腹腔镜联合辅助化疗及内镜治疗进展期结直肠癌合并腺瘤的应用研究

目的：探讨腹腔镜结直肠癌切除术加辅助化疗加二期内镜下治疗结直肠癌合并根治术切除范围外结直肠腺瘤的临床应用价值。方法：2005年1月-2010年6月对54例进展期结直肠癌合并根治术切除范围外结直肠腺瘤（〉1．0cm）的患者（研究组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）加二期内镜下腺瘤切除的综合治疗,对同期396例单发进展期结直肠癌患者（对照组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）。通过并发症发生率、长期随访等评价治疗效果。结果：2组患者在年龄、性别、手术方式、手术时间、术中出血量、并发症发生率、平均住院时间、肿瘤大小、淋巴结转移、TNM分期及1、3和5年存活率差异无统计学意义（P〉O．05）。研究组辅助化疗后对合并腺瘤进行内镜下切除治疗,4例出血经保守治疗后成功止血,未发生穿孔、狭窄等严重并发症;3例患者术后病理组织学检查为腺瘤癌变,其中2例癌变局限于腺瘤中,1例癌细胞侵犯达黏膜下层,该例患者再次行腹腔镜下切除,术后随访无复发。结论：腹腔镜联合辅助化疗及内镜为合并结直肠癌根治术切除范围外腺瘤的患者提供了一种安全有效的微创治疗方法,值得临床推厂和应用。     

内镜黏膜下剥离术治疗广基的结直肠息肉15例临床分析

目的：探讨内镜黏膜下剥离术（ESD）治疗广基的结直肠息肉的疗效和安全性。方法：总结2010年7月—2011年5月厦门大学附属第一医院结肠镜检查发现的15例直径〉2 cm广基结直肠息肉ESD治疗的方法及临床效果。结果：15例患者均顺利完成内镜粘膜下剥离术,手术时间85.8±25.26 min,息肉直径3.29±0.75 cm。术中出血3例,1例术后出现延迟性出血,均经电凝、氩离子血浆凝固或金属夹成功止血。穿孔1例,行腹腔镜下穿孔修补术治愈。癌变3例,2例残基部见有癌细胞,追加外科行根治性手术,1例黏膜原位癌予随访。术后随访13例,随访时间5.77±2.20月,无病变残留和复发病例。结论：ESD治疗广基结直肠息肉在临床上是安全可行的。     

鼻内镜下带吸引单极电凝治疗中青年难治性鼻出血临床分析

目的探讨中青年难治性鼻出血常见出血部位及鼻内镜下带吸引单极电凝的治疗方法。方法回顾性分析129例年龄在18～50岁的中青年难治性鼻出血患者的临床资料。结果一次性治愈114例（88．4％）。术后7天内再出血15例（11．6％）,经一般处理治愈,另需再次鼻内镜探查6例,术后仍未找到明确出血点的4例。痊愈出院后随访3-6个月,无1例鼻腔再出血。结论鼻内镜作为治疗难治性鼻出血的首选治疗,鼻内窥镜下带吸引单极电凝止血术对治疗难治性鼻出血是可行、有效的治疗方法。     

鼻内镜下双极电凝治疗鼻出血疗效观察

目的探讨鼻内镜下双极电凝治疗鼻出血的方法和效果。方法对28例鼻出血患者采用鼻内镜下双极电凝治疗。回顾性分析患者的临床资料。结果 28例患者中24例鼻内镜下双极电凝止血成功;4例联合藻酸钙敷料局部填塞,术后48 h取出鼻腔填塞物成功止血。术后随访3~6个月,未发生鼻中隔穿孔、鼻腔粘连等并发症,无1例患者再次出血。结论鼻内镜下双极电凝治疗鼻出血,视野清晰、患者痛苦小、止血效果确切、远期效果满意。     

