目的 探讨经肛门内镜显微手术(TEM)治疗直肠肿瘤的疗效。方法 回顾性分析2009年1~12月期间我院行TEM治疗7例直肠腺瘤患者的临床资料。结果 7例直肠肿瘤均获完整切除，切缘均阴性。手术时间55～240 min，平均110 min; 术中出血量5～100 ml,平均45 ml。术后病理诊断: 直肠绒毛状腺瘤4例，绒毛管状腺瘤2例，直肠腺癌1例。手术并发症: 术中直肠穿孔1例，肺部感染1例，尿潴留1例。 7例随访6~13个月,平均8个月，肿瘤无复发。结论 TEM治疗直肠肿瘤安全、有效。
近年胰腺癌的发病率明显增加，过去10年，美国及欧洲的发病率已达到8/10万～12/10万，我国与其相近似。胰腺癌的治疗效果至今却难以令人满意，5年生存率无显著提高。主要的原因是由于胰腺的位置深在，胰腺癌又缺乏特异性的临床表现，早期诊断非常困难，大多数患者到医院就诊时已属于Ⅱ、Ⅲ、Ⅳ期肿瘤。治愈的唯一可能性是肿瘤的外科切除，但根治性手术切除率仅为18.6%，5年生存率在0～24%。未治疗者中位生存期为6～8个月。目前，随着影像学技术、内窥镜和腹腔镜超声等多项检查手段的应用与普及，对胰腺癌能否切除可以做出较准确的术前评估，这对合理地选择治疗方法，提高手术切除率，避免不必要的“开腹探查”有着重要的意义。
目的探讨经脐单孔腹腔镜联合胃镜治疗微小胃间质瘤(gastric stromal tumors, GIST)的可行性和临床疗效。 方法回顾性分析我院2010年10月至2011年5月期间行经脐单孔腹腔镜联合胃镜治疗微小GIST 30例患者的临床资料。 结果30例病灶直径（1.0±0.2） cm（0.5～2.0 cm），术后病理检查均证实为极低危险程度GIST。 24例在单孔腹腔镜辅助下成功完成内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）； 3例因ESD术中发生胃壁穿孔而改行内镜全层切除术（endoscopic full-thickness resection, EFR），其中2例继续在单孔下完成穿孔修补术，1例于左上腹壁另加一 Trocar，在双孔下完成穿孔修补术； 另3例因ESD剥离瘤体困难，改行胃局部切除术，其中2例继续在单孔下完成手术，1例在双孔下完成手术。 ESD成功率为80.0%（24／30），经脐部单孔完成率为93.3%（28/30）。手术时间（87.5±10.3） min （45～150 min）。 全组术后（4.3±0.5） d （3～8 d）出院。术后随访期3～7个月（平均4.6个月），均无病变复发。 结论经脐部单孔腹腔镜联合胃镜治疗微小GIST是安全可行的，早期疗效令人满意。
Objective To summarize the research progress of magnetic-controlled capsule endoscopy (MCCE) in application for gastric diseases. Method By searching the literatures in domestic and foreign database, the latest literatures on the application of MCCE for gastric diseases were reviewed. Results Compared with traditional gastroscopy, the diagnostic accuracy of MCCE was comparable to that of traditional gastroscopy, and there was no serious complications had been reported in use of MCCE. In addition, MCCE had advantages of comfort, safety, and prevention of cross-infection. However, it could not be used for biopsy and treatment. With the constant technical innovation, application of MCCE would be more extensive in future. Conclusions The diagnostic accuracy of MCCE in gastric diseases is high. Compared with traditional gastroscopy, it has more advantages. The shortcomings of MCCE can be improved with the development of science and technology, and it can be used for the initial screening of gastric diseases.
目的探讨腹腔镜胆总管探查(LCBDE)取石与内镜(ERCP、EST)胆总管取石的适用范围，以及中西医结合治疗胆总管结石的疗效。方法25例胆囊结石合并胆总管结石患者，其中23例行腹腔镜胆囊切除(LC)+LCBDE，2例因高龄、胆总管直径lt;1.0 cm并伴有高血压和糖尿病不能耐受长时间手术而先选择ERCP+EST，后择期行LC。8例胆囊结石合并胆总管结石伴胆源性胰腺炎患者先行ERCP+EST，其中3例EST取石失败而行LC+LCBDE。4例胆囊结石合并胆总管结石伴急性化脓性胆管炎患者先在内镜下置鼻胆管引流，病情稳定后行LC+LCBDE。4例单纯胆总管结石患者行ERCP+EST。手术按常规方法进行。术后均给予口服中药。结果30例行LC+LCBDE患者，均获得治愈，术后无胆管残留结石。14例行ERCP+EST治疗胆总管结石患者中11例EST取石成功，3例失败后行LC+LCBDE。41例患者均获得治愈。平均随访6个月，无胆管结石复发、胆管狭窄及其他并发症发生。结论LCBDE和EST治疗胆总管结石微创、安全、有效，同时结合中药治疗，有利患者术后恢复。LCBDE较内镜胆总管取石成功率高，其与选择病例和严格掌握各自适应证有关。
Objective To compare proton pump inhibitors (PPI) and H2 receptor antagonists (H2RA) for both the prevention of bleeding and the healing of ulcer after endoscopic submucosal dissection (ESD), so as to provide best evidence for treating ESD-induced ulcer in clinic. Methods Databases including PubMed, CENTRAL, EMbase, ISI Web of Knowledge, VIP, CNKI, CBM and WanFang Data were searched from the date of their establishment to October 26, 2012 to collect the randomized controlled trials (RCTs) about comparison of PPI and H2RA on the prevention of bleeding and the healing of ulcer after ESD. Meanwhile the references of the included studies were also retrieved manually. According to the inclusion and exclusion criteria, literature selection, data extraction and quality assessment were performed by four reviewers independently, and meta-analysis was performed using RevMan 5.1 software. Results A total of 6 studies involving 616 patients were included finally. The results of meta-analysis showed that: for the prevention of ulcer bleeding after ESD, PPI preceded H2RA apparently (OR=0.51, 95%CI 0.29 to 0.89, P=0.02), especially when the treatment course was 8-week (OR=0.43, 95%CI 0.22 to 0.82, P=0.01); but among the merged, 8-week and 4-week groups, there were no significant differences between PPI and H2RA in the healing of ESD-induced ulcer (OR=0.85, 95%CI 0.39 to 1.86, P=0.69; OR=1.33, 95%CI 0.28 to 6.27, P=0.72; OR=0.75, 95%CI 0.31 to 1.79, P=0.52). Conclusion PPI is superior to H2RA for the prevention of ulcer bleeding induced by ESD, but there is no significant difference between them in the healing of ulcer, so PPI is recommended to prevent ESD-induced ulcer bleeding in clinic. Due to the limitation of quantity and quality of the included studies, the safety of PPI has to be further proved by conducting more high quality, large scale and multicenter RCTs.
Objective To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS). Methods The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L2, 3 and L3, 4 in 2 cases, L3, 4 and L4, 5 in 29 cases, L4, 5 and L5, S1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated. Results All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation (P<0.05), while the LLA was not significantly different from that before operation (P=0.050). The CAC significantly improved (P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant (P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%. ConclusionUBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.