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Objective To investigate the value of high resolution microendoscopy ( HRME ) for assessment of mucosal healing in patients with ulcerative colitis ( UC ) during clinical remission. Methods A total of 30 UC patients were randomly selected to collect HRME images. Pathological results were used as the gold standard to establish the diagnostic criteria of HRME on evaluation of colonic mucosal status. And then a prospective study was performed on 67 patients, who underwent standard endoscopy to evaluate colonic mucosal status and obtain biopsy specimens. The specimens were collected for HRME imaging. The accuracy of standard endoscopy and HRME in assessing ulcerative colonic mucosal healing was compared. Results According to the gland morphology, gland arrangement, gland opening and inflammatory cell infiltration, the HRME criteria for assessing UC mucosal status were formulated and divided into 0-3 grades with 4 levels. The prospective study of 67 patients with 113 sites showed that the sensitivity, specificity, positive predictive value, and negative predictive value of standard endoscopy for assessing mucosal healing in UC patients were 44. 68％ ( 21/47 ) , 90. 91％ ( 60/66 ) , 77. 78％ ( 21/27 ) , and 69. 77％ ( 60/86 ) , respectively, and the corresponding indicators of HRME imaging was 87. 23％ (41/47), 95. 45％ (63/66), 93. 18％ (41/44), and 91. 30％ (63/69), respectively. Compared with pathological results, the Kappa value of the consistency test of standard endoscopy and HRME imaging were 0. 379 and 0. 835, respectively ( both P<0. 05) . Conclusion HRME can achieve real-time virtual pathological imaging of colonic mucosa for UC patients, which is more accurate than standard endoscopy for assessing mucosal healing.
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Objective To summarize the image feature of normal colorectal mucosa and colorectal cancer tissues based on high-resolution microendoscopy (HRME), and evaluate the feasibility of HRME in the diagnosis of colorectal cancer. Methods Twelve colorectal cancer surgical specimens confirmed by pathology and 56 biopsy specimens from colorectal lesions by conventional endoscopy were selected for the study. The normal mucosa and colorectal cancer tissue were imaging-observed to establish the HRME-diagnostic criteria of the normal mucosa and colorectal cancer tissues taking pathological diagnosis as the gold standard. According to the established criteria, the 56 biopsy specimens of colorectal lesions were HRME-imaged, and the prediagnosis was made. The prediagnosis result was compared with the pathological results for evaluating the diagnostic value of HRME. Results In the prospective study of 56 colorectal lesion specimens, 25 patients were diagnosed with cancer by HRME, of which 21 cases were confirmed by pathological examination. 31 specimens were diagnosed as non-cancerous tissues by HRME, and 29 were confirmed by pathology. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of HRME in diagnosis of colorectal cancer were 91.3%, 87.9%, 89.3%, 84.0%, 93.5% respectively. The Kappa value was 0.78. Conclusions HRME can distinguish cancerous lesion from non-cancerous colon tissue, and have good consistency with pathological diagnosis, thus is of good prospects in terms of guidance for biopsy and diagnosis of colon cancer.
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Objective To explore the feasibility of high?resolution micro?endoscopy for diagnosis of gastric cancer. Methods A retrospective analysis of HRME pictures of gross specimen of gastric carcinoma of 20 cases of gastric cancer and normal gastric mucosa was made. Picture characteristics were studied and the HRME diagnostic criteria for normal gastric mucosa and gastric cancer tissues were developed. Based on the diagnostic criteria, a prospective study on gastric biopsy specimens of 64 cases of suspected gastric carci?noma was conducted and the diagnostic value of HRME for gastric carcinoma was evaluated by comparing HRME pre?diagnostic results with pathological findings. Results In the superficial layer of the fundic muco?sa, numerous regularly branched arranged glands as well as oval or elongated openings of the gastric pits and linear peripheral cracks were visible;the nuclei were arranged regularly. In the superficial layer of the antral mucosa, irregular or tubular openings of the gastric pits and cracked glandular cavities were visible, with the cells surrounding the gastric pits regularly arranged and the nuclei small and densely distributed. In the gas?tric carcinoma, nuclei sizes were different, arranged messy. Gland sizes were various, with unclear structure or glandular structures that could not be observed. Structure of gastric pits was damaged and normal gastric pits disappeared. After HRME imaging was performed on 64 cases of gastric biopsy specimens, the sensitivi?ty, specificity, accuracy, negative predictive value and positive predictive value of HRME diagnosis of gastric carcinoma were 96?4%( 53/55 ) , 88?9%( 8/9 ) , 95?3%( 61/64 ) , 98?1%( 53/54 ) and 80?0%( 8/10) respectively. Conclusion HRME, a new and instant pathological imaging tool with low price and simple operation, can distinguish normal gastric mucosa and gastric cancer tissue clearly, with a high diagno?sis value for gastric cancer.
