ObjectiveTo explain the advantage of laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma, and predict the future direction of the surgery methods for rectal carcinoma. MethodsA review and summary based on the clinical experience of our hospital and the published researches about the laparoscopic endoscopic rendezvous procedures over the past years in home and abroad were performed. ResultsLaparoscopy can monitor the situation of the abdominal cavity.Endoscopy can detect the location of rectal carcinoma.Laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma can combine the advantage of each other.And the purpose of "less invasion, less pain, and faster recovery" will be achieved.The effect of "1+1 > 2" will be realized. ConclusionLaparoscopy and transanal endoscopic microsurgery hybrid could be a naive form of nature orifice transluminal endoscopic surgery to treat rectal carcinoma.
Objective To explore complications of endoscopic thyroidectomy and conventional thyroidectomy and to analyze causes of them in order to reducing complications of endoscopic thyroidectomy. Methods A total of 1 112 patients with thyroid diseases from September 2008 to March 2017 in the Shanghai Tongren Hospital were collected, then were designed to endoscopic thyroidectomy group and conventional thyroidectomy group. The recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, tracheoesophageal injury, poor healing of surgical wound, skin ecchymosis and subcutaneous effusion, neck discomfort, and CO2 related complications were observed. Results ① There were 582 cases in the endoscopic thyroidectomy group and 530 cases in the conventional thyroidectomy group, the baselines such as the gender, age, most diameter of tumor, diseases type, operative mode, operative time, and intraoperative bleeding had no significant differences between the endoscopic thyroidectomy group and the conventional thyroidectomy group (P>0.05). ② All the operations were performed successfully, none of patients was converted to the open operation. The rates of the recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, and tracheoesophageal injury had no significant differences in these two groups (P>0.05). The rates of the poor healing of surgical wound and neck discomfort were significantly lower and the rate of the skin ecchymosis and subcutaneous effusion was significantly higher in the endoscopic thyroidectomy group as compared with the conventional thyroidectomy group (P<0.05). There were 32 cases of CO2 related complications in the endoscopic thyroidectomy group. Conclusion Results of this study show that endoscopic thyroidectomy is safe for thyroid diseases, it’s complications could be reduced by improving operation technique.
Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
目的：探讨鼻内镜手术治疗鼻内翻性乳头状瘤(NIP)的疗效。方法：回顾性分析用鼻内镜手术治疗的36例经病理确诊的NIP患者的临床资料，随访1～6年。结果:”一次性治愈31例(86.1%)；5例复发(13.9%)，3例在门诊内窥镜下分次摘除并结合YAG激光治愈，2例再次于鼻内镜结合Caidwell-Luc手术治疗，无恶变病例，结论：根据病变范围选择适当的手术方式，经鼻内镜手术切除鼻腔鼻窦内翻性乳头状瘤效果良好。
目的总结急性胆源性胰腺炎(ABP)的治疗经验。方法我院2005年2月至2009年10月期间收治89例ABP患者，梗阻型ABP 29例，其中2例胆总管下端结石梗阻致坏死型胰腺炎患者，24 h内行开腹或腹腔镜胆囊切除（LC）、胆总管切开取石、T管引流、胰腺被膜切开减压、胰腺坏死组织清除; 8例肝外胆管结石患者急诊(24～48 h)行内镜逆行胰胆管造影术(ERCP)+内镜下括约肌切开术(EST)+内镜下鼻胆管引流(ENBD); 17例胆囊结石伴胆总管结石及2例胆总管下端占位患者先行内科保守治疗病情得到控制，7 d后行CT、EST或ENBD，择期行LC、胆总管切开取石术、限期内镜胆管内支架放置术或开放根治术。非梗阻型ABP 60例，均为胆囊结石、胆囊炎所致，在入院后3～14 d急性胰腺炎控制后42例行胆囊切除术，18例行保守治疗。结果29例梗阻型ABP在及时或限时行胆道引流解除梗阻后均使胰腺炎得到控制，病情稳定后行手术治疗，均治愈出院; 60例非梗阻型ABP患者中，42例住院行一期胆囊切除术，治愈率达100%，18例保守治疗患者，1个月至1年胰腺炎复发9例，均再次入院，3例保守治疗好转后出院； 6例行胆囊切除术，其中LC 4例，开腹胆囊切除术2例，其中5例治愈，1例出现急性呼吸窘迫综合征抢救无效死亡。结论ABP应根据胆管有无梗阻分型治疗，梗阻型应尽早引流解除胆管梗阻，EST+ENBD能有效解除胆管梗阻控制胰腺炎症； 非梗阻型宜积极保守治疗，病情缓解后手术治疗，能有效降低并发症发生率和病死率。
目的 观察鼻内镜下三种不同微创手术治疗非侵袭型真菌性上颌窦炎的疗效及氟康唑冲洗术腔的临床意义。 方法 回顾性分析我科2006年1月－2010年12月收治的284例非侵袭型真菌性上颌窦炎住院患者资料。患者分别采用单纯鼻内镜下上颌窦窦口开放术（术式1）、鼻内镜下上颌窦窦口开放联合经唇龈沟上颌窦前壁开窗（术式2）、以及鼻内镜下上颌窦窦口开放联合下鼻道开窗（术式3）进行治疗；术式3治疗的患者术后定期换药时，分别使用生理盐水或氟康唑反复冲洗鼻腔和上颌窦。所有患者门诊随访至少半年。 结果 在本组接受术式1、术式2和术式3治疗的患者分别有51例、45例和188例。上述三种术式治疗的患者中，分别有15例，9例和6例患者出现复发，复发率分别为29.6%、20.0%和3.2%；其中术式3治疗的患者复发率显著性低于术式1或术式2治疗的患者（P＜0.05）。在术式3治疗的患者中，生理盐水和氟康唑冲洗的伤口愈合时间分别为3.8周和 3.7周，两种冲洗方式对伤口的愈合影响差异无统计学意义（P＞0.05）。 结论 鼻内镜下上颌窦窦口开放联合下鼻道开窗是治疗非侵袭型霉菌性上颌窦炎的最佳方式，且伤口愈合时间与冲洗液种类无关。
Objective To evaluate the safety and efficacy of simultaneous endoscopic bilateral placement of selfexpandable metal biliary stents in malignant hilar biliary obstruction． MethodFrom May 2007 to December 2010, a total of 24 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ underwent endoscopic retrograde cholangiopancreatography (ERCP) and bilateral metal stent placement. Technical success rate, functional success rate, ERCP related complications, stents’ patency time, and patient’ survival time were recorded and reviewed． Results Twentyone of 24 patients were followedup for average 39 months. Technical success rate was 100%, the average operation time was （36.2±13.9） min, the functional success rate was 95.45%. Mild cholangitis occurred in 2 cases and there was no ERCP related pancreatitis, bleeding, perforation, and death. Stents dysfunction occurred in 7 within followup period. Amonge them, plastic stents were inserted through the metallic stents in 4 cases, PTCD was required in 1 case, and conservative therapy was given in the other 2 cases. The median stent’ patency time and median patient’ survival time were 253 d (95% CI: 199.79-306.21) and 229 (95% CI : 154.53-303.47）, respectively, with no significant differences between Bismuth classification types. ConclusionEndoscopic simultaneous bilateral biliary metal stent placement is technically feasible, safe, and effective to malignant hilar obstruction.