CT引导下经皮微创技术与开放手术治疗脊柱结核的临床比较

目的分析CT引导下经皮微创技术与开放手术治疗脊柱结核的临床疗效。方法选取我院80例脊柱结核患者作为研究对象,随机分成对照组与研究组,每组各40例,对照组采用开放手术治疗,研究组采用CT引导下经皮微创技术治疗,分析和对比两组患者的手术时间、术中出血量、卧床时间、住院时间、抗生素使用时间,以及血沉降至正常范围的时间和椎体骨性融合的时间。结果研究组的手术时间、术中出血量、卧床时间、住院时间、抗生素使用时间、血沉降至正常范围时间、椎体骨性融合时间均明显小于对照组(P<0.05)。结论 CT引导下经皮微创技术在脊柱结核中的治疗具有疗效高、安全、操作简单等特点,值得临床应用与推广。     

急性脊柱创伤的诊断及微创手术治疗的效果分析

目的探讨分析急性脊柱创伤的诊断和微创手术治疗的临床疗效。方法以某医院2014-2015年收治的124例急性脊柱创伤患者为研究对象,对患者给予X线片、CT和MRI等联合辅助检查,根据随机数字表法将其分为对照组与研究组,各62例,对照组患者采用传统开放式手术治疗,研究组患者采用微创手术治疗。结果经X线片、CT和MRI等联合辅助检查,所有脊柱损伤均被检出,检出率100%。研究组患者治疗优良率、手术指标统计数据、切口感染率均明显优于对照组,而并发症发生率明显低于对照组(P0.05)。结论 X线片、CT和MRI三种辅助检查方法联合应用对于急性脊柱创伤的诊断具有重要意义;采用微创手术治疗急性脊柱创伤可获得较好的临床效果。     

腰椎间盘突出症的微创治疗现状

在回顾目前临床上常用的几种治疗腰椎间盘突出症微创术式的基础上,从各术式的适应证、禁忌证、优缺点及应用现状等方面,对目前治疗腰椎间盘突出症的微创术式的发展成果进行了概述,总结了微创术式与传统术式相比在治疗腰椎间盘突出症上的优势和不足,认为微创手术治疗腰椎间盘突出症具有十分远大的前景,将取代传统术式成为治疗腰椎间盘突出症的主流手术方式.     

虚拟现实技术在微创外科手术学的应用

本文简要回顾了虚拟现实技术在医学领域的应用,指出在外科学进入到微创手术显微时代,虚拟现实技术的发展为外科手术的教学以及手术指引与评估提供了全新的模式,因此建立相应的手术虚拟现实模型以及外科学培训系统平台也越来越得到医学与工程学专家的共识。文中分别从如何构建虚拟手术系统的三维模型、系统的功能设计、耳显微外科的临床应用等几个方面进行相关阐述,并展望了虚拟手术系统的发展前景。     

Cost-Effectiveness Analysis of Smoking Cessation Interventions in the United Kingdom Accounting for Major Neuropsychiatric Adverse Events

ObjectivesSmoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and e-cigarettes at various doses (low, standard and high) and used alone or in combination with each other. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the United Kingdom.MethodsAn established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by a systematic review and network meta-analysis. Base case results are reported for UK-licensed interventions only. Two sensitivity analyses are reported, one including unlicensed interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partial perfect information.ResultsWhen limited to UK-licensed interventions, varenicline standard-dose and NRT standard-dose were most cost-effective. Including unlicensed interventions, e-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose + bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose + NRT standard-dose was most cost-effective, followed by varenicline low-dose + NRT standard-dose.ConclusionAlthough found to be most cost-effective, combined therapy is currently unlicensed in the United Kingdom and the safety of e-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of e-cigarettes in studies with active comparators.     

