Early diagnosis of gastric cancer can improve the prognosis of patients, especially for those with early gastric cancer (EGC), but only 15% of patients, or less, are diagnosed with EGC and precancerous lesions. Magnifying endoscopy with narrow-band imaging (ME-NBI) can improve diagnostic accuracy. We assess the efficacy of ME-NBI in diagnosing ECG and precancerous lesions, especially some characteristics under NBI+ME. This was a retrospective analysis of 131 patients with EGC or gastric intraepithelial neoplasia (IN) who had undergone endoscopic submucosal dissection and were pathologically diagnosed with EGC or IN according to 2019 WHO criteria for gastrointestinal tract tumors. We studied the characteristics of lesions under ME-NBI ,compared the diagnostic efficacy of ME-NBI and white light endoscopy (WLI) plus biopsy, and investigated the effect of Helicobacter pylori infection on microvascular and microsurface pattern. The diagnostic accuracy of ME-NBI for EGC, high-grade IN (HGIN), and low-grade IN (LGIN) was 76.06%, 77.96%, and 77.06%, respectively. The accuracy of WLI plus biopsy in diagnosing the above lesions was 69.7%, 57.5%, and 60.53%, respectively. The rate of gyrus-like tubular pattern was highest in LGIN (60.46%), whereas the highest rate of papillary pattern was 57.14% in HGIN and villous tubular pattern was 52% in EGC. Demarcation lines have better sensitivity for differentiating EGC from IN (92.06%). The ME-NBI has higher diagnostic accuracy for EGC than WLI plus biopsy. Demarcation lines and villous and papillary-like microsurface patterns are more specific as EGC and HGIN characteristics. The cerebral gyrus-like microsurface pattern is more specific for LGIN.
Background:The incidence of gastric polyps in adolescents has been increasing every year in recent years. Endoscopic mucosal resection (EMR) is one of the most common treatments for adults, but there are few reports on the association between EMR of gastric polyps and the occurrence of bleeding and recurrence after the procedure in adolescents. This study sought to analyze the independent risk factors for postoperative bleeding and polyp recurrence after EMR to provide a reference for reducing the occurrence of postoperative complications.Methods:We retrospectively analyzed the data of 579 adolescent patients who developed gastric polyps from June 2016 to June 2021. Postoperative follow-up was conducted for 1 year by telephone, e-mail, and outpatient review. The general characteristics of the study population were compiled using a general information questionnaire designed by the investigators. The relationship between the patients' clinical characteristics and postoperative bleeding or recurrence was analyzed using the chi-square test. A binary logistic regression analysis was conducted to analyze the independent risk factors for the occurrence of postoperative bleeding and polyp recurrence in patients.Results:The results of the binary logistic regression analysis showed that being female [odds ratio (OR) =0.306, P=0.009], polyps >1 cm in diameter (OR =2.557, P=0.029), polyps in gastric sinus (OR =3.889, P=0.032), sessile lesions (OR =0.398, P=0.036), the need for additional intraoperative sedation (OR =3.469, P=0.005), concurrent diverticulum (OR =3.570, P=0.004), and intraoperative bleeding (OR =4.855, P=0.001) were independent risk factors for postoperative bleeding. We also found that polyps >1 cm in diameter (OR =2.134, P=0.003), multiple polyps (OR =2.117, P=0.005), adenomatous polyps (OR =2.684, P=0.041), combined Helicobacter pylori infection (OR =2.036, P=0.009), the occurrence of postoperative gastrointestinal reflux (OR =1.998, P=0.015), and an operative time ≥40 min (OR =2.021, P=0.010) were independent risk factors for the recurrence of polyps.Conclusions:There is still a high probability of postoperative bleeding and polyp recurrence after EMR in adolescents with gastric polyps. Clinicians should pay close attention to the clinical features of polyps, such as polyp size, number, morphology, and pathological type, to identify the related risk factors as early as possible and reduce the probability of postoperative bleeding and polyp recurrence in patients.
