基于Jack仿真的手术转移床人机工程设计

为改善医护人员在操作手术转移床过程中的舒适性,结合Jack仿真和有限元分析方法,在过弯道和坡道的仿真环境下,对手术转移床进行人机仿真和改良设计。通过分析不同场景下人机交互行为,得到手术转移床人机适配性的关键部位为导向手环、护栏、床架;进一步结合受力分析结果对关键部位进行尺寸设计和结构轻量化改进,并对改进后的手术转移床进行舒适性仿真验证。结果表明:医护人员的肌肉关节和腰背部受力明显降低,手术转移床操作舒适性增强,有效降低了造成医护人员不适或受伤的可能性,为手术转移床的人机工程设计提供参考。

Total laparoscopic liver resection in 78 patients

AIM： To summarize the clinical experience of laparoscopic hepatectomy at a single center. METHODS： Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma （n = 39）, metastatic liver carcinoma （n = 10）, and benign liver neoplasms （n = 29） underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients. RESULTS： The lesions were located in segments Ⅰ （n = 3）, Ⅱ （n = 16）, Ⅲ （n = 24）, Ⅳ （n = 11）, Ⅴ （n = ii）, Ⅵ （n = 9）, and Ⅷ （n = 4）. The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three （n = 4）, two （n = 8） and one （n = 66） in the study cohort. The surgical procedures included left hemi-hepatectomy （n = 7）, left lateral lobectomy （n = 14）, segmentectomy （n = 11）, local resection （n = 39）, and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer （n = 7）. Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion （400-800 mL）. There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred. CONCLUSION： Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.

Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy

AIM:To identify the predictive clinicopathological factors for lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to further expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of poorly differentiated EGC. METHODS: Data were collected from 85 poorly- differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. RESULTS: Univariate analysis showed that tumor size (OR = 5.814, 95% CI = 1.050 - 32.172, P = 0.044), depth of invasion (OR = 10.763, 95% CI = 1.259 - 92.026, P = 0.030) and lymphatic vessel involvement (OR = 61.697, 95% CI = 2.144 - 175.485, P = 0.007) were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found tohave metastasis, 29 (65.9%) and 15 (34.1%) of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. CONCLUSION: Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC (≤ 2.0 cm in diameter) with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited (D1) dissection or D1+ lymph node dissection should be performed depending on the tumor location.

Surgical management of gallbladder sarcomatoid carcinoma

AIM:To study the behavior as well as optimal treatment of gallbladder sarcomatoid carcinoma, we reviewed the results of treatment of gallbladder sarcomatoid carcinoma from Chang Gung Memorial Hospital. METHODS:From 1987 to 2005,six patients were diagnosed with gallbladder sarcomatoid carcinoma and treated at our institution.Tumor staging was based on 2002 revised tumor-node-metastasis(TNM)staging for gall bladder cancer from the American Joint Committee on Cancer.The clinical presentation,laboratory data and preoperative workup were reviewed retrospectively. RESULTS:Five patients were female and one was male.The age ranged from 51 to 66 years(median, 58 years).Surgical procedures included three curative resections,two palliative resections and one biopsy. There were two surgical complications(33.3%)and one case of surgical mortality(16.7%).The followup time ranged from 30 d to 5 mo.The median survival was 2.5 mo.The prognosis was extremely poor,even after curative resection and postoperative chemotherapy. CONCLUSION:The prognosis of gallbladder sarcomatoid carcinoma was not dependent on TNM stage and was always dismal.The clinicopathological features were different from those of gall bladder cancer.