简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AbstractBackground:Endoscopic resection bleeding (ERB) classification was proposed by the authors’ team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.

简介：AbstractBackground:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy-two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6-83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5-year follow-up, reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5-year survival is 91.1%.

简介：AbstractBackground:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection.Methods:The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and sub-group analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results.Results:A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD]= -27.1 min, 95% confidence interval [CI]: -40.8 to -13.4 min) and lengths of hospital stay (WMD = -1.43 days, 95% CI: -2.31 to -0.56 days) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 to 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31-25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = -41.03 min, 95% CI: -59.53 to -22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57-10.34).Conclusions:In general, endoscopic resection is an alternative method for gastric GISTs ≤5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.

简介：AbstractThis article presents a case of low-grade cribriform cystadenocarcinomas (LGCCC), a rare salivary gland tumor manifesting in the infratemporal fossa (ITF). The lesion in this case is unique in its location, histopathology, and management in that the tumor resection was performed using an exclusively endoscopic, endonasal approach. This case highlights the expanding application of endoscopic skull base techniques to address an indolent, slow-growing malignancy of the ITF.

简介：AbstractObjective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ2, Fisher's exact, and independent t tests.Results:Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps (n = 15, 44.1%) and free mucosal grafts (n = 11, 32.4%). Rigid reconstruction was uncommon (n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise (P < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis (P < 0.001), larger tumor size (P = 0.001), and operative exposure of orbital fat (P < 0.001) and extraocular muscle (P= 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short- or long-term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short-term postoperative diplopia when reconstruction was foregone (P = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well-selected by surgeons in the reported cases included in this systematic review.

简介：Middleearsurgeryisusuallyperformedusingasurgicalmicroscope.Initially,inotorhinolaryngologypractice,endoscopeswereusedforparanasalsinussurgeries.Itwasonlylaterthattheywereappliedintheareaofotology.Inotologicsurgeries,endoscopeswerefirstusedtovisualizethemiddleear,beforebeingusedtoassistwithvisualizationofinstrumentsduringcholesteatomasurgeries,althoughtheyarestillnotusedaloneinvariousotologicsurgeries.Asinothersurgicalfields,thereisalsoatrendtowardsminimallyinvasiveinterventioninthefieldofotorhinolaryngology.Smallerincisionsperformedundertheguidanceofendoscopesarepreferredoverconventionallargeincisions.Usingthisapproach,improvedoutcomescanbeachievedandpostoperativemorbiditiescanbereduced.Inaddition,theoutcomesofgraftsperformedusingtheendoscopicapproacharesimilartothatachievedbythemicroscopicapproach.Therefore,endoscopicearsurgeryimplementationsarebecomingincreasinglypopular.

简介：Chronicpancreatitisisanongoingdiseasecharacterizedbypersistentinflammationofpancreatictissues.Withdiseaseprogression,patientswithchronicpancreatitismaydeveloptroublesomecomplicationsinadditiontoexocrineandendocrinepancreaticfunctionalloss.Amongthem,apseudoaneurysm,mainlyinducedbydigestiveenzymeerosionofvesselsinproximitytothepancreas,isarareandlife-threateningcomplicationifbleedingofthepseudoaneurysmoccurs.Atpresent,noprospectiverandomizedtrialshaveinvestigatedthetherapeuticstrategyforthisrarebutcriticalsituation.Theroleofarterialembolization,thetimingofsurgicalinterventionandevensurgicalproceduresarestillcontroversial.Inthisreview,wesuggestthatdynamicabdominalcomputedtomographyandangiographyshouldbeperformedfirsttolocalizethebleedersandtoevaluatetheassociatedcomplicationssuchaspseudocystformation,followedbyarterialembolizationtostopthebleedingandtoachieveearlystabilizationofthepatient’scondition.Withadvancesandimprovementsinendoscopicdevicesandtechniques,therapeuticendoscopyforpancreaticpseudocystsistechnicallyfeasible,safeandeffective.Surgicalinterventionisrecommendedforableedingpseudoaneurysminpatientswithchronicpancreatitiswhoareinanunstablecondition,forthoseinwhomarterialembolizationofthebleedingpseudoaneurysmfails,andwhenendoscopicmanagementofthepseudocystisunsuccessful.Ifableedingpseudoaneurysmislocatedoverthetailofthepancreas,resectionisapreferentialprocedure,whereasifthelesionissituatedovertheheadorbodyofthepancreas,relativelyconservativesurgicalproceduresarerecommended.

