Endoscopic band ligation for postpolypectomy gastric bleeding

We report a case of a patient in whom endoscopic band ligation was achieved for postpolypectomy gastric bleeding. A 76‐year‐old man visited our hospital because of anemia. Endoscopy revealed a gastric polyp, approximately 12 mm in diameter, on the lesser curvature in the distal gastric body. The polyp was considered to be the source of chronic anemia and was therefore removed by using standard careful snare‐cautery polypectomy technique. Four days later, follow‐up endoscopy was performed to evaluate the postpolypectomy site, and an active bleeding postpolypectomy ulcer was identified. Initial attempts to achieve hemostasis with ethanol injection were unsuccessful. Immediate hemostasis was obtained with a subsequent endoscopic band ligation device. There has been no recurrent bleeding. Endoscopic band ligation might be a good treatment modality for the treatment of a postpolypectomy gastric bleeding lesion.     

Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas

OBJECTIVE: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasms. It is considered a safe and effective treatment but recurrence rates of 1-13% are reported for benign lesions. The aim of this study was to assess risk factors for local recurrence of benign rectal lesions and to evaluate mortality and morbidity following TEM. METHOD: Data were prospectively collected from all patients undergoing TEM for benign adenomas from January 1998 to March 2005. The procedure was performed by a single surgeon and patients were regularly followed up. RESULTS: One hundred and forty-six procedures were included, with a median patient age of 74 years (range 22-92 years). The mean lesion area was 16 cm(2) (range 0.3-150 cm(2)) and the median distance from the dentate line was 9 cm (range 0-17 cm). Immediate complications included bleeding (six) and acute urinary retention (six). There has been one (0.68%) procedure-related death. After a median follow up of 39 months (range 4-89 months) there have been seven recurrences (4.8%), recurring at a mean time of 23.3 months (range 5-48 months). Only microscopic involvement of the circumferential resection margin was found to be significantly associated with recurrence (P = 0.0059). Recurrence was not associated with age, size of lesion, previous treatment, severity of dysplasia or use of the harmonic scalpel. CONCLUSION: TEM is a safe and effective treatment for benign rectal adenomas. Circumferential resection margin involvement is associated with recurrence, which tends to occur late. Therefore extended follow up is recommended.     

Easier node dissection after chemoradiotherapy for lung cancer with collagen insertion at mediastinoscopy

Objective: Induction chemoradiotherapy followed by anatomical resection is a current therapeutic strategy for non-small-cell lung cancer with mediastinal node involvement. Dense peritracheal fibrosis and sclerosis after chemoradiotherapy cause difficult mediastinal node dissection. We evaluated a novel technique to make the mediastinal node dissection easier after induction therapy. Methods: At the end of mediastinoscopic node biopsy for staging of lung cancer, cotton-type collagen was inserted anterior and lateral to the trachea in patients with pathologically confirmed mediastinal node involve-ment (n=45). The induction therapy consisted of concurrent use of platinum-based chemotherapy and hyperfractionated radiotherapy. After the chemoradiotherapy all patients underwent a pulmonary resection with complete mediastinal node dissection 7–12 weeks after the collagen insertion. Surgical findings of the mediastinum and the time for node dissection were compared with those without collagen insertion at mediastinoscopy after chemoradiotherapy (n=5). Results: All five patients without collagen insertion showed sclerotic and fibrotic change of mediastinal nodes with severe adhesion to the trachea. In 42 of 45 patients with collagen insertion (93.3%) the collagen remained unabsorbed and separated the mediastinal nodes from the trachea. Mediastinal node dissection was easily accomplished by removing mediastinal tissues lateral and anterior to the collagen. The rate of mediastinal node separation was significantly higher with collagen insertion than without (p< 0.0001). The times for node dissection in patients with and without collagen insertion showed no significant difference. Conclusion: Cotton-type collagen insertion at staging mediastinoscopy for lung cancer separates the mediastinal nodes from the trachea and makes the node dissection easier after induction chemoradiotherapy.     

十二指肠镜治疗胆总管结石35例临床分析

目的探讨经十二指肠镜治疗胆总管结石的临床效果和价值。方法经十二指肠镜治疗胆总管结石共35例,其中行EST及取石术32例,行EPBD及取石术3例。EST胆总管取石时根据结石大小决定切开大小,不宜EST或结石较小者可选择EPBD后取石。结果35例均成功取出胆总管结石,取得较好的疗效。EST术中局部渗血4例,当时予电凝或喷洒止血药物即迅速止血,术后急性胰腺炎1例,经适当处理后1周痊愈,EPBD及取石术后未发现明显并发症。结论十二指肠镜治疗胆总管结石是一种微创、安全、有效的治疗方法。     

NEW DEVICE TO PERFORM COAGULATION AND IRRIGATION SIMULTANEOUSLY DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING AN INSULATION‐TIPPED ELECTROSURGICAL KNIFE

Background: Although bleeding is an unavoidable complication of endoscopic submucosal dissection (ESD), endoscopic hemostasis using an insulation‐tipped electrosurgical knife (IT) knife is impossible because an insulator is mounted at the tip of the knife. We have developed a new type of hood which could perform both coagulation and irrigation simultaneously. Methods: Our new device was fabricated by drilling a side hole in the cap portion of a conventional transparent hood followed by attaching a machined papillotomy knife to the exterior surface of the hole. Results: Our new hood was useful for hemorrhage during ESD using IT knife. Conclusions: With this method, endoscopic hemostasis using IT knife is easy, as hemostatic procedure can be performed under irrigation and coagulation using conventional endoscopy.     

