内镜下橡皮圈套扎术在上消化道广基息肉切除术中的应用

目的探讨橡皮圈套扎术在上消化道广基息肉切除术中的应用。方法回顾分析54例术前病理证实为良性病变的上消化道广基息肉,其中采用橡皮圈套扎术24例,为橡皮圈组,对照组30例单纯采用高频电凝电切术治疗。比较两组的术后出血发生率、穿孔率。结果所有患者均成功切除息肉,橡皮圈组无穿孔及出血发生,3 d后复查胃镜示息肉已脱落,溃疡形成。对照组有1例穿孔,5例早期出血,2例迟发性出血,均予钛夹钳夹创面后出血停止。两组比较,早期出血发生率有统计学差异(P<0.05),而迟发性出血发生率及穿孔率均无统计学差异(P>0.05)。结论橡皮圈套扎治疗广基息肉是一种安全有效的方法,能有效地避免早期出血等并发症。     

钛夹在内镜下息肉切除术中的应用研究

目的:探讨内镜下高频电圈套切除消化道大息肉后,应用钛夹防止术后出血的效果。方法:对102例消化道息肉(直径≥1.0 cm的粗蒂或体积较大息肉)患者行电子内镜下高频电圈套术,术中应用(43例)或不用(59例)钛夹,分别统计术后并发出血情况。结果:应用钛夹组出现出血并发症者共2例(4.7%);未用钛夹组中出血18例(30.5%),其中14例经保守疗法治愈,1例经剖腹作结肠区段切除后治愈,另3例再次行内镜下止血治愈。结论:大息肉行内镜下高频电圈套切除术,常规应用钛夹预防出血是一种安全、可靠的方法。     

结肠巨大息肉内镜下切除临床分析

目的对结肠巨大息肉内镜下切除的疗效及安全性进行评价。方法回顾性分析我院2004年3月至2014年5月经电子结肠镜检查发现直径>2cm结肠巨大息肉患者187例(201枚巨大息肉)临床资料。结果 201枚巨大息肉中经內镜黏膜切除186枚,其中57枚细长蒂息肉行全套器高频电凝切除,90枚粗长蒂息肉金属钛夹夹闭蒂根部后圈套器高频电凝切除,39枚短蒂息肉黏膜下注射1:10000肾上腺素盐水溶液后一次性内镜下黏膜切除(EMR)或分片黏膜切除(EPMR)。并发症:即时出血22例,延迟性出血2例(均经内镜下氩气喷凝或金属钛夹止血),息肉电凝切除术后综合征1例(经内科保守治疗临床治愈)。无肠穿孔等并发症的发生。结论结肠巨大息肉内镜下切除疗效确切,安全性较好,适合临床全面推广。     

内镜下高频电凝切除结肠息肉258例分析

目的 :探讨内镜下高频电凝切除结肠息肉的方法及疗效。方法 :对 2 58例结肠息肉患者采用电子结肠镜和高频电发生仪进行凝切 ,每次凝切时间 1s～ 3s ;较大息肉分块凝切。凝切务必彻底 ,避免烧伤正常组织及引起出血和肠穿孔。结果 :除 9例 16颗息肉经病理检查证实已恶变而行手术治疗外 ,余经肠镜复查显示息肉完全消失 ,无出血、穿孔等并发证发生。结论 :此技术创伤小 ,时间短 ,痛苦小 ,费用低 ,是消化道息肉治疗的首选方法 ,可以推广     

结肠镜下粘膜下注射并高频电切息肉159例分析

目的:探讨电子结肠镜下粘膜下注射并高频电刀切除大肠息肉的疗效.方法:对159例266枚大肠息肉经电子结肠镜下粘膜下注射并高频电刀治疗进行总结.结果:全部病例均镜下完全切除,未发生严重并发症.结论:经结肠镜黏膜下注射并高频电切治疗息肉,可有效预防出血或穿孔并发症,使高频电切除术的安全性得以提高,同时也提高了息肉摘除术的成功率,是治疗结肠息肉的有效手段.     

