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《Minimally invasive therapy & allied technologies》2013,22(6):561-563
SummaryWith the introduction of endoscopes for endonasal surgery, there have been an increasing number of endonasal dacryocystorhinostomies (DCR) performed. The advantages of the endonasal approach include the avoidance of an external facial scar and reduced risk of damage to the medial canthal ligament. We described our experience with the use of the Hall Osteon drill for endoscopic DCR. This procedure has been found to be technically reliable giving satisfactory post-operative results in 16 patients suffering from nasol-acrimal duct obstruction. The follow up was up to 12 months with a mean of 5 months. Three patients who had residual post-operative epiphora were considered as failures. There were no major complications and minor complications included one case of periorbital ecchymosis, one unretrieved silicone tube and a minor vestibule abrasion. The preliminary results suggest that the endoscopic drill-assisted DCR could offer a reliable treatment in patients with epiphora due to nasolacrimal duct obstruction. 相似文献
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《Minimally invasive therapy & allied technologies》2013,22(5):266-270
Abstract Aims: To study the efficacy of a new technique of single self-linking silicone stent exclusively in pediatric external dacryocystorhinostomy (DCR) and to report the new use and advantages of endoscopic guidance for the same. Material and methods: Prospective interventional case series, including 11 eyes of ten patients with nasolacrimal duct obstruction. Data collected included demographic data, clinical presentation, laterality, status of lids and puncta, syringing findings, probing interpretations, types and duration of intubation. Consecutive pediatric patients with post-saccal obstruction who underwent an external dacryocystorhinostomy were included. Exclusion criteria included patients who had undergone a DCR in the past by any route via external, endonasal or transcanalicular. Primary outcome measures were stent retention and ease of stent removal. Secondary outcome measures were anatomic patency of the passage and resolution of symptoms. Results: There were three male and seven female patients. Mean age was 9.4 years (range 6–15). A total of 11 procedures were carried out. Following placement of self-linked stents, the removal was done at a mean duration of 13.2 weeks (range:12–16 weeks). None of the patients had a stent prolapse during this period. All stents were removed in the outpatient without the use of general anesthesia with minimal endoscopic guidance. A minimum follow-up of three months following removal was considered for final analysis. Follow-up ranged from three months to six months after tube removal. The anatomical and functional success rate was 91%. There was one anatomical failure three months following tube removal and the remaining patients were free of symptoms at the last follow-up. Conclusions: Self-linking stents are a useful modality in pediatric patients not only to prevent stent prolapse but also to allow easy removal with minimum discomfort. Endoscopic guidance is a useful addition to this technique. 相似文献
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?eyhmus Ari Ramazan Gun Serdar Surmeli Ahmet Engin Atay Îhsan Çaca 《Current therapeutic research》2009,70(4):267-273
Background: The most common cause for the failure of external dacryocystorhinostomy (DCR) surgery is the formation of granulation tissue at the osteotomy site or common canaliculus.Objectives: The aims of this study were to assess the efficacy of intraoperative adjunctive mitomycin C (MMC) treatment in external DCR surgery and to compare this procedure with the standard DCR procedure alone in the long term (1 year).Methods: In this prospective, double-masked, randomized, controlled trial, patients with primary acquired nasolacrimal duct obstruction were randomized (using a random number table) into 2 groups based on surgical procedure. In the MMC group, intraoperative adjunctive MMC 0.2 mg/mL was applied to the osteotomy site for 30 minutes. The control group underwent standard DCR procedure only. The results of the DCR surgeries were assessed using objective findings (eg, cessation of excessive tearing via nasolacrimal duct irrigation and the improvement in height of tear meniscus) and subjective symptoms (asking patients to describe the degree of tearing improvement). Both the patients and the researchers who were assessing the study outcomes were masked to treatment group.Results: One hundred eyes of 100 Turkish patients were assessed and equally randomized to the MMC (27 women, 23 men; mean [SD] age, 47.0 [7.6] years) and control (26 women, 24 men; mean age, 46.6 [8.8] years) groups. The follow-up period was not significantly different between the MMC and the control groups (13.1 [1.1] vs 13.2 [1.4] months). Significantly more eyes in the MMC group than the control group remained symptom-free throughout the 1-year follow-up period (45/50 [90%] vs 33/50 [66%]; P=0.005). Significantly more patients in the control group than the MMC group had an improvement in symptoms at the 1-year follow-up (8/50 [16%] vs 2/50 [4%] eyes; P=0.005). Based on the patency of the drainage system, the success rate was significantly greater in the MMC group than the control group (48/50 [96%] vs 42/50 [84%]; P=0.005). Based on nasolacrimal duct irrigation, significantly fewer patients in the MMC group than the control group had an enclosed naso-lacrimal duct (2/50 [4%] vs 8/50 [16%]). