改良胸骨前入路在腔镜甲状腺手术中的应用体会

目的:探讨腔镜甲状腺切除术中改良手术入路的操作方法。方法:将28例甲状腺手术患者随机分为两组,分别采用改良胸骨前入路与传统胸乳入路。结果:改良组中1例快速病理提示乳头状癌,中转开放手术;传统组中1例于穿刺过程中出血120 ml,中转开放手术;余者均顺利完成腔镜手术。改良入路在入路游离时间、出血量、术后疼痛及并发症方面均具有明显优势。术区皮瓣术后无明显手术痕迹,除1例术后胸前出现瘀斑,余均较满意。结论:改良胸骨前入路优于胸乳入路,术中可减少游离出血及游离中的副损伤,缩短手术时间,减少手术并发症,且不影响美容效果;手术安全有效,值得推广应用。     

气管前入路手术路径在腹腔镜甲状腺手术中的应用

目的探讨腹腔镜甲状腺手术中的路径方法，以降低手术操作难度，减少并发症。方法对104例甲状腺疾病患者采用气管前入路手术方法施行腹腔镜甲状腺切除手术，先切断甲状腺峡部，继而切断管前筋膜、外侧韧带、悬韧带，甲状腺松动，再切断血管，根据病变决定甲状腺切除的多少。结果本组患者手术均获成功，手术平均时间105（85-195）min，平均出血量25（5-115）ml，平均住院时间4．5（3-6）d。2例二次患者术后出现轻微喉返神经麻痹症状，经观察分别于术后3、6个月后自行恢复，无永久．眭喉返神经损伤。结论气管前入路手术方法使腹腔镜甲状腺切除手术容易操作，同时减少手术并发症，是一种安全简捷的手术方法。     

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...     

经胸乳晕入路腔镜下甲状腺手术58例

目的:探讨经乳晕入路腔镜甲状腺切除术的临床应用价值和显露保护喉返神经的方法。方法:回顾性分析58例经胸乳晕入路腔镜下甲状腺切除术的临床资料。结果:58例均顺利完成手术,其中喉返神经解剖显露38例,解剖双侧喉返神经1例,左侧16例,右侧21例。手术时间60～265min,喉返神经解剖显露的时间5～10min。术中出血量5～30mL,术后引流量为40～150mL。术后颈部活动良好,无皮下淤斑、皮下积液,无出血、窒息,未见有声音嘶哑、咳嗽、手足抽搐、皮下气肿等并发症。结论:经乳晕入路腔镜甲状腺手术安全可行,是一种具有良好的微创、美观效果的手术方法;熟练掌握甲状腺游离切除的顺序和血管神经脉络化游离技巧是清楚显露并有效预防术中喉返神经损伤的关键。     

腔镜下经胸乳晕入路甲状腺手术的护理配合

腔镜下甲状腺手术自1997年问世,其美容效果被越来越多的患者接受,手术入路有多种方法,经胸乳晕入路是最受关注的方法。在手术配合等方面对手术室护士也有一套相应的要求,现将我院2001年9月～2008年7月92例腔镜下经胸乳晕入路甲状腺手术护理配合总结如下。     

经乳晕入路完全腔镜甲状腺手术的操作技巧与体会

目的:探讨经乳晕入路腔镜下甲状腺切除术的操作技巧。方法:收集2016年1月~12月符合条件的268例甲状腺疾病患者的临床资料,其中59例经乳晕入路行完全腔镜甲状腺切除术(腔镜组),209例行传统开放甲状腺手术(开放组)。比较两组手术时间、出血量及面部皮下气肿、声音嘶哑、窒息、Horner综合征、饮水呛咳、纵隔气肿、Trocar隧道感染及术区感染等术后并发症。结果:两组手术时间差异无统计学意义[(76.58±29.12)min vs.(73.21±28.14)min];腔镜组出血量少于开放组[(20.71±14.32)ml vs.(33.28±12.19)ml],差异有统计学意义;术后并发症(饮水呛咳、皮下气肿、引流管口红肿、声音嘶哑、口周及手足麻木等)发生率两组差异无统计学意义。术后7 d切口美容效果评分腔镜组优于开放组。结论:注射适量空气减少烟雾产生,熟练的超声刀及分离钳配合操作是乳晕入路腔镜下甲状腺手术成功的关键。经乳晕入路完全腔镜下甲状腺手术可作为甲状腺良性肿瘤的优选方案。     

