吲哚菁绿荧光成像技术在腹腔镜下肠隔膜手术中的应用研究

目的探讨吲哚菁绿(indocyanine green,ICG)分子荧光成像技术在先天消化道畸形肠隔膜手术中的应用价值。方法以2018年5月至2020年12月湖南省儿童医院普外一科10例肠隔膜患者作为研究对象,所有患者在ICG分子荧光成像技术指导下完成手术。术中按0.5 mg/kg剂量、将2.5 mg/20 mL ICG稀释液经胃管注入,通过ICG分子荧光成像技术对肠隔膜进行实时定位引导;术中完成吻合后再对吻合口部进行ICG分子荧光检测,协助判断有无渗漏。结果10例患者均在ICG分子荧光成像技术辅助下,术中实时呈现肠隔膜的精准定位,且发现肠吻合口渗漏1例,予以及时修补后再次检测原肠吻合口渗漏处无荧光聚集;术后无一例肠漏发生。结论ICG分子荧光成像技术不仅可在术中实时精准定位肠隔膜,而且发现吻合口渗漏的敏感度高。ICG分子荧光成像技术在儿童先天消化道畸形的手术导航中具有一定的临床应用价值。

Strictures, diaphragms, erosions or ulcerations of ischemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drug-induced lesions

AIM： To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA- induced erosions and ulcers of the stomach. METHODS： In the period between 1997 and 2002, we investigated biopsy materials obtained from 611 patients （415 women, 196 men, average age 60.5 years） with endoscopic focal erosions, ulcerations, strictures or diaphragms in the colon. In the biopsies obtained from these lesions, we always established the suspected diagnosis of NSA/D-inducecl lesions whenever necroses of the ischemic type were found. Together with the histological report, we enclosed a questionnaire to investigate the use of medication. The data provided by the questionnaire were then correlated with the endoscopic findings, the location, number and nature of the lesions, and the histological findings. RESULTS： At the time of their colonoscopy, 86.1% of the patients had indeed been taking NSAID/ASA medication for years （43.9%） or months （29.5%）. The most common indication for the use of these drugs was pain （64.3%）, and the most common indication for colonoscopy was bleeding （55.5%）. Endoscopic inspection revealed multiple erosions and/or ulcers in 60.6%, strictures in 15.8%, and diaphragms in 3.0% of the patients. The lesions were located mainly in the right colon including the transverse colon （79.9%）. A separate analysis of age and sex distribution, endoscopic and histological findings for NSAIDs alone, ASA alone, combined NSAID/ASA, and for patients denying the use of such drugs, revealed no significant differences among the groups. CONCLUSION： This uncontrolled retrospective study based on the histological finding of an ischemic necrosis shows that the histologically suspected diagnosis of NSAID-induced lesions in the colon is often correct. The true diagnostic validity of this finding and the differentiation from ischemic colitis should, however, be investigated in a prospective controlled study.

Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs

AIM:To summarize clinical,endoscopic,radiologic and pathologic features of special diaphragm-like strictures found in small bowel,with no patient use of nonsteroidal anti-inflammatory drugs(NSAIDs).METHODS:From January 2000 to fecember 2009,5 cases(2 men and 3 women,with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures of small bowel on imaging,,operation and pathology.All the patients denied the use of NSAIDs.The clinical,endoscopic,radiologic and pathologic findings in these 5 patients were retrospectively reviewedfrom the hospital database.Images of capsule endoscopy(CE) and small bowel follow-through(SBFT) obtained in 3 and 3 patients,respectively,and images of double-balloon enteroscopy and computed tomography enterography(CTE) obtained in all 5 patients were available for review.RESULTS:All patients presented with long-term(2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia.There was only one stricture in ?our cases and three lesions in one case,and all the lesions were located in the middle or distal segment of ileum.Circumferential stricture was shown in the small bowel in three cases in the CE image,but the capsule was retained in the small bowel of 2 patients.Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient.The lesions were shown as circumferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE(in all 5 cases),SBFT(in 2 cases) and double-balloon enteroscopy(in all cases).On microscopy,a chronic inflammatory infiltrate and circumferential diaphragm were found in all lesions.CONCLUSION:fiaphragm-like strictures of small bowel might be a special consequence of unclear damaging insults to the intestine,having similar clinical,endoscopic,radiologic and pathologic features.

Diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer:a case report

We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the diagnosis and treatment and resulted in colon perforation. After computed tomography confirmed the diagnosis, an emergency operation was performed. During the operation, we found colon perforation. Because pollution of thoracic cavity was serious, we performed proximal end colon neostomy. The patient recovered and discharged with active treatment 35 days after operation. We consider surgical repair of the diaphragmatic hernia is recommended to avoid the potentially disastrous complications, such as strangulation or perforation of the herniated contents, which can threaten the life of the patient if diagnosis is delayed.

疑诊克罗恩病的鉴别探讨:附4例分析

克罗恩病是一种病因尚未明确的慢性炎性肠病,发病率在近年来呈稳步升高趋势。某些特殊且少见的肠道疾病会出现类似的临床症状和辅助检查结果,易被误诊为克罗恩病而失去最佳治疗时机。2017至2019年武汉大学中南医院收治的4例初步疑诊为克罗恩病患者,术后分别诊断为肠系膜动脉肌纤维增生、特发性肠系膜静脉硬化性肠炎、隐源性多灶溃疡狭窄性肠炎和隔膜样肠病,本文结合4例患者临床资料,对不同疾病之间的特点作出鉴别讨论。