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Application of HC video laryngoscope combined with fiberoptic bronchoscopy in tracheal intubation in patients with cervical spine immobilization

Hanmin SHAN ; Liang YU ; Hefen WU

China Journal of Endoscopy.2017;23(3):64-68. doi:10.3969/j.issn.1007-1989.2017.03.012

Objective To explore the application of HC video laryngoscope combined with fiberoptic bronchoscopy in tracheal intubation in patients with cervical spine immobilization.Methods 80 cases of cervical spine immobilization to surgery patients under general anesthesia were randomly divided into bronchoscopy group (F group), HC video laryngoscope composite fiber bronchoscope nasotracheal intubation group (H group), 40 cases in each group. Full of local anesthesia and intravenous anesthesia, spontaneous breathing, tracheal intubation. Recorded before induction (T0), immediately before intubation (T1), immediately after intubation (T2), 1 minutes after tracheal intubation (T3) mean arterial pressure (MAP), heart rate (HR) changes, record for the first time intubation success rate, intubation time of patients. The incidence of complications related to intubation operation.Results there were no significant differences between the two groups before and after tracheal intubation (T1) MAP and HR (t = 0.75,-0.51,P = 0.453, 0.611); After the two groups were intubated immediately (T2), MAP and HR than immediately before intubation (T1), the differences were statistically significant MAP (t = 5.08, 4.36,P = 0.021, 0.013) and HR (t = 7.22, 6.54,P = 0.026, 0.031), hemodynamics were maintained in the normal range, after intubation immediately (T2) between the two groups compared differences in MAP and HR had no statistical significance (t = -0.51, -0.31, P = 0.411, 0.518); There was no significant difference in HR and MAP between the two groups (t = 0.38, 0.26, P = 0.681, 0.372) in 1 min after intubation (T3). Patients with tracheal intubation success rate for the first time H group was obviously higher than that of group F, the difference was statistically significant (χ2 = 7.31,P = 0.007). The two group intubation time in H group was significantly less than that in F group, the difference was statistically significant (t = 5.75,P = 0.000). The incidence of sore throat in group F was significantly higher than H group, the difference was statistically significant (χ2 = 5.00,P = 0.025).Conclusions The patients with cervical spine immobilization of nasotracheal intubation, HC video laryngoscope combined with fiberoptic bronchoscopy, compared with the traditional fiberoptic intubation, intubation for the first time a higher success rate, shorter intubation time, no aggravation of hemodynamic lfuctuations, lower incidence of sore throats.

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Effect of LEEP knife combined with biopsy in patients with small invasive cervical cancer

Yang ZHANG ; Fang WANG

China Journal of Endoscopy.2017;23(3):69-73. doi:10.3969/j.issn.1007-1989.2017.03.013

Objective To explore the effect of the application of cervical loop electric knife (LEEP) in the patients with cervical micro invasive cancer.Methods Clinical data of 66 patients with minimal invasive carcinoma diagnosed by LEEP cone resection in our hospital from June 2013 to June were retrospectively analyzed. Preoperative and postoperative patients with LEEP were compared with 66 patients who underwent biopsy with biopsy, the diagnosis of micro invasive carcinoma was compared with LEEP cone resection.Results The results of colposcopy biopsy were detected in 2 cases of LSIL, 60 cases of HSIL and 1 cases of AIS, 3 cases were diagnosed as cervical microinvasive carcinoma or suspicious cervical microinvasive carcinoma, the sensitivity was 4.54%, the misdiagnosis rate was 95.46%; LEEP conization were detected in 1 cases of LSIL, 44 cases of HSIL and 1 cases of AIS, 20 cases negative margin. There was no significant difference in the thickness and area of the resected tissue between the three groups (P > 0.05). The depth of the resected tissue was significantly higher than that in the HSIL and AIS group, the HSIL and AIS groups were significantly higher than the LSIL group, the difference was statistically significant (P < 0.05). Interstitial infiltration depth is less than or equal to 1mm group, the 1 depth of stromal invasion than 3mm group and 3 < rate were 15.00%, 19.51% and 20.00% of the remaining lesion depth of stromal invasion than the patients in the 5mm group after operation, there was no statistically significant difference (P > 0.05). Cut edge positive group, positive margin group and interstitial fiber positive margin group of patients with postoperative residual disease rates were 25.00%, 15.38% and 23.80%, the difference was not statistically significant (P > 0.05).Conclusion The rate of missed diagnosis of small invasive cervical cancer is higher, and the diagnosis rate can be improved by the combination of LEEP and cone resection.