内镜黏膜下剥离术治疗结直肠广基病变

目的：探讨内镜黏膜下剥离术（ESD）治疗大肠广基病变的临床价值。方法：回顾性分析17例肠镜发现的较大结直肠广基病变行ESD治疗患者的临床资料。结果：17例患者均顺利完成ESD手术。手术时间（68±21）min,病变直径（3.0±1.5）cm;术中出血4例,术后延迟性出血3例,均在肠镜下用热活检钳电凝、APC、钛夹等方法成功止血;术中发生穿孔2例,1例肠镜下用钛夹缝合修补成功,另1例行肠修补术。术后病理：管状腺瘤3例,绒毛状腺瘤4例,低级别上皮内瘤变2例,高级别上皮内瘤变3例,增生性息肉2例,类癌1例,早期癌（T1N0M0）2例。患者均痊愈出院,随访2~27个月均无复发。结论：ESD治疗结直肠广基病变是安全、可行的,具有创伤小、恢复快、无腹壁切口疤痕等优点,故推荐应用。

     

内镜黏膜下剥离术（ESD）治疗直肠广基癌前病变17例护理体会

目的探讨内镜黏膜下剥离术（endoscopicsubmucosal dissection,ESD）治疗直肠广基癌前病变的围手术期护理。方法对17例直肠广基癌前病变的患者应用钩刀、IT刀、氩气刀（APC）、内镜注射针、热活检钳等行ESD手术前后实施合理护理的临床资料作回顾性分析。结果17例患者均顺利完成ESD,痊愈出院,无1例留下后遗症。术中出血4例,术后延迟性出血3例,均通过热活检钳电凝、APC、钛夹夹闭血管等方法成功止血;术中发生穿孔2例,1例肠镜下钛夹缝合修补成功,另1例直肠因穿孔太大,钛夹无法修补,中转开腹行肠壁修补术。结论ESD是治疗直肠广基癌前病变的新方法,具有微创、治疗效果彻底的优势。术前、术中、术后实施合理的护理是保证ESD治疗成功重要环节。     

内镜治疗结直肠类癌43例

目的：探讨内镜下结直肠类癌诊断和治疗的安全性和有效性。方法：对黏膜隆起性病变、瘤体直径小于1．5cm、超声内镜检查无肌层浸润,超声或cT检查无转移,疑似结直肠类癌的43例患者,采用内镜下黏膜切除术和内镜黏膜下剥离术治疗。结果：43例患者中术后3d出血2例,迟发性出血1例,均经内镜及药物治疗痊愈;术后平均随访2．5年,无复发及转移。结论：结肠镜是结直肠类癌检查的重要手段,超声内镜是重要的辅助检查;对于直径小于1．5cm、无转移、未侵及肌层的结直肠类癌,行内镜下切除是一种简单、安全有效的方法,术后应定期随访。     

内镜下尼龙绳套扎联合高频电凝切除治疗结直肠息肉的疗效

目的 探讨内镜下应用尼龙绳套扎联合高频电凝切除治疗结直肠息肉的临床疗效与安全性.方法 回顾性分析2006年1月至2011年1月复旦大学附属中山医院内镜下应用尼龙绳套扎联合高频电凝切除治疗345例结直肠息肉患者的临床资料.观察患者术后有无出血、穿孔等并发症发生;肠镜随访观察患者术后创面愈合及病变残留、复发情况.结果 345例患者共成功切除362枚结直肠息肉.息肉直径1.5 ～4.0 cm,平均直径2.7 cm;1例患者术中出血;1例患者发生迟发性穿孔.93.6％(339/362)的息肉经病理检查证实为腺瘤性息肉,17枚为增生性息肉,5枚为炎症性息肉,1枚息肉出现癌变.334例患者术后1个月复查肠镜,9例患者残蒂存留,再次予内镜下切除,其余患者术后创面愈合良好,残蒂脱落消失.308例患者术后2个月获得肠镜检查随访,病灶均完全消失.患者首次治疗有效率为97.1％( 299/308).结论 内镜下应用尼龙绳套扎联合高频电凝切除结直肠息肉安全、有效.     

