Analysis of Ultrasonic Emulsification Surgery and Small Incision Cataract Extracapsular Extraction Surgery for Cataract Clinical Treatment Level Improvement

Objective:To analyze the efficacy of ultrasonic emulsification and small incision cataract extracapsular extraction in cataract patients.Methods:96 cataract patients admitted from May 2021 to May 2023 were selected and randomly grouped into group A(ultrasonic emulsification)and group B(small-incision extracapsular cataract extraction),with 48 cases each.Results:At 1 week,1-month,and 3 months post-operation,the visual acuity of group A was higher and the astigmatism value was lower than that of group B(P<0.05);at 12h,24h,and 48h post-operation,the intraocular pressure of group A was higher than that of group B(P<0.05);the thickness of macular area of group A was lower than that of group B at 1 week and 1-month post-operation(P<0.05).Conclusion:Ultrasonic emulsification in cataract patients was slightly better than small incision cataract extracapsular extraction in correcting astigmatism,improving visual acuity,and regulating macular thickness.However,due to the high energy of ultrasonic emulsification,the risk of complications such as high postoperative intraocular pressure was higher.Small-incision extracapsular cataract extraction has better application value in economically disadvantaged areas.

Validation of user-friendly models predicting extracapsular extension in prostate cancer patients

Objective:There are many models to predict extracapsular extension(ECE)in patients with prostate cancer.We aimed to externally validate several models in a Japanese cohort.Methods:We included patients treated with robotic-assisted radical prostatectomy for prostate cancer.The risk of ECE was calculated for each patient in several models(prostate side-specific and non-side-specific).Model performance was assessed by calculating the receiver operating curve and the area under the curve(AUC),calibration plots,and decision curve analyses.Results:We identified ECE in 117(32.9%)of the 356 prostate lobes included.Patients with ECE had a statistically significant higher prostate-specific antigen level,percentage of positive digital rectal examination,percentage of hypoechoic nodes,percentage of magnetic resonance imaging nodes or ECE suggestion,percentage of biopsy positive cores,International Society of Urological Pathology grade group,and percentage of core involvement.Among the sidespecific models,the Soeterik,Patel,Sayyid,Martini,and Steuber models presented AUC of 0.81,0.78,0.77,0.75,and 0.73,respectively.Among the non-side-specific models,the memorial Sloan Kettering Cancer Center web calculator,the Roach formula,the Partin tables of 2016,2013,and 2007 presented AUC of 0.74,0.72,0.64,0.61,and 0.60,respectively.However,the 95%confidence interval for most of these models overlapped.The side-specific models presented adequate calibration.In the decision curve analyses,most models showed net benefit,but it overlapped among them.Conclusion:Models predicting ECE were externally validated in Japanese men.The side-specific models predicted better than the non-side-specific models.The Soeterik and Patel models were the most accurate performing models.

Cataract surgery in aged patients:phacoemul-sification or small-incision extracapsular cataract surgery

AIM: To evaluate the effects and safety of phacoemulsification (Phaco) or small-incision extracapsular cataract surgery (SICS) and intraocular lens (IOL) implantation for aged patients. METHODS: Totally 137 aged patients (149 eyes) underwent cataract operation in the case of stable systemic condition, the blood pressure less than 160/95mmHg, blood glucose less than 8mmol/L, and under the help of electrocardiogram surveillance by anesthesiologists during the operation. 106 aged patients (114 eyes) underwent Phaco while 31 aged patients (35 eyes) underwent SICS. The postoperative visual acuity, corneal endothelial cell loss, surgery time and major complications were observed and analyzed retrospectively. RESULTS: The best-corrected visual acuity (BCVA) of >= 0.6 was achieved in 135 eyes (92.6%) at 1 month postoperatively (chi(2)=259.730, P<0.001). For aged patients, both Phaco and SICS could significantly improve visual acuity with no significant difference (chi(2)=4.535, P > 0.05). Postoperative corneal endothelial cell loss was 18.6%, in PHACO group, the rate was 18.5%; in SICS group, the rate was 19.0%, the difference of which was no significant (chi(2)=0.102, P>0.05). The surgery time was different in two groups. No severe complications occurred. CONCLUSION: Both Phaco and SICS combined with IOL implantation for aged patients are effective and safe. Before surgery, detailed physical examination should be performed. When the systemic condition is stable, cataract surgery for aged patients is safe.

Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma

BACKGROUND: This paper was to review the effects of intraoperative autologous transfusion during modified, normal-temperature, total hepatic vascular exclusion (THVE) for extracapsular resection of giant hepatic cavernous hemangioma. METHODS: The clinical data from 28 patients, who underwent hepatic resection requiring intraoperative autologous transfusion with the cell-saver apparatus, were analyzed retrospectively. The tumors in the 28 patients involved the proximal hepatic veins and inferior vena cava. The diameters of these hemangiomas ranged from 12x15 cm to 18-40 cm. All patients had varying degrees of THVE. ' RESULTS: The 28 patients with hemangioma received integrated resection and recovered. One patient had rupture of tumors resulting in massive hemorrhage of 6000 ml during liver resection; 4 patients had blood transfusions of 400-800 ml; the other 23 patients had no blood transfusion. Only 6 patients underwent the Pringle maneuver with resection. The other 22 patients underwent THVE during the liver resection. The interval of THVE was 5-30 minutes (mean 16 minutes). CONCLUSIONS: Intraoperative autologous transfusion during modified, normal-temperature THVE for extracapsular resection of huge hepatic cavernous hemangioma is feasible.

Neoadjuvant chemoradiotherapy for esophageal cancer:Impact on extracapsular lymph node involvement

AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.

Extracapsular invasion as a risk factor for disease recurrence in colorectal cancer

AIM: To evaluate the presence of extracapsular invasion (ECI) in positive nodes as a predictor of disease recurrence disease in colorectal cancer. METHODS: Two hundred and twenty-eight consecutive patients who underwent colorectal resection were identified for inclusion in this study, of which 46 had positive lymph nodes. Among 46 cases with stage Ⅲcolorectal cancer, 16 had ECI at positive nodes and 8 had disease recurrence. The clinical and pathological features of these cases were reviewed. RESULTS: In the univariate analysis, the number of positive lymph nodes and depth of tumor invasion were significantly associated with the presence of ECI at positive nodes. Multivariate analysis demonstrated that only ECI was a predictor of recurrence. The recurrence-free interval differed significantly among patients with ECI at positive nodes.CONCLUSION: Our results suggest that ECI at metastatic nodes can identify which cases are at high risk of short-term disease recurrence in colorectal cancer.

Multi-parametric MRI of the prostate:Factors predicting extracapsular extension at the time of radical prostatectomy

Objective:Extracapsular extension(ECE)of prostate cancer is a poor prognostic factor associated with progression,recurrence after treatment,and increased prostate cancer-related mortality.Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has shown promise in this regard,but is hampered by poor sensitivity.We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.Methods:mpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens.Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.Results:The prevalence of ECE was 32.4%,and the overall accuracy of mpMRI for ECE was 84.1%.Overall mpMRI sensitivity,specificity,positive predictive value,and negative predictive value for detection of ECE were 58.3%,97.8%,93.3%,and 81.5%,respectively.Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size((20.73±9.09)mm,mean±SD,p<0.001),T2 PIRADS score(p=0.009),overall primary lesion score(p<0.001),overall study suspicion score(p=0.003),and MRI evidence of seminal vesicle invasion(SVI)(p=0.001).

