Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed wel...Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.展开更多
Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods...Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This展开更多
Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the in...Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.展开更多
目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(6...目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(62.62±4.01)岁。记录患者基本信息及围手术期相关指标,并在术后1个月、6个月进行随访,记录术前术后改良日本骨科协会评分(modified Japanese orthopaedic association score,mJOA)、美国脊髓损伤协会(American spinal injury association,ASIA)感觉评分(ASIA sense score,ASS)和双下肢运动评分(ASIA motor score,AMS)变化情况。以mJOA评分计算术后6个月随访时的改善率(recover rate,RR)及优良率,对RR与性别、年龄、术前mJOA评分、影像学分型及病程进行相关性分析。结果平均手术时间为(108.46±16.12)min,平均出血量(23.46±7.47)mL,平均住院时间(6.08±0.86)d。术后随访时间为6~35个月,平均(16.77±9.33)个月,术后1个月及6个月随访时,mJOA、ASS、AMS评分均优于术前(P<0.05),平均RR为(55.69±19.73)%,优良率为69.23%。RR与术前病程呈负相关(P<0.001),与术前mJOA评分呈正相关(P=0.029),与性别、年龄、影像学分型均无明显相关性(P>0.05)。结论Delta大通道脊柱内镜技术治疗胸椎黄韧带骨化症安全可靠,具有术后恢复快、创伤小、出血量少等优势,短期效果良好。展开更多
文摘Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.
文摘Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This
文摘Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.
文摘目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(62.62±4.01)岁。记录患者基本信息及围手术期相关指标,并在术后1个月、6个月进行随访,记录术前术后改良日本骨科协会评分(modified Japanese orthopaedic association score,mJOA)、美国脊髓损伤协会(American spinal injury association,ASIA)感觉评分(ASIA sense score,ASS)和双下肢运动评分(ASIA motor score,AMS)变化情况。以mJOA评分计算术后6个月随访时的改善率(recover rate,RR)及优良率,对RR与性别、年龄、术前mJOA评分、影像学分型及病程进行相关性分析。结果平均手术时间为(108.46±16.12)min,平均出血量(23.46±7.47)mL,平均住院时间(6.08±0.86)d。术后随访时间为6~35个月,平均(16.77±9.33)个月,术后1个月及6个月随访时,mJOA、ASS、AMS评分均优于术前(P<0.05),平均RR为(55.69±19.73)%,优良率为69.23%。RR与术前病程呈负相关(P<0.001),与术前mJOA评分呈正相关(P=0.029),与性别、年龄、影像学分型均无明显相关性(P>0.05)。结论Delta大通道脊柱内镜技术治疗胸椎黄韧带骨化症安全可靠,具有术后恢复快、创伤小、出血量少等优势,短期效果良好。
