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					一、 會議名稱:International Symposium of Advanced Endoscopy
  and   Laparoscopic Surgery(台大醫院雲林分院內視鏡暨腹腔
  鏡國際學術研討會)
二、 會議地點:臺大醫院雲林分院虎尾院區第一會議室
    演講題目                          講者介紹                                                             演講內容摘要

Advanced           Manabu Muto(日本)                                 The ability of visualization of abnormality in the mucosal surface of the
                                                         gastrointestinal tract is essential to detect and diagnose the disease. Recent advance of
Diagnosis and         現職:Associate Professor,
                                                         endoscopic technology enabled endoscopists to see microscopic structures. This advantage
Treatment of           Department of Gastroenterology
                                                         brings in clinical significance in the edoscopic examination.
Pharyngeal and         and Hepatology Kyto University               Narrowband imaging (NBI) technology is an innovative optical technology that can
Esophageal             Hospital                          clearly visualize the microvascular structure of the organ surface, when it combined with
Cancer                重要經歷:Teikyo University            magnifying endoscopy (1,2). We reported that well-demarcated brownish area and scattered
                                                         irregular foci of microvascular proliferation projecting to the dysplastic squamous epithelium are
                       School of Medicine
                                                         the typical endoscopic features of the lesions (3-4). Multicenter prospective randomized study on
                                                         detection and diagnose for superficial squamous cell carcinoma revealed that NBI showed both a
                                                         high detection rate and high accuracy rate compared to conventional white light observation (5).
                                                         Then, NBI may become a standard examination for detection and making accurate diagnoses of
                                                         superficial squamous cell carcinoma.
                                                                   Early detection of superficial cancer is very important to treat them by minimally
                                                         invasive treatment. Because it has been quite difficult to find early cancer in the hypopharyngeal
                                                         region, most of the tumor was diagnosed at advanced stage at present. For such patients, radical
                                                         surgical dissection or radiotherapy has been the standard treatment in this region. We applied the
                                                         endoscopic treatment in this field to preserve the organ and its function.
                                                                   These breakthroughs opened a brand new door of endoscopic diagnosis and minimally
                                                         invasive treatments.
Application of     Noriya Uedo(日本)                       Autofluorescence edoscopy produces real-time pseudocolor images from natural tissue
                                                         fluorescence from endogenous fluorophores such as collagen, nicotinamide, adenine
Autofluorescence      現職:Vice-director, Endoscopic
                                                         dinucleotide, flavin and porphyrins, which is emitted by light excitation. The system can detect
Endoscopy in GI        Training and Learning Center,
                                                         mucosal abnormality by difference in tissue fluorescence property, so it may improve
Malignancy             Osaka Medical Center for Cancer   identification of premalignant lesions or early stage malignancies in the digestive tract. Recently,
                       and Cardiovascular Diseases       a new endoscopic tri-modal imaging system that works in white light, autofluorescence imaging
                                                         (AFI), or narrow band imaging (NBI) modes has been developed (EVIS-LUCERA system,
   演講題目                          講者介紹                                                                  演講內容摘要

                     重要經歷:大阪大学医学部、日本 Olympus Medical Systems Corp., Tokyo, Japan)
                                          In the AFI images, areas where autofluoresce is strong look green, whereas areas where
                      内科学会認定内科専門医、日本消
                                      autofluorescence is weak appear purple. Esophageal neoplasia is observed as purple area in
                      化器内視鏡学会指導医、日本消化
                                      green background. In the stomach, fundic mucosa looks purple whereas pyloric or atrophic
                      器病学会専門医         mucosa looks green similar to mucosa in the other digestive tract. Moreover, elevated tumor
                                      looks purple and most of depressed tumors look green. Therefore, depressed type tumors in the
                                                             fundic mucosa show green areas in purple background, whereas tumors in the pyloric or atrophic
                                                             mucosa look purple in green background. In the colon, AFI shows neoplastic polyps as purple
                                                             areas in green background but most of non-neoplastic polyps look similar color to background
                                                             mucosa. Combination of AFI and magnifying NBI enables us to detect abnormality including
                                                             gastrointestinal neoplasia and to evaluate morphological feature of the detected lesion
                                                             subsequently.