EXTRACAPSULAR SPREAD IN IPSILATERAL NECK METASTASIS:AN IMPORTANT PROGNOSTIC FACTOR IN LARYNGEAL CANCER

Objective To evaluate the impact of extracapsular spread （ECS） in ipsilateral neck metastasis on prognosis and its related factors in laryngeal cancer. Methods The study included 184 patients who underwent laryngectomy and simultaneous radical or modified radical neck dissection between January 1994 and December 1997 for laryngeal cancer. All of them had a complete 5-year follow-up. We used transparent lymph node detection and continuous slicing method on all neck dissection specimens. Kaplan-Meier model was used for survival analysis and the log-rank test was used to assess significance. Reults We found pathological neck metastases in 80 patients. Among them, 26 cases （32. 5% ） had ECS in ipsilateral neck. ECS incidence increased with advanced pathological N （pN） stages （pNl 3.7%, pN2a 25.0%, pN2b 50. 0%, and pN2c 55.6% ; P =0. 001）. ECS incidence also increased with number of positive nodes （1 positive node 8.6%, 2 positive nodes 33.3%, 3 and more positive nodes 66. 7% ; P 〈0. 001 ）. Incidences of contralateral neck metastases and ipsilateral neck recurrence in patients with ECS were higher than those in patients without ECS （46.2% vs. 24. 1%, P=0.046; 34.6% vs. 7.4%, P =0.002）. The 5-year survival rate of patients with ECS was significantly lower than that of patients without ECS （23.1% vs. 57.4%, P =0. 013）. Conclution ECS is an important prognostic factor in laryngeal cancer. Patients with ECS have a higher incidence of contralateral neck metastasis, so bilateral neck dissection should be selected.

A Clinical Analysis of 120 Cases with Traumatic Cataract Treated by Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation

Extracapsular cataract extraction was performed combined with posterior chamber intraocular lens implantation on 120 inpatients (122 eyes) with traumatic cataract from 1992 to 1997. The results revealed that this combined operation can make most of them get useful visual acuity, although they were often accompanied with several comlicated eye injuries. We think the most important thing is to choose suitable opertion time, the reasonable operation method and take close followup after operation.

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.

扁桃体切除影响大鼠TH1/TH2免疫平衡、B细胞亚群及LILR表达差异

目的 分析扁桃体切除对大鼠TH1/TH2免疫平衡及免疫蛋白表达的影响及可能的作用机制。方法 样本选取21只成年雄性大鼠,使用随机数字表法将所有大鼠分为对照组、囊内切除组及囊外切除组,对照组大鼠正常喂养,囊内组大鼠基于扁桃体囊内切除术,囊外组给予扁桃体囊外切除术。比较各组大鼠TH1/TH2细胞因子及TH1/TH2、CD3^(+)、CD4^(+)、CD8^(+)细胞水平、免疫蛋白水平表达,检测各组大鼠MCP-1、CCR2蛋白表达。结果 囊内组、囊外组TH1、TH2、TH1/TH2水平低于对照组且囊内组高于囊外组(P<0.05);囊内组、囊外组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平低于对照组且囊内组高于囊外组(P<0.05);囊内组、囊外组IgA、IgG、IgM水平低于对照组且囊内组高于囊外组(P<0.05);与对照组相比,囊内组B细胞亚群变化低于囊外组(P<0.05);囊内切除对大鼠B细胞亚群影响更小且B1在每个B细胞亚群上表达,而囊外组B2、B3在B细胞亚群上的表达减少。B4在ASC上呈现唯一表达,囊外组的水平低于囊内组(P<0.05),比较平均荧光强度,囊内组ASC的B1、B4水平显著高于囊外组(P<0.05);囊内组、囊外组MCP-1、CCR2蛋白相对表达水平高于对照组且囊内组低于囊外组,差异具有统计学意义(P<0.05)。结论 扁桃体囊内、囊外切除大鼠均表现出免疫失衡及免疫细胞、免疫蛋白降低,但使用囊内切除有助于提高大鼠TH1/TH2细胞因子及TH1/TH2免疫平衡、免疫蛋白表达、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平,其作用机制可能与MCP-1/CCR2蛋白通路调控有关。

Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts： Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty

Background： The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts. Methods： A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty （PKP） eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density （ECD）, and best-corrected visual acuity （BCVA） were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD. Results： Of the 54 eyes included in this study, extracapsular cataract extraction （ECCE） was performed in 34 eyes of 33 patients （ECCE group） whereas phacoemulsification was performed in 20 eyes of 20 patients （phacoemulsification group）. There was no signifcant difference in the median age （P = 0.081） or preoperative ECD （P = 0.585） between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group （P = 0.043）. In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months （P = 0.018）, 4 months （P 〈 0.001）, and 6 months （P 〈 0.001） after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group （P 〈 0.001） and phacoemulsification group （P 〈 0.001）, but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts （P 〈 0.001）. There was no signifcant difference in postoperative BCVA between the two groups （P = 0.065）. Conclusion： ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

同侧腮腺原发2种不同肿瘤1例及文献回顾

目的 探讨同侧腮腺内同时原发不同病理类型肿瘤的临床表现、组织病理学特点、诊断治疗及预后。方法 报道1例同侧腮腺内腺淋巴瘤和基底细胞腺瘤同时发生的病例,并结合文献对腮腺多原发肿瘤的诊疗进行回顾分析。结果 患者发现右腮腺区包块1个月,术前扪及右腮腺浅叶肿物,结合核磁共振检查诊断为右侧腮腺浅叶及深叶肿瘤。全麻下行右侧腮腺深叶及浅叶肿物和部分腺体切除术+面神经解剖术,术后病理报告右侧腮腺浅叶为腺淋巴瘤,深叶为基底细胞腺瘤伴囊变。手术效果良好,无并发症,术后随访1年未见复发。复习文献结果表明,腮腺多原发性肿瘤是指双侧或者单侧同时存在2种或以上的肿瘤。该疾病以手术治疗为主。结论 同侧腮腺内同时原发不同病理类型的肿瘤病例罕见,需完善影像学检查防止漏诊,手术为首选治疗方案,良性肿瘤预后良好。

对比超声乳化术与小切口囊外摘除术治疗白内障的效果

目的分析超声乳化术与小切口囊外摘除术治疗白内障的效果差异。方法回顾性分析商丘市眼科医院2018年1月至2022年12月接受治疗的白内障患者189人(189眼)的数据实施。依据患者所接受的手术方法差异实施分组,分为A组(接受超声乳化手术,n=93)以及B组(接受小切口囊外摘除手术,n=96)。均选择术前(T_(1))、术后7 d(T_(2))、术后1个月(T_(3))、术后3个月(T_(4))共4个时间点的数据实施分析,对比两组患者治疗效果。对比两组患者不同时间点的视力情况、角膜内皮细胞数量、黄斑区厚度以及T_(4)时两组患者的黄斑水肿发生率,不同时间点手术源性角膜散光值,两组患者术后3个月内的并发症情况。结果T_(1)、T_(3)、T_(4)时间点,两组患者的裸眼视力、最佳矫正视力数据差异无统计学意义(P>0.05),T_(2)时间点,小切口囊外摘除手术组的裸眼视力、最佳矫正视力水平均优于于超声乳化术组,差异有统计学意义(P<0.05)。T_(1)时间点,两组患者的角膜内皮细胞数量数据差异无统计学意义(P>0.05),在T_(2)、T_(3)、T_(4)时间点,B组的角膜内皮细胞数量均高于A组,差异有统计学意义(P<0.05)。T_(1)、T_(4)时间点,两组患者的黄斑区厚度和T_(4)时两组患者的黄斑水肿发生率的数据差异无统计学意义(P>0.05),在T_(2)、T_(3)时间点,B组的黄斑区厚度均低于A组,差异有统计学意义(P<0.05)。两组患者不同时间点的手术源性角膜散光值数据差异无统计学意义(P>0.05)。B组术后3个月的并发症发生率低于A组,差异有统计学意义(P<0.05)。结论针对白内障的患者,超声乳化术和小切口囊外摘除术均为有效的手术方法,两种方法相比,小切口囊外摘除术更利于患者术后短期的恢复以及围手术期并发症的降低。

