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Objective:To explore the characteristics of vowel production of dysarthria after stroke, and the relationship between vowel production and speech clarity. Methods:From October, 2019 to January, 2020, 19 patients with post-stroke dysarthria and 18 healthy controls were asked to read a short essay to extract vowels, and measured the jaw distance, tongue distance, F2i/F2u, vowel space area (VSA), vowel articulation index (VAI), F1 and F2 variability, and speech clarity. The correlation between vowel production and speech clarity were analyzed. Results:Tongue distance, F2i/F2u, VSA, VAI, and speech clarity were less in the patients than in the controls (|t| > 2.268, P < 0.05), while F2 variability was more (t = 2.375, P < 0.05). F2i/F2u (r = 0.465), VAI (r = 0.488) and F2 variability (r = -0.504) were correlated to speech clarity (P < 0.05). Conclusion:The vowel production impaired in patients with post-stroke dysarthria, featured as abnormal articulatory movements, concentration of vowels and poor stability of vowels, which impacts the speech clarity.
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Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.
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Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , China , Gastos em Saúde , Hospitalização , Pacientes Internados , Doente TerminalRESUMO
Objective To explore the effects of palliative care consultation on medical professionals who have requested it in Peking Union Medical College Hospital. Methods Semi-structured interviews were conducted with 17 medical professionals who had requested palliative care consultation.Results Palliative care consultation had the following positive effects:building a bridge for doctor-patient communication,providing psychological support to reduce the sense of occupational exhaustion for medical professionals,providing technical support for medical professionals to help patients relieve symptoms,helping medical professionals in the multidisciplinary learning of palliative care,adding humanistic care and neglected ethical concerns.Conclusion Palliative care consultation improves the quality of care for dying patients,and the capacity of consultation needs to be enhanced urgently.
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Humanos , Hospitais , Cuidados Paliativos , Pesquisa Qualitativa , Encaminhamento e ConsultaRESUMO
Results and Conclusion:Articulation disorder for children is classified to Developmental Speech Sound Disorder (6A01.0). It involves in the eye, ear and related structures (s2), structures involved in voice and speech (s3), especially structure of external ear (s240), structure of middle ear (s250) and structure of inner ear (s260); voice and speech functions (b3), especially articulation functions (b320); communication (d3), learning and applying knowledge (d1), interpersonal interactions and relationships (d7), and community, social and civic life (d9), especially speaking (d330), conversation (d350), using communication devices and techniques (d360) and acquiring language (d133). The assessment of articulation disorder should be covered articulation accuracy and motor function of articulation. A holistic rehabilitation solution for children with articulation disorder has been developed, involving in body structure, body function, activities and participation, and environmental factors, including assessment, training and treatment, educational counseling, and psychological and social support. Objective:To explore the diagnosis of diseases and functioning of articulation function and conduct content analysis of assessment tools in Chinese, and to construct framework of rehabilitation solution based on International Classification of Diseases 11th Revision (ICD-11), International Classification of Functioning, Disability and Health (Children and Youth version) (ICF-CY) and International Classification of Health Interventions (ICHI). Methods:The diagnosis of disease and functioning was discussed with ICD-11 and ICF. The assessment tools were analyzed with ICF. A holistic rehabilitation solution was constructed with ICF and ICHI.
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Objective@#To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.@*Methods@#The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively.@*Results@#Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(QR): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups.@*Conclusion@#Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.
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Objective@#To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.@*Methods@#The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively.@*Results@#Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(QR): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups.@*Conclusion@#Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.
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To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer. The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using test, χ(2) test, Kaplan-Meier curve and Log-rank test, respectively. Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes . (171.3±43.5) minutes, 2.50, 0.02), more mediastinal lymph node dissection ((): 17(9) . 11(10), =388, 0.02) and shorter postoperative hospital stay (7.0(3.5) . 9.0(3.0), =285, 0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% . 48.1%, 0.10) and 3-year disease-free survival (67.4% . 47.2%, 0.13) between the two groups. Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.