乳晕入路腔镜甲状腺切除术与开放手术的临床对比分析

目的：探讨腔镜技术用于甲状腺手术获得美容效果的临床应用价值及其安全性和可行性。方法：选择2008年1月-2011年08月行甲状腺良性肿物手术的患者80例,其中腔镜甲状腺手术40例（腔镜组）,单侧23例,双侧17例;传统开放甲状腺手术40例（开放组）,其中单侧22例,双侧侣例,2组行单侧大部分切除术或者双侧甲状腺大部分切除术,麻醉方法均采用气管插管全身麻醉。分别比较2种术式单侧和双侧的手术时间、术中失血量、术后住院时间、术后引流量、引流天数、住院费用、术后美容效果、术后并发症。结果：全部病例手术成功,2组均无术后大出血、喉返和喉上神经损伤、甲状旁腺损伤等严重并发症。腔镜组手术时间较长,2组单侧及双侧分别比较差异均无统计学意义（P〉0．05）;腔镜组术中出血量、住院时间、术后引流量、术后引流时间、术后并发症较开放组少,2组单侧及双侧分别比较差异均有统计学意义（P〉O．05）。虽然住院费用腔镜组高于开放组（P〈O,05）,但腔镜组取得较好美容效果。结论：乳晕入路腔镜甲状腺切除术与开放手术均是安全、有效的手术方法,腔镜手术有更加令人满意的美容效果,有着传统开放甲状腺手术不可比拟的优点,对适应证明确者,应该是值得推崇的手术方式。     

经胸乳入路腔镜甲状腺手术的护理

时5例采用胸乳入路腔镜下甲状腺手术的患者予以术前心理护理和常规准备，术后严密观察病情，预防并发瘟。结果均无甲状腺功能损伤，伤口甲级愈合，患者对术后的美客效果满意；其中l例出现肺部感染．经治疗痊愈；住院4～7d出院。提出充分的术前准备及对术后并发症的观察和护理是腔镜甲状腺手术成功的保证。     

完全乳晕入路腔镜甲状腺切除术

目的 探讨完全乳晕入路行腔镜甲状腺切除的可行性.方法 2005年4月至2008年9月,对28例美容要求较高的女性患者施行完全乳晕入路腔镜甲状腺切除手术,平均年龄22.5(18～38)岁,其中结节性甲状腺肿25例,原发甲状腺功能亢进2例,甲状腺微小乳头状癌1例.观察和取标本孔位于右侧乳晕内缘(10 mm),右侧乳晕外缘(5 mm)及左侧乳晕上缘(5 mm)为操作孔.观察总结28例患者的手术结果.结果 28例患者手术均成功,行甲状腺单叶腺体切除术5例、单叶次全切除术15例、双叶次全切除术3例、单叶近全切除+对侧叶次全切除术4例、单叶全切+中央区淋巴结清扫+对侧叶次全切除术l例.平均手术时间60.7 min(40～125 min),平均出血5.8 ml(2～15 ml),术后住院时间3.1 d(2～5 d).无甲状旁腺和喉返神经损伤等并发症出现.术后随访1～40个月无复发,全部患者均对切口美容效果表示满意.结论 完全乳晕入路腔镜甲状腺切除手术具有较佳美容效果,安全可行.     

Anterior Communicating Artery Aneurysm Surgery through the Orbitopterional Approach: Long-Term Follow-Up in a Series of 75 Consecutive Patients

Objective: In this retrospective review of prospectively collected data, we report outcomes for patients with anterior communicating artery (ACoA) aneurysms treated via the orbitopterional approach and discuss the potential impact in patient outcomes by the reduction of surgery-induced brain damage. Methods: We retrospectively reviewed prospectively collected data from 40 men and 35 women (mean age, 50.8 years) who underwent clipping of ACoA aneurysms through the orbitopterional approach. Results: Overall outcomes at discharge using the modified Rankin Scale were good in 52 (69.4%) patients, fair in 13 (17.3%), and poor in 10 (13.3%). At last follow-up, outcomes were good in 63 (84%) patients, fair in 6 (8%), and poor in 6 (8%). Disability included none in 53.6% patients, mild in 10%, partial in 18.8%, moderate in 8.6%, moderately severe in 1.4%, severe in 2.9%, extremely severe in 2.9%, and vegetative state in 1.4%. Overall, 74% of patients returned to work after 4 months, 83% of previously unemployed patients returned to baseline, and 25% were disabled. Complications were more frequent and severe after subarachnoid hemorrhage. Conclusions: Long-term follow-up data present the orbitopterional approach as an attractive alternative for ACoA aneurysm surgery given the low rates of surgery-related morbidity and good patient outcomes and functionality.     

