Endoscope Research Articles

Results of a screening program on high incidence area of esophageal cancer in Yanting Sichuan from 2006 to 2011

To study the prevalence of esophageal cancer and various lesions of esophagus in high risk areas through a screening program for early diagnosis and treatment. Random cluster sampling method was used to select some portions of a natural village as screening object in the high risk areas of esophageal cancer, from 2006 to 2011. Endoscope iodine staining and index biopsy screening methods were used on people with high risk and followed by pathological exams for confirmation. The detection rates regarding mild esophageal hyperplasia, moderate and severe esophageal hyperplasia were 5.33% (803/15 065), 1.28% (193/15 065), 0.68% (102/15 065) respectively while the detection rates on carcinoma in situ, intramucosal carcinoma and invasive cancer were 0.15% (22/15 065), 0.06% (9/15 065), 0.29% (43/15 065) respectively. The detection rate in male esophageal hyperplasia was higher than in female. People younger than 65 years old, the detection rates on mild, moderate or severe esophageal hyperplasia and invasive cancer showed an increase with age, with the 60-year-olds group reaching the highest. The detection rates on the above said diseases were 7.72% (198/2565), 2.07% (53/2565), 1.29% (33/2565), 0.51% (13/2565) respectively. The detection rates on mild, moderate or severe esophageal hyperplasia varied in different years and with statistically significant differences (P < 0.001) but did not show any obvious trend of changing. Geographical distribution of mild esophageal hyperplasia, moderate esophageal hyperplasia, severe esophageal hyperplasia also significantly varied in different villages (P < 0.001). The highest detection rate in the mountainous villages was seen the highest while the detection rate of village from hilly areas was the lowest. There were considerable numbers of patients with precancerous lesions in the general population from the high risk areas. The detection rate of esophageal cancer in the mountain residents was higher than the rate in the hilly areas. Men and the elderly were the key populations calling for esophageal cancer prevention programs to be carried out.

Influence of the disinfection effect of acidic electrolyzed oxidizing water on laryngeal endoscope

[Objective] To compare the disinfection effect of different disinfectants on disinfection effect of laryngeal endoscope,and seek for a more safe and effective disinfectant for laryngeal endoscope.[Methods] 180 laryngeal endoscope were divided into three groups with 60 of them in each group.Acidic electrolyzed oxidizing water(AEOW),2％ glutaraldehyde and orthophthalaldehyde were used for disinfection.Three minutes and five minutes after disinfection,the samples were got and underwent bacterial detection.The disinfection effect after three minutes and five minutes was compared.[Results] The qualified rate of disinfection and cost between AEOW,2％ glutaraldehyde and orthophthalaldehyde showed distinct difference.[Conclusions] Using acidic electrolyzed oxidizing water in the disinfection of laryngeal endoscope has advantages of fast,effective,low-cost,which can be applied in the clinical work. Key words: Laryngeal endoscope; Acidic electrolyzed oxidizing water; Disinfection

Endoscopic and endoscopic ultrasonography features of esophageal tuberculosis

Objective To identify endoscopic and the endoscopic uhrasonography （EUS） features of esophageal tuberculosis. Methods We retrospectively analyzed the data of 39 cases （ mean age 50. 7 ） of esophageal tuberculosis diagnosed by endoscopy and EUS in past 6 years. Results A total of 29 lesions were found in tile middle part of esophagus, and 5 in upper and lower part, respectively. The lesions under endoscope demonstrated as protrusion in 30 and ulceration in 9. EUS found esophageal wall thickness in 9 cases, intra-wall occupying lesion in 17, mediastinum occupying lesions involving esophagus in 13, and calcified lymph nodes in mediastinum which was integrated with esophageal outer wall in 28 cases. Conclusion The esophageal tuberculosis occurs mainly in the middle part of the esophagus, and appears as protrusion and ul- ceration under endoscopy. EUS can find occupying lesions intraor out of the esophageal wall, and full layer thickness, which can accompany calcified lymph nodes in meidastinum, and can be the basis of diagnosis. Key words: Esophageal tuberculosis ; Endoscopy ; Endoscopic ultrasonography

Therapeutic effect of endoscopy for anastomotic and nonanastomotic biliary strictures after livertransplantationt