Objective To investigate the clinical efficacy of arthroscopic debridement combined with platelet rich plasma(PRP)in treatment of supraspinatus calcified tendinitis.Methods 23 patients in the experimental group were treated with shoulder arthroscopic calcification clearing with PRP injection,while 23 patients in the control group were treated with simple arthroscopic clearing,and the curative effects were observed and compared.Results All the patients were followed up effectively.Of the 23 cases in the experimental group,5 cases were treated with rotator cuff repair(3 cases were diagnosed rotator cuff tear before operation,2 cases were diagnosed with large calcification,and rotator cuff repair was performed after cleaning),and 3 cases were treated with rotator cuff repair(2 cases were diagnosed with rotator cuff tear before operation,1 case was diagnosed with large calcification,and rotator cuff repair was performed after cleaning).The visual analogue scale(VAS)of the two groups one month after surgery was significantly lower than that before surgery,and the American Association of Shoulder and Elbow Surgeons(ASES)score of the two groups one month after surgery was significantly higher than that before surgery,with statistical significance(P＜0.05).The VAS of the experimental group was significantly lower than that of the control group one month after surgery,and the ASES score was significantly higher than that of the control group one month after surgery,with statistically significant differences(t =-5.52,t = 8.73,P = 0.001).Conclusion Arthroscopic debridement combined with PRP is an effective and minimally invasive method for the treatment of supraspinatus calcified tendinitis.The calcium salt can be removed as much as possible under arthroscopy,and the scope of rotator cuff injury can be accurately evaluated.For the obvious rotator cuff injury with large damage,the rotator cuff repair with thread anchor nail can be performed.At the same time,combined with PRP,it can accelerate the repair of rotator cuff injury,relieve pain,and accelerate the functional recovery of shoulder joint.
Objective To compare the surgical results of cholesteatoma of external auditory canal under the otoscope and the microscope.Methods Clinical data of 44 patients with cholesteatoma from January 2015 to December 2019 were analyzed retrospectively.According to the operation mode,the patients were divided into observation group and control group.The cholesteatoma in the observation group was cleaned under the otoscope,and the cholesteatoma in the control group was cleaned under the microscope.The clinical effects of the two groups were compared.Results The patients in both groups were cured and their hearing was improved in different degrees.Compared with the control group,the difference of speech frequency hearing threshold between the observation group and the control group was statistically significant(t = 19.71,t = 13.41,P＜0.05).The operation time of the observation group was short than that of the control group,and the local discomfort of the observation group was lighter than that of the control group after operation,which was statistically significant(t =-3.68,t =-2.44,P＜0.05).All the patients were followed up for 6 months with dry ears and no recurrence.Conclusion Endoscopic treatment of cholesteatoma of external auditory canal is simple and effective,which is worthy of clinical application.
Objective To investigate the clinicopathological characteristics and prognosis of well-differentiated rectal neuroendocrine tumor(RNET).Methods A retrospective analysis was conducted using the clinical data from 83 patients with well-differentiated RNET from August 2017 to December 2021,including clinical manifestations,endoscopy,endoscopic treatment,postoperative complications,postoperative pathology,follow-up and prognosis.Pathological results according to the 2019 World Health Organization(WHO)Classification of digestive system tumors,83 patients were divided into G1 stage group(72 cases)and G2 stage group(11 cases);Based on the number of tumors in the patient,83 patients were divided into two groups:single RNET group(77 cases)and multiple RNET group(6 cases),the expressions of chromogranin A(CgA),synapsin(Syn)and CD56 were compared among different groups.Results Based on pathological findings in the group,G1 stage group CgA positive rate was significantly higher than that of G2 stage group,the difference was statistically significant(χ2 = 4.23,P = 0.040);Based on the number of tumors,multiple RNET group CgA positive rate was significantly higher than that of single RNET group,the difference was statistically significant(χ2 = 5.74,P = 0.017).It was no significant difference in Syn and CD56 between the two groups(P＞0.050).Conclusion Well-differentiated RNET has no specific clinical manifestations.It is mostly isolated in G1 stage and single RNET.ESD is safe and has a good prognosis,the positive rate of CgA is higher in G1 stage patients,and the positive rate of CgA is higher in patients with multiple RNET.
