目的 研究脊柱经皮内镜椎间孔入路和椎板间入路治疗腰椎间盘突出的临床应用效果。方法 本次选取的研究对象为2016年1月—2017年12月期间在我院进行治疗的腰椎间盘突出患者,将60例患者根据红蓝球分组法分为两组,30例/组。将实施脊柱经皮内镜椎间孔入路椎间盘切除术的患者纳入PETD组,将采用椎板间入路椎间盘切除术的患者设为PEID组。将两组腰椎间盘突出患者的手术相关指标、治疗优良率、ODI评分、VAS评分进行比对。结果 观察组腰椎间盘突出患者的手术时间、C型臂透视次数同对照组相比存在差异(P＜0.05);术后卧床时间和住院时间、治疗优良率组间对比无统计学意义;两组术后三个月时的ODI评分、VAS评分均较术前更优(P<0.05)。结论 在腰椎间盘突出治疗中脊柱经皮内镜椎间孔入路、椎板间入路的效果相当,临床上需患者的实际情况和解剖特点选择适合的入路方式和手术方法。

目的 探讨神经导航辅助神经内镜经鼻蝶入路切除垂体瘤的疗效。方法 将2014年10月—2018年4月我院接诊的20例垂体瘤患者纳入本研究,按照随机数字表法均分为观察组和对照组各10例,对照组患者行常规神经内镜下经鼻蝶入路垂体瘤切除术,观察组患者行神经导航辅助神经内镜下经鼻蝶入路垂体瘤切除术,比较两组患者手术及术后住院情况(包括手术时间、术中出血量及术后住院时间)、手术效果(包括显效率和总有效率)、手术前后血清内分泌指标变化情况(包括GH、PRL水平)以及术后并发症情况(即术后并发症发生率)。结果 观察组患者手术时间、术中出血量及术后住院时间均低于对照组,差异有统计学意义(P＜0.05);观察组显效率和总有效率均略高于对照组,但两组间手术效果并差异无统计学意义(P＞0.05);观察组患者治疗后血清生长激素(GH)、催乳素(PRL)水平均低于对照组,差异有统计学意义(P＜0.05);两组患者术后并发症发生率无统计学差异。结论 神经导航辅助神经内镜经鼻蝶入路切除垂体瘤疗效显著,手术时间短、术中出血少、术后恢复快,可明显改善患者内分泌指标,值得临床推荐。

Objective To evaluate the efficacy of resection for pituitary tumors through transsphenoidal approach with endoscopic neuronavigation assisted. Methods From October 2014 to April 2018, 10 patients with pituitary tumor were operated in our hospital with neuronavigation, which were set as the observation group. Meanwhile, 10 patients with pituitary tumor underwent surgical treating through transsphenoidal approach without neuronavigation were set as the control group. SPSS 19.0 were used for statistical analysis to compare the difference between the two groups, including the operation time, blood loss, hospitalization time, hormone level, clinical total efficiency, and complications in the two groups. Results The operation time, blood loss and hospitalization time of the observation group were less than that of the control group, and there was statistical significance (P<0.05). The efficiency rate and overall efficiency rate of the observation group were a little more than that of the control group, but there was no statistical significance (P＞0.05). The level of growth hormone (GH) and prolactin (PRL) of the observation group were less than that of the control group, and there was statistical significance (P<0.05). And there was no statistical significance between the incidence rate of postoperative complications of the two groups. Conclusion The efficacy of resection for pituitary tumors through transsphenoidal approach with endoscopic neuronavigation is significant, which may shorten the course, reduce the blood loss, quicken recovery of a patient from operation, and improve the hormone level. It is worthy to be recommended to clinical application.

目的 比较分析神经内镜和常规开颅手术在治疗高血压脑出血时的优劣。方法 回顾性分析我院神经外科2015年12月1日—2017年12月31日收治的60例高血压脑出血患者,根据治疗术式的不同,分为对照组和观察组,各30例。对照组行常规开颅手术,观察组给予神经内镜治疗,通过对比两组患者的手术时长、术中出血量、血肿清除率、住院时间、术后并发症及术后6个月随访效果,分析两组优劣。结果 观察组手术时长短于对照组,差异有统计学意义（P<0.05）;观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组血肿清除率高于对照组,差异有统计学意义（P<0.05）;观察组术后并发症（颅内感染、肺部感染）发生率低于对照组,差异有统计学意义（P<0.05）,而两组再次出血及死亡率差异均有统计学意义（P>0.05）;观察组患者术后预后效果优于对照组,差异有统计学意义（P<0.05）。结论 神经内镜在治疗高血压脑出血时对比常规开颅手术具有显著缩短手术时长及住院时间,提高血肿清除率,减少术中出血,降低颅内及肺部感染率等优势,值得临床推广应用。

