The outcome of transnasal endoscopic total maxillectomy in the treatment of sinonasal adenoid cystic carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients（30%） were positive. The median time of follow-up was 38 months（6 to 85 months）. Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin（P=0.018）, recurrence（P=0.006） and distant metastasis（P=0.04）. Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.

Efficacy of full-endoscopic interlaminar and transforaminal discectomy for lumber disc herniation / Eficácia da discectomia interlaminar e transforaminal totalmente endoscópica na hérnia de disco lombar

ABSTRACT A previous study has reported the therapeutic effects of interlaminar/transforaminal approaches under full-endoscopic visualization to treat L5-S1 lumber disc herniation (LDH). However, the comparison of interlaminar/transforaminal approaches to treat other segments of LDH remains unclear. Objective: To evaluate the clinical efficacy of full-endoscopic interlaminar and transforaminal lumbar discectomy to treat LDH. Methods: A total of 93 patients with LDH who underwent fully-endoscopic lumbar interlaminar/transforaminal discectomy were retrospectively collected. Patients were divided into a Transforaminal group (n=41) and an Interlaminar group (n=52). Clinical efficacy was evaluated by visual analogue scale (VAS), the Oswestry disability index (ODI), and the modified MacNab scoring system. Results: Of the 93 patients, involving segments in LDH referred to L3-4, L4-5, and L5-S1. The fluoroscopy times in the Interlaminar group were smaller than that of the Transforaminal group. We found no obvious significances between the Transforaminal and Interlaminar groups regarding operation time, incision length, postoperative landing time, hospitalization, and incision healing time. Postoperative VAS and ODI scores notably improved at follow-up. Besides, almost 90% LDH patients achieved excellent/good outcomes. Conclusion: The full-endoscopic visualization technique via interlaminar and transforaminal approaches safely and effectively treat LDH. Level of Evidence III, Retrospective Study.

RESUMO Um estudo anterior relatou os efeitos terapêuticos das abordagens interlaminar/transforaminal sob visualização totalmente endoscópica para tratar a hérnia de disco lombar (HDL) L5-S1. No entanto, a comparação das abordagens interlaminar/transforaminal para o tratamento de outros segmentos de HDL permanece pouco clara. Objetivo: Avaliar a eficácia clínica da discectomia lombar interlaminar e transforaminal totalmente endoscópica no tratamento da HDL. Métodos: Foram recolhidos retrospetivamente 93 pacientes com HDL submetidos a discectomia lombar interlaminar/transforaminal totalmente endoscópica. Os pacientes foram divididos em um grupo transforaminal (n=41) e um grupo interlaminar (n=52). A eficácia clínica foi avaliada através da escala visual analógica (EVA), do índice Oswestry de incapacidade (ODI) e do sistema de pontuação de MacNab modificado. Resultados: Dos 93 pacientes, os segmentos envolvidos na HDL referiam-se a L3-4, L4-5 e L5-S1. Os tempos de fluoroscopia no grupo Interlaminar foram menores do que no grupo Transforaminal. Não encontramos significâncias óbvias entre os grupos Transforaminal e Interlaminar em relação ao tempo de operação, comprimento da incisão, tempo de pós-operatório, hospitalização e tempo de cicatrização da incisão. As pontuações EVA e ODI pós-operatórias melhoraram notavelmente no acompanhamento. Além disso, quase 90% dos pacientes com HDL obtiveram resultados excelentes/bons. Conclusão: A técnica de visualização totalmente endoscópica através de abordagens interlaminar e transforaminal trata a HDL de forma segura e eficaz. Nível de Evidência III, Estudo Retrospectivo.

Research on the clinical application of drainage tube after the operation of percutaneous endoscopic lumbar discectomy / 中国骨伤

