Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor(GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further man...Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor(GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor's dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.展开更多
AIM: To compare the efficacy and safety of endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for the treatment of colorectal tumors.METHODS: Databases, such as PubMed, EMBASE, Cochrane Librar...AIM: To compare the efficacy and safety of endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for the treatment of colorectal tumors.METHODS: Databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 were searched to include eligible articles. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histological resection rate and the local recurrence rate. Meanwhile, we also compared the operation time and the incidence of procedure-related complications.RESULTS: Six trials were identified and a total of 1642 lesions were included. The en bloc resection rate was higher and the local recurrence rate was lower in the ESD group compared with the EMR group(OR = 7.94; 95%CI: 3.96-15.91; OR = 0.09; 95%CI: 0.04-0.19). There was no significant difference in histological resection rate(OR = 1.65; 95%CI: 0.29-9.30) and procedure-related complication rate between the two groups(OR = 1.59; 95%CI: 0.92-2.73). The meta-analysis also showed that ESD was more time consuming than EMR.CONCLUSION: Compared with EMR, ESD results in higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications.展开更多
Objective To evaluate the use of titanium mesh reconstruction after sternal tumor resection. Methods From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital....Objective To evaluate the use of titanium mesh reconstruction after sternal tumor resection. Methods From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. Results Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. Conclusions Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.展开更多
Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the co...Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.展开更多
目的探讨等离子膀胱瘤整块切除术(bipolar plasma kinetic en-bloc resection of bladder tumor,PK-ERBT)、传统经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)和绿激光膀胱肿瘤整块剜除(green-light laser en ...目的探讨等离子膀胱瘤整块切除术(bipolar plasma kinetic en-bloc resection of bladder tumor,PK-ERBT)、传统经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)和绿激光膀胱肿瘤整块剜除(green-light laser en bloc enucleation of bladder tumors,GLEBT)治疗非肌层浸润性膀胱癌的疗效。方法回顾性选取104例非肌层浸润性膀胱癌患者作为研究对象,按照手术方法不同分为PK-ERBT组(35例)、TURBT组(34例)和GLEBT组(35例)。比较3组患者围手术期情况(手术时间、住院天数、导尿管留置时间)、术后1年肿瘤预后标志物(P53蛋白、ki-67蛋白)表达情况、并发症发生率及复发率。结果3组围术期相关指标比较,差异有统计学意义(P<0.05)。GLEBT组与PK-ERBT组手术时间比较,无统计学意义(P>0.05);GLEBT组、PK-ERBT组手术时间、导尿管留置时间、住院天数均少于TURBT组(P<0.05);GLEBT组导尿管留置时间、住院天数少于PK-ERBT组(P<0.05)。3组术后1年肿瘤预后标志物表达情况比较,差异有统计学意义(P<0.05);PK-ERBT组、GLEBT组P53蛋白、ki-67蛋白阳性率比较,无统计学差异(P>0.05);但PK-ERBT组、GLEBT组P53蛋白、ki-67蛋白阳性率低于TURBT组(P<0.05)。3组并发症发生率比较,差异有统计学意义(P<0.05);其中PK-ERBT组、GLEBT组并发症发生率比较,差异无统计学意义(P>0.05);但PK-ERBT组、GLEBT组并发症发生率均低于TURBT组(P<0.05)。3组患者术后1年复发率比较,差异有统计学意义(P<0.05);PK-ERBT组、GLEBT组复发率均低于TURBT组(P<0.05),但PK-ERBT组、GLEBT组复发率比较,无统计学差异(P>0.05)。结论治疗非肌层浸润性膀胱癌患者,采用GLEBT相比PK-ERBT、TURBT具有更高的安全性,有望成为治疗该病的推荐手术方式。展开更多
基金Supported by Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health and Welfare+3 种基金Republic of KoreaNo.HI14C3477Korea University grantNo.K1523601
文摘Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor(GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor's dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.
文摘AIM: To compare the efficacy and safety of endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for the treatment of colorectal tumors.METHODS: Databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 were searched to include eligible articles. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histological resection rate and the local recurrence rate. Meanwhile, we also compared the operation time and the incidence of procedure-related complications.RESULTS: Six trials were identified and a total of 1642 lesions were included. The en bloc resection rate was higher and the local recurrence rate was lower in the ESD group compared with the EMR group(OR = 7.94; 95%CI: 3.96-15.91; OR = 0.09; 95%CI: 0.04-0.19). There was no significant difference in histological resection rate(OR = 1.65; 95%CI: 0.29-9.30) and procedure-related complication rate between the two groups(OR = 1.59; 95%CI: 0.92-2.73). The meta-analysis also showed that ESD was more time consuming than EMR.CONCLUSION: Compared with EMR, ESD results in higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications.
文摘Objective To evaluate the use of titanium mesh reconstruction after sternal tumor resection. Methods From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. Results Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. Conclusions Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.
文摘Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.
文摘目的探讨等离子膀胱瘤整块切除术(bipolar plasma kinetic en-bloc resection of bladder tumor,PK-ERBT)、传统经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)和绿激光膀胱肿瘤整块剜除(green-light laser en bloc enucleation of bladder tumors,GLEBT)治疗非肌层浸润性膀胱癌的疗效。方法回顾性选取104例非肌层浸润性膀胱癌患者作为研究对象,按照手术方法不同分为PK-ERBT组(35例)、TURBT组(34例)和GLEBT组(35例)。比较3组患者围手术期情况(手术时间、住院天数、导尿管留置时间)、术后1年肿瘤预后标志物(P53蛋白、ki-67蛋白)表达情况、并发症发生率及复发率。结果3组围术期相关指标比较,差异有统计学意义(P<0.05)。GLEBT组与PK-ERBT组手术时间比较,无统计学意义(P>0.05);GLEBT组、PK-ERBT组手术时间、导尿管留置时间、住院天数均少于TURBT组(P<0.05);GLEBT组导尿管留置时间、住院天数少于PK-ERBT组(P<0.05)。3组术后1年肿瘤预后标志物表达情况比较,差异有统计学意义(P<0.05);PK-ERBT组、GLEBT组P53蛋白、ki-67蛋白阳性率比较,无统计学差异(P>0.05);但PK-ERBT组、GLEBT组P53蛋白、ki-67蛋白阳性率低于TURBT组(P<0.05)。3组并发症发生率比较,差异有统计学意义(P<0.05);其中PK-ERBT组、GLEBT组并发症发生率比较,差异无统计学意义(P>0.05);但PK-ERBT组、GLEBT组并发症发生率均低于TURBT组(P<0.05)。3组患者术后1年复发率比较,差异有统计学意义(P<0.05);PK-ERBT组、GLEBT组复发率均低于TURBT组(P<0.05),但PK-ERBT组、GLEBT组复发率比较,无统计学差异(P>0.05)。结论治疗非肌层浸润性膀胱癌患者,采用GLEBT相比PK-ERBT、TURBT具有更高的安全性,有望成为治疗该病的推荐手术方式。
