腹腔镜、结肠镜双镜联合在结直肠手术中应用13例报告

目的探讨纤维结肠镜和腹腔镜双镜联合在结直肠疾病手术中的应用意义。方法回顾对13例腹腔镜定位困难的结肠病变,用纤维结肠镜定位、标记,经腹腔镜完成手术操作。结果13例均顺利完成定位和手术。肠段切除平均用时130(80~190)min,结肠癌根治术平均用时170(140~230)min,术中平均出血量50(20~100)ml,肠道运动恢复时间44(18~52)h,术后平均住院6(4~10)d。结论纤维结肠镜和腹腔镜双镜联合术中定位准确、创伤小,可提高腹腔镜手术成功率,值得推广。     

多层CT仿真结肠镜在结肠息肉筛查中的应用价值

目的:评价多层CT结肠镜(CTC)用于结肠息肉诊断的临床价值。方法:采用多层螺旋CT(16/64)扫描及专业图像处理技术,以结肠镜检查为金标准。结果:回顾性分析了42例行CTC并结肠镜检查的临床怀疑结肠息肉或要求行结肠疾病筛查患者的临床资料。依据诊断性试验统计学方法,分为息肉组和患者组,其中息肉组再按直径分为≤5mm、5～10mm和≥10mm3组分别为68.8%/41.5%、93.8%/65.2%和100%/92.9%。患者组的敏感度、阳性预测者、特异度、阴性预测值及准确度分别为97.1%、89.5%、42.9%、75.0%和88.1%。结论:CTC图像能清晰准确显示出息肉形态,可作为临床息肉筛选的常规方法。     

结肠息肉的内镜治疗体会

结肠息肉临床较为常见,20世纪舳年代前常采用手术治疗,随着内镜技术的进步,现多采用内镜下息肉摘除,大大减轻了患者痛苦,且恢复快,效果好,并发症少,我院自2004年1月开展对结肠息肉内镜下治疗106例,取得良好疗效,现报告如下。     

结肠息肉的内镜治疗体会

结肠息肉临床较为常见,20世纪舳年代前常采用手术治疗,随着内镜技术的进步,现多采用内镜下息肉摘除,大大减轻了患者痛苦,且恢复快,效果好,并发症少,我院自2004年1月开展对结肠息肉内镜下治疗106例,取得良好疗效,现报告如下。     

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     

腹腔镜联合结肠镜在大肠肿瘤术中应用

目的:探讨腹腔镜联合结肠镜在大肠肿瘤中应用价值。方法:总结2003年8月~2006年4月间实施全腹腔镜下结肠肿瘤切除术67例,其中15例肿瘤体积小,肠管外观无异常,病变难以定位者,经肛置入肠镜,直观到肿瘤后停止进镜,术者供肠镜光亮用钛夹标记顺利完成腹腔镜手术。结果:15例患者在肠镜帮助下,顺利完成肠管切除术或肿瘤根治术,病变定位准确,避免中转开腹,无手术并发症。结论:两镜联合应用于大肠肿瘤术中,对于肿瘤体积小,肠管外形无改变者,是一种实用、安全、可靠的方法。     

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。     

腹腔镜胆囊切除术165例治疗体会

腹腔镜胆囊切除（LC）是近几年开展的一项新技术，但手术并发症不容忽视。现就我们在开膛LC中发生并发症情况进行讨论。临床资料一、一般情况165例中，男42例，女123例，男：女一l：2．7。年龄11～68岁，平均45岁。术前诊断为慢性胆囊炎、胆囊结石119例，胆囊炎、胆石症2例，急性胆囊炎6例，胆囊息肉38例。二、手术情况使用storz公司的全套腹腔镜器械。LC成功151例，成功率则．5鞘，改良或中转开腹手术14例。中转开膛手术原因：严重粘连及解剖不清6例，出血2例，肿瘤1例，机械故障1例，初期行改良LC（腹部小切口）4例。并有2例同时行腹…     