微创外科时代数字化手术室的设计

外科学进入全新的微创外科时代,微创外科手术更依赖各类先进技术及设备的应用,而传统手术室在设计上难以满足微创手术的开展,因此发展符合微创外科时代的手术室显得尤为重要。结合医院微创手术室设计实例,提出新时代微创手术室建设需要关注的问题,提出发展和建设数字化手术室应用优势和未来发展。     

微创联合阿替普酶治疗脑出血疗效的Meta分析

目的本研究旨在系统评价微创联合阿替普酶治疗脑出血的疗效。方法通过全面检索国内外数据库,筛选有关微创联合阿替普酶治疗脑出血的随机对照试验,提取的数据结果采用Revman 5.3统计软件对其进行Meta分析,Cochrane风险偏移分析工具进行质量评估。结果检索到5篇符合纳入标准的文献,共对794例患者进行研究分析。Meta分析结果显示,微创联合阿替普酶组在治疗脑出血的血肿体积方面显著优于标准药物治疗组(MD=-24.38,95%CI:-31.29^-17.48,P <0.01),但在30天内死亡率(OR=0.71,95%CI:0.43~1.15,P=0.17)、最后一次导管给阿替普酶72小时内症状性再出血(OR=2.47,95%CI:0.89~6.90,P=0.08)、治疗后30天内中枢神经系统感染率(OR=1.26,95%CI:0.30~5.29,P=0.75)方面,微创联合阿替普酶组与标准药物治疗组相比差异无统计学意义。结论脑出血患者行微创联合阿替普酶治疗仅能显著改善血肿体积,但对患者死亡率、症状性再出血率、中枢系统感染方面似乎并不推荐,仍需更大的样本量进一步评估微创联合阿替普酶在治疗脑出血方面的疗效和安全性。     

Cost-Effectiveness of Posaconazole versus Fluconazole or Itraconazole in the Prevention of Invasive Fungal Infections among Neutropenic Patients in the United States

Objectives:  Clinical trial data indicate that posaconazole is superior to fluconazole (FLU) or itraconazole (ITRA) in preventing invasive fungal infections (IFIs) among neutropenic patients. Our objective was to assess the cost-effectiveness of posaconazole versus FLU or ITRA for prevention of IFIs among neutropenic patients.
Methods:  We used modeling techniques to assess the cost-effectiveness of posaconazole versus FLU or ITRA in the prevention of IFIs among patients with acute myelogenous leukemia (AML) or myelodysplastic syndromes (MDS) and chemotherapy-induced neutropenia. The probabilities of experiencing an IFI, IFI-related death, and death from other causes over 100 days of follow-up were estimated from clinical trial data. Long-term mortality, drug costs, and IFI treatment costs were obtained from secondary sources.
Results:  Posaconazole is associated with fewer IFIs per patient (0.05 vs. 0.11) relative to FLU or ITRA over 100 days of follow-up, and lower discounted costs ($3900 vs. $4500) and increased life-years (2.50 vs. 2.43 discounted) over a lifetime horizon. Results from a probabilistic sensitivity analysis indicate that there is a 73% probability that posaconazole is cost saving versus FLU or ITRA and a 96% probability that the incremental cost-effectiveness ratio for posaconazole is at or below $50,000 per life-year saved.
Conclusions:  We conclude that posaconazole is very likely to be a cost-effective alternative to FLU or ITRA in the prevention of IFIs among neutropenic patients with AML and MDS, and may result in cost savings.     

A Modeling Study of the Cost-Effectiveness of a Risk-Stratified Surveillance Program for Melanoma in the United Kingdom

Background

Population-wide screening for melanoma is unlikely to be cost-effective. Nevertheless, targeted surveillance of high-risk individuals may be.

