ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
Objective To investigate the effect of implanting uncovered self-expandable metal stent for treatment of distal malignant biliary obstruction through endoscope. Methods The effect of therapy about implanting uncovered self-expandable metal stents to 16 patients who had unsectable malignant tumors companing with obstructive jaundice through endoscope was reviewed. Results Fifteen of the studied patients were implanted uncovered self-expandable metal stents successfully (94%), for their internal drainage were patent. At the seventh and fourteenth day after implantation, liver function and B-ultrasound were rechecked. Compared to the data before operation, total bilirubin, direct bilirubin and transaminase declined respectively (P＜0.01). And the diameter of the total biliary duct became shorter (P＜0.01). Six of them returned to the normal level in three weeks. Early adverse events (in seven days) included mild acute pancreatitis (one case) and acute cholangitis (one case). Mean survival and patency of drainage were 186.93 days (54 to 426 days) and 156 days (51 to 426 days) respectively. All of them, 3 cases occured obstruction of stents (20%). Conclusion Implantation of uncovered selfexpandable metal stent through endoscope is an ideal therapy for distal malignant biliary obstruction.
ObjectiveTo evaluate the safety and efficacy of endoscopic techniques for diagnosis and treatment of breast diseases. MethodsRelated literatures of recent years were reviewed. ResultsA minimally invasive endoscopic technique can be performed through small incisions. This can contribute greatly to reducing postoperative pain, shortening recovery time, and achieving a good cosmetic outcome. Under endoscopy, meticulous dissection and hemostasis can be achieved. Endoscopeassisted subcutaneous mastectomy, immediate mammary reconstruction, sentinel lymph node biopsy and axillary lymph node dissection, for breast cancer can be performed safely. Endoscopic surgery can also be applied for the diagnosis and treatment of benign breast tumor and transaxillary removal of glandular tissue in gynecomastia. In addition, fiberoptic ductoscopy can be used to diagnose patients with nipple discharge. Endoscopic surgery for patients with breast diseases can offer an excellent cosmetic outcome and maintain normal physiologic functions without a noticeable scar. It helps to give the patients confidence and improve the quality of life. ConclusionBreast surgery is a good candidate for endoscopic techniques.
Objective To compare vein graft patency after endoscopic great saphenous vein harvesting (EVH) and conventional open saphenous veinharvesting (OVH) in coronary artery bypass grafting (CABG), and to identify risk factors for vein graft stenosis. Methods The great saphenous vein was harvested using an EVH method in 60 patients, 34 males and 26 females, who underwent CABG in the General Hospital of PLA between May 2006 and May 2009. The mean patient age was 66.6±9.2 years in the EVH group.The OVH group had 60 patients (40 males and 20 females with a mean age of 65.7±10.6 years), chosen to match the clinical characteristics of the EVH group. 64multislice computed tomography (64MSCT) was used to evaluate vein graft patency at six months and two years postoperatively. We also collected and analyzeddata on possible risk factors for vein graft stenosis. Results The harvesting time was longer in the EVH group than in the OVH group (52.5±13.3 minutes vs. 36.1±18.0 minutes, t=2.13, P＜0.05). The EVH group requireda greater number of repairs to veins than did the OVH group (2.2±13 vs. 0.9±0.6,t=2.60, P＜0.05). There were no statistically significant differences invein length, number of vein grafts, or vein graft flow between the two groups. There was also no significant difference in vein graft patency between the EVH and OVH groups at six months postoperatively (96.2% vs. 94.5%) or at two years postoperatively (90.2% vs. 91.5%). The average of vein graft blood flow was a riskfactor for vein graft stenosis(t=2.61, P=001). Conclusion The EVH vein graft had a good patency rate at six months and two years after the surgery.
