【Abstract】 Objective To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperativenonunion of fracture of lower limb. Methods Between August 2004 and August 2008, 40 patients (23 males and 17 females) with postoperative nonunion of femoral and tibial fracture, aged 20-63 years (mean, 41.5 years) were treated. Nonunion of fracture occurred at 10-16 months after internal fixation. During the first operation, the internal fixation included interlocking intramedullary nail ing of femoral fracture in 12 cases and plate in 16 cases, and interlocking intramedullary nail ing of tibial fractures in 9 cases and plate in 3 cases. The X-ray films showed hypertrophic nonunion in 24 cases, common nonunion in 3 cases, and atrophic nonunion in 13 cases. Results The average operation time was 61 minutes (range, 40-80 minutes), and the blood loss was 80-130 mL (mean, 100 mL). The hospital ization time were 6-11 days (mean, 8.1 days). Incisions healed by first intention in all patients with no complication of infection or neurovascular injury. Forty patients were followed up 10-16 months (mean, 12.3 months). The X-ray films showed that all patients achieved healing of fracture after 4-10 months (mean, 6.8 months). No pain, disfunction, or internal fixation failure occurred. Conclusion Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.
ObjectiveTo investigate clinical efficacy and advantages and disadvantages of primary closure with two endoscopes (1aparoscope+choledochoscope) or three endoscopes (laparoscope+choledochoscope+duodenoscope) through the cystic duct for treatment of gallbladder stone with secondary common bile duct (CBD) stones.MethodsThe clinical data of 83 patients with gallbladder stones with secondary CBD stones treated by two or three endoscopes combined with CBD exploration and lithotomy and primary closure through cystic duct from January 2017 to December 2018 in the Chengdu Second People’s Hospital were collected retrospectively. Among them, 41 patients were treated by two endoscopes mode (two endoscopes group), 42 cases were treated by three endoscopes mode (three endoscopes group).ResultsThere were no significant differences in the general conditions such as the gender, age, preoperative diameter of CBD, chronic diseases, etc. between the two and three endoscopes group (P>0.05). All 83 cases underwent the operations successfully and recovered well. The success rate of operation, stone clearance rate, drainage volume of abdominal drainage tube on day 1 after the operation, time of abdominal drainage tube removal after the operation, and hospitalization time had no significant differences between these two groups (P>0.05). The time of operation, intraoperative bleeding volume, and the postoperative pancreatitis rate in the three endoscopes group were significantly more (or higher) than those in the two endoscopes group (P<0.05), but the condition of liver function recovered after the operation was better than that in the two endoscopes group (P<0.05).ConclusionsWith the strict control of the operation indications, it is safe and feasible to use two or three endoscopes through the cystic duct pathway and primary closure of CBD for treatment of gallbladder stone with secondary CBD stones. However, the choice of operative methods of two or three endoscopes should be based on the general situation of the patients before and during the operation.
ObjectiveTo investigate the safety of day surgery service model for one-stage prosthetic reconstruction after endoscopic radical mastectomy for breast cancer. MethodsThe breast cancer patients who underwent prosthesis reconstruction after endoscopic radical mastectomy at The First Affiliated Hospital of Air Force Military Medical University from January 2021 to December 2023 were retrospectively collected. The patients were assigned into an ambulatory group (ambulatory surgical service model) and an inpatient unit group (inpatient unit surgical service model) according to their surgical service modalities. The baseline data, surgery-related data, oncological safety-related indexes, and postoperative quality of life indicators by Breast-Q 2.0 score of the two groups were compared. ResultsThere were 239 patients were included, including 146 in the ambulatory group and 93 in the inpatient unit group. Except for the age and menopausal status of the patients of two groups (P<0.05), there were no statistically significant differences in the other baselines of the patients between the two groups (P>0.05). In the surgery-related data, except for the total hospitalization time and postoperative drainage in the ambulatory group, which were significantly less than those in the inpatient unit group (P<0.05), the differences between the two groups in terms of operation time, intraoperative bleeding, prosthesis size, postoperative dietary recovery time, postoperative pain score, and axillary lymph node dissection rate were not statistically significant (P>0.05). No significant differences were seen in the incidences of nipple-areola complex ischemia, flap ischemia, infection, implant loss, and capsular contracture (P>0.05). In the Breast-Q 2.0 score, the information satisfaction of the patients in the ambulatory group was significantly higher than that of in the inpatient unit group (P＜0.05), and there were no statistical significances in the breast satisfaction, social satisfaction, and physician satisfaction (P>0.05). The average follow-up time in the ambulatory group and inpatient unit group was (13.31±7.29) months and (13.41±9.02) months, respectively. All patients survived, among them, one patient (0.68%) in the ambulatory group and two patients (2.15%) in the inpatient unit group experienced local recurrence, and there was no significant difference in the rate of local recurrence between the two groups (P>0.05). ConclusionFrom the results of this study, day surgery for one-stage prosthetic reconstruction after endoscopic radical mastectomy for breast cancer is safe and can also improve the patient’s experience of care.
