Endoscopic guided single self-linking silicone stent in pediatric external dacryocystorhinostomy

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.     

Endoscopic transnasal dacryocystorhinostomy -long-term results

Summary

Endoscopic dacryocystorhinostomy (DCR) was successfully performed in 40 patients, with four patients having bilateral surgery. Follow-up data were obtained on 43/44 eyes using clinical notes and a patient questionnaire. Range of follow up was 1–46 months, with an average of 18 months (in nine patients follow up was at least 3 years). Epiphora was successfully relieved in 86% of patients and there was no evidence of a recurrence of nasolacrimal obstruction in the long term. Endoscopic DCR is a relatively quick and simple procedure with low morbidity, and as such is suitable for day case surgery. Satisfactory long-term results make endoscopic DCR an alternative to external DCR as primary surgical treatment for nasolacrimal duct obstruction. In cases of failed external DCR, or when epiphora is iatrogenic following surgery to the lateral nasal wall, a transnasal endoscopic approach is probably the treatment of choice.     

CT-guided percutaneous skull biopsy using a drill-assisted system: Technical report of two cases

The OnControl coaxial biopsy system (Vidacare Corporation, Shavano Park, TX) includes an inner diamond-tipped access needle and hollow biopsy needle that engage with a battery-powered hand drill. Herein, we report the use of this novel device to perform two CT-guided percutaneous skull biopsies. Both procedures were performed without complication and facilitated a pathologic diagnosis.     

鼻内镜下鼻腔泪囊造口术

目的 观察鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的疗效和特点。方法 对34例慢性泪囊炎患者行鼻内镜下鼻腔泪囊造口术。术中采用枪状镊鼻内定位泪囊，用电钻磨除泪囊内侧壁骨质，切开泪囊，银夹固定翻开的泪囊黏膜，术后随访半年以上。结果 全部病例中治愈31例（91％），好转4例（9％）。结论 经鼻内镜鼻腔泪囊造口术较传统鼻外泪囊鼻腔造口术操作更加简便，可控。     

鼻内镜在外伤性泪囊炎治疗中的应用

目的 探讨鼻内镜在外伤性泪囊炎治疗中应用的可能性并评价其疗效.方法 对16例因外伤所致泪囊炎患者行经鼻内镜下鼻腔泪囊造口术.结果 16例病例中,1次手术治愈和好转为14例,有效率达87.5%.结论 经鼻内镜下鼻腔泪囊造口术较传统的鼻外径路鼻腔泪囊吻合术有明显的优点,是一种较好的手术治疗方法.     

Transcanalicular Endoscopic Laser-assisted Dacryocystorhinostomy (TELA-DCR)

Objective:To assess the results in combined dacryoendoscopy followed by lacrimal drainage surgery with a transcanalicular laser-assisted approach combined with microsurgical endonasal DCR (TELA-DCR).

Methods:Retrospective follow-up of a case series between 1998 and 2003. 82 patients were included in the study (43 females/39 males, age 47.8 years). All patients underwent a combined examination by an ophthalmologist (GVA) and an otorhinolaryngologist (AS/KL) consisting of a routine clinical examination of the eyes, the lacrimal system and the nasal cavity as well as the paranasal sinuses with probing and syringing of the lacrimal drainage system, a radiological examination with digital subtraction dacryocystography (dsDCG) and computerized tomography (CT) of the bony structures. Of 122 lacrimal systems with dacryoendoscopy (Schwind Vitroptic®, Germany), 68 had a bicanalicular silicone intubation without surgery, 12 had a transcanalicular laserdacryoplasty (Erb:YAG-Laser; Schwind-Sclerostome®, Germany) with bicanalicular silicone intubation (Ritleng; FCI Ophthalmics, France) and 42 had TELA-DCR with a silastic-sheet inlay in the bony window for two to three days. 7 of these 42 have already had lacrimal surgery elsewhere. 2 had external lacrimal surgery (Toti procedure) and 5 had endonasal surgery (West procedure). Dacryoendoscopy was used to review the diagnosis of digital subtraction dacryocystography (dsDCG) and for surgical intervention in the same session. Surgery was done in general anesthesia. All patients were admitted to the inpatient department for 24 hours and were discharged the day after surgery. Follow-up (4–65 months) was done by the surgeons only. The silicone tubes were left for three to six months and removed endonasally by the same surgeons again.