Objective To evaluate the therapeutic effect of endoscopy for patients with anastomotic or nonanastomotic biliary strictures after liver transplantation. Methods Clinical and follow-up data of 56 patients, 38 （67.9%） with anastomotic strictures （AS）, and 18 （32. 1% ） with nonanastomotic strictures （NAS） after liver transplantation, who underwent endoscopic therapy were collected and analyzed. Results Compared to AS patients, NAS patients showed shorter time from liver transplantation to initial presentation （4. 45 ± 1.47 vs. 8. 00 ±2. 31 months, P =0. 000）, underwent more ERCP procedures （6. 20 ± 1.28 vs. 4. 11 ± 1.51, P = 0. 000） and received more stents （ 10. 20 ± 3.59 vs. 7.53 ± 2. 12, P = 0. 001 ）. Although the success rate was not statistically different, patients with NAS needed longer treatment duration and had higher recurrence rate （50. 0% vs. 18.2%, P =0. 033） as well as shorter duration from treatment to recurrence. Among patients with AS, the treatment failure group had longer stricture length （ 13.00 ± 3.61 vs. 6. 63 ±2.09, P =0. 000） than the success group and the patients who experienced recurrence had longer stricture length （ 10. 48 ± 1.07 vs. 5.86 ± 1.55, P = 0. 000 ） and narrower stricture diameter （ 1.52 ± 0. 38 vs. 1.94 ± 0. 32, P = 0. 001 ）. Among NAS patients, the multiple biliary strictures group had lower success rate and higher recurrence rate, but with no statistical significance （62. 5% vs. 90. 0%, P =0. 275 and 66.7% vs. 37.5%, P = 0. 592, recpectively）. Conclusion NAS patients have lower response to endoscopic treatment than AS patients. The length and diameter of biliary stricture in AS as well as the number of stricture in NAS may influent the effect of endoscopic treatment. Key words: Liver transplantation; Anastomotic biliary strictures; Nonanastomotic biliary stiletures ; Endoscopes ; Therapy

Clinical application of small incisions in the treatment of benign thyroid diseases with endoscopic assistance assistance

To explore the clinical application and value of small incisions in the treatment of benign thyroid diseases with endoscopic assistance.A total of 57 cases with thyroid nodules were operated under the assistance of ultrasonic scalpel and endoscope with the lifting-up of special instrument and small neck incisions.However one malignant case was converted iuto open surgery according to frozen sections.The other 56 cases were successfully operated.The mean operative duration was 42 min and postoperative stay 2 -3 days.All incisions achieved primary healing and the length range was 1.5 - 3.5 cm.Except for transient hoarseness in 1 case,there was no such complications as choking,lip paralysis or hemorrhage,etc.All were discharged uneventfully.This surgical approach shall be recommended for its merits of miniinvasiveness,less hemorrhage,fewer complications and wider applications. Key words: Video-assisted surgery; Thyroid tumors

Diagnosis and management of duodenal perforation after endoscopic retrograde cholangio-pancreatography: clinical analysis of 15 cases

To summarize the experience with duodenal perforations to determine a systematic management approach. A total of 11 250 patients who received endoscopic retrograde cholangiopancreatography(ERCP) in The First People's Hospital of Hangzhou from January 2005 to December 2011 and 15(0.13%) patients developed duodenal perforation. The clinical data of these 15 cases were analyzed. There were 6 males and 9 females. The age ranged from 45 to 87 years. Seven patients developed perforation after sphincterotomy of the duodenal papilla. Five patients perforated due to the endoscope, and 3 due to guide wire and net basket. All the patients presented varying degree of abdominal pain and distention. CT scan of the upper abdomen showed peripancreatic and retroperitoneal air or fluid. Diagnosis was confirmed in 7 patients using abdominal X-ray. Eight patients developed postoperative abdominal pain and distention, subcutaneous emphysema, and fever 3 hours to 5 days after surgery, and diagnosis was confirmed using plain abdominal X-ray or upper abdominal CT scan. Nine patients were managed conservatively, 4 of whom were diagnosed within 3 hours after perforation and were managed by endoscopic metal clip and nasobiliary drainage and no abdominal abscesses developed. The length of hospital stay ranged from 10 to 15 days. Five patients were diagnosed 10 hour to 5 days after perforation, of whom 2 had intestinal fistula, 4 had abscess, and one died, the length of hospital stay ranged from 15 to 105 days. Six patients were managed surgically, 4 received surgery within 4 to 8 hours after perforation and no abscess developed, and the length of hospital stay ranged from 18 to 21 days. The other 2 patients were operated at 24 hours and 30 hours after perforation respectively, one of whom had recurrent intra-abdominal bleeding after surgery and one died from intra-abdominal abscess and multiple organ failure. For duodenal perforations related to ERCP, early diagnosis can be made by prompt intraoperative identification and postoperative CT scan. Endoscopic metal clip and nasobiliary drainage should be considered aside from surgical intervention.

