吞咽石蜡油置胃管法的临床有效性研究

目的 探讨吞咽石蜡油置胃管法的临床有效性研究。方法 选择2019年1～11月进行治疗的患者90例作为对象,随机数字表分为对照组(n=45)和观察组(n=45)。对照组给予常规经鼻置胃管,观察组采用吞咽石蜡油置胃管法,比较两组患者的置管效果以及置管后不良并发症。结果 观察组患者一次成功置管的例数显著高于对照组(P0.05)。观察组患者置管过程中恶心、置管过程中呕吐的情况显著低于对照组(P0.05)。观察组患者出现咽喉不适症状、声带沙哑症状、食道出血症状及鼻腔出血症状的情况显著低于对照组(P0.05)。结论 使用吞咽石蜡油置胃管法,有助于提高患者的置管成功率并减少了并发症,值得推广应用。     

Relationship between vomiting reflex during esophagogastroduodenoscopy and dyspepsia symptoms

Aim: Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD. Methods: Subjects included 488 consecutive adults (mean age, 56.1 ± 8.9 years) who underwent transoral EGD for gastric cancer screening between February 2010 and March 2011. All procedures were performed by an endoscopist with 15 years of experience. Based on a questionnaire survey using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), symptoms (dyspepsia and acid reflux symptoms) and the number of vomiting reflexes during EGD were recorded. Results: Of the 488 subjects, 271 (56%) developed vomiting reflexes (mean, 4.2 times). This reflex‐positive group was younger (54.3 ± 9.5 years) than the reflex‐negative group (58.3 ± 7.7 years, P < 0.001). The number of subjects in the reflex‐positive group with a high FSSG dyspepsia score (2.27 ± 2.57 vs 1.23 ± 1.84; P < 0.001), acid reflux symptom score (1.96 ± 2.22 vs 1.34 ± 2.14; P < 0.01) or an esophageal hiatal hernia (14.8% vs 4.6%; P < 0.001) was significantly higher than in the reflex‐negative group. Multivariate analysis also showed a significant correlation between these four factors and the occurrence of vomiting reflexes. Using an FSSG dyspepsia score of 1 as the cut‐off offered 68% sensitivity and 57% specificity for predicting the occurrence of vomiting reflexes. Conclusion: Based on FSSG questionnaire responses on upper gastrointestinal symptoms, dyspepsia symptoms, in particular, are related to presence of vomiting reflexes during EGD.     

经鼻内镜眶尖和视神经管减压术治疗创伤性视神经病

目的探讨经鼻内镜眶尖和视神经管减压术治疗创伤性视神经病的疗效和影响因素。方法对该科2004年10月～2005年11月41例（42眼）经鼻内镜眶尖和视神经管减压术患者的临床资料进行回顾性分析。结果42眼中，21眼视力获得提高，有效率50．00％。伤后有残余视力和无眶尖骨折者疗效优于伤后无光感和有眶尖骨折者（P〈0．05）。伤后7d内接受手术和无视神经管骨折者术后视力提高百分比较7d后手术者和有视神经管骨折者高，但无统计学意义（P〉0．05）。结论经鼻内镜眶尖和视神经管减压术是治疗创伤性视神经病的有效手术方式。     

Utility of unsedated transnasal endoscopy for pharyngeal observation during esophagogastroduodenoscopy. A prospective study to assess cardiopulmonary function

Abstract

Objectives. Emergence of image-enhanced endoscopy has enabled an early detection of pharyngeal carcinoma. Pharyngeal observation during esophagogastroduodenoscopy (EGD) is sometimes difficult because of excessive reflexes and is a great burden to the patients and impacts on their cardiopulmonary function. In this study, the authors aimed to evaluate the utility of transnasal EGD (TN-EGD) in comparison with sedated and unsedated transoral EGD (TO-EGD) in pharyngeal observation using a continuous monitoring device. Methods. A total of 70 patients receiving diagnostic EGD (unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD) were enrolled in this study and were evaluated by the following three criteria: (1) numbers of patients with excessive gag and/or cough reflex, (2) vital signs before and during the pharyngeal observation, and (3) response to the request for vocalization or breath-holding. Results. Unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD were performed in 30, 20, and 20 patients, respectively. The rate of gag reflex was significantly lower in TN-EGD than in both types of TO-EGD (0% vs. 30%, chi-square test, p < 0.005). The changes in average values of both arterial oxygen saturation (SpO₂) and pulse rate (PR) in TN-EGD were smaller than those in sedated TO-EGD (?0.23% vs. ?1.23% in SpO₂ and 1.57 vs. 8.11 bpm in PR, p < 0.01, respectively). Unsedated TN-EGD patients could respond to the instructions of utterance and breath-holding during the observation (p < 0.05, p < 0.001, respectively). Conclusion. Unsedated TN-EGD is safe and feasible for pharyngeal observation during normal EGD examination.     