OBJECTIVE@#To investigate the clinical significance and related factors of drainage tube after percutaneous endoscopic lumbar discectomy(PELD).@*METHODS@#The clinical data of 151 patients with lumbar disc herniation who underwent PELD from January 2019 to September 2019 was retrospectively analyzed. According to whether the drainage tube was used after operation, the patients were divided into drainage tube group and non drainage tube group. The placement time and total drainage volume were recorded. The characteristics of patients, such as age, gender, body mass index, lumbar disc herniation segment, smoking history, basic diseases and whether taking anticoagulants, were analyzed by single factor and multiple factor.@*RESULTS@#Drainage tubes were used in 32 patients after PELD. There were statistical differences in visual analogue scale(VAS) and Japanese Orthopaedic Assiciation(JOA) scores between postoperative and preoperative of that in two groups(P<0.05). There were statistical differences in VAS and JOA scores at discharge between two groups(P<0.05), while there were no statistical differences at other time points(P>0.05). Univariate analysis showed that age, basic diseases and whether taking anticoagulants were related to the use of drainage tube, but gender, body mass index, lumbar disc herniation segment and smoking history were not significantly related to the use of drainage tube. Multivariate analysis showed that elderly patients, complicated with hypertension and diabetes, taking anticoagulants were related to the use of drainage tube.@*CONCLUSION@#The use of drainage tube after percutaneous endoscopic lumbar discectomy can improve the symptoms of lumbar and leg pain in early stage. For elderly patients with hypertension, diabetes and taking anticoagulants drugs, drainage tube can be considered after transforaminal endoscopy.

Cirurgia de resgate no câncer gástrico / Salvage surgery in gastric cancer

RESUMO - RACIONAL: A cirurgia de resgate é definida como a ressecção cirúrgica após falha de primeiro tratamento com intuito curativo. OBJETIVO: Relatar a experiência de um centro de referência no tratamento do câncer gástrico com a cirurgia de resgate para o adenocarcinoma de estômago. MÉTODOS: Análise retrospectiva dos pacientes com câncer gástrico operados entre 2009 e 2020. RESULTADOS: 40 pacientes foram submetidos à tentativa de gastrectomia de resgate com intuito curativo. Para análise, foram divididos em dois grupos: 23 pacientes após ressecção endoscópica e 17 após gastrectomia. No primeiro grupo, todos tiveram ressecção com margens livres, a média de internação foi 15,7 dias e 2 (8,6%) tiveram complicações maiores. No seguimento médio de 37,2 meses, houve apenas 1 recidiva. A sobrevida global média foi 46 meses. No grupo pós-gastrectomia 9 (52,9%) foram resgatados com intenção curativa, a média de internação foi 12,2 dias e 3 (17,6%) apresentaram complicações maiores. No seguimento médio de 22 meses, 5 recidivaram. A sobrevida global média e a sobrevida livre de doença foram respectivamente: 24 e 16,5 meses. CONCLUSÃO: A cirurgia de resgate no câncer gástrico oferece nova possibilidade de controle da doença a longo prazo e/ou aumento de sobrevida, tendo taxa de complicações aceitáveis.

ABSTRACT - BACKGROUND: Salvage surgery (SS) is defined as surgical resection after the failure of the first treatment with curative intent. AIM: The aim of this study was to report the experience of a reference center with SS for stomach adenocarcinoma. METHODS: This is a retrospective study of patients with gastric cancer (GC) operated on between 2009 and 2020. RESULTS: Notably, 40 patients were recommended for salvage gastrectomy with curative-intent treatment. For analysis purpose, patients were divided into two groups: 23 patients after endoscopic resection and 17 patients after gastrectomy. In the first group, all patients underwent R0 resection, their average hospital length of stay (LOS) was 15.7 days, and 2 (8.6%) patients had major complications. During the average follow-up of 37.2 months, there was only one recurrence. The median overall survival (OS) was 46 months. In the postgastrectomy group, 9 (52.9%) patients were rescued with curative intent, the average hospital LOS was 12.2 days, and 3 (17.6%) had major complications. In a mean follow-up of 22 months, five patients relapsed. Median OS and disease-free survival were 24 and 16.5 months, respectively. CONCLUSION: SS in GC offers the possibility of long-term disease control and increased survival rate with an acceptable complication rate.

Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly / Tratamento cirúrgico dos macroadenomas não secretores de hipófise por via endoscópica endonasal em idosos

Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

Nas últimas três décadas, foram publicadas casuísticas de pacientes idosos operados por adenomas de hipófise, nas quais foram utilizadas as vias transcraniana ou transesfenoidal microcirúrgicas. O objetivo deste estudo foi analisar retrospectivamente os resultados dos nossos primeiros 25 pacientes idosos com macroadenomas não secretores de hipófise, operados pela via endoscópica endonasal. O déficit visual pré-operatório foi encontrado em 92,8% dos casos e 70,8% apresentaram melhora da visão depois da cirurgia. O hipopituitarismo pré-operatório foi encontrado em 69,2% dos casos e a sua recuperação ocorreu em 22,2% destes casos. A estadia hospitalar média foi de 6,7 dias. Este estudo sugere que a cirurgia permanece como o tratamento de primeira escolha para pacientes idosos com macroadenomas não secretores de hipófise e a idade por si só não é contraindicação para cirurgia.