小切口联合整形外科缝合技术在甲状腺手术中的应用效果

分析甲状腺患者在治疗中应用小切口联合整形外科缝合技术的临床效果。方法 选取 2021年8月-2022年8月乐山市人民医院收治的80例甲状腺患者，随机分为对照组和试验组，每组40例。对 照组行传统甲状腺切除术，试验组行小切口联合整形外科缝合技术，比较两组临床疗效、手术指标、生 活质量及并发症发生率。结果 试验组临床治疗总有效率为85.00%，高于对照组的65.00%（P ＜0.05）； 试验组手术时间、术后下床活动时间、创面恢复时间、住院时间均短于对照组，术中出血量少于对照组 （P＜0.05）；试验组躯体功能、社会功能、生理功能、心理功能各方面评分均优于对照组（P ＜0.05）；试 验组并发症发生率为7.50%，低于对照组的22.50%（P ＜0.05）。结论 小切口联合整形外科缝合技术用于甲 状腺切除的效果较为理想，可有效改善临床指标，提升患者生活质量，减少并发症的发生。     

经改良的上胸椎前方手术入路切除上胸椎椎体

目的：探讨经改良的上胸椎前方手术入路切除上胸椎椎体，治疗上位胸椎病变的方法与初步结果。方法：作者经此入路为7例患者行上胸椎椎体切除术。结果：所有患者经此入路显露充分，按手术设计完成上胸椎椎体切除，损伤小，出血少，无其他并发症发生。结论：经改良的上胸椎前方手术入路切除上胸椎椎体，显露充分，安全有效；但术中须仔细操作，防止发生食道、气管、颈总动脉、左头臂静脉及喉返神经。     

Video-Assisted Endoscopic Thyroid and Parathyroid Surgery Using a Gasless Method of Anterior Neck Skin Lifting: A Review of 130 Cases

Purpose: Endoscopic endocrine neck surgery is desirable from a cosmetic viewpoint. We compared the effectiveness of our new technique with that of conventional surgery in a clinical study. Methods: We performed our original endoscopic method of video-assisted neck surgery (VANS) on 130 patients: 126 with thyroid tumors and 4 with parathyroid tumors. The percentage of patients who underwent VANS among all those who underwent neck surgery and the procedure involved were analyzed. Operating time and blood loss were compared between the first 40 patients and last 39, and all factors were statistically analyzed in the most recent 20 patients who underwent the VANS method and the most recent 20 who underwent conventional surgery. Results: More than 60% of benign thyroid tumors and 5.3% of malignant thyroid tumors were operated on by the VANS method. Nearly total lobectomy was the most common procedure (57.7%), followed by total lobectomy (26.1%), for benign tumors. Malignancy was defined as papillary carcinoma less than 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant tumors. There was less bleeding when the VANS method (P < 0.001) was used than when conventional surgery was performed, and the operating time has been reduced with experience. Conclusion: The VANS method is feasible, practical, and safe, and has great cosmetic benefits. Received: December 5, 2001 / Accepted: March 5, 2002     

小切口联合整形外科缝合技术在甲状腺手术中的应用效果

目的 分析在甲状腺手术患者中应用小切口联合整形外科缝合技术的价值。方法 选取2020年 1月-2021年11月西安国际医学中心医院甲乳外科收治的60例甲状腺手术患者作为研究对象，采用随机数字 表法分为试验组与参照组，各30例。试验组应用小切口联合整形外科缝合技术治疗，参照组应用常规甲状 腺手术治疗，比较两组临床指标（术中出血量、手术时间、住院时间、切口长度）、术后并发症发生率以 及免疫球蛋白水平（IgG、IgA、IgM）。结果 试验组术中出血量少于参照组，手术时间长于参照组，住院 时间与切口长度短于参照组，差异有统计学意义（P＜0.05）。试验组术后并发症发生率为6.67%，低于参 照组的30.00%，差异有统计学意义（P＜0.05）。两组术后IgG、IgA、IgM水平低于手术前，且试验组低于 参照组，差异有统计学意义（P＜0.05）。结论 小切口联合整形外科缝合技术在甲状腺手术患者的临床治 疗中的应用价值较高，既能保证其美观效果，又可以促进患者康复，同时减少并发症发生几率。     

Both-column Acetabular Fractures with Posterior Wall Involved can be Managed through Single Anterior Approach by Evaluation of Computer-assisted Virtual Surgery Technique

Objective

Posterior wall (PW) fractures were sometimes associated in both-column acetabular fractures. How to evaluate pre-operatively the necessity for the performance of the posterior approach was an issue to be solved. In order to solve this issue, the computer-assisted virtual surgery technique was used to evaluate if the involved PW in both-column acetabular fractures (BACF) should be managed through posterior approach and verify the feasibility of this method.

