25例内镜下甲状腺切除术的体会

目的：通过在内镜下进行甲状腺切除，探索利用内镜行甲状腺切除的优缺点。方法：用内镜为25例甲状腺肿物的病人实施了经胸入路甲状腺次全切除术。结果：全部病例均手术成功，平均手术时间170min，无喉返、喉上神经损伤、术后出血等并发症，无中转开放手术。术后恢复良好，近期随访颈部皮肤感觉接近正常。结论：内镜下行甲状腺部分切除术对良性甲状腺病变具有无颈部疤痕，损伤小，皮肤感觉接近正常，恢复快等优点。对适应症明确者，应该是值得推崇的手术方式。     

颈部无瘢痕内镜甲状腺切除的手术配合

常规甲状腺切除手术会在颈部留下切口瘢痕,影响美观。近年发展起来的内镜甲状腺切除可以较好地解决这一问题。2002年仇明报道了国内首例颈部无瘢痕内镜甲状腺切除手术。2004年2月至2004年8月,本院为19例患者实施低灌充压颈部无瘢痕内镜甲状腺切除,效果良好,现将手术配合报告如下。     

经内镜食管固有肌层肿瘤剥离术的护理配合

[目的]总结内镜黏膜下剥离术切除食管固有肌层肿瘤的术中配合。[方法]选择符合内镜黏膜下剥离术适应证的31例食管固有肌层肿瘤病人,均采用内镜黏膜下剥离术手术切除肿瘤,并予护理配合。[结果]31例病人经内镜黏膜下剥离术均完整切除病变,手术全部成功,无一例并发症发生。[结论]内镜黏膜下剥离术是治疗食管固有肌层肿瘤的有效治疗方法,对大多数病人能达到完全切除的效果,具有损伤小、效果好、易操作、较安全的优点,而完善的护理配合是手术成功的关键。     

内镜下甲状腺切除术的手术配合

内镜下甲状腺腺瘤切除术该术式由美国Gagher教授首创于1996年，其优点在于颈部无切口，有极佳的美容效果，深受广大病人特别是青年女性欢迎。我院于2005年7月～12月实施8例内镜下甲状腺切除术，现将手术配合报告如下。     

内镜下甲状腺部分切除术(附40例报告)

目的 探讨内镜下甲状腺部分切除术的优缺点。方法 为40例甲状腺良性疾病的病人施行了经胸骨前径路的内镜下甲状腺部分切除术。结果 全部病例均成功地施行了内镜下甲状腺部分切除术，平均手术时间160min，平均住院时间5d，无中转传统开放手术，无神经、甲状旁腺及其他并发症的发生。结论 与传统手术相比，内镜下甲状腺切除术由于创口微小，而且在隐蔽的部位，具有极佳的美容效果，病人的心理负担得以减轻。     

内镜下切除食管早癌的护理配合

[目的]总结内镜下切除食管早癌的护理配合。[方法]对35例食管早癌病人行内镜下黏膜切除术(EMR)或内镜下分次黏膜切除术(EPMR)。[结果]30例病人行EMR整体切除病变,5例采用EPMR分次切除病灶,手术时间短、出血少,无穿孔等并发症;术后4周复查胃镜均愈合良好,半年复查胃镜,无一例复发。[结论]加强内镜下切除食管早癌的护理配合是手术成功的保证。     

腔镜联合鼻内镜手术治疗Graves眼病的护理配合

[目的]探讨腔镜联合鼻内镜治疗甲状腺相关性眼病的手术护理配合。[方法]对37例(40眼)腔镜联合鼻内镜治疗甲状腺相关眼病病人的手术护理配合进行分析与总结。[结果]37例病人(40眼)手术均顺利完成,无中转开放手术,术中平均出血量5mL。病人术后无皮下积液感染,颜面部未留下任何与该手术相关瘢痕,对美容效果满意。[结论]加强腔镜联合鼻内镜手术治疗Graves眼病的护理配合是手术成功的保证。     

神经内镜手术的配合体会

目的探讨微侵袭内镜神经外科手术的护理配合。方法应用内镜辅助下经蝶垂体瘤切除术的护理配合，应用单纯内镜进行脑积水治疗的护理配合。其中经蝶垂体瘤切除11例，脑积水4例。结果通过手术及有效的护理配合，11例经蝶垂体瘤在内镜辅助下完全切除；3例脑积水患者改善症状，1例无变化。结论神经内镜手术尤其要注意术中患者生命体征的变化，掌握器械设备的术中合理配合，掌握神经内镜的清洗、消毒和保养，对手术的成功至关重要。     

内镜下大肠巨大息肉切除术的配合和护理

[目的]总结内镜下高频电切除大肠巨大息肉术的配合和护理.[方法]回顾性分析25例内镜下高频电切除大肠巨大息肉术病人的临床资料.[结果]本组病人术程顺利,术中、术后均未发生穿孔、出血等并发症.[结论]加强内镜下大肠巨大息肉切除术的配合和护理可减少并发症的发生,保证手术的成功.     

