腹腔镜下止血设备新进展

目的为提高血管闭合性能、手术效果和临床结局,市场上研发了许多新式的血管闭合系统。在微创手术中,爆破压、横向热扩散、闭合率和故障率是选择器备并获得最理想手术效果的重要考虑参数。本文详细介绍多种新式止血设备的物理学原理和基本运行机制,并回顾相关文献评价各个设备的优缺点。

在澳大利亚利用腹腔镜进行附件手术的现状和变化趋势

自从引入腹腔镜手术,普遍认为应用腹腔镜进行附件手术会取代开腹手术。然而事实证明,虽然腹腔镜手术开展了20多年,开腹附件手术仍未被淘汰。这份来自澳大利亚各州及地区关于附件手术病人的资料显示了在澳大利亚应用腹腔镜进行附件手术的变化趋势。同时还有一份来自悉尼利物浦医院病人的资料同样也说明了在附件手术中决定选择何种手术方式的影响因素。我们的研究认为,在所有附件手术中,应用腹腔镜进行手术已经增加到90%,然而大概还有10%的病人需要开腹手术。全国范围内附件手术在手术方式选择上的变化趋势受政府医疗保险政策变化的影响。利物浦医院的当地资料显示,不同个体在手术方式选择上的变化趋势与澳大利亚全国范围内附件手术方式变化趋势不同,是由于管理人员和资金的改变引起的。从病人利益角度考虑,一项对妇科医师问卷调查显示,下述因素是导致医师选择开腹手术的重要原因:术前怀疑肿瘤是恶性的;医生缺少腹腔镜技术的培训;急诊状况下。术前应用敏感性高和特异性好的肿瘤标志物改善附件恶性肿瘤术前诊断的准确性有利于更多病人进入腔镜组而不是开腹组,同时医师经过良好的训练和提高手术技术也可以在不久的将来促进腹腔镜手术的发展。

The evolution of sacrocolpopexy and development of novel techniques via natural orifice transluminal endoscopic surgery

Prolapse of one or more pelvic organs through the vagina,such as the uterus,bladder,or rectum,is an increasingly common occurrence in the aging female population,with rates approaching 60%of parous women.1 Its associated symptoms of vaginal bulge or bladder,bowel,or sexual dysfunction can drastically affect a woman's quality of life.Multiple surgical options for the treatment pelvic organ prolapse exist and may involve autologous tissue repair or the use of biological or synthetic grafts.Abdominal sacrocolpopexy,first described in 1957 by Arthure and Savage,involves using the sacrum as a point of support for the vaginal apex.2 The technique was further refined by Huguier and Scali by the incorporation of a graft to improve tissue strength and to improve postoperative anatomical cure rates.3 For many surgeons,abdominal sacrocolpopexy is the preferred surgical technique as it has demonstrated superior outcomes with higher postoperative success rates through restoration of normal anatomy and lower rates of prolapse recurrence and postoperative dyspareunia.