The 15-Year Evolution of the Thoracoscopic Anterior Release: Does It Still Have a Role?

STUDY DESIGN: Retrospective. PURPOSE: To determine how the indications for anterior thoracoscopic release and fusion have evolved over time. OVERVIEW OF LITERATURE: Anterior release was commonly performed to correct severe spinal deformities before the advent of pedicle screw fixation. The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures. METHODS: We reviewed charts and radiographs of pediatric spinal deformity patients who underwent thoracoscopic release/fusion for their deformity from 1994 to 2008. Indications for the thoracoscopic procedure were assigned to one of the following categories: hyperkyphosis, large/stiff scoliosis, crankshaft prevention, and 'other'. We analysed indications grouped in 3-year intervals to determine how the indications for this procedure evolved over the past 15 years. RESULTS: One hundred and thirty-eight patients (mean age, 15 years; range, 2-28 years) underwent the procedure, with 160 identified indications. The frequency of thoracoscopic anterior release/fusion decreased after peaking in the years 2000-2002. Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006. The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008). Severe or rigid scoliosis is currently the most common indication for thoracoscopic release/fusion at our center (11/17, 65%; 2006-2008). CONCLUSIONS: The indications for a thoracoscopic anterior release/fusion has evolved with our increased understanding of this procedure and improved posterior fixation with pedicle screw instrumentation. Thoracoscopy in select spinal deformity patients still has an important role despite its less frequent use, as compared to the past decade.

Multi-band mucosectomy for early esophageal cancer and precancerous lesions / 中华消化内镜杂志

Objective To evaluate the safety and efficacy of multi-band mucosectomy (MBM) for early esophageal cancer and precancerous lesions.Methods Data of 28 patients with early esophageal cancer or precancerous lesions undergoing MBM were reviewed in regarding of procedure complications and follow-up results.Results A total of 32 lesions were resected successfully by MBM in one session,with mean procedure time of 28.3 minutes.The mean diameter of specimens was 12mm.No residual neoplasm was found at the base of any resected specimens.The post-MBM pathological findings consisted of 2 cases of intramucosal cancer,1 case of submucosal cancer,and 25 cases of moderate-severe dysplasia.No perforation,delayed hemorrhage or subcutaneous emphysema occurred.Intraoperative bleeding occurred in 23 cases,including 3 cases of pulsatile bleeding,which were controlled with metal clip,and 20 cases of minor bleeding which were managed with APC or halted automatically at the end of procedure.Chest pain after the procedure occurred in 5 cases and were relieved soon.The patient with submucosal cancer underwent subsequent surgical resection,with no residual cancer in surgical specimen or lymph node metastasis.Twenty seven other cases were followed up endoscopically for 2-12 months.Esophageal stricture occurred in 2 cases,and were successfully relieved by dilatation with stent or bougienage.No recurrent lesion or metastasis were revealed.Conclusion MBM is a relatively safe and effective endoscopic technique for treatment of early esophageal intramucosal cancer and precancerous lesions,but further studies are needed to evaluate the long-term results.

Endoscopic submucosal dissection for tumors originating from gastric muscularis propria / 中华消化内镜杂志

Objective To explore the feasibility,efficacy and safety of endoscopic submucosal dissection (ESD) for tumors originating from gastric muscularis propria.Methods A total of 20 patients with tumors originating from gastric muscularis propria confirmed by EUS and CT scan underwent ESD.Laparoscopic intervention was applied in 3 cases when difficulties in en bloc removal or perforation occurred.Results The mean ESD procedure time was 74.8 min (40-120 min),and the mean resected tumor size was 2.6 cm (1.5-3.5 cm).No severe complication occurred.Pathological findings were 17 cases of gastrointestinal stromal tumors and 3 cases of leiomyoma.Conclusion ESD is an effective method for treating the tumors originating from gastric muscularis propria,and laparoscopic intervention is necessary for en bloc resection in some cases.