内镜下甲状腺切除术的手术配合

内镜下甲状腺腺瘤切除术该术式由美国Gagher教授首创于1996年,其优点在于颈部无切口,有极佳的美容效果,深受广大病人特别是青年女性欢迎.我院于2005年7月～12月实施8例内镜下甲状腺切除术,现将手术配合报告如下.     

内镜下气囊扩张术治疗贲门失驰缓症

目的：探讨内镜直视下气食扩张治疗贲门失驰缓症疗效。方法：对58例经用多种药物治疗效果不佳的贲门失驰缓症的病人，应用内镜直视下气食扩张治疗。结果：经内镜下气食扩张治疗后，58例病人的吞咽困难、反流及胸痛等症状均得到明显改善，4例病人4—8个月后症状复发，经再次气食扩张后，症状消失至今。结论：内镜下气食扩张术治疗贲门失驰缓症属微创性治疗，病人易接受，扩张疗效确切，并发症少，操作简单。     

胃Dieulafoy病的内镜诊断和治疗

目的：探讨胃Dieulafoy病的内镜诊断和治疗方法。方法：回顾性分析作者自1994年1月～2002年6月经内镜诊断和治疗胃Dieulafoy病的临床资料。结果：12例均在入院后2h之内行急诊内镜检查，经一次检查确诊10例．二次检查确诊2例。经内镜局部喷洒0．1％去甲肾上腺素治疗博动性出血3例，仅1例暂时止血约12h后再出血。电凝治疗11例均止血成功。结论：急诊内镜是诊断胃Dieulafoy病的最佳手段，浅表溃烂伴博动性或喷射状出血是内镜诊断的主要依据，单独的暗红色血痂或黑褐小隆起是内镜诊断的重要线索。经内镜局部喷洒止血药疗效不佳，电凝是治疗该病的有效手段。     

静脉曲张性上消化道出血内镜治疗117例护理体会

目的:探讨静脉曲张性上消化道出血内镜治疗的护理方法.方法:对117例食管曲张静脉破裂出血和胃底曲张静脉破裂出血的患者,做好常规的急诊内镜检查和治疗工作,根据不同出血部位分别给予硬化治疗、套扎治疗、组织粘合剂栓塞静脉治疗.结果:117例患者中,115例取得满意的止血治疗效果,2例术后出现再出血,均给予及时处理后止血.结论:做好术前准备、术中配合和术后护理,出院后做好随访工作,可使内镜治疗静脉曲张性上消化道出血顺利进行,取得满意效果.     

Peroral endoscopic removal of a regurgitated giant polisegmented fibrovascular polyp of the esophagus

Background: Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper esophagus and hypopharynx. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpretedMaterials and methods: The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removalResults: After one-year of follow-up, the patient is going well, without recurrence of his polypConclusion: Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation.     

Endoscopic tumor diagnosis and treatment

The abstracts from this year's Digestive Disease Week (DDW) show that endoscopic is consistently playing a prominent role in current gastroenterology. The topic of tumor diagnosis and treatment overlaps considerably with other review areas - e. g., endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. This review therefore focuses on the following topics: enhanced imaging, endoscopic mucosal resection (EMR), and palliative stent therapy. Endoscopy with tissue sampling is increasingly becoming an integral part of transitional research, in collaboration with molecular biologists and geneticists, among others. This role is unlikely to be challenged by any of the rapidly improving pure imaging modalities, and may well become a core role for endoscopy in the years to come. Abstracts from this category are not included in this overview.     

The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions

BACKGROUND AND STUDY AIMS: Dieulafoy lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly from the proximal stomach. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. However, the effectiveness of various endoscopic modalities in treating bleeding Dieulafoy lesion has been little studied. This study was therefore done to compare the hemostatic efficacy of endoscopic hemoclipping and epinephrine injection therapy. PATIENTS AND METHODS: Between January 1998 and December 2001, a consecutive series of 32 patients with bleeding Dieulafoy lesion underwent endoscopic treatment. They were randomly treated either by endoscopic epinephrine injection therapy (n = 16) or by hemoclipping (n = 16). We compared mortality rate, primary hemostasis rate, and rebleeding rate between two groups. RESULTS: There was no bleeding-related death in either group. There was no significant difference in primary hemostasis rates between the hemoclipping group (93.8 %) and epinephrine injection group (87.5 %, P = 1.00). There was a trend toward a lower rate of need for multiple endoscopic sessions to achieve permanent hemostasis in the hemoclipping group compared with the epinephrine injection group (6.3 % vs. 31.3 %, P = 0.086). Hemoclipping was significantly more effective in preventing recurrent bleeding than epinephrine injection therapy (0 % vs. 35.7 %, P < 0.05). With regard to lesion site, hemoclipping was significantly more effective in preventing recurrent bleeding of gastric body Dieulafoy lesion than epinephrine injection therapy (0 % vs. 50 %, P < 0.05). CONCLUSIONS: Bleeding from Dieulafoy lesion was well controlled by therapeutic endoscopic procedures. Hemoclipping was more effective for Dieulafoy lesion than epinephrine injection therapy, with less need for subsequent endoscopy.     