Objective To compare and analyze the advantages and disadvantages of neuroendoscopy and conventional craniotomy in the treatment of hypertensive intracerebral hemorrhage. Methods 60 patients with hypertensive intracerebral hemorrhage admitted to our hospital from December 1,2015 to December 31,2017 were divided into the control group and the observation group,each with 30 cases. The control group underwent conventional craniotomy,and the observation group underwent neuroendoscopic treatment. The length of operation,intraoperative blood loss,hematoma clearance,length of hospital stay,postoperative complications,and follow-up after 6 months were compared between the two groups, to analysis the advantages and disadvantages of both groups. Results The duration of operation in the observation group was shorter than that in the control group （P<0.05）. The intraoperative blood loss in the observation group was less than that in the control group （P<0.05）;The hematoma clearance rate in the observation group was higher than that in the control group （P<0.05）;The incidence of postoperative complications （intracranial infection,lung infection） in the observation group was lower than that of the control group （P<0.05）. There was no statistically significant in rebleeding and mortality between the two groups （P>0.05）. The prognosis of the observation group was better than that of the control group. In the control group,the difference was statistically significant （P<0.05）. Conclusion Neuroendoscope in the treatment of hypertensive intracerebral hemorrhage compared with conventional craniotomy may shorten the length of operation and hospital stay,improve hematoma clearance rate,reduce intraoperative bleeding,reduce intracranial and pulmonary infection and other advantages. It is worthy of clinical promotion and application.

目的 研究鼻内镜下三线减张矫正术治疗鼻中隔偏曲的疗效及安全性。方法 纳入2010年9月—2015年9月我院120例鼻中隔偏曲患者作为研究对象,采用随机数表法分为两组,各60例。观察组行鼻内镜下三线减张鼻中隔偏曲矫正术,对照组行鼻内镜下传统鼻中隔黏膜下切除术。比较两种手术方法对患者鼻塞、头痛、鼻出血等临床症状的改善情况,随访记录两组术后疼痛、鼻阻力及并发症发生情况,评价疗效和安全性。结果 观察组术后鼻塞、头痛及鼻出血症状评分分别为(1.05±0.16)分、(1.3±0.14)分及(1.63±0.14)分,均显著低于对照组和术前水平(P＜0.05)。观察组术后1周、2周及4周各时间点VAS评分和鼻阻力值均显著低于对照组(P＜0.05)。观察组术后鼻中隔血肿和黏膜撕裂发生率均为1.67%,无鼻中隔穿孔和外形改变病例,发生率显著低于对照组,差异有统计学意义(P＜0.05)。结论 鼻内镜下三线减张矫正术能显著改善鼻中隔偏曲患者鼻塞、头痛及鼻出血症状,促进鼻腔通气功能恢复,有效降低术后并发症发生率,安全性高。

自奥津一郎于1987年首次报道内镜辅助下行腕管松解术以来,腕管综合征的内镜治疗术式得到大量创新、改良。现本文就各种内镜术式优劣势做一概述。

目的 了解消化性溃疡发病特点,分析溃疡在秋冬和冬春之交发病情况的差异。方法 对我院10年胃镜检查结果进行统计分析。结果 共检出消化性溃疡8592例,其中十二指肠溃疡6875例,胃溃疡1121例,复合性溃疡596例,三者的检出率分别为12.72%、2.07%和1.10%,十二指肠溃疡明显多于胃溃疡,两者之比为6.13∶1。季节上,十二指肠溃疡与胃溃疡的检出率在秋冬之交高于春冬之交,十二指肠溃疡的检出率在春冬季高于夏秋季,复合性溃疡在冬季高发,秋季最低。胃溃疡好发于胃窦,其次是胃角;十二指肠球部溃疡的好发部位依次为前壁、大弯、小弯、后壁。十二指肠溃疡、胃溃疡和复合性溃疡的高发年龄段为30~39岁、40~49岁和 40~59岁。结论 十二指肠溃疡明显多于胃溃疡,十二指肠溃疡与胃溃疡的检出率在秋冬之交高于春冬之交。消化性溃疡的发病在性别、年龄、季节等方面上具有明显差异。

