Endoscope

内窥镜
  • 文章类型: Case Reports
    背景:侧脑室肿瘤的治疗需要在最大化安全切除和保留神经功能之间取得平衡。
    方法:作者介绍了一个成功的左侧脑室中枢神经细胞瘤切除病例。采用经上额沟入路,提供安全的走廊,同时最大限度地减少对周围神经解剖学的损害。内窥镜的使用进一步促进了手术,能够确认完全切除肿瘤并保留深静脉引流和脑室周围结构。
    结论:该病例强调了经沟入路的实用性和内镜辅助治疗侧脑室肿瘤的益处。
    BACKGROUND: The management of lateral ventricle tumors requires a balance between maximizing safe resection and preserving neurological function.
    METHODS: The authors present a successful case of a left lateral ventricular central neurocytoma resection. The trans-superior frontal sulcus approach was employed, providing a safe corridor while minimizing damage to the surrounding neuroanatomy. The use of an endoscope further facilitated the procedure, enabling the confirmation of complete tumor removal and the preservation of deep venous drainage and periventricular structures.
    CONCLUSIONS: This case highlights the utility of the trans-sulcal approach and the benefits of endoscopic assistance in the management of lateral ventricle tumors.
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  • 文章类型: Journal Article
    背景:当前的内窥镜再处理指南建议需要监视高风险内窥镜的手动清洁或更多。本研究的目的是确定结肠镜和支气管镜的最佳提取量,并证明ChannelCheck™快速测试的提取功效。
    方法:用作阳性对照的试验土壤是含有20%去纤维牛血的ATS2015。对结肠镜和支气管镜仪器通道的提取进行了评估,以确定蛋白质的最佳提取量和提取效率,碳水化合物,和血红蛋白.
    结果:在测试的提取量中,10mL对于结肠镜和支气管镜都是最佳的。碳水化合物的提取效率为91%,血红蛋白83.7%,蛋白质占82.4%。
    结论:通过ChannelCheck快速测试对这些分析物的检测限达到或超过与柔性内窥镜的适当手动清洁相关的既定水平。
    BACKGROUND: The need to monitor manual cleaning of high-risk endoscopes is recommended or more so required by the current endoscope reprocessing guidelines. The objective of this study was to establish the optimal extraction volume for colonoscopes and bronchoscopes and demonstrate the extraction efficacy for the ChannelCheck™ rapid test.
    METHODS: The test soil utilized as a positive control was ATS2015 containing 20% defibrinated bovine blood. The extraction from the instrument channel of a colonoscope and bronchoscope was evaluated to establish the optimal extraction volume and the extraction efficacy for protein, carbohydrate, and haemoglobin.
    RESULTS: Of the extraction volumes tested, 10 mL was optimal for both colonoscopes and bronchoscopes. The extraction efficacy was 91% for carbohydrate, 83.7% for haemoglobin, and 82.4% for protein.
    CONCLUSIONS: The limit of detection for these analytes by the ChannelCheck rapid test meet or exceed the established levels that correlate with adequate manual cleaning of flexible endoscopes.
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  • 文章类型: Journal Article
    内窥镜对于辅助手术和疾病诊断至关重要,包括癌症的早期检测。内窥镜的有效使用依赖于其光学性能,可以用一系列度量来表征,例如分辨率,揭示解剖细节至关重要。调制传递函数(MTF)是评估内窥镜分辨率的关键指标。然而,ISO8600-5标准的2020版本,在介绍内窥镜MTF测量方法的同时,缺乏经验验证,不包括光电视频内窥镜,最大的内窥镜家族。测量视频内窥镜的MTF需要针对其独特特征的定制标准。本文旨在扩大ISO8600-5:2020的范围,包括视频内窥镜,通过优化MTF测试方法和解决影响测量精度的参数。我们研究了图像亮度的强度和均匀性的影响,图表调制补偿,图像数字值的线性度,自动增益控制,图像增强,斜边测试图图像上的图像压缩和感兴趣区域尺寸,因此MTF基于这些图像。通过分析这些影响,我们为设定和控制这些因素以获得准确的MTF曲线提供了建议.我们的目标是提高标准的相关性和有效性,以测量更广泛的内窥镜设备的MTF,在其他数字成像设备的MTF测量中具有潜在的应用。
    Endoscopes are crucial for assisting in surgery and disease diagnosis, including the early detection of cancer. The effective use of endoscopes relies on their optical performance, which can be characterized with a series of metrics such as resolution, vital for revealing anatomical details. The modulation transfer function (MTF) is a key metric for evaluating endoscope resolution. However, the 2020 version of the ISO 8600-5 standard, while introducing an endoscope MTF measurement method, lacks empirical validation and excludes opto-electronic video endoscopes, the largest family of endoscopes. Measuring the MTF of video endoscopes requires tailored standards that address their unique characteristics. This paper aims to expand the scope of ISO 8600-5:2020 to include video endoscopes, by optimizing the MTF test method and addressing parameters affecting measurement accuracy. We studied the effects of intensity and uniformity of image luminance, chart modulation compensation, linearity of image digital values, auto gain control, image enhancement, image compression and the region of interest dimensions on images of slanted-edge test charts, and thus the MTF based on these images. By analyzing these effects, we provided recommendations for setting and controlling these factors to obtain accurate MTF curves. Our goal is to enhance the standard\'s relevance and effectiveness for measuring the MTF of a broader range of endoscopic devices, with potential applications in the MTF measurement of other digital imaging devices.
