管有结石,肝内肝管无结石时,行Oddi括约肌切开(EST),网篮碎石,取石和气囊排石,于术后3-5d再行腹腔镜胆囊切除(LC),结果:本组成功率为98%(43/44)。结石取净率100%(44/4),无中转开腹,术后住院5-15d。结论:内窥镜与腹腔镜联合治疗胆囊结石合并胆总管结石是一种安全有效的治疗方法。  相似文献
2.
超声内镜引导下针吸活检诊断肺癌及纵隔淋巴结转移   总被引:7,自引:0,他引:7  
Wang J  Sun Y  Wang Z  Wang X 《中华外科杂志》2002,40(10):743-745
目的:探讨超声内镜引导下的针吸活检术(EUS-FNA)诊断肺癌及纵隔淋巴结转移的可行性、准确性和安全性。方法:应用Pentax FG32-UA超声内镜及直径为0.8mm的GIP穿刺针(Medi-Globe),对10例患者(6例肺部肿块伴纵隔淋巴结肿大,1例右肺肿块,1例食管旁肿块,2例纵隔淋巴结广泛肿大)行EUS-FNA。结果:1例患者未能取得足够的标本;US-FNA诊断为恶性肿瘤者7例(小细胞癌5例,鳞癌、腺癌各1例,均经随诊确诊),良性病变者2例(分别经胸腔镜或纵隔镜及随诊确诊)。未出现任何与穿刺相关的并发症。结论:EUS-FNA在肺癌及纵隔淋巴结转移的诊断中是一准确、安全、实用的检查方法。  相似文献
3.
超声内镜对胰胆管扩张病因的诊断价值   总被引:6,自引:0,他引:6  
目的 探讨超声内镜对胰胆管扩张病因的诊断价值。方法 对25例体外超声(US)检查发现有肝外胆管胰管扩张,但病因诊断有困难的患者施行超声内镜(EUS)、CT、MRI检查,并比较各种检查法的诊断效能。病种包括壶腹周围肿瘤19例,胆总管下段嵌顿性结石3例和其他病变3例。结果 与手术后病理对比,US、EUS、CT、MRI的病变检出率依次为17.4%(4/23)、82.6%(19/23)、21.7%(5/23)和26.7%(4/15),对19例肿瘤的检出率分别为10.5%(2/19)、84.2%(16/19)、15.7%(3/19)、23.1%(3/13),EUS对肿瘤定位的符合率为87.5%(14/16)。与其他影像学检查相比,肿瘤越小EUS的优势越大。对3例结石US均未能确诊,EUS3例全部检出并确诊,CT检出2例,MRI在2例中检出1例。结论 EUS是诊断胰胆管扩张病因、鉴别病变性质、确定肿瘤起源的敏感检查方法,但对小于1cm的乳头癌和胆管癌的诊断可有一定的困难。  相似文献
4.
目的 了解经肛门超声内镜检查对内口已经愈合的肛瘘病人内口部位的诊断价值。方法 对临床常规手术未能发现肛瘘内口的12例病人进行超声内镜检查,并进行手术治疗。分析经肛门超声内镜检查对内口已经愈合的肛瘘病人内口部位的诊断价值和超声影像学特点,并与其它常规检查方法比较。结果 内镜超声检查在12例病 人均发现已经愈合的内口的准确位置,准确性优于Goodsall规律、肛门直肠肛门指诊、窦道造影或美蓝注射以及窦道探针探查。结论 经肛瘘外口位置注射美蓝,可方便手术医师快速定位内口。经肛门超声内镜检查是定位已经愈合的肛瘘内口的准确、快速、简单、耐受性好的检查手段。在超声内镜发现内口后,经内镜在内口位置注射美蓝,可方便手术医师快速定位内口。  相似文献
5.
Background: Endoscopic ultrasound is considered one of the best tools for the preoperative staging of esophageal, gastric, and rectal carcinoma. Depending on the individual investigator, the sensitivity of preoperative tumor staging by endosonography of the upper gastrointestinal tract (GEUS) is 80–92% for gastric carcinoma and 86–95% for esophageal carcinoma. However, the sensitivity and specificity of endosonography for the staging of lymph node metastases is less accurate. The accuracy of rectal endosonography (REUS) is ∼90% for tumor assessment and ∼80% for the detection of lymph node metastases. In this study, we address the question of whether endosonography enables the surgeon to distinguish scar tissue, which is rather homogeneous and echo-rich, from changes such as an anastomositis or a locoregional tumor recurrence, which are typically noninhomogeneous and echo-poor. Methods: During a 24-months period, we studied patients enrolled in a special tumor follow-up care program by either upper gastrointestinal (GEUS, n= 37 patients) or rectal endosonography (REUS, n= 49 patients) for exclusion of a locoregional tumor recurrence. In each patient, local tumor recurrence was suspected because of either medical history, clinical examination, or other diagnostic procedures. Results: As in previous studies, our retrospective analysis revealed that endosonography has a high sensitivity in the detection of local tumor recurrences (>90%) for both GEUS and REUS. Conclusion: Endosonography is a highly accurate means of detecting local tumor recurrence. Received: 9 March 1998/Accepted: 9 November 1998  相似文献
6.
