Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections

Summary Bronchus stump insufficiency following lung resection, with an average incidence of 4%, is a serious complication which carries a mortality of up to 90%. Operative transthoracic approaches have been largely unsatisfactory because of the high operative risk and rapidly spreading infection. In an experimental study on 18 pigs, endoscopic occlusion of infected bronchus stump fistulae was achieved with fibrin sealant (1 ml, 500 units/ml thrombin, 3500 units/ml aprotinin) applied via a flexible bronchoscope. During autopsy, all bronchus stump fistulae were found to have healed after the second postoperative week. Transitory local abscesses of the pleura could be prevented by high-dose systemic antibiotic therapy for 5 postoperative days but not by antibiotics added to the fibrin sealant. This endoscopic method has already been performed successfully in 3 clinical cases; additional sclerotherapy with (2–3 ml Ethoxysclerol applied around the fistula orifice was carried out before fibrin sealing to stimulate fibrosis. Endoscopic controls demonstrated fistula closure by granulation tissue after 2 weeks. This procedure could become the method of choice for infected postoperative fistulae of the bronchus stump and should be attempted in any case before operative approaches are considered.     

SUCCESSFUL ENDOSCOPIC CLOSURES OF COLONIC PERFORATIONS REQUIRING ABDOMINAL DECOMPRESSION AFTER ENDOSCOPIC MUCOSAL RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY COLON CANCER

Endoscopic submucosal dissection (ESD) for colorectal cancer is not widely accepted because of its technical difficulty and the risk of perforation. In addition, the risk of peritonitis cannot be completely eliminated even if a perforation is closed successfully. Reported here are two cases of early colon cancer in which the patients sustained iatrogenic perforations of the ascending colon during conventional endoscopic mucosal resection and of the sigmoid colon during ESD, respectively, requiring abdominal decompression with an 18 G Medicut needle. Both of these perforations were successfully treated by endoscopic clipping. In conclusion, conservative medical management may be possible in patients who have undergone successful closure of colonic perforations using endoscopic clipping. In order to perform immediate endoscopic closure, abdominal decompression has been useful to decrease patient discomfort and colonic lumen collapse. Now, CO₂ insufflation is being used effectively for the prevention of pneumoperitoneum.     

Detailed Analysis of Mucosal Restoration of the Small Intestine After the Cavitary Two-Layer Cold Storage Method

Small bowel transplantation (SBT) is associated with a high incidence of infectious complications because of ischemia/reperfusion (I/R) mucosal injury concomitant with potent immunosuppression. In this study, we evaluated whether the cavitary two-layer method (cTLM) could reduce I/R injury and allow early mucosal restoration, particularly after prolonged preservation and transplantation. Canine heterotopic segmental SBT was performed immediately without preservation (group 1), after 24-h preservation in UW solution (group 2) or by the cTLM (group 3). The graft samples were taken 1 h after reperfusion and on days 1, 4 and 7. We assessed graft mucosa with detailed microscopic and electromicroscopic analyses. In Group 3, histological injury and cell apoptosis after transplantation were significantly alleviated and rapidly recovered to a similar level of group 1. The mucosal restoration was morphologically completed within 4 days. In contrast, in group 2, more pronounced mucosal injury and delayed recovery were noted. Crypt cell proliferation activity was well maintained in groups 1 and 3 throughout the experimental period. Our ultrastructural analysis suggested that mitochondrial integrity achieved by the cTLM was a basal mechanism under the prompt mucosal restoration. The cTLM could reduce I/R injury, facilitate mucosal regeneration and restore the nearly normal structure early after SBT.     

腹腔镜胆囊切除术前超声内镜检查胆总管必要性的探讨

目的 探讨腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）术前超声内镜（endoscopic ultrasonography,EUS）检查胆总管的临床价值。方法 对25例术前经腹超声检查诊断胆囊结石,胆总管内径〉0.7 cm可疑胆总管梗阻的患者进行EUS检查,并与手术结果或内镜十二指肠乳头切开术（endoscopic sphincterotomy,EST）取石结果进行比较。结果 EUS对于胆总管病变诊断的敏感性、准确性和阴性预测值[100%（17/17）、92%（23/25）、100%（6/6）]均优于经腹超声[35%（6/17）、56%（14/25）、42%（8/19）]（P=0.000,0.008,0.020）。结论EUS对胆总管病变诊断优于经腹超声检查,可作为术前常规检查,特别是当胆总管内径〉1.0 cm时,EUS应作为术前必检项目。     