Cost-Effectiveness of Newborn Screening for Spinal Muscular Atrophy in The Netherlands

ObjectivesSpinal muscular atrophy (SMA) is a rare genetic disorder that causes progressive muscle weakness and paralysis. In its most common and severe form, the majority of untreated infants die before 2 years of age. Early detection and treatment, ideally before symptom onset, maximize survival and achievement of age-appropriate motor milestones, with potentially substantial impact on health-related quality of life. Therefore, SMA is an ideal candidate for inclusion in newborn screening (NBS) programs. We evaluated the cost-effectiveness of including SMA in the NBS program in The Netherlands.MethodsWe developed a cost-utility model to estimate lifetime health effects and costs of NBS for SMA and subsequent treatment versus a treatment pathway without NBS (ie, diagnosis and treatment after presentation with overt symptoms). Model inputs were based on literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and validity of results.ResultsAfter detection of SMA by NBS in 17 patients, the number of quality-adjusted life-years gained per annual birth cohort was estimated at 320 with NBS followed by treatment compared with treatment after clinical SMA diagnosis. Total healthcare costs, including screening, diagnostics, treatment, and other healthcare resource use, were estimated to be €12 014 949 lower for patients identified by NBS.ConclusionsNBS for early identification and treatment of SMA versus later symptomatic treatment after clinical diagnosis improves health outcomes and is less costly and, therefore, is a cost-effective use of resources. Results were robust in sensitivity and scenario analyses.     

小骨窗微创手术治疗脑出血的效果分析

目的 分析脑出血病人行小骨窗微创手术治疗的效果.方法 回顾我院2017年1月—2020年5月的80例脑出血病人的收治情况,按照治疗差异分组,对比两组的手术指标、恢复效果以及并发症.结果 观察组手术时长(93.54±14.37)min,出血量(65.76±5.24)mL,住院时间(12.13±1.42)d,数据优于对照组...     

右腋下小切口行心内直视手术26例

目的:总结右腋下小切口行心内直视手术治疗体会。方法:回顾分析了26例经右腋下小切口行心内直视手术的临床资料,切口取右腋中线与第3肋的交点为上缘,腋中线与第6肋的交点为下缘,经第4或第3肋间入胸,其中房间隔缺损15例、室间隔缺损10例、二尖瓣置换 右肺中叶切除1例。结果:全组26例手术顺利,无严重并发症;其中二尖瓣置换 右肺中叶切除的患者,并同行三尖瓣DeVega环缩,术后出现高热,抗炎治疗1月后治愈。结论:经右腋下小切口径路行心内直视手术,是一种安全、有效、美观的手术方式,具有损伤小,瘢痕隐蔽,不破坏胸廓完整性,出血少,恢复快等优点,符合微创外科的原则。     

某三级综合医院微创外科智慧医疗协同平台设计与应用

远程协同医疗突破了时间效率和空间距离的限制,将三级医院中的优质医疗资源提供方与基层医疗机构需求方连接起来.本院首创"云工作平台+微创外科"体系,以云工作平台为抓手,以三级医院为核心,构建医疗机构之间全面协同的微创外科智慧医疗工作平台.将大医院专家的先进的诊疗技术和丰富的医疗经验通过远程协同医疗的运行体系带给基层医生,提...     

Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among Heroin Users in the United Kingdom

Background: Heroin overdose is a major cause of premature death. Naloxone is an opioid antagonist that is effective for the reversal of heroin overdose in emergency situations and can be used by nonmedical responders. Objective: Our aim was to assess the cost-effectiveness of distributing naloxone to adults at risk of heroin overdose for use by nonmedical responders compared with no naloxone distribution in a European healthcare setting (United Kingdom). Methods: A Markov model with an integrated decision tree was developed based on an existing model, using UK data where available. We evaluated an intramuscular naloxone distribution reaching 30% of heroin users. Costs and effects were evaluated over a lifetime and discounted at 3.5%. The results were assessed using deterministic and probabilistic sensitivity analyses. Results: The model estimated that distribution of intramuscular naloxone, would decrease overdose deaths by around 6.6%. In a population of 200,000 heroin users this equates to the prevention of 2,500 premature deaths at an incremental cost per quality-adjusted life year (QALY) gained of £899. The sensitivity analyses confirmed the robustness of the results. Conclusions: Our evaluation suggests that the distribution of take-home naloxone decreased overdose deaths by around 6.6% and was cost-effective with an incremental cost per QALY gained well below a £20,000 willingness-to-pay threshold set by UK decision-makers. The model code has been made available to aid future research. Further study is warranted on the impact of different formulations of naloxone on cost-effectiveness and the impact take-home naloxone has on the wider society.     