Laparoscopic rectopexy for complete rectal prolapse   总被引:5,自引:0,他引:5  
Background: The purpose of this study was to evaluate the clinical outcome of laparoscopic rectopexy and its effect on anorectal function investigations. Methods: Twelve patients with complete rectal prolapse without constipation underwent laparoscopic rectopexy. Pre- and postoperative evaluation included scoring of incontinence, anorectal manometry, and anal endosonography. Results: No recurrences of rectal prolapse were seen (median follow-up 19 months). Continence improved in eight of nine preoperatively incontinent patients. Two patients had mild constipation after surgery. Median maximum basal pressure measured by anorectal manometry increased from 20 to 25 mmHg (p=0.005) and the rectoanal inhibitory reflex improved in seven patients (p=0.03). Rectal sensitivity did not change significantly. Endosonography showed asymmetry and thickening of the internal anal sphincter and submucosa preoperatively. After surgery the maximum internal anal sphincter thickness decreased from 3.0 mm to 2.6 mm (p=0.02). Conclusions: Laparoscopic rectopexy improved continence in our patients. Anorectal function tests show a partial recovery of the internal anal sphincter. Laparoscopic rectopexy combines the low morbidity of minimal invasive surgery with the good outcome of abdominal rectopexy.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995  相似文献
7.
Liu B  Lin N  Deng MH  Xu RY  Liu XY  Huang FZ  Li RZ 《中华外科杂志》2006,44(7):450-453
目的 研究内镜结扎、脾切除加贲门周围血管离断术(断流术)、内镜结扎联合部分脾栓塞、内镜结扎加脾切除加贲门周围血管离断术(联合断流术)对食管下段腔内外静脉的影响。方法 将142例患者根据治疗方法的不同分为4组:内镜结扎组(54例)、断流手术组(23例)、结扎联合部分脾栓塞组(34例)、腔内外联合断流组(31例)。运用微探头超声检查食管下段静脉结构的情况,进行治疗前后对比研究。结果 治疗后内镜结扎组黏膜下曲张静脉消失,食管周围静脉丛仍然存在;结扎联合部分脾栓塞组黏膜下曲张静脉消失,食管周围静脉丛曲张较术前减轻;断流组黏膜下曲张静脉存在,程度较前减轻,食管周围静脉丛消失;腔内外联合断流组食管黏膜下和周围静脉丛均消失。后两组治疗后穿静脉的显示率也显著降低。结论 腔内外联合断流能更有效地闭塞食管下段壁内外静脉,阻断门静脉奇静脉分流,防治食管静脉曲张出血与复发。  相似文献
8.
超声双重造影在胃癌术前TN分期中的价值   总被引:3,自引:1,他引:2  
目的 在胃癌术前分期中,通过与超声内镜检查(EUS)对比分析超声双重造影(DCUS)检查的价值.方法 选择162例经病理活检证实为胃癌并进行手术切除的患者,手术前5 d内进行EUS及DCUS检查,并进行TNM分期,与术后病理检查结果对照得出正确率,并进行相互比较.结果 本组162例胃癌患者中TNM分期:42例为T1期,49例为T2期,56例为T3期,15例为T4期.DCUS和EUS术前T分期总的正确率分别为77.2%、74.7%(χ2=0.273,P=0.603),而在T3分期上DCUS优于EUS(χ2=5.009,P=0.025);在N分期上两者总的正确率分别为78.4%、57.4%(χ2=16.370,P=0.001),而两者的敏感性和特异性分别为78.4%比49.5%、78.5%比69.2%.在对阳性淋巴结诊断上DCUS的正确率较高(78.4%比49.5%,χ2=17.523,P<0.01),尤其是对低分化腺癌患者阳性淋巴结的诊断正确率较高(81.5%比42.6%,χ2=17.338,P<0.01).结论 DCUS检查在胃癌术前分期中有较好的应用价值,其在预测阳性淋巴结方面,尤其是判断低分化腺癌患者有无淋巴结转移上正确率高于EUS检查.  相似文献
9.
Evaluating Patients with Anorectal Incontinence   总被引:3,自引:0,他引:3  
Fecal incontinence is a devastating disability, and although this condition is widely accepted as a problem in the elderly, it is now becoming apparent that much younger age groups are also frequently affected. Thorough assessment of anorectal incontinence is very important to choosing the most appropriate treatment. Careful history-taking and physical examination can identify the cause of most cases of incontinence and are essential in every patient. Several incontinence scoring systems have been proposed to provide an objective measure of a subjects degree of fecal incontinence, but only one acknowledges the important contribution of the severity of symptoms to quality of life. The investigations used to evaluate anorectal physiology include anorectal manometry, anal endosonography, nerve stimulation techniques, electromyography, defecography, endoluminal magnetic resonance imaging, the saline continence test, and the balloon-retaining test. Although all of these tests are important, the most useful for patients with incontinence are anal manometry, anal endosonography, and the pudendal nerve terminal motor latency test, because they can identify anatomic or physiologic abnormalities for which there may be effective treatments.  相似文献
10.
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