Application of supporting laryngoscope combined laryngeal endoscope in excision for 124 patients with benign lesions of vocal cords

Objective To investigate the clinucal value of the application of supporting laryngoscope combined laryngeal endoscope in excision for benign lesions of vocal cords.Methods 124 cases with benign lesions of vocal cords were resected under supporting laryngoscope combined larygeal endoscope,the effectiveness of surgical procedures were observed and evaluated.Results Lesions in all cases were resected successfully,mucosa of vocal cords returned to their normal state in all cases when observed through layngofiberscope.Vocal quality was significantly improved in 122 cases.Conclesion The application of supporting laryngoscope combined larygeal endoscope could provide a wild and clear sight,and make the exact procedure and minimal trauma in excision for benign lesions of vocal cords become possible. Key words: Laryngoscopy; Vocal cords; Meta-analysis

Clinical application of self-made drainage tube with balloon for iatrogenic colonic perforation

To investigate the clinical efficacy of colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation. A retrospective analysis of 8 patients with iatrogenic colonic perforations from January 2009 to March 2011 was performed. Self-made drainage tubes with balloon were placed in the bowel lumen endoscopically after perforations were closed with endoclips or endoloops under endoscope. The inflatable balloon at the front-end of the tube was fixed at the mouth side of colonic perforation to achieve continuous drainage of stool and intestinal juice. Endoscopic bypass continuous drainage by using self-made drainage tube with balloon was successfully carried out in all the 8 patients. All the perforations healed and no surgical intervention required. Bypass drainage continued for 3-10 days(mean 7.6 days). One patient received colonoscopy 3 days after the procedure, and displacement of the drainage tube was noticed requiring endoscopic adjustment. All the drainage tubes were removed uneventfully, and no ulceration or perforation occurred at balloon fixed site after removal. After follow up ranging from 12 to 36 months, no chronic fistula, adhesive obstruction, or abdominal infection occurred. Colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation is simple, feasible, safe and reliable.

Feasibility and safety of patient controlled analgesia technology in double-balloon endoscopy

To evaluate the feasibility and safety of patient controlled analgesia (PCA) technology during double balloon endoscopy(DBE) inspection. According to the anesthesia, 120 patients with suspected intestinal disease were randomized into non-anaesthesia(Group A), propofol infusion with TCI vein pump(Group B), and remifentanil vein infusion with PCA pump(Group C), with 40 patients in each group. The feasibility and safety of the three methods in double balloon endoscopy(DBE) inspection were evaluated. The tolerance in groups B and C was good and the procedure success rate was 100%, significantly higher than Group A(80%, 12/40, P<0.01). The fluctuation of blood pressure, heart rate, and oxygen saturation was significantly greater in groups A and B, while patients in Group C remained stable. The detection rate was 67.5%(27/40) in Group B and 72.5%(29/40) in Group C, significantly higher than that in Group A(37.5%, 15/40, all P<0.01). The depth of endoscope was longer and the length of hospital stay shorter in Group C as compared to Group B(both P<0.05). The application of PCA technology in the double-balloon endoscopy inspection can meet the individualized analgesic needs of patients in different period, increase the tolerance and compliance of patients to the inspection, facilitate patient-operator communication and positions change, reduce the operation risk, and increase the success rate of double balloon endoscopy.

