预注右旋美托咪啶用于喉显微手术麻醉的研究

目的研究分析预注右旋美托咪啶用于喉显微手术麻醉中的临床效果。方法选取2017年12月—2018年12月本院收治的80例行喉显微手术治疗的患者为观察对象,并将其随机分为普通组与观察组,每组各40例,普通组中患者行常规诱导麻醉,观察组中患者行预注右旋美托咪啶诱导麻醉,比较两组麻醉应用效果。结果在T1、T4、T5时段,观察组患者HR、MAP水平均低于普通组,其血流动力学稳定,且不良反应发生率相比普通组降低,两组间比较差异有统计学意义(P<0.05)。结论对行喉显微手术患者在应用预注右旋美托咪啶麻醉,能改善患者血流动力学指标水平,减少患者不良反应。     

Role of live animals in the training of microvascular surgery: a systematic review

As training in microvascular surgery often involves the use of live animals, it is important that such a practice is regularly revisited and justified, particularly in the context of emerging training strategies such as virtual simulation. This systematic review was therefore designed to assess the ongoing need for their use over other methods. A search of PubMed and MEDLINE using the major MeSH terms: anastomosis, surgical vascular procedures, microsurgery, and training, yielded 1386 titles from which 153 abstracts were read, 70 papers analysed, and 17 included. Nine of these papers were randomised studies that compared different methods of training. Other publications were included if the use of live animals was assessed or commented upon, or both (8 publications). Only one study randomised trainees to a non-living animal model or a living model, with detailed assessment that included clinical transfer to live surgery. It showed no significant difference in the quality of training, and excellent techniques of assessment. There was much discussion on the advantage of regular training and opportunities to practise without tuition, but there was no clear advantage for the use of live animals. Our review emphasises the lack of evidence regarding the need for live animals in the training of microsurgical or microvascular skills. Although the assumption remains that the use of live rats is essential, there is a clear need for a high-quality, comparative study to justify the continued use of such models given the quality of the alternatives now available.     

Outcomes of endodontic micro-resurgery: a prospective clinical study

Introduction

This study examined the outcomes of endodontic resurgery by using current microsurgery techniques on failed teeth with previous endodontic surgery. Another goal was to determine any significant outcome predictors of endodontic surgery by determining the causes of failure in the first endodontic surgery.

Methods

The data were collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and May 2009. All 54 teeth that required surgical retreatment were included in this study. All surgical procedures were performed by using an operating microscope and biocompatible root-end filling materials such as mineral trioxide aggregate (MTA) or Super EBA. The patients were recalled every 6 months for 2 years and every year thereafter to assess the clinical and radiographic signs of healing.

Results

The recall rate was 77.8% (42 of 54 patients). Of the 42 cases recalled, 39 cases were included in the success category, giving an overall success rate of 92.9%. The most common possible causes of failure were no root-end filling and incorrect root-end preparation.

Conclusions

The use of microsurgical techniques and biocompatible materials such as MTA and Super-EBA resulted in a high clinical success rate, even in endodontic resurgery.     

三维可视化技术在中央区窦旁脑膜瘤手术中的应用

目的 探讨三维可视化技术指导中央区窦旁脑膜瘤显微手术切除的效果.方法 收集大连医科大学附属第一医院神经外科于2015年9月至2019年12月收治中央区窦旁脑膜瘤患者36例.其中男16例,女20例;年龄26～70岁.所有患者术前均在磁共振检查基础上建立三维可视化影像模型,均在三维可视化技术指导下行显微手术切除肿瘤.术后24小时复查头CT,以Simpson分级结合影像等检查评估肿瘤切除程度,以KPS评分评价患者术后功能分级.结果 在术前三维可视化模型下,可清晰显示肿瘤与瘤周重要结构关系,术中所见与术前模型相符.术后24小时复查CT均未见需要手术处理的颅内血肿.36例患者中,29例获得全切,7例获得次全切.术后随访3～60个月,肿瘤复发4例,31例患者恢复良好KPS评分＞80分可正常生活,3例KPS评分60分,轻度偏瘫生活可自理,1例KPS评分30分,重度偏瘫生活需辅助,1例术后28个月因肺栓塞死亡.结论 三维可视化技术可清晰显示中央区窦旁脑膜瘤与瘤周重要结构关系,有利于术前制订手术计划及术中重要结构的保护,对中央区窦旁脑膜瘤的显微手术治疗有指导意义.     

大型矢状窦旁脑膜瘤显微外科治疗

目的探讨显微外科技术在大型矢状窦旁脑膜瘤手术中的应用。方法肿瘤位于矢状窦前1/3有6例,中1/3有13例,后1/3有8例;其中跨上矢状窦两侧的有2例,颅骨侵犯的2例,软组织侵犯的1例合并有肿瘤卒中。采用跨中线骨瓣,显微手术技术切除27例上矢状窦旁大型脑膜瘤。结果肿瘤SimpsonⅠ级16例,SimpsonⅡ级8例,SimpsonⅢ级3例;术后回访3~36个月,1例术后二个月复发。结论采用显微外科技术,暴露上矢状窦,充分显露肿瘤,有效控制出血,保护回流静脉,可减少并发症。     

颞下经小脑幕锁孔入路解剖与临床应用

目的通过神经导航下颞下经小脑幕锁孔入路的解剖和手术方案研究,探讨该入路临床应用效果。方法应用成人头颅标本12例(24侧),模拟颞下经小脑幕锁孔入路,观察暴露的岩斜区解剖结构;利用神经导航技术定位标本岩骨内部结构,最大限度磨除岩尖,观察斜坡鞍后区,上、中斜坡区等结构;利用该入路切除11例临床颅底肿瘤,探讨该入路的安全性和实用性。结果颞下经小脑幕锁孔入路可完全暴露鞍旁区,通过海绵窦外侧壁的手术三角可对累及海绵窦内外病变进行直视手术;神经导航辅助下耳蜗、内听道等结构定位准确,头颅标本岩尖磨除后耳蜗内侧缘岩尖剩余最大骨质平均厚度(0.8±0.19)mm,内侧视角较非导航入路增加(8±2.5)°,后外侧视野增加了(25±3.2)°,获得(3.3±0.4)cm2硬膜显露,明显扩大了后颅窝的暴露范围。临床病例资料肿瘤全切除6例,次全切3例,大部分切除2例,手术时间与既往相比缩短1~1.5 h,术后新增脑神经损害症状或原有脑神经损害症状加重3例,无长期昏迷及手术相关死亡病例。结论神经导航辅助下颞下经小脑幕锁孔入路,能最大程度暴露蝶岩斜区病变,有利于提高肿瘤的全切率和术后疗效。