Objective To investigate the safety and short-term efficacy of π-shaped anastomosis and circular anastomosis(reverse puncture device)in reconstruction of esophagojejunostomy after laparoscopic total gastrectomy.Methods A retrospective study was used to collect the clinical and pathological data of 75 cases of gastric cancer from January 2019 to March 2021.According to the different reconstruction methods of esophagojejunal anastomosis,the patients were divided into a linear cutting obturator group(π-shaped anastomosis group,n = 27)and a circular anastomat anastomosis group(reverse puncture device group,n = 48).The general information of the two groups,operation time,esophagojejunostomy time,intraoperative bleeding volume,number of intraoperative lymph node dissection,intraoperative complications,and postoperative complications were compared and analyzed.Results The operation time and esophagojejunostomy time in the π-shaped anastomosis group were(221.5±8.8)and(34.7±3.7)min,and the reverse puncture device group were and(246.9±5.6)and(47.2±4.6)min,respectively,the differences were statistically significant(t = 15.19,t = 11.81,P＜0.05).There were no statistical significance in the comparison of intraoperative bleeding volume and number of intraoperative lymph node dissection between the two groups(P＞0.05).In the reverse puncture device group,there were two intraoperative complications,including one case of esophageal jejunal anastomosis atresia and one case of anastomosis tear,postoperative complications occurred in 3 cases,postoperative anastomotic stenosis occurred in 2 case,and anastomotic bleeding occurred in 1 case.Conclusion Laparoscopic total esophagojejunostomy with π-shaped anastomosis and reverse puncture device are safe and feasible.In terms of esophagojejunostomy time,π-shaped anastomosis reconstruction time is shorter.When the small intestine diameter is relatively small and it is difficult to extend into the 25 mm stapler,the advantage of π-shaped anastomosis is more obvious.When the tumor is Siewert type Ⅰ and type Ⅱ adenocarcinoma of gastroesophageal junction,which infiltrates into above the dentate line,reverse puncture device method is recommended for reconstruction.
Objective To investigate the clinical results of plasma electrosurgery in elderly female patients with urethral caruncle using a modified homemade urethral extender.Methods 28 patients with urethral caruncle were admitted from January 2019 to December 2022,all with modified homemade urethral extender-assisted plasma electrosurgery,and the patients'operative time,length of hospital stay,catheter retention time and occurrence of postoperative complications were analyzed.Results All the 28 patients in this group completed the operation successfully with the assistance of homemade urethral extender,no conversion to open surgery.The operation time was 15～40 min,with an average of(24.4±6.4)min.The catheter retention time was 3～7 d,with an average of(5.1±1.1)d.The hospitalization time was 4～8 d,with an average of(6.5±1.0)d.After removal of catheter,all urination was clear,no recent complications such as urinary incontinence and urination difficulty,and all had pathology suggestive of urethral caruncle.Follow up time was 2～22 months,with an average of(11.8±6.5)months,no long-term complications such as urethral stricture and recurrence of urethral caruncle occurred.Conclusion Endoscopic treatment of urethral caruncle with a modified homemade urethral extender is one of the safe and effective treatments that deserves clinical promotion.
Objective To explore the clinical efficacy of Delta endoscopic lumbar decompression fusion for the treatment of giant lumbar disc herniation(GILDH).Method A retrospective analysis was performed on 36 cases of GILDH from April 2020 to May 2022,including 18 cases in the Delta group and 18 cases in the open group.There was no statistically significant difference in gender,age,and responsible section between the two groups of patients.Compare the surgical time,perioperative indicators,and clinical efficacy between the two groups.Results The intraoperative bleeding and drainage volume in the Delta group were lower than those in the open group,the incision length and hospital stay were shorter than those in the open group,the degree of paraspinal muscle injury was lighter than that in the open group,and the surgical time was longer than that in the open group,with statistical significance(P＜0.05);The lumbago visual analogue scale(VAS)of the two groups of patients at each postoperative period was significantly reduced compared to preoperative,and the lumbar spine function score of the Japanese Orthopaedic Association(JOA)was significantly increased compared to preoperative,with statistical significance(P＜0.05);The lumbago VAS of the Delta group was significantly lower than that of the open group at all postoperative stages,and the lumbar spine function JOA score was significantly higher than that of the open group,with statistical significance(P＜0.05);There was no statistically significant difference in the modified MacNab score between the two groups of patients at the last follow-up after surgery(P＞0.05).Conclusion Delta endoscopic lumbar decompression fusion for GILDH has significant therapeutic effects,with advantages such as less bleeding,small surgical incision,and fast postoperative recovery;After crossing the Delta endoscopic learning curve and optimizing the surgical process,this technology can become an alternative to conventional open surgery.
