Lone-Star retractor perineal exposure method for laparoscopic abdominal perineal resection of rectal cancer

BACKGROUND The abdominal perineal resection(APR),historically referred to as Mile’s proce-dure,stands as a time-honored surgical intervention for rectal cancer manage-ment.Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer,including those with ultralow rectal cancer.Despite these improvements,APR maintains its irreplaceable role in the clinical landscape,particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles.Optimal perineal exposure stands as a pivotal phase in APR,given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient’s subse-quent long-term prognosis.AIM To evaluate the value of Lone-Star retractor(LSR)perineal exposure method in the treatment for laparoscopic APR of rectal cancer.METHODS We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023,including 20 patients who underwent the APR procedure with a LSR perineal exposure method(LSR group)and 18 patients who underwent the APR procedure with a conventional perineal exposure method(control group).In the LSR group,following incision of the skin and subcutaneous tissue,the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.RESULTS A total of 38 patients underwent laparoscopic APR,none of whom were found to have distant metastasis upon intraoperative exploration.Perineal blood loss,the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group.A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group(P<0.05).The incidence of infection via the perineal incision in the LSR group was significantly lower than that in the control group(P<0.05).No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.CONCLUSION The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications,shorten the postoperative hospital stay,improve postoperative pain,and allow one surgeon to perform the perineal operation.

A self-made disposable iris retractor in small pupil phacoemulsification

AIM:To explore a simple and low-cost self-made disposable flexible iris retractor and study its clinical efficacy and safety in small pupil phacoemulsification.METHODS:Polyproplyenesutureandscalpacupuncture were used to make iris retractor.A prospective study were carried on 50 patients(50 eyes)with a maximally dilated pupil size of 2.5-4.0 mm which underwent phacoemulsification using this self-made iris retractor.Another 50 cases of phacoemulsification with normal pupil size sever as control group.The mean operation time,ultrasound time and ultrasonic power,volume of irrigation fluid were documented intraoperatively.The visual acuity,pupil size and complication were observed on 1d,1wk,1mo and 1y after operation.Corneal endothelial cell was measured at 1mo postoperatively.·RESULT:Pupils could be expanded to approximately4.5-5.5 mm with our self-made iris retractor in operation.No serious postoperative complication was found.Most(88%)of the pupils returned round or oval shape,light reflex restored to varying degrees at the first day after surgery.Best corrected visual acuity stabilized in 37 eyes(74%)at one day,in 43 eyes(86%)at one week,in 44eyes(88%)at one month and 46 eyes(92%)at one year.Compared with the control,more time was needed to complete the operation in the small pupil group.There was no significant difference of the mean ultrasound time,ultrasonic power,volume of irrigation fluid requiredand corneal endothelial cell loss in 1mo follow up between the two groups.CONCLUSION:Our self-made disposable flexible iris retractor could be easy obtained preoperatively or intraoperatively.It performed both safety and efficacy in our clinical trials.This simple self-made device has shown economic and practical values,especially in primary care hospital of the less developed districts.

Improvements to the retractor and muscle flap design for minimally invasive cochlear implantation

Objective: The aim of this study was to improve muscle flaps and to evaluate surgical outcomes with the use of a novel specialized retractor, which is a surgical instrument used to locate and shape a bony seat for minimally invasive cochlear implantation.Methods: 50 patients aged 1 e75 years with sensorineural hearing loss who required cochlear implantation were recruited. A small incision(<3 cm) was made, and the novel specialized retractor was used in the study group during cochlear implantation. The incision length, surgical outcomes and operative time were recorded and analyzed.Results: The incision length, total operative time and drilling bony time were shorter in the study group than in the control group(P < 0.05, respectively). All patients recovered well after the surgery without any severe complications.Conclusion: The use of a novel specialized retractor standardized the surgical processes of cochlear implantation. The retractor helped locate and control the size of the bony well during bone drilling. The tool reduced the technical difficulty and improved the efficacy of this minimally invasive operation.