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Objective To summarize the picture features of high resolution micro-endoscopy (HRME) for normal gastrointestinal mucosa. Methods We select 10 cases' normal esophageal mucosa, gastric and duodenal mucosa, in-testinal mucosa and colonic mucosal biopsies for this study, use HRME to observe the specimens and describe the features of different parts of the digestive tract normal mucosa according to the collected HRME pictures. Results After HRME imaging, all specimens were sent to pathological examination. We obtained 1 284 HRME pictures for 50 cases of biopsy specimens, 400 pictures were selected for results analysis after screening. HRME image charac-teristics of different parts of the digestive tract normal mucosa are as follows. Esophageal mucosa: cell arrangement rules, round and bright nucleus, the same size, nuclear spacing normal, the number of cells per field in basically are the same. Fundic mucosa: numerous closely arranged glands as well as oval or elongated branched openings of the gastric pits and linear peripheral cracks were visible; the nuclei were arranged regularly. Antral mucosa: irregular or tubular openings of the gastric pits and cracked glandular cavities were visible, with the cells surrounding the gastric pits regularly arranged and the nuclei small and densely distributed. Duodenal mucosa:visible villi was large fingers,on both sides of lint jagged depression, stereoscopic obviously, a cluster-like arrangement and the gap was crack-like. Intestinal mucosa:villous structures wider gap is wider, less than the number of the duodenum. Colonic mucosa:the nucleus of the same size, shape rules, round or oval and daisy-like glandular structures. All specimens were confirmed normal mucosa by pathology. Conclusion HRME can accurately identify the different parts of the diges-tive tract normal mucosa and it has a high consistency compared with pathological results.
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Objective To investigate the therapeutic value of high-resolution microendoscopy for early esophageal cancer.Methods A total of 60 patients,who underwent esophageal endoscopy,were included in this study.The therapeutic value of high-resolution microendoscopy was investigated with reference to pathological results as golden standard.Results Diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy of microendoscopy for high grade dysplasia/early cancer were 81.22％,94.12％,81.82％,94.12％,91.11％,respectively.Diagnosis of severe dysplasia/carcinoma with high-resolution microendoscopy was highly consistent with that of pathology (K =0.760).Conclusion The high-resolution microendoscopy is of high diagnostic value for early esophagus cancer.
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Objective To evaluate the clinical outcome of one-level posterior lumbar interbody fusion (PLIF) performed with microendoscopic approach.Methods A consecutive series of 56 patients who under went one-level PLIF procedure(24 cases performed with microendoseopic approach and 32 cases with tradition- al open approach)were studied from January 2005 to May 2006.The following data were compared between 2 groups with 12 to 27 months follow-up:estimated blood loss,postoperative drainage,transfusion needs,surgi- cal time,length of hospital stay,postoperative back pain by visual analogue scale,complications,and the clinical and radiographic results.Results The microendoscopic approach was found to have a significantly less blood loss,less postoperative drainage,less needs of transfusion,less postoperative back pain,shorter re- covery time and shorter length of hospital stay.However,the microendoscopic approach needed significantly longer surgical time.There was no significant difference between 2 groups in the aspects of the complications and the clinical and radiographic results.Conclusion The one-level PLIF performed with microendoscopic approach minimize estimated blood loss,length of hospital stay,postoperative back pain.It also shows the ex- cellent surgical efficacy of the microendoscopic approach for suitable patients.
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Objective To study the surgical techniques,indications and clinical effects of microendoscopic lumbar discectomy with the preservation of the ligamentum flavum.Methods A total of 65 patients with lumbar disc herniation were enclosed in the study.All the patients suffered from low back pain and radicular syndrome.The diagnosis was confirmed with CT scanning and/or MRI examination.The Microscope Endoscopic Tubular Retractor System(METRx) was used to access the interlaminar space.The superior,inferior and lateral edges of the ligamentum flavum were released using a micro-scalpel.The nerve root was retracted medially with a nerve root retractor to expose the herniated lumbar disc for performing the discectomy.The dissociative ligament was restored anatomically after disc removal and the decompression of the nerve root.Results The operation was completed smoothly in all the 65 patients without conversions to open surgery.The operation time was 136?21 min(range,110~170 min).The wound healed by first intention in all the patients.No nerve root injuries,intervertebral infection,or cerebrospinal fluid leakage were observed.A follow-up was carried out for 6~24 months(mean,14.5 months).According to the Nakai classification,excellent results were achieved in 42 patients,good in 18 patients,fair in 3,and poor in 2,the rate of excellent or good outcomes being 92.3%(60/65).Conclusions Microendoscopic lumbar discectomy with the preservation of the ligamentum flavum using the METRx is feasible.The preserved ligamentum flavum,as a good natural barrier,is helpful to prevent epidural fibrosis.