Objective Using the evidence-based management to manage the flexible endoscope based on the data collected by information means, to reduce the rate of serious faults and control maintenance costs. Methods From January 2017 to December 2018, we collected and analyzed the flexible endoscope data of the use, leak detection, washing and disinfection, and maintenance between 2015 and 2018 from the Gastroenterology Department of our hospital. Three main causes of flexible endoscope faults were found: delayed leak detection, irregular operation, and physical/chemical wastage. Management schemes (i.e., leak detection supervision, fault tracing, and reliability maintenance) were enacted according to these reasons. These schemes were improved continuously in the implementation. Finally, we calculated the changes of the fault rate of each grade and the maintenance cost. Results By two years management practice, compared with those from 2015 to 2016, the annual rates of grade A and grade C faults of flexible endoscope from 2017 to 2018 decreased by 10.3% and 16.7% respectively, and the annual average maintenance cost fell by 53.2%. Conclusions The maintenance costs of flexible endoscope could be effectively controlled by enacting and implementing a series of targeted management schemes based on the data from the root causes of faults applying the evidence-based management. Evidence-based management based on data has a broad application prospect in the management of medical equipment faults.
Objective To study the methods and techniques of the treatment forextensive suprasellar pituitary adenona and repairing hole.Methods From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via Ⅰand Ⅱ space of optic chiasma. The small bone flap was fixed with Ti clamp. Results After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. Conclusion Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.
Due to the special structure and material of the flexible gastrointestinal (GI) endoscopes, it is difficult to reprocess endoscopes. Infections caused by endoscope reprocessing failure often occur. Strict implementation of the guidelines/relevant national standards and manufacturer's instructions is essential to prevent the occurrence of endoscopy-related infections and ensure patient safety. In 2020, ASGE (American Society for Gastrointestinal Endoscopy) released the "multisociety guideline on reprocessing flexible GI endoscopes and accessories". This paper aimed to promote the understanding of the reprocessing process of flexible GI endoscopes by the endoscope decontamination staff, and to provide references for clinical practice.
In order to promote the implementation of the three standards of central sterile supply department (CSSD), new standards for cleaning and disinfection/sterilization of flexible endoscope, dental instruments, and environmental surface in healthcare, this article elaborates about central management of CSSD; management of loaners and implants; technique of autoclave sterilization, ethylene oxide sterilization, and hydrogen peroxide sterilization; high level disinfection or sterilization of flexible endoscope; disinfection and sterilization of dental instruments; daily and enhanced cleaning and disinfection of environmental surface in healthcare facilities. This could help clinical healthcare workers to implement these new standards, effectively prevent nosocomical infection, and guarantee the personal safety of patients.
Objective To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L4, 5 degenerative lumbar spondylolisthesis (DLS). Methods The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. Results Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). Conclusion OSE-assisted posterolateral approach lumbar interbody fusion for L4, 5 DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.
ObjectiveTo investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation.MethodsBetween December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C3, 4 in 2 cases, C4, 5 in 5 cases, C5, 6 in 9 cases, C6, 7 in 12 cases, and C7, T1 in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation.ResultsAll patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation (P<0.05). There was no significant difference between the time points after operation (P>0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation (t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae.ConclusionFor the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure.
ObjectiveTo investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus.MethodsBetween August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung’s technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups (P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height.ResultsThe discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm3 in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups (P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups (P<0.05); no significant difference was found between groups A and B (P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups (P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group (P<0.05), but no significant difference of above scores and recovery values was found among 4 groups (P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups (P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant (P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups (P>0.05).ConclusionThe ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.