经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例

目的 探讨da Vinci Si机器人甲状腺手术不同径路的安全性.方法 2014年1月济南军区总医院用da Vinci Si外科手术系统完成甲状腺腺叶切除2例.1例取腋窝径路,于患侧腋窝沿腋前线取切口约5 cm,对侧锁骨中线乳头上方取横切口约8 mm,建立皮下隧道至术区,经腋窝切口置入da Vinci Si外科手术系统摄像臂及1、2号器械臂,经8 mm trocar置入3号器械臂.另一例取胸前径路,于胸骨切迹下约12 cm处建立观察孔12 mm,双侧锁骨中线乳晕上方处建立操作孔8 mm,观察孔置入摄像臂,操作孔置入1、2号器械臂,术中止血及腺体切除均采用超声刀,标本用取物袋取出,术毕于术区留置负压引流管并关闭手术切口.结果 2例患者均成功实施机器人甲状腺腺叶切除术,无中转开放或腔镜手术,无手术并发症,术中估计出血量10 ～20 mL,平均手术时间为163 min,平均引流量90.5 mL.病理诊断分别为结节性甲状腺肿和甲状腺滤泡性腺瘤.术后测甲状旁腺素及血清钙磷均在正常范围.结论 经腋窝与胸前径路机器人甲状腺腺叶切除安全可行,手术美容效果好.     

内窥镜辅助下乳房聚丙烯酰胺水凝胶取出术

目的探讨内窥镜辅助下取出隆乳术后注射物的整形修复的临床应用与操作要点。方法N2006年1月至2012年10月,应用内窥镜辅助取出聚丙烯酰胺水凝胶注射隆乳术后35例70侧。行双侧腋窝切口或乳晕切口,内窥镜直视下取出注射材料,21例I期放置乳房假体。结果随访1年,术后恢复良好,无明显包块,无包膜挛缩。所有患者术后乳房无明显注射物残留,无血肿及感染。结论采用内窥镜辅助下行注射隆乳术后注射物取出整形修复术,手术在直视下进行,去除注射物较彻底,创伤较小;I期假体置入无明显影响,术后效果好,无明显并发症发生,是值得推广应用的辅助技术。     

经腋窝内窥镜辅助下隆乳术不同操作方法的临床分析

目的总结利用内窥镜技术经腋下进行双平面隆乳术的经验,探讨不同的操作方式及效果。方法利用内窥镜进行层次分离步骤时,主要有3种不同的操作方式：第1种,由手术医师独自完成内窥镜下的显露及分离;第2种,在助手协助下完成内窥镜下的显露及分离;第3种,利用气腹机辅助显露完成内窥镜下层次的分离。结果自2010年8月至2014年3月,利用3种操作方式进行内窥镜隆乳术130例。前2种方法切口愈合不良发生率较高;再次手术率、包膜挛缩、乳头乳晕感觉减退方面,第3种方法均好于其他2种方法。结论经腋下内窥镜隆乳术中,利用气腹机辅助分离是可行并有效的。     

Randomized controlled trial of alfacalcidol supplementation for the reduction of hypocalcemia after total thyroidectomy

BackgroundThe aim of this study was to evaluate the effect of perioperative alfacalcidol on postoperative hypocalcemia after total thyroidectomy.MethodsA total of 219 patients scheduled for total thyroidectomy were randomized into groups not receiving (group A) or receiving (group B) perioperative alfacalcidol. Postoperative hypocalcemia was compared between groups on postoperative day (POD) 1 and POD2. Patients with hypocalcemia (<2.00 mmol/L) received oral calcium supplementation. Calcium and vitamin D levels were measured at 5-week and 6-month follow-ups.ResultsThe incidence of symptomatic hypocalcemia was significantly lower in group A (P = .02), whereas similarly low levels of calcemia were observed in both groups on POD1 (37% and 30%, respectively; P = not significant) and persisted on POD2 (14% and 6%, respectively; P = not significant). Patients with severe hypocalcemia (<1.90 mmol/L) showed faster recovery in group A compared with group B (6% vs 1%, P = .04). At 5 weeks, calcium and vitamin D levels were similar between the groups. Six months after surgery, 4% (group A) versus 0% (group B) of subjects exhibited permanent hypoparathyroidism (P = .04).ConclusionsAlthough the treatment did not correct vitamin D deficiency, perioperative alfacalcidol uptake resulted in decreased transient hypocalcemia and related symptoms in patients undergoing total thyroidectomy.     

