Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used...Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used to repair tympanic membrane(TM)perforation.To obtain good results,appropriate surgical methods and repair materials should be selected.This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa(SIS)during transcanal endoscopic type I tympanoplasty.Method A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Perforation size,tympanic status,pre-and postoperative symptoms,follow-up data,wound healing rates,and hearing improvement were analysed.Results Of the 115 patients included in the study,56 underwent interlayer repair with porcine SIS of the TM,and 59 patients underwent internal repair with tragus cartilage.No significant difference was found between the two groups at baseline in terms of age,sex,disease course,perforation side,tympanic status,underlying disease,or preoperative infection.The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07%(51 patients),and that of internal implantation with tragus cartilage was 88.14%(52 patients).No significant difference was found in terms of the graft success rate between the two surgical methods(p=0.887).Postoperative pure tone auditory(PTA)and air-bone gap(ABG)density significantly increased in both groups compared with before surgery(p<0.05).However,the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups(p>0.05).Compared to those in the internal implantation group,the patients in the interlayer group had a shorter operation duration(51.36±6.76 min vs.59.71±7.45 min,t=6.298,p<0.001)and less blood loss(11.91±2.61 mL vs.15.27±2.57 mL,t=7.019,p<0.001).Conclusions Our study suggests that the porcine SIS,as well as the tragus cartilage,has a high success rate in repairing irreversible TM perforation.Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages,including the absence of donor-site incision and scar formation,and ease of graft modification and manipulation.展开更多
BACKGROUND We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions.Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure metho...BACKGROUND We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions.Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions.AIM To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection(ESD).METHODS Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study.In this method,endo-clips are placed at the edges of a mucosal defect.Additional endo-clips are then applied in the same way to facilitate reduction of the defect size.Additional endo-clips are applied to both sides of the mucosal defect.Complete closure can be achieved.We have also developed a“location score”and“closure difficulty index”for assessment purposes.RESULTS Complete closure was achieved in 68.2%of the patients(15/22).The location score in the failure group was significantly larger than that in the complete closure group(P=0.023).The closure difficulty index in the failure group was significantly higher than that in the complete closure group(P=0.007).When the cutoff value of the closure difficulty index was set at 99,the high closure difficulty index predicted failure with a sensitivity of 57.1%,specificity of 100%,and accuracy of 86.3%.CONCLUSION The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD,especially in cases with a high closure difficulty index.展开更多
Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter....Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter. Although a few reports have described the use of endoscopic resection of duodenal carcinoids, there are no published studies on endoscopic mucosal resection with circumferential mucosal incision (EMR-CMI). We performed EMR-CMI for 5 cases of duodenal carcinoids in the duodenal bulb. The mean tumor diameter was 4.6 ± 1.8 mm. Although all of the tumors were located in the submucosa, R0 resection was performed without complication in each case. EMR-CMI may thus be a safe and effective treatment for duodenal carcinoids less than 10 mm in diameter.展开更多
Tympanic membrane perforationsoccur frequently in children,and can result in hearing loss,otorrhea,pain,and cholesteatoma.Due to the narrower ear canal in children,a postauricular incision is often needed to access th...Tympanic membrane perforationsoccur frequently in children,and can result in hearing loss,otorrhea,pain,and cholesteatoma.Due to the narrower ear canal in children,a postauricular incision is often needed to access the tympanic membrane for surgical repair.Endoscopic approaches are increasingly being used for tympanic membrane repair,reducing the need for postauricular incisions.As the need for a postauricular incision decreases,the demand for non-autologous grafting material has increased.Acellular porcine small intestinal submucosa (SIS) has been described in the literature as an alternative to commonly used autologous grafts,and is well suited for use with transcanal endoscopic ear surgery as a minimally invasive approach.This paper describes techniques for use of SIS in endoscopic tympanic membrane repair in children.展开更多
AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retr...AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.展开更多
Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis.A solitary PeutzJeghers type polyp of the stomach is rare.We here report a case o...Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis.A solitary PeutzJeghers type polyp of the stomach is rare.We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months.During the hospital treatment course for this patient,endoscopic examination revealed a bulging lesion with a central hole,mucosal ulceration,an asymmetrical wall thickness and a narrowing of the gastric lumen.A gastric biopsy further revealed ulceration with moderate dysplasia.The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm×3 cm.Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes,all greater than 1 cm.The suspected diagnosis was malignant gastric cancer with lymph node metastases.The other lesion,which measured 2 cm×2 cm×1 cm was noted in the submucosa of the jejunum during surgery.The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor.The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer,and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum.This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.展开更多
基金approved by the Ethical Committee for Human Subjects at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine(20240276).All participants or their guardians provided written consent for their medical information to be used for publication.