软通道微创术与开颅术治疗高血压病脑出血的效果

目的 探究与分析软通道微创术与开颅术治疗高血压病脑出血的临床效果.方法 按照不同手术操作方法 将我院自2017年1月—2019年1月收治的80例高血压病脑出血患者分为软通道微创术组及开颅术组,各40例,对比两组围术期指标及NIHSS量表.结果 观察组与对照组相比手术时间较短、住院时间较短,骨窗直径较小、血肿清除率较高,...     

麦默通微创切口置管负压引流与传统开放手术治疗乳腺脓肿的临床疗效对比研究

目的 探讨麦默通微创切口置管负压引流与传统开放手术治疗乳腺脓肿患者的临床疗效.方法 选取2016年3月至2019年11月我院收治的40例乳腺脓肿患者,随机分为两组各20例.对照组行常规开放手术治疗,实验组行麦默通微创切口置管负压引流术治疗.比较两组的手术指标、疗效、复发率以及并发症.结果 实验组的手术时间、术中出血量、...     

TST微创术与PPH治疗混合痔的术后并发症及肛肠动力恢复效果比较

目的观察及对比选择性痔上黏膜吻合(TST)微创术与吻合器痔环切术(PPH)治疗混合痔术后的并发症情况及肛肠动力恢复效果。方法选取我院收治的94例混合痔患者,随机平均分为两组。观察组采用TST微创术治疗,对照组采用PPH治疗,对比两组的治疗效果、并发症情况及肛肠动力学指标。结果观察组的治疗总有效率为97.9%,显著高于对照组的85.1%(P <0.05)。观察组的并发症发生率为6.4%,显著低于对照组的21.3%(P <0.05)。术前,两组的HPZ、 ARP、 MSP水平比较无统计学差异(P>0.05);术后,观察组的HPZ、 ARP、 MSP水平均显著高于对照组(P <0.05)。结论采用TST微创术治疗混合痔能够有效减少并发症的发生,促进肛肠动力恢复,效果显著,值得临床推广应用。     

微创小切口胃癌根治术与传统开腹手术的临床对比研究

目的通过经腹胃癌根治微创小切口手术的尝试,探讨我国胃癌患者外科小切口微创手术应用及效果,寻求结合中国国情的胃癌患者的微创开腹手术治疗模式。方法对2009年11月～2010年9月期间四川大学华西医院胃肠中心收治的胃癌患者进行经腹根治性外科手术并将其的手术分为微创组和常规切口组,且比较住院时间、手术切口大小、手术后并发症等指标之间的差异。结果从住院总时间及伤口愈合时间上看2组差异无统计学意义(P﹥0.05),而术后住院时间上微创组与常规组比较差异有统计学意义(P﹤0.05);从手术切口大小上看,微创组患者切口明显小于常规组(P﹤0.05);术后出血、吻合口瘘和伤口感染的发生率两组差异无统计学意义(P﹥0.05)。结论开腹微创小切口手术的外科治疗对我国胃癌患者是一套具有可行性和安全性的治疗方案。     

等离子射频技术辅助经口微创手术在口咽及口腔恶性肿瘤中的应用

目的 探究等离子射频技术辅助经口微创手术治疗口咽及口腔恶性肿瘤患者治疗效果.方法 以2019年1—6月为研究背景时间,选择56例口咽及口腔恶性肿瘤患者,随机分成甲组(开放手术)和乙组(等离子射频技术辅助经口微创手术),各28例.对比两组手术指标(包括手术时间、术中出血量、住院时间)及并发症发生情况.结果 乙组手术时间、...