36例食管乳头状瘤的临床内镜分析

目的探讨食管乳头状瘤（Ep）的临床内镜特点及病理。方法回顾性总结分析36例EP患者的临床内镜资料。结果（1）EP的临床表现无特异性。（2）内镜下病变主要位于中下段并且与食管炎相关，易被误诊为息肉及白斑。（3）治疗后15例患者随访3个月正常，11例随访2年未见复发，1例2年后在原来不同部位再发EP。结论（1）EP是否并发临近脏器肿瘤有待进一步研究。（2）黏膜慢性炎在EP发病中起一定作用。（3）乳头状病毒（HPV）感染与EP的发病关系有待进一步探讨。（4）EP的发病是否与遗传基因相关也值得关注。     

腹腔镜手术治疗胃间质瘤的临床体会(附25例报告)

目的 探讨胃间质瘤的临床诊断及行腹腔镜手术治疗的可行性与安全性.方法 回顾分析25例超声内镜拟诊胃间质瘤患者的临床诊断与治疗资料.结果 25例患者中19例术后病理证实为胃间质瘤,诊断符合率76.0%;21例完成腹腔镜手术治疗,主要的手术方式为局部切除;4例(16.0%)中转开腹,主要原因为术中定位困难.结论 超声内镜可以作为胃间质瘤临床影像学诊断的重要手段,腹腔镜手术切除胃间质瘤安全可行.     

大肠幼年性息肉,息肉病的内镜特点及与癌关系的探讨

回顾16408例结肠镜检查资料,发现大肠幼年性息肉121例,幼年性息肉病4例。分析总结其内镜下特点,并对其中1例幼年性息肉癌变进行探讨,推测由幼年性息肉→腺瘤→癌可能为其癌变过程。     

Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract.

OBJECTIVE: To study the yield of endoscopic ultrasonographically guided fine-needle aspiration cytologic examination in the diagnosis of submucosal masses. METHODS: From 1999 to 2003, 10 patients underwent ultrasonographically guided fine-needle aspiration for the cytologic diagnosis of submucosal masses in our institution. The endoscopic ultrasonography records and the cytology database were consulted, and the reports were analyzed, as were slide material and the technical aspects related to these procedures. All procedures were performed under conscious sedation and cardiorespiratory monitoring on an outpatient basis. Ten patients (4 men and 6 women; mean age, 60.8 years) were studied. RESULTS: Eight lesions were located in the stomach, and 2 were located in the esophagus, with a mean diameter of 3.3 cm. An experienced cytopathologist was present on-site during all procedures for assessment of adequacy and preliminary cytologic examination. Cytologic diagnoses were obtained in 8 cases as follows: 6 gastrointestinal stromal tumors, 1 organizing submucosal hematoma, and 1 low-grade mucosa-associated lymphoid tissue-associated lymphoma. Two cases consisted of scant gastric epithelium only and were considered nondiagnostic. The cytologic diagnoses guided further clinical treatment. CONCLUSIONS: Ultrasonographically guided fine-needle aspiration with cytopathologic analysis has a high accuracy rate (80%) for diagnosing submucosal lesions. These findings potentially affect clinical decision making.     

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports

BACKGROUNDAppendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARYWe report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSIONERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.     

超声内镜下胆道引流对外科术后解剖结构改变患者恶性梗阻性黄疸的治疗探讨

目的评估超声内镜引导下胆道引流术(EUS-BD)对外科术后解剖结构改变患者并发恶性梗阻性黄疸的可行性及安全性。方法选取2017年1月-2019年3月外科术后解剖异常伴发恶性胆道梗阻行EUS-BD的患者14例,评估治疗效果及术后短期并发症。结果14例中成功13例,技术成功率为92.86%,成功的13例中,9例行经肝顺行胆管支架引流,1例行经胃经肝内胆管穿刺造瘘术,1例行经胃经食道肝内胆管穿刺造瘘术,2例行经肝经空肠胆道穿刺造瘘术。术后1例发生消化道穿孔,1例发生胆汁性腹膜炎,1例出现贲门黏膜撕裂伴出血,均予以保守治疗好转,术后未发生支架移位。术后患者胆红素较术前明显下降,并顺利出院。结论在有经验的内镜中心,对外科术后解剖改变并发恶性胆道梗阻的患者实施EUS-BD是安全可行的。     

消化性溃疡合并血管裸露出血的内镜征象及内镜治疗的研究

目的研究消化性溃疡合并血管裸露出血患者的内镜征象与内镜治疗和常规药物治疗的预后之间的关系。方法参考ForreSt分级将136例患者分为4级：Ⅱa、Ⅱa Ⅰa级、Ⅱa Ⅰb级、Ⅱa Ⅱb级。每级患者随机接受内镜下注射治疗与常规药物治疗，反复大出血者外科手术。结果内镜治疗组的即刻止血率均为100．0％，内镜治疗组、药物治疗组的24h止血率分别为100％、39．7％；平均输血量分别为2μ、8μ；再出血率分别为7．4％、45．6％，手术率分别为2．9％、17．6％。结论消化性溃疡合并血管裸露出血的临床表现较重，内镜下治疗的止血效果优于药物治疗，且再出血的发生率和手术率较低。     

纤维鼻咽喉镜吞咽功能检查在急性脑卒中患者中的应用

目的 探讨纤维鼻咽喉镜吞咽功能检查(FEES)在急性脑卒中患者吞咽功能评估中的应用价值.方法 对95例急性脑卒中患者进行FEES检查,以食物渗漏、穿透、误吸和潴留为主要观察指标,比较误吸患者及无误吸患者的肺炎发生情况,根据FEES检查结果 对患者进食途径给予相应的建议.结果 FEES检查显示,入组的95例患者中有45例存在食物渗漏,34例存在穿透,47例存在误吸,53例存在潴留;检查中出现误吸的患者肺炎发生率显著高于无误吸的患者(分别为5.5%和O%,P＜0.001,OR=1.343,95%CI为1.136～1.588).根据FEES检查结果 ,建议34例患者可正常经口进食,27例患者需要接受代偿性治疗措施,34例患者需要鼻饲饮食.所有患者均未出现鼻出血、气道痉挛和心率血压骤然变化等严重并发症.结论 FEES检查在急性脑卒中患者吞咽障碍的诊断和处理中是一个非常有价值的评估工具.     

鼻腔填塞法的研究进展

鼻腔填塞是耳鼻喉科常用的治疗技术,鼻出血和鼻部手术后通常都需要采用鼻腔填塞止血。医护人员应根据病人的情况选择鼻腔填塞的部位以及填塞物。     

内镜下中耳胆脂瘤手术路径探索

目的探索内镜下3种手术路径治疗中耳胆脂瘤的临床价值。方法回顾性分析2010年1月-2019年12月203例209耳行中耳胆脂瘤切除术患者的临床资料。其中,85例88耳借鉴"锁孔"理念、吸收显微镜手术技术,通过外耳道-上鼓室-鼓窦-乳突、外耳道-鼓窦-乳突和耳甲艇切口-鼓窦-乳突3个手术路径行内镜下手术入路中耳胆脂瘤切除,118例121耳行显微镜下乳突根治术。比较两组患者手术并发症和术后复发情况。结果所有病例术后随访6～24个月,内镜组干耳率94.32%、显微镜组95.87%;内镜组并发症发生率10.23%、显微镜组12.40%;内镜组残留和复发率6.82%、显微镜组4.13%,两组患者比较,差异均无统计学意义(P 0.05)。结论耳内镜手术可通过3个路径切除涉及整个乳突的中耳胆脂瘤,拓展了中耳胆脂瘤手术的治疗范围。