��᳦����������������Ƽ����ɿ���̽��

目的 探讨应用软结肠镜(内镜)对常见下消化道外科疾病的诊治，以提高利用内镜进行诊治的安全性及疗效。方法 回顾1984～2001年37939例行内镜诊治的病人，其中行内镜治疗9039例，包括低位肠梗阻64例、乙状结肠扭转11例、假性结肠梗阻6例、下消化道出血56例、良性肠狭窄23例及肠道息肉8879例。总结操作体会，分析疗效及并发症的原因。结果 低位肠梗阻明确梗阻原因、部位者35例(54．7％，35／64)；乙状结肠扭转复位成功11例(100％，11／11)；假性结肠梗阻经内镜减压，治愈者5例(83．3％，5／6)，急性下消化道出血明确出血原因及部位者37例(66．1％，37／56)，37例中立即经内镜止血成功者36例(97．3％，36／37)；结、直肠吻合口经内镜下扩张均成功(100％，23／23)；内镜下行大肠息肉摘除术8864例，共10105枚，术后出血4例，迟发性穿孔2例；术中经内镜行小肠息肉摘除术15例，共412枚，术后无并发症。结论 内镜提高了下消化道外科疾病的诊治水平，但应严格把握适应证。     

内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤的临床疗效及护理体会

目的:分析内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤的临床疗效，总结护理对策。方法:回顾2019年10月至2021年10月郑州市第三人民医院收治的40例结直肠侧向发育型肿瘤患者资料，患者均采用内镜黏膜下剥离术治疗，分析治疗效果及复发率，总结护理对策。结果:本组40例患者均顺利完成手术，其中38例(95.00%)成功完整切除病灶，2例因病灶较大借助圈套器切除。术中出血2例，肠穿孔1例。术后苏醒期躁动1例，迟发性出血1例，肠功能紊乱1例。术后随访1年，复发1例(2.50%)。结论:内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤疗效确切，完整切除率高，复发率低。围手术期做好护理工作，有助于提高手术疗效，促进患者康复。     

急诊内镜诊疗在结直肠癌根治术后吻合口出血中的应用

目的探讨结直肠癌根治术后吻合口出血病人使用急诊内镜检查及止血的安全性和有效性。方法回顾性分析华中科技大学同济医学院附属协和医院2014年1月至2019年11月结直肠癌根治术后吻合口出血行急诊内镜检查以及内镜下治疗的28例病人资料。结果28例病人包括直肠癌术后15例、左半结肠癌术后3例及右半结肠癌术后10例。上述病例均完成急诊内镜检查并接受内镜下止血治疗。仅1例直肠癌术后吻合口出血病人因合并吻合口漏经内镜下止血效果不佳,最终接受外科手术治疗;其余27例吻合口出血病人均经过内镜止血成功。所有病例住院期间无再发出血,内镜诊疗并未导致术后吻合口漏及穿孔。结论结直肠癌根治术后吻合口出血急诊内镜检查及止血的方案,不增加吻合口出血、穿孔及漏等风险。术后急诊内镜下止血是安全有效的治疗手段,能明显提高止血成功率,降低再手术率。在病人出血后8 h内行急诊内镜是非常关键的诊治措施。     

Endoscopic hemoclip application in the treatment of nonvariceal gastrointestinal bleeding: short-term and long-term benefits

We conducted an uncontrolled retrospective study to evaluate endoscopic hemoclip application as the first-choice hemostatic treatment of gastrointestinal bleeding lesions from a wide variety of sources. Clinical data, endoscopic findings, complications, and short- and long-term outcomes were also investigated. A total of 52 patients (men/women, 36/16; age, 65 +/- 11.5 years) were included in the study. Hemoclipping was technically successful in 51 cases (98%). The average number of therapeutic endoscopic sessions needed to achieve permanent hemostasis was 1.42 +/- 1.2 (range, 1-4). The number of hemoclips required for hemostasis depended on the nature of bleeding with the average number of hemoclips used being 3.11 +/- 1.12 (range, 2-8). No complications occurred, although 1 patient presented recurrent bleeding and was operated on. No further hemorrhage occurred during a median follow-up period of 17.32 +/- 5.4 months (range, 2-53). Endoscopic hemoclipping provided an effective and safe modality for achieving hemostasis in gastrointestinal bleeding from a wide variety of sources, with long-term benefits.     