New Application   Hironori Yamamoto(日本)                           We devised a new insertion method of enteroscopy “the double-balloon method” in 1997.
                                                             In this method, two balloons at the distal ends of both an endoscope and an overtube are
of Double Balloon    現職:Professor, Department of
                                                             operated in combination and the endoscope is inserted while shortening the intestine. Using this
Enteroscopy           International Research and
                                                             method, double balloon endoscopy (DBE) was developed in cooperation with Fujinon Company
                      Education for Endoscopy Jichi          and first released to the market in 2003. Currently, three types of DBE, EN-450P5, EN-450T5
                      Medical University                     and EC-450BI5 are available. EN-450P5 is a standard DBE with outer diameter of 8.5mm and
                     重要經歷:International Committee,          the working length of 200cm and EN-450T5 is a therapeutic DBE with outer diameter of 9.4mm
                                                           and the working length of 200cm. EC-450BI5 is a shorter version of DBE with outer diameter of
                      ASGE、University of Texas
                                                           9.4mm and the working length of 152cm, which is useful for colonoscopy and ERCP in patients
                      Southwestern Medical Center, Dallas, with Roux-en-Y reconstruction.
                      TX (INTERNATIONAL                       We have performed over 1500 examinations using the Fujinon DBE system since September
                      TRAINING)、下部光学医療センタ 2000. In our experience, endoscopic examination of the entire intestine is possible with over 80
                                                           % of success rate using the combination of the oral and anal insertions of DBE. DBE as
                      ー センター長兼務、フジノン国
                                                             enteroscopy is indicated for suspicion of small intestinal bleeding, obstructive symptoms and
                      際光学医療講座兼務
                                                             suspicion of small intestinal tumors, etc. A variety of small intestinal lesions including ulcers of
    演講題目                         講者介紹                                                                 演講內容摘要

                                 、内視 various etiologies, angiodysplasia, small intestinal tumors and polyps were detected by DBE.
                      專長:小腸内視鏡(DBE)
                                                           DBE is useful not only to make a diagnosis of the small intestinal lesions but also to perform
                      鏡的粘膜下層切開剥離術(ESD)
                                                           endoscopic treatments in the small intestine. Using DBE, precise control of the endoscope is
                                                           possible even in the deep segment of the small intestine because the intestine can be stabilized
                                                           by the overtube balloon. Endoscopic therapies such as hemostasis using clipping devices or
                                                           electrocoagulation, polypectomy, endoscopic mucosal resection, balloon dilation, and stent
                                                           placement were successfully carried out in the small intestine.
                                                               Other than regular small intestinal endoscopy, application of DBE for difficult colon,
                                                           endoscopic treatment in the colon, and biliary examination and treatment for patients with
                                                           surgically altered anatomies such as Roux-en-Y reconstruction is also useful.
                                                               In this lecture, techniques and tips for the insertion of DBE and endoscopic treatments using
                                                           DBE will be explained.
Stenting of Biliary Hiroyuki Maguchi(日本)                          Biliary drainage can be achieved via percutaneous or enteral access. Percutaneous
                                                           transhepatic biliary drainage (PTBD) can provide extensive drainage and contrast
Obstruction          現職:Chief, Center of
                                                           cholangiography can be performed. However, PTBD can be complicated by catheter
                      Gastroenterology Teine-Keijinkai
                                                           dislodgement and portal vein thrombosis. Malignant seeding has also been reported. Endoscopic
                      Hospital                             biliary drainage (EBD) can be achieved by either naso-biliary drainage (ENBD) or biliary
                     重要經歷:                                stenting (EBS), and it has become more popular than PTBD due to being less invasive. Although
                      Advising Doctor of the Japanese      ENBD is relatively discomfort of nasal intubation, it permits evaluation of the volume of biliary
                                                           secretions and is able to obtain a precise contrast cholangiography. Although EBS improves
                      Society of Gastroenterology
                                                           nutritional status, it is limited by cholangitis due to the retrograde flow of duodenal fluid into the
                      Advising Doctor of the Japan         bile duct. Recently, ENBD has become a reasonable initial preoperative drainage method for
                      Gastroenterological Endoscopy        operable patients with hilar cholangiocarcinoma.