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Efficacy of sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy and the factors associated with the prognosis

Jianzhong SANG ; Hong ZHANG ; Jianbo ZHOU ; Qifeng SONG ; Xiaohui SUN ; Jian HUANG ; Yuyan SHI ; Qianqian YANG ; Sheng CAI

China Journal of Endoscopy.2017;23(3):56-63. doi:10.3969/j.issn.1007-1989.2017.03.011

Objective To explore the efficacy of sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy and the factors associated with the prognosis.Methods 106 cases with esophageal varices in control group was treated with drugs alone;study group had 113 cases, was given endoscopic therapy add drugs, The study group randomly divided into two groups, one was treated with endoscopic variceal ligation all the time (EVL group), another was treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy (sequential group). After the treatment, the rate of removal of varicose veins, the rate of rebleeding, the number of total treatment,mortality and intra-operative complications and postoperative complications were compared. And compared rebleeding rate and mortality with the control group and study groups with different CTP and MELD, analyze the factors of prognosis, and evaluate their prognostic value.Results Rebleeding, rate in control group, EVL group and sequential group were 41.51%,10.53% and 10.64%,sequential group was significantly better than control group (P = 0.000); mortality in control group, EVL group and sequential group were 15.09%, 5.26% and 2.13%, sequential group was also significantly better than control group (P = 0.001); rate of recurrence in EVL group and sequential group within half a year were 73.68% and 44.68%, sequential group was significantly better than EVL group (P = 0.021). In all control group and EVL group and the sequential group, rebleeding rate and mortality of the liver function Child-Turcotte-Pugh (CTP) class C was significantly higher than that of calss A; In MELD model, AUC area under the ROC curve of rebleeding rate in control group and sequential group were 0.944 and 0.851, mortality of the two groups were 0.881 and 0.984, while the rate of recurrence in the EVL group and sequential group were respectively 0.914 and 0.765, the MELD score has the important value to the prediction of rebleeding and death.Conclusion The rebleeding rate and mortality in cirrhotic patients with esophageal varices treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy were significantly decreased and the recurrence rate was lower than that of the patients with endoscopic variceal ligation all the time. Liver function Child-Turcotte-Pugh (CTP) score and the MELD score have important value in prediction of rebleeding and death, ligation and sclerosing sequential therapy can significantly reduced rebleeding and mortality in CTP class B and C, and improve the MELD threshold of rebleeding and death.

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Percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for lumbar disc herniation: a Meta-analysis

Huajun LING ; Lei FAN ; Maosong LAI ; Weiwen LIN ; Hao XIONG ; Penggang LUO ; Zengzhi WU ; Xiongchao XIA

China Journal of Endoscopy.2017;23(3):47-55. doi:10.3969/j.issn.1007-1989.2017.03.010

Objective To compare the curative effect of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in lumbar disc herniation.Methods A literature search was performed in PubMed, Web of Science, Embase, Wanfang, CNKI. Two authors reviewed all articles individually. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool, and the quality of retrospective studies was evaluated by the modified Newcastle-Ottawa scale. The data was extracted by the Review Manager 5.30.Results A total of 19 articles were brought into this Meta-analysis. The outcomes were divided into primary outcomes and secondary outcomes. Excerpt for the short-term VAS score was lower in PELD group (P = 0.010), other index, including long-term VAS score (P = 0.120), ODI score (P = 0.260), complication (P = 0.100) and recurrence (P = 0.100), didn't had significant difference in two groups. The blood loss (P = 0.000), hospital stay (P = 0.000) and the length of incision (P = 0.000) were all superiority in PELD group. Whereas the operative time was shorter in MED group (P = 0.001).Conclusion PELD was a more minimally invasive and secure technique in lumbar disc herniation.

