Endoscopic laser pancreatic cystogastrostomy

Traditionally the drainage of pancreatic pseudocysts has been carried out operatively, forming a cystenterostomy. A simple endoscopic method of forming a pancreatic cystogastrostomy with laser is presented. This procedure does not require a general anesthetic, is safe, and allows resolution of symptoms.     

Gastric ulceration caused by heater probe coagulation

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.     

Huge gastric diospyrobezoars successfully treated by oral intake and endoscopic injection of Coca-Cola

A diospyrobezoar is a type of phytobezoar that is considered to be harder than any other types of phytobezoars. Here, we describe a new treatment modality, which effectively and easily disrupted huge gastric diospyrobezoars. A 41-year-old man with a history of diabetes mellitus was admitted with lower abdominal pain and vomiting. Upper gastrointestinal endoscopy revealed three huge, round diospyrobezoars in the stomach. He was made to drink two cans of Coca-Cola every 6 h. At endoscopy the next day, the bezoars were partially dissolved and turned to be softened. We performed direct endoscopic injection of Coca-Cola into each bezoar. At repeated endoscopy the next day, the bezoars were completely dissolved.     

早、中期胃癌的临床病理学研究(附75例报告)

目的　了解早、中期胃癌的临床、胃镜和病理学特征。方法　回顾性分析我院 11年中经外科手术和病理诊断的 75例早、中期胃癌患者的临床、胃镜、外科手术和病理等方面资料。结果　早、中期胃癌临床表现无特征性 ,男女之比为 2 .41∶1,以 61～ 70岁最多 ,胃窦是其好发部位 ,病理组织学以管状腺癌为多 ,胃镜误诊率是 12 .86%,淋巴转移率是 2 5 .3 3 %。结论　早、中期胃癌有明显的好发年龄和好发部位 ,以管状腺癌为多 ,胃镜误诊的主要原因是不能鉴别病变的良、恶性和准确判断病变量 ,影响淋巴转移的因素是浸润深度、广度、肿瘤大小和年龄 ,而与性别、组织学的分化程度无明显关系。     

鼻内镜治疗颅底疾病112例报告

目的探讨鼻内镜径路治疗颅底疾病的价值。方法2002年5月~2006年12月,对112例颅底疾病行鼻内镜径路手术,其中脑脊液鼻漏39例,垂体瘤4例,脑膜膨出或脑膜脑膨出3例,蝶筛囊肿9例,蝶窦炎伴息肉2例,真菌性蝶窦炎12例,内翻性乳头状瘤11例,鼻咽纤维血管瘤6例,骨化纤维瘤2例,骨纤维异常增殖2例,脊索瘤7例,颅咽管瘤2例,鳞癌10例,未分化癌1例,乳头状瘤癌变2例。结果全组均在鼻内镜下处理,其中20例病变为次全切除,包括鳞癌8例、未分化癌1例、脊索瘤7例、颅咽管瘤2例、骨纤维异常增殖2例。脑脊液鼻漏1次手术成功31例(79.5%),2次成功4例,3次成功4例,最终成功率100%。1例脑膜脑膨出术后2个月复发并伴脑脊液漏,内镜下再次手术成功。1例内翻性乳头状瘤术后11个月复发,改行鼻侧切开术。1例真菌性蝶窦炎术后4个月复发行再次内镜手术。1例脑脊液鼻漏术后颅内感染。结论鼻内镜径路可以处理多种颅底疾病,是一种安全、有效、微创的手术方式,但仍需严格掌握手术适应证,特别是恶性肿瘤。     

内镜活检对胃癌组织学分类术前诊断的价值

目的 探讨内镜活检对胃癌组织学分类术前诊断的价值。方法 术前对141例胃癌患的内镜活检标本分别根据Lauren分类和世界卫生组织（WHO）分类判断组织学分类，并与手术标本结果对照。结果 内镜活检对胃癌Lauren分类术前诊断的准确率为76.6%。对肠型胃癌诊断的敏感性和特异性分别为85.4%和80.6%。而对弥漫型胃癌则分别为82.7%和80.3%，在59例术前诊断为肠型胃癌的病例中，18例（30.5%)在手术标本中呈弥漫性行生长，而在75例术前诊断为弥漫型胃癌的病例中，仅6例（8.0%)术后诊断为肠型胃癌，内镜活检对胃癌WHO分类术前诊断的准确率为87.2%，其中对乳头状/管状腺癌，黏液腺癌和印戒细胞癌的敏感性分别为91.9%。33.3%和66.7%。结论 内镜活检对胃癌组织学分类的术前诊断具有较高的临床应用价值。     

