ObjectiveTo discuss the indication, therapeutic effect, complication of endoscopic surgery for pancreatic pseudocyst and its defect and merit.MethodsThe pertinent literatures about pancreatic pseudocyst treated by endoscopic technique were summarized. ResultsEndoscopic technique possessed the peculiarities of less trauma, convenience to operate and could be repeatedly used. The number of patients with pancreatic pseudocyst suitable for endoscopic therapy was increasing. When pancreatic pseudocyst was accompanied with complication, polycystic or failed in endoscopic treatment, surgical intervention was the only choice. Endoscopic technique would be considered firstly in other conditions.ConclusionIndividual scheme should be advocated according to the size, number location and complication of the pancreatic pseudocyst.
ObjectiveTo compare the clinical efficacy of endoscopic thyroidectomy via breast approach and open thyroidectomy for multiple nodular goiter. MethodsBetween September 2010 and March 2013, a total of 138 patients with multiple nodular goiter were divided into two groups based on even or odd number. Patients in the endoscopy group (n=69) had a mean age of 38.3 years and they underwent endoscopic thyroidectomy via breast approach, while patients in the open group (n=69) had a mean age of 36.8 years and underwent open thyroidectomy. Surgery time, blood loss, pain and drainage, as well as postoperative complications were compared between these two groups. ResultsSurgery time in the endoscopy group was significantly longer than that in the open group (P<0.05). Blood loss in the endoscopy group was significantly less than that in the open group (P<0.05). Scores of pain at different times in the endoscopy group were significantly lower than those in the open group (P<0.05). There was no significant difference in drainage and duration of drainage between the two groups (P>0.05). There were no significant differences in incidence of transient hypocalcemia, hypoparathyroidism and recurrent laryngeal nerve injury between the two groups (P>0.05). ConclusionEndoscopic thyroidectomy via breast approach and open thyroidectomy are both effective and safe procedures for multiple nodular goiter. However, endoscopic thyroidectomy via breast approach is superior to open thyroidectomy in reducing blood loss, relieving pain with excellent cosmetic results.
ObjectiveTo evaluate the high-level disinfection effect of flexible endoscopes in the Endoscopy Center of the First People’s Hospital of Longquanyi District of Chengdu, explore the key links of flexible endoscope cleaning and disinfection, and provide theoretical guarantee and technical support for the next step of the endoscope center work.MethodsWe sampled and monitored the lumens, water and air injection ports and biopsy ports of 19 flexible endoscopes after high-level disinfection in the Endoscopy Center of the First People’s Hospital of Longquanyi District of Chengdu. A total of 307 specimens were collected from 108 flexible endoscopes. We compared the disinfection effects of different flexible endoscopes and different sampling sites, and compared the microbial detection status of different flexible endoscopes.ResultsThe qualified rates of disinfection of gastroscopes, colonoscope and duodenoscopy were 79.22%, 86.21% and 100.00%, respectively, and the difference was not statistically significant (P=0.721). The qualified rates of disinfection of the endoscopic lumen, water and air injection port and biopsy port were 87.04%, 93.00% and 94.95%, respectively, and the difference was not statistically significant (χ2=4.585, P=0.101). The qualified rates of the lumen, water and air injection port and biopsy port of gastroscope, colonoscope and duodenoscope were 84.42%, 93.10%, 100.00%, 92.96%, 92.59%, 100.00%, 94.29%, 96.30%, 100.00%, respectively. There was no statistically significant difference in the disinfection effect of various parts of different flexible endoscopes (P>0.05). Bacteriological identification showed that of the 28 specimens with excess bacteriological standards, 16 gram-positive bacteria (57.1%), and 12 gram-negative bacteria (42.9%) were found.ConclusionThe cleaning and disinfection effect of flexible endoscopes has certain defect. Endoscope should be treated in strict accordance with the technical specifications for cleaning and disinfection of the flexible endoscope to further improve the disinfection effect of the flexible endoscope.
【Abstract】Objective To search for the significance of endoscopic thyroidectomy and parathyroidectomy. Methods Literatures about endoscopic thyroidectomy and parathyroidectomy were collected and reviewed. Results Thyroidectomy and parathyroidectomy may be performed with endoscope or with the help of endoscope. Conclusion By endoscopic thyroidectomy and parathyroidectomy, the patients are lightly injured without scar in the neck. The quality of life is improved.
ObjectiveTo systematically review the efficacy and safety of endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). MethodsDatabases including The Cochrane Library (Issue2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to August 2015 to collect randomized controlled trials (RCTs) and cohort studies about endoscopic radial artery harvesting technique versus traditional incision technique for CABG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 12 studies involving 1359 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in perioperative mortality (OR=0.66, 95%CI 0.17 to 2.57, P=0.55), the incidence of postoperative myocardial infarction (OR=0.78, 95%CI 0.30 to 2.06, P=0.62), vascular graft patency rate (OR=1.40, 95%CI 0.80 to 2.45, P=0.24) and the incidence of wound infection (OR=0.59, 95%CI 0.33 to 1.07, P=0.08). The endoscopic group showed significantly lower incidence of hematoma formation (OR=0.39, 95%CI 0.20 to 0.74, P=0.004) and paresthesia (OR=0.44, 95%CI 0.22 to 0.88, P=0.02) than that of the incision group. ConclusionCurrent evidence shows that, compared with the incision technique, the endoscopic radial artery harvesting could significantly reduce the incidence of hematoma formation and paresthesia in patients underwent CABG. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more high-quality studies.
