Background Conventional high ligation and stripping of the great saphenous vein （GSV） has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery （S...Background Conventional high ligation and stripping of the great saphenous vein （GSV） has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery （SEPS） plus endovenous laser treatment （EVLT） could be applied as individual therapy. This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators. Methods Placement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011. After randomization, SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia, in combination with EVLT to close the superficial varicose veins without impacting the GSV. The remaining 42 limbs were treated using traditional GSV phlebectomy as controls. Results Postoperatively, all varicose veins were resolved, with lightening of the pigmentation and healing of the ulcer. Within a follow-up period of 5-11 months, no symptoms had recurred. Compared with the control group, the operation time, the number of incisions sutured, and the in-hospital time decreased on average by 1.5 hours, 4.7, and 6.8 days, respectively （P 〈0.01 in all cases）. Conclusion Combined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.展开更多
Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastr...Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastrointestinal(GI)tract provides a unique opportunity to access multiple vascular structures,especially in the mediastinum and abdomen,thus permitting a variety of EUS-guided vascular interventions.The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract.EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy.EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity,thus,avoiding radiation exposure.EUS-guided techniques also allow real-time microscopic examination after target biopsy.Furthermore,many necessary interventions can be done during the same procedure after diagnosis.This article provides an overview of EUS-guided vascular interventions such as variceal,non-variceal bleeding interventions,EUSguided portal vein(PV)access with the formation of an intrahepatic portosystemic shunt,and techniques related to diagnosis of GI malignancies.Furthermore,we discuss current insights and future outlook of therapeutic modalities like PV embolization,PV sampling,angiography,drug administration,and portal pressure measurement.展开更多
文摘Background Conventional high ligation and stripping of the great saphenous vein （GSV） has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery （SEPS） plus endovenous laser treatment （EVLT） could be applied as individual therapy. This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators. Methods Placement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011. After randomization, SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia, in combination with EVLT to close the superficial varicose veins without impacting the GSV. The remaining 42 limbs were treated using traditional GSV phlebectomy as controls. Results Postoperatively, all varicose veins were resolved, with lightening of the pigmentation and healing of the ulcer. Within a follow-up period of 5-11 months, no symptoms had recurred. Compared with the control group, the operation time, the number of incisions sutured, and the in-hospital time decreased on average by 1.5 hours, 4.7, and 6.8 days, respectively （P 〈0.01 in all cases）. Conclusion Combined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.
文摘Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastrointestinal(GI)tract provides a unique opportunity to access multiple vascular structures,especially in the mediastinum and abdomen,thus permitting a variety of EUS-guided vascular interventions.The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract.EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy.EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity,thus,avoiding radiation exposure.EUS-guided techniques also allow real-time microscopic examination after target biopsy.Furthermore,many necessary interventions can be done during the same procedure after diagnosis.This article provides an overview of EUS-guided vascular interventions such as variceal,non-variceal bleeding interventions,EUSguided portal vein(PV)access with the formation of an intrahepatic portosystemic shunt,and techniques related to diagnosis of GI malignancies.Furthermore,we discuss current insights and future outlook of therapeutic modalities like PV embolization,PV sampling,angiography,drug administration,and portal pressure measurement.
文摘目的评估内镜序贯经颈静脉肝内门体分流术(TIPS)治疗肝硬化急性食管胃静脉曲张破裂出血(EGVB)的安全性及有效性。方法将2019年9月—2021年3月接受内镜序贯TIPS治疗的肝硬化急性EGVB 31例作为内镜序贯TIPS组,将接受单纯内镜序贯治疗的46例作为内镜序贯组。观察内镜序贯TIPS组门静脉压力梯度变化情况,比较2组静脉曲张改善程度及肝功能变化,术后1、3、6、12个月再出血率及肝性脑病发生率,随访结束后分析2组生存情况。结果内镜序贯TIPS组术后门静脉压力梯度低于术前(P<0.01)。内镜序贯TIPS组术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)术后1个月高于其他时点(P<0.05),术后3个月开始下降;内镜序贯TIPS组术后血清胆红素升高,术后3个月直接胆红素(DBIL)和间接胆红素(IBIL)升至高峰,术后6个月逐渐下降(P<0.05)。内镜序贯组术后3、7 d ALT、AST较术前降低,ALB较术前升高(P<0.05);术后1个月总胆红素(TBIL)水平低于术前(P<0.05);术后7 d及术后1、3个月DBIL低于术前(P<0.05)。2组术后静脉曲张根除率比较差异无统计学意义(P>0.05)。内镜序贯TIPS组术后6、12个月再出血率低于内镜序贯组(P<0.01);2组术后肝性脑病发生率及术后1年生存率比较差异均无统计学意义(P>0.05)。结论TIPS可降低门静脉压力,静脉曲张根除率与内镜序贯治疗相当,但可有效降低再出血率,而并不降低生存率且不增加肝性脑病发生率。内镜序贯TIPS治疗肝硬化EVGB安全有效。
