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不需X线透视引导的经鼻内镜检查直接视觉控制食管支架植入

发布日期:2014-1-29 12:40:32 文章来源:Endoscopy 作者次数:1151
    不需X线透视引导的经鼻内镜检查直接视觉控制食管支架植入

    M. Borgulya, C. Ell, J. Pohl

    德国威斯巴登(美因茨大学医学院)Horst Schmidt Kliniken博士,第二内科部

    自膨式金属支架(SEMSs)植入术是一项行之有效的治疗食管狭窄和术后吻合口瘘的手段。自膨式金属支架(SEMSs)植入的传统内镜手术需要透视引导,但是采用超薄内镜行经鼻内镜检查(TNE)可能会允许在直接视觉控制下精确地释放支架,而不需X线透视引导。此前瞻性收集的数据审查了不需透视并在TNE引导下的自膨式金属支架植入的可行性和安全性。20093月至20112月期间,20例患者接受了无透视并在TNE引导下的自膨式金属支架植入术。该技术成功率为100%,而且手术过程中不需X线透视检查。5例患者在重症监护病房接受了作为一种病房简单手术的SEMS植入术。平均干预时间为13.4分(范围为6-26),而且未出现早期并发症。总之,TNE引导的SEMS植入使不需透视引导而精确地释放支架成为可能,因此它可作为一种病房简单手术而被执行。

     

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    Transnasal endoscopy for direct visual control of esophageal stent placement without fluoroscopy

    M. Borgulya, C. Ell, J. Pohl

    Department of Internal Medicine II, Dr. Horst Schmidt Kliniken, Wiesbaden(MedicalSchoolof the University ofMainz),Germany

     

    Placement of self-expanding metal stents (SEMSs) is a well-established treatment for esophageal stenosis and postoperative anastomotic leaks. Conventional endoscopic procedures for SEMS placement require fluoroscopic guidance, but transnasal endoscopy (TNE) with ultraslim endoscopes may allow precise stent release under direct visual control without the need for fluoroscopy. This prospectively collected data investigated the feasibility and safety of TNE-guided SEMS placement without fluoroscopy. Between March 2009 and February 2011, 20 consecutive patients underwent TNE-guided SEMS placement without fluoroscopy. The technical success rate was 100 % and no fluoroscopy was required during the procedures. Five patients underwent SEMS placement as a bedside procedure in the intensive care unit. The mean intervention time was 13.4 minutes (range 6 - 26) and there were no early complications. In summary, TNE-guided SEMS placement allows precise stent placement without fluoroscopic control and can therefore be performed as a simple bedside procedure.

     

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