经尿道膀胱肿瘤电切术48例报告

目的：探讨经尿道膀胱肿瘤电切术（TURBT）治疗浅表性膀胱癌的疗效和安全性。方法：经尿道膀胱肿瘤电切术48例,观察疗效及并发症。结果：手术顺利,视野清晰,均1次手术成功,无严重出血或膀胱穿孔。随访1-3年,原位复发6例,异位复发7例,3例在术后2年内死亡。结论：经尿道膀胱肿瘤电切术具有操作简单,损伤小,恢复快,并发症少等优点。     

下消化道息肉电凝电切后继发出血急症处理7例

1988～1998年行纤维结肠镜检查2040例,发现结肠息肉296例,经纤维结肠镜下圈套电凝电切292例(348颗),术后24ｈ内继发出血7例(3ｈ内出血4例,5ｈ内出血3例),出血量120～300ｍｌ,分别于出血后给于处理,病人转归正常,无1例经外科处置,现将资料报告如下。1　临床资料7例出血病例中,男5例,女2例,年龄24～56岁,平均年龄42岁。7例患者均有明确诊断,息肉位于直肠2例,乙状结肠4例,横结肠1例,息肉形态:葡萄状广基息肉2例,亚蒂状息肉伴基底部出血1例,息肉大小15～20ｃｍ2例,20～24ｃｍ4例,大于25ｃｍ1例。出血病例中均有不同程度的腹胀、腹痛、鲜血便,4例…     

宫腔镜手术治疗绝经期子宫内膜息肉的应用

 目的探讨官腔镜手术在治疗绝经期子宫内膜息肉方面的临床效果.方法回顾性分析1999年10月～2004年10月在我院经门诊宫腔镜诊断为子宫内膜息肉而行官腔镜手术的49例绝经后妇女的临床资料.41例行单极电切手术:其中13例行单纯息肉切除,15例息肉切除同时行滚球电极子宫内膜剥除,13例息肉切除同时行热球子宫内膜剥除;5例行双极汽化电切息肉及子宫内膜剥除;余3例患者因术中诊为黏膜下子宫肌瘤而行官腔镜下肌瘤切除术.结果49例中术后病理诊断为子宫内膜息肉46例,其中1例合并子宫内膜复杂性伴轻度非典型增生;黏膜下子宫肌瘤3例.宫腔镜检查诊断子宫内膜息肉的符合率为93.88%(46/49).所有患者均耐受手术,无麻醉意外及手术并发症.31例绝经后出血患者均未再出现异常出血.结论官腔镜手术是绝经后妇女子宫内膜息肉的首选微创诊治方法,为了防止息肉复发可于息肉切除同时行子宫内膜去除术.     

腹腔镜胆囊切除术出血原因分析及预防措施探讨

目的探讨腹腔镜胆囊切除术（LC）术中术后出血的原因及预防处理措施,方法对我院1999年9月至2007年5月共31例行Lc术出血患者的临床资料做回顾性分析。结果1例制造气腹时套管针刺伤腹主动脉,中转开腹止血;7例Trocar穿刺孔出血,压迫,缝合止血;9例胆囊动脉出血,电凝,钛夹钳夹血管止血;12例胆囊床渗血,电凝,填塞止血材料止血;1例钛夹滑脱后胆囊动脉出血,开腹结扎血管止血,1例分离粘连时电凝钩误伤肠系膜动脉,小功率电凝止血。结论腹腔镜胆囊切除术术中术后出血原因较多,但只要熟悉解剖结构,操作技术熟练,异常出血是可以避免和及时处理的。     

新型OTSC吻合夹止血术治疗溃疡性上消化急性出血的疗效及并发症分析

目的 分析新型OTSC吻合夹止血术治疗溃疡性上消化急性出血的疗效及并发症。方法 选择2019年1月-2021年1月经徐州医科大学附属淮海医院收治的溃疡性上消化急性出血患者113例,根据患者意愿将其分为观察组（n=63）与对照组（n=50）,观察组行新型OTSC吻合夹止血术治疗,对照组行传统TTSC内镜夹止血术治疗。收集患者一般资料：性别、平均年龄、出血部位、Forrest分级、平均Rockall评分。比较两组患者临床疗效、临床指标：患者输血量、止血时间、住院时间、术后再出血率、并发症等。结果 观察组患者有效率高于对照组,差异有统计学意义（P<0.05）。观察组患者输血量、止血时间、住院时间、术后再出血率均低于对照组患者,且止血成功率高于对照组,差异有统计学意义（P<0.05）。两组患者治疗后均未出现消化道瘘、穿孔等严重并发症。结论 新型OTSC吻合夹止血术可提高溃疡性上消化急性出血患者临床疗效,且安全性较高。     

