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．     

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。     

假性胰腺囊肿的内窥镜治疗

目的 探讨假性胰腺囊肿内窥镜治疗的适应证、手术效果、并发症及优缺点。方法 对假性胰腺囊肿内窥镜治疗的相关文献进行综述。结果 内窥镜技术具有创伤小、操作方便、可反复进行等特点，其适应证正不断扩大．除内窥镜治疗失败、囊肿合并并发症和多发性囊肿时考虑外科手术外，其他情况下假性胰腺囊肿的治疗可考虑内窥镜优先的策略。结论 假性胰腺囊肿的治疗应根据囊肿大小、数量、解剖学部位及有无并发症等综合因素实行个体化原则。     

控制性降压在鼻内窥镜手术中的应用

目的 :观察控制性降压在鼻内窥镜手术中应用的意义。方法 :80例双侧鼻息肉、鼻窦炎患者 ,局麻、鼻内窥镜下行双侧鼻息肉摘除、全筛切除及开放上颌窦自然开口。其中 38例术中控制性降压 (降压组 ) ,另 42例作为对照。结果 :降压组术中出血 (6 1 39± 38 5 2 )ml,对照组出血 (140 12± 81 82 )ml,差异有显著性意义 (P <0 0 1) ;手术时间分别为 (4 9 2 5± 7 0 6 )min和(6 2 4 0± 9 90 )min ,差异有显著性意义 (P <0 0 1)。结论 :控制性降压可明显减少术中出血 ,缩短手术时间。     

"Endoview" project of intrapartum endoscopy.

INTRODUCTION: The change in obstetrical practices over the last decade in favor of trials of labor in patients with uterine scars has resulted in increased incidences of uterine ruptures. Although neither repeat cesarean delivery nor a trial of labor is risk free, evidence from a large multicenter study shows vaginal birth after the cesarean (VBAC) is associated with shorter hospital stays, fewer postpartum blood transfusions, and a decreased incidence of postpartum maternal fever. The uterine rupture remains the most serious complication associated with VBAC. Factors associated with uterine rupture include excessive exposure to oxytocin, dysfunctional labor, and a history of more than 1 cesarean delivery.2 Because uterine rupture may be a life-threatening event, intrapartum surveillance and the ability to perform an emergency surgery are both necessary when trial of labor is allowed. Until now, no early symptoms pathognomonic to uterine rupture had been described. We share our experiences with the novel approach to the problem - an intrapartum endoscopy. MATERIALS AND METHODS: Endoscopic examination was accomplished by using the intraoperational fiberscope (Olympus and Endoview system (Costa Mesa, CA, USA). A gas-sterilized 25-cm long fiberscope is introduced into the amniotic cavity through the cervical canal after rupture of the membranes. The distance between the fiberscope and the object varies from 3 to 50 mm. The fiberscope has a separate channel for the fluid infusion (normal saline) throughout the procedure; the surgeon looks through the eyepiece directly and exhibits control over the flexible scope. The duration of endoscopy is less than 15 minutes. The inserting of the endoscopic device is very similar to that of insertion of an intrauterine pressure catheter. The IRB Committees of both participating institutions approved the study protocol. Twenty-eight patients with an unknown or poorly documented site of the uterine scar were included in the study. An ultrasound examination had been performed on all patients prior to endoscopy to assess fetal wellbeing and placental location. The ages of the patients ranged from 21 to 38 years. Eighteen women had 1 previous cesarean delivery, and 10 had 2. The performance of intrapartum endoscopy did not interfere with fetal monitoring; 21 fetuses were monitored externally, 7 internally. Indications for previous cesarean deliveries were as follows: fetal distress in 11 cases, failure to progress in labor in 8, placenta previa in 2, and unknown in 7. Twenty-one patients delivered vaginally; 7 had had repeat cesarean deliveries. All neonates were born in satisfactory condition. The Apgar scores at 1 minute varied from 7 to 9 and at 5 minutes from 8 to 10. The integrity of the uterine wall was assessed by manual postpartum uterine exploration in each case of vaginal delivery and by visualization and palpation of the scar site in each abdominal delivery. RESULTS: The lower uterine segment and contractile portion of the anterior uterine wall were visualized successfully in all patients. In 25 patients, the presumed scar site looked totally indistinguishable from the rest of the lower uterine segment and anterior uterine wall. Two scars were identified as vertical in 2 patients who were delivered by a repeat abdominal operation. A vertical scar appears as a groove running in a cephalad-caudad direction from the lower uterine segment into the contractile portion of the anterior uterine wall. The usefulness of the intrapartum endoscopy is best demonstrated by the following case reports (2 of 28 study cases).     

CT仿真结肠内窥镜的临床应用研究

目的:研究CT仿真结肠内窥镜(CT Virtual Colonoscopy,CTVC)的使用价值,应用方法及镜下表现。方法:使用Hispeed FX/i扫描机,扫描层厚3～5mm,螺距1～2,重叠重建率50％～67％。利用Navigator Smooth软件对容积扫描数据进行三维重建,获得仿真结肠内窥镜的影像,并与纤维肠镜和/或手术所见对照分析,全部病例经病理证实。结果:通过选择不同的观察方位,角度和阈值,CTVC能清楚显示靶器官内正常解剖结构的立体影像和病变的部位、大小、形态及其侵犯范围。CTVC对结肠病变形态的显示与FC或/和标本显示具有良好的对应性,另外,CTVC能从闭塞和狭窄的远端观察病变。但CTVC不能显示组织的颜色变化,不能活检。结论:CTVC作为一种新的非侵袭性结肠检查方法,可以作为纤维结肠镜的有效补充手段,有较好的临床应用价值。     

Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

Real time endoscopic imaging of oxyradical generation in pig stomach during ischemia–reperfusion

BACKGROUND: Oxygen-free radicals generation is considered to be a major cause of gastric injury during reperfusion. Chemiluminescence has been used to assess real-time free radical release on the surface of isolated organs. AIMS: To evaluate the combined use of chemiluminescence and gastroendoscopy techniques and to assess the real-time production of free radicals during ischemic damage of the gastric wall in an animal model. PATIENTS AND METHODS: For the experiment, an optical junction was set up between a fibroendoscope and a luminograph apparatus. Three pigs were submitted to gastrofibroendoscopy before, during and after 30 min of clamping of the coeliac artery. Under basal conditions, at the end of the ischemic phase and at the beginning of reperfusion, 1 mM of lucigenin, a specific superoxide enhancer, was injected in the left gastric artery of the animal. The endoscopic live images and chemiluminescence emission were recorded and successively superimposed to measure rate and spatial distribution of photon emission (photons/s). RESULTS: Free radical production was not observed under basal conditions or during the ischemic phase, but significantly increased during reperfusion reaching a maximum peak after 15 min (0.6+/-0.2 photons x 10(5)/s) and decreased progressively thereafter. The superimposition of live and chemiluminescence images allowed the determination of the regional production rate and distribution of photons. CONCLUSIONS: Preliminary observations, in an animal model, on an innovative imaging system which allows the visualization of rate and spatial distribution of reactive oxygen species formation are presented. This new endoscopic technique could be useful for the assessment of oxidative gastric mucosal injury in several gastric diseases; however, further studies remain necessary to determine the applicability of this technique in humans.