原发性肝癌合并肺转移的微创治疗

19例、发热16例、术后疼痛17例及局部出血1例,肺部病灶处理过程中出现出血3例、气胸2例、气促1例,经对症治疗后均缓解.患者近期平均生存期(11.5±1.1)个月.结论 微创治疗技术的综合运用是治疗原发性肝癌合并肺转移的有效手段.     

原发性肝癌合并肺转移的微创治疗

19例、发热16例、术后疼痛17例及局部出血1例,肺部病灶处理过程中出现出血3例、气胸2例、气促1例,经对症治疗后均缓解.患者近期平均生存期(11.5±1.1)个月.结论 微创治疗技术的综合运用是治疗原发性肝癌合并肺转移的有效手段.     

微创心脏外科手术

微创心脏手术正在经历快速演变.几十年来,瓣膜手术通常都是通过使用体外循环全胸骨切开在心脏停搏下来进行.在过去的十年中,这个基本的模式已部分向微创心脏外科转变.微创心脏外科包括了诸多的外科治疗技术,目前比较统一、公认可以开展的微创心脏外科手术有不停跳冠状动脉旁路移植手术、胸部小切口心脏手术如部分胸骨切开或右胸小切口的瓣膜和先天性心脏病手术和介入方法在心脏外科中的应用如经皮、经主动脉和经心尖的主动脉瓣膜手术.     

Minimally invasive follicular thyroid carcinoma

Infiltration of the capsule, vascular invasion, and/or neoplastic extension into the adjacent parenchyma are regarded as prerequisites for the diagnosis of follicular carcinoma. In modern practice, most of these tumors fall into the category of follicular carcinoma, minimally invasive (FCMI) characterized by evidence of limited capsular or vascular invasion with an excellent long-term prognosis and a good patient outcome. Notwithstanding the wide acceptance of the diagnostic criteria established by the World Health Organization for the classification of follicular carcinomas in particular, they have been difficult to apply and have led to a great deal of confusion. This confusion is compounded when applied to "low-grade" or "minimally invasive" follicular carcinoma because of the poor reproducibility of the classification and the variable results reported in the literature. Our surgical colleagues face a similar lack of a standardized treatment for low-grade follicular carcinomas, which leads to unnecessary surgical treatment. Standardization of histologic criteria is necessary to promote confidence and uniformity in the therapeutic approach of these tumors. We believe that a FCMI is defined as an encapsulated follicular tumor (not papillary), with only small to medium vessel invasion within or immediately adjacent to the tumor capsule and/or up to full-thickness capsular transgression without accompanying extension into the thyroid parenchyma with intervening fibrosis. By using these criteria, patients can be managed with conservative surgical excision to yield an excellent long-term patient outcome.     

Minimally invasive parathyroidectomy using surgical sonography

Minimally invasive parathyroidectomy is the procedure of choice for primary hyperparathyroidism due to parathyroid adenoma. Localization of the offending adenoma in minimally invasive parathyroidectomy (MIP) has been described in the literature aided by isotope, telescope or ultrasound guidance. We present a prospective study of two techniques based on surgeon experience. Thirty patients diagnosed with primary hyperparathyroidism at the Mater hospital in Dublin, Ireland were randomized to have a minimally invasive parathyroidectomy using surgical sonography (MIPUSS) or the conventional unilateral open procedure (OP) over a two year period. The age, sex and serum calcium/parathormone were comparable in both groups. There was no significant difference in complications between the two groups with temporary hypocalcemia occurring in 3 patients undergoing unilateral neck exploration and in 2 MIPUSS patients. There was one transient episode of recurrent laryngeal neuropraxia occurring in the OP group which resolved at 30 day follow-up. The incision size, operating time, hospital stay, and required post-operative analgesia were all markedly reduced in the MIPUSS group. In conclusion, MIPUSS is safe, effective and has advantages in terms of operating time, incision size and early discharge.     