Design and development of a new type of phimosis dilatation retractor for children

BACKGROUND Phimosis is one of the most common diseases in children.Early selection of appropriate treatment for phimosis in children is beneficial to the development of their reproductive organs and significantly improves the prognosis of phimosis in children.Although traditional circumcision is the most widely used,it has many disadvantages,including postoperative bleeding and incision infection,pain,obvious scars on the surgical incision,and unsatisfactory appearance.In addition,there is much contro-versy regarding treatment options and timing at home and abroad.Surgical procedures such as circumcision and cerclage for children with excessively long foreskin will greatly affect the normal life of children after the operation.Young children need general anesthesia,but this anesthesia carries a great risk.AIM To design a new children phimosis dilatation retractor for children phimosis.METHODS The children phimosis was dilated with an elastic dilation frame,in order to expand the foreskin mouth and expose the penis head,and after that,the phimosis was cured.RESULTS A new type of phimosis dilatation retractor was designed,which can gently dilate the prepuce at multiple angles and in multiple directions at the same time.It has obtained the national patent for clinical application.CONCLUSION The phimosis dilatation retractor based on the principle of elastically expanding the prepuce can achieve the purpose of expanding the phimosis.The clinical application shows that the effect of the children phimosis retractor is significant,which is worth promoting.

Development of a Retractor Holding Device to Reduce the Manpower in Total Hip Arthroplasty through Direct Anterior Approach

Direct anterior approach (DAA) for total hip arthroplasty (THA) is a minimally invasive technique. In this approach, two assistants are necessary. We developed a retractor holding device called “Spider arm” to replace an assistant in the contra-lateral side. In this study, we investigated the usefulness of Spider arm in THA through direct anterior approach. 20 hips were operated without Spider arm and 21 hips were operated with Spider arm. The surgery time and the blood loss were compared. The cup position and leg length discrepancy were measured on radiography. There was no statistical significance between two groups in all parameters. No clinical complications were reported. With Spider arm, DAA-THA could be performed by two surgeons without deterioration of the surgery time and blood loss. The accuracy of cup position and leg length discrepancy was not affected. Spider arm can contribute to reducing the manpower in DAA-THA.

不同术式治疗退行性下睑内翻的临床效果分析

目的分析2种不同术式治疗退行性下睑内翻的临床疗效。方法选取2017年3月—2020年9月在首都医科大学宣武医院诊治的退行性下睑内翻患者84例(86只眼)。按照随机数字表法分为加固组41例(42只眼)和前徙组43例(44只眼)。加固组予下睑缩肌加固联合睑板前轮匝肌缩短术;前徙组予下睑缩肌前徙联合外侧睑板条固定术。比较2组的手术时间、术后眼睑瘀血持续时长、复发率和临床疗效。结果(1)2组术前下睑前方牵拉试验、下睑侧方牵拉试验和下睑缩肌松弛试验阳性率比较,差异均无统计学意义(P>0.05)。(2)手术时间:加固组手术时间低于前徙组,差异有统计学意义(t=32.444,P=0.000)。(3)术后眼睑瘀血持续时长:加固组术后眼睑瘀血持续时长低于前徙组,差异有统计学意义(t=5.544,P=0.000)。(4)复发率和临床疗效:2组复发率和临床疗效比较,差异均无统计学意义(P>0.05),且术后均未出现严重并发症。结论下睑缩肌加固联合睑板前轮匝肌缩短术和下睑缩肌前徙联合外侧睑板条固定术均是治疗退行性下睑内翻的有效方法。但下睑缩肌加固联合睑板前轮匝肌缩短术具有手术步骤简单、手术用时短、术后眼睑瘀血轻等优点。

基于声音信号的汽车安全带卷收器质量检测方法研究

为提高汽车安全带生产现场质量检测效率,根据《QC/T987—2014汽车安全带卷收器性能要求和试验方法》搭建实验平台,采集卷收器合格品与次品工作过程中的声音信号,将卷积注意力模块(CBAM)嵌入残差网络(ResNet-18)残差块之前,设计CBAM-ResNet-18“Before Blocks”模型,对采集到的卷收器声音信号进行分类。与不加注意力机制的ResNet-18模型、在残差块后加注意力机制的CBAM-ResNet-18“Within Blocks”模型、传统分类模型支持向量机和随机森林相比,模型在卷收器声音信号分类任务中的混淆矩阵、准确率、精确率、召回率和F 1值等方面均表现良好。实验结果表明:所设计的模型对于基于声音信号的汽车安全带卷收器质量检测十分有效。