电子结肠镜引导下腹腔镜治疗结肠息肉的应用体会

目的探讨电子结肠镜引导下腹腔镜治疗结肠良恶性息肉的应用价值。方法 45例基底直径≥2.0 cm、位置特殊、操作困难、无法内镜切除的结肠良恶性息肉,在结肠镜引导下行腹腔镜手术治疗。结果 45例均顺利完成手术,其中内镜辅助的腹腔镜小切口切除10例,内镜辅助的腹腔镜楔形切除21例,内镜辅助的腹腔镜经肠腔切除3例,内镜辅助的腹腔镜肠段切除8例,术中冰冻为恶性追加腹腔镜结肠癌根治术3例。无中转开腹,未出现吻合口瘘、梗阻、出血等主要并发症。手术时间平均100（40～220）min,肠功能恢复时间平均3（2～5）d。术后随访平均12（4～24）个月,38例复查肠镜未见息肉残留、复发。结论电子结肠镜引导下腹腔镜联合内镜切除困难的结肠息肉定位准确,切除彻底,对冰冻为恶性的病例可追加结肠癌根治术,是一种治疗结肠良恶性息肉安全、有效的方法。     

腹腔镜联合结肠镜微创技术在结直肠息肉治疗中应用价值

目的探讨腹腔镜联合结肠镜微创技术在结直肠息肉治疗中的临床应用价值。方法选取上海市宝山区仁和医院自2014年1月至2016年1月收治的结直肠息肉患者86例,根据随机数表法分为A组和B组,每组各43例患者。A组采用结肠镜切除术进行治疗,B组采用腹腔镜联合结肠镜进行治疗。记录两组患者的总有效率、术中指标、术后恢复情况,并严密观察患者并发症的发生情况。术后6个月随访,观察患者的息肉残留率及复发率。结果 B组患者的总有效率为88.4%(38/43),明显高于A组的60.5%(26/43),两组间比较,差异有统计学意义(P<0.01);B组患者术中出血量及手术时间均显著低于A组,且差异均有统计学意义(P<0.01);与A组相比,B组患者术后恢复情况明显改善(P<0.01);A组患者的并发症发生率、息肉残留率及复发率均显著高于B组,且差异均有统计学意义(P<0.05)。结论腹腔镜联合结肠镜微创技术可以有效地治疗结直肠息肉,改善患者的围术期及术后相关指标,并降低患者并发症的发生率、息肉残留率及复发率,为临床治疗结直肠息肉提供了新的思路。     

大肠息肉679例临床特征及内镜、病理学特点分析

 目的 研究大肠息肉患者的年龄,息肉的发生部位、大小、病理类型以及息肉癌变的相关规律.方法 对电子肠镜检查中检出的大肠息肉患者的临床表现、内镜特点及病理资料进行总结和分析.结果 在3 680例肠镜检查者中,发现大肠息肉679例,其中男468例,女211例,检出率18.45%; 好发年龄以30～69岁为主,占80.41%;炎性、增生性、腺瘤性、错构瘤性、幼年性息肉分别占33.87%、32.11%、31.37%、1.77%、0.59%;息肉部位分别为直肠34.18%、乙状结肠23.12% 、降结肠14.96%、横结肠12.13%、升结肠11.49%、盲肠4.11%.679例大肠息肉患者中有30例发生癌变,癌变率为4.42%.管状腺瘤、混合性腺瘤、绒毛状腺瘤癌变率分别为5.88%、4.21 %、23.08%.息肉直径≤1.0 cm,无癌变发生;1.1～1.9 cm息肉,癌变率4.24%;≥2.0 c m息肉,癌变率21.37%.结论 30～69岁大肠息肉发病率较高,年龄大于50 岁为危险因素,男性较女性更容易患大肠息肉;息肉好发部位为左半结肠;病理类型以炎性息肉、增生性息肉和腺瘤性息肉常见;左半结肠、直径≥2.0 cm息肉、绒毛状腺瘤容易癌变 ;发现大肠息肉应尽可能切除,并应建立良好的随访机制,内镜下切除大肠息肉可预防息肉癌变.     

Imaging evaluation of complications at optical colonoscopy

Optical colonoscopy (OC) is an essential component of colorectal cancer screening. In addition to favorable polyp detection capabilities, OC has a unique therapeutic role with the ability to remove identified polyps. However, this procedure carries a low but real risk for morbidity and mortality. OC requires physical intubation of the length of the colon and manipulation of the instrument. In addition, the performance of therapeutic polyp removal increases risk. Inherent to this procedure are several pathways for potential adverse events. Complications can be divided into several major categories including perforation, hemorrhage, postpolypectomy syndromes, and issues related to sedation. The imaging manifestations of complications related to optical colonoscopy as well as the potential underlying mechanisms will be reviewed. Emphasis will be placed on cross-sectional imaging given the improved sensitivity and specificity over conventional radiography.     