Results:Of 122 interventions with dacryoendoscopy 68 needed a bicanalicular stenting with a silicone tube for relative stenosis only. 12 of these needed further intervention by DCR (17.6%) due to restenosis. 12 out of 122 had primary laserdacryoplasty and 2 (16.6%) of these needed DCR later. 42 of 122 had primary TELA-DCR. 5 out of these 42 primary TELA-DCR were revision-DCR after external or endonasal DCR elswhere and 2 of these needed a 2^nd TELA-DCR for restenosis (4.8%). Anatomically all lacrimal systems are still patent ever since. 76 patients (92.7%) are free of symptoms. Overall anatomic patency rate was 82.4% in tubing as single intervention, 83.4% in laser-dacryoplasty and 95.2% in TELA-DCR.

Conclusions:Combined dacryoendoscopy and TELA-DCR is an efficient, safe and successful method in the managment of lacrimal obstructive disease. Our experience suggests that TELA-DCR may be considered as a treatment option in selected patients with lacrimal obstructive disease.     

鼻内镜下鼻腔泪囊造孔术治疗老年慢性泪囊炎

目的 探讨经鼻内镜泪囊鼻腔吻合术治疗老年慢性泪囊炎的临床效果.方法 回顾性分析鼻内镜下泪囊鼻腔吻合术治疗老年慢性泪囊炎患者20例(24眼).观察临床疗效.结果 20例患者(24眼)术后随访6个月～2年,治愈22眼(91.7%);好转2眼(8.3%).结论 鼻内镜下泪囊鼻腔造孔术治疗老年慢性泪囊炎疗效好,创伤小,简便快捷.     

Endoscopic approach to posterior epistaxis

Management of epistaxis is directly related to the site of the bleeding. The introduction of multi-angled rigid nasal endoscopes has refined the diagnostic capabilities of various conditions affecting nose and sinuses. The posterior epistaxis presents significant greater problems as bleeding is severe and treated with conventional packing can lead to increased morbidity and life-threatening complications. The precise location of a bleeding point with an endoscope has revolutionized the management of these difficult emergencies.     

内镜治疗急性胆源性胰腺炎的临床疗效

目的探讨内镜治疗急性胆源性胰腺炎(ABP)的临床应用价值。方法整理经内镜治疗的48例及内科保守治疗的37例ABP患者的临床资料,分析内镜治疗对ABP的临床疗效和对ABP重症化的影响。结果内镜治疗ABP可明显缩短患者病程,加速患者恢复,降低患者住院费用并能减少ABP的重症化转化。结论内镜治疗ABP可加速患者恢复,缩短住院时间,同时可抑制ABP重症化转换并降低并发症发生率,是治疗ABP的一种安全、有效的方法。     

高龄衰弱患者X线透视下经皮内镜下胃造瘘转为经皮内镜下空肠造瘘技术

  目的  探讨高龄衰弱患者在X线透视下将经皮内镜下胃造瘘(percutaneous endoscopic gastrostomy, PEG)转为经皮内镜下空肠造瘘(percutaneous endoscopic jejunostomy, PEJ)的技术, 并评价其安全性和可行性。  方法  对2009年1月至2011年4月在本院行X线透视下PEG转为PEJ的12例高龄衰弱患者进行回顾性分析。  结果  12例患者共行16例次操作, 技术成功率100%, 操作时间8~32 min, 平均18 min, 无并发症发生。  结论  X线透视下采用介入放射学技术将PEG转为PEJ安全可行。     

肝硬化食管胃静脉曲张的内镜治疗

肝硬化食管胃静脉曲张出血是危及生命的门脉高压并发症。食管静脉曲张一级预防策略为非选择性β受体阻滞剂（non selective beta blockers,NSBBs）或内镜下静脉曲张套扎术（endoscopic variceal ligation,EVL）,急性出血时首选EVL,其二级预防推荐NSBBs联合EVL。胃静脉曲张出血中,食管胃静脉曲张1型（gastroesophageal varices type 1,GOV1）应用EVL,食管胃静脉曲张2型（gastroesophageal varices type 2,GOV2）和孤立胃静脉曲张（isolated gastric varices,IGV）推荐内镜下组织胶注射术。预防胃静脉曲张再出血方面,内镜下组织胶注射术和经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt,TIPS）可应用于GOV2型和IGV,EVL、NSBBs或内镜下组织胶注射术可应用于GOV1型。胃静脉曲张一级预防可选用NSBBs或内镜下组织胶注射术。     

