Endoscopic treatment of oesophageal leiomyoma: four new cases

Abstract Background and study aims: The advent of endoscopic techniques in the last decades has produced a change in the approach of the oesophageal leiomyoma. The aim of the study is to explain our experience in the laparoscopic surgery of the oesophageal leiomyoma. Materials and methods: We realised a retrospective study of the oesophageal leiomyoma operated on in our centre by the endoscopic approach between 2001 and 2004. There were two females and two males. All were symptomatic and pyrosis was the most frequent symptom. The preoperative study was an oral endoscopy and barium swallow. In all the cases enucleation was performed, two by thoracoscopy and two by laparoscopy approach. Results: The mean operating time was 230 min. No deaths or intraoperative complications occurred and there were no cases of conversion to open surgery either. The mean postoperative hospital stay was 3.25 days (range 2–4 days). There was no case of recurrence. Conclusions: The enucleation is an easier procedure and constitutes the therapy of choice of the oesophageal leiomyoma. We think that muscle borders should be closed after enucleation and that biopsy is not indicated preoperatively.     

The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain.

OBJECTIVE: This study was designed to determine the relationship between interstitial cystitis (IC), endometriosis (endo), and chronic pelvic pain (CPP) in individuals in whom nongynecological and nonurological problems had been previously ruled out. METHODS: A prospective study of 162 consecutive women with a complaint of chronic pelvic pain seen in the clinic was performed between August 2002 and December 2005. These patients underwent a workup to exclude other causes of pelvic pain, had PUF (Pain Urgency and Frequency) questionnaires filled out, and underwent a laparoscopy and a cystoscopy with hydrodistention. Pain levels were determined, and treatment was reviewed and enumerated. Results were obtained and quantified. RESULTS: In this study, 123 (76%) patients were diagnosed with active endometriosis, 133 (82%) were diagnosed with interstitial cystitis, and 107 (66%) had both disease entities simultaneously. Thirteen (8%) patients were diagnosed with pathologies unrelated to endometriosis and interstitial cystitis. Pain levels were seen to decrease at 6 months in all groups of patients with the exception of those patients with endometriosis only. CONCLUSION: CPP is a difficult, taxing, and frustrating concern for many women in the United States. These individuals have traditionally been difficult to treat. A large number of women with CPP in our patient population have been shown to have endometriosis, interstitial cystitis, or both. Therefore, a workup for premenopausal individuals with CPP involves obtaining a history that keys into possible nongynecologic causes of pain, a complete accounting of urinary problems, and a thorough history of gynecological problems. A physical examination with a comprehensive history should be performed, and the investigation may include the possibility of a simultaneous laparoscopy and cystoscopy if warranted. These procedures can serve as both a means for diagnosis and treatment of these problems when encountered.     

内镜腔内手术的实验研究

目的探讨内镜腔内手术的可行性. 方法 6只家猪经皮建立胃内通道,腹腔镜引导下胃内模拟缝合止血操作实验. 结果 6只家猪均很好地耐受了手术.术后开腹检查所有胃壁缝合处无渗漏及其它脏器损伤.建立胃内通道时间、胃内缝合时间及总手术时间分别为(60.5±12.2)min、(26.5±5.78)min和(92.1±15.0)min. 结论内镜腔内手术在技术上是可行的.     

消化道类癌的诊断与治疗(附44例报告)

目的探讨消化道类癌的诊断与治疗. 方法回顾性分析我院1990年1月～2005年4月44例消化道类癌的临床资料. 结果本组44例中直肠(包括直肠乙状结肠交界处)类癌29例发生率最高65.9%(29/44),结肠4例9.1%(4/44),阑尾1例2.3%(1/44),小肠2例4.5%(2/44),十二指肠2例4.5%(2/44),胃5例11.4%(5/44),肝1例2.3%(1/44).44例中治疗了39(39/44,88.6%),其中手术切除14例,内镜下粘膜切除术(EMR)20例(5例EMR后病理断端残余癌细胞又追加手术局部切除),内镜下直接钳除5例,5例未治疗.直径≤1 cm 30例占68.2%, 26例全部治愈,15例(50%)行EMR完全切除,其中20例肠镜随访10～84个月,均无复发,预后好;直径1～2 cm 4例占9.1%,手术局部切除,1例1年后肝转移;直径>2 cm 10例占22.7%,均位于直肠外,8例手术,2例未治疗,3例死亡,5例有远处或淋巴结转移,预后差.44例中6例发生远处或淋巴结转移,转移率13.6%. 结论内镜是诊断消化道类癌的首选方法,≤1cm的类癌可在内镜下行EMR切除.     