Objective To explore the validity and security of treatment of different operation approach under nasal endoscope in patients with benign maxillary sinus lesions.Methods A retrospective analysis was performed on 80 patients with benign maxillary sinus lesions diagnosed and treated from January 2020 to January 2022,and they were divided into group A(n = 40)and group B(n = 40)according to the operative method.Group A was treated with middle nasal meatus combined with Caldwell-Luc operation under nasal endoscope,and group B was treated with middle nasal meatus antrostomy first and anterior lacrimal recess approach later under nasal endoscope.The clinical efficacy,operation index,visual analogue scale(VAS),Lund-Kennedy endoscopic score,adverse reactions and recurrence rate of both groups were compared before and after operation.Results The total effective rate was sensibly higher in group B than that in group A,the intraoperative blood loss was sensibly less in group B than that in group A,the operation and hospitalization time were sensibly shorter in group B than those in group A,6 months after operation,the VAS and Lund-Kennedy scores were sensibly decreased in comparison with those before operation,and group B was sensibly decreased in comparison with those in group A,the total incidence rate of adverse reactions and recurrence rate were sensibly lower in group B than those in group A,the differences were statistically significant(P＜0.05).Conclusion The surgical treatment of patients with benign maxillary sinus lesions through the middle nasal meatus and the anterior lacrimal recess approach under nasal endoscope is effective and can relieve the pain of patients with high safety.It is worthy of clinical application.
Objective To investigate the risk factors of postoperative pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP),establish a quantitative risk prediction model,and conduct external validation.Methods The clinical data of patients with ERCP were analyzed.Among them,603 ERCP patients From January 2017 to January 2021 were selected as the modeling group,and 205 ERCP patients from March 2021 to March 2022 were selected as the validation group.Pancreatitis was diagnosed according to Atlanta standards.There were 45 cases in the modeling group and 23 cases in the validation group developed pancreatitis after ERCP.Compare the clinical data and biochemical indicators of patients with and without pancreatitis in the modeling group,and screen for risk factors of pancreatitis through multivariate Logistic regression analysis.Then,establish a risk prediction model and validate it.Results Univariate analysis showed that there were statistically significant differences in age,history of gastectomy,calculus of common bile duct,papillary foramen nodule type,pancreatic wire channel,sphincterotomy,serum total bilirubin and albumin between the two groups(P＜0.05).Multivariate Logistic regression analysis showed that the history of gastrectomy(O(R) = 6.417,95%CI:1.900～21.675,P = 0.000),calculus of common bile duct(O(R) = 3.442,95%CI:1.496～7.917,P = 0.000),papillary foramen nodule type(O(R) = 2.447,95%CI:1.072～5.585,P = 0.018),pancreatic wire channel(O(R) = 3.673,95%CI:1.609～8.383,P = 0.000),sphincterotomy(O(R) = 1.758,95%CI:1.140～2.711,P = 0.004),elevated total bilirubin(O(R) = 1.415,95%CI:1.084～1.847,P = 0.008)and decreased albumin(O(R) = 1.239,95%CI:1.016～1.510,P = 0.010)were independent risk factors for post ERCP pancreatitis.Establish a risk prediction model Y =-1.023 + 1.859×(history of gastrectomy)+ 1.236×(calculus of common bile duct)+ 0.895×(papillary foramen nodule type)+ 1.301×(pancreatic wire channel)+ 0.564×(sphincterotomy)+ 0.347×(elevated total bilirubin)+ 0.214×(decreased albumin).The receiver operator characteristic curve(ROC curve)showed that the area under the curve(AUC)of the model predicting pancreatitis in the modeling and validation groups were 0.895 and 0.864,respectively.After assigning values to each variable in the model,it was divided into low risk(0～5 points),medium risk(5～10 points),and high risk(≥10 points).The actual incidence of high-risk pancreatitis in the modeling and validation groups was significantly higher than that of low-risk patients,and the actual incidence of high-risk pancreatitis was significantly higher than that of medium risk patients,with statistical significance(P＜0.05).Conclusion The history of gastrectomy,calculus of common bile duct,papillary foramen nodule type,pancreatic wire channel,sphincterotomy,elevated total bilirubin and decreased albumin were independent risk factors for post ERCP pancreatitis.We have developed a quantitative risk prediction model with good predictive efficacy for pancreatitis,which has important clinical application value.
