内镜下高频电治疗消化道息肉临床分析

目的探讨内镜下高频电治疗消化道息肉的临床效果。方法对36例(50枚)消化道息肉实施内镜下高频电治疗,术后定期复查内镜,观察治疗效果。结果 36例(50枚)息肉均成功切除。术后2例发生出血,内镜下予以止血,未发生穿孔等严重并发症。术后1a复查胃镜,未见复发病例。结论实施内镜下高频电治疗消化道息肉,操作简单、并发症少、有效率高。     

腹腔镜肝切除技术的立体化培训实践

目的 建立腹腔镜肝切除技术培训的方法,评价其教学效果. 方法 通过理论授课、影像学习、模拟训练、动物实验、临床实践等一套立体化培训方法,对2010年6月至2012年6月38名医师进行腹腔镜肝切除技术的培训,培训周期为1个月.结果 38名受训者均掌握腹腔镜肝切除的基本操作,在上级医师指导下均可完成腹腔镜肝左外叶切除及肝脏边缘局部切除等较为简单的手术过程,3个月内可独立完成上述手术.结论 本研究所建立的立体化培训方法教学效果较好,腹腔镜“模式化”肝左外叶切除可以作为腹腔镜肝切除技术培训的切入点.     

内镜黏膜下隧道切除术治疗上消化道肿瘤疗效分析

目的内镜黏膜下隧道切除(ESTD)技术是在消化道黏膜层与肌层之间建立隧道,在该隧道空间中进行内镜操作。该文旨在评价ESTD在上消化道肿瘤切除中的应用价值。方法通过数据库检索2007年至2014年国内外关于ESTD治疗上消化道肿瘤的临床报道,系统分析该技术的操作技巧、临床应用及并发症情况。结果共入选16篇文献,涉及病例196例,其中恶性病变33例,良性病变163例。多数报道肿瘤最长径3cm,手术完全切除率及整块切除率均接近100%。常见的手术并发症为消化道穿孔,根据不同的肿瘤大小、肿瘤位置等,术中穿孔发生率波动于0~100%,但未发生术后持续的消化道穿孔。无周围脏器损伤、大出血、严重纵隔感染等严重并发症的报道。结论 ESTD治疗上消化道黏膜下良性病变具有有效、安全、微创的特点。当肿块最长径3cm时,可达到与外科手术治疗相当的水平。     

腹腔镜辅助的全小肠内镜检查

目的:探讨腹腔镜辅助全小肠内镜检查的可行性。方法:腹腔镜辅助下用内镜逐段对实验猪小肠进行检查,发现模拟病变后切除。结果:内镜检查肠管长度250 ~540cm,平均( 320±140 )cm。手术时间40 ~120min,平均( 78±36 )min。动物内镜检查均发现模拟病变,完成模拟病变肠壁切除。结论:腹腔镜辅助全小肠镜检查技术上是可行的。     

内镜下结肠息肉切除术出血的预防

结肠息肉是下消化道的一种常见病,息肉可并发出血或恶变,确诊后需及时切除。内镜下高频电凝切除术是治疗消化道息肉的有效方法,但对于直径≥1.0cm体积较大的息肉,特别是广基无蒂或粗蒂宽基底息肉的患者,用圈套高频电切除,术后出血和穿孔是常见并发症。2010年2月—2011年10月,我院在内镜下高频电圈套切除息肉中使用注射剂和金属钛夹,减少了出血和穿孔等并发症,现报告如下。1资料与方法     

以内镜黏膜下剥离术为基础的消化内镜外科微创治疗的进展

发现与治疗消化道病变,一直是内镜医师关注的焦点.1973年Dehle等[1]发明注射生理盐水切除结肠无蒂息肉的方法,1984年多田正弘等[2]首次将该技术用于诊治早期胃癌,并将之命名为“剥脱活检(Strip Biopsy)”,又称“内镜黏膜切除术( EndoscoMucosal Resection,EMR)”.此后,随着内镜技术的改进与器械的发明,EMR技术得到不断发展与创新,透明帽法、套扎器法、黏膜分片切除术等内镜下手术方式相继问世.但EMR切除病变的局限性和不完整性,促使着人们思考更新的技术去剥离更大、更完整的组织.1994年,Takeoshi等[3]发明了尖端带有陶瓷绝缘头的新型(Insulatedtip Knife,IT)电刀,它使医生对更大的胃肠道黏膜病变进行一次性完整切除成为可能.     

