区域麻醉下行甲状腺及甲状旁腺手术

甲状腺及甲状旁腺手术通常在全麻下进行,但对于经过选择的病人应用局麻和区域阻滞也能有良好效果.作者回顾了1977～1986年应用区域阻滞麻醉进行的17例甲状腺手术及2例甲状旁腺手术,并介绍了颈部手术区域麻醉的最新改良.适应证和禁忌证:甲状腺疾病病人伴有心肺疾病及病人要求接受局麻或区域阻滞麻醉者为适应证.禁忌证包括焦虑,耳聋,高位脊髓损伤,喉返神经或膈     

腔镜甲状腺手术的研究进展

腔镜甲状腺切除术作为甲状腺肿瘤的重要治疗手段之一,近年发展迅速.经过不断探索,研究者们开创了各种手术入路,其手术适应证不断拓展,一些术中辅助技术及器械也随之诞生.腔镜甲状腺手术具有手术切口隐蔽、外形美观、疗效确切等优点,深受年轻患者的青睐.本文现就近年腔镜甲状腺技术的发展作一综述.     

胸前壁乳晕入路内镜甲状腺手术的回顾性分析

目的:总结取胸前壁乳晕入路作内镜甲状腺手术治疗的经验,并以此指导临床适应证的选择.方法:回顾性分析单一术者,连续400例采取胸前壁乳晕入路施行内镜甲状腺手术的临床资料.取前200例按时间顺序平均分为10组,每组20例.统计包括病人一般情况、手术方式、手术难度分组、手术时间、并发症等数据.用统计学方法分析各组甲状腺手术难度分组构成比及手术时间等差别.结果:平均手术时间为104.55 min;各组病人的一般资料、术后并发症等无明显差别;各组手术难度分组有统计学差异(P<0.05);各组手术时间均数有显著统计学差异(P<0.01).相邻组间第3组与第4组有统计学差异(P<0.05).结论:胸前壁乳晕入路内镜甲状腺手术是治疗甲状腺肿瘤的一个安全、有效的手术方式.经过60例内镜甲状腺手术学习曲线早期阶段后,可将手术适应证适当放宽.     

甲状腺结节腔镜外科治疗的变迁

目的总结腔镜甲状腺切除术的手术入路、适应证、禁忌证及手术并发症的变迁。方法复习国内外有关腔镜甲状腺切除术的文献,总结其入路、适应证、禁忌证及常见并发症的历史与现状。结果各腔镜甲状腺手术的入路均有其优点,其中胸乳入路及完全乳晕入路为主流术式;腔镜甲状腺切除术的适应证和术者及器械有紧密的关联,目前尚无统一的适应证;随着腔镜技术的提升,禁忌证会逐渐被克服;新器械的辅助和术者经验的累积降低了手术并发症的发生率,但仍有并发症发生。结论腔镜甲状腺切除术是治疗甲状腺结节的主要手段,随着技术的提升、器械的革新、适应证的扩大及禁忌证的克服,其会获得更广泛的应用。     

腔镜甲状腺癌手术后复发特点及处理

腔镜甲状腺手术是指采用颈部或颈外入路在腔镜辅助或完全腔镜下进行的甲状腺手术.随着腔镜技术的完善、手术经验的积累和器械的研发,目前腔镜甲状腺手术适应证已扩大到早期甲状腺乳头状癌.腔镜甲状腺手术有成像放大和术后美容的优势,但也存在一些不足,如腔镜甲状腺癌手术清扫淋巴结时,可能会存在操作盲区,为肿瘤复发和转移留下隐患.腔镜甲...     

胸乳入路腔镜手术与开放手术治疗甲状腺单侧叶结节的疗效分析

比较胸乳入路腔镜甲状腺手术与开放手术治疗甲状腺单侧叶结节的临床效果.回顾性分析2019年5～10月134例行甲状腺单侧叶切除术患者临床资料.根据患者意愿及腔镜甲状腺手术适应证,行开放手术患者90例(开放组),行胸乳入路腔镜甲状腺手术(腔镜甲状腺)患者44例(腔镜组).根据术中快速病理确定术式,甲状腺良性病变者行甲状腺单...     

