ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the short-term outcomes and complication management of submucosal tunneling endoscopic resection(STER) for esophageal submucosal tumors (SMTs) originating from the muscularis propria(MP) layer.</p><p><b>METHODS</b>Clinical data of 48 patients with esophageal SMTs from MP layer undergoing STER in the Department of Gastroenterology, the First People's Hospital of Xiangshan, Zhejiang, and the Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai between September 2013 and August 2014 were retrospectively analyzed. The clinicopathological features, complication management, and short-term outcomes were evaluated.</p><p><b>RESULTS</b>All the patients underwent STER successfully. The complete resection rate was 100%. The mean maximum diameter of the lesions was (22.9±12.1) mm (range 9.0-60.0 mm), and the mean operation time 41.8 min (range 15.0-140.0 min). Intraoperative mucosal injury occurred in 5 patients (10.4%), which was successfully clipped, pneumoperitoneum in 2 patients (4.2%) and subcutaneous emphysema in 3 patients(6.3%), which were successfully controlled with conservative treatments. Five patients (10.4%) had postoperative severe chest pain. Seven patients (14.6%) developed fever, among them, 5 were managed by conservative therapy, and 2 were submucosal tunnel infection, who were successfully treated after reclosing the ruptured tunnel entry with clips. All the removed tumors had tumor-free resection margins. The average length of postoperative hospital stay was 2.4 days (range 1-13 days). Local recurrence and distant metastasis did not occur during mean 6.8 months (range 2-12 months) follow up.</p><p><b>CONCLUSIONS</b>STER appears to be a safe and effective option for esophageal SMTs originating from MP layer. Common complications related to STER often can be successfully controlled with conservative treatments.</p>
Subject(s)
Humans , China , Esophageal Neoplasms , Esophagoscopy , Mucous Membrane , Muscle, Smooth , Operative Time , Retrospective StudiesABSTRACT
Objective To investigate the influence of follow-up treatment compliance on prognosis after gastroesophageal varices treated under endoscopy.Methods Up to 416 liver cirrhosis patients after gastroesophageal varices treated under endoscopy were follow-up and divided into compliance group and control group according to whether the patients had follow-up treatment compliance condition.The factors caused the difference of follow-up treatment compliance were analyzed.The differences in the follow-up indexes such as rebleeding,mortality,rehospitalization were compared between the two groups.The differences in indexes between two groups were stratifiedly analyzed according to liver function Child-Pugh classification.Chi-square four data table test was for two independent samples comparison.Results The differences of education level,income and the medical condition of residential area determined the difference of follow-up compliance.After gastroesophageal varices patients treated under endoscopy,the total rebleeding rate was 35.1 ％ (146/416) and and the mortality rate was 9.4％ (39/416).The rebleeding rate and mortality rate of the compliance group were significantly lower than those of control group (26.1％ (61/234) vs 46.7％(85/182),x2=19.137,P＜0.01; 6.4％(15/234) vs 13.2％(24/182),x2=5.533,P=0.019).Among the 273 Child-Pugh A level patients,the detection rate of liver cancer (3.7％,10/273),liver transplantation rate (3.7％,10/273),splenectomy plus portal azygous disconnection rate (6.6％,18/ 273) of compliance group were higher than those of control group (x2 =4.086,P =0.043; x2 =4.086,P=0.043; x2 =5.515,P=0.019).Among the 102 Child-Pugh B level patients,there were statistical differences between compliance group and control group in rebleeding rate (x2 =21.297,P＜0.01),motality (x2=3.525,P=0.042),ascites (x2=4.451,P=0.035),life quality (x2 =10.454,P=0.001) and liver function (x2 =8.197,P=0.004).However,there were no statistical differences in all indexes between the two groups of Child-Pugh C level patients (all P＞0.05).Conclusion To improve the follow-up treatment compliance remarkably,decreased the rebleeding rate and mortality,contributed to early detection of liver cancer and early liver transplatation,thus the prognosis was improved consequently.
ABSTRACT
OBJECTIVE:To investigate the problems in the publicity materials of drugs and to discuss the solutions to these problems.METHODS:35copies of publicity materials were randomly chosen from our hospital's pharmacy and were compared with the drug instructions provided by the same manufacturers.Indication,dosage and administration were the main items compared.RESULTS:Inconsistency was found in8out of35copies(22.86%),which was manifested in three aspects:widening of indications,increase in dosages,and inconsistency in administration.CONCLUSIONS:It is suggested that the technology of manufacturers and the comprehensive quality of salesmen should be improved basically.Furthermore,the su?pervisory administration should establish the law to limit drug promotion sales.