ENDOSCOPIC NASOBILIARY DRAINAGE: CURRENT INDICATIONS AND EVALUATION OF THE PRODUCTS

Endoscopic nasobiliary drainage (ENBD) is a well established mode of biliary decompression. Although ENBD is certainly an uncomfortable procedure with the potential risk of spontaneous dislocation or removal of the drainage catheter by disoriented patients, it has several advantages over endoscopic biliary drainage (EBD) using an indwelling stent. The current indications for ENBD are: (i) temporary drainage to treat obstructive jaundice and cholangitis caused by malignant or benign biliary stricture; (ii) urgent drainage to treat suppurative cholangitis primarily caused by common bile duct stones; (iii) temporary drainage after stone removal in patients with suspected incomplete clearance and/or with cholangitis; and (iv) biliary leaks that occur primarily after surgery, as well as other indications. Different types of nasobiliary catheters are currently available that have been designed with various diameters, shapes, and materials. However, the current catheters are not considered by most endoscopists to be sufficient. Further improvements are needed to achieve better drainage and better maneuverability.     

434例肺癌淋巴结转移及其廓清的临床研究

目的：研究肺癌淋巴结转移的方式与规律，以探讨肺癌淋巴结合理的手术廓清范围。方法：对434例肺癌患者施行手术并予淋巴结廓清，回顾性分析病理证实的转移淋巴结的分布情况。结果：手术共清除2198组淋巴结，病理证实有癌细胞转移的749组。淋巴结转移率T1期为16．5％，T2期33．5％，T3期35．6％，T4期52．3％，T1期和T4期的组间有显著性差异（P＜0．01）。上叶肺癌上纵膈与下纵膈淋巴结转移有显著差异。左上叶肺癌第5组淋巴结有30．6％转移，左下叶和右中、下叶肺癌第7组淋巴结有26．5％转移。结论：除T1期肺癌淋巴结转移仅限于区域性上纵膈或下纵膈外，总体上，上叶肺癌以上纵膈淋巴结转移居多，而中、下叶肺癌则上、下纵膈均可发生淋巴结转移。左上叶肺癌第5组淋巴结转移和中、下叶肺癌第7组淋巴结转移是上、下纵膈之间淋巴结扩大转移的信号。原发肺癌除T1期可仅行区域性上纵膈或下纵膈淋巴结清扫外，均应行系统性肺门和上下纵膈淋巴结廓清。     

室间隔夹层瘤的超声诊断(附4例报告)

目的 总结室间隔夹层瘤的超声心动图诊断及临床应用价值。方法1985～2005年超声诊断罕见的室间隔夹层瘤4例。超声主要取左室长轴、四腔心、五腔心、大动脉短轴及非标准切面，观察主动脉窦的形态及结构：如扩张窦瘤的大小、窦壁厚度、窦瘤破口的部位、窦瘤破口与室间隔之间的关系，主动脉窦瘤与室间隔夹层瘤之间交通口的大小，测量形成室间隔夹层瘤的大小及夹层瘤左、右室面的厚度，结合彩色多普勒观察心动周期夹层瘤与主动脉窦瘤血流动态变化，频谱多普勒测量窦瘤与室间隔夹层瘤之间的血流速度。结果4例室间隔夹层瘤均为主动脉右窦破人室间隔基底段，且均行手术治疗证实超声诊断。结论超声心动图对室间隔夹层瘤可直接做出诊断，超声诊断价值在于早发现、早诊断、及早治疗，并可为外科选择手术方式提供重要的有价值的依据。     

术后胆漏和继发胆管狭窄的内镜治疗

胆漏和继发胆管狭窄是严重的外科并发症，传统的治疗方法是再次开腹手术，但再手术并发症多，死亡率高。而内镜胆管造影不仅可明确诊断，且内镜下治疗具有安全、疗效肯定、创伤小和并发症少等优点，可作为大多数胆漏和胆管狭窄患者首选治疗方法。     

经颞部骨膜下剥离面中部提紧术

目的探讨一种经颞部矫正面中部老化征象的简单而有效的方法。方法经颞部头皮切口在颞浅筋膜和颞深筋膜间剥离,下达颧弓,内达眶外侧缘。在颧弓上约2cm,平行颧弓切开颞深筋膜浅层约3cm,在颞深筋膜浅层下剥离至颧弓上缘进入骨膜下剥离。松解面中部。将已充分活动的面中部全层组织上提,缝合固定于颞深筋膜表面。结果自2000年以来,临床应用21例,术后效果满意,外观自然,无并发症发生。结论本方法具有手术时间短,剥离层次深,耳前无切口,术后恢复快,效果自然,维持时间长的优点。选择合适的病例,能获得满意的效果。