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Sixty two patients with small bowel bleeding underwent double balloon endoscopy (DBE).Clinical features were compared between patients with positive DBE findings (50 cases) and those with negative findings (12 cases).Results revealed that the causes of melena were discovered in 75.0％(21/28) patients via oral approach,while the lesions were found in 81.8％ (18/22) patients with hematochezia via anal approach ( P ＜ 0.01 ). Duration of bleeding was longer and number of bleeding episodes was higher in patients with positive DBE findings than those with negative findings (P ＜ 0.05 or P ＜ 0.01 ).The time interval between the latest bleeding and DBE was significantly shorter in patients with positive DBE findings (P ＜ 0.05).Positive diagnostic rate was significantly higher in patients with three or more bleeding episodes than those less than three times (92.5％ vs.11.1％,P ＜ 0.01 ).DBE performed within seven days or less increased the positive diagnostic rate significantly than that after seven days (97.1％ vs.59.3％,P＜0.01).
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Objective To research early pathological morphology and clinical significance of perforated duodenal ulcer (PDU) closed after non-surgical treatment. Methods Observed morphological changes of duodenal ulcer (DU) lesion with gastroscopy for 302 patients of PDU with non-surgical treatment in early period,when the perforation closed and measured up the clinical indicators during this hospitalization.Results There were 255 patients to be diagnosed with DU caused the perforation. These lesions were characteristic and shown the PDU closed at the bottom and the deep concave ulcers, except for 1 case which complicated by duodenal fistula. These ulcer types were diverse according to the time difference after treatment. No case of re-perforated ulcers or recurrence of peritonitis caused by gastroscopy. Conclusions Deep concave ulcer with A1 phase mainly is an early pathological manifestations of the DU after treated the PDU with non-surgical method characteristically. The wall of the closure of the serosal side is an original form closed perforated ulcer by non-surgical treatment. The risk of perforation associated with the following factors:( 1 )A single DU is located in the anterior wall region. (2)The shape of two kissing DU. (3)The diameter of DU ≥ 1.1 cm. In this case,early diagnosis by using endoscopy is a safe way.
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OBJECTIVE To discuss the related factors of toxigenic Helicobacter pylori(Hp) infection among adult population in Futian District,Shenzhen.METHODS A total of 1164 adults who had health examination in community centers were investigated through questionnaire and detected Hp antibodies.RESULTS The Hp and toxigenic Hp infection rates among them were 45.5% and 14.2%.Among them 46.3% and 14.8% were in males,and 44.7% and 13.4% in females.People less than 60 years old had higher incidence of Hp and toxigenic Hp,but decrease in people rnore than 60 years old.Hp and toxigenic Hp infection rate in married people were higher than those of unmarried.In workers,farmers and doctors were higher than staff and other occupations.The incidence were higher in drinking raw water than those drinking boiling water.in taking antibiotics before serologic examination were lower than no taking antibiotics;in peptic ulcer disease were higher than in no peptic ulcer disease;in per capita housing area over 6 m2 were higher than less 6 m2.CONCLUSIONS The infection rates of Hp and toxigenic Hp among our adult population are low,and positively correlated with age but gender.The social environment such as living condition,economic income,culture level and residential density maybe influence the infection of Hp.The route of transmission of Hp is unknown yet,water perhaps is an important dissemination medium.
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Objective To evaluate the curative effect and superiority of minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA.Method Local resection was clone in 15 patients with cancerate rectal adenoma or early rectal cancer,the tumours were excised intactly by 5 mm CUSA(submucosal or superficial muscularis),the incisions were closed by continuous suture in the lumen.Results All of the tumours were excised intactly,the incisal edges and funduses were all negative.The operation time was 30～180 min,average:60 min,the amount of bleeding during operation was 0～30 ml,average:10 ml.Complications:temporary fecal incontinence in 2 cases,acute urinary retention in 1 case.Pathology after operation:villous adenoma accompanied by high grade intra epithelial neoplasia in 8 cases,mixed adenoma in 2 cases,intra-mucosal carcinoma in 5 cases.15cases were followed up 4～48 months,averge 18 months,no tumour recur in original place.Conclusion Minimally invasive transanal surgery by CUSA is a safe and effective operation in the treatment of cancerate rectal adenoma and early rectal cancer.It can keep the anus and improve the quality of life.
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0.05),but significant difference in procalcitonin((2.12?1.57) vs(1.60?0.58)ng/ml,P
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Objective To evaluate the effects of Laparoscopic cholecystectomy (LC) combined with intraoperative cholanggiography (IOC)and intraoperative endoscopic sphincterotomy (IOEST) for the treatment of cholecystocholedocolithiasis. Methods 106 cases with cholecystocholedocolithiasis diagnosed and treated by LC combined with IOC and IOEST were reviewed retrospectively. Results 60 40%(64/106)patients diagnosed cholelithiasis pre-LC were found choledocholithisis; LC combined with IOC and IOEST was successfully performed on 99 of 106 cases(93 40%),and their CBD stones were completely cleared in 98 of 99 cases(99 00%). Six cases(6 1%) were complicated with mild acute pancreatitis, 1 case(0 01%) with duodenal perforation,1 case(0 01%) with bile leakage, and 2 cases(0 02%) with stomach stasis. Conclusions LC combined with IOC and IOEST was a safe ,effective approach to diagnosis and minimally invasive treatment of cholecystocholedocholithiasis.