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Objective To investigate the use of sodium hyaluronate and the preservation of epidural fat in the prevention of epidural scar adhesion after microendoscopic discectomy (MED). Methods A total of 300 patients receiving MED from July 2000 to October 2001 were randomly divided into 2 groups: patients in group A were given sodium hyaluronate with the preservation of epidural fat, while those in group B were on the contrary. Results The mean follow-up duration was 42 months in the group A and 44 months in the group B, respectively. The rate of excellent or good results was 98.6% in the group A (144/146), while 93.8% in the group B (135/144) ( ? 2=4.731, P =0.030). Postoperatively, the pain reappeared in 4 cases in the group A and in 6 cases in the group B, respectively, in which a re-operation was required. Re-operations found the epidural scar adhesion was grade 0 (3 cases) and grade 1 (1 case) in the group A, and grade 2 (2 cases) and grade 3 (4 cases) in the group B ( P =0.005). Conclusions Use of sodium hyaluronate with the preservation of epidural fat can improve the efficacy of MED and effectively prevent epidural scar adhesion.
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Objective To summarize the experience of microendoscopic discectomy (MED). Methods A retrospective analysis was made on causes and the management of complications following 115 cases of MED in this hospital from April 2001 to April 2003. Results A conversion to open surgery was required in 13 cases. There were 2 cases of endoscope displacement and 7 cases of dural abruption intraoperatively. Postoperative hematoma pressing on neighbouring nerves was seen in 2 cases but no nerve root injuries were found. All the patients were followed for 3～12 months (mean, 7 5 months). According to the Nakai scale, 70 cases were classified as “excellent”, 36 cases “good”, 7 cases “fair”, and 2 cases “poor”, the “good” or “excellent” rate being 92.2% ( 106/115 ). Conclusions Proper selection of patients, intraoperative localization by “C”-arm X-ray examination, removal of the ligamenta flava and the lamina, detachment of adhesions surrounding the nerve root to obtain a complete exposure, and thorough hemostasia are crucial to minimize the incidence of complications.
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Objective To investigate the difficulties in posterior approach lumbar microendoscopic discectomy (MED). Methods We retrospectively analyzed records of 42 cases of lumbar disc protrusion (totally 45 interspaces) treated by MED from February 2002 to October 2003. Results Conversion to open surgery was required in 3 cases.No intra- or post- operative complications were seen.Follow-up survey for 2 ～ 22 months (mean,8 months) found the "good" or "excellent" results in 95 2% of the patients (40/42).Surgical difficulties were mainly classified into two aspects: technical and etiological,including 8 cases of failure of collimation between the passage and the interspace,5 cases of excessive bleeding disturbing the operation,3 cases of incomplete surgical apparatus,2 cases of incorrect passage localization,2 cases of hyperplasia in tiny joints,1 case of ossification of the posterior longitudinal ligament,1 case of nerve root edema,1 case of accretion,and 1 case of laceration,respectively. Conclusions Treatment of lumbar disc protrusion with MED gives satisfactory efficacy.Proper selection of patients and careful performance during surgery are essential to a successful procedure.
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Objective To evaluate the clinical application of anterior approach microendoscopic discectomy for cervical spondylosis. Methods Clinical data of 21 cases of cervical spondylosis from October 2001 to June 2002 treated by anterior approach decompression with bone allograft or autograft for cervical fusion by means of microendoscopic discectomy system were reviewed. Results The mean intraoperative blood loss was 150 ml. The drainage was removed 48 hours and the stitches taken out 5 days after the operations. The mean hospital stay was 10 days. All the patients got out of bed for motion wearing a cervical collar 2 days after the operations. Follow-up ranged 6～12 months with a mean of 9 months.The outcome was determined using Odom grading. Of the 21 cases, 16 were classified as excellent results, 4 as good, 1 as poor, the rate of excellent or good results being 95%.Complications were found in 3 cases:rupture of threaded fusion cage in 1 case;hoarseness in 1 case;and multiple infarction of brain stem in 1 case. Conclusions Anterior approach microendoscopic discectomy in the treatment of cervical spondylosis has the advantages of minimal invasion and rapid recovery. It offers a clear surgical vision for vertebral posterior margin and effective protection for blood vessels and nerves, conforming to the standards of minimally invasive surgery.