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Objective@#To analyze the diagnosis treatment and methods for pancreatic pseudoaneurysms complicated with pancreatitis.@*Methods@#The diagnostic methods, treatments and clinical effects of 11 patients with pancreatic pseudoaneurysms complicated with pancreatitis from January 2006 to December 2014 were retrospectively analyzed in Shengjing hospital.@*Results@#Two cases of pancreatic pseudoaneurysms were diagnosed by endoscopic ultrasonography(EUS). Eight cases were diagnosed with contrast-enhanced computed tomography. One case was diagnosed by angiography. Ten patients received endovascular embolization, and nine of them were successfully treated. Rebleeding occurred in one patient 28 days after embolization, and was successfully treated by repeated embolization. One patient was successfully treated by surgery.@*Conclusion@#Contrast-enhanced computed tomography and angiography are the current main methods to diagnose pancreatic pseudoaneurysms. With the wide use of EUS in the diagnosis of pancreatic disease, EUS becomes an option for diagnosis of pancreatic pseudoaneurysm. Traditionally, pancreatic pseudoaneurysm is treated by surgery. With the advancement of endovascular techniques, endovascular treatment has become the first-line treatment. Further studies with a large sample size are needed to establish the better diagnostic methods and treatments for pancreatic pseudoaneurysm.
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Objective To analyze the diagnosis treatment and methods for pancreatic pseudoaneurysms complicated with pancreatitis. Methods The diagnostic methods,treatments and clinical effects of 11 patients with pancreatic pseudoaneurysms complicated with pancreatitis from January 2006 to December 2014 were retrospectively analyzed in Shengjing hospital. Results Two cases of pancreatic pseudoaneurysms were diagnosed by endoscopic ultrasonography(EUS). Eight cases were diagnosed with contrast-enhanced computed tomography. One case was diagnosed by angiography. Ten patients received endovascular embolization,and nine of them were successfully treated. Rebleeding occurred in one patient 28 days after embolization,and was successfully treated by repeated embolization. One patient was successfully treated by surgery. Conclusion Contrast-enhanced computed tomography and angiography are the current main methods to diagnose pancreatic pseudoaneurysms. With the wide use of EUS in the diagnosis of pancreatic disease,EUS becomes an option for diagnosis of pancreatic pseudoaneurysm. Traditionally, pancreatic pseudoaneurysm is treated by surgery. With the advancement of endovascular techniques, endovascular treatment has become the first-line treatment. Further studies with a large sample size are needed to establish the better diagnostic methods and treatments for pancreatic pseudoaneurysm.
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Objective To investigate the relationship between anxiety sensitivity (AS), resilience and mental health of soldiers. Methods A total of 260 soldiers were selected from an army troop, and were surveyed by anxiety sensitivity index Ⅲ (ASI-3), Conner-Davidson resilience scale (CD-RISC) and self-reporting inventory (SCL-90). The relationships of these variables were analyzed by structure equation modeling analysis. Results Totally 240 (92.3%) valid questionnaires were collected. There were no significant differences in AS or mental health between soldiers with different demographic factors including service length, single-child or not, job division, educational level, or residence before entering army (P＞0.05). The total score of SCL-90 and each factor scores of soldiers with high-AS were significantly higher than those with low-AS (P＜0.01). The correlation analysis results showed that the total score of SCL-90 was positively correlated with the total score and each factor score of ASI-3 (rASI ＝0.487, rsomatic＝0.435, rsocial＝0.455, rcognitive＝0.445; P＜0.001), and was negatively correlated with each factor score of CD-RISC (rtenacity ＝0.315, rstrength ＝0.321, roptimism ＝0.227; P＜0.001). Structural equation modeling analysis and Sobel test showed that AS indirectly affected the mental health of soldiers through the mediating effect of resilience (χ2/df＝20.222/12＝1.685 2, P＝0.063, goodness of fit index [GFI]＝0.977, adjusted goodness of fit index [AGFI]＝0.946, normed fit index [NFI]＝0.977, relative fit index [RFI]＝0.960, incremental fit index [IFI]＝0.991, Tucker-Lewis index [TLI]＝0.983, comparative fit index [CFI]＝0.990, and root mean square error approximation [RMSEA]＝0.054). Conclusion RS has partial mediating effect on the relationship between AS and mental health of soldiers. More attention should be paid on the mental health of soldiers with high AS, so as to improve their RS and mental health.
