23G微创玻璃体切割术治疗特发性黄斑裂孔的疗效

目的：观察23G 微创玻璃体切割术治疗特发性黄斑裂孔的临床效果。方法：选取2013-01/10在我院采用23G 玻璃体切割系统治疗特发性黄斑裂孔患者28例28眼,进行回顾性研究。对患者进行 3～12mo的术后随访观察,进行疗效评价与分析。结果：23G微创玻璃体切割术治疗特发性黄斑裂孔28 眼,27眼黄斑裂孔愈合,1眼未愈合。术后1,3mo矫正视力较术前有显著提高（χ2=8.65,P=0.003; χ2=10.33,P=0.001）。光学相干断层扫描（optical coherence tomography,OCT）提示黄斑区裂孔封闭。术中切口缝合5例（18%）。术后眼压与术前相比差异无统计学意义。术后未发生眼内炎、视网膜脱离、玻璃体出血等并发症。结论：23G微创玻璃体切割术是治疗特发性黄斑裂孔的一种安全有效的方法,对于简单的黄斑区手术考虑首选23G微创玻璃体切割术。     

Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery

A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C₃F₈ gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid–gas exchange with 14% C₃F₈ gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.     

特发性黄斑裂孔患者黄斑部脉络膜厚度的观察

目的应用增强深部成像的相干光断层扫描（EDI-OCT）技术观察特发性黄斑裂孔（Idiopathic Macular Hole,IMH）患者黄斑部脉络膜厚度,比较患眼、对侧健眼、正常人眼黄斑部脉络膜厚度的变化,分析其相关性。方法临床对照研究。对2013年1-12月在我院眼科就诊的30例单眼特发性黄斑裂孔患者,应用EDI-OCT测量患眼及对侧健眼黄斑部中心凹处脉络膜厚度;并设年龄、性别、屈光度匹配的正常成年人30例作为对照组。采用增强深度扫描模式测定中心凹下脉络膜厚度（subfoveal choroidal thick-ness,SFCT）。结果特发性黄斑裂孔患眼SFCT均值为（182.03±38.28）μm,对侧健眼为（214.97±43.74）μm,正常人眼为（232.60±26.74）μm。特发性黄斑裂孔患者黄斑中心凹处脉络膜厚度较正常人变薄,采用两独立样本t检验,t=-5.93,P=0.000,差异有统计学意义（P〈0.05）;对侧健眼较正常人变薄,采用两独立样本t检验,t=-1.88,P=0.066,差异无统计学意义（P〉0.05）。患眼与对侧眼进行配对t检验,t=-4.13,P=0.015,差异有统计学意义（P〈0.05）。结论 IMH患眼黄斑部脉络膜厚度明显变薄,提示脉络膜血管代谢功能下降,可能与其发病机制有关。对侧健眼变薄,可能为其发病易感因素。     

Surgical Removal of Retained Subfoveal Perfluorocarbon Liquid through a Therapeutic Macular Hole with Intravitreal PFCL Injection and Gas Tamponade

We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.     

微创手术在卵巢癌治疗中的应用与争议

手术在卵巢癌治疗中至关重要，正确评价手术方式和手术路径对患者生存获益的影响一直是临床关注的热点。微创技术在早期卵巢癌的分期手术、晚期卵巢癌的肿瘤减灭手术以及复发卵巢癌的减灭手术中均有所应用。随着微创技术持续发展，机器人手术、单孔手术等都参与了卵巢癌手术治疗。文章囊括了最新的文献荟萃分析结果和临床研究结果，将目前微创手术在卵巢癌治疗中的应用及争议进行综述。期待有更多、更高质量的临床研究来评价各种手术方法和指导临床实践。     

Effects of Processing Parameters of Selective Laser Melting Process on Thermal Conductivity of AlSi10Mg Alloy