Complications of surgical endoscopy

Background: This study examines the notion that gastrointestinal endoscopy performed by supervised surgical residents is safe. Methods: We reviewed all gastrointestinal endoscopic procedures performed by surgical residents with faculty supervision for complications and deaths occurring up to 30 days following the procedures. Results: The overall complication rate for 9,201 upper and lower endoscopy procedures was 1.4% and 0.42%, respectively. Overall mortality rate was 0.76% for upper endoscopy and 0.6% for lower endoscopy. No mortality was a direct result of a procedure-related complication. Intestinal perforation, drug overdose, bleeding, and aspiration were the most common procedure-related complications. Each resident completed an average of 75 upper endoscopies and 79 lower endoscopies during their training period. Conclusions: Gastrointestinal endoscopy can be performed safely by surgical residents with appropriate supervision. The higher morbidity and mortality of upper endoscopy are most likely related to the underlying disease rather than the procedure. Awareness of common complications and application of appropriate precautions and instruction are critical for minimizing complications. Received 25 March 1996/Accepted: 24 April 1996     

Use of endoscopy in the management of postoperative ureterovaginal fistula

The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%). Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2 of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy) with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture, one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive. EDITORIAL COMMENT: This is an interesting paper that is worthy of mention because of an important concept in the management of an iatrogenic ureterovaginal fistula. The traditional management of these fistulas has been ureteroneocystostomy [1]. However, recent urologic literature suggests that modern endoscopic treatment is highly successful if the passage of an internal stent is possible [2,3]. This is a concept that must be shared with our urogynecologic colleagues. In this paper, 4 of 14 patients with an iatrogenic fistula underwent placement of an indwelling stent. Of these, two were placed cystoscopically, whereas the other two were placed percutaneously. All four ureterovaginal fistulas healed successfully. However, 1 patient developed a ureteral stricture. It is noteworthy that in the combined series of Selzman [2] and this Tulane group not only were all ureterovaginal fistulas successfully treated with a stent, but only 1 of 11 patients (9%) developed a stricture. Although the sample size is small, this paper supports the conclusion that successful endoscopic placement of a double-J stent does allow the ureterovaginal fistula to heal spontaneously. Therefore, initial endoscopic management of an iatrogenic ureterovaginal fistula is a reasonable recommendation. However, equally important is the development of a ureteral stricture causing ‘silent hydronephrosis’. After stent removal the patient may develop a distal ureteral stricture with a completely asymptomatic hydronephrosis — ‘silent hydronephrosis’. Although the patient may be clinically asymptomatic, the renal units remain in jeopardy. Therefore, routine periodic follow-up with radiologic studies is warranted after stent removal.     

经内镜微探头超声检查对结直肠黏膜下肿瘤的诊断价值

目的 探讨经内镜微探头超声检查对结直肠黏膜中肿瘤的诊断价值。方法 应用微探头对结直肠黏膜下肿瘤进行肠镜下超声检查。结果 28例结直肠黏膜下肿瘤中，平滑肌瘤12例，脂肪瘤7例，直肠类癌3例，淋巴管瘤3例。恶性淋巴瘤1例，肠气囊肿症1例和直肠腔外黏液囊肿1例，其中1例较大的平滑肌瘤误诊为平滑肌肉瘤。结论 经内镜微探头超声检查可以明确结直肠黏膜下肿瘤的大小，肠壁起源和边界，对黏膜下肿瘤的诊断有较高的准确率，同时能与控外压迫性病变相鉴别，术前经内镜微探头超声检查可以为结直肠黏膜下肿瘤患选择合适的治疗方案提供指导。     

鼻内窥镜下咽鼓管导管注药治疗分泌性中耳炎

目的 :探讨鼻内窥镜下咽鼓管导管注药治疗分泌性中耳炎的方法。方法 :回顾分析鼻内窥镜直视下咽鼓管导管注药治疗分泌性中耳炎 36 0例、4 0 0耳的临床资料。结果 :治愈 2 5 2例 ,占 70 % ;好转 90例 ,占2 5 % ;总有效率 95 %。治疗前听力平均损失 4 5 .4± 8.2dBHL ,治疗后平均为 33.0± 8.2dBHL ,差异有高度显著性 (P <0 .0 1)。鼓室功能曲线治疗前B型 32 0耳 ,C型 80耳 ,治疗后转变为A型 30 3耳 ,占 75 .8%。结论 :此法操作简单 ,在直视下进行 ,患者痛苦小 ,不破坏鼓膜的正常生理结构 ,可改善分泌性中耳炎的咽鼓管功能 ,提高听力