Atraumatic retractor for endoscopic surgery

A novel retractor has been designed to achieve atraumatic retraction of the liver and displacement of hollow viscera during endoscopic surgery. The functional section of the instrument, when locked, forms a silicon-covered uniplanar hook which can be deployed for horizontal lift of solid organs such as the liver or be used to engage bowel for displacement from the operative field. Following laboratory testing, the instrument has been evaluated clinically and its ease of deployment and atraumatic nature have been confirmed. It has been found to be particularly effective for elevation of the thick fatty left lobe of the liver during antireflux surgery.     

Self-expanding mesh stent for endoscopic palliation of rectal obstructing tumors: a preliminary report

Summary The endoscopic insertion of self-expanding mesh stents in four patients affected by obstructing rectal malignant tumors is reported. The preliminary experience shows that, in the short term, normal defecation was achieved, with no complications. Longer follow-up is necessary to evaluate the duration and the quality of the palliative effect.     

Endoscopic fistulotomy and biliary drainage as the ultimate palliative treatment for obstruction due to malignant tumors of the papilla of Vater

Summary This report describes the technique and results of endoscopic fistulotomy as a drainage procedure in cases of malignant obstruction of the biliary system from bulky and friable growths in the papilla of Vater. Fistulotomy, coupled with insertion of stents, was successful in seven of eight patients and was associated with relief of jaundice. It is suggested that the method be applied when conventional transpapillary insertion of stents is impossible either due to distortion of the papilla or bleeding of the growth on touch.     

胆管残余结石的内镜治疗(附306例分析)

目的：探讨内镜治疗肝内外胆管残余结石的效果。方法：对1994年1月～2004年1月间306例胆道残余结石的治疗效果进行回顾性分析，采用十二指肠镜127例，胆道镜116例，经皮经肝胆道镜(PTCS)63例。结果：306例．1中有286例成功(93．46％)。十二指肠镜治疗127例成功125例；胆道镜经T管窦道治疗116例，成功109例；PTCS治疗肝内结石63例，成功52例。结论：内镜治疗肝内外胆道结石效果显著，可使绝大多数患者避免再次手术。     

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.     

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。     

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。     

Voice prosthesis insertion after endoscopic balloon-catheter dilatation in case of a stenotic hypopharyngo-oesophageal junction

Stenosis of the hypopharyngo-oesophageal junction can be a rare complication of laryngectomy and/or partial pharyngectomy and makes the insertion of voice prosthesis extremely difficult. This study describes the authors’ experiences gained by endoscopic balloon-catheter dilatation of hypopharyngo-oesophageal stenoses prior to implantation of voice prostheses in four cases. In two patients a single balloon-catheter dilatation resulted in wide enough pharyngo-oesophageal lumen on the long run. The average prosthesis wearing-times were 6.8 months in case 1 and 4.6 months in case 2, corresponding to the published literature data. In case 3, repeated dilatation of the pharyngo-oesophageal transition had proved to be unsuccessful despite taking every effort with the endoscopic balloon-catheter method. Having excised the stenotic segment, reconstruction with pectoralis major myocutaneous flap (PMMF) was indicated. Eighteen months later, a repeated restenosis was observed and a free jejunal flap needed to be performed as a final solution. In case 4, the insertion was carried out into a previously dilated jejunal free flap, which became gradually ischemic and stenotic since the major head-and neck procedure was carried out that resulted in prosthesis rejection after just 1 week. The authors emphasize that correct indication of pedicled and free flaps in head and neck reconstruction is a prerequisite from the aspect of prevention of pharyngo-oesophageal strictures. Endoscopic balloon-catheter dilatation is a safe and established method for dilatating hypopharyngo-oesophageal stenoses of different origin. The procedure provides maximum patient benefit with minimal trauma and morbidity; moreover, facilitates insertion of voice prostheses. However, a single balloon-catheter dilatation cannot always result in wide enough oesophageal lumen on the long run (case 3). Insertion of a voice prosthesis into a previously dilated ischemic jejunal segment is challenging and avoidable due to risks of complications.     

内镜治疗甲状腺功能亢进7例报告

目的总结内镜治疗甲状腺功能亢进（甲亢）的经验。方法7例原发性或继发性甲亢，内镜经胸人路行甲状腺全切或次全切除术。结果7例手术均成功，无中转开放手术。手术时间130～260min，平均168min；术中出血量10～200ml，平均70ml。无喉返、喉上神经损伤，无术后出血等并发症。术后恢复良好，近期随访美容效果满意。随访1～12个月，平均5．1月，无复发，2例出现甲状腺功能低下，1例在术后2个月时恢复。结论内镜治疗甲亢技术安全、可行。除常规手术前甲亢准备外，必须行CT检查确认腺体大小，确定残留腺体的大小和位置。