Objective To explore the features of peptic ulcer disease, and analyze difference of incidence in difference months. Methods Gastroscopy results were collected and analyzed in our hospital. Results A total of 8592 cases of peptic ulcer were collected, including 6875 cases of duodenal ulcer, 1121 cases of gastric ulcer and 596 cases of compound ulcer, the detection rate were 12.72%, 2.07% and 1.10% respectively. Duodenal ulcer presented significantly more than gastric ulcer, the ratio was 6.13∶1. As to season changed, the detection rate of duodenal ulcer and gastric ulcer in the months when autumn turns winter were higher than in the months when winter turns spring. The detection rate of duodenal ulcers in winter and spring were higher than summer and autumn. Compound ulcer had highest incidence in winter and lowest in autumn. As to predilection site, gastric ulcer was mainly in gastric antrum, followed by gastric angle, duodenal ulcer was mainly in anterior wall. The peak age of duodenal ulcer, gastric ulcer and compound ulcer were 30~39, 40~49, and 40~59 years old. Conclusion Duodenal ulcer was remarked more than gastric ulcer. The detection rate of duodenal ulcer and gastric ulcer in the months when autumn turns winter was high than in the months when winter turns spring. The incidence of peptic ulcer has obvious differences in gender, age, season, etc.

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.

目的 回顾性分析采用内镜下氩离子凝固术治疗胃出血的治疗效果,为临床治疗胃出血提供经验及理论基础。方法 选取2010年1月—2014年7月我院收治的胃出血患者199例,随机分为两组,分别对其进行内镜下氩离子凝固术治疗和内镜下高频电凝治疗,总结对比其治疗效果,并对其并发症情况进行统计。结果 经治疗后,A组28例胃黏膜溃烂出血患者未再出血27例(96.43%),E组22例胃黏膜溃烂出血患者未再出血例数17例(77.27%),差异有统计学意义(P<0.05);A组治疗后形成局部炎性肉芽肿及发生胃穿孔的百分比低于E组,差异有统计学意义(P<0.05)。结论 采用内镜下氩离子凝固术治疗胃出血,止血率高,并发症发生率低,效果良好,值得在临床中推广使用。

Objective A retrospective analysis was performed using endoscopic argon plasma coagulation treatment of stomach bleeding, to provide experience and theoretical basis for the clinical treatment of stomach bleeding. Methods January 2010-July 2014 199 cases of bleeding in patients admitted to our hospital.They were randomly divided into two groups and had therapeutic endoscopic argon plasma coagulation. We summarized the treatment effect and its complications statistics. Results After therapy, 27 gastric mucosa fester patients(96.43%) of 28 patients in group A stopped bleeding and 17 gastric mucosa fester patients(77.27%) of 22 patients in group B stopped bleeding and the difference is statistical significance(P<0.05), and the incidence rate of inflammatory granuloma and gastric perforation of group A is significant lower than that of group B (P<0.05). Conclusion Endoscopic argon plasma coagulation therapy is taken to treat gastrorrhagia, hemostasis rate is higher and complication rate is lower. It is worth widely using in the clinic.

       目的   分析早期结直肠癌内镜下治疗前行窄带成像结合放大内镜 （ME-NBI）和超声内镜技术的评估价值。方法   采用回顾性分析方法，以2021年1月— 2023 年 12月中山市第五人民医院收治的102例早期结直肠癌患者为观察对象，所有患者均接受内镜下黏膜切除术（EMR）或内镜黏膜下剥离术（ESD）治疗，根据内镜下治疗前是否进行ME-NBI和超声内镜检查分为研究组与对照组各51例。比较两组年龄、性别、肿瘤大小、直乙结肠占比及组织病理特征；比较两组治疗时间、ESD治疗后非治愈性切除发生率、治愈性切除率、并发症发生情况及再次ESD或外科手术治疗率。结果   两组年龄、性别、肿瘤大小、直乙结肠占比及组织病理比较差异均无统计学意义（P＞0.05）。研究组中37例行ESD治疗，治疗时间为（120.6±140.3）min，12例行EMR治疗，治疗时间为（11.6±9.3）min，有2例不符合内镜下治疗指征，转外科手术治疗。对照组有38例行ESD治疗，治疗时间为（128.8±144.5）min，13例行EMR治疗，治疗时间为（12.5±9.5）min，两者治疗时间比较差异均无统计学意义（P＞0.05）。研究组非治愈性切除率为7.84，低于对照组27.45；治愈性切除率为88.24，高于对照组72.55；研究组ESD手术并发症为8.11%，低于对照组31.58；ESD或外科手术率为6.12，低于对照组25.49（P＜0.05），结论  ME-NBI和超声内镜对早期结直肠癌患者行内镜下治疗指征评估更准确，可提高治愈性切除率。