Photodynamic therapy of tumours in gastroenterology—a review

Photodynamic therapy (PDT) is the local destruction of tissue by the interaction of light with a previously administered photosensitizer producing a photochemical effect. This technique has been demonstrated to permit the eradication of small tumours in experimental and clinical practice, with clear biological advantages. This paper reviews PDT experience in gastroenterology, together with concepts currently under experimental investigation.     

神经导航内窥镜辅助下单鼻孔入路垂体腺瘤切除

目的神经导航、内窥镜辅助下垂体腺瘤的经单鼻孔经蝶手术治疗。方法对6例经磁共振成像诊断垂体腺瘤的病人术前进行磁共振成像定位,将影像资料输入导航工作站,作术前手术计划。采用零度及45度镜经单鼻腔,在导航的动态指引下确认鞍底,于内窥镜下实施瘤实质切除。结果本组5例完全切除,1例因为瘤实质较韧而作大部分切除,术后病人的视力均得到了改善。导航预期误差1.48mm,实际误差1.8mm。结论神经导航引导下的经鼻蝶垂体腺瘤手术定位准确,内窥镜下操作对鼻腔的解剖结构影响小、组织损伤轻,病人恢复快。     

60例胃癌临床资料分析

目的：探讨胃癌的临床特点以及内镜、CT对胃癌的术前诊断价值。方法：对60例手术切除，且具备内镜、CT检查资料的进展期胃癌病例进行回顾性分析。结果：胃癌的临床表现缺乏特异性；内镜是直接、准确的检查方法，对肿瘤腔内的诊断准确率达95.0%；CT能估计肿瘤的腔外扩展情况。结论：重视非特异性临床表现，综合内镜、CT检查能提高对胃癌的术前诊断水平，从而使胃癌得到及早诊断和合理治疗。     

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。     

CT结合内镜检查诊断胃肠道间质瘤的价值

目的：探讨CT结合内镜检查诊断胃肠道间质瘤(GIST)的价值。方法：回顾分析18例均经手术病理检验证实为GIST病人的CT及内镜检查资料。结果：(1)18例GIST的CT表现为类圆形或分叶状肿瘤，边界清楚，13例平扫及增强密度均匀，强化明显，5例瘤灶内有坏死液化区；肿瘤周围肠管不同程度受压移位或粘连。(2)15例源于胃、十二指肠及结肠的间质瘤均行内镜检查，4例瘤侧胃壁镜下所见黏膜呈外压性改变者未行咬检；11例伴有溃疡形成，溃疡处咬检获取病理组织。(3)18例均行手术后光镜观察及免疫组化检查，18例CD-117均为阳性，13例CD-34阳性，10例Vimentin阳性。结论：CT与内镜相结合检查，能提高胃、十二指肠及结肠GIST定位、定性的准确性。     

经尿道手术治疗尿道狭窄与闭锁(附364例报告)

目的 提高经尿道手术治疗尿道狭窄与闭锁的成功率。方法 总结364例经尿道手术治疗尿道狭窄与闭锁的经验。患者平均年龄43岁。病程1个月～23年。尿道狭窄与闭锁长度平均2．2cm。结果 364例中手术成功343例(94．23%)，其中一次成功290例，二次手术成功34例，三次手术18例，四次手术1例；手术失败21例，其中20例改为开放手术，失败原因主要为骨盆骨折致尿道错位成角，骨片压迫尿道。术后268例随访4～138个月，平均34个月。17例感染性尿道狭窄者及29例骨盆骨折后尿道狭窄者术后曾需短期尿道扩张，其余排尿通畅。结论经尿道手术治疗尿道狭窄与闭锁安全、有效，是尿道狭窄与闭锁的首选治疗方法。术后尿道扩张是防止再狭窄的重要手段．