Long-term Outcome after Endoscopic Treatment for Early Gastric Cancer in Korea

The early diagnosis of gastric cancer allows patients and physicians to pursue the option of endoscopic resection, which is significantly less invasive than conventional surgical resection. Newly developed endoscopic technique and devices have helped to overcome the limitations of therapeutic endoscopy in terms of lesion size, location, and presence of fibrotic scarring. As a result, the indications for endoscopic submucosal dissection (ESD) have been expanded from the classical indication for endoscopic mucosal resection (EMR), and there is now support for a further expansion of ESD indications. Long-term follow up data are needed for the clinical application of the expanded criteria of endoscopic treatment. In Korea, the use of endoscopic treatment has been increasing, and many reports on endoscopic treatment such as EMR or ESD have been published. This review was to elucidate the feasibility of the expanded guidelines, based on evidence from long-term outcome.

Application value of ureteroscopytherapy in the treatment of hematospermia / 中华泌尿外科杂志

Objective To treat hematospermia by ureteroscopy and investigate its application value for the treatment of hematospermia.Methods Nineteen patients with persistent hematospermia, TRUS,seminal vesicle MRI or CT were examined to exclude seminal vesicle tumor, tuberculosis, prostatic occupancy and preoperative prostatic fluid and drug sensitivity.Transurethral 4.5 - 6 F ureteroscopy entered through the microscopic seminal vesicle, wash of the old blood, reserved perfusion with Quinolones, and the lithoclasty on the seminal stones by holmium laser, resection of small polypi.Results The ureteroscopy was successful in 18 (95%) cases for bilateral seminal vesicle, wash and drug reserved perfusion, and one case was also successful seminal vesicle microscopy on the affected side; five cases with the seminal stones by olmium laser, three cases with small polypi by resection.The averse duration of the procedure was 35 10 -75) min.There were no compliocations during or after the operation.In 18 cases at 6 - 12 months follow-up the hematospermia and symptoms of hematospermia disappeared fully after 90 d.There was recurrence in one case which improved with anti-inflammaotry treatment.Conclusions Ureteroscopic treatment for persistent hematospermia by 4.5 - 6 F ureteroscopy through the seminal vesicle is effective and safe method and results in a micro-wound.

Trans-umbilical NOTES for abdominal adhesion lysis using a flexible endoscope: a case report / 中华消化内镜杂志

Objective To evaluate the feasibility and safety of trans-umbilical NOTES to perform abdominal adhesion lysis using a flexible endoscope.Methods A 42-year-old female was admitted to our hospital with a complain of abdominal pain due to abdominal adhesion after hysterectomy.A gastroscope (GIF-2TQ260M,Olympus)was inserted into the peritoneal cavity through an incision(1.5 cm)of the umbilical opening.Pneumoperitoneum was established by the endoscopic air supply system using CO2 instead of air.Abdominal exploration showed that omentum and bowel were stuck to the scar of the low central peritoneum incision.Separation of the abdominal wall adhesions was performed with an IT knife and a hook knife respectively.After most of the adhesions were separated,bleeding was found from the isolated adhesion wound of the omentum and bowel.Hemorrhaged blood vessel was difficult to be found with the flexible gastroscope.Then a 5 mm Trocar was placed at the left lower abdomen and laparoscopic assistance was adopted to search the bleeding point.However,no bleeding site was found and the hemorrhage was stopped automatically.Residual adhesion lysis was conducted with laparoscopic assist.After the procedure,the umbilical incision was closed with absorbable suture,but lower left abdominal incision was left without suturing.Results The operation time was 40 minutes.The patient suffered from minus pain from the umbilical incision without need of treatment.She had normal diet and got out of bed after reconsious.She was discharged 2 days after the procedure without any complaints.Conclusion Trans-umbilical NOTES using a flexible endoscope for peritoneal adhesion lysis is safe and feasible,but the effectiveness remains to be further confirmed.