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed.Conclusions: In the management of these patients with primary acquired nasolacrimal duct obstruction, adjunctive intraoperative MMC application with standard DCR surgery had a significantly higher success rate than did standard DCR surgery alone. Further large, double-masked, randomized studies are needed to confirm these findings. 相似文献
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鼻泪管支架置入术治疗鼻泪管阻塞 总被引:3,自引:0,他引:3
目的 探讨介入性鼻泪管支架置入术治疗鼻泪管阻塞的临床疗效。方法 采用Song 601 型鼻泪管支架组套,经鼻侧逆行置入支架治疗鼻泪管阻塞5 例。结果 技术成功率100 % 。术后即刻造影鼻泪管通畅。1 例术后1 周出现再堵塞,其余4 例溢泪症状完全缓解。随访5 ~12 个月,1 例4 个月后复发,另3 例保持通畅至今。结论 鼻泪管支架置入术是治疗鼻泪管阻塞简单有效的方法。 相似文献
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Swetha Parvataneni Harshit S Khara David L Diehl 《World Journal of Clinical Cases》2020,8(22):5701-5706
BACKGROUNDBouveret syndrome, also known as gallstone ileus, is a rare form of gastric outlet obstruction accounting for 1%-3% of cases. This condition is most often reported in females. The diagnosis can be challenging and is often missed due to atypical presentations, which occasionally mimic gastric outlet obstruction symptoms such as nausea, vomiting, loss of appetite and hematemesis. The symptoms vary with stone size. Larger stones are managed with a surgical approach, but this carries increased morbidity and mortality. Over the past decade, the endoscopic approach has emerged as an alternative mode of treatment, but it is generally unsuccessful in the management of larger-sized stones. A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 cm. Here we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction, who was successfully managed in a single session using a complete endoscopic approach with laser lithotripsy.CASE SUMMARYAn 85-year-old female patient presented with 1-month history of intermittent abdominal pain, vomiting, decreased appetite and weight loss. An abdominal computed tomography showed a 4.5 cm × 4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet obstruction. Endoscopy showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal bulb. Endoscopic nets and baskets were used in an attempt to remove the stone, but this approach was unsuccessful. Given her advanced age, poor physical condition and underlying comorbidities, she was deemed to be high-risk for surgery. Thus, a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the stone. Post-procedure, the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her diet. She was subsequently discharged home at 48 h, with an uneventful recovery.CONCLUSIONIn our paper we describe Bouveret syndrome and highlight its management with a novel endoscopic approach of laser lithotripsy in addition to various other endoscopic approaches available to date and its success rates. 相似文献
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《Minimally invasive therapy & allied technologies》2013,22(1):21-24
Endoscopic sphincterotomy (ES) is a highly successful and preferred method for common bile duct (CBD) stone removal. In the rare instance when ES is unsuccessful and CBD stones are removed percutaneously, improved biliary drainage remains desirable to prevent stone recurrence. To this end, percutaneous transhepatic sphincterotomy (PTS) has been performed in nine patients. All patients presented with ascending cholangitis due to biliary obstruction from CBD stones. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy was unsuccessful due to previous upper Gl reconstructive surgery (n = 8) and technical failure (n = 1). Percutaneous biliary drainage (PBD), followed by transhepatic stone removal, was performed prior to the transhepatic sphincterotomy using a standard endoscopic papillotome. Fluoroscopic guidance was used in the first three patients and in the remainder both fluoroscopy and percutaneous choledochoscopy were used. Sphincterotomy was successfully performed in all nine patients; post-procedure cholangiograms showed improved biliary drainage. In two patients, the choledochoscope was passed through the sphincter with ease. One patient bled soon after the procedure (fluoroscopic control only) and responded quickly to treatment with blood transfusion. No complications have occurred since choledochoscopy was incorporated into the procedure. All patients remained free of biliary symptoms for an average follow-up of 19 months (range 12-45 months). Our early experience shows that PTS is efficacious in improving biliary drainage and that it offers a therapeutic alternative to surgery in highly-selected patients. 相似文献