Selected laser melting (SLM) is a representative process of powder-bed type 3D printing technology that is used to manipulate metals and it generally results in various structural properties according to the process conditions. In this study, a thermal conductivity test was conducted on AlSi10Mg specimens that were manufactured using the SLM process to investigate the influence of various process conditions on the thermophysical characteristics and cellular microstructure of the samples. The building direction of the specimen, laser scan speed, and hatch spacing were considered as process variables, and the thermal conductivity was analyzed for each process variable. In the test results, as the polar angle of the specimen increased from 0° to 90°, the thermal conductivity increased. Furthermore, the thermal conductivity gradually decreased as the scan speed and hatch spacing increased. The differences in thermal characteristics are discussed in connection with the microstructure of the cells constituting the melt pool. The solidified melt pool that formed by the laser beam is composed of cells consisting of an Al matrix and a surrounding Si-rich area. The differences in thermal conductivity of the overall specimens are explained based on the variations in thermal conductivity and cell shape and size for each chemical component.     

基于数据挖掘的针灸治疗急迫性尿失禁临床取穴规律*

目的对针灸治疗急迫性尿失禁临床文献的取穴规律进行归纳分析。方法 参考中国知网（China National Knowledge Infrastructure，CNKI）、万方（WanFang Data，WF）、维普（China Secience and Technology Journal，VIP）、PubMed、Ovid、Cochrane Library等数据库并从中摘取2000年1月-2019年6月以来针灸治疗急迫性尿失禁的临床研究类文献，通过数据挖掘技术分析针灸临床取穴规律特点。结果 共纳入32篇文献，涉及腧穴25个：①腧穴使用频次最高的为会阳、次髎、中髎、中极；②腧穴关联度：会阳-中膂俞、次髎-三阴交（会阳）、大赫-委中；③涉及到的经脉以足太阳膀胱经、任脉、足太阴脾经为主，占总频次的81.2%；④腰骶部选穴部位频次最高，占选穴部位总频次的53.4%。结论 以数据挖掘技术的方式总结出针灸治疗急迫性尿失禁的腧穴和经脉的内在规律，以会阳、次髎、中髎、中极最为常用，电针为主，采用局部（病位）（腰骶部）与“经脉所过，主治所及”原则相结合的取穴方式，为针灸治疗急迫性尿失禁的临床选穴依据提供循证依据。     

玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔的疗效及影响因素分析

目的　观察特发性黄斑裂孔行玻璃体切割联合内界膜剥离及消毒空气注入术后的临床疗效，并分析术黄斑裂孔闭合的影响因素。方法　回顾性分析2015年1月至2017年8月在我院诊断为特发性黄斑裂孔并行25 G玻璃体切割联合内界膜剥离及消毒空气注入术的43例43眼患者的临床资料。所有患者术前和术后均行最佳矫正视力（best corrected visual acuity，BCVA）、裂隙灯显微镜及光学相干断层扫描检查。术前测量黄斑裂孔最小直径、裂孔最大基底直径、裂孔高度，并计算裂孔牵拉指数（tractional hole index，THI）及黄斑裂孔指数（macular hole index，MHI）等参数。术后随访3~36个月，观察患眼术后BCVA、黄斑裂孔闭合情况，分析该术式下影响术后黄斑裂孔闭合的相关因素。结果　43例43眼中黄斑裂孔闭合者37眼（86.05%），其中完全闭合29眼，暴露性闭合8眼，未闭合6眼。手术前患眼BCVA为（1.15±0.35）logMAR，术后为（1.04±0.40）logMAR，差异有统计学意义（t=3.197，P=0.003）。术前黄斑裂孔最小直径、最大基底直径与术后BCVA（logMAR）呈正相关，THI及MHI与术后BCVA（logMAR）呈负相关（均为P<0.05）。术后BCVA与术前黄斑裂孔高度无相关性（P=0.339）。当THI＞1.0或MHI＞0.5时，黄斑裂孔闭合率（包括完全闭合和暴露性闭合）为100%，当THI＞0.5或MHI＞0.3时，黄斑裂孔闭合率（包括完全闭合和暴露性闭合）分别为94.74%和97.14%。结论　玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔临床疗效较好，THI、 MHI是影响黄斑裂孔闭合的重要指标。