鼻内镜鼻窦手术后应用香菊片对粘膜转归的影响

目的 观察内镜鼻窦手术后应用香菊片对术腔粘膜转归的影陶。方法 Ⅱ型鼻窦炎、鼻息肉患者180例作为治疗组，行内镜鼻窦手术后，在常规辅助治疗基础上加用香菊片口服，并设ll0例Ⅱ型鼻窦炎、鼻息肉患者作为对照组，对比观察术腔清洁时间、术腔上皮化时间及术后复发率。结果 治疗组术腔清洁时间平均为：Ⅰ期1．5周，Ⅱ期1．8周，Ⅲ期2．1周；对照组Ⅰ期2．0周，Ⅱ期2．5周，Ⅲ期3．3周，差异有显著性意义(P＜0．01)。治疗组术腔上皮化时间平均为：Ⅰ期7．0周，Ⅱ期7．5周，Ⅲ期7．8周；对照组Ⅰ期8．0周，Ⅱ期8．4周，Ⅲ期9．0周，差异有显著性意义(P＜0．01)。治疗组术后复发率为4．4％，明显少于对照组7．3％。结论 内镜鼻窦手术后，应用香菊片对鼻腔功能的恢复具有良好的疗效，并能减少复发率，可做为常规药物应用临床。     

儿茶酚胺类药物对感染性休克兔胃肠灌注的影响

Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.     

内镜下十二指肠乳头括约肌切开术治疗胆总管结石697例临床分析

目的 总结内镜下十二指肠乳头括约肌切开术治疗胆总管结石的疗效及并发症的处理经验。方法 回顾性总结了我院5年间经内镜十二指肠乳头括约肌切开术（EST）治疗胆总管结石697例的临床资料，分析临床应用的疗效及并发症的发生情况、种类、处理及预防的措施。结果 5年间697例EST取石术成功682例，成功率97．8％，并发急性胰腺炎25例（3．6％），消化道穿孔3例（0．43％），延迟出血5例（0．72％），术后胆管炎5例（0．72％），经内科保守治愈30例，外科手术治疗4例，内镜再次处理4例。结论 内镜下十二指肠乳头括约肌切开术治疗胆总管结石安全可行。熟练的内镜外科技术和丰富的开腹手术经验是完成此治疗的关键。     

输尿管口囊肿的微创手术治疗

目的评价输尿管口囊肿的微创手术治疗方法及其疗效。方法回顾性分析25例行经尿道电切（TURU）手术治疗输尿管口囊肿患者资料。男9例，女16例；年龄18—61岁，平均38岁；单侧18例，双侧7例；单纯输尿管囊肿22例，异位输尿管囊肿3例。结果25例患者手术一次成功22例，手术平均时间15min，术后平均住院3d。术后定期B超、膀胱造影随诊，随诊时间1—9年，3例异位输尿管囊肿合并重复肾、输尿管畸形患者存在术后膀胱输尿管返流，2例再次行开放手术后痊愈。结论TURU是治疗成人输尿管口囊肿的有效方法；当合并存在重复肾输尿管畸形或术后膀胱输尿管返流时，应采用输尿管膀胱抗返流手术。     

Is endoscopic one‐piece mucosal resection essential for early gastric cancer?

Background: Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However, the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods: We investigated 1101 EGCs that had been resected by EMR at the National Cancer Center Hospital (NCCH), Tokyo, Japan, according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results: The recurrence rate of non‐evaluable resection was higher than that of evaluable resection (P < 0.0001). Eighty‐three lesions among 772 lesions in the JGCA group were non‐evaluable. Thirty‐seven leisons among 329 lesions in the NCCH group were non‐evaluable. There was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.8329). However, the rate of curative resection was lower in the NCCH group than in the JGCA group (P = 0.0009). In piecemeal resection, there was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.0527). In one‐piece resection, the rate of non‐evaluable resection was lower in the NCCH group than the JGCA group (P = 0.0137). Conclusion: Based on our series of cases, we propose one‐piece resection as a gold standard for EMR because it enables accurate histological evaluation, even in the EMR, according to the expanded indication.     

经尿道前列腺电切术和汽化电切术并发症48例分析

目的 分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化电切术（TVP）术中、术后常见并发症的原因、预防及治疗，提高手术安全性和有效性。方法 回顾性分析1999年5月-2006年6月我院TURP和TVP术48例并发症患者的临床资料。结果 平均手术时间75min，平均切除组织41g。术中、术后出血20例，电切综合征（TURS）5例，暂时性尿失禁11例，膀胱颈部挛缩5例，尿道狭窄8例，尿路感染7例，膀胱穿孔1例。结论 TURP和TVP是良性前列腺增生症安全有效的外科治疗方法，术前详细采集病史，术中正确操作。术后对病人正确指导及处理可有效减少手术并发症。