The management of foreign bodies in the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO)

INTRODUCTION

We describe our experience of the diagnosis and removal of foreign bodies from the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO) under local analgesic. The advantages of this novel instrumentation and technique are discussed.

PATIENTS AND METHODS

Patients were examined with a Pentax 80K Series Digital Video Endoscope after local analgesia. The instrument was passed transnasally examining the oro- and hypopharynx, and then passed into the oesophagus. The presence, type and site of a foreign body could then be established. If a foreign body was detected, such as fish bone, it was extracted using flexible grabbing forceps passed down the instrument channel and delivered through the nasal or oral cavity. The object was then inspected to ensure removal in its entirety.

RESULTS

Five cases have been successfully managed using TNFLO.

CONCLUSIONS

TNFLO represents an improvement in the diagnosis and subsequent treatment of a selected group of foreign bodies as compared with established methodologies.     

Comparison of investigation modalities for evaluation of esophageal peristaltic function

We reviewed the recent literature concerning investigations of esophageal peristaltic function. The gold standard for the assessment of esophageal peristaltic function is manometry with pH monitoring. Even with this investigation modality, however, we are in fact doing no more than estimating esophageal peristaltic function from the manometry and pH results. With esophageal fluoroscopy and scintigraphy, where we observe esophageal motility, there are problems with radiation exposure and handling of radioactive agents that make widespread use difficult. In recent years, the development of multichannel intraluminal impedance (MII) manometry has allowed simultaneous measurement of intraesophageal pressure and assessment of esophageal peristalsis. Using MII it is also possible to distinguish whether gas or liquid is passing down the esophagus. When manometry is performed in conjunction with transnasal esophagogastroduodenoscopy, with this unique combination it is possible to measure the intraesophageal pressure while actually observing the swallowing motion at the same time. Assessment of esophageal peristaltic function is now moving from simple measurement of intraesophageal pressure to simultaneous impedance manometry and endoscopic observation of esophageal peristalsis itself.     

13例经鼻内镜下复发性鼻咽纤维血管瘤切除术的围手术期护理

目的探讨DSA超选择供瘤动脉栓塞术后经鼻内镜切除复发性鼻咽纤维血管瘤的护理方法。方法对我院13例复发性鼻咽纤维血管瘤患者采用DSA超选择动脉栓塞加鼻内镜切除术的护理进行回顾性总结分析。结果13例患者均造影栓塞成功后,经鼻内镜切除复发性鼻咽纤维血管瘤,无并发症,均康复出院。结论DSA超选择供瘤动脉栓塞术后经鼻内镜切除复发性鼻咽纤维血管瘤可减少肿瘤组织的残留、降低肿瘤的复发率。术前个性化的心理护理、术后严密的病情观察、适当的体位及饮食护理、局部对症处理对手术顺利开展及术后并发症的预防、患者早日康复有重要的作用。     

13例经鼻内镜下复发性鼻咽纤维血管瘤切除术的围手术期护理

目的探讨DSA超选择供瘤动脉栓塞术后经鼻内镜切除复发性鼻咽纤维血管瘤的护理方法。方法对我院13例复发性鼻咽纤维血管瘤患者采用DSA超选择动脉栓塞加鼻内镜切除术的护理进行回顾性总结分析。结果13例患者均造影栓塞成功后,经鼻内镜切除复发性鼻咽纤维血管瘤,无并发症,均康复出院。结论DSA超选择供瘤动脉栓塞术后经鼻内镜切除复发性鼻咽纤维血管瘤可减少肿瘤组织的残留、降低肿瘤的复发率。术前个性化的心理护理、术后严密的病情观察、适当的体位及饮食护理、局部对症处理对手术顺利开展及术后并发症的预防、患者早日康复有重要的作用。