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THE ROLE OF ENDOSCOPIC VARICEAL LIGATION IN THE TREATMENT OF BLEEDING VARICES

经口内镜下环形肌切开术治疗贲门失弛缓症的术后护理

目的　探讨经口内镜下环形肌切开术（POEM）治疗贲门失弛缓症（AC）的整体护理措施在临床的应用价值。 方法　对2011年5月－2012年10月收治的25例行POEM治疗患者的术后护理方法及要点进行回顾性分析。 结果　全部患者顺利完成手术，术后1例患者出现皮下气肿，未经特殊处理，3 d后自然消退。经治疗与护理，25例患者痊愈出院。 结论　POEM作为一项近年来内镜下治疗的新型微创技术，是目前治疗AC的首选方法，其术后系统性的护理则是手术得以成功的重要保障。

Research progress of endoscopic vacuum-assisted closure therapy for esophageal fistulas

How to effectively repair esophageal fistulas, caused by esophageal perforation, rupture and anastomotic leakage after esophagectomy has always been a key problem for the digestive surgeon. Although there are many clinical treatment methods, the therapeutic effect is still completely unsatisfactory, especially when severe mediastinal purulent cavity infection is associated with the esophageal fistula. In recent years, foreign centers have promoted a new minimally invasive endoscopic treatment technology to repair the esophageal fistula, endoscopic vacuum-assisted closure therapy, with significantly curative effect. In this article, we will review the specific operation, advantages and disadvantages, as well as the clinical efficacy of endoscopic vacuum-assisted closure therapy in treating the esophageal fistulas, to provide a new therapeutic technique for esophageal fistulas and expand the new field of minimally invasive endoscopic therapy.

Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones

Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.

Etiology of pancreatitis in pediatric patients and effect of endoscopic retrograde cholangiopancreatography

ObjectiveTo investigate the etiology of pediatric pancreatitis and the effect of endoscopic retrograde cholangiopancreatography (ERCP) in it. MethodsPatients hospitalized for pancreatitis in West China Hospital of Sichuan University from Jan. 2008 to Jun. 2023 were included according to the inclusion and exclusion criteria. Totally, 241 cases (207 cases with acute pancreatitis and 34 with chronic pancreatitis) were included. Patients were divided into primary group (n=168) and recurrent group (n=73) according to their previous medical history. ResultsThe duration of hospitalization in the primary group was longer than that in the recurrent group [10.0 (7.0, 16.0) d vs. 7.5 (6.0, 11.8) d, P=0.012]. The proportion of acute pancreatitis in primary group (163/168, 97.0%) was higher than that in the recurrent group (44/73, 60.3%), P<0.001. There was no significant difference in the etiological component ratio between the primary and recurrent groups (χ2=7.504, P=0.347). However, in the primary group, the first etiology was biliary factors (38/163, 23.3%), and the second was biliary pancreatic anatomic abnormality (22/163, 13.5%). In the recurrence group, biliary pancreatic anatomic abnormality (13/44, 29.5%) was the first cause, and biliary factor (7/44, 15.9%) was the second cause. Among 207 cases with acute pancreatitis, there were 114 cases (55.1%) with clear etiology, including 45 cases (21.7%) of biliary factors, 35 cases (16.9%) of abnormal biliary pancreatic structure, 12 cases (5.8%) of traumatic factors, and 10 cases (4.8%) of drug-induced factors. In this study, 66 cases were treated with ERCP for pancreatitis, and a total of 103 ERCP operations were performed with cannulation success rate of 100%. Twenty-three cases (23/37, 62.2%) of acute pancreatitis resulted from biliary and biliary pancreatic structure abnormalities received ERCP. In biliary acute pancreatitis, the removal rate of choledocholithiasis in single ERCP operation was 80.0% (8/10). The clinical symptoms (abdominal pain, jaundice, and fever) of all cases were significantly improved after surgery, and no complications such as cholangitis, bleeding and perforation occurred. ConclusionsBiliary, congenital pancreatic anatomical abnormalities, drugs and trauma are the common causes of acute pancreatitis in children. ERCP is a safe and effective treatment for children with biliary pancreatitis, pancreatic anatomical abnormalities, and chronic pancreatitis.

急诊内镜下止血夹治疗消化道机械吻合术后早期吻合口出血的疗效

目的 探讨急诊内镜下使用止血夹治疗消化道机械吻合术后早期吻合口出血的疗效。 方法 回顾性分析 2005 年 1 月至 2016 年 12 月期间在笔者所在医院胃肠外科接受内镜下止血的 12 例消化道机械吻合术后早期吻合口出血患者的临床资料。 结果 本组 12 例患者中，10 例患者一次止血成功；2 例出现再次出血，其中 1 例再次内镜下止血成功，1 例胃空肠吻合术后患者止血失败、行手术治疗。所有患者术后均未出现吻合口漏等严重并发症。术后 11 例内镜止血成功患者获访 6～28 个月，中位随访时间 18 个月，随访期间未见再次出血。 结论 急诊内镜下止血夹治疗消化道机械吻合术后早期吻合口出血的操作简单、安全及有效，可作为首选方法在临床上推广应用。

Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation

Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Results Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences (P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). And there was no significant difference between the two groups at each time point after operation (P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months (P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group (P<0.05). ConclusionFor the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.

Comparison of the Clinical Efficacy between Endoscopic Surgery and the Surgery Combined with Plasma Low-temperature Radiofrequency in Treating Papilloma of External Auditory Canal

目的　观察独用内镜下手术以及联合等离子低温射频治疗外耳道乳头状瘤的疗效。 方法　2006年7月－2010年7月，随机将收治的45例外耳道乳头状瘤患者（150只耳）分组，比较独用内镜下手术组（A组）以及联合等离子低温射频组（B组）治疗外耳道乳头状瘤的疗效。 结果　患者均术后成功随访1～3年，48只患耳无复发及恶变，2只患耳3个月后复发。 结论　内镜下手术联合等离子低温射频治疗外耳道乳头状瘤具有微创，手术彻底有效，防止复发的优点，值得临床广泛应用。

硫糖铝混悬凝胶混合血凝酶与血管夹用于防治内镜下息肉切除术后出血的随机对照研究

目的 探讨硫糖铝混悬凝胶混合血凝酶用于防治内镜下息肉切除术后出血的临床效果。 方法 纳入 2014 年 4 月—2015 年 3 月在消化内镜中心行内镜检查发现直结肠息肉，并行内镜下肠道息肉黏膜切除术患者 112 例，随机分成药物组和血管夹组，每组各 56 例，分别予以术后创面喷洒硫糖铝混悬凝胶混合血凝酶及血管夹止血处理，观察两种方法操作时间、止血成功率、术后再出血的发生率及创面愈合情况。 结果 药物组和血管夹组分别有 15 例和 13 例出现术中即时出血，两组差异无统计学意义（P>0.05）。两组术中观察均成功止血，未追加其他止血方法。药物组和血管夹组平均操作时间分别为（58±16）、（192±94） s，两组差异有统计学意义（P<0.05）。术后观察，药物组无再出血，血管夹组 1 例再出血，两组差异无统计学意义（P>0.05）。两组患者术后 1 个月复查创面均愈合良好。 结论 硫糖铝混悬凝胶混合血凝酶用于防治内镜下息肉切除术后出血是一种简单、经济、有效的止血方法。

Clinical Observation on Spot-Welding Electrocoagulation with Needle-Knife to Prevent Bleeding after Endoscopic Sphincterotomy: Report of 102 Cases

ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.