内镜下黏膜切除术治疗结直肠无蒂息肉52例

目前对结直肠息肉的治疗首选内镜下切除,但经内镜切除大的无蒂结直肠息肉比较困难,且容易发生结肠穿孔和出血。内镜黏膜切除术（endoscop-ic mucosal resection ,EMR）是近10年来发展起来的诊治消化道扁平病灶的一项新技术,自2009年1月-2012年5月,我院对52例结肠广基息肉行肠镜下EMR,取得良好疗效,现总结如下。     

腹腔镜手术治疗胃镜黏膜下剥离术致胃穿孔9例报告

正随着内镜操作技术的不断提高与器械的改进,内镜技术得到不断发展与创新,内镜检查发现的胃肠道局部病变行内镜下微创切除一直是内镜医师努力的目标。近十年,内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在临床的应用与发展对消化道黏膜及黏膜下病变的治疗产生了重要影响,部分早期胃癌亦可应用ESD技术~[1]。与外科手术相比,内镜切除术具有疗效相近、侵袭性小的优点,充分体现了"微创治疗"的优越性,与单纯的电灼等其他内镜治疗方法相比,内镜切除术具有获     

医护四手操作模式在结直肠息肉内镜下切除术的应用效果

为探讨医护四手操作模式在结直肠息肉内镜下切除术(EMR)中的应用效果,选择拟行结直肠息肉EMR治疗的160例患者随机分为对照组和观察组,各80例,对照组接受单手操作模式治疗,观察组接受医护四手操作模式治疗,比较2组单颗息肉切除时间、手术时间、黏膜下注射一次性成功率、圈套器切除一次性成功率、钛夹封闭一次性成功率及医师满意...     

脑室内血肿动物模型制作方法的研究

目的:通过研究脑室内血肿动物模型的制作方法,为神经内镜技术的培训提供较理想的疾病模型。方法:将60头实验用猪平均分为3组,分别采用CT定位下脑室穿刺自体血注入法、超声引导下脑室穿刺自体血注入法、神经内镜下脉络丛动脉切断法制作脑室内血肿疾病模型。通过对比3种方法的优缺点,确定一种操作简单、适宜培训的模型制作方法。结果:CT定位下脑室穿刺自体血注入法的成功率为90%(18/20),超声引导下脑室穿刺自体血注入法成功率为65%(13/20),神经内镜下脉络丛动脉切断法成功率为15%(3/20)。结论:CT定位下脑室穿刺自体血注入法制作脑室内血肿动物模型成功率较高,可重复性强,可为培训神经内镜技术提供较理想的疾病模型。     

Therapeutic tactics in patients operated on for diffuse polyposis of the colon

The endoscopic sanitation is possible in patients operated upon for diffuse polyposis in cases of the absence of malignization of the polyps in the other parts of the colon. The endoscopic polypectomy performed on patients with diffuse polyposis allows preserving the rectum in 88.8% and the upper parts of the gastrointestinal tract in 99.1% of the cases.     

Endoscopic removal of small intestinal polyps in total polyposis of the digestive tract

In patients with proliferative and mixed forms of total polyposis of the digestive tract the intestinal polyps are mainly localized in the duodenum, with hamartomal polyposis--in the jejunum and ileus. The endoscopic polypectomy from the small intestine may be performed intraoperatively and during endoscopy under narcosis. 174 polyps with the diameter of 0.5-5 cm were removed in 27 patients. There were 3 complications (bleedings) after polypectomy.     