切口保护套在剖宫产手术中的价值

切口保护套是一类采用高分子材料制成的,能够扩展切口术野,保护切口免受损伤的医疗器械,其已被证实可降低在普通腹部手术后发生手术部位感染的风险。为减少剖宫产手术切口并发症,切口保护套在剖宫产手术中的使用也逐渐增多。本文结合国内外的研究综述切口保护套在剖宫产手术中的应用及效果,总结切口保护套在预防手术部位感染的作用,并对切口保护套在剖宫产手术中未来的研究和临床应用提出展望,使切口保护套的使用更加规范。

眼轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术在老年性下睑内翻治疗中的临床价值

目的:探讨老年性下睑内翻治疗中眼轮匝肌切除术联合眼轮匝肌缩短下睑缩肌复位术方案的临床效果。方法:回顾性分析2022年1—12月于南平市第二医院接受治疗的90例老年性下睑内翻患者的临床资料,依据治疗方案的不同将患者分为对照组(n=45,行眼轮匝肌切除术)和研究组(n=45,行眼轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术)。比较两组围手术期指标、术后恢复指标、术后并发症发生情况、复发情况和眼部美观度。结果:两组术中出血量比较,差异无统计学意义(P>0.05);和对照组相比,研究组手术时间长,切除皮肤宽度小,术后睑裂高度高,泪阜显露率高及睫毛朝向大(P<0.05);相比于对照组,研究组治疗总有效率高,复发率低,术后各眼部美观度评分均高(P<0.05);两组术后各项并发症发生率比较,差异均无统计学意义(P>0.05)。结论:老年性下睑内翻治疗中,选择眼轮匝肌切除术及眼轮匝肌缩短下睑缩肌复位术联合方案安全有效,可积极改善疾病症状,降低复发率,并改善眼部美观度。

新型免充气拉钩在经口联合颏下入路腔镜甲状腺手术中的应用

目的探讨使用自制新型免充气拉钩行经口联合颏下入路腔镜甲状腺手术(transoral endoscopic thyroidectomy via submental and vestibular approach,TOETSMVA)的安全性。方法回顾性分析2021年1月~2022年6月119例单侧叶甲状腺肿瘤手术资料,其中37例使用新型免充气拉钩行免充气TOETSMVA(免充气组),37例行充气TOETSMVA(充气组),45例行传统颈前开放甲状腺手术(开放组)。比较3组手术指标、术后并发症、患者对切口满意度的差异。结果与开放组相比,免充气组手术时间长[(131.0±20.1)min vs.(81.1±15.7)min,P=0.000],但术中出血量少[19(15,27)ml vs.30(25,37)ml,P=0.000],术后第1天疼痛评分低[(4.8±2.1)分vs.(6.4±1.9)分,P=0.000],患者对切口满意度高(非常不满意、不满意、满意、较为满意、非常满意的例数分别为0、0、6、16、15 vs.4、3、19、17、2,P=0.000)。与充气组相比,免充气组手术时间短[(131.0±20.1)min vs.(141.8±22.9)min,P=0.019],术中出血量、术后第1天疼痛评分、患者对切口满意度差异无统计学意义(P>0.05)。3组淋巴结清扫数量、术后总引流量、术后1天甲状旁腺激素(parathyroid hormone,PTH)水平差异无统计学意义(P>0.05)。开放组术后出血1例,免充气组颈部皮下瘀斑1例、声音嘶哑1例,3组均无气管食管损伤、严重皮下气肿、高碳酸血症、气体栓塞等并发症。结论新型免充气拉钩在TOETSMVA术中能够有效地维持空间,与传统颈前开放甲状腺手术和常规充气TOETSMVA相比,手术安全性好。