小切口囊外摘除术与超声乳化术分别联合人工晶状体植入术治疗白内障患者的效果比较

目的:比较小切口囊外摘除术与超声乳化术分别联合人工晶状体植入术治疗白内障患者的效果。方法:选取2020年1月至2022年12月该院收治的70例白内障患者进行前瞻性研究,按照随机数字表法分为研究组与对照组各35例。对照组采取超声乳化术联合人工晶状体植入术治疗,研究组采取小切口囊外摘除术联合人工晶状体植入术治疗,比较两组手术前后视力水平、角膜内皮细胞密度、六角形细胞占比和并发症发生率。结果:术后1 d、3 d、7 d、1个月,研究组视力水平高于对照组,差异均有统计学意义(P<0.05);术后3个月,两组角膜内皮细胞密度、六角形细胞占比均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为8.57%,低于对照组的28.57%,差异有统计学意义(P<0.05)。结论:小切口囊外摘除术联合人工晶状体植入术治疗白内障患者可提高其术后视力水平和角膜内皮细胞密度、六角形细胞占比,降低其并发症发生率,效果优于超声乳化术联合人工晶状体植入术治疗。

小切口白内障囊外摘除术与超声乳化术治疗硬核白内障患者的效果比较

目的:比较小切口白内障囊外摘除术与超声乳化术治疗硬核白内障患者的效果。方法:回顾性分析2022年10月至2023年10月该院收治的90例硬核白内障患者的临床资料,按照手术方式不同将其分为对照组和观察组各45例。对照组采用超声乳化术治疗,观察组采用小切口白内障囊外摘除术治疗。比较两组手术前后泪膜功能[泪膜破裂时间(BUT)、泪液分泌试验(STT)]、角膜功能[角膜厚度、角膜荧光染色(FL)评分]、视力水平及并发症发生率。结果:术后3 d,两组BUT、STT值及角膜厚度均小于术前,但观察组大于对照组,两组FL评分均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);术后3个月,两组患眼视力水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率为8.89%(4/45),低于对照组的35.56%(16/45),差异有统计学意义(P<0.05)。结论:小切口白内障囊外摘除术治疗硬核白内障患者效果良好,可提高患者视力水平,减少对泪膜、角膜功能的损伤,降低术后并发症发生率,效果和安全性优于超声乳化术。

飞秒激光LenSAR与LenSx联合白内障囊外摘除术在老年白内障患者治疗中的效果比较

目的比较飞秒激光LenSAR与LenSx联合白内障囊外摘除术在老年白内障患者治疗中的效果,以期为临床完善治疗方式提供依据。方法前瞻性选取永煤集团总医院2021年4月至2023年3月期间收治的老年白内障患者96例作为研究对象,依据随机抽签法分成SAR组与Sx组,每组48例。两组均行白内障囊外摘除术,其中SAR组行飞秒激光LenSAR治疗,Sx组行飞秒激光LenSx治疗,统计对比两组围术期指标、手术前后眼压、并发症发生率。结果SAR组前囊膜切开时间、尝试对接次数、预劈核时间以及激光发射时间均少于Sx组,负压吸引眼球时间长于Sx组(P<0.05);术后两组眼压较术前均升高,且SAR组眼压升高幅度高于Sx组(P<0.05);与Sx组27.08%相比,SAR组并发症发生率(8.33%)下降(P<0.05)。结论飞秒激光LenSAR与LenSx联合白内障囊外摘除术在老年白内障患者治疗中的效果各异,其中LenSAR便于接口对接,且并发症少,而LenSx能有效控制眼压且减少总负压吸引眼球时长。

