食管良性疾病的腔镜微创治疗应用体会

目的：总结我院近年来开展微创治疗食管良性疾病的手术经验及治疗效果。方法回顾研究自2007-2013年以来,我院应用胸腔镜及腹腔镜微创手段治疗食管良性疾病,包括食管平滑肌瘤、贲门失弛缓、胃-食管返流性疾病等33例的临床资料。结果本组33例患者手术全部腔镜下完成,手术过程顺利,无死亡病例,无中转开胸或开腹病例,无消化道黏膜破损,总体效果良好。手术时间40~150 min,平均96.6 min。手术出血量15~70 ml,平均26.42 ml。结论食管良性疾病的微创治疗效果良好、创伤小、恢复快,具有较好的应用价值及发展前景。     

内镜辅助手术治疗额部良性肿物

目的 探讨内镜辅助手术治疗额部良性肿物的临床效果.方法 19例临床诊断为额部体表良性肿物的患者,应用内镜技术切除肿物.结果 19处肿物均完整切除,切口Ⅰ期愈合.病理报告:脂肪瘤11例、表皮样囊肿及皮脂腺囊肿各3例、皮样囊肿2例.随访6个月至2年,未见肿物复发.术后局部均有不同程度的凹陷,17例在半年内凹陷自然消失,2例未能完全恢复,经过1次自体脂肪颗粒注射移植后凹陷消失.结论 选择合适的适应证,应用内镜辅助手术治疗额部良性肿物,切口小、恢复快、额部皮肤不留瘢痕,患者容易接受,在有条件的医疗单位值得推广应用.     

Endoscopic clipping of spontaneous esophageal rupture: Case reports of three patients

IntroductionSpontaneous esophageal rupture is a life-threatening condition which is difficult to diagnose early, and is usually treated surgically. Prolonged hospitalization is common. Non-operative treatment of esophageal rupture localized to the mediastinum has been reported. We report three patients with spontaneous esophageal rupture successfully managed with endoscopic clipping.Case presentationsTwo patients had ruptures localized to the mediastinum, and were discharged within one week of undergoing closure. The third patient presented with Boerhaave’s syndrome with a leak into the pleural space and needed prolonged hospitalization (34 days), but she did not need surgery and began oral intake two days after endoscopic clipping. The patient had an uneventful recovery.     

Endoscopic electrosurgical section of benign esophageal strictures

The work presents material on the treatment of patients with benign strictures of the esophagus by means of the method of electrosurgical endoscopic cutting. The results obtained made it possible to shorten the periods of treatment considerably and avoid an operative intervention.     

Endoscopic dilation of benign esophageal strictures in a surgical unit: a report on 95 cases

Ninety-five patients were treated by endoscopic dilation without fluoroscopic guidance between 1997 and 2005 for benign esophageal strictures. The etiologies were: anastomotic (38), postfundoplication (13), caustic (14), peptic (11), radiation-induced (10) and others (9). The strictures were classified at every session on a 0 to 4 scale on the basis of the diet and the luminal diameter. Savary-Gillard or Through-the Scope balloon dilators were used depending on the type and the location of the stenosis. A total of 472 dilation sessions were carried out without serious complications. A normal and a semisolid diet were respectively achieved in 75% and 91%. Recurrence of dysphagia was found in 33% and 51% of the patients respectively after 2 months and 1 year. Improvement of dysphagia, the number of sessions, and recurrence were significantly better in the patients with postsurgical stenosis as compared with those affected by caustic, peptic, and radiation-induced strictures.     

Endoscopic treatment of benign tumors of the nose and paranasal sinuses.