腹腔镜治疗胃十二指肠急性大出血的体会

目的:探讨腹腔镜手术治疗胃十二指肠急性大出血的应用价值及手术技巧。方法:回顾分析2010年8月至2012年1月5例胃十二指肠急性大出血患者经胃镜确诊并初步止血后行腹腔镜手术的临床资料。其中胃窦巨大溃疡出血2例,十二指肠球后溃疡出血、胃底溃疡出血、胃间质瘤胃镜活检后出血各1例。结果:5例患者经胃镜确诊并初步止血后急诊行腹腔镜手术,疗效良好,无一例围手术期死亡,术后无手术相关并发症发生。结论:腹腔镜手术治疗胃十二指肠急性大出血术中能快速处理病灶,止血效果确切,具有较高的治疗价值。     

Use of hemostatic forceps as a preoperative rescue therapy for bleeding peptic ulcers

Standard endoscopic management of bleeding peptic ulcers includes injection, thermal coagulation, or mechanical clipping. The use of hemostatic forceps has increased with the widespread use of endoscopic submucosal dissection to control bleeding. However, there are few reports on the use of hemostatic forceps to control bleeding peptic ulcers. From January to October 2010, four hundred twenty-seven patients received endoscopic therapy at our institution for bleeding peptic ulcers. In 5 patients hemostasis was achieved with hemostatic forceps as a rescue therapy after standard endoscopic therapy had failed. In 4 patients successful hemostasis was achieved, whereas 1 patient had to undergo emergency surgery. We found that hemostatic forceps are a useful alternative for the control of bleeding peptic ulcers after standard endoscopic treatment has failed. This treatment may help in avoiding the necessity of surgery. Further large-scale studies are required to confirm our observations.     

Endoscopic diagnosis and treatment of upper gastrointestinal bleeding

Considerable progress has been made in endoscopic hemostasis. Several methods are available. Sclerotherapy of esophageal varices is the procedure of choice for the control of active variceal hemorrhage and for the prevention of recurrent bleeding. For endoscopic treatment of nonvariceal gastrointestinal bleeding, the nonerosive contact probes (heater probes and BICAP) and injection sclerotherapy are preferred. Several hemostatic modalities should be available and applied depending on the anatomic location and type of bleeding lesions. Advanced endoscopic hemostatic techniques seem to be decreasing the mortality rates in patients with upper gastrointestinal bleeding.     

透明帽用于消化内镜止血治疗的护理配合

目的探讨透明帽在消化内镜止血治疗中的作用及护理配合方法。方法对86例消化道出血患者实施内镜止血治疗,均于内镜下找到出血点后安装透明帽,其中32例消化道溃疡底部动脉或Dieulafoy病出血者选用带侧孔的透明帽电凝止血,21例贲门黏膜撕裂综合征出血者选用不带侧孔的透明帽以金属夹止血,33例食管胃静脉曲张者选用带侧孔的透明帽注射硬化剂止血,同时加强术前准备、术中配合及术后观察护理。结果 86例均顺利完成内镜治疗并取得较好的止血效果,无相关并发症发生;术后3~6个月内镜复查,出血部位瘢痕形成,2例食管胃静脉曲张患者再出血,第2次给予硬化剂注射联合套扎治疗止血成功;余84例无复发出血。结论透明帽用于消化内镜止血治疗效果好,并发症少,护理人员熟练掌握其性能和操作,能缩短操作时间,提高治疗效果。     

结直肠腺瘤性息肉和早期癌的内镜治疗

目的 评价结直肠腺瘤性息肉和早期癌的内镜治疗效果.方法 自2006年1月至2007年10月对245例肠镜发现的腺瘤性息肉,局限于黏膜层、抬举征(+)的早期癌患者分别进行息肉圈套切除术、内镜黏膜切除术、内镜分片黏膜切除术和内镜黏膜下剥离术.结果 253枚病变,大小0.5～8.5 cm(平均2.3 cm),其中<2 cm 157枚,>2 cm 96枚.内镜下成功切除249枚,内镜切除成功率98.4%(249/253).内镜治疗中未出现无法控制的创面大出血,2例术后出现迟发出血.1例长蒂息肉治疗后出现少量膈下游离气体,2例直肠病变剥离治疗后出现皮下气肿,保守治疗后气肿减退;4例病变剥离过程中创面见裂口,3例金属夹成功缝合;1例治疗后出现腹胀和腹腔大量游离气体,急诊开腹手术修补创面.总的并发症发生率3.6%(9/253).内镜治疗后8例接受外科手术(病变局部抬举不良4例,分化不良腺癌1例,高级别瘤变2例,穿孔1例).术后随访231例,随访期3～22个月(平均14.3个月),内镜黏膜下剥离术后巨大人工溃疡创面3个月基本愈合;3例分片黏膜切除术后复发.结论 内镜治疗可以有效切除结直肠腺瘤性息肉和早期癌,提供准确的病理诊断资料,内镜治疗并发症发生率有待进一步降低.     

Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding

We reviewed endoscopic hemostatic effects of the pure ethanol injection (PEI) method for reducting emergency operations and deaths due to gastroduodenal ulcer bleeding. During 17 years beginning in June 1979 in Tohoku University Hospital, 331 patients underwent endoscopic hemostasis by the PEI method. Initial hemostasis was successfully obtained in all cases. Rebleeding occurred in about 4% of the patients, and rehemostasis was obtained successfully in all of them. Complete hemostasis was obtained in 330 of 331 patients (99.7%) using the PEI method; there were no deaths. Only one patient required emergency operation after hemostasis because of repeated neogenetic bleeding complicated with a perforation and another because of an unidentifiable neogenetic ulcer bleeding located just above the Vater papilla. None required other endoscopic hemostasis or interventional radiology. Moreover, after introduction of “second-look” endoscopy, the rebleeding rate decreased to about 1% with PEI hemostasis. Based on these excellent hemostatic effects of the PEI method, we believe that a comparative study with other hemostatic methods is not needed.     

直肠癌根治术骶前静脉大出血的原因及处理对策

目的 探讨直肠癌根治术中骶前大出血的原因及纱布填塞压迫法治疗骶前大出血的临床应用价值。方法 对我院2001年1月-2006年9月的直肠癌患者术中发生的5例骶前静脉大出血的原因及纱布填塞法压迫止血治疗的经验进行回顾性分析。结果本组患者1例因用手指分离至骶尾部时撕破骶前筋膜致骶前静脉破裂出血,2例为未进入正常解剖层次盲目钝性分离骶前筋膜而引起出血,2例因术中骶前静脉出血处理不当致大出血,均使用纱布填塞压迫法后很快止血成功,顺利完成手术。术后72小时去除纱布,无再次继发性出血发生,患者恢复好,随访无不良反应。结论 直肠癌根治术中未能掌握正确的解剖层次或操作方法失当是骶前静脉丛大出血主要原因．纱布填塞压迫止血是处理骶前静脉破裂大出血可靠的方法。     

Use of FloSeal hemostatic sealant in transsphenoidal pituitary surgery: technical note

OBJECTIVE: Bleeding during transsphenoidal pituitary surgery can lead to a variety of operative difficulties. When the endonasal transsphenoidal approach is used, even mild intraoperative hemorrhage can lessen visibility in the confined operative field of view. This technical note describes the use of a hemostatic agent we have found of benefit in obtaining prompt hemostasis during this operation. METHODS: Operative records were reviewed for an 18-month period for all patients who underwent transsphenoidal surgery since we began using FloSeal hemostatic sealant in January 2000. RESULTS: During the study period, 293 transsphenoidal operations were performed for pituitary lesions. Of these, 20 procedures involved vigorous or persistent bleeding. When the standard techniques for hemostasis failed or were inadequate, FloSeal, a sterile mixture of a gelatin matrix and thrombin component mixed at the time of use, was applied to the site of hemorrhage by use of a 14-gauge angiocatheter to reach the sella. We observed complete hemostasis immediately on application of FloSeal in all cases except one, which required a second application. Hemostasis was obtained immediately after the second application. No operations were aborted during this period as a consequence of undue bleeding. CONCLUSION: We detail the method in which we use FloSeal in transsphenoidal surgery and report our impression of its effectiveness. FloSeal has been demonstrated to be safe and biocompatible as compared with hemostatic agents currently in use.