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 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.
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.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.
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 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 evaluate the efficacy and safety of traditional Chinese medicine (TCM) in treating Chronic Rhinosinusitis (CRS) after Functional Endoscopic Sinus Surgery (FESS). Methods The following databases and periodicals such as PubMed (Jan. 1980 to Jan. 2009), MEDLINE (1980 to 2009), EBSCOhost (Jan. 1975 to Jan. 2009), CALIS (1984 to 2009), CNKI (1979 to 2007), VIP (1989 to 2009), CBM (1978 to 2009); Chinese Journal of Otorhinolaryngology Head and Neck Surgery (1990 to 2008), Journal of Clinical Otorhinolaryngology Head and Neck Surgery (1988 to 2008), Otorhinolaryngology Head and Neck Surgery (1990 to 2008), and Chinese Journal of Otorhinolaryngology of Integrated Traditional and Western Medicine (1996 to 2008) were searched by computer and handwork for randomized controlled trials (RCTs) about TCM to treat CRS after ESS. The trial screening, quality assessment, and the data extraction of the included trials were conducted before performing statistical analyses by using RevMan 4.2.10 software. Results A total of 32 RCTs in three sub-groups in Chinese literatures were identified with meta-analyses in comparisons of the cure rate (OR=1.99, 95%CI 1.78 to 2.23), total effective rate (OR=2.66, 95%CI 2.20 to 3.22), degree I postoperative improvement rate (OR=2.22, 95%CI 1.60 to 3.06), total postoperative improvement rate (OR=8.77, 95%CI 1.09 to 70.64), postoperative clean time (OR=2.54, 95%CI 1.70 to 3.79), postoperative epithelization time (OR= –29.46, 95%CI –37.73 to –21.18), and mucociliary transport rate (OR=1.14, 95%CI 0.22 to 2.06). A total of 4 RCTs were meta-analyzed to evaluate the safety in comparisons of gastrointestinal reaction (OR=0.25, 95%CI 0.00 to 33.78) and local reaction (OR=0.03, 95%CI 0.01 to 0.12). Conclusion The current evidence shows TCM in treating CRS after ESS tends to improve the clinical efficacy and reduce the cure time without obvious adverse reaction. Due to the low methodological quality of included trials, more RCTs with high quality and large scale are required.
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.
ObjectiveTo compare the disinfection effect of peracetic acid versus glutaraldehyde in disinfection of flexible endoscope, and provide suggestions for choosing endoscopic disinfectant.MethodsWe searched literatures in PubMed, Embase, Cochrane Central Library, China National Knowledge Infrastructure, Wanfang database and VIP database, with the retrieval time from the establishment of each database to July 2017, screening and comparing the disinfection qualification rate of peroxyacetic acid versus glutaraldehyde in immersion disinfection of flexible endoscope. The number of flexible endoscopies after disinfection was the main effect index, and a fixed effect model analysis was performed.ResultsSix comparative studies were enrolled in this Meta-analysis, with a total of 786 flexible endoscopes. The result of Meta-analysis showed that the qualification rate of disinfection of peracetic acid was higher than that of glutaraldehyde with the same disinfection time [relative risk=1.09, 95% confidence interval (1.06, 1.13), P<0.000 01].ConclusionThe disinfection effect of peroxyacetic acid immersion method is better than that of glutaraldehyde.
Objective To study the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) and early endoscopic management for acute biliary pancreatitis. Methods Ninety-one patients with acute biliary pancreatitis were divided into ERCP group (46 cases) and control group (45 cases) according to the therapy methods. All patients were given positive conventional treatment, the patients of the ERCP group accepted endoscopic therapy within 48 h after hospitalization. The curative effects of two groups were observed, and the related indexes, such as time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, average time in hospital, and mortality were compared between two groups. Results Among 46 patients by ERCP diagnosis, there were 27 cases of common duct stone (CDS), 6 cases of cholecystolithiasis, 3 cases of great diverticulum at duodenal papilla side, 4 cases of suppurative cholangitis, 3 cases of stenosis in bile common duct inferior segment and 3 cases of no abnormality. Among 27 cases of CDS, 20 patients had endoscopic sphincterotomy (EST), 4 had duodenal papilla artifistulation, 20 had calculus removed by once basket and aerocyst, and 7 patients with suppurative cholangitis and great stone saccepted EST or macadam after stabilization. The cases of great diverticulum at duodenal papilla side and cases of stenosis in bile common duct inferior segment accepted EST, the cases of suppurative cholangitis accepted endoscopic nasobiliary drainage (ENBD), and all accepted ENBD. The time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, and the average time in hospital in the ERCP group were significantly shorter than those in the control group (Plt;0.05). The blood amylase to normal time and mortality had no significant differences between two groups (Pgt;0.05). Conclusion The early endoscopic management for patients with acute biliary pancreatitis can clear etiology, reduce the time in hospital and be minimally invasive, safe, and effective.