胰腺炎的微创介入治疗

为进一步提高胰腺炎的综合治疗水平．广泛查阅近年来国内外对胰腺炎行微创介入治疗研究的文献．从血管性介入和非血管性介入治疗不同类型胰腺炎及其并发症等方面进行综述,提出介入治疗胰腺炎以其痛苦小、并发症少、操作简便、疗效确切等特点,已经成为胰腺炎积极而有效的主要治疗手段,在胰腺炎的治疗中发挥重要作用。     

微创治疗中脊柱转移瘤椎体成形骨水泥注入及射频消融和放射疗法

背景：微创技术的发展明显降低了脊柱转移瘤手术并发症,目前微创治疗方法主要有椎体骨水泥增强、射频消融联合椎体成形、术中放疗联合椎体成形3大类。 目的：总结上述3大类微创治疗脊柱转移瘤的研究进展。 方法：以“脊柱转移瘤,椎体成形,射频消融,放射治疗;spinal metastases,vertebroplasty,radiofrequency ablation,radiotheray”为关键词,检索PubMed、万方数据库文献。 结果与结论：骨水泥增强技术应用广泛、止痛效果很好,有效率达80%-90%,但骨水泥产热杀灭肿瘤的效果非常有限,不能控制肿瘤生长;射频消融及放疗能够杀灭肿瘤,但不能重建稳定性,将不同技术结合可以提高脊柱肿瘤的治疗效果。术中应用放射线、植入放射性粒子或放射性骨水泥是近年发展起来的新技术,因报道较少,缺乏长期随访,目前还不能得出优于单纯骨水泥增强技术的结论。尤其是针对椎体后壁破坏及部分侵入椎管的转移瘤患者,虽然做了很多尝试,但骨水泥渗漏导致神经功能加重的风险依旧很高,所以目前还没有一种完善的微创治疗方法。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

Minimally invasive estimation of systemic vascular parameters

A cardiovascular parameter estimator to identify the systemic vascular parameters was developed using an extended Kalman filter (EKF) algorithm. Measurements from a ventricular assist device (VAD) and arterial pressure were used in the estimator. The systemic vascular parameters are important indices of heart condition. However, obtaining these parameters usually requires invasive measurements, which are difficult to obtain under most clinical environments. Including a VAD model into the estimator and using the signals from a VAD to identify the cardiovascular parameters for VAD patients would minimize the need for indwelling sensors. This paper illustrates the use of a Novacor left ventricular assist system (LVAS) model with a cardiovascular model in the estimator to identify the systemic vascular parameters: characteristic resistance, blood inertance at the aorta, systemic compliance, and systemic resistance. Performance of the estimator was evaluated using data from a computer simulation and from a mock circulatory system experiment. Robustness of the estimator to the available measurements was also described. The estimation results showed that the estimates converged with reasonable accuracy in a limited time when the LVAS pump volume and arterial pressure were used as measurements. These parameter estimates can provide additional diagnostic information for patient and device monitoring and can be used for future VAD control development. © 2001 Biomedical Engineering Society. PAC01: 8719Uv, 8719Hh     

Minimally invasive spectroscopic system for intraocular drug detection

A novel, minimally invasive measurement technique has been developed for the detection of drugs in the anterior chamber of the eye. Presently there is no satisfactory, real-time detection method available to the ophthalmic community. Accurate determination of drug concentrations in the eye would be of great value and assistance to researchers and manufacturers of ophthalmic drugs and ocular implants, to enable a better understanding of intraocular pharmacokinetics. At present researchers use techniques of direct sampling of the aqueous humor from laboratory animal eyes into which the drug has been introduced topically or systemically. Rabbit eyes are frequently used in this context. Sampling via paracentesis is invasive, and does not yield a continuous measurement. Our approach to addressing this measurement requirement is, in effect, to turn the eye into a cuvette and use optical absorbance spectroscopy measurements to detect drug concentrations. A novel contact lens has been designed using commercial, off-the-shelf, optical design software. The lenses have been optimized to direct light across the anterior chamber of a rabbit's eye. Practical demonstration and characterization of light propagation across the eye have been undertaken and are reported. Preliminary results of the identification of drug compounds introduced into model eyes are also reported.     