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Objective s The in-hosptial palliative care consultation (PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital. Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally (requested from the department other than the Geriatrics) and informally (by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform. Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine (n=8), Gynaecology (n=16) and Surgery (n=13), rotating residents (n=30), visiting doctors (n=16) in Geriatric department, and PCC team members (n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members (97.6% vs. 80%, P0.05). Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.
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Humanos , China , Hospitais Gerais , Cuidados Paliativos , Médicos , Psicologia , Encaminhamento e Consulta , Inquéritos e QuestionáriosRESUMO
Objective To analyzed the current situations and needs of the continuing education on hospice and palliative care (HPC) in China based on the response from trainees in the 2016 National Hospice and Palliative Medicine Training Program. Methods A questionnaire-based survey was performed among 141 trainees who attended the program held by Peking Union Medical College Hospital in 2016. The questionnaire items included the awareness and knowledge of HPC,learning Objective s,learning gains,and future plans. Results The trainees came from 19 provinces and municipalities. Their professions included doctors (66.0%),nurses (17.0%),physical therapists (1.4%),psychologists (5.0%),social workers (2.1%),volunteers (6.4%) and hospital managers (2.1%). Doctors'disciplines included geriatrics (56.0%),medical oncology (11.8%),and others (32.2%). Among these 141 participants,111 (78.7%) had not attended any HPC course before,134 (95.0%) were aware of HPC,and 131 (92.9%) needed help from others when providing care for terminally-ill patients. The median score for symptom control and communication skills among 141 trainees were 3.0(2.0,4.0) points and 1.0(0.0,2.0) points,respectively. The average score of the final examination involving case analysis and medical knowledge of symptom control was (59.1±18.0)scores (centesimal system). Finally,136 trainees (96.5%) were willing to receive further training on HPC. Conclusion It is important to do more HPC education and training among medical staff,so as to strengthen their knowledge and capability in symptom control,communication,and evaluation of death quality.
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<p><b>OBJECTIVE</b>To investigate the clinical features of acute poisoning in hospitalized children.</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 586 hospitalized children who were diagnosed with poisoning and discharged from the Children's Hospital of Chongqing Medical University between January 2006 and December 2015.</p><p><b>RESULTS</b>The patients included 354 males and 232 females (age: 24 days to 15.8 years). Of the 586 cases, 450 (76.8%) were infants and preschool children; 463 (79.0%) came from rural areas; 551 (94.0%) were hospitalized because of unintentional poisoning. The drug poisoning, pesticide poisoning, and rodenticide poisoning accounted for 221 cases (37.7%), 167 cases (28.5%), and 175 cases (29.9%) respectively. There was a significant difference in the distribution of the poisoning toxins between urban and rural children (P<0.01), and drugs and pesticides were the most common toxins for urban and rural children respectively. There were significant differences in main clinical manifestations between the children with drug poisoning, pesticide poisoning, and rodenticide poisoning (P<0.01), who presented with main clinical symptoms of the nervous system, digestive system, and circulatory system respectively. There was no significant difference in overall response rate between the children poisoned by different toxins.</p><p><b>CONCLUSIONS</b>Acute poisoning is most common in infants and preschool children. The majority of the patients are from rural areas. The majority of acute poisoning is unintentional. Poisoning by drugs is the main type of acute poisoning. There is no significant difference in overall response rate between the children poisoned by different toxins, but their clinical manifestations are different.</p>
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Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doença Aguda , Criança Hospitalizada , Intoxicação , Terapêutica , Estudos RetrospectivosRESUMO
