ObjectiveTo systematically review the efficacy and safety of endoscopic radial artery harvesting for coronary artery bypass grafting (CABG).
MethodsDatabases including The Cochrane Library (Issue2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to August 2015 to collect randomized controlled trials (RCTs) and cohort studies about endoscopic radial artery harvesting technique versus traditional incision technique for CABG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software.
ResultsA total of 12 studies involving 1359 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in perioperative mortality (OR=0.66, 95%CI 0.17 to 2.57, P=0.55), the incidence of postoperative myocardial infarction (OR=0.78, 95%CI 0.30 to 2.06, P=0.62), vascular graft patency rate (OR=1.40, 95%CI 0.80 to 2.45, P=0.24) and the incidence of wound infection (OR=0.59, 95%CI 0.33 to 1.07, P=0.08). The endoscopic group showed significantly lower incidence of hematoma formation (OR=0.39, 95%CI 0.20 to 0.74, P=0.004) and paresthesia (OR=0.44, 95%CI 0.22 to 0.88, P=0.02) than that of the incision group.
ConclusionCurrent evidence shows that, compared with the incision technique, the endoscopic radial artery harvesting could significantly reduce the incidence of hematoma formation and paresthesia in patients underwent CABG. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more high-quality studies.
ObjectiveTo observe the clinical effect of retrograde lacrimal intubation under endoscope in the treatment of chronic dacryocystitis.
MethodsWe retrospectively analyzed the clinical data of 83 patients (103 eyes) with chronic dacryocystitis treated in our department from March 2011 to January 2013. They underwent retrograde lacrimal intubation under endoscope. The postoperative follow-up continued 9 months and the curative effect was observed.
ResultsEighty-eight eyes were cured, accounting for 85.44%; improvement occurred in 10 eyes, accounting for 9.71%; five eyes were not cured, accounting for 4.85%. As a result, the total effective rate was 95.15%.
ConclusionRetrograde lacrimal intubation under endoscope is a safe and effective surgical method for the treatment of chronic dacryocystitis.
Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder. Methods Literatures related to the basis, advantage, indication, contraindication, operative method and current controversy were reviewed and summarized. Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder. The progress of endoscopic technique made it possible for reservation of gallbladder. The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure. Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone. Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function, but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.
【Abstract】Objective To explore the operative technique of endoscopic thyroidectomy and prevent its complications. Methods A retrospective analysis was made on the clinical data of 32 patients with benign thyroid diseases who were treated with endoscopic thyroidectomy between May 2002 and March 2005. Results Thirtytwo cases were successfully treated with the mean operation time 130 min(80～180 min). Twelve cases with thyroid adenomas and 20 cases with thyroid tubers were confirmed by histologic examinations. In this group, the postoperative complications included fat liquefaction in 2 cases and transient hoarseness in 1 case who recovered 3 months after operation. No parathyroid injury occurred. The drainage tubes were removed 2~3 days after operation. All of the patients were discharged 2~5 days after operation.Conclusion Endoscopic thyroidectomy is safe and feasible with favorable cosmetic effect.
ObjectiveTo investigate short-term outcomes and surgical techniques of endoscopic saphenous vein harvesting (ESVH) for coronary artery bypass grafting (CABG).
MethodsClinical data of 554 patients undergoing CABG with ESVH in General Hospital of Shenyang Military between July 2009 and August 2013 were retrospectively analyzed. There were 372 male and 182 female patients with their age of 38-84(61.3±9.0) years. Clinical outcomes, postoperative lower extremity pain and edema, wound infection and healing were analyzed.
ResultsDuring ESVH, 13 patients with very little subcutaneous fat received transition to skin bridge technology or partially open incision. Average number of harvested vein grafts was 1-4 (2.0±0.6), and the quality of the vein grafts was satisfactory. Postoperative lower extremity pain and edema were significantly reduced, and there was no delayed wound healing or infection. Seven patients died postoperatively, including 2 patients with perioperative myocardial infarction, 2 patients with pneumonia, 1 patient with ventricular fibrillation, 1 patient with massive cerebral infarction, and 1 patient with multiple organ dysfunction syndrome. A total of 452 patients were followed up for 120-1 460 (742.6±188.5) days. There was no late death or reintervention during follow-up.
ConclusionESVH is a safe and efficacious procedure with less postoperative lower extremity pain and edema, satisfactory vein graft quality, better postoperative recovery and cosmetic results, compared with traditional fully or intermittently open wound for saphenous vein harvesting.
【Abstract】 Objective To evaluate the detection and localization of obscure lower gastrointestinal bleeding by using SPECT/CT and intraoperative endoscopy. Methods Twenty-six cases of patients with obscure lower gastrointestinal bleeding were analyzed retrospectively. Results The positive detection rate of SPECT/CT was 88.5%. All 26 patients (100%) were identified the bleeding source by using intraoperative endoscopy. No recurrence was found during 1-24 months follow-up. Conclusion SPECT/CT examination should be chosen firstly for patients with obscure lower gastrointestinal bleeding in order to localize the bleeding site roughly. Intraoperative endoscopy can localize the bleeding site accurately in patients who undergoes operation.