Objective To explore the efficacy and safety of endoscopic ligation in treatment of gastric submucosal tumors(diameter≤1 cm).Methods Clinical data of 177 patients with gastric submucosal tumors who received endoscopic therapy from October 2020 to July 2022 were retrospectively analyzed.Patients were divided into endoscopic submucosal dissection(ESD)group(n = 142)and endoscopic ligation group(n = 35)according to different endoscopic treatment methods,and the operation time,intraoperative complications,postoperative hospital stay,surgical cost,complete lesion resection,postoperative complications and pathology of the two groups were compared.Results The operative time of the ESD group was(33.23±8.55)min,which was significantly longer than that of the endoscopic ligation group(24.85±5.96)min.The intraoperative bleeding was ERB-c1 and no ERB-c2 of the ESD group,which was better than that of the endoscopic ligation group,and the operative cost was(24 615.08±5 678.32)yuan,significantly more than that of the endoscopic ligation group(21 319.26±7 235.95)yuan,the differences were statistically significant(P＜0.05).There was no significant difference in the intraoperative perforation rate,postoperative hospitalization time and postoperative follow-up time between the two groups(P＞0.05).No surgical transfer,serious infection,delayed hemorrhage and perioperative death occurred in both groups,and no tumor recurrence,metastasis and death were found.Conclusion Endoscopic ligation has the advantages of relatively safe,efficient,less blood loss and low cost,but it has the risk of bleeding which is difficult to predict.Therefore,it is particularly important to select appropriate treatment after adequate evaluation.
Objective To observe the clinical curative effect of unilateral biportal endoscopy(UBE)in the treatment of extreme lateral lumbar disc herniation(ELLDH).Methods From June 2019 to June 2022,25 patients with ELLDH were treated with UBE-guided discectomy,including 16 males and 9 females.The age ranged from 26 to 62 years with a mean of(53.67±17.45)years.History ranged from 3 d to 10 years.There were 9 cases of internal foraminal type(type Ⅰ),13 cases of external foraminal type(type Ⅱ)and 3 case of mixed type(type Ⅲ).There were 8 cases of L4/5 space and 17 cases of L5/S1 space.All the patients underwent anterior and lateral lumbar X-rays,CT and MRI scans before surgery.The visual analogue scale(VAS)pain score and Oswestry disability index(ODI)assessed lower limb and lower back pain and functional recovery before surgery and at 3 d and 3 months after surgery,respectively.Macnab criteria evaluated the immediate surgical outcome.Results The UBE technique was used to treat ELLDH.The operative time was(79.79±23.97)min,the intraoperative bleeding volume was 40～80 mL,with an average of(55.80±10.74)mL.Follow-up time was(7.02±4.26)months.Preoperative VAS of lower limb was(7.04±0.92),lower back VAS was(3.49±1.52),ODI was(35.03±2.97)%.Compared with the preoperative results,the lower limb VAS was(2.17±0.61),lower back VAS was(1.48±0.43),and ODI was(18.77±3.15)%on day 3 after surgery,lower limb VAS was(1.38±0.65),lower back VAS was(1.03±0.48)and ODI was(6.05±1.80)%on the 3 months after surgery were improved(P＜0.05).The excellent and good rate was 96.0%(excellent 20,good 4,fair 1),and no obvious complications were observed during the follow-up.Conclusion UBE is effective,with little trauma,clear intraoperative visual field,good intraoperative experience,and less traumatic and safe in the treatment of ELLDH.