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Effect of minimally invasive surgery on lymphadenectomy in patients with adenocarcinoma of esophagogastric junction

Pengcai FENG ; Jinyu YANG ; Mingjie TANG ; Xinsheng WANG

China Journal of Endoscopy.2017;23(3):42-46. doi:10.3969/j.issn.1007-1989.2017.03.009

Objective To investigate the effect of laparoscopic lymphadenectomy in patients with adenocarcinoma of esophagastric junction (AEG).Methods 105 patients with AEG underwent open or laparoscopic surgery from June 2014 to September 2015 were enrolled in the study and divided into minimally invasive group (n = 70) and laparotomy group (n = 35). The baseline data, lymphadenectomy result and perioperative data were compared between the two groups.Results Total number of splenic hilar lymph nodes dissection in minimally invasive group was significantly more than that in laparotomy group (P < 0.05). But there were no significant differences in the total number of lymph node dissection, number of positive lymph node dissection, positive rate of all node, number of positive splenic hilar lymph node dissection and positive ratef of splenic hilar lymph node between two groups (P > 0.05). Operation time, intraoperative blood loss, length of incision, positive proximal margins rate, thoracoabdominal resection rate and spleen resection rate in minimally invasive group were significantly lower than that in laparotomy group, esophagus resection length was significantly bigger than that in laparotomy group (P < 0.05). No death occurred postoperatively in all patients. The time of anus exsufflation, first intake liquid diet and postoperative ambulatory episode in minimally invasive group were significantly lower than that in laparotomy group (P < 0.05). There were no significant differences in the incidence of complications between two groups (P > 0.05).Conclusions Compared with open surgery, laparoscopic surgery is superior in splenic hilar lymph nodes dissection of AEG, with longer esophageal cutting distances, lower thoracoabdominal resection and spleen resection rate. It is safe and feasible, worthy of clinical promotion.

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Comparison of double-channel lfexible ureteroscopy and electronic lfexible ureteroscopy for lithotripsy

Tian LI ; Xun LI ; Yongzhong HE ; Minlong YANG ; Yufei YIN ; Ming SHENG ; Dehui LAI ; Weiqing YANG

China Journal of Endoscopy.2017;23(3):34-37. doi:10.3969/j.issn.1007-1989.2017.03.007

Objective To compare the efficiency and safety of double-channel flexible ureteroscopy and electronic flexible ureteroscopy.Methods From April 2007 to 2016 July, clinical data of 836 cases flexible ureteroscopic holmium laser lithotripsy were collected. All the patients were randomly divided into electronic lfexible ureteroscopy group (n = 427) and double-channel lfexible ureteroscopy group (n = 409), the operation time, success rate of surgery, complications, residual stone rate of the two groups were compared.Results The success rate of surgery was 92.5% and 83.6% of the two groups respectively, the difference was significant (P < 0.05); postoperative systemic inlfammatory response syndrome (SIRS) were occurred in 10 cases and 13 cases respectively, which were cured and the difference was not statistically significant (P > 0.05); the average operation time was (81.1 ± 7.9) min and (95.3 ± 7.6) min respectively, the difference was significant (P < 0.05); The formation of stone street of electronic lfexible ureteroscopy group and double-channel lfexible ureteroscopy group were 17 cases and 25 cases. The residual stone rate of electronic flexible ureteroscopy group and double-channel flexible ureteroscopy group were 6 cases and 8 cases, of them were cleared after extracorporeal shockwave lithotrips (ESWL). There were no difference between the two groups (P > 0.05).Conclusion Both double-channel lfexible ureteroscopy and electronic lfexible ureteroscopy are effective and safe therapeutic modalities. Electronic flexible ureteroscopy is better than double-channel lfexible ureteroscopy in success rate of surgery because of its high deifnition and lfexible operation.

