经皮椎弓根钉微创手术治疗脊柱骨折的临床效果及应用价值

目的讨论经皮椎弓根钉微创手术治疗脊柱骨折的临床效果及应用价值。方法现随机选取2015年7月至2016年4月我院收治的脊柱骨折患者62例,分成实验组和对照组各31例,对照组采取传统开放式手术内固定治疗,实验组患者采取经皮椎弓根钉微创手术治疗。对两组患者的神经功能恢复优良率、术中出血量以及住院时间进行对比和分析。结果实验组患者神经的神经功能恢复优良率为93.55%,明显优于对照组的74.19%,组间差异明显具有统计学意义(P <0.05);实验组患者的术中出血量明显低于对照组,组间差异明显具有统计学意义(P <0.05);实验组患者的住院时间明显短于对照组,组间差异明显具有统计学意义(P <0.05)。结论在脊柱骨折的治疗中可采取经皮椎弓根钉微创手术治疗方法,其能够提升神经损伤会恢复的程度,缩短手术时间,减少术中出血量,能够促进患者术后恢复,临床应用效果较好。

快速康复外科理念在脊柱微创手术围手术期护理中的应用分析

探究快速康复外科理念在脊柱微创手围手术期护理中的应用效果。方法:以脊柱微创手术者60例为对象,分为参照组(常规护理)、研究组护理(快速康复外科理念),各30例,对比护理效果。结果:研究组患者经过护理后,研究组生活能力评分更高,优于参照组(P<0.05)。对于护理后的生活质量评分,研究组更高(P<0.05)。结论:脊柱微创手术者实施快速康复外科理念护理,具有显著护理效果。

舒芬太尼复合丙泊酚麻醉在腰腹部微创吸脂手术中的临床应用

目的探讨舒芬太尼复合丙泊酚麻醉在腰腹部微创吸脂手术中的临床应用效果。方法选取2020年5月至2023年12月郑州市中心医院收治的68例腰腹部微创吸脂手术患者,按治疗方法不同分为对照组和观察组,每组34例。对照组患者采用瑞芬太尼复合丙泊酚麻醉,观察组患者采用舒芬太尼复合丙泊酚麻醉,比较两组患者的麻醉效果及不良反应。结果观察组患者麻醉优良率高于对照组的,差异有统计学意义(P<0.05);观察组患者的术中心率(HR)、平均动脉压(MAP)高于对照组,差异有统计学意义(P<0.05);不良反应发生率低于对照组35.29%,差异有统计学意义(P<0.05)。结论腰腹部微创吸脂手术中行舒芬太尼复合丙泊酚麻醉,可取得较好的麻醉效果,麻醉优良率高,生命体征变化较小,不良反应少。

Comparative study on the efficacy of transoral robotic surgery and non-robotic surgery for tongue base tumors

Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.

首例高原地区快速康复外科治疗肺大疱报告

目的探讨在高海拔地区引入快速康复外科治疗理念,行单孔经乳晕胸腔镜肺大疱切除术的可行性;方法依据快速康复外科的理念,严格的病员筛查及认真细致的术前准备、教育,经患侧乳晕单孔全胸腔镜下行肺大疱切除术,术后不留置胸腔闭式引流管,切口予皮内美容缝合;结果手术取得成功,术后患者恢复好,手术切口几乎不可见,患者对手术结果非常满意;结论高原地区可能由于低温、低压、低氧及低湿的原因,肺大疱的发生率较高,通过引入快速康复外科的理念,严格的病员筛查及认真细致的术前准备,完成了首例在海拔3700米的高原地区经乳晕全胸腔镜下肺大疱切除术,并获得成功,认为此种方法可以明显缩短患者住院时间、降低医疗费用、减轻患者疼痛、减少患者术前顾虑及术后不适,术后手术切口的隐蔽性高,患者满意度高,符合快速康复外科的理念,为相同疾病患者提供了一种治疗思路。