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  • 文章类型: Journal Article
    探讨内镜经鼻蝶垂体瘤切除术后患者嗅觉功能障碍的现状,并分析其影响因素,为临床护理和康复提供参考。
    采用横断面研究设计和便利抽样法,对四川省3家甲级综合医院神经外科2022年1月至2023年6月158例经内镜经蝶入路垂体瘤切除术的垂体瘤患者进行调查。术后1周评估患者的嗅觉功能,收集患者的一般临床资料和嗅觉相关资料,对嗅觉障碍的影响因素进行Logistic回归分析。
    嗅觉功能障碍的发生率为73.42%。分析显示血痂的形成,鼻腔粘连,脑脊液漏和手术时间是经蝶入路垂体瘤切除术后患者嗅觉功能障碍的独立危险因素(p<0.05)。
    内镜经蝶入路垂体瘤切除术后患者嗅觉功能障碍的发生率较高,提示医务人员应在疾病知识和技能指导的基础上,密切关注和识别嗅觉功能障碍患者,制定有针对性的护理干预措施,促进患者嗅觉功能和生活质量的改善。
    UNASSIGNED: To investigate the current situation of olfactory dysfunction in patients after endoscopic transsphenoidal resection of pituitary tumors, and analyze its influencing factors, to provide references for clinical nursing and rehabilitation.
    UNASSIGNED: A cross-sectional study design and convenience sampling method were used to investigate 158 patients with pituitary tumors treated by endoscopic transsphenoidal pituitary tumor resection in the Department of Neurosurgery of three Grade-A general hospitals in Sichuan Province from January 2022 and June 2023. The olfactory function of patients was evaluated 1 week after surgery, and the general clinical data and olfactory related data of patients were collected, and the influencing factors of olfactory disorder were analyzed by logistic regression.
    UNASSIGNED: The incidence of olfactory dysfunction was 73.42%. analysis revealed that the formation of blood scabs, nasal cavity adhesion, cerebrospinal fluid leakage and operation time were independent risk factors for olfactory dysfunction in patients after transsphenoidal pituitary tumor resection (p < 0.05).
    UNASSIGNED: The incidence of olfactory dysfunction is high in patients after endoscopic transsphenoidal resection of pituitary tumors, suggesting that medical staff should pay close attention to and identify patients with olfactory dysfunction based on the guidance of disease knowledge and skills, develop targeted nursing interventions, and promote the improvement of patients\' olfactory function and quality of life.
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  • 文章类型: Journal Article
    背景:对于前颅窝(ACF)的前内侧部分的微创治疗方法,ACF后外侧部分的小切口和开颅术是优选的。
    方法:我们描述了超锁眼入路(SPKA)的概念和技术,使用外镜和内窥镜治疗ACF病变。
    结论:SPKA可以从横向方向观察ACF;内窥镜的扩展视角可以观察ACF的前内侧部分,包括双侧嗅沟。避免了面部皮肤和大的头皮切口,使这种方法对ACF病变有效。
    BACKGROUND: For a minimally invasive treatment approach to the anteromedial part of the anterior cranial fossa (ACF), a small incision and craniotomy of the posterolateral part of the ACF are preferable.
    METHODS: We described the concept and technique of suprapterional keyhole approach (SPKA), which uses an exoscope and endoscope to treat ACF lesions.