内镜下钬激光治疗消化道息肉的护理

目的 探讨经内镜下应用钬激光治疗消化道息肉的护理配合.方法 回顾性分析88例各种消化道息肉患者经内镜下应用钬激光治疗过程中所采取的护理措施.结果 88例消化道息肉患者行钬激光治疗,84例有效,总有效率95.5%,无护理并发症.结论 针对患者不同特点,术前的健康教育、术中的临床观察及术后的康复护理是治疗成功的重要环节.     

Straightening the colon with curved cross sections: An approach to CT colonography

RATIONALE AND OBJECTIVES: The purpose of this study was to straighten digitally and consistently the colon with curved cross sections and to compare the results with planar cross-section-based processing for computed tomographic (CT) colonography. MATERIALS AND METHODS: In electric field-based straightening, curved cross sections are formed along electric force lines because of electric charges digitally distributed along the colon central path. Four straightening experiments were conducted on CT scans of a colonoscopy phantom. Representative images were studied for polyp detectability and feature distortion. Two further trials involved patient data to demonstrate the clinical feasibility of this method. RESULTS: In colon straightening with planar sections, a polyp was counted multiple times in both phantom and patient studies where the polyps were in central path turns with substantial curvature. Furthermore, opposite the central path turns, the colon walls were undersampled with planar sections. Straightening with curved sections produced consistent mappings. Image distortion was present in straightening with curved sections, but the conspicuity of polyps was maintained. In the soft-straightening process, trilinear interpolation greatly suppressed the surface- or volume-rendering noise associated with nearest neighbor interpolation. CONCLUSION: Straightening with curved sections outperforms straightening with planar sections in terms of polyp detectability. This approach eliminates the navigation difficulties of current CT colonography and may have clinical use.     

Graded compression sonography of the colon in the diagnosis of polyps in pediatric patients

OBJECTIVE: We report seven cases of juvenile polyps detected by graded compression gray-scale and color Doppler sonography in five children with nonspecific symptoms. CONCLUSION: Intestinal polyps can be detected by graded compression gray-scale and color Doppler sonography without colonic preparation. On gray-scale sonography, polyps appeared as spherical or ovoid hypoechoic nodules in the colon lumen. Small cysts were identified inside the nodules. Four polyps had fewer and smaller cysts, whereas three others contained many cysts. A hyperechoic layer surrounding the polyp corresponded to the submucosa. In two patients, the polyp was visualized in the transverse colon and caused a colocolic intussusception, which reduced spontaneously during sonography. Color Doppler sonography showed four hypovascularized and three hypervascularized polyps.     

Endoscopically removed giant submucosal lipoma

BACKGROUND: Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. CASE REPORT: A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. CONCLUSION: Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.     

Positional change in colon polyps at CT colonography

PURPOSE: To determine the frequency with which polyps change positions with respect to the bowel surface and the cause of this movement. MATERIALS AND METHODS: From December 2001 to March 2003, 113 patients underwent computed tomographic (CT) colonography prior to colonoscopy. For all confirmed polyps that were 5 mm and larger, images obtained with CT colonography were retrospectively analyzed by one author to determine if the polyp was present on both data sets or on only one data set. Retrospective evaluation of these polyps for ventral or dorsal location within the colonic lumen was performed for data sets obtained with patients in the prone and the supine position. The data sets were further reviewed by another author to determine the cause of positional change, when present. RESULTS: Twenty-six patients had a total of 49 histologically proved colorectal polyps that were 5 mm and larger. Eight of 49 colorectal polyps were depicted only on images obtained with the patient in the supine or prone position. Of the remaining 41 polyps that were depicted on images obtained with the patient in the supine and the prone position, 11 moved from a dorsal to a ventral location or vice versa relative to the colonic surface when the patient changed position. Five of these polyps were pedunculated on a stalk. Six were sessile; two were located in the sigmoid colon, two in the transverse colon, one in the ascending colon, and one in the cecum. In these cases, polyp mobility was related to positional changes of the colon in the mesentery, as opposed to true mobility of the polyp. CONCLUSION: In this series, 27% of polyps moved from a ventral location to a dorsal location relative to the colonic surface when the patient was turned from the supine to the prone position; thus, polyps appeared to be mobile. Thus, a mobile filling defect cannot be assumed to be residual fecal material at CT colonography.