超声内镜辅助下ESD治疗上消化道隆起性病变的疗效及安全性探讨

目的探讨超声内镜对于应用ESD治疗上消化道隆起性病变的疗效及安全性。方法20例上消化道黏膜局限性隆起病变,先行超声内镜检查,再采用ESD进行治疗,比较术前超声内镜诊断与内镜治疗术后病理结果的一致性,记录手术耗时、整块切除率、并发症发生率及局部残留复发率。结果食管病变6例,其中早癌及高级别上皮内瘤变各1例,平滑肌瘤4例;胃内病变14例,其中胃早癌及高级别上皮内瘤变各3例,异位胰腺1例,间质瘤7例。术前EUS诊断与术后病理结果的一致性为100%。手术时间16~100（32.8±15.7）min;整块切除率85%,出血率为20%,穿孔率10%,术后随访1～12个月,无残留与复发。结论超声内镜对消化道黏膜隆起性病变诊断准确率高,超声内镜辅助下ESD治疗上消化道隆起性病变安全有效。     

基于旋转扫描探头的OCT内窥成像系统设计*

为了同时获取样品的表面和深度信息,研究光学相干层析的成像原理,建立了基于光学相干层析技术的内窥系统,实现了旋转扫描成像,系统的工作波长为1 310 nm,工作带宽为80 nm.理论推导及计算机仿真得到了系统信噪比与干涉仪的分光比、反射率之间的关系并分析了理论分辨率和探测深度.提出外径为5 mm的内窥镜扫描探头,聚焦距离为12 mm,数值孔径NA为0.47,折射率分布常量A=0.218 7.利用微型电机驱动直角棱镜实现扫描,旋转速度为25 rpm,旋转一周得到640个采样点.采用多层盖玻片和洋葱表皮作为样品进行实验分析,得到了盖玻片和洋葱的图像,横向分辨率和纵向分辨率分别为10 μm和15 μm.结果表明,设计的光学相干层析内窥系统能够用于旋转扫描成像,获取更多的组织信息.     

Transoral Robotic Surgery (TORS): Glottic Microsurgery in a Canine Model

OBJECTIVES/HYPOTHESIS: We hypothesize that bimanual, three-dimensional robotic surgery will prove valuable for glottic microsurgical procedures. STUDY DESIGN: To test this hypothesis, we developed and optimized a canine model for glottic microsurgery using a commercially available surgical robot. Methods Using a da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), glottic microsurgery was performed with a hydrodissection technique in a canine model. The experiments were performed on two orotracheal intubated mongrel dogs under general anesthesia in the supine position on a standard operating room table. A videoscope and two, 360-degree rotating, 5- and 8-mm, wrested-end effector instruments were introduced transorally with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. The procedure was performed in duplicate and was documented with still and video photography. RESULTS: Glottic microsurgery was successfully performed using the da Vinci Surgical Robot, with both 5- and 8-mm instrumentation. The smaller, 5-mm instruments afforded greater visualization of the operative site and increased maneuverability, which resulted in reduced operative time. The robotic system provided excellent visualization as well as controlled and delicate microdissection at the vocal cord level. CONCLUSIONS: Robotic laryngeal microsurgery is technically feasible in the canine model and warrants consideration for evaluation in controlled human trials.     

Preliminary study on the ability of trained singers to control the intrinsic and extrinsic laryngeal musculature

Little literature is available on professional musical theater female singers, a population that regularly uses a wide variety of vocal qualities. This study tested the hypothesis that different vocal qualities cause observable specific configurations of muscular movements and structural changes of the larynx, hypopharynx, oral pharynx, and oral cavity for individual singers. Fiberoptic rigid and flexible endoscopic observation were used to determine visual analysis of such configurations. This study documents observable physiologic changes that were made by professional musical theater female singers in specific vocal qualities.     

Endoscopic optical probe with a PZT actuator and MR tracker

A miniaturized optical probe with a magnetic-resistance (MR) position tracker and piezoelectric-transduce (PZT) mirror system was developed for endoscopic optical imaging. All of the optical components such as collimation and focal lenses, reflection mirror, PZT linear actuator and MR sensor were wholly packaged in a single scanning probe with a volume of 3.57 cm³. This endoscopic probe has the advantages of having a small volume, extended stroke length (4.5 mm), high scanning speed (18.2 mm/s), efficient recoupling ratio (78.3%) and high spatial resolution (11.7 μm) compared to conventional endoscopes. Consequently, it showed the potential for improving the endoscopic imaging system and utilizing the image-guided robotic surgery system.     

老年急性梗阻性化脓性胆管炎的急诊内镜治疗

目的探讨急诊内镜治疗老年急性梗阻性化脓性胆管炎（ AOSC）的疗效及临床应用价值。方法对42例老年AOSC患者行急诊内镜下十二指肠乳头括约肌切开取石（EST）、鼻胆管引流（ENBD）或胆管内支架引流（ERBD）。结果患者全部存活，术后1周患者临床症状及实验室指标均明显改善（均P＜0.05）。38例胆总管结石患者，17例一次取石成功，21例改善症状后二次取石成功；4例胆管癌患者，2例置入塑料支架，2例病情稳定后行手术治疗。结论急诊内镜治疗老年AOSC成功率高，安全有效。     

基于旋转扫描探头的OCT内窥成像系统设计

为了同时获取样品的表面和深度信息,研究光学相干层析的成像原理,建立了基于光学相干层析技术的内窥系统,实现了旋转扫描成像,系统的工作波长为1 310 nm,工作带宽为80 nm.理论推导及计算机仿真得到了系统信噪比与干涉仪的分光比、反射率之间的关系并分析了理论分辨率和探测深度.提出外径为5 mm的内窥镜扫描探头,聚焦距离为12 mm,数值孔径NA为0.47,折射率分布常量A=0.218 7.利用微型电机驱动直角棱镜实现扫描,旋转速度为25 rpm,旋转一周得到640个采样点.采用多层盖玻片和洋葱表皮作为样品进行实验分析,得到了盖玻片和洋葱的图像,横向分辨率和纵向分辨率分别为10 μm和15 μm.结果表明,设计的光学相干层析内窥系统能够用于旋转扫描成像,获取更多的组织信息.     

Effect of image fiber on the speckle fringe pattern in image fiber-guided DSPI endoscopy

The effect of using an image fiber on the speckle fringe visibility in an endoscopic DSPI is analyzed here. An endoscope system was designed and developed, using image fiber as the speckle pattern image conduit, to work in the out-of-plane speckle interferometric configuration and experiments were carried out using a curved phantom tissue specimen as the test target. Experimental results obtained using the developed system are compared with that obtained using conventional DSPI system. To obtain a relative and quantitative comparison of the quality of the fringes obtained employing the two methods, an evaluation method that can give a quantified ‘score’ is proposed here.     

超声内镜换能器的应用进展

超声内镜集结了超声检查与内镜检查双重功能,可以获得腹部和胸腔内器官的高质量图像,是一种先进的医疗设备。超声内镜探头的核心部分是超声换能器。超声内镜检查需经过狭窄的消化道或内窥镜的活检通道伸进体内,由于工作环境的限制,超声内镜用换能器与普通超声成像换能器相比,工作频率更高、尺寸更小、制作工艺更精密。本文从超声内镜所用换能器的外形结构、内部组成、工作模式及材料等角度,对目前国内外超声内镜换能器的应用进展情况进行了描述,并根据超声内镜换能器的现状对未来的发展趋势进行了分析。