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Comparison of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax

Guoyi SHEN ; Yi ZHANG ; Zhen HUANG ; Wenshan ZHANG

China Journal of Endoscopy.2017;23(3):30-33. doi:10.3969/j.issn.1007-1989.2017.03.006

Objective To compare the efficacy of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax.Method From January 2013 to December 2015, we retrospectively collected clinical data of 53 patients with spontaneous pneumothorax who were treated with uniportal VATS, as study group; compared with control group: 53 patients received single utility port VATS in the same period. The clinical data was compared between the two groups, including the operation time, intraoperative blood loss, drainage time, postoperative extubation time, postoperative pain score, postoperative hospitalization and recurrence.Results All patients were successfully completed the operation, no death and serious complications occurred. There were no significant differences in intraoperative blood lose, duration of chest drainage, duration of hospital stay and incidence of serious postoperative complications between two groups (P > 0.05). Mean Visual Analogic Scale (VAS) score for 24 h post-operative pain was: (2.60 ± 0.71) for uniportal VATS and (3.38 ± 0.84) for single utility port VATS (P > 0.05), 72 h post-operative pain was: (1.30 ± 0.51) for uniportal VATS and (1.58 ± 0.62) for single utility port VATS (P > 0.05). Follow up 5 ~ 36 months, median follow up was 19 months. No recurrence occurred during follow up.Conclusions The study suggested that both surgical approaches to spontaneous pneumothorax are safe and effective. Significant differences were found for early post-operative pain between the two approaches, the uniportal way is better. It is worthy of clinical promoting.

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Sphincter Oddi manometry and endoscopic sphincterotomy in diagnosis and treatment of patients with sphincter of Oddi dysfunction

Ting LI ; Qiang GUO ; Hong FAN ; Xiaodan TANG

China Journal of Endoscopy.2017;23(3):25-29. doi:10.3969/j.issn.1007-1989.2017.03.005

Abstact: Objective To investigate the diagnostic value of endoscopic sphineter Oddi manometry (SOM) in patients with recurring abdominal pain and observe the value of endoscopic sphincterotomy (EST) in treatment of patients with sphincter of Oddi dysfunction (SOD).MethodsClinical data of 30 patients with chronic abdominal pain after cholecystectomy who were suspected SOD from 2012 October to 2014 September were collected and retrospectively analyzed. These patients received SOM in ERCP examination and the observation of Oddi sphincter basal pressure, contraction amplitude, frequency and mode of transmission were carried out. The EST were carried out in patients with basal pressure of Oddi sphincter higher than 40.0 mmHg or higher than 30.0 mmHg, and the presence of serum amylase, lipase, ALT, AST, AKP increased more than 2 times of the normal value and (or) of common bile duct, pancreatic duct widening.ResultThe SOM of all the 30 patients were all abnormal. The basal pressure of Oddi sphincter, the contraction amplitude, the contraction frequency and the reverse shrinkage were (36.6 ± 21.1) mmHg, (210.6 ± 25.7) mmHg, (10.1 ± 3.1) times/min and (55.0 ± 8.0)%. All the patients were treated with EST, of which 27 cases (90.0%) received good results.Conclusion SOM is helpful in evaluation of Oddisphincter function, it is of great value in diagnosis of SOD. EST treatment obtained satisfactory effect in patients with elevated basal pressure of Oddi sphincter.

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Clinical observation of oxycodone hydrochloride injection successive subtraction method background infusion for postoperative analgesia in patients of lobectomy under thoracoscope

Junfeng LIAO ; Wenlong TU ; Na YANG ; Zhijian LAN ; Wenyong PENG ; Jun XU

China Journal of Endoscopy.2017;23(3):14-19. doi:10.3969/j.issn.1007-1989.2017.03.003