                      Society                                      Biliary stenting with plastic tube stent (PS), metallic stent (MS) or covered MS (CS) can
                                                           also be achieved via either percutaneous or endoscopic access, EBS has gained wide acceptance
                      Certified Specialist of the Japan
                                                           due to its reduced invasiveness. EBS has its major role in the palliation of advanced malignant
                      Society of Ultrasonics in Medicine
                                                           biliary obstruction. It is currently agreed that CS is effective for strictures at the middle or lower
    演講題目                       講者介紹                                                                  演講內容摘要

                    Advising Doctor of Japanese            part of the bile duct. Questions remain in the management of biliary strictures at the hilar part.
                                                           There is controversy whether unilateral drainage or bilateral drainage is needed and which stent
                    Society of Gastroenterological
                                                           is more effective, TS or MS.
                    Mass Survey
                                                                   We have to consider a number of points in the management of biliary stricture: 1. cause
                                                           of the stricture, 2. location of the stricture, 3. evaluation of operability, 4. whether anti-cancer
                                                           therapy can be indicated or not, 5. approach route, and 6. type of stent to be used.
Advanced        Jong Ho Moon(韓國)                                Malignant duodenal obstruction (MDO) may result from malignancies of the
                                                       duodenum, stomach, biliopancreas, or from metastasis from distant organs. Surgical bypass is a
Endoscopic         現職:Associate Professor, Division
                                                       traditional management for palliation. Endoluminal palliation using self-expandable metal stent
Management of       of Gastroenterology, Department of
                                                       (SEMS) is generally safe and easily performed procedure to relieve the symptoms of MDO.
Duodenal            Medicine Soon Chun Hyang           Reported findings suggest that endoscopic placement of SEMS provides equal palliation of
Malignancy -        University of School of Medicine   symptoms at a lower cost, less morbidity and mortality, earlier per oral intake compared with
Stenting and       重要經歷:Ph.D., Soon Chun                  surgical bypass to palliation. The most commonly reported complication was stent obstruction
                                                           caused by tumor ingrowth. Patients with malignant duodenal obstruction can have concomitant
Ampullectomy        Hyang University of School of
                                                           biliary obstruction or a history of biliary stenting. Combined endoscopic biliary and duodenal
                    Medicine, Korea、2004.3-2004.2          stent-in-stent placement is a promising solution for the palliation of malignant biliary and
                    Fellow Division of                     duodenal obstruction.
                    Gastroenterology, Department of                   Endoscopic papillectomy for ampullary adenoma was introduced as an alternative to
                                                           surgery. To prevent tumor recurrence, the technique should ensure complete resection with a low
                    Medicine, University of
                                                           rate of complications. However, there is no standardized procedure for snare resection of
                    Washington School of Medicine,         ampullary tumor. En bloc resection is fundamental in the treatment of adenomatous lesion. The
                    Seattle, USA、2005.3-2005.8             common problematic complication is post-procedure pancreatitis.                      Prophylactic
                    Visiting Assistant Professor           placement of a pancreatic duct stent is a possible supportive measure to prevent severe
                                                           pancreatitis after endoscopic papillectomy. In some patients, a stent cannot be placed after snare
                    Division of Gastroenterology,
                                                           resection when pancreatic cannulation is impossible. Wire-guided endoscopic snare
                    Department of Medicine, University
                                                           papillectomy in selected patients is one of useful techniques to maintain pancreatic access for
                    of Washington School of                stenting. Study for consensus among endoscopists is needed to more effective techniques with
    演講題目                      講者介紹                                                           演講內容摘要

                    Medicine, Seattle, USA、2005.3      minimal complication.

                    Associate Professor Division of
                    Gastroenterology, Department of
                    Medicine Soon Chun Hyang
                    University of School of Medicine
Endoscopic      Han-Mo Chiu(台灣)        Colorectal cancer (CRC) is nowadays not only the leading cause of cancer mortality in
                                    Western countries but also in Asian countries including Taiwan. CRC can be well prevented if
Screening for      現職:台灣大學醫學院臨床助理教
                                    diagnosed early and early detection of cancer or precancerous lesions become of utmost
Colorectal          授、台大醫院健康管理中心專任主
                                    important. According to National Polyp Study in U.S., polypectomy has proven to reduce
Neoplasm in         治醫師             incident CRC and resultant mortality.