Objective To analyze the effectiveness of endoscopic calcaneoplasty (ECP) for treating hindfoot pain in patients with Haglund’s deformity by comparing with conservative treatment. Methods According to the included standard, 64 hindfoot pain patients (77 feet) with Haglund’s deformity treated between January 2007 and October 2013 were enrolled. Based on the patient’s sports habit, 39 patients (49 feet) who had no requirement on sports were given conservative treatment (control group) and 25 patients (28 feet) who had stable sports habit were given ECP (ECP group). There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 2 groups (P > 0.05). Results The patients were followed up 16-44 months (mean, 33.7 months) in ECP group, and 12-40 months (mean, 37.5 months) in control group. In control group, the syndrome in 34 cases (43 feet) disappeared after 2 weeks; pain was improved in 5?cases (6 feet), and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases (30 feet) during following-up, 11 cases (13 feet) underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment (P < 0.05). With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment (P < 0.05). According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups (Z=-2.194, P=0.028). Conclusion Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund’s deformity.
【Abstract】Objective To explore the operative technique of endoscopic thyroidectomy and prevent its complications. Methods A retrospective analysis was made on the clinical data of 32 patients with benign thyroid diseases who were treated with endoscopic thyroidectomy between May 2002 and March 2005. Results Thirtytwo cases were successfully treated with the mean operation time 130 min(80～180 min). Twelve cases with thyroid adenomas and 20 cases with thyroid tubers were confirmed by histologic examinations. In this group, the postoperative complications included fat liquefaction in 2 cases and transient hoarseness in 1 case who recovered 3 months after operation. No parathyroid injury occurred. The drainage tubes were removed 2~3 days after operation. All of the patients were discharged 2~5 days after operation.Conclusion Endoscopic thyroidectomy is safe and feasible with favorable cosmetic effect.
Objective To explore the feasibility and safety of endoscopic thyroidectomy via chest-breast approachand summarize the operation skill. Method The clinical data of 40 cases performed endoscopic thyroidectomy via chest-breast approach from August 2010 to August 2012 in this hospital were analyzed retrospectively. Results The endoscopic thyroidectomies via chest-breast approach were successfully performed in all 40 patients without conversion to open surgery， massive haemorrhage， hypercapnia， severe subcutaneous emphysema， cutaneous necrosis on chest，permanent impairment of recurrent laryngeal nerve， and permanent hypoparathyroidism. One case of hoarseness was found on 2d after operation， who returned to normal after symptomatic treatment. One case of numbness in the extremitieshappened on day 2 after operation and the symptom was relieved through intravenous and oral administration of calcium treatment in 3d. One case of cutaneous tightness on chest happened， and it was spontaneous remission in a month. The operation time was （102±28.4） min （55-182 min）， intraoperative bleeding was （46±16.6） mL （30-106 mL）， and the drainage tube was removed postoperative 2-7d with an average （4±2.2） d， the postoperative hospitalization was 3-8 d with an average （4±1.1） d. All of the cases were followed-up after operation without low calcium， low parathyroid hormone， hoarseness， and local goiter recurrence. Two cases of hypoparathyroidism returned to normal after oral thyroxine dose adjustment. All the patients were satisfied with the cosmetic results. Conclusions The endoscopic thyroidectomy via chest-breast approach is safe and feasible with good cosmetic results. The subcutaneous Y tunnel， the “upper yellow middle white lower red” appearance on the chest， and the landmark of inverse trapezium on the neck are the key points for creation of operation compartment. Sufficient exposure， stepwise procedure， blunt dissection combined with sharp dissection in the precise gap are the surgical skills for endoscopic thyroidectomy.
Objective To summary the change of surgical approaches, indications, contraindications, and complications of endoscopic thyroidectomy. Methods Endoscopic thyroidectomy related literatures at home and abroad were collected to summary the change of surgical approaches, indications, contraindications, and complications of it. Results The approaches of endoscopic thyroidectomy had their own advantages, wherein breast and complete areola approaches were mainstream surgical procedures; the indications were closely correlated with surgeons and devices, and there were no uniform indications yet. With the advance in endoscopic techniques, the contraindications would be gradually resolved, and the assistance of new devices and the accumulation of experience reduced the incidence of surgical complications, but there were still probability of occurrence of such complications. Conclusion Endoscopic thyroidectomy is the main means of treating thyroid nodules, which will be more widely used with the advance in techniques, the innovation of devices, the expansion of indications as well as the overcoming of contraindications.
【Abstract】 Objective To evaluate the detection and localization of obscure lower gastrointestinal bleeding by using SPECT/CT and intraoperative endoscopy. Methods Twenty-six cases of patients with obscure lower gastrointestinal bleeding were analyzed retrospectively. Results The positive detection rate of SPECT/CT was 88.5%. All 26 patients (100%) were identified the bleeding source by using intraoperative endoscopy. No recurrence was found during 1-24 months follow-up. Conclusion SPECT/CT examination should be chosen firstly for patients with obscure lower gastrointestinal bleeding in order to localize the bleeding site roughly. Intraoperative endoscopy can localize the bleeding site accurately in patients who undergoes operation.