The outcome of anterior transposition of the ulnar nerve in treatment of cubital tunnel syndrome with endoscopically assisted

Objective To investigate the outcome between endoscopically assisted and routine anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. Methods From Februray 2008 to June 2010, forty-four patients with cubital tunnel syndrome were treated with routine anterior subcutaneous transposition (routine group,28 cases) and endoscopically assisted anterior subcutaneous transposition (endoscope group,16 cases).The operate time,drug administration,scar and postoperative hospital stay were compared.The patients were followed 1-12 month postoperatively,postoperative time back to work and function of ulner nerve were recorded. Results The results of endoscope group were as follows: operative time was (67.20 ± 19.69)min; postoperative scar length was (1.5％ ± 0.58) cm; rate of administration of anodyne was 6.3％; postoperative hospital stay was (2.4％ ± 1.42) days; postoperative time back to work,(14.6 ± 4.69)days; the results of open surgery group were as follows:operative time (62.8％ ± 11.06) min; postoperative scar length was (8.7％ ± 1.42) cm; rate of administration of anodyne was 42.8％; postoperative hospital stay was (5.7％ ± 2.53) days; postoperative time back to work was (29.40 ± 8.75) days; all differences of the results were significant between two groups (P ＜ 0.05).According to function of ulner nerve scoring system,one year postoperatively, excellent or good results were 82.14％ in routine group and 81.25％ in endoscope group,no significant difference between two groups (P ＞ 0.05). Conclusion Compared with routine anterior transposition of the ulnar nerve,endoscopically assisted anterior transposition has the following advantages: smaller incision and less tissue damage,less postoperative pain and sooner returning to work.And similar outcome was achieved from the two group. Key words: Cubital tunnel syndrome; Endoscope; Ulnar nerve; Nerve release

Clinical value of transgastric endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection

Objective To investigate the clinical value of transgastrie endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection.Methods The clinical data of 22 patients with pancreatic abscess or pancreatic cyst and infection who underwent transgastric puncture and drainage or transgastric debridement under the guidance of endoscopic ultrasonography (EUS) at the Xinqiao Hospital of Third Military Medical University from July 2008 to August 2011 were retrospectively analyzed.All patients were comfirmed with bacteria infection after liquid aspiration culture. Patients with pancreatic abscess underwent endoscopic transgastric debridement,and for patients with pancreatic cyst and infection,10 F double pigtail stent and 8.5 F nasal bile duct were placed for drainage.Results The results of liquid aspiration culture confirmed that 2 patients were infected by staphylococcus aureus,3 by proteus mirabilis,4 by pseudomonas aeruginosa,4 by klebsiella and 9 by escherichia coli bacilli.The double pigtail stent and nasal bile duct were installed under EUS (16 patients) or duodenoscope (6 patients).The lesions of 9 patients with pancreatic abscess were healed after endoscopic transgastric debridement with an average period of (6.5 + 1.8 )weeks,and the lesions of 13 patients with pancreatic cyst and infection were healed after transgastric puncture and drainage under the guidance of EUS with an average period of ( 8.3 ± 2.1 ) weeks.All patients were followed up for 2 years,and no recurrence of pancreatic abscess or pancreatic cyst was observed.Conclusion The effect of transgastric endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection is satisfactory. Key words: Pancreatic abscess; Pancreatic cyst; Infection; Endoscope

Risk factors for false negative diagnosis of obscure gastrointestinal bleeding by capsule endoscopy