经皮内窥镜引导下胃造口术的麻醉

  目的  探讨经皮内窥镜引导下胃造口术(percutaneous endoscopic gastrostomy, PEG)的临床麻醉经验。  方法  回顾性分析北京协和医院90例PEG患者的临床资料, 并对麻醉方式、静脉麻醉药物和麻醉风险进行总结。  结果  85例采用表面麻醉+局部麻醉+静脉镇静或全麻, 其中仅1例采用气管插管全麻; 其他5例采用表面麻醉+局部麻醉。静脉麻醉药物主要为咪达唑仑、芬太尼或舒芬太尼、丙泊酚或依托咪酯, 用药剂量和方法各不相同。在PEG过程中患者血流动力学和呼吸基本平稳, 但可能发生低氧血症、高血压和心动过缓等风险。与PEG前比较, PEG期间收缩压、舒张压和心率最小值明显下降, 脉搏血氧饱和度最大值明显上升, 差异有统计学意义(P < 0.05)。  结论  PEG的麻醉方式可以采用表面麻醉+局部麻醉+静脉镇静或全麻, 但应加强麻醉管理。     

超声内镜在154例上消化道黏膜下肿瘤患者微创治疗中的应用

目的 探讨超声内镜指导下内镜微创治疗上消化道黏膜下肿瘤的应用价值.方法 对内镜发现的154例上消化道黏膜下肿瘤患者根据超声内镜检查结果选择不同内镜微创治疗方案,术后常规行病理学及免疫组化检查,定期内镜随访.结果 154例采用内镜微创治疗,其中皮圈套扎术83例、高频电凝电切37例、内镜黏膜切除术26例、内镜黏膜下剥离术8例.除1例因出血中转手术外,其余均成功切除病灶,无严重出血、穿孔等并发症.超声内镜诊断与术后病理性质符合率为92.8％,来源层次符合率90.6％.113例内镜术后随访1～24个月,未见复发.结论 在超声内镜指导下选择不同方法进行内镜下切除黏膜下肿瘤是一种安全、有效的微创治疗手段.     

食管黏膜下肿瘤的内镜下诊断与治疗

目的基于食管黏膜下肿瘤(SMTs)内镜检查及治疗手段,分析食管SMTs的临床病理学特征,同时评价食管SMTs内镜下诊治的安全性、经济性和有效性。方法选择2012年1月-2017年12月新疆医科大学第一附属医院收治的98例食管SMTs患者,并同时完善普通胃镜和超声内镜(EUS)检查,所有患者均接受内镜下治疗,所有切除的肿瘤均行病理学检查。结果共98例患者。其中,女55例(56.12%),男43例(43.88%)。肿瘤位于食管上段27例(27.55%),中段28例(28.57%),下段43例(43.88%),56例病例行内镜黏膜下剥离术(ESD),25例行内镜黏膜下肿瘤挖除术(ESE),12例行内镜黏膜下隧道肿瘤切除术(STER),另3例行电凝电切除术,1例孤立性纤维性肿瘤因术中发现肿瘤基底部深转为外科手术,另1例平滑肌瘤因肿瘤体积太大致内镜操作困难,中途转胸腔镜下治疗。1例神经鞘瘤,ESD术后出现气胸、胸腔积液、术后瘘及食管狭窄等并发症,1例胸腔镜下行肿瘤摘除术的平滑肌瘤,术后发生气胸和胸腔积液,另外2例出现纵隔气肿和皮下气肿,均于术后2或3 d自行好转。病理学检查及免疫组化结果证实,最常见的食管SMTs为平滑肌瘤,共90例,占所有病例91.84%。结论食管SMTs以女性多见,好发于中下段食管,病理以平滑肌瘤最为常见;应用EUS技术能够对病变性质及组织学来源进行较准确的评估;内镜下治疗食管SMTs不仅能提供完整的病理学资料,而且有效安全。     