简介：Lidui(厉兑ST45)istheJing(井Well)pointoftheStomachMeridianofFoot-Yangming.It'seffectivetoreducetheheatfromthestomachortheStomachMeridian.TheStomachMeridianisabundantwithqiandblood,andisinchargeofhemopathy.So,inclinic,weoftenapplyLidui(ST45)pointbleedingmethodtothetreatmentofmanykindsofdiseasesandgetgoodtherapeuticeffects.Followingare3typicalcases.

简介：ThisworkisconductedinMansouraUniversityHospitals,Egypt,toshowtheadvantagesanddisadvantagesofendoscopicstapedotomyincomparisontomicroscopicstapedotomy.Theworkdescribedhasnotbeenpublishedpreviouslynorunderconsiderationforpublicationelsewhere.Theauthorsdeclarethatthereisnoconflictofinterest.ThisstudyisapartofamasterdegreethesissubmittedbyEslamMahmoudaspartialfulfillmentforamasterdegree.Institutionalreviewboardapproval,FacultyofMedicine-MansouraUniversity,wasobtainedforthestudy(IRB:MS/15.09.49).

简介：Bothmorphologicalcharactersandaportionofof28SrDNAsequenceswereusedtoidentifyingTomicusspecies.Thespecimenswereclassedintogroupswiththefollowingcharacters:1)granulesorpuncturesoninterstria2onthedeclivityoftheelytra;2)lengthoftheelytralinterstrialhairsandhairsarisingfrompunctures;3)arrangementofpronotalpuncturesandhairs.Thesecharacterscouldbeclearlyexaminedunderabinocularmicroscopeat30×magnificationandtheywereapplicableandvaluablefortheforestentomologiststoidentifyTomicusspecies.Thephylogenetictreeestablishedwithdifferencein28SrDNAsequenceofD2regionrevealedthatthespecimensofeachgroupidentifiedbymorphologicalcharacterswerealsogroupedtogether.Thegeneticdistancesofintra-species,inter-speciesandinter-genuswerenotoverlapped.Geneticdivergenceof28SrDNAwasalsousefulforidentifyingTomicusspecies.

简介：摘要Endoscopic ultrasound (EUS) has both diagnostic and therapeutic clinical applications. This review article focuses on recent advances in two commonly performed procedures: EUS-guided tissue acquisition and EUS-guided drainage. There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses. There is growing interest and research about artificial intelligence in EUS. Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic. The range of EUS-guided drainage procedures has expanded. EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option. EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) is now an accepted alternative to percutaneous transhepatic biliary drainage. EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates. Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction, and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible, but further prospective randomized studies are needed to establish the actual clinical impact.

简介：现在的调查被执行决定通过最佳索引因素(OIF)选择的特征是否能作为与一起考虑的所有特征相比象二不同的年的叠的图象一样在单个年的卫星图象上提供各种各样的范畴的改进分类精确性。进一步，以便决定是否在那里发生有特征的OIF价值的相应增加的不同范畴的分类精确性的增加从两个提取了单个年并且叠了图象，我们与特征的不同联合的OIF价值执行了在各种各样的范畴的制片人精确性(PA)之间的线性回归。调查证明那在那里发生在二不可渗透的范畴viz的PA的重要改进。中等布满建筑物、低密度布满建筑物从作为与所有乐队相比与最高的OIF值联系的乐队和主要部件和为两个的主要部件的分类坚定单个年和叠的图象分别地。回归分析为决定单个年并且叠了分别地意味着与OIF价值的相应增加的在信息内容的增加之间的直接关系的流行的图象的各种各样的范畴展出了在回归系数和OIF价值之间的积极趋势。研究证明特征提取了通过从单个年和叠的图象的OIF能够作为与一起分享的所有特征相比提供显著地改进的PA。

简介：AbstractNew discoveries based on genetic and epigenetic evidence have significantly expanded the understanding of diffuse gliomas. Molecular biomarkers detected in diffuse gliomas are not only potential targets for radiotherapy, chemotherapy, and immunotherapy, but are also able to guide surgical treatment. Previous studies have suggested that the optimal extent of resection of diffuse gliomas varies according to the expression of specific molecular biomarkers. However, the specific guiding role of these biomarkers in the resection of diffuse gliomas has not been systemically analyzed. This review summarizes several critical molecular biomarkers of tumorigenesis and progression in diffuse gliomas and discusses different strategies of tumor resection in the context of varying genetic expression. With ongoing study and advances in technology, molecular biomarkers will play a more important role in glioma resection and maximize the survival benefit from surgery for diffuse gliomas.