Objective To analyze the risk factors for false negative diagnosis of obscure gastrointes- tinal bleeding （OGIB） by capsule endoscopy. Methods A total of 133 OGIB inpatients, 104 in true posi- tive group and 29 in false negative group, were reviewed. The features of demography, diseases and capsule endoscopy were collected and then analyzed, which included 10 variables like age, sex, time of bleeding, diseases accompanied, type and location of the disease, hemoglobin concentration, transit time of CE, quality of CE pictures and type of purgative agents. All data were analyzed with t test, and all the enumeration data were analyzed with chi square test. Logistic regression was used to analyze the correlation between the factors and results of diagnosis. Results Age （ t = 2. 095, P ： 0. 038 ）, concentration of hemoglobin （ t=2. 143, P = 0. 034）, type （X2 = 20. 222, P 〈 0. 001 ） and location （X2 = 33. 732, P 〈 0. 001 ） of the diseases, image quality of the CE （X2 =9. 219, P =0. 002） and the type of purgative agents （X2 =6. 999, P =0. 024） were found to have statistical differences between the two groups. Chi-square and partition Chi-square test revealed the occurrence of divertieulosis and lesion location, i.e. lower ileum and ileumcecum, were of statistical difference between the two groups （X2 = 22. 233, P 〈0. 001 and x2 = 24. 412, P 〈 0. 001 ）. Univariate logis- tic regression showed diverticulosis （ OR = 0. 102, P 〈 0. 001 ） , lower bowel diseases （ OR = 0. 110, P 〈 O. 001 ）, poor quality of CE pictures （ OR = 0. 258, P = 0. 004 ） and the use of sodium phosphate agent （ OR = 0. 367, P = O. 027 ） were risk factors for false negative diagnosis, while older age facilitated diagnosis （ OR = 1. 024, P =0. 041 ）. However, multivariate logistic regression showed no statistic significance in type of purgative agent （ P = 0. 05 ） or the concentration of hemoglobin （ P = 0. 394）. Furthermore, elder age facilitated positive diagnosis （ OR = 1. 031, P =0. 032）, while divertieulosis （ OR =0. 118, P =0. 001 ）, low- er bowel diseases （ OR = 0. 145, P = 0. 001 ） and poor quality of CE pictures （ OR = 0. 245, P = 0. 016） were correlated with higher probability of false negative diagnosis. Conclusion Age, disease type, disease location and image quality exert great influence on CE diagnosis. Divertieulosis, lower location of the disea- ses and poor CE image quality are risk factors for false negative diagnosis. Key words: Capsule endoscopes; Obscure gastrointestinal bleeding

A survey of sedated gastrointestinal endoscopy

Objective To investigate the popularity of the sedated gastrointestinal endoscopy in ma- inland China. Methods The survey on the popularity of the sedated gastrointestinal endoscopy was conduc- ted with questionnaires sent by e-mails or telephones to the GI endoscopy units of three levels of hospitals. Results From May, 2010 to November, 2010, 169 units from 28 provinces （90. 3% ） were enrolled, including 46 hospitals of grade Ⅲ, 91 of grade Ⅱ and 32 of grade Ⅰ. Sedated gastrointestinal endoscopy were performed in 110 （65.1%, 110/169） hospitals, i. e. 93.5% （43/46） grade m hospitals, 68.1% （62/91） grade Ⅱ hospitals and 15.6% （5/32） grade Ⅰ hospitals. Significant difference was observed between the grade Ⅲ and the grade Ⅱ hospitals （ P 〈 0. 05 ） , so was between the grade Ⅱ and the grade Ⅰ hospitals （ P 〈 0. 05 ）. Propofol was frequently used in sedation in 98 hospitals （ 89. 1% ）. The only 9. 1% （10/110） hospitals, which had full-time anesthetists or anesthetic nurses, were all grade Ⅲ hospitals. Conclusion There has been great progress in the popularity of sedated gastrointestinal endoscopy in mainland China during the past decade. However, it is less frequently performed in grade Ⅰ and Ⅱ hospitals. Shortage of full-time anesthetists is still a problem. Key words: Gastrointestinal endoscopes ; Sedation ; Survey report

Sedation with propofol plus fentanyl for cirrhotic patients during upper gastrointestinal endoscopy