OBJECTIVE: The endoscopic approach can be successfully employed for the treatment of benign tumors such as fibroosseus and vascular lesions, pleomorphic adenomas, gliomas, and schwannomas. STUDY DESIGN AND SETTING: Nineteen patients diagnosed with benign tumors of the nasal cavity and paranasal sinuses and treated using an endoscopic approach were retrospectively reviewed. The endoscopic approach was used exclusively in 15 cases and was associated with an external approach in 4 cases (due to an intracranial extension of the tumor in 3 patients and its location at the level of the anterior wall of the frontal sinus in the last case). RESULTS: The resection of the lesions was radical in 18 patients and subtotal in 1 case. The mean follow-up was 27 months and only 1 recurrence (5%) was observed in the juvenile angiofibroma group 20 months postoperatively. CONCLUSION: and significance In selected cases, endoscopic surgery can be considered an effective treatment for the resection of benign tumors involving the sinonasal tract.     

Endoscopic resection of benign breast tumors: retromammary space approach

Endoscopic surgery is characterized by the creation of a working space. At our department, we have obtained good results with a retromammary space approach in which the tumor is resected after creation of a working space in the retromammary space. The special instruments used for this purpose comprise an endoscopic vein harvesting system to dissect the retromammary space, a dissecting balloon to compress the space to achieve hemostasis, and laparosonic coagulating shears to incise the tumor. This surgical technique provides a superior cosmetic result, and the level of patient satisfaction has been high.     

脊柱内镜下手术治疗腰椎黄韧带囊肿1例报道

<正>脊柱黄韧带囊肿(spinal ligamentum flavum cyst)是椎管内一种脊柱退变性病变^[1],发病机制尚不明确,可能是黄韧带发生退变从而形成^[2],最早由Moile教授在1976年报道^[3],多见于下腰段(L4/5、L5/S1)^[4]。黄韧带囊肿多无特征性的临床表现,部分表现为腰骶部疼痛,如出现神经根受压,可引起典型神经根受压症状,表现出与腰椎间盘突出症相似的症状,容易引起误诊^[5]。我科2019年11月收治1     

内镜辅助前额良性肿块切除术

目的 探讨经发际内切口,在内窥镜辅助下切除前额部皮下肿块的可行性及临床效果.方法 对位于前额皮下直径为10～30 mm(平均16.6 mm)肿块,手术应选择离肿块最近处即发际后头皮切口,长约2 cm;通过皮下隧道至肿块表面,在内窥镜引导下,将肿块切除.结果 16例患者中,11例为脂肪瘤,5例为皮样囊肿.术中均完整切除肿块.手术时间为20～90min,平均38min;无伤口感染、皮下积液、皮肤坏死等并发症.术后随访3～12个月,肿块无复发,前额无瘢痕,效果满意.结论 对位于前额皮下肿块,在内窥镜辅助下经发际内切口同样能够完整切除,且安全有效,并有良好的美容效果.     

Endoscopic balloon dilatation for benign fibrotic strictures after curative nonsurgical treatment for esophageal cancer

BACKGROUND : Endoscopic balloon dilatation (EBD) is performed to treat strictures after esophagectomy. However, little is known about using EBD for benign strictures that occur after nonsurgical treatments for esophageal cancer such as chemoradiotherapy (CRT) or endoscopic mucosal resection (EMR). The aim of this study was to evaluate the safety and efficacy of EBD for benign strictures after nonsurgical treatment compared with those after surgery. METHODS : We identified 823 patients with esophageal cancer who completed definitive treatments between 2004 and 2007. Of these patients, 122 were enrolled in our study, including 60 who had surgery and 62 who did not have surgery (32 CRT, 30 EMR). The indication criteria for EBD were complaint of dysphagia and the inability to pass a conventional endoscope due to benign stricture. We retrospectively analyzed the safety and efficacy of EBD, and the measured outcomes were treatment success rate, time to treatment success, and refractory stricture rate. RESULTS : Perforation occurred in 3 (0.3?%) of 1,077 EBD sessions, with no bleeding. Efficacy was evaluated in 110 of the 122 patients. While the treatment success rate was over 90?% in both the surgery and the nonsurgery group, there was a significant difference in the median time to treatment success between both groups (2.3 vs. 5.6?months, p?=?0.02: log-rank test). There was a significant difference in the median time to treatment success between CRT and surgery groups (7.0?months, p?=?0.01), with no significant difference in the EMR group (4.4?months, p?=?0.85). A significant difference in the refractory stricture rate was evident between the nonsurgery group (75?%) and the surgery group (45?%, p?相似文献   