腹腔镜联合胆道镜保胆取息肉112例临床分析

目的探讨腹腔镜联合胆道镜保胆取息肉术的临床应用价值。方法对我院2009年1月—2011年5月期间112例行腹腔镜联合胆道镜保胆取息肉术患者的临床资料进行回顾性分析。结果 112例均顺利行腹腔镜联合胆道镜保胆取息肉术,病理诊断胆固醇息肉87例(77.67%),胆囊腺瘤17例(15.18%),胆囊炎性息肉8例(7.14%),无恶性病变者。术后2例发生切口脂肪液化,余无并发症发生。96例(85.7%)患者术后随访30~56(41.9±6.3%)个月,3例(3.13%,3/96)多发胆固醇息肉患者复发,无胆囊癌发生。结论腹腔镜联合胆道镜保胆取息肉术安全、微创、有效。     

16层螺旋CT诊断结肠癌及息肉的价值

目的：探讨16层螺旋CT诊断结肠癌及息肉的价值。方法：通过对36例结肠病变患者的16层螺旋CT轴位图像和MPR、SSD、Raysum、CTVC及PE图像进行观察分析,与手术和/或结肠镜活检病理结果进行对照研究。结果：36例中23例结肠癌在MPR、SSD、Raysum、CTVC、PE图像均清晰显示,其大体分型的诊断符合率分别为91.67%、83.33%、87.5%、100%、100%。结肠息肉13例（共27个）,MPR、SSD、Raysum图像各显示15个;CTVC、PE清晰显示25个,其对1.0-5.0mm和6.0-9.0mm息肉的检出率分别为80%和100%。结论：16层螺旋CT三维成像大大提高了图像质量和病变检出能力,在结肠癌分型、定位及结肠小息肉的诊治中具有很高的价值。     

腹腔镜联合胆道镜治疗胆总管结石84例

目的探讨腹腔镜联合胆道镜在治疗胆总管结石中的临床应用价值。方法 2008年5月—2011年5月,联合应用腹腔镜和纤维胆道镜行胆囊切除术、胆总管探查取石及T型管引流治疗胆总管结石病人84例,并回顾性分析手术时间、术后胆总管引流时间、术后住院天数、并发症等。结果 84例无中转开腹,平均手术时间120min;术后疼痛轻,无胆漏、胆道出血、急性胰腺炎、腹腔感染及胆道结石残留等并发症;术后住院时间5～7d(带T型管出院),T型管放置时间为4周。结论腹腔镜联合胆道镜治疗胆总管结石具有损伤小、痛苦轻及恢复快等优点,效果可靠,具有广泛的临床应用价值。     

CT colonography: effect of colonic distension on polyp measurement accuracy and agreement-in vitro study

RATIONAL AND OBJECTIVES: To investigate the effect of colonic distension on polyp measurement accuracy and reader agreement. MATERIALS AND METHODS: Institutional review board permission was obtained. A sealed colectomy specimen from a patient with familial adenomatous polyposis was scanned using a four-detector-row computed tomography (CT) after half and full air distension. A histopathologist measured the maximum dimension of all polyps in the opened specimen. Digital photographs and line drawings were used to individually match polyps visible in the CT datasets. Two observers (radiologist, technician) independently estimated the maximum polyp diameter using both two-dimensional (2D) and three-dimensional (3D) surface rendering. Full-distension measurements were repeated 1 week later. Accuracy was analyzed using paired t-test. Observer agreement was assessed using Bland Altman limits of agreement. RESULTS: Twenty-three polyps (4-15 mm) were identified. 2D measurements were significantly smaller than histologic size at both half distension (radiologist first): mean difference [md] -1.1 mm, md -1.7 mm, and full distension md -1.1 mm, md 1.4 mm (all P < .001). 3D measurements were not significantly different from true size other than after half distension for the technician (md -0.7 mm, P = .01). 95% Bland Altman limits for interobserver agreement were narrower after full distension, and better using 2D (half-distension span of agreement approximately 4.7 mm and 6 mm for 2D and 3D, respectively). 2D intraobserver span of agreement between half and full distension was approximately 3.8 mm and 3.2 mm for the radiologist and technician, respectively, compared with 6.2 mm and 5.5 mm using 3D. CONCLUSION: 3D polyp measurement is more accurate than 2D. However, in the presence of suboptimal distension, inter- and intraobserver agreement is superior using 2D.     