Objective: To explore the therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer. Methods: A total of 138 SD rats were selected to make rat models with gastric ulcer induced by acetic acid (24 rats with sham operation served as sham operation group), and were randomly divided into model group (n = 30), western medicine group (n = 30), traditional Chinese medicine (TCM) group (n = 24) and combination group (combined western medicine and TCM group, n = 30). Western medicine group was gavaged with omeprazole in the morning and with iso-volumetric distilled water in the afternoon; TCM group and TCM sham operation group were gavaged with iso-volumetric distilled water in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon; combination group was gavaged with omeprazole in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon; sham operation group and model group were gavaged with iso-volumetric distilled water both in the morning and afternoon. Ulcer indexes and degree of mucosal degree in rats at different time points after gavage were observed. Twenty-eight days after gavage, interleukin (IL)-1β was given to induce ulcer recurrence so as to observe the recurrent severity and rate of ulcer in each group. Results: Compared with model group and western medicine group, treatment in combination group could prominently reduce the ulcer index of rats with peptic ulcer, and increase the healing rate and inhibition rate of peptic ulcer. After IL-1β-induced ulcer recurrence, combination group was significantly superior to model group and western medicine group in ulcer recurrent rate [50% (3/6) vs. 100% (6/6)] and severity. Conclusions: Basic acid-suppression therapy combined with Qi-Replenishing and Blood-Activating Formula can effectually improve the ulcer healing quality and reduce ulcer recurrence.
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OBJECTIVE@#To explore the therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer.@*METHODS@#A total of 138 SD rats were selected to make rat models with gastric ulcer induced by acetic acid (24 rats with sham operation served as sham operation group), and were randomly divided into model group (n = 30), western medicine group (n = 30), traditional Chinese medicine (TCM) group (n = 24) and combination group (combined western medicine and TCM group, n = 30). Western medicine group was gavaged with omeprazole in the morning and with iso-volumetric distilled water in the afternoon; TCM group and TCM sham operation group were gavaged with iso-volumetric distilled water in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon; combination group was gavaged with omeprazole in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon; sham operation group and model group were gavaged with iso-volumetric distilled water both in the morning and afternoon. Ulcer indexes and degree of mucosal degree in rats at different time points after gavage were observed. Twenty-eight days after gavage, interleukin (IL)-1β was given to induce ulcer recurrence so as to observe the recurrent severity and rate of ulcer in each group.@*RESULTS@#Compared with model group and western medicine group, treatment in combination group could prominently reduce the ulcer index of rats with peptic ulcer, and increase the healing rate and inhibition rate of peptic ulcer. After IL-1β-induced ulcer recurrence, combination group was significantly superior to model group and western medicine group in ulcer recurrent rate [50% (3/6) vs. 100% (6/6)] and severity.@*CONCLUSIONS@#Basic acid-suppression therapy combined with Qi-Replenishing and Blood-Activating Formula can effectually improve the ulcer healing quality and reduce ulcer recurrence.
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Objective To evaluate the safety and efficacy of carbon dioxide (CO2) used as an alternative to air in the gastric endoscopic submucosal dissection (ESD). Methods 80 cases underwent ESD treatment were randomly as-signed to two groups, 40 cases in CO2 group and 40 in air group. Arterial blood CO2 partial pressure was measured preoperative, intraoperative and postoperative respectively. Visual analog scale (VAS) was used to record patients the degree of abdominal pain and distention at 1 h, 6 h and 24 h after operation in each group. The incidence of com-plications were evaluated. Regular follow up were scheduled in all the patients. Results There was no significant dif-ference in degree of abdominal pain score and the CO2 partial pressure between the two groups. The abdominal dis-tension scores of CO2 group were significant lower than air group at 1 h, 6 h after the ESD procedure. There were no statistically significant difference in the incidence rate of complications. Conclusion The utilization of CO2 in gas in-sufflation during gastric ESD is safe. CO2 insufflation can significant reduce the postoperative abdominal distension and improve the quality of postoperative recovery.
