Endoscopes with latest technology and concept

Endoscopic imaging systems that perform as the "eye" of the operator during endoscopic surgical procedures have developed rapidly due to various technological developments. In addition, since the most recent turn of the century robotic surgery has increased its scope through the utilization of systems such as Intuitive Surgical's da Vinci System. To optimize the imaging required for precise robotic surgery, a unique endoscope has been developed, consisting of both a two dimensional (2D) image optical system for wider observation of the entire surgical field, and a three dimensional (3D) image optical system for observation of the more precise details at the operative site. Additionally, a "near infrared radiation" endoscopic system is under development to detect the sentinel lymph node more readily. Such progress in the area of endoscopic imaging is expected to enhance the surgical procedure from both the patient's and the surgeon's point of view.     

中耳特种内镜检查与手术

目的：应用特种内镜－－变焦显微内镜及针形内镜进行中耳检查、治疗和手术,探讨其应用价值。方法：对不同的中耳病变应用不同的特种内镜,显微内镜外径４ｍｍ,最大放大倍数１５０倍,针形内镜外径１．９ｍｍ。配套使用的设备还有自行研制组装的多功能数字图像系统。结果：４９５例（耳）应用特种内镜检查与手术。有４８例分泌性中耳炎患者作鼓室穿刺抽液及鼓膜置管。７０例残余性中耳炎病人在特种内镜下作鼓膜成形术,其中２３例在显微内镜下进行,另４７例在针形内镜下手术,效果良好。显微内镜可调节为全景观察及显微检查,从大体至微细的正常结构或病理改变均有清晰显示。而应用针形内镜则可通过狭窄的耳道进行中耳检查及手术。连接数码图像系统,可获得高质量的图像并打印出彩色图文报告。结论：变焦显微内镜及针形内镜在中耳的检查、治疗及某些手术中有较好的应用价值。     

消化内镜清洗消毒方法改进及其效果观察

目的探讨消化内镜引起医源性感染的因素及预防对策。方法从内镜的清洗消毒方法、附件的消毒灭菌和管理方法、预防消毒后内镜的二次污染3方面完善和加强消化内镜的院感管理,比较改进法与原方法内镜的消毒合格情况。结果改进后内镜清洗合格率从改进前74.2%提高到82.9%(P<0.05);内镜消毒合格率从改进前95.0%提高到100%(P<0.005);活检钳及一次性器械合格率从改进前75%上升至100%(P<0.005);口塞、弯盘消毒合格率从改进前92%上升至100%(P<0.005);采取预防内镜二次污染措施后检测镜身与弯曲部合格率从92%上升至100%(P<0.05);检测活检孔道合格率从98%上升至100%(P>0.05)。结论通过完善和加强消化内镜的院感管理,内镜与附件合格率达100%,避免了内镜二次污染,从而预防和控制消化内镜引起的医源性感染。     

Percutaneous Valvular Leak Repair

Percutaneous closure of paravalvular leaks has been reported in patients who are poor operative candidates. Transesophageal echocardiography (TEE) currently plays an important role in procedures of this kind. TEE provides essential information regarding the characteristics of the dehiscence, periprosthetic regurgitation severity, during the intervention, procedure-related complications, immediate result of the procedure, and long-term follow-up. Also, three-dimensional TEE enables us to determine the location and number of the leaks, its shape, length, width, area, and extent, and would improve the ascertainment of the causes underlying failure of these techniques to reduce regurgitation secondary to the defect. All of this information could improve patient selection and results of this procedure in the future.     

Systemic Capillary Leak Syndrome

Systemic capillary leak syndrome is a rare condition characterizedby unexplained episodic capillary hyperpenneability. A shiftof fluid and protein from the intravascular to the interstitialspace results in hypovolaemia. Attacks vary in frequency, severityand duration and can be fatal, although they often remit spontaneously.During acute episodes there is a pathognomonic elevated haematocritand reduced serum albumin, frequently associated with a monoclonalgammopathy. Treatment has been largely empirical but there areanecdotal reports of beneficial therapy. We describe a furthercase which highlights the typical clinical presentation, courseand investigative findings and review the other cases described.     

Leak after vertical banded gastroplasty

We have reported the case of a morbidly obese patient who became gravely ill during the first day after vertical banded gastroplasty. The diagnosis of a leak from the stomach was established by a Gastrografin swallow, and ten additional operations were done before the patient was discharged on the 135th postoperative day.     