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目的探索内镜下3种手术路径治疗中耳胆脂瘤的临床价值。方法回顾性分析2010年1月-2019年12月203例209耳行中耳胆脂瘤切除术患者的临床资料。其中,85例88耳借鉴"锁孔"理念、吸收显微镜手术技术,通过外耳道-上鼓室-鼓窦-乳突、外耳道-鼓窦-乳突和耳甲艇切口-鼓窦-乳突3个手术路径行内镜下手术入路中耳胆脂瘤切除,118例121耳行显微镜下乳突根治术。比较两组患者手术并发症和术后复发情况。结果所有病例术后随访6~24个月,内镜组干耳率94.32%、显微镜组95.87%;内镜组并发症发生率10.23%、显微镜组12.40%;内镜组残留和复发率6.82%、显微镜组4.13%,两组患者比较,差异均无统计学意义(P 0.05)。结论耳内镜手术可通过3个路径切除涉及整个乳突的中耳胆脂瘤,拓展了中耳胆脂瘤手术的治疗范围。 相似文献
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Xiao-Le Song Jing-Yi Yang Yu-Ting Lai Jia-Ying Zhou Jing-Jing Wang Xi-Cai Sun De-Hui Wang 《World Journal of Clinical Cases》2020,8(22):5684-5689
BACKGROUNDHere we present a rare case of localized amyloidosis involving the nasolacrimal duct and lacrimal sac which was managed by endoscopic surgery.CASE SUMMARYA 50-year-old man whose medical history included bilateral ventricular fold and vocal cord amyloidosis complained of bilateral epiphora. Magnetic resonance imaging revealed a neoplasm within the nasolacrimal sac. Characteristic positivity for Congo red staining and birefringence under a polarized microscope proved the diagnosis of amyloidosis. Dacryocystorhinostomy via an endoscope obtained a favorable result. A one-year follow-up found no recurrence.CONCLUSIONThere are few reports on amyloidosis involving the lacrimal outflow system, and management and outcome are not clear. Endoscopic dacryocystorhinostomy can be a choice to relieve symptoms. Regular follow-up and monitoring of systemic diseases are highly recommended. 相似文献
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Zi-Gang Che Ting Ni Zhen-Chang Wang De-Wang Wang 《World Journal of Clinical Cases》2021,9(8):1940-1945
BACKGROUNDNasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare. CASE SUMMARYA 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSIONThis case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system. 相似文献
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目的探讨鼻内镜下微创治疗鼻中隔偏曲的手术方法及意义。方法回顾分析我院2001~2003年鼻内镜下微创治疗鼻中隔偏曲106例的临床资料。结果术后复诊3~6个月,治愈99例,好转7例,无效0例。全部病例鼻中隔居中,无穿孔,鼻中隔无飘动,鼻腔通气良好。结论鼻内镜下微创治疗鼻中隔偏曲与传统的鼻中隔矫正术相比,具有疗效良好、并发症小、安全性高等优点,在临床上值得推广应用。 相似文献
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《Minimally invasive therapy & allied technologies》2013,22(3):146-149
AbstractIn the general population, endoscopic retrograde cholangiopancreatography (ERCP) procedures are the gold standard in the treatment of bile duct stones. However, repeat endoscopic procedures and sometimes even open surgery are needed in difficult cases with retaining bile duct stones. The aim of the present study was to determine the clinical success of ERCP procedures in the treatment of bile duct stones in extremely old patients. A retrospective data review comprising prospective data collection and double-entry bookkeeping of 23 therapeutic ERCPs in 20 nonagenarians with bile duct stones was conducted between 1997 and 2007. The primary ERCP procedure was the definitive treatment in 17 out of 20 patients with bile duct stones, giving a clinical success rate of 85 % for the first endoscopic procedure. In the remaining three patients, a repeat ERCP procedure had to be done in the follow-up. After these three repeat procedures with successful outcome, the clinical success of endoscopic treatment was 100%. There was no further recurrent biliary obstruction in any of the patients prior to death which occurred after a mean of 38 months (two patients are still alive), and no open surgery had to be performed in these patients. To be concluded, endoscopic treatment modality seems to be excellent in extremely elderly patients with bile duct stones. 相似文献
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目的 对比分析内镜下切除和腹腔镜手术切除非微小胃间质瘤(直径大于1 cm且小于5 cm)的疗效及安全性。方法 回顾性分析2012年1月-2017年12月在苏州大学附属第一医院和苏州大学附属张家港医院行内镜下切除和外科腹腔镜手术治疗、并经术后病理及免疫组化确诊为非微小胃间质瘤患者的临床资料。根据手术方式将患者分为内镜切除组和腹腔镜手术组,比较两组患者术后住院时间、并发症、治愈性切除率等。结果 内镜切除组术后进食时间、术后排气时间、住院时间较腹腔镜手术组短,住院费用较腹腔镜手术组少,两组患者比较,差异有统计学意义(均P < 0.05)。术后对所有患者进行随访,内镜切除组平均随访时间为32个月,有1例出现复发;腹腔镜手术组平均随访时间为35个月,有1例出现复发,1例出现转移,两组患者比较,差异无统计学意义(P > 0.05)。结论 内镜下切除直径大于1 cm且小于5 cm的非微小胃间质瘤,具有肿瘤切除率高、术后恢复快、并发症少等优势,且与腹腔镜手术相比,复发率无明显差异。 相似文献
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Jae Hyun Yoon Chung Hwan Jun Jae Pil Han Ji-Woong Yeom Seung-Ku Kang Hyun Yi Kook Sung Kyu Choi 《World Journal of Clinical Cases》2021,9(5):1228-1236
BACKGROUNDPrimary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.CASE SUMMARYA 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.CONCLUSIONEndoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation. 相似文献