Objective To explore the feasibility and effectiveness of spinal pedicle screw internal fixation through endoscope-assisted posterior approach for the treatment of traumatic atlantoaxial instability. Methods Between September 2008 and September 2010, 44 patients with traumatic atlantoaxial instability received spinal pedicle screw internal fixation through endoscope-assisted posterior operation (micro-invasive surgical therapy group, n=22) or traditional surgical therapy (control group, n=22). There was no significant difference in gender, age, type of injury, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between 2 groups (P gt; 0.05). The blood loss, operation time, length of the incision, improvement rate of JOA, and graft fusion rates were compared between 2 groups to assess the clinical outcomes. Results The blood loss, operation time, and length of the incision in the micro-invasive surgical therapy group were better than those in control group (P lt; 0.05). All incisions were primary healing. Of 88 pedicle screws, 7 pedicle screws penetrated into the interior walls of cervical transverse foramen in the micro-invasive surgical therapy group and 8 in the control group, but there was no syndrome of vertebral artery injury. All patients of the 2 groups were followed up 12 to 37 months (mean, 26 months). Bony fusion was achieved in all cases within 3 to 12 months (mean, 5.3 months). No loosening or breakage of screw occurred. At 6 months to 1 year after operation, the internal fixator was removed in 6 cases and the function of head and neck rotary movement were almost renewed. The JOA score was significantly improved at last follow-up when compared with preoperative score (P lt; 0.05), and no significant difference in JOA score and improvement rate between the 2 groups at last follow-up (P gt; 0.05). Conclusion The micro-invasive surgical therapy can acquire the same effectiveness to the traditional surgical therapy in immediate recovery of stability, high graft fusion rate, and less complication. Moreover, it can significantly reduce the operation time, blood loss, and soft tissue injury, so this approach may be an ideal way of internal fixation to treat traumatic atlantoaxial instability.
To evaluate the effectiveness of interrupt percutaneous endoscopy lumbar discectomy (PELD) through interlaminar approach for L5, S1 disc protrusion. Methods Between November 2006 and August 2010, 115 patients with L5, S1 disc protrusion were treated, including 79 males and 36 females with an average age of 38 years (range, 14-79 years). All patients showed the dominated symptom of the S1 nerve root. The working channel was establ ished by puncturing through interlaminar approach under the local anesthesia. After the needle was used to make sure no nerve root or dural sac on working face, the disc tissue was excised directly by bl ind sight. Then the nerve root decompression was observed through the endoscope. In patients with free type, fragment compression was observed through the endoscope, and the disc tissue around the nerve roots was removed, then the free disc tissue around intervertebral space was excised. Results One patient who failed to puncture changed to miniopen discectomy; 3 patients who failed changed to post lateral approach; and the others underwent interrupt PELD through interlaminar approach. Eighty patients were followed up 18 months on average (range, 12-36 months). The average Oswestry Disabil ity Index (ODI) was reduced to 13% ± 5% at 12 months after operation and to 12% ± 8% at last follow- up from 73% ± 12% at preoperation, showing significant differences (P lt; 0.01). According to modified Macnab ,s criterion, the results were excellent in 59 cases, good in 15 cases, fair in 3 cases, and poor in 3 cases at last follow-up, and the excellent and good rate was 92.5%. Conclusion For the treatment of disc protrusion at the L5, S1 level, interrupt PELD through interlaminar approach should be ideal with short operation time, small trauma, and quick recovery.
Objective To invest igate the ef fect iveness and signi f icance of percutaneous endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer for degenerative lumbosacral disc disease. Methods Between January 2007 and August 2008, 21 patients with degenerative lumbosacral disc disease were treated with endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer. Among them, there were 13 males and 8 females with an average age of 52 years (range, 28-79 years). And the disease duration ranged from 3 months to 40 years (median, 9 months). The affected segments included T11, 12, T12-L1, L1, 2, and L2, 3 in 1 case respectively, L4, 5 in 4 cases, and L5, S1 in 13 cases. All patients had intractable low back pain or lower extremity radicular symptoms. The placement methods of B-Twin expandable spinal spacer were double sides in 15 cases and single side in 6 cases. Oswestry Disabil ity Index (ODI) and Macnab grading were used to determine the function recovery after operation. And Suk’s standard was used to determine the fusion effects by X-ray. Results All 21 patients were followed up 18 months to 3 years (mean, 23.8 months). Sciatica symptoms disappeared after operation in 19 cases, no significant improvement occurred in 2 cases of thoracic disease. The ODI scores were 79% ± 16% at preoperation, 30% ± 9% at 1 month, 26% ± 10% at 3 months, 21% ± 12% at 6 months, and 20% ± 10% at 18 months after operation, showing significant differences between pre- and postoperation (P lt; 0.05). According to Macnab grading at 6 months postoperatively, the results were excellent in 14 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 90.5%. According to Suk et al. standard, the results were excellent in 1 case, good in 19 cases, and poor in 1 case with an excellent and good rate of 95.2%. The muscle strength of the lower extremities had no improvement in 1 case of T11, 12 disc protrusion; pedicle screws fixation and decompression laminectomy were given after 6 months, but no improvement was achieved during follow-up. Protrusion recurred after 4 months in 1 case of L4, 5 disc protrusion, then was cured by laminectomy discectomy. The remaining patients achieved postoperative rel ief. Conclusion Endoscope combined with interbody fusion is a good combination to solve lumbar instabil ity. B-Twin expandable spinal spacer is a minimally invasive fusion choice of L4, 5 and L5, S1.