Objective
To analyze the effectiveness of endoscopic calcaneoplasty (ECP) for treating hindfoot pain in patients with Haglund’s deformity by comparing with conservative treatment.
Methods
According to the included standard, 64 hindfoot pain patients (77 feet) with Haglund’s deformity treated between January 2007 and October 2013 were enrolled. Based on the patient’s sports habit, 39 patients (49 feet) who had no requirement on sports were given conservative treatment (control group) and 25 patients (28 feet) who had stable sports habit were given ECP (ECP group). There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 2 groups (P > 0.05).
Results
The patients were followed up 16-44 months (mean, 33.7 months) in ECP group, and 12-40 months (mean, 37.5 months) in control group. In control group, the syndrome in 34 cases (43 feet) disappeared after 2 weeks; pain was improved in 5?cases (6 feet), and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases (30 feet) during following-up, 11 cases (13 feet) underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment (P < 0.05). With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment (P < 0.05). According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups (Z=-2.194, P=0.028).
Conclusion
Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund’s deformity.
ObjectiveTo introduce the hiatal hernia (HH) and to summarize the research development of relationship between HH and respiratory symptoms.
MethodsLiteratures in recent years which about relationship between HH and respiratory symptoms at home and abroad were collected and reviewed.
ResultsGastroesophageal reflux disease (GERD), which always be caused by laryngeal airway and other esophageal symptoms, was a common illness and easily be misdiagnosed. One common symptom of the GERD was the HH. For those patients with reflux-associated esophageal symptoms, many of them suffered from HH. The treatment results showed that the endoscopic surgery could relieve the reflux symptom and effectively control the respiratory symptoms.
ConclusionsThe HH can increase the risk of respiratory symptoms; an active treatment on the HH can relieve the respiratory symptoms, which is caused by the reflux symptom.
ObjectiveTo compare the clinical efficacy of endoscopic thyroidectomy via breast approach and open thyroidectomy for multiple nodular goiter.
MethodsBetween September 2010 and March 2013, a total of 138 patients with multiple nodular goiter were divided into two groups based on even or odd number. Patients in the endoscopy group (n=69) had a mean age of 38.3 years and they underwent endoscopic thyroidectomy via breast approach, while patients in the open group (n=69) had a mean age of 36.8 years and underwent open thyroidectomy. Surgery time, blood loss, pain and drainage, as well as postoperative complications were compared between these two groups.
ResultsSurgery time in the endoscopy group was significantly longer than that in the open group (P<0.05). Blood loss in the endoscopy group was significantly less than that in the open group (P<0.05). Scores of pain at different times in the endoscopy group were significantly lower than those in the open group (P<0.05). There was no significant difference in drainage and duration of drainage between the two groups (P>0.05). There were no significant differences in incidence of transient hypocalcemia, hypoparathyroidism and recurrent laryngeal nerve injury between the two groups (P>0.05).
ConclusionEndoscopic thyroidectomy via breast approach and open thyroidectomy are both effective and safe procedures for multiple nodular goiter. However, endoscopic thyroidectomy via breast approach is superior to open thyroidectomy in reducing blood loss, relieving pain with excellent cosmetic results.
ObjectiveTo know the fundamental status of painless digestive endoscopy in China.
MethodsA 23-item survey including multiple choices and fill-in-the-blank questions on 3 pages was performed on anesthesiologists in China excluding Taiwan, Macao and Hong Kong on www.xqnmz.com and www.dxy.cn/bbs from November 1 to December 31, 2013, among which 5 questions were on personal details, 9 on hospital and department, and 9 on clinic details. The results about the basic facts, risk factors of anesthesia and drug use and monitoring of painless digestive endoscopy in China were analyzed.
ResultsA total of 726 questionnaires were collected, among which 667 (91.87%) were considered valid. Interviewed hospitals included hospitals from 31 provinces, municipalities and autonomous regions excluding Taiwan, Macao and Hong Kong. Thirty questionnaires were from the first-grade hospitals (4.5%), 292 from the second-grade (43.78%), and 345 from the third-grade (51.72%). And 69.12% of the questionnaires showed these hospitals could only carry out painless gastroscopy and/or colonoscopy, while 80.81% showed the number of the mean painless endoscopy cases was 0-30 per day; 47.23% of the respondents working in digestive endoscopy center had to complete the anesthesia procedure alone, and 35.83% of the respondents illustrated their digestive endoscopy centers had established the post anesthesia care unit; 62.97% were equipped with anesthesia apparatus or ventilator; 89.96% were equipped with tracheal intubation tool; and 21.44% were equipped with defibrillator. Among them, 25.79% did not prepare rescue medicines regularly in digestive endoscopy center. Propofol was the most frequently used anesthetic, and composited fentanyl was at the highest use rate for gastrointestinal endoscopy. Respondents who used electrocardiogram, non-invasive blood pressure and pulse oxygen saturation the least to monitor during painless gastroscopy and colonoscopy took up 43.48% and 46.08% respectively.
ConclusionPainless digestive endoscopy needs further development and standardization with the regulation of related guidelines and standardized residents training.