鼻息肉的临床与CT诊断

目的：探讨鼻息肉临床与CT的关系,提高对鼻息肉CT影像的认识,合理使用CT检查,方法：41例鼻息肉,分别行鼻窦CT冠状位（和）轴位薄层扫描,所有病例均经手术病理证实,其中误诊2例,结果：鼻息肉的临床表现与其大小,部位有关,CT表现为组织肿块,好发于窦口鼻道复合体区,易在鼻腔及鼻窦双向生长,结论：CT对鼻息肉的诊断,判定病变范围有重要价值,是术前必不可少的检查手段。     

胃肠癌单抗在大肠癌和大肠息肉中的抗原表达

本文应用胃肠癌单抗对66例肠癌,68例肠息肉进行PAP免疫组织染色,结果表明,三株单抗联合应用可明显提高阳性率,大肠息肉的功能改变早于形态改变,这一结果对临床有重要意义。     

Screening of colonic tumors by air-inflated magnetic resonance (MR) colonography

PURPOSE: To assess the accuracy of air-inflated magnetic resonance (MR) colonography for the detection of colonic lesions. MATERIALS AND METHODS: A total of 36 patients underwent both colonoscopy and air-inflated MR colonography. Breath-hold sequences (volumetric interpolated breath-hold examination (VIBE) coronal, and half-Fourier acquisition single-shot turbo spin-echo (HASTE) axial and coronal, both supine and prone) were performed with a 1.5T scanner. The detection of colonic lesions by MR colonography was then correlated with the findings from the colonoscopy performed on the same day. RESULTS: Two patients were unable to complete the MR colonography examination. Analysis was based on the results from 34 patients (17 males and 17 females, 38-70 years old, mean age = 54.9 years) who completed both examinations. MR colonography depicted two of two colonic tumors, one of one P4 (> 2 cm) polyp, one of two P2 (0.5-1 cm) polyps, and two of 11 P1 (< 0.5 cm) polyps. False-positive MR colonography interpretations were noted for one P1 polyp and two P2 polyps. The overall sensitivity, positive predictive value, and accuracy of MR colonography were 38%, 67%, and 46.2%, respectively. For the detection of endoluminal lesions > 5 mm, air-inflated MR colonography yielded a sensitivity of 75%, specificity of 93.3%, accuracy of 91.2%, positive predictive value of 60%, and negative predictive value of 96.6%. CONCLUSION: Air-inflated MR colonography is a new technique that deserves further investigation.     

老年人结肠癌并急性肠梗阻86例外科处理分析

目的探讨老年人结肠癌并发急性肠梗阻的特点、诊断、外科处理方法与预后。方法回顾性分析我院2000年1月—2009年8月86例年龄>60岁的老年患者手术治疗的结肠癌并发急性肠梗阻病人的临床资料,其中一期切除吻合58例(右半结肠一期切除吻合39例,左半结肠一期切除吻合19例),分期手术19例(右半结肠4例,左半结肠15例),行Hartmann手术。肿瘤无法切除行单纯结肠造瘘和捷径手术9例。结果术后出现并发症8例,发生率为9.3%,其中切口感染3例,腹腔感染2例,肺部感染2例,感染性休克1例,1例死亡,病死率1.2%,85例痊愈出院。结论老年人结肠癌致肠梗阻的外科治疗要根据老年病人的具体情况选择合理的术式,准确的早期诊断,恰当的围术期处理,正确的手术方式的选择,是提高其预后的关键。