Objective To evaluate the efficacy and safety of endoscopic variceal ligation (EVL) versus endoscopic variceal sclerotherapy (EVS) for acute esophageal variceal bleeding in patients with liver cirrhosis.Methods We searched CBMdisc (1979 to 2006), CNKI (1994 to 2006) and VIP for randomized controlled trials (RCTs) and quasi-RCTs comparing EVL and EVS for acute esophageal variceal bleeding patients with liver cirrhosis. The methodogical quality of included trials was critically assessed and the data were extracted by two reviewers, working independently. The Cochrane Collaboration’s RevMan 4.2.7 software was used for meta-analysis. Results Nine RCTs involving a total of 1371 patients were included: 688 in EVL group and 683 in EVS. The meta-analyses showed a significant reduction for mortality [RR 0.60, 95%CI (0.36, 0.98)], and non-significant reductions in complications, rebleeding and emergency hemostasis in the EVL group compared to the EVS group. EVS was non-significantly better than EVL for the rate of eradication varices and recurrent varices. Conclusions For acute esophageal variceal bleeding in patients with liver cirrhosis, EVL has better effect and fewer complications than EVS. However, because the quality of included RCTs was poor, the strength of our conclusions was limited. Further high-quality RCTs are required.
ObjectiveTo investigate the clinical significance of lengthened Trocars in endoscopic thyroidectomy.
MethodsThere were 102 cases of endoscopic thyroidectomy via the areola approach, which were divided into two groups:33 patients via lengthened Trocar, and 69 patients via normal Trocar. The operative time, blood loss, wound drainage, hospital stay, and postoperative complications in two groups were comparatively analyzed.
ResultsCompared with the normal Trocar group, the operative time was shorter, subcutaneous separation area was smaller, blood loss was less, and postoperative drainage was less in the lengthened Trocar group(P < 0.05). The postoperative complications of lengthened Trocar group was less than normal Trocar group(P < 0.05).
ConclusionsApplication of lengthened Trocars in endoscopic thyroidectomy brings benefits of less subcutaneous damage, shorte operative time, and better operation experience. This procedure is worth popularizing in clinical use.
Objective To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). Methods The recent l iterature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. Results There were two techniques of minimally invasive approach for CSR at peresent: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneouspuncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopicdiscectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local l igamentum flavum thickening and spondylotic foraminal stenosis. Conclusion The minimally invasive procedure has the advantages of simple handl ing, minimally invasive and low incidence of compl ications. But the scope of indications is relatively narrow at present.
The choice of the graft conduit for coronary artery bypass grafting (CABG) has significant implications both in the short-and long-term. The patency of a coronary conduit is closely associated with an uneventful postoperative course, better long-term patient survival and superior freedom from re-intervention. The internal mammary artery is regarded as the primary conduit for CABG patients, given its association with long-term patency and survival. However, long saphenous vein (LSV) continues to be utilized universally as patients presenting for CABG often have multiple coronary territories requiring revascularization. Traditionally, the LSV has been harvested by creating incisions from the ankle up to the groin termed open vein harvesting (OVH). However, such harvesting methods are associated with incisional pain and leg wound infections. In addition, patients find such large incisions to be cosmetically unappealing. These concerns regarding wound morbidity and patient satisfaction led to the emergence of endoscopic vein harvesting (EVH). Published experience comparing OVH with EVH suggests decreased wound related complications, improved patient satisfaction, shorter hospital stay, and reduced postoperative pain at the harvest site following EVH. Despite these reported advantages concerns regarding risk of injury at the time of harvest with its potential detrimental effect on vein graft patency and clinical outcomes have prevented universal adoption of EVH. This review article provides a detailed insight into the technical aspects, outcomes, concerns, and controversies associated with EVH.