Objective To evaluate the surgical method and the results of endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. Methods Between May 2008 and August 2009, 13 cases of cubital tunnel syndrome were treated with endoscopic decompression and anterior transposition of the ulnar nerve. There were 4 males and 9 females with an average age of 47.5 years (range, 32-60 years). The injury was caused by fractures of the humeral medial condyle in 1 case, by long working in elbow flexion position with no obvious injury in 10 cases, and subluxafion of ulnar nerve in 2 cases. The locations were the left side in 6 cases and the right side in 7 cases. The disease duration was 4-30 months. The time from onset to operation was 3-20 months (mean, 8.5 months). Ten patients compl icated by intrinsic muscle atrophy. Results The operation was successfully performed in 13 cases, and the operation time was 45-60 minutes. All the wounds gained primary heal ing. All patients were followed up 12-18 months (mean, 14 months). The numbness of ring finger, l ittle finger, and the ulnar side of hand were decreased obviously on the first day after operation. The examination of electromyogram showed that the ulnar nerve conduction increased at 2 weeks, the ampl itude was improved, and recruitment of the intrinsic muscles of hand enhanced. In 10 cases compl icated by intrinsic muscle atrophy, myodynamia was recovered to the normal in 7 cases and was mostly recovered in 3 cases at 3 months after operation. The symptom of cubital tunnel syndrome disappeared and gained a normal function at 12 months after operation. According to the assessment of Chinese Medical Association and Lascar et al. grading criteria, the cl inical results were excellent in 10 cases and good in 3; the excellent and good rate was 100%. Patients recovered to work 12-16 days (mean, 14 days) after operation. No recurrence occurred during followup. Conclusion The surgical method of endoscope and microscope assisted three small incisions for treatment cubital tunnel syndrome has less invasion with small incision and complete decompression. Patients can recover to work early. It is a convenient and efficient procedure for treating cubital tunnel syndrome.
Objective To study the effect of surgical treatment of carpal tunnel syndrome (CTS) by endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament. Methods Between April 2003 and April 2008, 56 patients with CTS were treated with endoscopic carpal tunnel release through a transparent combined with dilation conductor. There were 8 males and 48 females with an average age of 50 years (range, 38-65 years). CTS was caused bywrist injury in 5 cases, by forearm fracture in 12 cases, and by wrist strain in 39 cases. The locations were left hand in 14 cases and right hand in 42 cases with a disease duration range of 2-7 years (4 years on average). According to Hamada classification of CTS, 38 cases were classified as stage I, 12 cases as stage II, and 6 cases as stage III. Results All cases achieved the primary heal ing of incision. All patients were followed up 14-68 months (40 months on average). According to Kelly’ s evaluation, the results were excellent in 25 cases, good in 22 cases, fair in 4 cases, and poor in 5 cases with an excellent and good rate of 83.93%. The distal motor latency of median nerve was (4.48 ± 0.50) ms at 1 months, (4.06 ± 0.35) ms at 3 months, (3.79 ± 0.25) ms at 6 months, and (3.42 ± 0.24) ms at 12 months after operation, showing significant differences when compared with the preoperative one [(5.09 ± 0.61) ms, P lt; 0.05]. There were significant differences among different time points after operation (P lt; 0.05). Conclusion The method of endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament is a simple and effective surgical procedure for treament of CTS, which can precisely cut the transverse carpal l igament and completely release the pressure of carpal tunnel.
OBJECTIVE: To investigate the therapeutic effect of subfascial endoscopic perforator vein surgery (SEPS) in treatment of varicose of the lower limb. METHODS: From 1999. 11 to 2000. 12, 108 patients with varicose of the lower limb underwent venous surgery and 34 of them were treated by SEPS. There were 16 males and 18 females aged 20-79(averaged 51.4 years). Thirty limbs (26 cases) had open ulcers and the diameter of ulcer was 1.5-12.0 cm. Eleven limbs (8 cases) had severe pigmentation and the skin changes had been presented for 1 month to 15 years. According to the severity of illness, flush saphenofemoral ligation, great saphenous vein stripping, percutaneous continuous venous circum suture, external femoral vein valve repair and SEPS were performed separately or simultaneously. RESULTS: Active ulcers healed in 19 limbs after 1 month, in 7 limbs after 3 months, and in the other 4 ulcers after skin transplantation. There was no ulcer recurrence during follow-up (ranged 9-22 months). CONCLUSION: SEPS can accelerate the healing of venous ulcers, and it is one of important methods in the treatment of chronic venous insufficiency.