目的 探讨内镜逆行胰胆管造影(ERCP)检查及内镜治疗在腹腔镜胆囊切除(LC)术前、术后的应用价值。 方法 对61例拟行LC的患者术前或术后行ERCP检查，发现异常再行内镜治疗。结果 LC术前行ERCP者42例中39例显影，其中37例伴有其他胆管疾病，占94.9%。术后行ERCP者19例均显影，总的插管成功率为95.1%。LC术前或术后42例行EST治疗，4例行EPBD，2例行ERBD，15例行ENBD，另4例在行ERCP检查后改开腹手术，取石成功率为92.9%。结论 诊治性ERCP在LC前、后的应用，对进一步明确诊断、选择手术方式、预防LC的并发症和提高LC的成功率具有重要价值。
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。
Objective?To assess the effectiveness and safety of diclofenac, one of the routine-used NSAIDs, in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods Firstly, the electronic searches were conducted to retrieve Randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, OVID, CBM, CNKI, VIP and WanFang Data. Secondly, 12 kinds of specific Chinese journals like Chinese Journal of Gastroenterology and conference proceedings were hand-searched till June 2011, and all references in all included trials were searched, too. The RCTs on diclofenac for preventing PEP were identified and retrieved. The systematic review was conducted by using methods and principles recommended by the Cochrane Collaboration. Results A total of 5 RCTs involving 675 PEP patients were included. The Meta-analysis showed that diclofenac might reduce the incidence of PEP (OR=0.41, 95%CI 0.18 to 0.95, P=0.04), but the sensitivity analysis indicated this result was not stable. No evidence showed diclofenac could reduce the incidence of severe PEP (OR=0.40, 95%CI 0.08 to 2.06, P=0.27). And no adverse reactions related to the drug were reported. Conclusion Diclofenac may be safe and effective in reducing the incidence of PEP, but it has no significant effect on preventing severe PEP. Considering the methodological and scale limitation of included studies, this conclusion still needs to be proved by more large-scale and high-quality RCTs.
With the popularization of digestive endoscopy in children, colonoscopy has been widely used. As the basis of digestive endoscopy, bowel preparation directly affects the diagnosis and treatment results of colonoscopy. Compared with adults, the functioning of important organs of children is immature, and their ability of cognition, communication and tolerance are weak. Their structure of the digestive tract is also significantly different in different ages. However, there have been no existing evidence-based guidelines on bowel preparation for digestive endoscopy of Chinese children. Therefore, it is important to develop evidence-based guidelines for bowel preparation combined with the clinical practice in China. In order to provide guidance and decision-making basis for Chinese pediatricians, we collaborated with multidisciplinary experts, based on existing evidence, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, followed the Reporting Items for Practice Guidelines in Healthcare (RIGHT) to develop this guideline for bowel preparation related to the diagnosis and treatment of children's digestive endoscopy.
Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.
Objective To investigate the effect of implanting uncovered self-expandable metal stent for treatment of distal malignant biliary obstruction through endoscope. Methods The effect of therapy about implanting uncovered self-expandable metal stents to 16 patients who had unsectable malignant tumors companing with obstructive jaundice through endoscope was reviewed. Results Fifteen of the studied patients were implanted uncovered self-expandable metal stents successfully (94%), for their internal drainage were patent. At the seventh and fourteenth day after implantation, liver function and B-ultrasound were rechecked. Compared to the data before operation, total bilirubin, direct bilirubin and transaminase declined respectively (P＜0.01). And the diameter of the total biliary duct became shorter (P＜0.01). Six of them returned to the normal level in three weeks. Early adverse events (in seven days) included mild acute pancreatitis (one case) and acute cholangitis (one case). Mean survival and patency of drainage were 186.93 days (54 to 426 days) and 156 days (51 to 426 days) respectively. All of them, 3 cases occured obstruction of stents (20%). Conclusion Implantation of uncovered selfexpandable metal stent through endoscope is an ideal therapy for distal malignant biliary obstruction.
ObjectiveTo study the current situation and influencing factors of biofilm formation of digestive endoscopy in Zhongshan Hospital, Fudan University.MethodsFrom September 1st to 13th, 2020, ATP fluorescence assay and membrane filtration method were carried out on 130 endoscopes from the Endoscopy Center of Zhongshan Hospital, Fudan University. The type, number, source, duration of use and disinfection times in the past week were collected. Positive culture samples were identified by matrix-assisted laser desorption / ionization time of flight mass spectrometry. Logistic regression analysis was used to explore the factors affecting the formation of biofilms.ResultsThe total qualified rate of ATP assay and bacterial culture was 94.62% and 92.31% respectively. The 10 positive culuture samples were mainly composed of Pseudomonas aeruginosa, Moraxella osloensis, Stenotrophomonas maltophilia, Pseudomonas putida and Micrococcus luteus. Multivariate logistic regression analysis showed that the frequency of disinfection in the past week was associated with positive biofilm culture (P=0.001). The odds ratio of disinfection frequency more than 30 times in past week compared with disinfection frequency less than 15 times was 0.040, and 95% confidence interval was (0.005, 0.295).ConclusionsThe biofilm of digestive endoscopy in the Endoscopy Center of Zhongshan Hospital, Fudan University is mainly formed by aquatic bacteria. The formation biofilm can decrease by increasing disinfection frequency, and attention should be paid to the monitoring of endoscopic biofilm in the future.