Video-assisted Endoscopic Thyroidectomy by the Breast Approach

Objective: To retrospectively evaluate the feasibility and clinical value of video assisted endoscopic thyroidectomy by the breast approach. Methods: From December 2002 to May 2003, 28 patients with a mean age of 28 years (range from 20 to 45 years) were selected and given video assisted endoscopic thyroidectomy by the breast approach. The subcutaneous space in the breast area and the subplatysmal space in the neck were bluntly dissociated through a 10 mm incision between the nipples, and CO 2 was insufflated at 6 8 kban to create the operative space. Three trocars were inserted in the mammary regions, and dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: Among the patients, 3 were mass resections, 17 subtotal lobectomies, 2 total lobectomies, and 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1±26.0) min; the mean estimated blood loss was (47.9±19.6) ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36 60 h postoperatively. There were no conversions to open surgery or complications. No scars left in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Video assisted endoscopic thyroidectomy using a breast approach and low pressure subcutaneous CO 2 insufflation is a feasible and safe procedure, which results in satisfactory appearance. We believe that video assisted endoscopic thyroidectomy by such approach will play a role in the future.

Natural orifice transluminal endoscopy surgery:A review

Minimally invasive surgery started spreading worldwide in 1987,when the first laparoscopic cholecystectomy was performed.Meanwhile,improvement of endoscopic equipment and instruments allowed gastroenterologists to attempt more aggressive endoluminal interventions,even beyond the wall barrier.The first transgastric peri-toneoscopy,in 2004,brought to light the concept of natural orifice transluminal endoscopic surgery(NOTES).The idea of incisionless surgery is attractive and has become a new goal for both surgeons and other people interested in this field of investigation.The authors present a review of all developments concerning NOTES,including animal studies and human experience.

Magnetic Helical Micro-and Nanorobots:Toward Their Biomedical Applications

Magnetic helical micro- and nanorobots can perform 3D navigation in various liquids with a sub- micrometer precision under low-strength rotating magnetic fields （〈 10 rer）. Since magnetic fields with low strengths are harmless to cells and tissues, magnetic helical micro/ nanorobots are promising tools for biomedical applications, such as minimally invasive surgery, cell manipulation and analysis, and targeted therapy. This review provides general information on magnetic helical micro/nanorobots, including their fabrication, motion control, and further functionalization for biomedical applications.

Clinicopathological significance of loss of heterozygosity and microsatellite instability in hepatocellular carcinoma in China

AIM: To determine the features of microsatellite alterations and their association with clinicopathological characteristics of hepatocellular carcinoma (HCC). METHODS: Loss of heterozygosity (LOH) and microsatellite instability (MSI) of 55 microsatellite loci were detected with PCR-based microsatellite polymorphism analyses in tumors and corresponding noncancerous liver tissues of 56 surgically resected HCCs using the MegaBACE 500 automatic DNA analysis system.RESULTS: LOH was found in 44 of 56 HCCs (78.6%) at one or several loci. Frequencies of LOH on 1p, 4q, 8p,16q, and 17p were 69.6% (39/56), 71.4% (40/56), 66.1% (37/56), 66.1% (37/56), and 64.3% (36/56), respectively. MSI was found in 18 of 56 HCCs (32.1%) at one or several loci. Ten of fifty-six (17.9%) HCCs had MSI-H. Serum HBV infection, alpha-fetoprotein concentration, tumor size, cirrhosis, histological grade, tumor capsule, as well as tumor intrahepatic metastasis, might be correlated with LOH on certain chromosome regions. CONCLUSION: Frequent microsatellite alterations exist in HCC. LOH, which represents a tumor suppressor gene pathway, plays a more important role in hepatocarcinogenesis. MSI, which represents a mismatch repair genepathway, is a rare event during liver carcinogenesis. Furthermore, LOH on certain chromosome regions may be correlated with clinicopathological characteristics in HCC.

Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia

AIM:To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS:Fifty-six patients(26 men,30 women;mean age 42.8±14.7 years)presenting for minimally invasive surgery for oesophageal achalasia,were enrolled.All patients underwent laparoscopic Heller myotomy followed by a 180°anterior partial fundoplication in 30 cases(group 1)and calibrated NissenRossetti fundoplication in 26(group 2).Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication.A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken.One and two years after surgery,the patients underwent symptom questionnaires,endoscopy,oesophageal manometry and 24 h oesophago-gastric pH monitoring.RESULTS:At the 2-year follow-up,no significant difference in the median symptom score was observed between the 2 groups(P=0.66;Mann-WhitneyU-test).The median percentage time with oesophageal pH< 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group(2;range 0.8-10 vs 0.35;range 0-2)(P<0.0001;Mann-WhitneyU-test).CONCLUSION:Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia.Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure.

Natural orifice transluminal endoscopic surgery:New minimally invasive surgery come of age

Although in the past two decades,laparoscopic surgery,considered as a great revolution in the minimally inva-sive surgery field,has undergone major development worldwide,another dramatic surgical revolution has quietly appeared in recent years.Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004,interest in a new surgical procedure named natural orifice transluminal endoscopic surgery(NOTES)has blossomed worldwide.Considering that a NOTES procedure could theoretically avoid any abdomi-nal incision,operation-related pain and scarring,many surgeons and endoscopists have been enthusiastic in their study of this new technique.In recent years,sev-eral NOTES studies have been carried out on porcine models and even on humans,including transvaginal cholecystectomy,transgastric appendectomy,transvagi-nal appendectomy,and transvesical peritoneoscopy.So what is the current situation of NOTES and how many challenges do we still face?This review discusses the current research progress in NOTES.

Optimization Algorithm for Operation Comfortability of Master Manipulator of Minimally Invasive Surgery Robot

To evaluate the operation comfortability in the master-slave robotic minimally invasive surgery(MIS), an optimal function was built with two operation comfortability decided indices, i.e., the center distance and volume contact ratio. Two verifying experiments on Phantom Desktop and Micro Hand S were conducted. Experimental results show that the operation effect at the optimal relative location is better than that at the random location, which means that the optimal function constructed in this paper is effective in optimizing the operation comfortability.

Impact of minimally invasive surgery on the treatment of benign esophageal disorders

Thanks to the development of minimally invasive surgery, the last 20 years have witnessed a change in the treatment algorithm of benign esophageal disorders. Today a laparoscopic operation is the treatment of choice for esophageal achalasia and for most patients with gastroesophageal reflux disease. Because the pathogenesis of achalasia is unknown, treatment is palliative and aims to improve esophageal emptying by decreasing the functional obstruction at the level of the gastro-esophageal junction. The refinement of minimally invasive techniques accompanied by large, multiple randomized control trials with long-term outcome has allowed the laparoscopic Heller myotomy and partial fundoplication to become the treatment of choice for achalasia compared to endoscopic procedures, including endoscopic botulinum toxin injection and pneumatic dilatation. Patients with suspected gastroesophageal reflux need to undergo a thorough preoperative workup. After establishing diagnosis, treatment for gastroesophageal reflux should be individualized to patient characteristics and a decision about an operation made jointly between surgeon and patient. The indications for surgery have changed in the last twenty years. In the past, surgery was often considered for patients who did not respond well to acid reducing medications. Today, the best candidate for surgery is the patient who has excellent control of symptoms with proton pump inhibitors. The minimally invasive approach to antireflux surgery has allowed surgeons to control reflux in a safe manner, with excellent long term outcomes. Like achalasia and gastroesophageal reflux, the treatment of patients with paraesophageal hernias has also seen a major evolution. The laparoscopic approach has been shown to be safe, and durable, with good relief of symptoms over the long-term. The most significant controversy with laparoscopic paraesophageal hernia repair is the optimal crural repair. This manuscript reviews the evolution of these techniques.