Objective To observe the analgesia effect of oxycodone hydrochloride injection successive subtraction method background infusion on postoperative analgesia in patients of lobectomy under thoracoscope.Methods Ninety lobectomy under thoracoscope patients, using the random number table method patients were randomly divided into three groups:sufentanil group (group S), the constant speed oxycodone infusion group (Q1) and the decreasing background infusion oxycodone group (Q2), 30 cases in each group. On the time of 10 minutes before the end of surgery, S group was given sufentanil 0.10 μg/kg, Q1 and Q2 group was given oxycodone 0.10 mg/kg, each patient was given intravenous patient-controlled analgesia (PCIA), the group of S set electronic pump sufentanil 2.00 μg/kg (100 ml), background infusion was 0.03 μg/(kg·h), PCA dose was 0.015 μg/kg; The group of Q1 was oxycodone 1.00 mg/kg (100 ml), background dose of 15.00 μg/(kg·h), PCA dose of 15.0 μg/kg; The group of Q2 also was oxycodone 1.00 mg/kg (100 ml), on the first 12 h after operation, the background infusion was 15.00 μg/(kg·h), every 12 h later, the background infusion decreased by 20%, PCA dose was 15.00 μg/kg, all of the pump locking time was 10 minutes, lock 4 times per hour. Recorded the number of hemodynamic on the end of operation, immediate extubation and extubation after 5 minutes. On the time of postoperative 2 h, 8 h, 12 h, 24 h, 48 h, recorded the scores of NRS?, NRS (M), Ramsay. Recorded the times of PCA compression,times of medicaments remedies,the amount of drug use, adverse reactions such as respiratory depression, nausea, vomiting, itching and satisfaction of patients to postoperative analgesia.Results The MAP and HR of three groups of patients were increased in the time of tube drawing (P < 0.05), there was no significantly difference in MAP and HR among the three groups at the end of operation, immediate extubation and after 5 minutes of extubation (P > 0.05). The score of NRS ? in the groups of Q1 and Q2 was lower than group S at the time of (T3~5) (P < 0.05), the score of NRS (M) in the groups of Q1 and Q2 was lower than group S at the time of (T3~6) also. The Ramsay score of Q1 and Q2 group was higher than the group S in the point (T3~7). Which the times of PCA and remedial drug use, sleep disturbed times in the first day and second day of group Q1 and Q2 was lower than the group S (P < 0.05). The volume of drug use at 48 h in the group of Q2 was lower than the group Q1 and S (P < 0.05). Postoperative nausea and vomiting of group Q2 was lowered than group S (P < 0.05). The satisfaction of Patients to postoperative analgesia in the group Q2 and Q1 was higher than group S (P < 0.05).Conclusion Lobectomy under thoracoscope patients with postoperative application of successive subtraction method background infusion oxycodone can obtain satisfactory analgesia effect with a smooth anesthesia recovery period, satisfied analgesic effect, reduce the dosage of drugs and reduce the adverse reaction.

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Applications of syphon system in transurethal resection of prostate

Hongping TAO ; Weiping ZHAO ; Yangjing ZHU ; Shicheng YU ; Zhiqiang CHEN ; Dongyou ZHANG ; Yueping WANG

China Journal of Endoscopy.2017;23(3):1-8. doi:10.3969/j.issn.1007-1989.2017.03.001

Objective To explore the availability and safety of conducting low-pressure TURP assisted by a home-made cystometry and warning system.Methods 167 benign prostatic hyperplasia (BPH) patients admitted from Jan 2014 to Jan 2016 were randomly assigned into cystostomy group (group A) and non-cystostomy group (group B). In group A (n = 85), 42 patients (group A1) were performed percutaneous cystostomy + TURP, and 43 (group A2) were performed continuous flushing sheath TURP. In group B (n = 82), 42 patients (group B1) were received percutaneous cystostomy + TURP, and 40 (group B2) were received continuous lfushing sheath TURP. In group A, bladder pressure was monitored in real time with a cystometry and was monitored by bladder puncture using a home-made siphon, ensuring low bladder pressure throughout TURP. Serum Na+ levels were measured before and after operation in all four groups. The operation time, the intraoperative bleeding, the weight of resected prostates and the time before which urine turned clear were recorded. The IPSS, maximum lfow rate (Qmax), postvoid residual volume (PVR) and life quality score (QOL) were evaluated.Results While no significant differences were found between group A1 and A2, there were significant differences between group B1 and B2, indicating cystostomy group was safer than non-cystostomy group. When compared group A1 with B1, or group A2 with B2, it showed that the safe operation time to perform prostate tissue resection was longer in cystostomy group; the weight of the resected prostates was heavier; the time before which urine turned clear were shorter; and the IPSS improvement was better. These findings presented better therapeutic effects in cystostomy group than in non-cystostomy group.Conclusions This home-made cystometry and warning system could timely detect high bladder pressure state during TURP, making it possible to avoid of high pressure, ensuring low bladder pressure lfushing during the operation, lengthening the safe operation time, increasing tissue resection ratio, reducing transurethral resection syndrome, thus helping TURP to be safer.

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