Endoscopic papillectomy for ampullary adenomas / 中华消化内镜杂志

Objective To evaluate the endoscopic papillectomy (EP) for ampullary adenoma (AA). Methods The resection rate, complications, local residual rate and local recurrence of EP for AA at endoscopy center of Changhai Hospital were retrospectively reviewed. Results From July 2005 to July 2009, a total of 19 patients with endoscopically diagnosed and pathologically confirmed AA underwent EP, in which 18 cases were scattered AA (94. 7%) including 1 case of multiple adenomas in duodenum, and 1 (5.3%) was familial adenomatous polyposis (FAP). The lesion was resected en bloc in 11 cases (57.9%) , and piecemeal in 8 (42. 1%). All patients were followed up at a mean period of 24. 5 months (range 7-48 months). The residual rate after first EP was 21. 1% (4/19), and the total success rate was 89.5% (17/19). Short-term complications after EP included 3 cases of bleeding, 3 cases of mild acute pancreatitis and 2 cases of acute cholangitis. Long-term complications were 1 case of stenosis of the common bile duct (CBD) orifice accompanied with acute cholangitis, 1 case of CBD stone and 1 case of acute cholangitis after stent placement. No such severe complications as perforation or procedure-related death was observed.Conclusion EP is a safe and effective modality for ampullary adenoma.

Pathological features of gastro-esophageal high-grade intraepithelial neoplasia: a pre- and post-procedure comparative study / 中华消化内镜杂志

Objective To investigate the pathological features of gastro-esophageal high-grade intraepithelial neoplasia (HGIEN) confirmed by biopsy and to compare the differences of its diagnosis after endoscopic resection. Methods Data of 147 patients with gastro-esophageal HGIEN confirmed by biopsy, who underwent EMR or ESD in recent 4 years were analyzed for the pathological findings of pre- and post- procedures. Results Among 147 cases of HGIEN diagnosed by endoscopic biopsy, 106 lesions were in esophagus and 41 in stomach. After endoscopic resection, intraepithelial neoplasia was confirmed in 97 (66%), and cancer was diagnosed in 50 (34%), of which submucosal layer was involved in 11. There were 34 cases of adenocarcinoma and 16 squamous cell carcinomas, in which 22 cases (44%) were poorly or moderately differentiated. Conclusion More than one third cases of biopsy diagnosed HGIEN are confirmed to be carcinoma after endoscopic resection, which needs active therapeutic measures.

Surgical Treatment of Contact Point Headache

OBJECTIVES: Contact point headache is caused by contact between the nasal septum and the lateral nasal wall, resulting in referred pain involving the trigeminal nerve. We aimed to assess the benefits of surgical correction in patients with endoscopic and radiographic evidence of a contact point in the nasal cavity. MATERIALS AND METHODS: A prospective study was performed on patients who met the following criteria:) history of chronic headache, 2) lack of acute or chronic inflammatory findings, 3) presence of a contact point upon nasal endoscopy and CT scan, 4) relief of headache within five minutes after applying topical anesthesia to the contact point. The severity of pain was assessed preoperatively and postoperatively using a visual analogue scale (VAS). The duration and frequency of headaches were also assessed using a questionnaire. RESULT: The patients whose headaches were believed to result from an intranasal contact point underwent surgical management. According to the same pain questionnaire given preoperatively and postoperatively, severity, duration, and frequency of headache were significantly reduced. CONCLUSION: A contact point headache must be considered in patients who have no other obvious causes of headache. Significant relief can be obtained by surgery in patients with endoscopic and radiographic evidence of a contact point in the nasal cavity.

Natural orifice transluminal endoscopic surgery on animal models / 中华消化内镜杂志

Objective To evaluate the safety and feasibility of natural orifice transluminal endoscopic surgery(NOTES)with current available techniques and endoscopic accessories.Methods Transgastric and transvaginal endoscopic abdominal cavity exploration were performed in 6 female pigs.A needle-knife and a ERCP scalpel were used to make an anterior gastric wall incision,and a dilating balloon to expand the passage,through which a therapeutic gastroscope was sent into the abdominal cavity to seek the target organ.Partial liver resection was performed in 2 cases.For incision closure,a clip was applied to the incision orifice or it was just given putting-aside therapy.One week later,the abdominal cavity was examined via vagina.Another week later,it was observed via other incision of the stomach.Four weeks after the operation,the pigs were sacrificed.Adhesion,injury to the organs and closure of the incision were evaluated.Results Transgastric procedures were performed 12 times and transvaginal procedures 6 times.Mean operation time via stomach was 33.4±10.9 min.and that via vagina WaS 10.1±2.5 min.All animals recovered and gained weight after the operation.The incision healed up with no obvious complications.Re-exploration showed adhesion of various degrees,no effusion,or injury to the organs were observed.Ketamine plus propofol achieved satisfactory anesthetic effect with no complications.One of the two animals which underwent liver partial resection died of disphragmatic muscle perforation.Hemarrhage occurred twice,both in the procedures via satisfied.One case developed abdominal abscess.Conclusion It Was feasible and safe to perform NOTES via transgastric and transvaginal approach to the abdominal cavity and liver resection.But development of NOTES specific instruments is essential to the procedure.