    CONCLUSIONS: The SPKA enables ACF observation from the lateral direction; the endoscope\'s extended viewing angles enable the observation of the anteromedial part of the ACF, including the bilateral olfactory groove. Facial skin and large scalp incisions are avoided, making this approach efficient for ACF lesions.
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  • 文章类型: Journal Article
    目的:评价内镜下改良蝶形软骨-软骨膜技术1型鼓室成形术的解剖和功能结果。
    方法:在我们的修改中,软骨膜周向升高,直到复合移植物的附着部分与穿孔的大小和形状大致相同,根据穿孔对软骨进行修整,但增大0.5毫米。移植物的软骨部分放置在穿孔边缘的内侧,然后将软骨膜铺开并覆盖在周围剩余的鼓膜的圆周原始表面上。
    结果:在4个月后,中小穿孔组和大穿孔组的鼓膜解剖完整率分别为100%和94%(p>0.05)。对于中小型穿孔组,前和4个月后的平均ACs分别为30±8dB和18±6.4dB(p<0.01)。前和后4个月的平均ABG为19±11dB和9±3dB(p<0.01)。对于大穿孔组,前和4个月后的平均ACs分别为43±12.5dB和21.5±7dB(p<0.01)。前和后4个月的平均ABG分别为34±8.5dB和12.5±6dB(p<0.01)。两组平均4个月后ACs和平均4个月后ABGs差异无统计学意义(p>0.05)。
    结论:与常规镶嵌蝶形软骨鼓室成形术相比,大的或边缘的穿孔可以通过这种修改更安全地密封。
    OBJECTIVE: To evaluate the anatomic and functional outcomes of type1 tympanoplasty with endoscopic modified butterfly cartilage-perichondrium technique.
    METHODS: In our modification, perichondrium was elevated circumferentially till the attached part of the composite graft was approximately same size and shape of the perforation, cartilage was trimmed based on the perforation but 0.5 mm larger. Cartilage portion of the graft was placed medial to the edge of the perforation, then perichondrium was rolled out and draped on the circumferential raw surface of remaining tympanic membrane around.
    RESULTS: At 4 months postop, the anatomic integrity rate of the tympanic membrane perforation for small & medium sized perforation and large sized perforation group were 100 % and 94 % (p > 0.05). For the small & medium perforation group, the mean pre and 4 months postop ACs were 30 ± 8 dB and 18 ± 6.4 dB (p < 0.01). The mean pre and 4 months postop ABGs were 19 ± 11 dB and 9 ± 3 dB (p < 0.01). For the large perforation group, the mean pre and 4 months postop ACs were 43 ± 12.5 dB and 21.5 ± 7 dB (p < 0.01). The mean pre and 4 months postop ABGs were 34 ± 8.5 dB and 12.5 ± 6 dB (p < 0.01). The differences of mean 4 months postop ACs and mean 4 months postop ABGs between the two groups were not significant (p > 0.05).
    CONCLUSIONS: Compared to the conventional inlay butterfly cartilage tympanoplasty technique, large or marginal perforations can be sealed more securely by this modification.
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  • 文章类型: Journal Article
    背景:鼻插管和面罩是常规氧疗中常用的充氧工具,适用于内窥镜手术并进行镇静的患者。然而,作为一种新颖的声门上通气技术,声门上喷射氧合和通气(SJOV)在内窥镜手术中的应用尚未得到很好的证实.
    方法:从开始到2024年1月16日,我们搜索了六个电子数据库,以评估SJOV在内窥镜手术中的氧合/通气功效和副作用。主要结果是低氧血症的发生率。次要结果是呼吸抑制和不良反应的发生率(鼻出血,喉咙痛,和口干)。
    结果:纳入了9项涉及2017年患者的试验。结果表明,与常规氧疗(COT)组相比,SJOV组的低氧血症发生率较低[9个试验;2017年患者;风险比(RR)=0.18;95%置信区间(CI),(0.11-0.28)]。亚组分析显示,SJOV降低了高风险组低氧血症的发生率,但对低风险组没有影响。SJOV的呼吸抑制发生率低于COT,但增加了口干等副作用。两组在鼻出血或咽喉痛方面差异无统计学意义。
    结论:与COT相比,SJOV降低了内镜手术和镇静期间高危患者低氧血症的发生率.口干的风险增加,但不是鼻出血或喉咙痛,在内窥镜手术中镇静。
    BACKGROUND: Nasal cannulas and face masks are common oxygenation tools used in conventional oxygen therapy for patients undergoing endoscopic surgery with sedation. However, as a novel supraglottic ventilation technique, the application of supraglottic jet oxygenation and ventilation (SJOV) in endoscopic surgery has not been well established.