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 explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
Objective To summarize the clinical significance of endoscopic treatment for obstructive jaundice. Methods The recently published literatures in domestic and abroad about endoscopic treatment for obstructive jaundice were reviewed. Results The results of endoscopic treatment for bile duct stones and bile duct surgery for biliary stricture had the same outcome. The endoscopic treatment could identify bile duct and duodenal periampullary tumors and lesions. Conclusion Endoscopic treatment for obstructive jaundice is a safe and effective method.
Objective To investigate the feasibility and operation effect of endoscopic sentinel lymph node biopsy （SLNB） in breast cancer. Methods The data of 410 breast cancer patients who underwent SLNB （including 107 patients with endoscopy and 303 with open operation） were analyzed in our hospital from January 2009 to March 2012. SLNB was performed by using methylene blue staining or the combination of methylene blue and 99Tcm-sulfur colloid tracing. Results The successful rate of SLN detection with methylene blue and 99Tcm-sulfur colloid tracing was 94.56% （139/147） in open operation group and 94.25% （82/87） in endoscopy group. The successful rate of SLN detection with methylene blue was 88.46% （138/156）in open operation group and 85.00% （17/20） in endoscopy group. The mean of detected SLN number with combined method or methylene blue was 1.90/1.98 in open operation group and 1.91/1.82 in endoscopy group respectively. SLN-positive rate was 22.30% （31/139） and 25.36% （35/138） in open operation group， and 19.51% （16/82） and 23.53% （4/17） in endoscopy group， respectively. The rate of subcutaneous effusion in endoscopy group was higher than that in open operation group （P=0.001）, but other postoperative complications presented no significant difference. Conclusions Endoscopic SLNB can obtain the similar safety and the clinical efficacy with traditional SLNB， but superior cosmetic effect. So it is worthy of clinical application in breast cancer.
ObjectiveTo compare postoperatively clinical effect of endoscopic total thyroidectomy via breast approach versus traditional total thyroidectomy via neck in treatment of thyroid papillary carcinoma on postoperative function of parathyroid gland.
MethodsRetrospective study performed on 124 thyroid papillary carcinoma patients who were hospitalized between June 2014 and December 2015 in Department of General Surgery of The First Affiliated Hospital of General Hospital of PLA. All patients underwent total thyroidectomy plus central Ⅵ lymphadenectomy. Endoscopic total thyroidectomy via breast were applied on 48 patients and traditional total thyroidectomy via neck were applied on 76 patients. Serum intact parathyroid hormone (iPTH) and calcium on postoperative day 1 were monitored for all patients. Then comparison of the serum iPTH and calcium between the 2 groups was performed.
ResultsSerum iPTH and calcium for all 124 patients were within the normal range before surgery, and there was no significant difference between the endoscopic total thyroidectomy via breast group and traditional total thyroidectomy via neck group in the serum iPTH and calcium (P > 0.05). On 1 day after surgery, the level of iPTH in endoscopic total thyroidectomy via breast group was lower than that of traditional total thyroidectomy via neck group[(20.8±5.7) pg/mL vs. (28.3±4.9) pg/mL], and ratio of lower iPTH than normal of endoscopic total thyroidectomy via breast group was higher[43.8% (21/48) vs. 22.4% (17/76)], P < 0.05; but there was no significant difference in serum calcium between 2 groups[(2.1±0.3) mmol/L vs. (2.0±0.5) mmol/L], P > 0.05. In addition, the incidence of perioral, chiral and pedal numbness was higher in endoscopic total thyroidectomy via breast group than that of traditional total thyroidectomy via neck group[47.9% (23/48) vs. 27.6% (21/76)], P < 0.05.
ConclusionsComparably, endoscopic total thyroidectomy via breast approach is more prone to lowly postoperative serum iPTH and calcium. Patients are more prone to exhibit clinical symptom such as perioral numbness, chiral and pedal numbness.
Objective To discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion. Methods Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation (n=18), PTCD (n=17) and ERCP (n=7) respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （Plt;0.05). The median survival time was 22 weeks. The average survival time was (32.89±33.87) weeks. Two patients died in hospital after PTCD, and the mortality was 4.76%. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure. Conclusion The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.