Laparoscopy-assisted trans-gastric endoscopic biopsy of retroperitoneal lymph node:a report of 1 case in human being / 中华消化内镜杂志

Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery(NOTES)in human being with current available devices.Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoscopy in a 50-year-old man,who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure.After routine anesthesia and abdominal skin sterilization,a pneumoperitoneum was induced with a Veress needle placed in the umbilical area,followed by the introduction of a 5-mm trocar.Gastral cavity Was sterilized with antibiotics and povidone iodine.Under laparoscopie optical control,we made a styliform incision in the anterior wall of gastric corpus with a needle knife,and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope.We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy.The specimen was taken out by retrieval basket through the stomach.The gastric incision Was closed with metal clips.Results The biopsy by means of NOTES was successfully performed without intra-or postoperative complications.The diagnosis was confirmed as lymphoma pathologically.The patient received chemotherapy and was discharged on the sixth postoperative day.There was no short or long-term complication.Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being.

Intranasal endoscopic repair of 15 cases of cerebrospinal fluid rhinorrhea / 临床耳鼻咽喉头颈外科杂志

Objective:To summarize endoscopic management of cerebrospinal rhinorrhea and position-determining means.Method:Fifteen cases of cerebrospinal rhinorrhea treated by endoscopic approach at our institution were analyzed retrospectively.Aetiology included accidental trauma (10), surgical trauma (4), idiopathic (1). All patients presented with CSF rhinorrhea.Six cases were operated after failure of conservative treatment. Two cases after failure of neurosurgical repair were referred to our department. The largest defect was as big as 2.5 cm×1.5 cm. All patients were scanned by computed tomography and magnetic resonance imaging and confirmed by biochemistry test.Ten patients received high resolution spiral computed tomography bonding ventriculography.Result:We performed intranasal endoscopic repair in all 15 patients. All repairs were successful at the first attempt with a mean follow up of 20 months. One patient had light headache postoperatively and relieved with conservative treatment. All defects of skull base detected by computed tomography and ventriculography were confirmed in the operation.Conclusion:Intranasal endoscopic repair of cerebrospinal rhinorrhea can be an effective method. High resolution spiral computed tomography scan combined with ventriculography is a precise position-determining means. With the advancement of instrument and operative skill,the scope of endoscopic repair will further extend.

The Usefulness of Endoscopic Management in Benign Sinonasal Tumors

BACKGROUND AND OBJECTIVES: There are increasing evidence suggesting that the endoscopic approach can be used successfully for the treatment of benign sinonasal tumors. In the present study, we reviewed a 12-year experience of our institution for endoscopic management of benign sinonasal tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records and radiologic findings of 185 patients who underwent endonasal endoscopic resection of benign sinonasal tumors at the Catholic Medical Center between 1996 and 2007. RESULT: Inverted papilloma (119 cases, 64.3%) was most common, followed by hemangioma (14 cases), pyogenic granuloma (11 cases), angiofibroma (9 cases), and osteoma (7 cases). The most common symptom was nasal obstruction (70.8%). Sixteen cases (8.6%) recurred after endoscopic resection (12 cases of inverted papilloma, 2 cases of ossifying fibroma, and 2 cases of fibrous dysplasia). No major complications were reported. CONCLUSION: Endoscopic approach allows for successful surgical outcomes and good cosmetic effects among patients with benign sinonasal tumors. We suggest that, in selected cases, benign tumors involving the sinonasal tract can be safely and radically removed using the endoscopic technique.

Evaluation of posterior microendoscopy discectomy In the treatment of lumbar disc herniation / 中国基层医药

Objective To study the curative effect of posterior microendoscopy discectomy (MED)in the treatment of lumbar disc herniation(LDH). Methods 57 patients with LDH were treated by posterior MED to evalu-ate the curative effect. Results 57 patients were followed up for 3～12 months( average,6.5 months) ,the excellent and good rate was 91.2% (52/57). Conclusion Posterior MED has the advantages of less trauma,prompt recovery and less complications.