    METHODS: We searched six electronic databases from inception to January 16, 2024, to assess the oxygenation/ventilation efficacy and side effects of the of SJOV in endoscopic surgery. The primary outcome was the incidence of hypoxemia. The secondary outcomes were the incidence of respiratory depression and adverse effects (nasal bleeding, sore throat, and dry mouth).
    RESULTS: Nine trials involving 2017 patients were included. The results demonstrated that the incidence of hypoxemia was lower in the SJOV group compared with the conventional oxygen therapy (COT) group [9 trails; 2017 patients; risk ratio (RR) = 0.18; 95% confidence interval (CI), (0.11-0.28)]. Subgroup analyses showed that SJOV reduced the incidence of hypoxemia in the high-risk group but had no effect on the low-risk group. The incidence of respiratory depression is lower in SJOV than in COT, but has increased side effects such as dry mouth. There was no statistically significant difference in nose bleeding or sore throat between the two groups.
    CONCLUSIONS: Compared with the COT, the SJOV decreased the incidence of hypoxemia in high-risk patients during endoscopic surgery with sedation. There was an increased risk of dry mouth, but not of nose bleeding or sore throat, during endoscopic surgery under sedation.
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  • 文章类型: Case Reports
    第三脑室肿瘤的手术选择需要精心的计划,考虑到复杂的解剖环境。传统的开放式显微外科手术方法可能会限制对某些肿瘤的访问,促使人们探索替代技术。内镜眶上经椎板入路(ESOTLA)已成为治疗这些肿瘤的有希望的替代方法。通过将微创锁孔方法与内窥镜可视化相结合,ESOTLA在第三脑室内提供增强的照明和更宽的视角。这种独特的优势允许改善对后交叉肿瘤的访问,并减少对显微技术所需的额叶和视神经交叉回缩的需求。降低神经认知和视觉缺陷的风险。与ESOTLA相关的并发症很少见,主要与下丘脑或光学装置的美容问题和潜在损害有关。可以通过仔细的蛛网膜下腔解剖来最小化。本章全面介绍了ESOTLA的技术方面,提供对其应用的见解,优势,和潜在的限制。此外,一个病例描述强调了通过ESOTLA成功手术切除脑室内乳头状颅咽管瘤,然后进行靶向治疗.为了通过这种新颖的方法更好地说明逐步解剖,包括一系列尸体和术中照片。
    Surgical selection for third ventricle tumors demands meticulous planning, given the complex anatomic milieu. Traditional open microsurgical approaches may be limited in their access to certain tumors, prompting the exploration of alternative techniques. The endoscopic supraorbital translaminar approach (ESOTLA) has emerged as a promising alternative for managing these tumors. By combining a minimally invasive keyhole approach with endoscopic visualization, the ESOTLA provides enhanced illumination and a wider angle of view within the third ventricle. This unique advantage allows for improved access to retrochiasmatic tumors and reduces the need for frontal lobe and optic chiasm retraction required of microscopic techniques, decreasing the risk of neurocognitive and visual deficits. Complications related to the ESOTLA are rare and primarily pertain to cosmetic issues and potential compromise of the hypothalamus or optic apparatus, which can be minimized through careful subarachnoid dissection. This chapter offers a comprehensive description of the technical aspects of the ESOTLA, providing insights into its application, advantages, and potential limitations. Additionally, a case description highlights the successful surgical extirpation of an intraventricular papillary craniopharyngioma via the ESOTLA followed by targeted therapy. To better illustrate the stepwise dissection through this novel approach, a series of cadaveric and intraoperative photographs are included.