结肠镜下结肠息肉摘除术后延迟出血18例

为探讨结肠息肉摘除术后延迟出血在结肠镜下治疗的价值,对18例行结肠息肉摘除术后24-72h肠道出血的患者,行结肠镜检查和内镜下治疗。结果显示,对结肠镜检查发现的出血部位,立即于结肠镜下行注射治疗和电凝治疗可使出血停止。18例全部治愈,未发生任何并发症。结果发明,结肠镜下治疗结肠息肉摘除术后延迟出血,是可行、有效和安全的方法。     

Establishing a flexible sigmoidoscopy/colonoscopy program for surgical residents. The University of Illinois experience

The clinical value of lower gastrointestinal endoscopy and the requirement of the American Board of Surgery for endoscopic training mandate establishing a program in flexible sigmoidoscopy and colonoscopy for all surgical residents. In a 12-month period, the surgical residents at the authors' institution performed 599 flexible sigmoidoscopic and 116 total colonoscopic examinations under the supervision of two attending colorectal surgeons, with no mortality and a 0.03 per cent morbidity. There was an average of 42 endoscopic examinations per resident for the 3-week training period. Three hundred seventy (62%) of the flexible sigmoidoscopic examinations were for screening and 229 (38%) were for the evaluation of symptomatic patients. Colorectal polyps were identified in 68 patients (11.4%) and carcinoma in 14 patients (1.9%). Forty-nine per cent of the colonoscopic examinations were for endoscopic polypectomy. Sixty-four per cent of patients with more than one adenomatous polyp harbored polyps in different surgical segments of the colon. Every resident was able to perform flexible sigmoidoscopy safely by the end of the 3-week training period, and in addition, the residents rated their endoscopic experience as a valuable part of their surgical training.     

Endoscopic polypectomy in the surgical treatment of diffuse polyposis of the large intestine

The article analyses experience in the treatment of 81 patients with diffuse polyposis who underwent subtotal resection of the colon with abdominoanal resection of the rectum and downward displacement of the right parts into the anal canal. It is shown that growth of the remaining occasional polyps and appearance of new polyps are encountered in the maintained parts of the colon and upper parts of the gastrointestinal tract in the postoperative period. The authors found that endoscopic polypectomy allows the right colon to be preserved in 92.6% of cases and the upper digestive tract in 97.5% of cases at a minimum risk of a surgical intervention.     

Peutz-Jeghers综合征临床综合治疗模式初探(附71例报道)

目的探索将临床综合治疗模式应用于Peutz-Jeghers综合征(PJS)的临床治疗效果。方法 2000年1月至2010年12月期间我院收治的71例PJS患者先接受内镜下息肉灼除或圈套切除,对无法镜下切除或出现严重并发症者进行外科解救治疗;在内镜或手术治疗后对患者进行宣教,签署知情同意书者口服塞来昔布6～9个月进行预防性治疗。定期随访,对其治疗结果进行分析。结果 71例(男41例,女30例)中有家族史者29例(40.8%)。62例共行94次手术,肠套叠为其最主要的手术原因(72.3%,68/94)。65例行169次双气囊电子小肠镜下治疗,共摘除或灼除胃肠道息肉1 714枚,最大者直径8 cm;3例发生小肠穿孔。口服塞来昔布者共8例,完成6个月疗程者共3例,息肉的数量减少、大小缩小。结论包括局部治疗(内镜)、解救治疗(手术)、预防治疗(药物干预)的综合治疗模式用于PJS胃肠道息肉的临床治疗是积极、有效的。     

Peutz-Jeghers syndrome in children: high recurrence rate in short-term follow-up

We have managed four cases of Peutz-Jeghers syndrome (PJS) in children. Fathers of three of these patients had PJS. There was also a family history of cancer in three cases, with pancreatic cancer in a father, colonic and laryngeal cancers in a grandfather, and hepatic and gastric cancers in a grandmother. It is presumed that in each of the cases, the largest polyp was responsible for initial symptoms. Preoperative examination revealed additional small polyps in the whole alimentary tract except for the oesophagus. Patients underwent laparotomy to remove the largest polyps and subsequent intraoperative endoscopic polypectomy for other small polyps, to minimize intestinal resection. Follow-up gastrointestinal examinations, including upper gastrointestinal series, small intestinal contrast study, and barium enema, were repeated about once a year. Three of four cases showed recurrent small intestinal polyps, and one required a second laparotomy because of recurrent abdominal pain. In conclusion, patients with PJS occurring in childhood have a strong hereditary family history of cancer and a high incidence of recurrence. Careful follow-up examination is mandatory for the gastrointestinal tract, as well as other solid organs that are susceptible to malignant change, throughout a patient's life.     