       Objective  To  study the application value of magnifying endoscopy combined with  narrow  band imaging （ME-NBI）and ultrasonic endoscopy system before endoscopic treatment in patients with early colorectal cancer．Methods  A retrospective analysis was carried out on  102  patients with early-stage colorectal cancer who were admitted to Zhongshan Fifth People’s Hospital from January 2021 to December 2023．All patients were treated with endoscopic mucosal resection（EMR）or endoscopic submucosal dissection（ESO）．The patients were divided into study group（51 cases）and control group（51 cases）according to whether ME-NBI and ultrasonic endoscopy was performed before endoscopic treatment or not．The patient age，sex，volume of tumor，location of tumor and pathological result of the tumor were compared between two groups．Time for treatment，curative resection rate，non-curative resection rate and the complication incidence of ESD，incidences of second ESD or surgery were compared between the two groups．Results  There were no statistical differences in age，sex，volume of tumor，location of tumor and pathological result of the tumor（P＞0.05）．In the study group，37 patients received ESD treatment，operation time was（120.6±140.3）minutes，and 12 patients received EMR treatment，operation time was（11.6±9.3）minutes，two cases were transferred to surgery due to endoscopic ultrasonography combined with magnifying endoscopy showed that they did not meet the indications for ESD treatment．In the control group，38 patients received ESD treatment，operation time was（128.8±144.5）minutes，13 patients received EMR treatment，operation time was（12.5±9.5）minutes．There was no significant difference in treatment duration between the two groups．The non-curative resection rate of the study group was 7.84%，which was significantly lower than that in the control group（27.45%），and the curative resection rate（88.24%）was significantly higher than that in the control group（72.55%）．The complications of ESD surgery in the study group were 8.11%，lower than 31.58% in the control group．The rate of second ESD or surgery was 6.12%，lower than 25.49% in the control group（P＜0.05）．Conclusions  ME-NBI and endoscopic ultrasound are more accurate in the evaluation of endoscopic indications for early colorectal cancer patients，and can improve the curative resection rate．

       目的     探讨内镜下黏膜切除术患者肠道准备教育程序的优化方法及改善效果。方法    选择2022年12月—2023年12月广州市中西医结合医院接收的内镜下黏膜切除术患者180例进行研究，电脑随机编号按奇偶数分为两组各90例，对照组采取常规肠道准备教育工作，观察组实施基于优化的教育程序展开教育工作，比较两组依从性、肠道准备质量、满意度、不适症状发生情况。结果    观察组饮食依从率96.88%、服药依从率98.44%、运动依从率93.75%，均高于对照组的78.13%、79.69%、71.88%（χ ² 分别为6.172、7.745、7.120，P分别为0.012、0.005、0.007）。观察组左侧、横结肠、右侧等评分及肠道准备质量总分高于对照组（t分别为7.175、6.442、5.971、8.234，均P＜0.001）。观察组肠道准备满意度为98.89%，高于对照组的88.89%（χ ² =7.842，P=0.005）。观察组恶心11.11%、呕吐4.44%、腹胀5.56%、腹痛0.00%，低于对照组的22.22%、13.33%、14.44%、6.67%（χ ² 分别为4.000、4.390、3.950、4.310，P分别为0.045、0.036、0.046、0.037）。结论    对内镜下黏膜切除术患者实施基于优化的教育程序展开肠道准备教育工作可提高患者肠道准备依从性，保证良好的肠道准备质量和肠道清洁度，提高患者的满意度，有助减少肠道不适症状。

       Objective  To explore the optimization method and improvement effect of bowel preparation education program in patients undergoing endoscopic mucosal resection．Methods  A total of 180 patients with endoscopic mucosal resection admitted to the hospital from December 2022 to December 2023 were selected for the study．They were randomly divided into two groups with 90 cases in each group．The control group was given routine bowel preparation education，and the observation group was given education based on optimized education procedures．The compliance，quality of bowel preparation，satisfaction and discomfort symptoms were compared between the two groups．Results  The diet compliance rate 96.88%，medication compliance rate 98.44%，exercise compliance rate 93.75% in the observation group were significantly higher than 78.13%，79.69%，71.88% in the control group（χ ² =6.172，7.745，7.120，P=0.012，0.005，0.007）．The scores of left colon，transverse colon and  right colon and the total score of bowel preparation quality in the observation group were significantly higher than those in the control group（t=7.175，6.442，5.971，8.234，all P＜0.001）．The satisfaction of bowel preparation in the observation group（98.89%）was significantly higher than that in the control group（88.89%）（χ ² =7.842，P=0.005）．Nausea 11.11%，vomiting 4.44%，abdominal distension 5.56%，abdominal pain 0.00% in the observation group were significantly lower than 22.22%，13.33%，14.44%，6.67% in the control group（χ ² =4.000，4.390，3.950，4.310，P=0.045，0.036，0.046，0.037）．Conclusions  The implementation of bowel preparation education based on optimized education program in patients undergoing endoscopic mucosal  resection can improve the compliance of bowel preparation，ensure good quality of bowel preparation and bowel cleanliness，improve patient satisfaction，and reduce the occurrence of intestinal discomfort symptoms，which is worthy of promotion．