超声吸引刀联合超声刀在原发性肝癌手术中的应用

目的：探讨超声吸引刀联合超声刀在原发性肝癌手术中的应用技巧和优势。方法：回顾性将82例原发性肝癌根据应用技术分成两组,A组40例,使用超声吸引刀联合超声刀行肝切除,B组42例,常规肝切除,比较两组治疗效果。结果：A组的术中出血量、术后引流量、术后平均住院日均少于B组（P〈0.01）,术后第1、3、7d的血ALT及术后第7d的血总胆红素均明显低于B组（P〈0.01）,术后并发症发生率与B组比较无统计学差异。结论：在原发性肝癌手术治疗中,超声吸引刀联合超声刀能减少术中出血量、术后引流量以及术后住院时间,术后肝功能损伤轻且恢复快。     

Technology and clinical application of ultrasonic dissection

Summary

The implementation of UltraCision (The Harmonic Scalpel) can be seen as a milestone in the development of surgery. Ultrasound is now used for tissue cutting and/or simultaneous vessel sealing and transection. No electric current passes through the patient. Thus the typical complications associated with electrocautery can be avoided. This technology was primarily developed for videoscopic surgery and then successfully transferred to all branches of open surgery. The clean and blood-saving dissection technology and the ability to dissect very close to sensitive structures in oncological surgery are highly beneficial for patients. The development of new blades and multifunctional shears has further enhanced both practicability and ergonomics. UltraCision can now be used for the complete surgical spectrum, both in open and in laparoscopic surgery.     

超声刀在开放性甲状腺手术中应用的前瞻性研究

目的：探讨超声刀在开放性甲状腺手术中应用的有效性及安全性。 方法：采用前瞻性随机对照方法,将2010年2月—2012年5月210例患者分为超声刀组与电刀组,各105例,分别采用超声刀与传统电刀手术方法行开放性甲状腺切除术,手术均由普外科甲状腺手术经验丰富同一手术团队完成。比较两组在不同手术方式中手术时间、术中出血量、术后引流量、术后并发症等指标。 结果：两组患者年龄、性别、肿块大小及疾病构成比差异无统计学意义（均P>0.05）。在相同的手术方式中,超声刀组手术时间手术、术中出血量及术后引流量（减少10~40 mL）均较传统结扎结合电刀组明显减少,组间差异均有统计学意义（P<0.05）;两组间术后并发症的差异无统计学意义（P>0.05）。 结论：超声刀集切割、止血于一体,简化手术操作过程;在开放性甲状腺手术中应用超声刀,可缩短手术时间,减少出血。     

LigaSure和超声刀在Miccoli手术中的应用研究

目的 比较LigaSure血管闭合系统与超声刀在Miccoli手术中应用的手术时间和并发症.方法 回顾性分析上海交通大学附属第六人民医院普外科2007年1月至2011年12月期间684例行Miccoli术式患者的临床资料,其中应用LigaSure血管闭合系统者335例,应用超声刀完成手术者349例.对其平均手术时间及术后常见并发症(切口内血肿、一过性声音嘶哑、永久性喉返神经麻痹及低钙血症)进行对比.结果 所有684例患者中,有263例行甲状腺全切除术,421例行甲状腺腺叶切除术.使用超声刀者手术时间略短于使用LigaSure血管闭合系统,但二者比较差异无统计学意义(P＞0.05);二者的术后常见并发症比较差异亦无统计学意义(P＞0.05).结论 LigaSure血管闭合系统和超声刀设备应用于甲状腺手术均是安全、可靠的,术者可根据手术习惯及医院配备选择应用手术器械.     