传统藏医眼部穿刺术在现代白内障颞侧手术中的应用研究及疗效评价

目的观察传统藏医白内障穿刺术与现代白内障囊外摘除术+IOL植入术方法结合后,其视力、并发症及术后散光等情况的疗效研究。方法对2350例2400眼白内障患者行传统藏医眼部穿刺术,作颞侧角巩膜缘隧道三粒中等量小麦直径(约3~4.5mm)长度的穿刺切口,行白内障囊外摘除+IOL植入术,巩膜隧道自行闭合,无需缝线。结果2350例2400只眼术后7天内有近52.29%的患者最佳矫正视力好于或等于0.5,全部病例切口愈合,术后并发症主要为一过性角膜水肿、前房闪辉、暂时性的高眼压等。结论传统藏医白内障穿刺囊外摘除+IOL植入术手术安全、视力恢复快、散光小、器械成本低、容易掌握、手术不受眉弓影响,尤其对睑裂较小眼窝较深的患者提供方便,并为病人后期青光眼等手术留下良好的局部手术条件。可见,此方法是值得在基层医院、偏远高海拔地区防盲治盲工作中可广泛推广的有效方法。

年轻眼科医师基于手术模拟器的小切口白内障囊外摘除手术培训的有效性评估

目的:探讨基于手术模拟器操作训练在眼科年轻医师小切口白内障囊外摘除手术培训的有效性评估。方法:前瞻性对照研究。选取2020/2022年在沈阳何氏眼科医院已完成至少3a住院医师规范化培训的眼科专业住院医师或刚取得主治证书的眼科主治医师共48名为研究对象,通过小切口白内障囊外摘除手术相关理论培训及考核后,随机分为模拟器手术操作训练组(试验组)和实体动物眼手术操作训练组(对照组),每组各24名。试验组和对照组医师分别使用手术模拟器和猪眼进行训练。训练结束后使用手术模拟器和实体猪眼操作对两组研究对象进行考核评分,并对两组医师的总体培训效果进行有效性评估。结果:手术模拟器考核评分及用时比较,试验组研究对象在各步骤考核用时均低于对照组(均P<0.05)。试验组研究对象在角膜穿刺注入黏弹剂、娩核及水密角膜穿刺口操作评分与对照组比较均无差异(P>0.05),其余步骤评分,试验组均高于对照组(均P<0.05)。实体动物眼考核评分,试验组研究对象各步骤考核评分均高于对照组(均P<0.05)。试验组研究对象在巩膜切口、角巩膜隧道、连续环形撕囊、水分离及转核至前房、娩核步骤手术模拟器与实体动物眼考核评分比较均无差异(P=0.068、0.126、0.960、0.520、0.206);在穿刺注入黏弹剂、隧道穿刺进入前房及水密角膜穿刺口考核中,模拟器评分均低于实体动物眼(P=0.007、0.014、<0.01);在皮质吸除、人工晶状体植入操作考核时模拟器评分要高于实体动物眼操作评分(P=0.035、<0.01)。结论:将手术模拟器操作训练应用于眼科年轻医师小切口白内障囊外摘除手术技能培训,可以显著提升医师的白内障显微手术操作技能,为建立眼科年轻医师规范化的白内障手术培训提供了新的模式及思路。

MRI影像组学用于前列腺癌包膜外侵犯的研究进展

前列腺癌(PCa)的包膜外侵犯(ECE)是影响PCa病人治疗方案和预后的重要因素,MRI影像组学对其诊断和评估具有重要作用。传统的临床-病理风险因素的预测或医学影像的宏观特征分析对评估ECE的临床应用价值有限。影像组学以客观定量的方式将医学图像转化为数据特征,已广泛应用于PCa的检测、分级及侵袭性预测等方面。就MRI影像组学应用于PCa的ECE的研究进展进行综述。