Experience in the endoscopic management of large colonic polyps

Background: Large colonic polyps present a particular challenge to endoscopists because of the risks of significant haemorrhage, perforation, inadequate polypectomy, or trying to snare an unrecognized cancer. The alternative to endoscopic therapy of large polyps is surgical resection and although minimally invasive techniques are available, risks are significant. Although neither surgery nor endoscopy is a perfect way of treating large colonic polyps, endoscopic resection is usually tried first. Most series of endoscopic polypectomies are small, include both rectal and colonic polyps and have varying size and shape criteria. The purpose of the present study is to describe a large consecutive series of colonic polyps evaluated endoscopically, to determine the chances of performing a safe, effective endoscopic polypectomy. Methods: All colonic polyps>20 mm in maximum dimension assessed during colonoscopy from 1989 to 2002 were reviewed. Rectal polyps were excluded. Demographic data for the patients were abstracted, as were data regarding the outcomes of polyp assessment and treatment. Primary end‐points were: the need for surgical resection, the incidence of postpolypectomy complications and the persistence of the index polyp at follow up. Independent variables included the endoscopically assessed size of the polyps, the year in which the polypectomy took place, the shape of the polyps and their location within the colon. Results: During the period under review 311 large polyps were removed from 252 different patients. Of these, 263 polyps were removed endoscopically and 48 polyps were removed surgically. An additional 18 endoscopically removed polyps ultimately needed surgery for recurrence or malignancy. There were no deaths but 19 complications of endoscopic polypectomy (17 late haemorrhage and two postpolypectomy syndrome). At first follow up, 22% of polyps had persisted, this decreased to 14% at second follow up and 7% at third. Complications were more common in right sided polyps and in flat or sessile lesions. Pedunculated polyps never persisted or recurred and had the lowest rate of surgery. Larger polyps had higher rates of advanced histology, complications, polyp persistence and the need for surgery. Conclusions: Polyp size, location and shape influence the results of endoscopic resection of large colonic polyps. Polyps>30 mm in maximum diameter are significantly more advanced histologically but also significantly more difficult to treat successfully than those <30 mm. However, size alone is rarely a contraindication to endoscopic resection.     

无痛胃肠镜下息肉摘除术治疗肠道息肉的疗效观察

目的 了解肠道息肉患者临床行无痛胃肠镜下息肉摘除术的具体操作方法,并对其临床疗效展开系统性的评价.方法 选取南通大学第二附属医院2019年6月至2021年6月收治的80例肠道息肉患者,以1:1的比例分为对照组和观察组,每组40例,对照组和观察组的治疗方法分别选用腹腔镜息肉摘除术、胃肠镜下息肉摘除术,比较两组患者的手术相...     

Laparoscopic-assisted colonoscopic polypectomy--indications and results

OBJECTIVE: Endoscopic treatment of large, sessile or awkward localized polyps, especially in the colon sigmoideum or the coecum holds the risk of colonic perforation. For these cases the combined colonoscopic-laparoscopic approach is described in this publication as an alternative procedure. PATIENTS AND METHODS: Since 1995 23 patients (male 11, female 12, age 70.7 +/- 12.0 years) were treated by laparoscopic-assisted colonoscopic polypectomy. Thirteen polyps were localized in the colon descendens or sigmoideum, seven in the cecum and one in the right respectively the left colonic flecture. Under general anesthesia and modified lithotomy position laparoscopy with occlusion of the colon or terminal ileum was followed by colonoscopy. After endoscopic localization the polyp was removed under laparoscopic visualization. During this procedure the colonic wall was stabilized, interfering adhesions were cut and coagulation- induced lesions of the wall were laparoscopically sutured if needed. RESULTS: In 17 patients the endoscopic polypectomy could be performed laparoscopically-assisted. In two patients the polypectomy was done by colotomy and in two others by segmental colonic resection due to the volume of the polyp. In two patients with histologically verified carcinoma laparoscopic-assisted left hemicolectomy was performed secondarily. Intra- or perioperative complications did not occur. CONCLUSION: Laparoscopic-assisted colonoscopic polypectomy is a new minimal-invasive therapeutical approach in selected cases with large, sessile or arkward localized polyps. The endoscopic procedure is possible also in polyps which should be treated by colotomy or segmental resection in the past. The additional discomfort for the patients due to laparoscopy is minimal.