小针刀治疗跟痛症85例远期疗效观察

目的观察小针刀松解术治疗跟痛症的远期疗效。方法 170例患者随机分为观察组和对照组各85例,观察组采用小针刀松解术治疗,对照组采用常规封闭疗法,通过随访比较2组远期疗效。结果观察组6个月和1年后总有效率高于对照组,差异有统计学意义(P<0.05)。结论小针刀治疗跟痛症,远期疗效满意,方法简便、安全,费用低,值得临床推广。     

流感2号辅助治疗支原体肺炎疗效观察

分别采用普通按摩、小针刀、大推拿来配合牵引的非手术综合治疗方法治疗腰椎间盘突出并对其疗效进行比较分析,结果显示此三种方法疗效并无显著性差异。     

后腹腔镜下肾切除术21例

目的总结后腹腔镜肾切除术的技巧及其并发症与安全性。方法对需行肾切除术的21例患者应用后腹膜外入路三孔法，在超声刀辅助下实施肾脏切除。结果21例中17例经后腹腔镜下成功完成肾切除术，4例中转开放手术，无1例出现严重并发症。手术最长时间238分钟，最短85分钟，平均160分钟。术后第2天即可下床活动，平均术后6～8d出院。结论后腹腔镜下肾切除术和传统开放手术相比，具有创伤小、恢复快、住院时间短、安全性高等优点，值得在有条件之医院开展，能获得良好的社会效益和经济效益。     

鼻内镜辅助超声刀鼻咽血管纤维瘤切除手术

目的探讨从鼻腔径路鼻咽血管纤维瘤超声刀切除术减少术中出血的可行性。方法14例鼻咽血管纤维瘤患者，行同侧主供血动脉DSA栓塞后经传统硬腭径路手术7例，鼻内镜下辅以鼻腔径路超声刀手术7例，比较两组患者的出血量、手术时间等指标。结果传统手术术中出血约700-1200ml，平均860ml，手术时间180-300min；鼻内镜下辅以鼻腔径路超声刀手术术中出血约250-350ml，平均293ml，手术时间90-180min，组间差异有统计学意义（均P〈0．001）。结论鼻内镜下辅以腔径路超声刀手术，是有效切除鼻咽血管纤维瘤的安全术式，能明显减少术中出血，缩短手术时间，降低术后复发率。     

Comparative observations on effects of carbon dioxide laser-induced peripheral nerve lesions in the rat

This study was conducted to determine any changes that might occur in the associated cell bodies and proximal nerve stumps of sciatic nerves cut with carbon dioxide laser radiation. These changes were then compared with the changes that occur when performed with cutting cautery and scalpel. Both the proximal stump and the related dorsal root ganglia were examined with light and electron microscopy. The sciatic nerve was severed in 10 rats with the carbon dioxide laser, a cutting cautery, or a scalpel. Subsequent histopathologic examinations revealed: (a) both myelin and axonal degeneration in scalpel cuts; (b) less degeneration of proximal stump myelin in laser cuts compared with cautery cuts; and (c) no abnormalities in the associated dorsal root ganglia of nerves cut with the carbon dioxide laser. It was concluded that both the carbon dioxide laser and cutting cautery result in less damage and degeneration than a scalpel when used to sever peripheral nerves. The difference between the laser and cautery lesions was more quantitative than qualitative in that both impart thermal energy to the nerve. The carbon dioxide laser resulted in the least amount of injury.     

Hereditary hemorrhagic telangiectasis treated by the harmonic scalpel

BACKGROUND: Hereditary hemorrhagic telangiectasis (HTT) is a familial autosomal dominant genetic disorder that causes abnormalities of the wall of peripheral blood vessels. Severe nosebleed often is the dominant symptom. A variety of therapies have been proposed for epistaxis control in HHT but with limited success. METHODS: We report two cases of HHT in which recurrent nasal bleeding was successfully controlled using the Harmonic Scalpel. RESULTS: Use of the Harmonic Scalpel avoids the carbonization and incrustation of the nasal mucosa that commonly results from electrocautery and laser irradiation. Even during active bleeding, hemostasis can be achieved by repeated applications of the scalpel blade. CONCLUSION: This method can be performed quick and reliably on an outpatient basis. The Harmonic Scalpel may be the treatment of choice for recurrent epistaxis in HHT.