Objective To explore the clinical application of opportunistic screening(OS)for colorectal cancer in order to provide a basis for further improving the screening process and improving screening efficiency.Methods Clinical data of 3 398 patients with positive OS for colorectal cancer who completed total colonoscopy from January 2019 to December 2020 were retrospectively analyzed.After completion of the high risk factor questionnaire(HRFQ)and fecal immunochemical test(FIT),colonoscopy was recommended for patients who tested positive for either of the two screening methods.The age,sex,lesion detection and lesion location of the patients were counted,and the detection rate of colorectal tumors by different screening methods was compared according to the preliminary screening results.Results Among the 3 398 subjects,the detection rate of advanced adenoma and colorectal cancer in HRFQ(-)FIT(+)group were higher than that in HRFQ(+)FIT(-)group,there were significant differences between the two groups(P＜0.05).The detection rate of non-advanced adenoma in HRFQ(-)FIT(+)group was lower than that in HRFQ(+)FIT(+)group,there was significant difference between the two groups(P＜0.05).The sensitivity of FIT to colorectal tumors was generally better than that of HRFQ,and the sensitivity of FIT to distal colorectal tumors was higher than that of proximal colorectal tumors,there were significant differences between the two groups(P＜0.05).Conclusion The combination of HRFQ and FIT can screen more high-risk groups than FIT or HRFQ alone,thus detect more colorectal tumors,effectively improve the 5-year survival rate through timely endoscopic treatment or surgical resection,and ultimately reduce the morbidity and mortality of colorectal cancer in the population.
Objective To observe the effect of deep muscle relaxation by rocuronium on oxygenation of normal frequency jet ventilation during rigid bronchoscopy procedures.Methods From December 2021 to February 2023,60 patients with central airway diseases underwent rigid bronchoscopy under general anesthesia,they were randomly divided into deep muscle relaxation group(group D,n = 30)and moderate muscle relaxation group(group M,n = 30).After induction of general anesthesia,the patients were inserted rigid bronchoscopy for jet ventilation,muscle relaxant was rocuronium in induction and maintenance.Train of four(TOF)stimulation was used to measure the depth of muscle relaxation in group M,and the TOF count was maintained at 1 or 2;In Group D,the depth of muscle relaxation was measured by post tetanic count(PTC),and the PTC was maintained at 1 or 2.After operation,Sugammadex antagonized residual muscle relaxation.Results There was no significant difference in operation time,recovery time and extubation time between the two groups(P＞0.05).The total operation time,operation pause time and anesthesia time in group D were shorter than those in group M,the dosage of muscle relaxant in group D was more than that in group M,the incidence of hypoxemia during surgery in group D was less than that in group M,the operators'satisfaction in group D was better than that in group M,and the arterial partial pressure of oxygen(PaO2)in group D was higher than that in group M at 15 min(T1)and 30 min(T2)after jet ventilation,the number of patients with postoperative sore throat in group D was less than that in group M,the differences were statistically significant(P＜0.05).Conclusion The application of deep muscle relaxation by rocuronium in rigid bronchoscopy procedures can improve the oxygenation effect of normal frequency jet ventilation,reduce the operation pause time and anesthesia time,improve the satisfaction of operators,antagonizing residual muscle relaxation with Sugammadex can relieve the worry of delayed recovery from deep muscle relaxation.