某车型关门时安全带卷收器异响问题分析和优化

针对某车型在关门时车内出现的振颤异响问题,识别车内异常噪声产生原因为关门产生振动激励,经车身和安全带卷收器固定支架传递至卷收器本体,并引起卷收器内部异响。建立了车身和卷收器的系统动力学模型,分析了卷收器安装支架对振动传递特性的影响,完成了卷收器单体在台架上响度随频率变化的试验,获得了卷收器单体噪声的敏感频率。通过合理优化卷收器安装支架刚度,将振动传递峰值与卷收器敏感频率避开,有效地改善了异响问题,为同类问题的分析和优化提供了参考。

胸骨拉钩配合人工气胸在胸腔镜前纵隔肿瘤切除手术膈神经保护中的作用

目的:探讨胸骨拉钩配合人工气胸在胸腔镜前纵隔肿瘤切除手术中膈神经保护作用、术中指标和术后康复水平。方法:回顾性分析南京鼓楼医院集团宿迁医院收治的55例胸腔镜前纵隔肿瘤患者的临床资料。采取胸骨拉钩配合人工气胸经剑突入路接受膈神经保护的22例为研究组,采取胸腔镜传统侧进胸未接受膈神经保护的33例为对照组,比较两组各项指标和术后膈神经损伤情况。结果:55例患者均完成手术,研究组手术中膈神经损伤率低于对照组,差异有统计学意义(P<0.05)。研究组在术后手术时间、出血量、疼痛评分、通气时间方面均优于对照组,差异有统计学意义(P<0.05),两组在住院时间、引流管留置时间等方面比较,差异无统计学意义(P>0.05)。结论:对于前纵隔肿瘤患者,采取胸骨拉钩配合人工气胸经剑突入路实行膈神经的保护效果较传统术式有显著的提升,具有降低术中创伤、促进术后康复、减少术后并发症的优势。

通道辅助微创后颅窝减压手术治疗ChiariⅠ型

目的评估应用通道辅助进行微创后颅窝减压手术治疗ChiariⅠ型畸形(CM-1)的临床效果.方法在2020年3月至2021年2月期间,北部战区总医院神经外科对20例CM-1成人患者进行了通道辅助下的后颅窝减压手术.其中13例采用显微镜技术,7例采用神经内镜技术.本研究通过回顾性分析,评估了手术前后神经功能、影像学检查结果、术后并发症以及术后12个月的颈椎日本骨科协会评分(JOA).结果20例患者在术后均有不同程度的症状改善,颈椎JOA评分平均恢复率为65.3%.术后MRI检查显示,3例患者的脊髓空洞完全消失,16例缩小,1例无变化.术后出现3例硬膜外积液和1例轻度感染,但无患者需要二次手术.结论通道辅助的微创后颅窝减压手术能够缓解脊髓压迫,有效减小脊髓空洞,并改善临床症状.该技术具有肌肉损伤小、恢复快的优点,是一种安全有效的治疗CM-1的手术方式.

下睑缩肌移位术联合眼睑轮匝肌折叠缩短术治疗睑内翻的疗效探讨

目的探讨下睑缩肌移位术联合眼睑轮匝肌折叠缩短术治疗睑内翻的疗效。方法将眼科100例老年单眼睑内翻患者作为研究对象,以随机抽签方式分为对照组(50例)、试验组(50例)。对照组给予下睑缩肌移位术治疗,试验组给予下睑缩肌移位术联合眼睑轮匝肌折叠缩短术治疗。对比两组围术期手术指标(切除皮肤宽度、手术出血量、手术时间),症状和体征(流泪、异物感、畏光)评分,眼部指标(睑裂宽度、泪阜显露率、睫毛朝向)恢复情况,并发症发生率。结果试验组切除皮肤宽度(1.51±0.23)cm小于对照组的(1.65±0.29)cm、手术出血量(38.76±6.76)ml多于对照组的(28.34±5.43)ml、手术时间(31.34±6.34)min长于对照组的(24.65±5.33)min(P<0.05)。治疗后,试验组流泪、异物感、畏光评分分别为(1.12±0.34)、(1.06±0.35)、(1.06±0.44)分,均低于对照组的(1.42±0.76)、(1.72±0.73)、(1.77±0.29)分(P<0.05)。治疗后,试验组睑裂宽度(28.21±3.77)mm、泪阜显露率(0.86±0.17)%、睫毛朝向(96.12±10.14)°均大于对照组的(25.23±2.89)mm、(0.63±0.14)%、(82.67±8.65)°(P<0.05)。试验组并发症发生率为4.00%,较对照组的16.00%更低(P<0.05)。结论睑内翻使用下睑缩肌移位术联合眼睑轮匝肌折叠缩短术进行治疗可将手术质量进行提升,有效改善流泪、异物感等临床症状,并调整睑裂宽度、泪阜显露等指标,控制术后并发症发生率,值得推广普及。