Taiwan             重要經歷 台北醫學大學醫學系美
                        :              Colonoscopy, which enables detection and treatment of colorectal neoplasm at the same
                    國喬治台大醫院內科部住院醫       procedure, has become more and more popular not only as confirmatory diagnostic tool but also
                                        as a primary screening modality. In Taiwan, primary screening colonoscopy is becoming popular
                    師 1996-1999、台大醫院內科部
                                        in the past few years along with the notably increasing incidence of CRC and the advancement
                    總醫師 1999-2001、台大醫院急 of endoscopic techniques. In National Taiwan University Hospital, we offer primary
                    診醫學部總醫師 2002、王德宏 colonoscopic screening since 2003 as a part of thorough health check-up program. The number
                    教授消化醫學基金會獎助赴日 of examinee that received screening colonoscopy increased stepwisely in our institute in the past
                                        few years and more than 7,000 subjects attended this program in 2008. The prevalence of
                    本國立癌中心進修
                                                       screening detected colorectal neoplasm was 25.8 % and advanced neoplasm was 5.7 % in
                                                       average-risk population older than 50 years which are comparable to that reported in Western
                                                       countries.
                                                          Quality issues can never be over-emphasized regarding screening colonoscopy and they
                                                       greatly implicate on the efficacy of the screening program in terms of CRC incidence and
                                                       mortality reduction. Adenoma detection rates, colon cleansing level, colonoscope withdrawal
                                                       time and examinee satisfaction are amongst the most important ones and deserve our special
                                                       attention and best effort.
    演講題目                      講者介紹                                                       演講內容摘要

13:30-14:00      陳自諒(台灣)
                                     Since the first laparoscopic colonic resections report by Moises Jacobs et al almost two decade
Evidence-based      現職:中國醫藥大學附設醫院大腸
                                     ago, thousands of colorectal resections have been performed all over the world in the past 18
Laparoscopic         直腸外科主任          years. Throughout the years, many skillful surgeons have consistently introduced new surgical
Colorectal          重要經歷:美國佛羅里達州克里夫 techniques with excellent outcomes and thus motivated other surgeons to apply these techniques
Surgery              蘭醫學中心大腸直腸肛門外科研 to their patients. Currently almost every part of the large intestine colon has now been resected
                                     using laparoscopic techniques. When treating benign colorectal lesions, compared to a
                     究員、彰化基督教醫院大腸直腸肛
                                     conventional midline laparotomy, the laparoscopy has several advantages, these including less
                     門外科研究醫師、彰化基督教醫院 wound pain, an earlier return of bowel function, reduction of the length of hospital stay, greater
                     大腸直腸肛門外科主治醫師、彰化 facilities to resume normal life, and a preservation of the abdominal wall. However, there has
                     基督教醫院大腸直腸外科主任、彰 been considerable controversy regarding the safety of laparoscopy in treatment of malignant
                                     colorectal disease. Evidence has accumulated from recent clinical trails and the experience of
                     化基督教醫院大腸直腸肛門生理
                                     skillful surgeons. Laparoscopic resection of colon and rectum is an advanced minimally
                     功能檢查室主任、彰化基督教醫院
                                     invasive surgery; this approach is considerate as one of the most difficult procedure in
                     員生醫院醫務長、亞洲內視鏡外科 laparoscopic surgery, and requires proper training. To achieve patient safety and clinically
                     醫學會理事、美國大腸直腸肛門外 good results this procedure must performed precisely. This talk will review current available
                     科醫學會國際顧問委員會台灣委 evidences in regard of laparoscopic colorectal surgery, and will include the overall clinical
                                     management of patients with curable colon and rectal cancer as well; hope it can help surgeons
                     員、中華民國內視鏡外科醫學會監
                                     make decisions regarding the safety of laparoscopic resection in this scenario.
