磁锚定技术及其临床应用

Magnetic anchor technique and its clinical application

磁锚定技术是磁外科体系的重要组成部分,该技术利用磁体以"场"相互作用的特点,通过操作体外的锚定磁体,将体内靶磁体及其携带的器械牵拉至目标位置,协助暴露手术视野.目前国内外已将磁锚定技术应用于普通外科、胸外科、妇产科、泌尿外科和内镜操作等诸多领域.在减戳孔或者单孔腔镜手术中,建立有效的操作三角比较困难,而且由于需要在狭小的手术入口内同时容纳主操作器械、辅助腔镜抓钳、腔镜摄像系统等,器械之间容易出现相互碰撞干扰,增加了操作难度,术者也不易掌握.磁锚定技术通过胸、腹壁耦合,成功减少了胸腹壁所需的戳孔及常规牵拉器械,建立了有效的操作三角,获得了良好的手术视野,提高了手术的微创化和精准化.这些优势体现在腹腔镜胆囊切除术、阑尾切除术、全子宫切除术、子宫肌瘤剔除术、附件切除术、卵巢囊肿切除术、肾脏切除术及前列腺癌根治术、胸腔镜肺切除术及食管切除术、内镜下黏膜剥离术中.另外,磁锚定技术在乳腺癌根治术及肝移植供肝修整中得到了很好的应用.随着强化磁性材料、生物力学和临床诊疗技术的不断深度交叉融合,未来磁锚定技术将进一步拓宽应用领域,推动我国外科诊疗技术及器械产业的共同进步.

Magnetic anchor technique(MAT) is an important part of the magnetic surgery that utilizes the characteristics of the "field" interaction of magnets. By operating the anchoring magnets outsides the body, it draws the target magnets in the body and the instruments carried by them to the target position to assist expose the surgical field. At present, MAT has been applied in many fields, such as general surgery, thoracic surgery, gynecology and obstetrics, urinary surgery and endoscopic operation. In the reduction trocar or single incision laparoscopic surgery, it is difficult to establish triangulation. Besides,the main operating instrument, laparoscopic grasping forceps, laparoscopic camera system, etc. need to be accommodated in a narrow surgical entrance, they are easy to collide and interfere with each other, which increases the difficulty of operation and makes it difficult for operators to master. With the chest and abdominal wall coupling, MAT successfully reduces the trocar and pulling instruments, establishes effective triangulation, obtains a good surgical insight, and makes the surgery more minimally invasive and precision. MAT has been successfully used in laparoscopic cholecystectomy,appendectomy, total hysterectomy, hysteromyomectomy, adnexectomy, ovarian cyst resection, nephrectomy and radical prostatectomy, thoracoscopic pulmonary wedge resection and esophagectomy, endoscopic submucosal dissection. Besides,it also works well in radical mastectomy and preparation of donor liver in liver transplantation. In magnet-assisted single trocar(MAST) surgery, magnetic instruments provide sufficient retraction, good triangulation and surgical field exposure,improving the human mechanics of the surgeon during appendectomy and cholecystectomy. With the help of MAT, single incision laparoscopic surgery has been successfully completed appendectomies, cholecystectomies, Nissen fundoplications, gastrojejunostomies, splenectomies, ovarian tumor/cyst resections, retroperitoneal lymphangioma resection,adrenalectomy, total abdominal colectomy and pulmonary wedge resection. The traction generated by the combination of external magnets and internal magnets makes it possible to carry out NOTES surgery in patients with thick abdominal walls, and obtain a powerful traction/reverse traction without abdominal puncturing. With the deep cross and integration of magnetic materials, biomechanics and clinical diagnosis and treatment technique, MAT will expand the application in the future and promote the progress of surgical diagnosis and treatment technique and medical device industry.