Objective To prospectively study the safety and feasibility of sedation with propofol plus fentanyl for cirrhotic patients undergoing upper gastrointestinal endoscopy （UGIE）. Methods A total of 50 cirrhotic patients and 50 control subjects without liver diseases referred to UGIE were assigned to the cirrhotic sedation group and the non-cirrhotic sedation group, respectively. Patients of both groups received sedation with propofol plus fentanyl. Meanwhile, 30 cirrhotic patients underwent conventional UGIE. Vital signs of all subjects were recorded before sedation and procedure, five minutes, ten minutes and one hour after the pro- cedure. Number connection test A （NCT-A） and line tracing test （LTT） were completed for all patients be- fore sedation or procedures and 4 hours after endoscopy procedures. Occurrence of sedation-related complica- tions was measured. Results In the cirrhotic sedation group and the non-cirrhotic sedation group, blood pressure, heart rate, respiratory rate and saturation of pulse oximetry decreased of different degrees after sedation （ P 〉 0. 05 or P 〈 0. 05 ）, but returned to normal one hour after endoscopy procedures （ P 〉 0. 05 ）. The total complication rates differed significantly between the cirrhotic sedation group and the non-cirrhotic sedation group [ 36% （18/50） v.s. 14% （7/50）, P 〈 0. 05 ]. However, the rate of such complications as hypotension,bradycardia and hypoxemia in both groups was of no statistical difference （ P 〉 0.05 ）. No cir- rhotic patient developed overt hepatic encephalopathy after procedures. In addition, the NCT-A and LTY times before and after sedation in the cirrhotic sedation group and the cirrhotic non-sedation group were lon- ger than those before and after procedure in the non-cirrhotic sedation group （before sedation or procedure： （55.1 ±22.1）s, （58.6±23.1）sv.s. （36.9±7.0）s, （98.6±33.1）s, （89.5±15.6）s v.s. （81.4±13.6）s, P〈0.05; four hours after procedure ： （54.4±21.6）s, （58.3±22.4）s v.s. （36.3±6.3）s, （ 88.4±30. 6） s, （80. 2±15. 9） s v.s. （ 71.8±12. 0） s, P 〈0. 05, while there was no difference between cirrhotic sedation group and cirrhotic non-sedation group （ P 〉 0.05 ）. Within-group comparison showed NCT-A did not change （ P 〉 0.05 ） , whereas, LTT was obviously shorter than pre-sedation or pre-proeedure （P 〈 0. 05 ） due to ＂learning effect＂. The differences in the NCT-A and LTT times before and after sedation or procedure were not significant among the three groups （P 〉 0. 05 ）. Conclusion Sedation with propofol plus fentanyl is relatively safe in eirrhotic patients during UGIE, which will not precipitate hepatic encepha- lopathy or cause irreversible complications. Key words: Liver cirrhosis ; Propofol; Endoscopes; Hepatic encephalopathy; Complication

Clinical analysis of complications of percutaneous nephrostomy lithotomy

Objective To investigate the complication and its treatment method of the percutaneous nephrolithotomy(PCNL).Methods The clinical data of 137 patients with PCNL,were retrospectively analyzed statistical analysis of complications.Results In 137 cases of PCNL,83 cases were male,54 cases were female; 103 cases of kidney stones,ureteral calculi in 34 cases,including 24 cases of ureteral calculi with renal calculi.All patients were cured,no patients died;complications occurred in 9 cases,in which the puncture failure in 1 case,renal hemorrhage in 5 cases,postoperative arteriovenous fistula in 1 case,infection in 2 cases.Conclusion PCNL is minimally invasive,effective,but still had more serious complications.We should strengthen the prevention and cure measures. Key words: Endoscope; Intraoperative complications; Ureterolithiasis; Kidney calculi

Effect of the endoscope operation equipments managed by designated persons

Objective To explore the effects of the endoscope operation equipments managed by designated persons.Methods The endoscope operation equipments managed by different persons between April 2009 and April 2010 were control group (n =2000) and that managed by designated persons between May 2010 and May 2011 were test group (n =2 000).The effects index such as packaging error rate and the surgeon's satisfaction of operation equipments were evaluated by self-designed questionnaire.Results There were 200 error packages in control group and the error rate was 10.0％,while 2 error packages in the test group and the error rate was 0.1％,and the difference was statistically significant ( x2 =204.40,P ＜ 0.01 ).The surgeon' s satisfaction of control group was 86.0％,and that of test group was 98.0％,and the difference was statistically significant( P ＜0.01 ).Conclusions The endoscope operation equipments managed by designated persons can improve the surgeon' s satisfaction and reduce the packaging error rate of operation equipments effectively,which effectively ensure the patient' s medical safety. Key words: Endoscopes; Surgical instruments; Department of sterilization and supply; Designated person; Inventory; Package

Comparisoil between ERCP and conventional treatment for bile leakage after cholecystectomy