Large cavernous hemangioma in the cecum treated by laparoscopic ileocecal resection

A cavernous hemangioma of the cecum is a rare vascular malformation but is clinically important because of the possibility of massive bleeding.We report a case of a large cavernous hemangioma with pericolic inf iltration in the cecum which was removed successfully using minimally invasive surgery.

Study of Image Denoising in Robot Visual Navigation System

In the technique of robot-assisted invasive surgery, high quality image is a key factor of the visual navigation system. In this paper, the authors have made a study of the image processing in visual system. Based on the analysis of plentiful demising methods, they proposed a new method （S-AM-W） which oxnbines Adaptive Median filter and Wioaer filter to renmve the main noises （Salt ＆ Pepper noise and Gattssian noise）. The sinlflation results show that it is simple, well real time, and has high Peak Signal-to-Noise Ratio （PSNR）. It was found that the new method is effective and efficient in dealing with medical image of background noise.

Is adjuvant chemotherapy necessary for patients with microinvasive breast cancer after surgery？

Objective: Survival and treatment of patients with microinvasive breast cancer(MIBC) remain controversial. In this paper, we evaluated whether adjuvant chemotherapy is necessary for patients with MIBC to identify risk factors influencing its prognosis and decide the indication for adjuvant chemotherapy.Methods: In this retrospective study, 108 patients with MIBC were recruited according to seventh edition of the staging manual of the American Joint Committee on Cancer(AJCC). The subjects were divided into chemotherapy and non-chemotherapy groups.We compared the 5-year disease-free survival(DFS) and overall survival(OS) rates between groups. Furthermore, we analyzed the factors related to prognosis for patients with MIBC using univariate and multivariate analyses. We also evaluated the impact of adjuvant chemotherapy on the prognostic factors by subgroup analysis after median follow-up time of 33 months(13-104months).Results: The 5-year DFS and OS rates for the chemotherapy group were 93.7% and 97.5%, whereas those for the nonchemotherapy group were 89.7% and 100%. Results indicate that 5-year DFS was superior, but OS was inferior, in the former group compared with the latter group. However, no statistical significance was observed in the 5-year DFS(P=0.223) or OS(P=0.530) rate of the two groups. Most relevant poor-prognostic factors were Ki-67 overexpression and negative hormonal receptors. Cumulative survival was 98.2% vs. 86.5% between low Ki-67(≤20%) and high Ki-67(>20%). The hazard ratio of patients with high Ki-67 was 16.585 [95% confidence interval(CI), 1.969-139.724; P=0.010]. Meanwhile, ER(-)/PR(-) patients with MIBC had cumulative survival of 79.3% compared with 97.5% for ER(+) or PR(+) patients with MIBC. The hazard ratio for ER(-)/PR(-) patients with MIBC was 19.149(95% CI, 3.702-99.057; P<0.001). Subgroup analysis showed that chemotherapy could improve the outcomes of ER(-)/PR(-) patients(P=0.014), but not those who overexpress Ki-67(P=0.105).Conclusions: Patients with MIBC who overexpress Ki-67 and with negative hormonal receptors have relatively substantial risk of relapse within the first five years after surgery. However, adjuvant chemotherapy can only improve the outcomes of ER(-)/PR(-)patients, but not those who overexpress Ki-67. Further studies with prolonged follow-up of large cohorts are recommended to assess the prognostic significance and treatment of this lesion.