                     事
Laparoscopic     李威傑(台灣)             Today, obesity surgery, as the only effective therapy for morbid obesity, is expanding
                                     exponentially to meet the global epidemic of obesity. The rapid growth of obesity surgery can
Surgery for         現職:桃園敏盛醫療體系經國院區
                                     also be contributed to the introduction of laparoscopic surgery in obesity surgery. The
Morbid Obesity       副院長、台灣大學醫學院外科兼任
                                     advantage of mini-invasive surgery is much more prominent in morbid obese patients than other
                     教授              patients. There have increasing evidences that effective long-term weight loss has been
                    重要經歷:台灣大學臨床醫學博 achieved after obesity surgery. A substantial majority of patients with diabetes, hyper-lipidemia,
                     士、恩主公醫院副院長兼外科部主 hypertension and obstructive sleep apnea have experienced complete resolution or improvement
    演講題目                      講者介紹                                                              演講內容摘要
                                                                                                                         2
                     任、國立台灣大學附設醫院外科兼 with significant survival benefits. Patients with a body mass index (BMI) >35.0 kg/m and
                                     co-morbidities, or Asian people with a BMI of 32.0 kg /m2 and diabetes mellitus can be
                     任主治醫師、國立台灣大學醫學院
                                     candidates for weight reducing surgery. Currently, laparoscopic adjustable gastric banding
                     外科兼任副教授、文化環境基金會
                                     (LAGB) and laparoscopic gastric bypass (LGB) are two commonly used procedures in weight
                     董事長、台灣內視鏡外科醫學會常 reducing surgery. LAGB, a purely restrictive method, is the safest procedure. LGB, a mixed type
                     務監事             procedure, is more effective but difficult in technique and carries higher risk. Laparoscopic
                                                       sleeve gastrectomy (LSG) is a new procedure for high risk or lower BMI patients.
                                                       Biliopancreatic diversion (BPD) or duodenal switch (DS), a mal-absorption procedure, is used as
                                                       a second line operation. The survival benefits of bariatric surgeries rely heavily on their
                                                       safety. Unlike other gastrointestinal surgery performed by general surgeons, obesity surgery
                                                       requires a team approach in a center of excellence. The surgeon requires training in advanced
                                                       laparoscopic techniques and also in the care of the morbid obese surgical patient. How to
                                                       provide safe laparoscopic obesity surgery for the soaring demand from morbidly obese patients
                                                       will be an important issue in the near future.
Laparoscopic     王偉(台灣)              Laparoscopic surgery for gastric cancer is currently performed in many centers but is not widely
                                     accepted because of the consideration of oncological debate. This procedure is technically
Surgery for         現職:台北醫學大學附設醫院一般
                                     feasible and safe. Japanese randomized trial on distal gastrectomy with Billroth I reconstruction
Gastric Cancer       外科主治醫師
                                     for early gastric cancer demonstrated the short-term benefits of the laparoscopic approach over
                    重要經歷:恩主公醫院外科主治醫 open techniques. The multicenter study in Japan also showed laparoscopic surgery for early
                     師 、桃園敏盛醫院一般外科主  gastric cancer yields to good short-term and long-term outcomes. The first laparoscopic
                     任、台灣大學附設醫院兼任主治醫 gastrectomy for malignancy was reported by Kitano in 1991, and acceptance of laparoscopic
                                     resection for early gastric cancer becomes gradually accepted. Despite the good results of pilot
                     師、台灣內視鏡外科理事、台灣大
                                     studies, whether the indication for laparoscopic surgery broadened to advanced gastric cancer
                     學醫學系外科臨床講師      still remains controversial.
                                     From 2007-2008, fifteen patients with the diagnosis of early gastric cancer underwent
                                                       laparoscopic assisted distal gastrectomy at our hospital. There is no operation related mortality.
                                                       One complication of leakage was encountered and was treated conservatively. The operation
    演講題目                     講者介紹                                                                演講內容摘要
                                                      time was longer compared to that of open procedure. The hospital stay was shorter, and the time
                                                      to diet commencement showed no difference. The number of lymph node dissection showed no
                                                      difference to open procedure. According t the short term result, laparoscopic assisted
                                                      gastrectomy for early gastric cancer is safe and effective alternaives.
