消化内镜超级微创不同治疗通道的手术新进展

超级微创是医学手术史上全新的阶段,也是未来治疗学的终极理念。其原则是基于保持人体解剖结构不变的情况下祛除疾病,核心是患者术后恢复原样,治疗前后整个身体无大差异。超级微创理念下的治疗希望达到完美无缺的程度,患者生活质量保持不变,生存时间不受该疾病影响,完全区别于目前的传统外科和微创外科以切除器官为代价的手术模式。目前对于超级微创不同治疗通道以及相关的研究并没有进行梳理。本文将对消化内镜超级微创不同治疗通道的手术新进展进行综述。超级微创的消化内镜手术通道分为4大类,包括消化管道单通道、多腔隙双通道、隧道技术通道和穿刺通道。未来的超级微创理念手术都将在这些通道内进行新的术式研究。     

活体猪模型在高阶内镜治疗技术培训中的应用价值

目的通过活体猪模型实验,进一步证实和明确其在高阶内镜治疗技术培训中的应用价值。 方法选取6名受训者接受活体猪模型培训,之后6名受训者与6名对照者均进行手把手教学培训。随后,对于受训者接受活体猪模型和手把手培训的差异性,以及受训者和对照者关于是否接受活体猪模型培训的差异性分别进行对比。 结果所有活体猪模型和手把手培训手术均未出现术中大出血及术后迟发性出血,两种培训手术术中各有2例局部微小穿孔,以组织夹可有效封闭,均无术后迟发性穿孔;所有实验动物及患者未出现其他严重并发症。所有手术均完整剥离了病变,仅少数需上级带教医师接手后完成。接受活体猪模型培训后,受训者自身的剥离时间和剥离速度明显改善(P< 0.05);相比于对照者,受训者的手术时间(包括各步骤时间)、剥离速度以及手术完成度评分、注射评分、切开评分均明显改善(P< 0.05)。 结论活体猪模型用于高阶内镜治疗技术的培训是安全有效的,其对于改善初学者的学习曲线及有效应对并发症均有所帮助。     

活体猪模型在超级微创内镜隧道法黏膜下剥离手术培训中的应用

目的对活体猪模型在超级微创内镜隧道法黏膜下剥离手术(ESTD)培训进行初步的探讨。 方法对消化内镜培训者进行为期3个月的隧道法黏膜下剥离术的动物培训,共操作活猪8头,分别建立超级微创内镜黏膜下剥离术(ESD)和ESTD动物训练模型。训练者进行手术理论学习,在高年资医师的指导下进行ESTD术和ESD术,记录ESD和ESTD的总体操作时间,隧道长度,创面面积大小,操作速度(创面面积/时间)。使用调查问卷检测学员培训前后的能力变化。数据使用SPSS.23统计软件进行分析。 结果ESD和ESTD手术解剖模型在手术训练中,未出现不可处理的术中大出血和术后延迟性出血。ESTD模型出现食管小穿孔2例,均使用软组织夹进行封闭处理,2种手术模型均无延迟穿孔。分别有1例ESTD和3例的ESD未完成而需要高级医师接手,未出现动物死亡的情况。 结论活体猪模型用于内镜隧道法黏膜下剥离手术培训安全且可行,相对于传统ESD手术在黏膜下剥离的培训过程更有优势。     

Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms

With the development of cross-sectional imaging modalities and the increasing attention being paid to physical examinations, the prevalence of pancreatic cystic neoplasms(PCNs) has increased. PCNs comprise a broad differential spectrum with some PCNs having low or no malignant potential and others having high malignant potential. The morbidity and mortality rates related to major pancreatic surgical resection are high. Long-term surveillance may not only increase the financial burden and psychological stress for patients but also result in a missed malignancy. Minimally invasive endoscopic ultrasound(EUS)-guided ethanol ablation was first reported in 2005. Several other agents, such as paclitaxel, lauromacrogol, and gemcitabine, were reported to be effective and safe for the treatment of PCNs. These ablative agents are injected through a needle inserted into the cyst via transgastric or transduodenal puncture. This treatment method has been substantially developed in the last 15 years and is regarded as a promising treatment to replace surgical resection for PCNs. While several reviews of EUS-guided ablation have been published, no systematic review has evaluated this method from patient preparation to follow-up in detail. In the present review, we systematically describe EUS-guided injective ablation with regard to the indications, contraindications, preoperative treatment, endoscopic procedure, postoperative care and follow-up, evaluation method, treatment efficiency, safety profile, tips and tricks, and current controversies and perspectives.     

内镜下黏膜切除及黏膜剥离术的治疗进展

近年来随着内镜技术的进步,内镜下黏膜切除术（endoscopy mucosal resection,EMR）和内镜黏膜下层剥离术（endoscopic submucosal dissection,ESD）逐渐成为一种切除消化道癌前病变与早癌的一种标准微创治疗手段,随着癌前病变与早癌检出率的升高,用于内镜下黏膜切除术与内镜黏膜下层剥离术的附件与技术也在不断的完善与提高。     

Stent implantation through rendezvous technique of PTBD and ERCP: the treatment of obstructive jaundice

OBJECTIVE: To study the technical method and clinical value of stent implantation through the rendezvous technique of percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) in patients with obstructive jaundice. METHODS: Thirty-six patients with obstructive jaundice underwent the rendezvous technique of PTBD and ERCP after initially unsuccessful ERCP. RESULTS: The procedure of 36 cases were all successful. Sixteen cases underwent PTBD drainage from the bile duct through the right lobe approach and in 20 cases the left lobe approach was used. The one-stage procedure involved in the rendezvous technique of PTBD and ERCP was successful in 23 cases, while the other 13 cases underwent PTBD first and then rendezvous ERCP the next time. The serum total bilirubin 4 days later had decreased by 44.75%, and direct bilirubin had decreased by 45.61%. The main complication was infection of the bile duct. CONCLUSION: Stent implantation using the rendezvous technique of PTBD and ERCP is a new and feasible method to treat obstructive jaundice after initially unsuccessful ERCP. This may be of considerable value in clinical practice.     

消化内镜技师培训方法探讨

目的探讨消化内镜技师三级培训方法,以指导技师的临床教学工作。方法根据学员工作年资和基础,分初、中、高三种级别进行培训,各级别按理论培训、实践技能培训、考核三阶段实施。结果初级培训学员共54名,优秀率100％;中级培训学员共27名,优秀10名,良好15名,差2名;优秀率37％;高级培训学员共3名,优秀3名,优秀率100％。结论中级技师培训是消化内镜技师培训的重点和难点。     

超声内镜技术在超级微创切除术中的应用价值与机遇

“超级微创”（SMIS）理念作为一种全新的医学理念，可以在保留器官结构和功能完整的基础上治愈疾病，是未来治疗学的发展目标，目前已经在消化内镜领域广泛应用。对疾病的发展认识的提高是SMIS实施的前提。超声内镜（EUS）作为兼容了内镜与超声探查两类功能的检查方法，可以对消化道病变进行定位及定性诊断，尤其对早期病变的分析为进一步的精准治疗提供了依据。该文深入分析EUS在消化道疾病SMIS术前诊断中的价值，以期为未来的内镜治疗提供帮助。