Objective To explore the curative effect of day care unit on the efficacy,safety and satisfaction of elderly patients who underwent a cold snare polypectomy for the treatment colorectal polyps.Methods Clinical data from 454 elderly patients with 824 colorectal polyps(Diameter 4～10 mm)who received a polypectomy from Mar 2020 to Mar 2021 were collected.These patients were classified into three groups.The cold snare polypectomy group and hot snare polypectomy group in day care unit,and the cold snare polypectomy group in general wards.The clinical characteristics,adverse events,recurrence,hospitalization time,and expenses,were compared among three groups.Additionally,the patients'hospitalization satisfaction was investigated and analyzed.Results There were no significant differences in clinical characteristics,histopathology,and rates of postoperative bleeding,perforation,and recurrence among the 3 groups(P＞0.05),but the probability of immediate bleeding was higher in the cold snare polypectomy group.Moreover,coagulation syndrome was unique to the hot snare polypectomy group.The hot snare polypectomy group used the highest amount of endoclips,while the cold snare polypectomy group in the general wards used the least.Furthermore,the hospitalization time and expenses in the day care unit group were significantly lower than in the general wards group.However,the patients'satisfaction survey showed that the day care unit group scored lower than the general wards group(P＜0.05).Conclusions It is safe,cost-effective and effective for elderly patients with colorectal polyps using cold snare polypectomy technique under the day care unit mode,but the lack of communication with the patient's condition in a short period of time rather leads to a decrease in hospital satisfaction.
目的 探讨改良的乐奥尼龙绳息肉根部结扎术在结直肠大息肉摘除中的应用效果.方法 回顾性分析2018年1月-2022年11月该院应用改良的乐奥尼龙绳息肉根部结扎术治疗的136例≥1.0 cm结直肠息肉患者的临床资料,最大息肉3.0 cm×5.0 cm,观察术后出血、穿孔、感染、息肉切缘病理、恢复进食时间、住院时间和随访情况等.结果 136例结直肠大息肉均顺利摘除,平均操作时间(16.0±8.2)min,135例患者无术后出血、穿孔和感染,仅有1例患者术后出血,经肠镜检查证实为尼龙绳脱落后出血,直接上止血夹止血.息肉术后切缘病理均为阴性,所有患者均在术后24 h内进食,住院时间(2.2±1.7)d,术后3～6个月随访复查肠镜,显示尼龙绳均已经脱落,所有创面均为白色瘢痕,表面无息肉残留.结论 改良的乐奥尼龙绳息肉根部结扎术用于结直肠大息肉摘除,是一种操作简便,且安全有效的方法.
目的 探讨人工智能技术对社区大肠癌(CRC)筛查高危人群息肉检出率(PDR)的影响.方法 选取2020年12月-2021年3月社区CRC筛查结果阳性并接受结肠镜检查的患者202例.分析受检者的临床资料、肠道准备情况和内镜精灵辅助诊断等指标,比较PDR.结果 PDR为37.62%.单因素分析结果提示,检出组年龄大于未检出组[(61.26±6.45)和(58.37±7.01)岁,P = 0.004],体重重于未检出组[(65.28±9.51)和(60.81±9.20)kg,P = 0.001],体重指数(BMI)高于未检出组[(24.80±2.69)和(23.51±2.96)kg/m2,P = 0.002],男性占比高于未检出组(38.16%和24.60%,P = 0.041),有慢性腹泻或便秘症状者占比为42.11%,未检出组为55.56%,差异无统计学意义(P = 0.064),使用内镜精灵的占比高于未检出组(67.11%和43.65%,P = 0.001).多因素回归分析结果表明,年龄((OR) = 1.066,95%CI:1.017～1.119,P = 0.008)和使用内镜精灵((OR) = 3.101,95%CI:1.625～5.916,P = 0.001)为PDR的独立影响因素.对使用内镜精灵组进一步分析发现,年龄、体重、BMI、退镜时间、肠道准备评分和性别对PDR有影响.多因素回归分析结果显示,退镜时间((OR) = 1.007,95%CI:1.001～1.013,P = 0.027)和肠道准备评分((OR) = 1.535,95%CI:1.018～2.316,P = 0.041)为PDR的独立预测因素.结论 对于社区CRC筛查高危患者,男性、高龄和肥胖患者息肉发生风险可能更高.提高肠道准备评分,使用内镜精灵辅助诊断时,延长退镜时间,可能有助于病灶检出.
Objective To summarize the application of endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA） in mediastinal cysts, and improve the understanding of the application of EBUS-TBNA in mediastinal cysts. Methods The clinical data of 4 cases with mediastinal cysts treated by EBUS-TBNA were retrospectively analyzed, and the relevant literatures on the application of EBUS-TBNA in mediastinal cystic lesions were reviewed to summarize the application and common complications. Results The diagnosis of mediastinal cysts were confirmed by ultrasound in all four cases of mediastinal cystic lesions, the source of the cysts could be clarified in two cases by analysis of the cystic fluid, and one case had severe infection-related complications. Conclusion EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, clinical application should be carried out scrupulously with appropriate patient selection and strict aseptic principles.