腺叶精细化解剖全甲状腺切除治疗分化型甲状腺癌

甲状腺切除术已经开展了一个多世纪.甲状腺肿瘤的手术方式仍未完全完善,手术技巧仍在逐步提高.分化型甲状腺癌的甲状腺切除范围也是一直争论不休的问题.全甲状腺切除是甲状腺癌的主要手术方式之一,手术并发的喉神经损伤及甲状旁腺功能低下是常见的并发症,尤其是甲状旁腺功能低下已严重影响患者生存质量.严格适应证选择、提高手术操作技术、手术中精细操作可减少这些并发症的发生.笔者自2007年起运用甲状腺叶精细解剖技术切除全甲状腺治疗分化型甲状腺癌,总结分析以供临床参考.     

甲状腺全切除术93例临床分析

国内外对于全甲状腺切除术的应用范围一直有争议~([1-2]).近些年来,在我国该术式的应用有盲目扩大适应证的趋势.本文回顾性分析总结我院2007年-2008年收治的93例实施甲状腺全切除术患者的临床及近期随访资料,探讨全甲状腺切除术的手术适应证、操作技术要点及其术后并发症的防治方法,现报告如下.     

腔镜技术在甲状腺手术中的应用选择

随着腔镜技术的发展及甲状腺手术技巧的不断完善,腔镜技术在甲状腺手术中的应用越来越广泛。然而腔镜甲状腺手术在适应证选择及如何合理选择腔镜技术在实际应用中仍存在争议。腔镜技术为甲状腺疾病患者带来的价值是不可否认的,但严格把握适应证、规范的治疗策略、成熟的操作技巧以及根据患者病情提供个体化治疗仍为关键。     

经胸骨前入路腔镜甲状腺手术临床分析

目的:探讨经胸骨前入路行腔镜甲状腺手术的方法、适应证及安全性.方法:回顾分析为22例甲状腺疾病患者经胸骨前入路行腔镜甲状腺手术的临床资料.结果:21例成功完成手术,其中腺瘤摘除术4例,单侧腺叶次全切除术12例,双侧腺叶次全切除术5例,1例甲状腺癌中转开放手术,行双侧甲状腺全切除及颈淋巴结廓清术.手术时间70～170mi...     

肛提肌外腹会阴联合直肠切除术治疗低位直肠癌

传统的腹会阴联合直肠切除术存在环周切缘阳性率高及术中穿孔率较高而影响预后的缺点,肛提肌外腹会阴联合直肠切除术可克服这些缺点．但该术式存在操作复杂、创伤大和并发症多等缺点。通过近几年的临床研究．国内外学者对该术式的适应证、手术方式改良及并发症的防治有了更加深入的认识。本文就经胍提肌外腹会阴联合直肠切除术的特点、手术适应证、研究进展及相关并发症的防治进行讨论。     

Miniforum: rhinoplasty by external approach. Technical aspects of rhinoplasty by external approach]

The authors present the principle techniques of external transcolumellar rhinoplasty and stress the excellent exposure it provides, allowing effective treatment under direct vision of the anatomical structures of the nose tip, nasal spine and septum. Based on a series of 186 operated cases with a follow-up of between one and more than six years, the advantages and indications of this technique are briefly defined. The best indications are difficult nose tips, whether rhinoplasty is primary or, more particularly, when it is secondary.     

Hip arthroscopy in children and adolescents

Hip arthroscopy has become an established procedure for certain indications in adults; however, experience in children and adolescents has been more limited. This article reviews the technique, indications, and results of hip arthroscopy in children and adolescents.     

Anchor suture technique for muscle belly repair

Upper extremity lacerations occur frequently. Although surgical indications for tendon repair are widely accepted, indications for repairing the midsubstance of muscles are not as clear. As the standard of care for muscle repair is absent, there are a variety of techniques available to the treating surgeon. In this study, we describe a technique used on several patients seen in our orthopedic practice. The use of orthogonally placed anchor sutures allows for more reliable suture passes and purchase in the muscle belly compared with simple end-to-end approximation. Furthermore, our technique does not introduce excessive foreign material as has been suggested by previous techniques.     