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  • 文章类型: Journal Article
    脑出血是一种多发病,也是致残的主要原因之一。即使在脑出血的情况下,如果有改善功能预后的治疗方法,好处是不可估量的。尽管在过去的研究中,证据水平很高的报道有限,已经发现,如果可以以微创方式去除大量血肿,手术可以有效。此外,很明显,在卒中发作后2天内进行手术时,出血的控制成为一个问题,而且治疗时间窗可能会更长.在日本,自从西原等人引入透明护套以来。,内镜下血肿清除术已得到广泛应用,并已成为标准手术.这个手术需要的三个基本设备是一个刚性的范围,抽吸凝结器,和一个透明的鞘。手术的重点是通过透明的鞘管寻找血肿和出血点,使出血血管凝固。在这一章中,我们将介绍使用这些设备的手术技术,但是通过考虑自己的技术来仔细决定手术选择是很重要的,每个病人的情况,以及该地区可用的设备。
    Cerebral hemorrhage is a frequent disease and one of the main causes of disabilities. Even in the case of cerebral hemorrhage, if there were a treatment that would improve the functional prognosis, the benefits would be immeasurable. Although there are limited reports with a high level of evidence in past studies, it has been found that surgery can be effective if a large amount of hematoma can be removed in a minimally invasive manner. Also, it has become clear that the control of bleeding becomes a problem when surgery is performed within 2 days after the onset of stroke and that the therapeutic time window might be longer. In Japan, since the introduction of the transparent sheath by Nishihara et al., endoscopic hematoma removal has been widely performed and has become the standard surgical procedure. The three basic equipment needed for this surgery are a rigid scope, a suction coagulator, and a transparent sheath. The key point of the surgery is to search for hematomas and bleeding points through a transparent sheath and coagulate the bleeding vessels. In this chapter, we will introduce surgical techniques using these devices, but it is important to carefully decide on surgical options by considering your own technique, the condition of each patient, and the devices available in the area.
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  • 文章类型: Journal Article
    目的:使用基于刮刀的牵开系统的经皮质入路传统上用于深部脑室内和实质脑肿瘤的显微外科切除。最近,已经开发了透明的圆柱形或管状牵开器,以提供稳定的走廊来进入更深的脑部病变并进行双向显微外科手术切除。灵活的内孔可最大限度地减少手术期间的大脑收缩损伤,以及内窥镜的卓越视力,提供了几个优点比标准的显微外科手术。在这一章中,我们描述了内窥镜引导下内窥镜切除深部轴内脑肿瘤的手术技术。
    方法:我们在我们机构中用于脑室内和脑实质内脑肿瘤的外科治疗的内窥镜内移植技术已通过说明性案例进行了详细描述。
    结果:分析了脑室内和实质内手术的文献综述结果,并讨论了该技术的可行性和安全性。强调了手术并发症的避免和处理。端口技术提供了许多潜在的优势,包括(1)通过均匀分配回缩力来减少局灶性脑损伤,(2)在插管期间将白质破坏和束状损伤的风险降至最低,(3)确保手术过程中手术通道的稳定性,(4)防止在整个手术中意外扩张的皮质切除术和白纤维束夹层,(5)保护周围组织免受器械进入和折返造成的医源性损伤。
    结论:内窥镜辅助技术是安全的,为切除脑室内和脑实质病变提供了有效的替代选择。
    OBJECTIVE: Transcortical approaches using a spatula-based retraction system have traditionally been used for the microsurgical resection of deep-seated intraventricular and parenchymal brain tumors. Recently, transparent cylindrical or tubular retractors have been developed to provide a stable corridor to access deeper brain lesions and perform bimanual microsurgical resection. The flexible endoports minimize brain retraction injury during surgery and, along with the superior vision of endoscopes, offer several advantages over standard microsurgery. In this chapter, we describe the surgical technique of the endoport-guided endoscopic excision of deep-seated intraaxial brain tumors.
    METHODS: The endoscopic endoport technique that we use at our institution for the surgical management of intraventricular and intraparenchymal brain tumors has been described in detail with illustrative cases.
    RESULTS: Results from the literature review of intraventricular and intraparenchymal port surgery were analyzed, and the feasibility and safety of this technique were discussed. Surgical complication avoidance and management were highlighted. The port technique offers numerous potential advantages, including (1) reducing focal brain injury by distributing retraction forces homogenously, (2) minimizing white matter disruption and the risk of fascicle injury during cannulation, (3) ensuring the stability of the surgical corridor during the procedure, (4) preventing inadvertent expansion of the corticectomy and white fiber tract dissection throughout surgery, and (5) protecting the surrounding tissues against iatrogenic injuries caused by instrument entry and reentry.
    CONCLUSIONS: The endoport-assisted endoscopic technique is safe and offers an effective alternative option for the resection of intraventricular and intraparenchymal lesions.
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