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Objective To discuss the technique,advantages and follow-up results of subfascial endoscopic perforator surgery.Methods Subfascial Endoscopic Perforator Surgery was performed for 23 patients wth chronic venous insufficiency.Over two years postoperative follow-up was done.Results 21 in 23 cases with ulcers healed.Only one case had wound infection.Conclusion Subfascial Endoscopic Perforator Surgery is a safe and effective procedure in treating venous insufficiency.
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ObjectiveTo evaluate the effect of laparoscopic cholecystectomy (LC) combined with intraoperative cholangiography (IOC) and intraoperative endoscopic sphincterotomy (IOEST) for the diagnosis and treatment of choledocolithiasis. Methods Statistical analysis was carried out for 106 patients with cholecystocholedocolithiasis diagnosed and treated by LC-IOC-IOEST. Results Sixty-four (60.4%, 64/106 ) patients with preoperative diagnosis of simple gall stone were found with complicated choledocholithisis; LC-IOC -IOEST was successfully performed in 99(93.4%, 99/106) cases. Six cases (6.1%) suffered from mild postoperative acute pancreatitis. Duodenal perforation, bile leakage, peumothorax (0.9%) developed in one each. Duodenal adenocarcinoma was overlooked in one case, and 2 cases (1.8%) suffered from gastric paralysis. Conclusion LC combined with IOC and IOEST was a safe, effective approach to the diagnosis and minimally invasive treatment of choledocholithiasis.
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Objective To study the therapeutic effect of e ndoscopic injection on Forrest graded peptic ulcer bleeding and evaluate its sig nificance.Methods From July 2001 to August 2002, eighty-one patients wi th haematemesis and/or hematochezia diagnosed as peptic ulcer by immediate endos copy were divided into two groups based on Forrest grading, 41 were treated with injection therapy (injection group); other 40 with conservative therapy only (c ontrol group).Results The haemostatic rates in injection therapy group and co ntrol group were 95 1% and 80 0% respectively with prominent statistical diffe rence (P
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Objective To evaluate multiple instrument guide (MIG) in the use of laparoscopic choledochotomy (LCD). Methods The common bile duct (CBD) exploration time,surgical outcome,complications and damage of choledochoscope with or without MIG were compared retrospectively. Results MIG assisted LCD was performed successfully in all 25 cases,no complication such as bleeding,bile leakage or retained stones happened. CBD exploration time were 30 minutes,the mean number of removed stones was 6,no damage of choledochoscope was encountered. In 38 cases receiving traditional LCD,an average 5 pieces of stone were removed,the duct exploration time was 60 minutes. Two cases were complicated with hyperamylasia,stones were retained in one case. Choledochoscope was damaged in 6 times. Conclusions MIG facilitates LCD procedure,shortens operative time,and protects choledochoscope.
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Objective To explore the feasibility and indications of T tube free laparoscopic common bile duct exploration (LCBDE). Methods The therapeutic results of LCBDE in 175 cases were reviewed retrospectively regarding the cure rate, complications, and postoperative hospital stay. Results LCBDE was performed successfully in 169 cases. Laparoscopic stone removal was failed in 6 out of the 175 cases. Two were converted to open exploration, the remaining 4 cases received intraoperative EST, the procedure failed in one case and it was converted to open surgery. T tube free LCBDE was performed successfully in 104 cases, in 36 out of the 104 cases laparoscopic transcystic common bile duct exploration was successful, the mean operation time was 140 minutes and the mean hospital stay after operation was 2 days; in other 68 cases laparoscopic choledochotomy with primary duct closure was performed, the mean operation time was 135 minutes and the mean hospital stay after operation was 3 days. T tubes were placed in 65 cases, the mean operation time for those patients was 150 minutes and the mean hospital stay after operation was 4 days, the mean T tube drainage time was 38 days. Retained stone was found in one out of the 65 cases, and was removed by EST. Bile leakage after removal of T tube developed in one case, and was cured by conservative therapy. No mortality nor complications such as bleeding or bile leakage occurred in remaining cases, asymptomatic hyperamylasia was found in 4 cases postoperatively. No stone recurrence or duct stricture were found at a mean follow-up of 13 months. Conclusions T tube free LCBDE as an alternative to the treatment of CBD stones is safe and feasible, with shorter hospitalization and avoiding the potential complications related to the T tube placement.
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ObjectiveTo assess the value of intraoperative cholangiography(IOC) for detecting bile duct injury during laparoscopic cholecystectomy.Methods31 cases of bile duct injuries were reviewed regarding the site of injury,mechanism,time of diagnosis,and the place of IOC was evaluated.ResultsBile duct injuries resulted from misidentification in 19 cases.In 12 of these 19 cases,the diagnosis was made by IOC.Primary laparoscopic repair or open repair and T-tube drainage solved the problem without postoperative complications.However,in 3 of the above 19 cases the result of IOC was misinterpreted and in 4 of the above 19 cases IOC was not performed.Two of the 7 patients had aberrant bile duct injuries, in all of them the diagnoses were delayed.There were two cases in which bile duct injury developed after an IOC.ConclusionsCorrect interpretation of IOC enables detecting bile duct injury caused by intraoperatively misidentification and consequent morbidity.