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经口内镜下环形肌切开术治疗贲门失弛缓症的术后护理

目的　探讨经口内镜下环形肌切开术（POEM）治疗贲门失弛缓症（AC）的整体护理措施在临床的应用价值。 方法　对2011年5月－2012年10月收治的25例行POEM治疗患者的术后护理方法及要点进行回顾性分析。 结果　全部患者顺利完成手术，术后1例患者出现皮下气肿，未经特殊处理，3 d后自然消退。经治疗与护理，25例患者痊愈出院。 结论　POEM作为一项近年来内镜下治疗的新型微创技术，是目前治疗AC的首选方法，其术后系统性的护理则是手术得以成功的重要保障。

急诊内镜下止血夹治疗消化道机械吻合术后早期吻合口出血的疗效

目的 探讨急诊内镜下使用止血夹治疗消化道机械吻合术后早期吻合口出血的疗效。 方法 回顾性分析 2005 年 1 月至 2016 年 12 月期间在笔者所在医院胃肠外科接受内镜下止血的 12 例消化道机械吻合术后早期吻合口出血患者的临床资料。 结果 本组 12 例患者中，10 例患者一次止血成功；2 例出现再次出血，其中 1 例再次内镜下止血成功，1 例胃空肠吻合术后患者止血失败、行手术治疗。所有患者术后均未出现吻合口漏等严重并发症。术后 11 例内镜止血成功患者获访 6～28 个月，中位随访时间 18 个月，随访期间未见再次出血。 结论 急诊内镜下止血夹治疗消化道机械吻合术后早期吻合口出血的操作简单、安全及有效，可作为首选方法在临床上推广应用。

Clinical Observation on Spot-Welding Electrocoagulation with Needle-Knife to Prevent Bleeding after Endoscopic Sphincterotomy: Report of 102 Cases

ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.

内镜黏膜下剥离术治疗胃肠道间质瘤的围手术期护理

目的　总结内镜黏膜下剥离术（ESD）治疗胃肠道间质瘤的围手术期护理方法。 方法　回顾分析2007年1月－2011年8月符合内镜下治疗77例胃肠道间质瘤患者行ESD的临床资料和护理措施。 结果　77例患者全部经内镜完整切除肿瘤，其中3例出现出血，5例发生穿孔，2例发生术后狭窄，经内科保守治疗、内镜下治疗以及围手术期精心护理，患者痊愈出院。 结论　ESD治疗胃肠道间质瘤安全、有效，正确细致的各项护理措施是胃间质瘤患者手术获得成功、且身体早日康复的有力保障。

Study on Laparoscopic Cholecystectomy Combined with Endoscopic Sphincterotomy in the Treatment of Cholecystolithiasis Associated with Choledocholithiasis

目的:探讨腹腔镜胆囊切除术(LC)与内镜十二指肠乳头括约肌切开术(EST)联合应用治疗胆囊结石合并胆总管结石的临床效果。方法:回顾性分析我院开展的LC联合EST治疗胆囊结石合并胆总管结石76例,其中56例先行EST后行LC,20例先行LC后行ERCP/EST。结果:本组全部治愈,先行EST组56例,3例并发胰腺炎,3例出血,2例再发胆总管结石,先行LC组20例行EST11例,6例取石后未做括约肌切开,3例结石自行掉入肠道,1例出现胆道感染,1例胰腺炎,无出血及穿孔。结论:内镜治疗胆囊结石继发胆总管结石具有创伤小、效果好、并发症少、恢复快的的特点;先作EST可解除胆道梗阻、减轻炎症,并为LC创造条件,选择性先行LC后可减轻创伤,甚至不必做EST。

内镜下黏膜剥离术治疗早期胃癌的护理

目的　总结内镜下黏膜剥离术（ESD）治疗早期胃癌的护理经验，为临床护理提供参考依据。 方法　对2011年1月－12月20例接受ESD治疗患者的围手术期护理方法及要点进行回顾性总结。 结果　 20例患者均术后康复出院，其中1例术中发生穿孔，予钛夹夹闭，后经保守疗法痊愈。1例术后病理示：上皮内瘤变及黏膜内癌，追加外科手术。本组患者2个月后随访，内镜复查无l例病变残留及复发。 结论　护理行ESD早期胃癌患者，需具备丰富的临床护理经验和娴熟的操作技能，并采用周全有效的护理措施，方可减少术后并发症，促进患者早日康复。

Establishment and Management of Enteral Nutrition Support in Critical Patients

Efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage

ObjectivesTo explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.MethodsA total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.ResultsThe operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.ConclusionsCompared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.

Comparison of the Clinical Efficacy between Endoscopic Surgery and the Surgery Combined with Plasma Low-temperature Radiofrequency in Treating Papilloma of External Auditory Canal

目的　观察独用内镜下手术以及联合等离子低温射频治疗外耳道乳头状瘤的疗效。 方法　2006年7月－2010年7月，随机将收治的45例外耳道乳头状瘤患者（150只耳）分组，比较独用内镜下手术组（A组）以及联合等离子低温射频组（B组）治疗外耳道乳头状瘤的疗效。 结果　患者均术后成功随访1～3年，48只患耳无复发及恶变，2只患耳3个月后复发。 结论　内镜下手术联合等离子低温射频治疗外耳道乳头状瘤具有微创，手术彻底有效，防止复发的优点，值得临床广泛应用。

Efficacy and safety of PELD for L5/S1 disc herniation via transforaminal approach versus interlaminar approach: a meta-analysis

ObjectiveTo systematically review the efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) for L5/S1 disc herniation via transforaminal approach (TF-PELD) versus interlaminar approach (IL-PELD).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and the cohort studies of TF-PELD versus IL-PELD for L5/S1 disc herniation from inception to October 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 1 RCT and 7 cohort studies involving 414 patients were included. The results of meta-analysis indicated that: compared with IL-PELD group, TF-PELD group had longer operative time (MD=17.42, 95%CI 12.86 to 21.97, P<0.000 01) and more frequency of intraoperative fluoroscopy (MD=8.42, 95%CI 6.18 to 10.65,P<0.000 01), respectively. However, there were no significant differences between two groups in the post-operative visual analogue scale (MD=0.01, 95%CI –0.23 to 0.25,P=0.94), the post-operative Oswestry disability index (MD=–0.46, 95%CI –2.42 to 1.49, P=0.64), the excellent and good outcomes rate (RR=1.00, 95%CI 0.89 to 1.12, P=0.96), and the rate of complications (RR=0.73, 95%CI 0.45 to 1.18, P=0.20).ConclusionCurrent evidence shows that TF-PELD and IL-PELD are equally effective and safe for L5/S1 disc herniation, but IL-PELD is superior to TF-PELD in less operative time and less radiation exposure. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.