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Objective To evaluate the efficacy of endoscopic metal stent implantation for afferent limb obstruction after pancreaticoduodenectomy(PD). Methods A retrospective analysis of 5 patients with afferent limb obstruction after PD treated by endoscopic metal stent implantation was performed.Data of each patient was reviewed including the records of the endoscopic procedure,the complications and the clinical outcomes. Results All the metal stents were implanted successfully in the 5 patients. The abdominal disten-sion and cholangeitis were well relieved in all the patients. The liver function improved in all the patients in 3 to 5 days.No abdominal discomfort,bleeding,perforation,or stent dislocation occurred.CT scan showed that all stents were well expanded.The survival time of the 5 patients were 3 to 8 months,and 4. 6 months on av-erage. There was no recurrence of afferent limb obstruction. Conclusion For afferent limb obstruction after PD,endoscopic metal stent implantation is effective in relieving obstruction,the symptoms,and improving the quality of life.
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Objective To investigate the incidence of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in the colorectal laterally spreading tumors (LST) and the risk factors. Methods Data of 51 patients with coloretral LST,treated with ESD from January 2010 to May 2014 at Shengjing hospital affiliated to China Medical University,were reviewed.The incidence of electrocoagulation syndrome was analyzed and logistic regression was used to evaluate risk.Results The incidence of electro-coagulation syndrome was 9.8%(5 /51).The incidence of tumors in the rectal area(7.1%,2 /28)was lower than that of the left half colon (12.5%,1 /8),and the right colon (13.3%,2 /15).Multivariable logistic regression analysis showed that the independent risk factors for the development of electrocoagulation syndrome were LST located in non-rectum area (OR =1.655,P <1.655),lesion size larger than 25 mm (OR =1.028, P <0.05),the operation time longer than 129 min (OR =1.016,P <0.05),age older than 62 year old (OR =0.987,P <0.05).Conclusion For the patients aged over 62 year old,lesion size larger than 25 mm,the operation time longer than 129 min and LST located outside the rectum,the mucous membrane should be separated from the muscularis propria in the ESD procedure to reduce electrocoagulation time as much as possible. In the postoperative period,patients need fasting,fluid replacement support,and prevention of post endoscopic submucosal dissection electrocoagulation syndrome (PEECS).
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Objective To evaluate the short-term safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction.Methods A total of 208 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2012 to May 2014 at the endoscopy center of Shengjing hospital were enrolled.The technical and clinical success rate and the complications were reviewed.Results The technical and clinical success rates were 99.04％ (206/208) and 96.15％ (200/208), respectively.Abdominal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 13.46％ (28/208), 2.88％ (6/208), 1.92％ (4/208), respectively.The abdominal pain in most patients was self-relieving except for 6 patients with perforation of colon.Patients with perforation were cured by emergency surgery.One patient with intraperitoneal hemorrhage was also cured by emergency surgery, the other patients developing bleeding recovered themselves.Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study.As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effective and safe for malignant colorectal obstruction.
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Objective To evaluate the clinical effects and safety of double-channel forward-view endoscopy for lower-position biliary obstruction after Billroth-Ⅱ gastrectomy.Methods A total of 18 patients with lower-position biliary obstruction after Billroth-Ⅱ gastrectomy were enrolled and treated with doublechannel forward-view endoscopy.The process and the outcomes were recorded.Effectiveness and safety were evaluated.Results Double-channel forward-view endoscopic treatment was successfully performed in 13 of the 18 patients (72％),with stone removal or stents implantion to resolve biliary obstruction.The procedure failed in 5 patients,who were transferred to surgery or underwent percutaneous transhepatic cholangial drainage.Delayed bleeding occurred in 1 patient,and pancreatitis in 2,who were cured after standard treatments.Conclusion Double-channel forward-view endoscopy is effective and safe for lower-position biliary obstruction in patients after Billroth-Ⅱ gastrectomy.