腹腔镜胆囊切除术后胆漏的临床分析

目的:探讨腹腔镜胆囊切除术后胆漏的原因、预防和治疗。方法:回顾分析2000年1月—2011年9月复旦大学附属中山医院青浦分院10例腹腔镜胆囊切除术后胆漏患者的临床资料。结果:1例开腹置管腹腔引流;5例置鼻胆管引流,并继续原腹腔引流,其中1例因腹腔引流管滑脱而剖腹冲洗后重置腹腔引流管;3例置鼻胆管引流,同时行超声引导下穿刺引流;1例开腹行胆管空肠Roux-en-Y吻合;全部患者于2～5周内痊愈。结论:腹腔镜胆囊切除术后出现胆漏应早期充分引流,一旦怀疑胆漏应尽早行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)检查,但关键在于预防胆漏。     

不同方法清洗内镜的消毒效果及其监测分析

目的对部分科室内镜清洗消毒效果进行监测,为推广高效清洗消毒方法提供科学依据。方法2005年6月至2006年8月对我院8个科室的内镜分别随机进行3次共161份标本进行细菌学检测。结果本次抽查检测内镜共计161份标本,检出阳性标本32份,阳性率为19.9%。其中,无酶清洗消毒标本84份,监测阳性22份,阳性率为26.2%;含酶清洗消毒标本77份,监测阳性10份,阳性率为13%。含酶清洗消毒与无酶清洗消毒比较,细菌阳性检出率差异有统计学意义(P<0.05)。结论含酶清洗消毒优于无酶清洗消毒,值得临床上进一步推广。     

不同方法清洗内镜的消毒效果及其监测分析

目的 对部分科室内镜清洗消毒效果进行监测,为推广高效清洗消毒方法提供科学依据.方法 2005年6月至2006年8月对我院8个科室的内镜分别随机进行3次共161份标本进行细菌学检测.结果 本次抽查检测内镜共计161份标本,检出阳性标本32份,阳性率为19.9%.其中,无酶清洗消毒标本84份,监测阳性22份,阳性率为26.2%;含酶清洗消毒标本77份,监测阳性10份,阳性率为13%.含酶清洗消毒与无酶清洗消毒比较,细菌阳性检出率差异有统计学意义(P＜0.05).结论 含酶清洗消毒优于无酶清洗消毒,值得临床上进一步推广.     

Low-Pressure/Spinal Fluid Leak Headache

Low cerebrospinal fluid (CSF) pressure results in neurologic deficits, of which the most common manifestation is headache. Typically, the headache is postural – and specifically, orthostatic – in presentation. There are three hypotheses to explain the occurrence of headache associated with low CSF fluid. The first is traction on pain-sensitive intracranial and meningeal structures; the second is CSF hypovolemia; and the third is spinal loss of CSF resulting in increased compliance at the caudal end of the CSF space. Spontaneous intracranial hypotension (SIH), once believed to be rare, is now more commonly recognized. It is typically associated with orthostatic headache (although initially it may not be) and one or more other symptoms such as alterations in hearing, nausea, vomiting, neck stiffness, diplopia, and visual field cuts. Magnetic resonance imaging (MRI) of the brain with gadolinium is the first study of choice, which typically reveals diffuse pachymeningeal enhancement and, frequently, cerebellar tonsillar descent and posterior fossa crowding. Epidural blood patch (EBP) is the treatment of choice. Surgery and epidural fibrin glue injection are options for those who fail conservative therapy and/or EBP.     

术后持续胆瘘的非手术治疗

1994年 1月～ 1999年 8月 ,我院用改良内镜鼻胆管引流 (ＭＥＮＢＤ) [1] 治疗 6例术后持续胆瘘患者取得满意效果 ,现总结报道如下 :1　临床资料和方法本组 6例 ,男 2例 ,女 4例 ,年龄在 2 4～ 6 7岁之间 ,病因为胆囊切除术后胆总管针眼瘘 1例 ,胆囊切除术后囊颈管残端瘘 2例 ,胆总管切开取石术后拔“Ｔ”管窦道破裂致胆瘘 1例 ,肝脏部分切除术后胆瘘 2例。术前准备与常规逆行胰胆管造影 (ＥＲＣＰ)相同。胆瘘引流管为改良鼻胆管。方法与普通ＥＲＣＰ相同。在Ｘ线监控下选择性插入胆漏的胆管 ,插管深度大于 5ｃｍ ,边送导管边牵拉导线使导管…     

Recurrent undifferentiated shock: Idiopathic Systemic Capillary Leak Syndrome

Idiopathic Systemic Capillary Leak Syndrome is a potentially fatal disorder that is under diagnosed. It commonly presents as recurrent undifferentiated shock with hypotension, hypoalbuminemia and hemoconcentration. There are three distinct phases that define the syndrome; Prodromal, Extravasation and Recovery.