微创外科-手术学教学的新领域

进入20世纪后期，随着现代医学观念的改变，外科手术和器械、设备不断改进及医学科学技术不断发展，减少创伤、外科微创化的观念已逐步渗透到外科学的各个方面，以腔镜技术为代表的微创外科手术技术应运而生，微创化外科观念得以迅速建立、传播和发展。     

Minimally invasive neurosurgical methods in treatment of pharmacoresistant epilepsy

The first clinical attempts at neuromodulation in the form of applying functional electrostimulations started some thirty years ago. Nowadays, it is obvious that the approach to neuromodulation and functional electrostimulation has changed significantly. Neuromodulation tends to affect the disturbed function either by the modulation of neuronal signals or by abolition of dysfunction, preserving the intact central nervous system. The mechanism of activity is connected through direct afferent projections, neurotransmitter modulation and neuronal network regulation. NeuroCybernetic Prosthesis (NCP; Cyberonics) is a vagal nerve stimulator consisting of a pulse generator, bipolar VNS lead, programming wand with accompanying software for IBM-compatible computer, a tunneling tool and handheld magnets. NCP is placed on the left vagal nerve (middle cervical part). In 1988, Penry JK et al. inserted the first human implant. The Food and Drug Association indicated VNS as add-on therapy for diminishing the number of seizures in the adults and adolescents over 12 years of age with partial seizures, who are resistant to pharmacological therapy.     

A device guidance method for organ motion compensation in MRI-guided therapy

Organ motion compensation in image-guided therapy is an active area of research. However, there has been little research on motion tracking and compensation in magnetic resonance imaging (MRI)-guided therapy. In this paper, we present a method to track a moving organ in MRI and control an active mechanical device for motion compensation. The method proposed is based on MRI navigator echo tracking enhanced by Kalman filtering for noise robustness. We also developed an extrapolation scheme to resolve any discrepancies between tracking and device control sampling rates. The algorithm was tested in a simulation study using a phantom and an active mechanical tool holder. We found that the method is feasible to use in a clinical MRI scanner with sufficient accuracy (0.36 mm to 1.51 mm depending on the range of phantom motion) and is robust to noise. The method proposed may be useful in MRI-guided targeted therapy, such as focused ultrasound therapy for a moving organ.     

Real-time correction of magnetic field inhomogeneity-induced image distortions for MRI-guided conventional and proton radiotherapy

Image-guided radiotherapy has the potential to increase the success of treatment by decreasing uncertainties concerning tumour position and shape. We pursue integrated diagnostic quality MRI functionality with radiotherapy systems to boost the possibilities of image guidance by providing images with superior soft-tissue contrast during treatment. However, the use of MR images in radiotherapy can be hindered by geometrical distortions due to magnetic field inhomogeneity problems. A method for fast correction of these distortions is presented and implemented. Using a 20 cm square phantom containing a regular grid, a measure of residual deformation after correction is established. At very low gradient strength (which leads to large deformations) a maximum displacement of 2.9 mm is shown to be reduced to 0.63 mm. Next, the method is applied in vivo to the case of pelvic body contour extraction for prostate radiotherapy treatment planning. Here, again with low gradient strengths, distortions of up to 6 mm can be reduced to 2 mm. All results are provided within a lag time of 8 ms. We discuss implications of image distortions for MRI-guided photon and proton radiotherapy separately, since the dose-depth curves in these treatments are very different. We argue that, although field inhomogeneities cannot be prevented from occurring, distortion correction is not always necessary in practice. This work opens new possibilities for investigating on-line MRI-based plan adaptations and ultimately MRI-based treatment planning.     

Minimally invasive maxillofacial vertical bone augmentation using brushite based cements

An ideal material for maxillofacial vertical bone augmentation procedures should not only be osteoconductive, biocompatible and mechanically strong, but should also be applied using minimally invasive procedures and remain stable with respect to the original bone surfaces. This way, implant exposure and infection might be reduced and good mechanical stability may be achieved. Calcium phosphate cements are proven biocompatible and osteoconductive materials that can be injected using minimally invasive procedures. Among these cements, brushite based cements have the added advantage of being biodegradable in vivo. Therefore, this material has the potential for use in the aforementioned procedures. An in vivo study was performed in rabbits to evaluate the potential use of brushite cements in minimally invasive maxillofacial vertical bone augmentation procedures. In this study, we injected self-setting brushite cements on the subperiosteal bone surface using a minimally invasive tunnelling technique. The cement pastes were stable on the bone surface and hardened soon after they were injected thereby negating the need for additional supports such as membranes or meshes. The animals were sacrificed 8 weeks after the intervention and histological observations revealed signs of successful vertical bone augmentation. Therefore, we have demonstrated a minimally invasive vertical bone augmentation procedure that is an attractive alternative to current surgical procedures in terms of increased simplicity, reduced trauma, and lower cost of surgery.