简介：ObjectivesConventionalapproachesforremovaloflateralskullbasetumors,includingtransmandibular,infratemporalfossa,preauriculartranszygmaticsubtemporalapproaches,aremajorinvasiveproceduresthatoftensacrificehearingandcauseabnormalocclusionandcosmeticdefects.Reportsofthetranscervicalapproachforresectionofskullbasetumorsarerare,althoughitwasdescribedforresectionofclivalchordomasinasearlyas1966.Thepurposeofthisstudyistoreviewourexperiencesinmanagementoflateralskullbasetumorsusingthetranscervicalapproach.StudyDesignRetrospectivechartreview.MethodsSixlateralskullbasetumorcasestreatedwithtranscervicalapproachprocedureswerereviewed,includingthemedicalrecords.ResultsTherewere4malesand2females.Agerangedfrom12through52years.Histopathologicaldiagnosesincludedmalignantschwannoma(n=1),malignantcarotidbodytumor(n=1),heamangioma(n=1),schwannoma(n=2)andpleomorphicadenoma(n=1).Transcervicaltechniqueswereusedinallcaseswiththeuseofmicroscopeinthelateralskullbasearea.Completetumorremovalwasachievedinallcases.Postoperativeradiotherapywasimplementedin1caseofmalignantschwannomaand1caseofmalignantcarotidbodytumor.Jugularforamensyndromeoccurredasasurgicalcomplicationin1caseofmalignantSchwannomaofthevagusnerve.Therewasnotumorrecurrenceduringthe10-42monthfollow-upperiod.ConclusionComparedwithconventionalapproaches,thetranscervicalapproachprovidesaeasy,safe,minimalinvasiveandeffectiveprocedureforremovalofselectedlateralskullbasetumors.

简介：Duringthepastdecade,roboticsurgicalsystemshavebeenincreasinglyutilizedtoperformhighlycomplexsurgicalprocedures.Infact,therobotic-assistedapproachtothetreatmentofmanygynecologicalandurologicalsurgicalprocedureshasbecomethestandard-of-care.Theuseofroboticsurgicalsysteminthoracicsurgeryisinitsearlydevelopment.Video-assistedthoracoscopicsurgery(VATS)

简介：ChildsNervSyst.2008Jun18.OBJECTIVES:Despiterevolutionarytechnicaladvancementinneuroimagingandoperativeneurosurgery,surgicalextirpationoffocalbrainstemglioma(BSG)remainssteepedincontroversy.Inthisstudy,weevaluatedourseniorauthor's(CT)surgical

简介：AbstractThe surgical approach to lesions of the ventral craniovertebral junction (CVJ) has evolved significantly in the last several years with the advent of endoscopic skull base surgery. Differing pathologies of the CVJ can result in irreducible compression of the cervicomedullary region. The endoscopic endonasal approach lends itself well to this region due to the ventral location, and while there is a steep learning curve, is a safe and effective way to perform decompression of the cervicomedullary region. Herein, we discuss the anatomy of the CVJ, preoperative evaluation and surgical considerations, our surgical approach, complications, and outcomes.

简介：OBJECTIVETodeservetheeffectsofFG(FibrinGlue)onendoscopicliposuction.Methods:FromOct.1998toAug.2000fortycaseswereundergoingfortheliposuction.Attheaidsoftumescentteachnique,endoscopyandFGwereused,ofwhich20casesoperationontheirabdominalwalls,8casesupperabdomenwallsand12casesownerabdominal.

简介：Endoscopicsubmucosaldissection(ESD)inventedinJapan,playsanimportantroleinthetreatmentofearlygastrointestinalcancer(EGC)anddysplasia.Endoscopicproceduresarenowwidelyspreadingaroundtheworld.ESDhastheadvantagethatenblocresectionaswellaspathologicalviewcanbeachievedwhencomparedwithconventionalendoscopicmucosalresection(1).Thankstothe