Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding ri...Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.展开更多
Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its effi cacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been ...Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its effi cacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bi-directional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.展开更多
背景:由于社会步入老龄化,老年股骨转子间骨折发病率亦呈现上升趋势,其治疗方法也多种多样。积极手术治疗、早期下地活动、减少术后并发症是目前基本的治疗原则,手术方法包括内固定和人工关节置换两大类,人工关节置换目前仅用于严重粉...背景:由于社会步入老龄化,老年股骨转子间骨折发病率亦呈现上升趋势,其治疗方法也多种多样。积极手术治疗、早期下地活动、减少术后并发症是目前基本的治疗原则,手术方法包括内固定和人工关节置换两大类,人工关节置换目前仅用于严重粉碎性骨折伴严重骨质疏松的患者。近年来国内外开始尝试人工关节置换治疗老年股骨转子间骨折,但疗效与安全性仍存在诸多争议。人工关节置换作为其中的一种治疗方法,随着它的优势越来越明显,逐渐受到临床骨科医师的关注。目的:通过对国内外人工关节置换治疗老年股骨转子间骨折的体会进行综述,为骨科医师在临床治疗老年股骨转子间骨折提供选择。方法:第一作者应用计算机检索2000年1月至2018年10月PubMed数据库、Webofscience数据库、万方数据库、中国期刊全文数据库的相关文章,英文检索词"intertrochanteric fractures of the femur,the elderly,artificial joint replacement,fracture treatment";中文检索词"股骨转子间骨折,老年人,人工关节置换,骨折治疗"。结果与结论:①共检索到75篇相关文献,60篇文献符合纳入标准;②人工髋关节置换治疗老年股骨转子间骨折短期疗效令人满意,但是术前必须明确人工置换的适应证及禁忌证;③国内外文献在老年股骨转子间骨折治疗手段上并未达成一致,目前开展的临床治疗较少,缺少多中心大样本量的临床试验,这些都需要进一步研究探索。展开更多
文摘Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
文摘Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its effi cacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bi-directional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.
文摘背景:由于社会步入老龄化,老年股骨转子间骨折发病率亦呈现上升趋势,其治疗方法也多种多样。积极手术治疗、早期下地活动、减少术后并发症是目前基本的治疗原则,手术方法包括内固定和人工关节置换两大类,人工关节置换目前仅用于严重粉碎性骨折伴严重骨质疏松的患者。近年来国内外开始尝试人工关节置换治疗老年股骨转子间骨折,但疗效与安全性仍存在诸多争议。人工关节置换作为其中的一种治疗方法,随着它的优势越来越明显,逐渐受到临床骨科医师的关注。目的:通过对国内外人工关节置换治疗老年股骨转子间骨折的体会进行综述,为骨科医师在临床治疗老年股骨转子间骨折提供选择。方法:第一作者应用计算机检索2000年1月至2018年10月PubMed数据库、Webofscience数据库、万方数据库、中国期刊全文数据库的相关文章,英文检索词"intertrochanteric fractures of the femur,the elderly,artificial joint replacement,fracture treatment";中文检索词"股骨转子间骨折,老年人,人工关节置换,骨折治疗"。结果与结论:①共检索到75篇相关文献,60篇文献符合纳入标准;②人工髋关节置换治疗老年股骨转子间骨折短期疗效令人满意,但是术前必须明确人工置换的适应证及禁忌证;③国内外文献在老年股骨转子间骨折治疗手段上并未达成一致,目前开展的临床治疗较少,缺少多中心大样本量的临床试验,这些都需要进一步研究探索。