内镜下切除术治疗成人重复胃畸形的疗效

目的 探讨内镜下切除的胃重复畸形的病例特征及其预后。方法 选择2017年1月至2021年1月在复旦大学附属中山医院进行内镜切除治疗且病理证实为胃重复畸形的患者9例,回顾性收集其临床病理资料,包括一般资料、内镜下病灶表现、术后病理、住院天数、术后并发症、随访情况等。结果 共纳入9例胃重复畸形患者,女性3例,男性 6例;2例患者病灶位于胃上1/3,2例位于胃中1/3,5例位于胃下1/3。8例患者内镜下表现为黏膜下肿瘤,仅1例表现为息肉样隆起。住院天数为2（1.5, 4）d,无围手术期不良事件,随访时间46（26, 51）个月。术后随访病灶无残留、无复发。结论 内镜下切除对于符合指征的胃重复畸形的治疗安全可行,临床可尝试推广。     

经皮内镜下胃造瘘术16例临床分析

目的：探讨经皮内镜下胃造瘘术（PEG）的临床应用价值。方法：2001年10月-2004年12月PEG／PEJ共治疗16例患者，其中15例行PEG胃肠营养；1例行PEG胃肠减压加PEJ小肠内营养。结果：手术成功率100％。3／16例次出现造瘘管周围皮下感染。1／16例次出现造瘘口出血。1／16例次出现造瘘管滑脱导致堵塞。所有患者造瘘管置人后营养迅速恢复，停止静脉补液。16例患者随访1～38个月无严重并发症。结论：PEG／PEJ是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法，安全、有效、降低医疗费用、并发症少。     

鼻内镜下泪囊鼻腔造孔术治疗老年人慢性泪囊炎

目的探讨治疗老年人慢性泪囊炎更有效的手术方法。方法21例(22眼)老年人(≥60岁)慢性泪囊炎患者行鼻内镜下泪囊鼻腔造孔术,术后进行泪道冲洗、鼻内镜检查随访3～68个月。结果治愈20/22眼(91%)、好转1/22眼(4.5%)、有效率21/22(95.5%)。结论鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎疗效好,简便快捷,尤其适合老年人群。     

经自然腔道内镜下胰腺包裹性坏死引流清创术*

感染性胰腺坏死(IPN)是急性胰腺炎(AP)的严重局部并发症,其死亡率达32.0%。目前的共识认为对于怀疑或确诊的IPN,有创的干预治疗(包括经皮引流、内镜或手术)应尽可能推迟至发病4周后进行,使坏死组织液化并形成包裹性坏死(WON)。随着内镜技术发展,经自然腔道(胃或十二指肠)内镜下引流及清创术已被国内外指南推荐为WON的首选方法之一。该文详细阐述了WON的诊断与评估;内镜下引流与清创术的适应证、禁忌证、操作步骤、术后评估和并发症处理,最后介绍了近年内镜引流与清创治疗的研究进展。     

内镜下经鼻入路切除颅咽管瘤(附65例报告)

目的探讨内镜下经鼻入路切除颅咽管瘤的临床经验和应用价值。方法回顾性分析2012年2月-2016年5月使用内镜下经鼻入路切除的65例颅咽管瘤患者的临床资料,综合评价治疗效果、并发症发生率及随访结果。结果肿瘤全切52例(80.0%),次全切11例(16.9%),部分切除2例(3.1%);术中发现垂体柄共57例,保留41例(71.9%);术后视力改善31例(47.7%),6例维持在术前水平,1例术后视力下降;术后出现垂体功能下降21例(32.3%);术后短暂性尿崩45例(69.2%),长期尿崩9例(13.8%);4例(6.2%)患者出现脑脊液漏,均伴随颅内感染,均予以再次修补,成功3例,死亡1例;围手术期死亡3例(4.6%)。52例患者接受随访,时间4.0~45.0个月,平均20.8个月,44例(84.6%)恢复正常生活,8例(15.4%)出现肥胖,2例复发,尚无死亡病例。结论内镜下经鼻入路切除颅咽管瘤安全、有效、微创,具有其独到的优势。