Complications after subclavian-cortical middle cerebral artery bypass

Subclavian-cortical middle cerebral artery bypass by saphenous vein interposition is an uncommon recent revascularization technique used for immediate volume flow to the brain or when donor arteries are unavailable or inadequate. We used this technique in four cases of symptomatic common carotid artery occlusion. In the last two cases, severe, reversible neurological complications occurred. We think that these complications are due to this particular technique, and more cautious indications than for traditional extra-intracranial arterial bypass are recommended.     

The artificial urinary sphincter in the female: Indications for use, surgical approach and results

Female urinary incontinence is a common problem. Among the many treatment options a few patients may be suitable candidates for the artificial urinary sphincter (AUS). The indications for placement of an AUS are much more common in males: however, we review the indications, technique and potential complications of the AUS in the female population. Although few indications exist for the placement of an AUS in women, if proper patient selection is made, with strict adherence to proper surgical technique, it can be a suitable treatment option for those suffering from sphincteric incontinence.     

Retrograde flexible ureteroscopic approach of upper urinary tract pathology: What is the status in 2014?

Flexible uretero‐renoscopy witnessed dramatic technological improvements, ultimately translating in more diverse indications, better instrument durability, procedural efficacy and safety. Diagnostic exploration of the upper urinary tract, treatment of selected cases of ureteral and especially pyelocaliceal stones, caliceal diverticulum and infundibular stenosis, treatment, and follow‐up of upper urinary tract tumors are the main indications for this approach. We review the technique, results and complications of retrograde flexible ureteroscopy, with an emphasis on the latest developments of the method.     

Minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: Evolution and application

Background: The evolution of the author's technique for minimal incision rhytidectomy is reviewed. Objective: The purpose of this article is to outline the indications, advantages, and disadvantages of this technique. Methods: A total of 749 cases covering more than 10 years of clinical experience are reviewed. A classification of patient types is proposed that includes indications and surgical programs appropriate for each patient category. Results: In properly selected patients, the technique is safe, reliable, and reproducible. Complication rates are similar to those of other standard techniques. Conclusions: Minimal incision rhytidectomy with lateral SMASectomy is a useful technique that the plastic surgeon can add to his or her armamentarium.     

Laparoscopic surgery in urology

Not more than 10 years ago, laparoscopy was introduced to the armamentarium of urology. The start was slow, with pelvic lymphadenectomy, nephrectomy and varicocelectomy being about the only indications. However, very soon great enthusiasm developed, and almost every urological operation was performed by means of laparoscopy. For several reasons this exaggerated enthusiasm had to be followed by disappointment. First of all, laparoscopy turned out not to be as easy as many would have liked it to be. Due to a low frequency of operations, many surgeons were never able to overcome their learning curve, and the early literature reflects this problem. Unlike general surgery where cholecystectomy developed into a pacemaker operation, which forced everybody to go ahead with laparoscopy, urology was long searching for good and frequent indications for this new technique. Within the last few years, the pendulum has swung back to the other side. Adrenalectomy was one of the first indications where laparoscopy proved superior to open surgery in every aspect. Several other good indications have followed, some of which, namely cryptorchidism, nephrectomy and pyeloplasty, will be presented in detail to give an example. But the breakthrough that recently occurred is due to the success of laparoscopy in the field of oncologic surgery. Laparoscopic radical nephrectomy has shown its surgical efficiency as well as its oncologic efficacy. However, the main interest is now focused on radical prostatectomy, since this is the most frequently performed operation in urology by now. Recently this operation could be developed to a standardized technique, but only time will tell its true impact. Several indications will change in the future, but laparoscopy is here to stay.     

Kyphoplasty in traumatic vertebral fractures

The kyphoplasty evolved as a very useful “instrument” as it is being developed for curing osteoporotic fractures. And even more than that in the past few years this technique is being more and more applied in the treatment of traumatic vertebral body (VB) fractures, in particular in young patients. Our experience during the past 6 years encourages us to continue applying this technique for the A type fractures. The immediate disappearance of pain, the faster return to daily activities and to work are the great advantages of this treatment with guaranteed stability of the anterior column. However, one should be aware that a kyphoplasty, especially when performed with calcium phosphate cements (CPC), needs some experience. In this article we describe the indications, advantages, disadvantages as well as the technique itself.