EXPERIENCE OF MINIMALLY INVASIVE TREATMENT IN 520 PATIENTS WITH INTRACR ANIALANEURYSMS

Objective.To summarize the experience of minim ally invasive treatment in 520patie nts with intracranial aneurysms on a retrospective study.Methods.The measures used in the treatment of520patients were reviewed in terms o f timing of surgery,induced-hypotensive anesthesia,b rain protection combined with temporal occlusion of the feeding artery,exter-nal drainage of CSF,dynamic monitoring of intracranial pressure,blood flow velocity,serum osmolality and CT scanning,anti-vasospasm therapy a s well as selected interventional en dovascular embolization of aneurysms.Results.Of the 520patients,485were treated with either direct clipping or endov ascular embolization and35patients were treated non-surgic ally.In 449patients undergoing dir ect clipping and 36undergoing endov ascu-lar embolization,intraoperative r upture of aneurysm occurred in 27(6.0%)and 0%,respectively.Death oc-curred in 13(2.6%),hemiplegia in 8(1.6%),and vegetative state in 2(0.4%).The operative mortality of direct clipping was 3.8%in 210patie nts before 1990and 1.8%in 275patien ts after 1990(36patients undergo-ing endovascular embolization,the operative mortality was 0%).Conclusion.The outcome of patients with intracranial aneurysms can be markedly impr oved and the opera-tive mortality can be lowered by mini mally invasive treatment.

Hypervascular aoustic tumor

objective: To explore the surgical treatment of hypervascular acoustic tumor (HAT). Methods: In past ten years (1975–1985) there were 90 patients with unilateral acoustic tumors were treated by surgery. Among them (4 cases of HAT and 86 cases of nonhypervascular acoustic tumors, NHATs) were retrospectively reviewed and clinical characteristics, radiological and surgical finding were compared. Results: HATs presented at a younger age than NHATs (28±10 vs. 54±17 years old) (P<0.01). MRI showed that HATs was solid, without tumor cyst, and larger than NHATs significantly (P<0.05). The surface of HATs consistently showed multiple flow voids representing large draining veins. The characteristic angiographical findings of HATs were extensive tumor vessels, tumor stains and early filling of draining veins; Vertebrobasilar arteries supplied HATs. The authors preferred the control hypotension anaesthesia to remove HATs and got total resection of 4 cases of HATs successfully. No patients has needed transfusion or suffered any other complications after operation. Conclusion: HATs was a solid tumor presented at young. Angiographical findings may provide characteristic manifestation, and could be managed by control hyper- tension in one-stage surgical approach.

Clinical Efficacy of Super-Selective Renal Artery Embolization for Rupture of Renal Angiomyolipoma

OBJECTIVE To evaluate the efficacy of selective transcatheter arterial embolization （TAE） in renal angiomyolipoma （AML） spontaneous ruptures with hemorrhage. METHODS A retrospective evaluation was carried out in 21 renal AML cases with acute bleeding confirmed by imaging. Selective renal arterial embolization was used to control bleeding. All the cases were detected by renal arteriography had abnormal vascular hyperplasia and enlarged blood vessels. RESULTS Initial renal arteriography for all the patients showed that tortuous, hypervascular, and aneurysm-forming angiogenic components with aneurysm formation occurred in 13 cases （61.9%） and extravasation of the contrast agent was found in 8 cases （38.1%）. Immediate complete obliteration was technically successful in 19 （90.5%） of the 21 patients. To prevent uncontrollable complications, 3 patients received nephron-sparing surgery after hemodynamic status was stabilized with TAE a week later. Two days and 3 days after the embolizations, 2 patients presented with incomplete embolizations and then underwent nephrectomy when they were in a stable condition. There were no significant differences in the plasma creatinine levels before and after the treatment. All the patients were followed up for 6 months to 6 years （median, 45 months）. The largest tumor diameter was reduced from （11.57-±4.28） cm to （9.57±2.28） cm. The tumor had no blood supply and no relapses have occurred. CONCLUSION TAE is a technically feasible and minimally invasive procedure for ruptured renal angiomyolipoma. The aneurysms were a predictor of renal AML spontaneous rupture and detection of such aneurysms by CT may help to determine the timing of embolization. In patients who still need surgical treatment, TAE can make tumor resection easier to perform and reduce blood loss during the operation.