数码图像内镜系统在颅底外科的应用

目的：进一步探讨内窥镜技术在颅底外科的应用价值。方法：在应用常规内窥镜手术进行颅底手术的基础上,根据不同的患者及病变,结合使用特种内窥镜及数码图像技术辅助进行颅底手术。结果：进行颅底手术共４７ 例,年龄最小为２ 岁半,最大７２ 岁,其中脑脊液鼻漏探查修补１３ 例,全部成功;视神经减压５ 例,３ 例视力改善。颅内外沟通瘤联合手术７ 例,４ 例痊愈,１ 例好转,２ 例失访。其它２２ 例不同的病例也获得较好效果。结论：内窥镜数码图像系统使颅底手术操作条件得到进一步改善。由于视角大,图像清晰,手术可做得更加精细彻底,创伤小,部分病例可明显提高疗效。     

内镜治疗胆道蛔虫病的临床价值

目的 探讨内镜治疗胆道蛔虫病的临床价值。方法 回顾性分析104例经十二指肠镜治疗的胆道蛔虫病临床资料。结果 7例蛔虫嵌顿于乳头者，取虫成功率100％；在97例疑为胆管腔内蛔虫者中，直接取虫成功者23例，结合ERCP取虫者74例，71例插管成功者中66例经EPBD或EST后取虫成功，3例插管不成功而转手术治疗；总的成功率92．3％(96／104)。术后发生急性胆管炎3例(2．9％)，急性胰腺炎1例(0．9％)。结论 经内镜取虫治疗胆道蛔虫病是一种安全、有效、并发症少的新方法。     

Endoluminal loco-regional resection by TEM after R1 endoscopic removal or recurrence of rectal tumors

Purpose The aim of this study is to evaluate the safety and efficacy of endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) after R1 endoscopic resection or local recurrence of early rectal cancer after operative endoscopy. Material and methods Twenty patients with early rectal cancer were enrolled, including patients with incomplete endoscopic resection, or complete endoscopic resection of a tumor with unfavorable prognostic factors (group A, ten patients), and local recurrence after endoscopic removal (group B, ten patients). At admission, histology after endoscopic polypectomy was: TisR1(4), T1R0G3(1), T1R1(5) in group A, and TisR0(8), T1R0(2) in group B. All patients underwent ELRR by TEM with nucleotide-guided mesorectal excision (NGME). Results Mean operative time was 150?minutes. Complications occurred in two patients (10%). Definitive histology was: moderate dysplasia(4), pT0N0(3), pTisN0(5), pT1N0(6), pT2N0(2). Mean number of lymph-nodes was 3.1. Mean follow-up was 79.5 months. All patients are alive and disease-free. Conclusions ELRR by TEM after R1 endoscopic resection of early rectal cancer or for local recurrence after operative endoscopy is safe and effective. It may be considered as a diagnostic procedure, as well as a curative treatment option, instead of a more invasive TME.     

应用腔内超声检查的内镜三脑室底造瘘术

目的 探讨在治疗脑积水的内镜三脑室底造瘘术(endoscopic third ventriculostomy ETV)中，应用多普勒微血管探头作超声扫描检查的意义。方法 单纯神经内镜下完成梗阻性脑积水ETW 34例，其中21例应用多普勒微血管探头经内镜通道抵达三脑室底部进行超声探测，监测基底动脉的走向、血流速度，进行术中实时定位，造瘘前后记录血管的多普勒超声图像。结果 21例造瘘术前后BA的管径、血流速度无变化，无血管损伤并发症。术后21例(61，76％)影像学证实扩大的脑室术后有回缩；半年后症状缓解29例(85，29％)，5例无效(14，71％)，2例做脑室腹腔分流术。无手术死亡或残疾。结论 多普勒微血管探头在ETV中加以应用，可减少血管损伤类并发症的发生，使得内镜插入定位精确，安全。