Endoscopic treatment of benign ureteral strictures

BACKGROUND: The traditional choice of procedure for treatment of ureteral stricture is open surgical repair. Advances in endourology have provided the urological surgeon with an alternative to open surgery for the treatment of benign ureteral stricture. METHODS: Twenty-seven benign ureteral strictures in 24 patients were treated by the endourological method. Twelve endoureterotomies were performed using a cold knife via a 9.5Fr Storz ureteroscope and 15 high pressure balloon dilations were performed. The ureters were stented with 7 Fr double-J stents for 6 weeks. RESULTS: The success rate was 9/12 (75%) in the endoureterotomy group and 9/15 (60%) in the balloon dilation group after follow-up for more than 6 months. CONCLUSIONS: Endoscopic treatment of ureteral strictures appeared to be a safe and reasonably effective modality for the treatment of ureteral strictures, especially for the short type that are non-ischaemic in origin and not associated with radiation therapy. Endourological treatment of ureteral strictures is the procedure of choice for initial management of benign ureteral strictures and has high success rates and fewer complications.     

Treatment of benign esophageal tumors by endoscopic techniques

Gastrointestinal endoscopy has changed in recent years from a largely diagnostic to a highly therapeutic procedure. Technical advances in endoscopic ultrasound as well as new devices designed for endoscopic mucosal resection (EMR) have opened the field to many therapeutic possibilities. Endoscopic resection is technically challenging, and while our colleagues in the Far East have been using such techniques for over a decade, EMR in the West is still in its infancy. The decision to resect a benign esophageal tumor must take several factors into account including whether the patient is symptomatic; characteristics of the particular tumor (including the potential for malignant transformation, risk of bleeding, and obstruction); and the available therapeutic options. Endoscopic resection of benign esophageal tumors is an attractive option as it is a safe and minimally invasive procedure. Its use is limited, however, to smaller tumors arising from the mucosal or submucosal layers. In this article we examine the techniques used in endoscopic mucosal resection and review the literature on this subject.     

Endoscopic third ventriculostomy with cystoventricular stent placement in the management of dandy-walker malformation: technical case report of three patients

OBJECTIVE AND IMPORTANCE: Dandy-Walker malformation has conventionally been managed with placement of cystoperitoneal or ventriculoperitoneal shunts. However, associated aqueductal obstruction requires simultaneous drainage of both the supratentorial and infratentorial compartments. CLINICAL PRESENTATION: Three children with Dandy-Walker malformation and aqueductal obstruction were managed with endoscopic third ventriculostomy and placement of a stent from the third ventricle to the posterior fossa cyst. INTERVENTION: After an endoscopic third ventriculostomy was performed, the stent was placed from the third ventricle to the posterior fossa cyst through the thinnest part of the posteroinferior wall of the aqueduct. There was no operative morbidity. In one patient, the stent was malpositioned, requiring a repositioning. The endoscopic third ventriculostomy was successful in two patients, whereas it failed in one, requiring a ventriculoperitoneal shunt placement. CONCLUSION: Cystoventricular stent placement with endoscopic third ventriculostomy is a promising alternative in patients with Dandy-Walker malformation with aqueductal obstruction.     

食管良性狭窄的治疗

目的 探讨食管良性狭窄外科治疗的效果与经验。方法 1982年2月至2001年2月，治疗食管良性狭窄45例。手术治疗42例中局限性狭窄段食管纵切横缝1例。食管部分切除食管胃吻合术5例，结肠代食管术36例，单纯扩张治疗1例，保守治疗2例，全组中胃或空肠造瘘21例，经食管镜或胃造瘘顺行或逆行扩张11例次。结果 43例痊愈，2例保守治疗者均死亡。结论 食管良性狭窄可运用机械扩张缓解，食管腐蚀性狭窄持续扩张1年以上者，应积极手术治疗，在食管重建术中以结肠代食管术为好。     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.