Objective To compare the therapeutic result between ERCP and conventional treatment for bile leakage after cholecystectomy. Methods Data of 35 cases with bile leakage after cholecystectomy were retrospectively studied, in which 18 patients underwent conventional therapy and surgery （conventional group）, and 17 others underwent ERCP （endoscopy group）. The time of bile leakage closure, complication rate, and re-operation rate of the 2 groups were compared. Results In conventional group, leakage location was identified in 7 cases and mean bile leakage closure time was 23 days. A second operation was performed in 8 cases and complications occurred in 7. In endoscopy group, leakage location was identified in 13 cases and mean bile leakage closure time was 13 days. A second operation was performed in 2 cases and complications occurred in 3. Significant differences were found between 2 groups in regarding of the above references. Conclusion ERCP is accurate and valuable for diagnosis and treatment for bile leakage after cholecystectomy. Key words: Cholecystectomy; Biliary fistula; Endoscopes ; Comparative study

Clinical application of Draf IIb frontal sinusotomy and it's modified procedures

To summarize the follow-up outcomes of Draf IIb frontal sinusotomy and it's modified procedures, and to discuss the surgical indications and prognostic factors. Thirty-two patients treated between 2004 and 2010 were enrolled in this study. There were 15 patients for recurrent frontal inverted papilloma (IP), 6 for mucocele, 4 for recurrent frontal sinusitis, 3 for osteoma, 2 for meningoencephalocele with cerebrospinal fluid rhinorrhea, 1 for meningoencephalocele alone and 1 for acute frontal sinusitis. All patients underwent preoperative paranasal sinus computed tomography (CT) scans. Patients with tumor accepted magnetic resonance imaging (MRI). The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea received magnetic resonance cisternography (MRC). The Draf IIb frontal sinusotomy and it's modified Draf IIb-1-3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system. The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation. Postoperative follow-up was performed under endoscope. Among 19 cases of Draf IIb, 12 were recurrent IP of frontal sinus, 4 were mucocele, 2 were recurrent frontal sinusitis and 1 were osteoma. Five cases received Draf IIb-1, 2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf IIb-2, 3 for meningoencephalocele, 1 for each IP, acute frontal sinusitis and osteoma. Two cases received Draf IIb-3 were mucocele. The follow-up ranged from 8 to 73 months. Twenty-two cases of the frontal nepostium were widely opened, 7 were stenosis and 3 were closed. Revision surgery was seen in 2 cases with IP. All of them had no complications. The Draf IIb frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease, which can be selected according to pathological and anatomical features, and have a good prospect for clinical application.

Treatment of orbital blowout fracture by CT image navigation assisted nasal endoscope

Objective To study the curative effect of CT image navigation assisted nasal endoscope in the treatment of orbital blowout fracture.Method To perform CT image navigation assisted nasal endoscope reduction surgery on 23 patients(23 eyes) with clear surgical indieations of orbital blowout fractures,and observe the effect of the surgery.Results Follow up 23 patients(23 eyes) for 3 months to 1 year after the operation,the data shown that 19 patients( 19 eyes) were cured,4 patients(4 eyes) were improved,the invalid was 0,the improvement rate was 100％ and cure rate was 82.6％.Conclusion CT image navigation assisted nasal endoscopy is a good and effective method in the treatment of orbit blowout fracture Key words: Navigation; Nasal endoscopic; Fracture orbital wall, blowout

Transvaginal appendectomy by endoscopy in canine models

Objective To evaluate the technical feasibility and safety of transvaginal appendectomy by endoscopy in canine models. Methods Six female dogs weighing between 12-15 kg underwent transvaginal appendectomy by endoscopy. A small incision at posterior fornix of the vagina was made endoscopically by a needle knife and then dilated by a balloon dilator. After the endoscope entered the peritoneal cavity, the appendicular artery was clipped and the appendix was dissociated, and then the free appendix was ligated by an endoloop near root and removed by snare cutting. The appendix was then removed through the vaginal port. Fi- nally, the vaginal incision was closed by clipping and endolooping. Two weeks after the procedure, the animals were sacrificed for anatomic investigation. Results Endoscopic transvaginal appendectomy was successfully performed in all animals with a mean operating time of （94. 2 ±41.8） min. Complicated bleeding occurred in 1 dog and rectal burn in another during the operation. All the experimental animals survived the post operative period for 2 weeks without any complications. Post mortem examination revealed that the wound and vaginal incision healed well. Conclusion Transvaginal appendectomy by endoscopy is safe and feasible in a canine model, while further study and progression of appropriate accessories are needed for future clinical use. Key words: Natural orifice transluminal endoscopic surgery; Appendectomy; Vagina; Animal, laboratory