Laparoscopic transgastric suturing for bleeding peptic ulcers

Background: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing. Methods: After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a lift and cut technique. Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots. Results: Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm³/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement. Conclusions: It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.Poster presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

羟甲唑啉在鼻内镜手术中的应用

目的：探讨经甲唑啉(商品名：达芬霖)在鼻内镜手术中的应用价值。方法：观察在68例鼻内镜手术中应用经甲唑啉对患者的脉搏、纤毛运动的影响及出现反跳的时间。结果：在经甲唑啉应用前后，68例患者的脉搏变化差异无显著性意义(P＞0．05)；10例慢性鼻窦炎患者的纤毛移动率差异无显著性意义(P＞0．05)；降低鼻血流量约50％；作用持续时间长达6h。结论：经甲唑啉作为鼻教膜血管减充剂和麻醉辅助药，常规用于鼻内镜手术，安全、有效。     

慢性鼻窦炎手术方法的探讨

目的：探讨治疗慢性鼻窦炎的手术方法及中鼻甲前端部分切除术在治疗慢性鼻窦炎中的作用。方法：对87例(155侧)慢性鼻窦炎患者，根据其发病原因及病情不同分为3类，采用相应的手术方法进行治疗。结果：第l类43侧，治愈39侧，好转4侧；第2类8l侧，治愈69侧，好转l0侧，无效2侧；第3类3l侧，治愈17侧，好转9侧，无效5侧。总治愈率为80．6％，有效率为95．5％。结论：对慢性鼻窦炎的手术治疗应因病因、病情不同，采用不同的手术方法，中鼻甲前端部分切除术对治疗慢性鼻窦炎具有重要作用。     

重组人表皮生长因子促进鼻内镜术后术腔上皮化

目的观察重组人表皮生长因子(rhEGF)对鼻内镜手术后术腔愈合的影响.方法对131例(235侧)施行鼻内镜手术分析的Ⅱ型2期、3期患者,随机分为两组,A组应用rhEGF,B组不用,随访4个月以上比较同期两组的治愈率.结果同期治愈率A组显著优于B组(P＜0.05).结论 rhEGF能促进术腔早日上皮化.     

Management of papillary microcarcinoma of the thyroid gland

DESIGN: To investigate the frequency, treatment and clinical behaviour of differentiated microcarcinoma of the thyroid gland (PTMC). PATIENTS AND METHODS: Out of 376 patients submitted to surgical treatment for differentiated thyroid cancer from June 1980 to October 2003, 77 had been identified has having a PTMC (63 females, 14 males; mean age 43+/-13 years). Sixty-seven patients (87%) met the AMES risk definition for low (group I) and 10 (13%) for high-risk (group II) definition. The surgical procedures were lobo-isthmusectomy (n=14) or subtotal thyroidectomy (n=20) and total thyroidectomy (n=43) with node dissection in 15 cases. Follow-up ranging from 9 to 274 months (mean 124+/-84). RESULTS: Overall patient survival rates were 100 and 94% at 20 years in groups I and II, respectively (p=ns). There were no significant differences in surgical complications and in survival in patients submitted to total thyroidectomy when compared to partial thyroid resection. The presence of cervical node metastasis did not affect patient survival (p=0.8). The overall mean survival time was 266 months. CONCLUSIONS: Despite the overall excellent prognosis, PTMC was associated with a 1% disease-related mortality, a 2.5% local recurrence rate, 1% lymph-node recurrence rate, and 1% distant metastasis rate. We recommend total thyroidectomy accompanied by modified neck dissection if enlarged nodes are diagnosed.     

Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial

Blood isotone contrast media is considered to be less toxic to vascular and pancreatic duct endothelium than high-osmolar contrast media. In this study we assessed the impact of a low-osmolar contrast agent compared with a blood isotone product on pancreatic damage induced by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde sphincterotomy (EST). In a prospective trial 42 consecutive ERCP/EST patients were randomized to receive either iopromid, a low-osmolar non-ionic contrast agent (770 mosmol/kg H₂O), or iotrolan, a blood-isotone non-ionic product (320 mosmol/kg H₂O). The endoscopies were performed by two experienced endoscopists. Forty patients were included in the study. Blood samples were collected before and 40 min, 2, 4, 6 and 24 h after the endoscopic procedure. Samples were analysed for pancreatic serum enzymes, acute-phase proteins and blood counts. A clinical pain score was investigated. Post-ERCP pancreatitis was diagnosed in 2 patients in the iopromid group and in 5 patients in the iotrolan group. There was no significant difference between groups in the time course of pancreatic serum enzymes, acute-phase proteins or in the pain score. Due to the small number of patients in this study, only stronger differences caused by the two contrast media could have led to statistically significant results. We did not observe statistically significant differences in comparing iotrolan and iopromid concerning ERCP/EST-induced pancreatic damage. Received: 26 February 1999; Revised: 14 May 1999; Accepted: 9 June 1999     

经鼻内镜鼻窦手术360例临床分析

目的 探讨经鼻内镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的远期疗效。方法 对1996-2000年360例（663侧）完成随访的鼻内镜手术进行临床分析。术后随访6个月-2年。结果 治愈率为73.15%，其中I型治愈率为92.53%，Ⅱ型治愈率为67.92%，Ⅲ型治愈率为44.44%，3型治愈率呈递减趋势。结论 鼻内镜手术是治疗慢性鼻窦炎和鼻息肉的有效方法，手术疗效与其临床分型密切相关。术中恰当处理中鼻甲、鼻中隔偏曲及术后的综合治疗，对鼻内镜鼻窦手术远期疗效具有重要的意义。     

上颌窦窦口大小与鼻内镜手术疗效

目的探讨鼻内镜手术中扩大上颌窦自然窦口大小对手术疗效的影响.方法对我院1995～2002年Ⅱ型鼻窦炎患者行ESS手术扩大上颌窦自然窦口,按大小分为两组.一组为0.5～1.0cm,另一组为＞1.0cm.术后随访6～12月.结果窦口0.5～1.0cm治愈率为84.4%;窦口＞1.0cm治愈率为71.3%.窦口0.5～1.0cm明显优于窦口＞1.0cm,两组间治愈率差异有显著性意义(P＜0.01).结论在FESS手术中上颌窦自然窦口不宜过分扩大.     

非甾体类消炎药致上消化道出血的临床表现与内镜特征

目的　探讨非甾体类消炎药物导致上消化道出血的临床与内镜特征。方法　回顾性分析 5 6例非甾体类消炎药物导致上消化道出血病人的临床资料。结果　服用非甾体类消炎药物后 5 d内出血 38例 (6 8% ) ,表现为上腹痛 39例 (6 9% ) ,呕血伴黑便 34例 (6 1% ) ,单纯黑便 2 2例 (39% ) ,内镜下表现为弥漫性胃黏膜充血、水肿及多发糜烂 38例 (6 8% ) ,胃溃疡 14例 (2 5 % )。结论　非甾体类消炎药物致上消化道出血的主要临床表现为腹痛、呕血伴黑便或单纯黑便。内镜下为弥漫性胃黏膜充血、水肿 ,多发性糜烂和溃疡。     

经乳晕入路腔镜甲状腺切除术的效果观察

目的探讨腔镜甲状腺切除术的方法、优缺点及安全性。方法采用胸部乳晕入路行腔镜甲状腺切除术50例。其中甲状腺腺瘤16例,结节性甲状腺肿30例,原发性甲状腺机能亢进4例。结果成功完成手术50例。手术时间50-270分钟,平均80.5分钟。术后住院时间3-7天,平均4.2天。术后随访1-12个月,疗效理想,无中转开放手术。结论腔镜甲状腺手术是一种安全的手术方法,和传统的甲状腺手术相比手术效果相同,且将微小切口开在隐蔽位置,具有很好的美容效果。