文摘Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used to repair tympanic membrane(TM)perforation.To obtain good results,appropriate surgical methods and repair materials should be selected.This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa(SIS)during transcanal endoscopic type I tympanoplasty.Method A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Perforation size,tympanic status,pre-and postoperative symptoms,follow-up data,wound healing rates,and hearing improvement were analysed.Results Of the 115 patients included in the study,56 underwent interlayer repair with porcine SIS of the TM,and 59 patients underwent internal repair with tragus cartilage.No significant difference was found between the two groups at baseline in terms of age,sex,disease course,perforation side,tympanic status,underlying disease,or preoperative infection.The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07%(51 patients),and that of internal implantation with tragus cartilage was 88.14%(52 patients).No significant difference was found in terms of the graft success rate between the two surgical methods(p=0.887).Postoperative pure tone auditory(PTA)and air-bone gap(ABG)density significantly increased in both groups compared with before surgery(p<0.05).However,the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups(p>0.05).Compared to those in the internal implantation group,the patients in the interlayer group had a shorter operation duration(51.36±6.76 min vs.59.71±7.45 min,t=6.298,p<0.001)and less blood loss(11.91±2.61 mL vs.15.27±2.57 mL,t=7.019,p<0.001).Conclusions Our study suggests that the porcine SIS,as well as the tragus cartilage,has a high success rate in repairing irreversible TM perforation.Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages,including the absence of donor-site incision and scar formation,and ease of graft modification and manipulation.
文摘BACKGROUND We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions.Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions.AIM To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection(ESD).METHODS Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study.In this method,endo-clips are placed at the edges of a mucosal defect.Additional endo-clips are then applied in the same way to facilitate reduction of the defect size.Additional endo-clips are applied to both sides of the mucosal defect.Complete closure can be achieved.We have also developed a“location score”and“closure difficulty index”for assessment purposes.RESULTS Complete closure was achieved in 68.2%of the patients(15/22).The location score in the failure group was significantly larger than that in the complete closure group(P=0.023).The closure difficulty index in the failure group was significantly higher than that in the complete closure group(P=0.007).When the cutoff value of the closure difficulty index was set at 99,the high closure difficulty index predicted failure with a sensitivity of 57.1%,specificity of 100%,and accuracy of 86.3%.CONCLUSION The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD,especially in cases with a high closure difficulty index.
文摘Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter. Although a few reports have described the use of endoscopic resection of duodenal carcinoids, there are no published studies on endoscopic mucosal resection with circumferential mucosal incision (EMR-CMI). We performed EMR-CMI for 5 cases of duodenal carcinoids in the duodenal bulb. The mean tumor diameter was 4.6 ± 1.8 mm. Although all of the tumors were located in the submucosa, R0 resection was performed without complication in each case. EMR-CMI may thus be a safe and effective treatment for duodenal carcinoids less than 10 mm in diameter.
文摘Tympanic membrane perforationsoccur frequently in children,and can result in hearing loss,otorrhea,pain,and cholesteatoma.Due to the narrower ear canal in children,a postauricular incision is often needed to access the tympanic membrane for surgical repair.Endoscopic approaches are increasingly being used for tympanic membrane repair,reducing the need for postauricular incisions.As the need for a postauricular incision decreases,the demand for non-autologous grafting material has increased.Acellular porcine small intestinal submucosa (SIS) has been described in the literature as an alternative to commonly used autologous grafts,and is well suited for use with transcanal endoscopic ear surgery as a minimally invasive approach.This paper describes techniques for use of SIS in endoscopic tympanic membrane repair in children.
文摘AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.
文摘Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis.A solitary PeutzJeghers type polyp of the stomach is rare.We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months.During the hospital treatment course for this patient,endoscopic examination revealed a bulging lesion with a central hole,mucosal ulceration,an asymmetrical wall thickness and a narrowing of the gastric lumen.A gastric biopsy further revealed ulceration with moderate dysplasia.The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm×3 cm.Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes,all greater than 1 cm.The suspected diagnosis was malignant gastric cancer with lymph node metastases.The other lesion,which measured 2 cm×2 cm×1 cm was noted in the submucosa of the jejunum during surgery.The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor.The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer,and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum.This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.