目的 探讨鼻内镜手术治疗真菌性鼻窦炎的疗效及术后复发的影响因素.方法 选择2019年4月-2022年4月于该院接受治疗的163例真菌性鼻窦炎患者作为研究对象,观察组(117例)采用鼻内镜手术进行治疗,对照组(46例)采用上颌窦根治术进行治疗.将观察组患者按照随机数表法以2∶1的比例,分为训练集(78例)和验证集(39例),根据患者术后是否复发,将训练集患者分为术后复发组(27例)和术后未复发组(51例).比较观察组和对照组的治疗效果;对训练集患者的临床资料进行比较,并对患者术后复发的影响因素进行单因素和多因素分析.通过R软件构建贝叶斯网络模型,并进行模型的推理预测;通过受试者操作特征曲线(ROC curve)和校准曲线对模型的效能进行验证.结果 观察组治疗真菌性鼻窦炎的有效率为70.94%,明显高于对照组的52.17%,差异有统计学意义(χ2 = 5.16,P = 0.023);观察组的复发率为29.91%,明显低于对照组的47.83%,差异有统计学意义(χ2 = 4.66,P = 0.031).Lund-Mackay评分>15分、吸烟、哮喘、多发性鼻息肉、嗜酸性粒细胞计数高和术后感染是鼻内镜术后复发的独立危险因素(P<0.05).训练集和验证集的曲线下面积(AUC)分别为0.767(95%CI:0.699～0.835)和0.741(95%CI:0.668～0.813),ROC curve特异度分别为90.42%和90.23%,灵敏度分别为90.18%和90.06%.结论 鼻内镜手术治疗真菌性鼻窦炎的疗效显著.Lund-Mackay评分>15分、吸烟、哮喘、多发性鼻息肉、嗜酸性粒细胞计数高和术后感染,是影响真菌性鼻窦炎患者鼻内镜术后复发的危险因素.
目的 探讨中耳风险指数(MERI)对耳内镜下鼓室成形术预后的影响.方法 选择2019年7月-2022年4月于该院耳鼻喉科行耳内镜下鼓室成形术的慢性中耳炎患者112例作为研究对象,回顾性分析患者的临床资料.术后6个月行纯音测听检测气骨导间距(A-B gap),将患者分为预后较好组(A-B gap>20 dB HL,n = 77)和预后不佳组(A-B gap≤20 dB HL,n = 35).通过电子病历系统,获取相关临床资料,并计算MERI得分情况.采用汉化版苏黎世慢性中耳炎量表(ZCMEI-21Chn)进行生活质量随访,并统计患者并发症发生情况.结果 预后较好组与预后不佳组性别、年龄、病程、手术时间、病变部位、术前气导听阈和术前骨导听阈比较,差异均无统计学意义(P>0.05);两组患者咽鼓管情况、鼓室黏膜情况和MERI评分比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,咽鼓管不通、鼓室黏膜病变和MERI评分较高,是慢性中耳炎患者耳内镜下鼓室成形术后6个月预后不佳的独立危险因素(P<0.05);受试者操作特征曲线(ROC curve)结果显示,MERI预测慢性中耳炎患者耳内镜下鼓室成形术后 6 个月预后的曲线下面积(AUC)为 0.863,约登指数为0.561,最佳截断值为7分,灵敏度为73.17%,特异度为82.93%.MERI≤7分组和MERI>7分组术前ZCMEI-21Chn总分比较,差异无统计学意义(P>0.05);MERI≤7分组,术后6个月ZCMEI-21Chn总分和并发症总发生率低于MERI>7分组,差异均有统计学意义(P<0.05).结论 MERI评分较低的慢性中耳炎患者,耳内镜下鼓室成形术后6个月预后较好,且生活质量较高,并发症发生率较低,值得临床推广应用.