Laparoscopic    吳耀銘(台灣)                                    During the last decade, laparoscopic surgery evolved from its infancy to rapid
                                                      dissemnination throughut the world. Laparoscopic cholecystectomy was rapidly adopted in the
Liver Surgery      現職:台灣大學醫學院附設醫院一
                                        1990’s. Laparoscopic colectomy has proven to be safe and effective in randomized trials.
                    般外科臨床助理教授
                                        Laparoscopic splenectomy, adrenalectomy, anti-reflus surgery , bariatric surgery, and hernia
                   重要經歷:美國紐約 Albert    repair have all been shown to have advantages in terms of postoperative pain, recovery time, and
                    Einstein 醫學院肝臟研究中心研 return to work. Laparoscopic liver surgery was first reported in 1993, with few case reports on
                    修醫師 美國賓州匹茲堡大學肝 peripheral wedge resections. It was not until Cherqui et al. reported a prospective cohort of 40
                           、
                                        patients that many recognized the true feasibility of this procedure. This procedure has been
                    臟移植研修醫師
                                                      applied more widely in recent years, although the accumulation of cases is slow due to the high
                                                      technique demand. There are even some small series reports to harvest the right lobe liver from
                                                      the living donor by laparoscopic approach. But some issues still need to be addressed before
                                                      wide application of this procedure, including the patients selection, the approach technique, the
                                                      safety and efficacy and the potential benefits for patients.
                                                      We set up the laparoscopic liver surgery program in NTUH since 2007, and performed 26 cases
                                                      till now. The disease categories include hepatocellular carcinoma 14, focal nodular hyperplasia
                                                      6, liver metastasis 3, hemangioma 1, angiomyolipoma 1 and dysplastic regenerative nodule 1
                                                      cases. The operative procedures include lateral segmentectomy 9, left lobectomy 3, and
                                                      segmentectomy 14 cases. We also performed simutaneously laparoscopic colectomy and
                                                      hepatectomy for 3 cases with colon cancer and liver metastasis. Patients in our series with
                                                      laparoscopic approach for liver resection have the benefits of shorter hospital stay ,less
                                                      postoperative pain and smaller abdominal wound. The accumulated experience will help us to
                                                      extend the criteria and clinical application of laparoscopic liver resection.
   演講題目                    講者介紹                                演講內容摘要

Percutaneous      李遜(中國)                對微創經皮腎取石術 (mPCNL)治療鹿角狀腎結石的病例資料進行回顧性分析,並探計其
                                        安全性及優越性。方法:自 2001 年 7 月至 2007 年 12 月應用微創經皮腎取石術治療鹿角
Nephrolithotomy    現職:廣州醫學院港灣醫院教授兼
                                        狀腎結石鹿角石 1875 例,其中部分鹿角狀 1284 例,完全鹿角狀 591 例,結石平均表面積
in Mainland         院長
                                        2352 mm2(748~6950 mm2)。結果:所有病例均行一期穿刺取石,其中單通道 1063 例
China              重要經歷:2006 年获国内腔内泌   (57%),雙通道取石 652 例(35%),三通道以上取石 160 例(9%)。平均手術時間 110 min
                    尿外科最高荣誉奖“金膀胱镜       (46~210 min),術後第 2 天及 1 個月後復查 X 線攝片,無石率分別為 79 %及 86 %。出現
                                                      ,其中嚴重出血 12 例,7 例保守治療治癒,5 例經高選擇性腎動
                    奖”、第十六届 “恩德思”国际内镜 明顯併發症 27 例(1.4 %)
                                        脈栓塞止血成功;胸膜損傷 6 例,膿毒症 5 例,腎周膿腫 2 例,結腸損傷 1 例;無病人需
                    奖—泌尿外科奖,多次获国家、省
                                        開放手術或腎切除。結論:微創經皮腎取石術治療鹿角狀腎結石安全、有效。與傳統經皮
                    部级、市级科技成果奖          腎取石術相比,具有併發症少、結石清除率高的優點。

				
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