海洋平台工况下钢丝动力电缆投捞重载绞车设计分析

绞车在海洋工况上,主要用于深海调查仪器的下放和回收,在海洋平台上,主要用于下放动力电缆,或采用钢丝绳悬吊的井下工具筒、工具串,绞车、卷扬机、收放机均为类似功能功用的产品.钢丝动力电缆投捞作业的作业方式,对绞车的承载能力、绞车的可靠性提出了新的要求,介绍了一种海洋平台工况下钢丝动力电缆投捞重载绞车,为相关产品的制造、设计、生产提供了全新的解决思路.

新型儿童包茎扩张牵开器多次短时持续扩张法治疗儿童包茎的临床效果

目的 观察新型儿童包茎扩张牵开器多次短时持续扩张法治疗儿童包茎的临床效果。方法 选取2021年11月至2023年5月于深圳市南山区桃源社区健康服务中心就诊的87例包茎儿童为研究对象,根据不同的治疗方法分为对照组(43例)和观察组(44例)。对照组采用传统的包皮扩张治疗,观察组采用新型儿童包茎扩张牵开器多次短时持续扩张治疗,比较两组疼痛程度、临床效果。结果 观察组疼痛程度低于对照组,差异有统计学意义(P<0.05);治疗后2个月,观察组治愈率高于对照组,差异有统计学意义(P <0.05)。结论 应用新型儿童包茎扩张牵开器多次短时持续扩张法治疗儿童包茎效果良好,能够减轻疼痛程度,提高治愈率,值得推广。

钢丝动力电缆专用收放机技术研究

随着自喷井时代的结束,人工举升成为海上油田采油的主要方式,为了给井下机组供电,潜油电缆成为油井不可或缺的一部分,从收放机的三大系统组成:机械结构、液压系统、电路系统入手,针对目前常规收放机存在的七项技术难题,对产品防腐、连轴效率、驱动部件进行优化,提高了钢丝动力电缆专用收放机的可靠性与在各大海洋平台上作业的适配性,为日后相关产品的设计开发贡献了新的思路。

甲状腺自动拉钩在甲状腺手术中应用效果

小切口微创甲状腺手术具有安全、微创、美容、医疗费用低等明显的优点,已经成为我国当前三级医院甲状腺手术的主流。本研究通过采用甲状腺自动拉钩,辅以弓状拉钩,完成小切口甲状腺手术上下皮瓣的牵开以及术区的显露,使切开显露这一手术环节更加简单、方便、快速、微创、安全。其在国内多家县级基层医院临床应用,均获得了良好的临床效果,有望在更大范围内的基层医院推广使用。

腹腔镜手术应用自制脐部拉钩经脐部穿刺建立气腹200例报告

目的探讨自制脐部拉钩在腹腔镜手术脐部穿刺建立气腹中的应用价值。方法 2013年10月~2014年10月应用自制脐部拉钩在200例腹腔镜手术中经脐部切口穿刺建立气腹。尖刀在脐上或脐下切开1.5~2.0 cm切口,以脐部拉钩上下方向提拉皮缘,尖刀柄尾端延脐上下缘的腹白线垂直刺入腹腔,形成垂直进入腹腔的间隙,最后用带保护的trocar沿此间隙置入,完成气腹的建立。结果穿刺建立气腹均1次完成,操作时间10~30 s,平均15 s。无并发症发生。结论应用自制脐部拉钩经脐部切口穿刺建立气腹,安全、简单、实用,操作方便,值得临床推广。

上颌第二磨牙颊向错位的早期矫正

上颌第二磨牙颊向错位是临床上常见的错畸形,可以导致多方面的损害。可调式上颌磨牙腭向牵引器可以有效地矫正此种畸形,尤其适合于对其进行早期矫正。