Methods

Data of a consecutive cohort of 72 patients with both-acetabular fractures from January 2012 to January 2020 was collected for retrospective study, of which 44 patients had concomitant acetabular PW fractures, and patients without PW fractures were labeled as the BCAF group. Computer-assisted virtual surgery technique was performed pre-operatively to evaluate the necessity for performance of posterior approach in 44 patients, and posterior approach was required if more than 3 mm of displacement was still present in the reduced 3D model. The 23 patients without treatment through posterior approach were labeled as the BCAF-PW⁻ group, and the 21 patients with treatment through posterior approach were labeled as the BCAF-PW⁺ group. Operation-related and post-operative parameters were recorded. The quality of reduction and functional outcomes were assessed by the Matta scoring system and modified Merle d'Aubigné and Postel scoring system. The measurement data were analyzed using the t-test of independent samples and rank-sum test of ranked data between every two groups. Also, the one-way analysis of variance (ANOVA) was used to analyze data between the three groups.

Results

Comparing operation-related and post-operative parameters in the three groups, some PW fractures in both-column acetabular fractures could be ignored, and which could be evaluated pre-operatively for necessity of an additional posterior approach. Operative time (271.2 ± 32.8 mins) and intra-operative blood loss (1176.7 ± 211.1 mL) were significantly higher in the BCAF-PW⁺ group. The excellent/good of reduction (25/28 of the BCAF group, 21/23 of the BCAF-PW⁻ group, 19/21 of the BCAF-PW⁺ group) and functional outcomes (24/28 of the BCAF group, 18/23 of the BCAF-PW⁻ group, 18/21 of the BCAF-PW⁺ group) of three groups were similar. The incidence of complications, such as deep vein thrombosis (4/28 of the BCAF group >3/23 of the BCAF-PW⁻ group >1/21 of the BCAF-PW⁺ group) and injury of lateral femoral cutaneous nerve (3/23 of the BCAF-PW⁻ group >2/28 of the BCAF group >0/21 of the BCAF-PW⁺ group), was no significant difference.

Conclusion

The partial both-column acetabular fractures with PW involvement could be managed through a single anterior approach without another posterior approach by evaluation of computer-assisted virtual surgery technique.     

Laparoscopic splenectomy: an evolving technique

Background: The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Laparoscopic splenectomy (LS) suffers from several technical problems for mobilization and manipulation of a solid organ. Lateral approach has been proposed as an alternative to the anterior approach which facilitates LS. The aim of this paper is to compare the results of LS using and anterior or lateral approach. Methods: Between February 1993 and May 1995, 27 LS were performed (group I, Ant-LS, n: 10; group II, Lat-SL, n: 17). LS was indicated in 19 patients for treatment of an idiopathic purpura, for spherocytosis in four; for AIDS-related thrombocytopenia in two; and for autoimmune anemia and leucopenia in two. Gallstones were associated in two cases and an ovarian cyst in another. Results: LS was completed in 8 patients of group I (80%) and 17 of group II (100%). Operative time (236±21 min vs 159±71 min p<0.003), number of trocars (4.5±0.5 vs 4±0.5, p<0.02), transfusion requirements (60 vs 17%, p<0.04) and mean stay (6.5±3.6 days vs 4±2 days, p<0.05) were significantly lower in the group of LS with a lateral approach. Conclusions: The lateral approach significantly facilitates the performance of LS compared with the anterior approach.Presented as a free paper in the 4th Congress of the EAES, Luxembourg, 14–17 June 1995     

甲状腺手术中超声刀应用与喉返神经保护

目的:探讨开放性甲状腺疾病手术中超声刀的应用与喉返神经保护.方法:回顾性分析187例开放性甲状腺良性疾病手术患者的临床资料,据治疗方式分为超声刀组和传统电刀组,比较两组手术时间、术中出血量、术后引流量、术后住时间及声嘶等并发症发生率.结果:超声刀组手术时间、术中出血量均显著少传统电刀组(P<0.05),术后并发症发生率降低(P<0.05),术后住时间及术后引流量两组间无明显差异(P>0.05).结论:开放性甲状腺手术中,合理使用超声刀及有限度显露喉返神经可以缩短手术时间,减少术中出血,减少术后并发症发生率.     

严重胸腰椎骨折前路或前后路联合手术的临床应用研究

目的 探讨严重胸腰椎骨折采用前路或前后路联合手术的优缺点,为术式选择提供依据.方法 对2002年3月～2004年3月随访时间>3年,资料完整的59例严重胸腰椎骨折单纯前路手术、42例前后路联合手术的治疗结果进行回顾性分析.结果 处理1个椎体,前路手术平均出血量997 ml,手术时间216 min,前后路联合手术平均出血877 ml,手术时间170 min;治疗结果评价:单纯前路手术优良率89%;前后联合入路手术优良率92%.术后满意度调查:单纯前路手术为93.6%;前后联合入路手术为92.9%.结论 前路及前后路联合手术治疗严重胸腰椎骨折各有优缺点及其适应证.根据不同病人情况及骨折损伤类型合理选择术式能取得满意手术效果.