The Effectiveness of Endoscopic Radiofrequency Denervation of Medial Branch for Treatment of Chronic Low Back Pain

Objective

The aim of this study is to evaluate the clinical results of endoscopic radiofrequency ablation of medial branch in patients with chronic low back pain originating from facet joints.

Methods

Between October 2010 and December 2013, 52 consecutive patients had suffering from chronic low back pain had undergone endoscopic radiofrequency denervation of medial branch of dorsal ramus. The clinical outcomes of these 52 patients were reviewed retrospectively. Preoperative and postoperative Visual Analogue Scale (VAS) and Korean version of Oswestry Disability Index (K-ODI), and patients'' satisfaction with the procedure were assessed.

Results

The pain scores on the VAS for back pain had improved significantly from a preoperative mean of 7.1 to a postoperative mean of 2 at the last follow-up (p<0.001). The clinical outcomes based on the K-ODI had also improved significantly from a preoperative mean of 26.5% to postoperative mean of 7.7% at the last follow-up (p<0.001). 80% of patients were satisfied with the procedure. There were no complications associated with the procedure.

Conclusion

Our preliminary results demonstrate that endoscopic radiofrequency denervation of medial branch could be an effective alternative treatment modality for chronic back pain originating from facet joints that provides long-term pain relief.     

Outcome of Endoscopic Transsphenoidal Surgery in Combination with Somatostatin Analogues in Patients with Growth Hormone Producing Pituitary Adenoma

Objective

To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor.

Methods

We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated.

Results

A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery.

Conclusion

Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.     

Endoscopic management for pancreatic injuries due to blunt abdominal trauma decreases failure of nonoperative management and incidence of pancreatic-related complications

Introduction

The actual benefit of endoscopic techniques in the non-operative management (NOM) of pancreatic injury is still unclear, with its role and effectiveness in the NOM of pancreatic injury remains defined and doubted. The purpose of this study was to evaluate the feasibility and long-term results of endoscopic techniques in the NOM of blunt pancreatic injury, and to determine whether NOM can be performed safely for selective patients with pancreatic injury.

Patients and methods

The records and follow-up data of all patients with blunt pancreatic injuries over 16-year period from October 1, 1996, to September 30, 2012 at our department were retrospectively reviewed. Failure of NOM (FNOM) occurred if laparotomy was required after attempted NOM.

Results

132 patients (32% of all patients with blunt pancreatic injury) underwent NOM, including 58 who underwent endoscopic management (EM) and 74 who were observed without EM (NO-EM). FNOM of overall NOM was 20%, including 30% of NO-EM and 9% of EM. There was no significant difference in FNOM for NO-EM versus EM for grade I, however, a significant decrease in FNOM was noted with the addition of EM for grade II and III. EM was a statistically significant independent risk factor. Regular follow-up of 1 year showed that, for patients from grade I to III, 53 patients (42%) from operative management (OM) and 34 patients (46%) of the NO-EM developed various pancreatic-related complications, while only 15 patients (26%) of the EM developed such complications, and the difference was significant.

Conclusion

Application of strictly defined selection criteria for NOM and EM in patients with blunt pancreatic injury resulted in one of the lowest FNOM rates (9%) and pancreatic-related complications incidence (25%). Selective application of EM for hemodynamically stable patients with blunt pancreatic injury will extend the indications for, and improve success of NOM.