激光及其在泌尿外科的应用

近年来 ,激光在泌尿外科中的应用倍受关注。本文对不同种类激光的特性及其临床应用机制作一介绍 ,并综述了近年来国内外关于激光在泌尿外科中应用方面报道的最新进展。     

微创钬激光泌尿外科手术的护理配合与管理

本总结我院2001年4月～2002年6月41例泌尿外科钬激光手术期间的护理配合与管理方法。作认为护士熟练掌握钬激光手术程序、术中护理观察等是配合手术成功的首要因素。     

低位肛瘘激光手术与常规手术的细菌学比较

Since 1989, 42 eases with low anal fistula were operated by laser method or ordi-nary method. During" operation some tissues were taken from the surfaee of the wound for bacte-rial culture. Experimeutal group (laser method), no bacteria were cultured in 24 eases operated bythe laser method. Control" group (ordinary method): bacteria were eultured in 16 out of 18 casesoperated by the ordinary method. The difference between these two groups was of statistical sig-ni[ieance ( P<0.001). Thus, CO2 laser is a simple, Convinient, sere baeteriocidal tool for surgical use.     

从传统手术教学到泌尿外科手术技能三阶段培训体系的建立

泌尿外科手术技能教学是泌尿外科住院医师专科培训中重要的组成部分。随着泌尿外科手术进入微创外科时代,手术技能教学模式也需不断优化和改进。结合目前泌尿外科的专科手术特点,北京协和医院探索建立了泌尿外科手术技能三阶段培训体系,利用多媒体、模拟教学等多种教学方法,旨在为泌尿外科住院医师提供更加可行而有效的手术技能培训。通过该体...     

从循证医学谈腹腔镜与开腹结直肠癌手术的比较

14年前腹腔镜结直肠癌手术的成功施行,使结直肠外科在手术技术上有了里程碑式的变化。多项随机对照试验(RCT)显示了腹腔镜结直肠癌手术相对于传统开腹手术有诸多优点:美容效果好,术后胃肠道功能恢复快,住院时间短,对术后生活质量(QOL)影响小等,其短期疗效已得到广泛认可。腹腔镜结直肠癌手术遵循与开腹手术一样的肿瘤根治原则,包括:①强调肿瘤及周围组织的整块切除。②肿瘤操作的非接触原则。③足够的切缘。④彻底的淋巴结清扫,理论上应该可以达到同开腹手术一样的远期疗效,主要评价标准为5年生存期、无病生存期、局部复发率及远处转移等…     

泌尿外科腔镜手术护理记录单的设计与应用

设计泌尿外科腔镜手术护理记录单,并应用于各类泌尿腔镜手术1 000余例.结果该记录单能客观、真实、准确、及时、完整地反映腔镜手术中护理情况及特点,在保障病人利益的同时也保护医务人员自身合法权益,可为完善、规范泌尿外科腔镜手术护理记录提供参考.     

钬激光与传统手术治疗下肢静脉曲张的临床对照研究

目的比较钬激光与传统手术治疗下肢静脉曲张的临床效果。方法2005年3月~2006年12月,对226例(274条患肢)下肢静脉曲张分别采用钬激光治疗120例(148条患肢)(钬激光组),传统大隐静脉高位结扎加抽剥术106例(126条患肢)(传统组)。结果与传统组相比,钬激光组手术时间短[(38.0±10.8)minvs(61.5±12.3)min,t=-15.294,P=0.000],术后需止痛剂患者比例少[0%(0/120)vs54.7%(58/106),χ2=88.329,P=0.000],下床活动早[(6.2±0.8)hvs(22.5±1.5)h,t=-105.034,P=0.000],术后住院时间短[(3.0±0.5)dvs(8.5±2.5)d,t=-23.632,P=0.000],并发症发生率相近[16.9%(25/148)vs18.3%(23/126),χ2=0.087,P=0.768],1年复发率相近[3.8%(3/78)vs3.1%(2/65),χ2=0.000,P=1.000]。结论钬激光治疗下肢静脉曲张具有能明显缩短手术时间及住院时间,减少切口数量,术后疼痛轻,可早期下床活动等优点。保证疗效...     

腔内激光联合手术治疗下肢静脉曲张的评价

目的 评价腔内激光(EVLT)联合手术治疗下肢静脉曲张的疗效.方法 下肢静脉曲张172例,198条下肢.按不同病因分为3组,采用EVLT 相应手术方法治疗:①A组:原发性下肢深静脉瓣膜功能不全45条患肢,行股浅静脉瓣膜包窄 EVLT 内镜下小腿内侧功能不全交通静脉离断术(SEPS);②B组:轻度原发性深静脉瓣膜功能不全55条下肢,行EVLT SEPS;③C组:单纯性大隐静脉曲张,98条下肢,行EVLT.结果 随访2～44个月,平均32个月,5例有曲张静脉复发,再次行EVLT后未再复发;其余167例症状消退或明显好转,溃疡均愈合,彩超示大隐静脉全程闭合,深静脉通畅.结论 EVLT具有微创、安全、易于操作的特点,联合手术治疗下肢静脉曲张的效果满意.     

激光介入治疗腋臭患者的围手术期护理

目的总结激光介入治疗腋臭患者围手术期护理体会。方法对160例激光介入治疗腋臭手术配合的总结。结果150例患者治愈,5例6个月后患者症状改善,但不满意,再经激光手术,达到治愈。5例患者出现皮瓣坏死,其中4例皮瓣坏死范围2cm,经3周后治愈。1例出现较大范围皮瓣坏死,经再次手术治愈。160例患者均无腋窝区神经、血管损伤并发症。结论半导体激光仪治疗腋臭是一种操作简便,安全损伤小,无切开,恢复快,并能保持皮下皮肤状态,效果确切。强调术前、术中、术后全面的心理护理。     

喉显微手术耐激光“安全型”导管的实验研究

多数市售塑料、橡胶或硅胶制导管,用于麻醉吸氧过程中,遇激光辐射,会立即燃烧及破坏,有可能引起呼吸道粘膜灼伤,术后远期可能继发气管蹼或气管狭窄等店遗症,故需认真研究改进。实验研究证实,聚四氟乙烯(Teflon)导管可在高浓度氧的环境中,耐受激光最大能量密度的辐射,是制作耐激光“安全型”导管的较理想材料,本文介绍有关研究资料。     

physics of surgical lasers

The fundamental physical properties of lasers are discussed. Included in this presentation is a discussion of carbon dioxide, argon, neodymium:YAG and ruby lasers. Laser optics and beam characteristics as well as Q-switching are presented. Ocular hazards of lasers and preventive measures are discussed.     

Biophysical basis and technical requisites for the use of Nd-YAG laser in neurosurgery

Summary The different interactions between laser light and biological tissue are demonstrated for the CO₂- and the Nd-YAG-laser by histological examinations.For Neurosurgery the following results became significant: The CO₂ laser has become an important tool in contactless cutting and vaporization. The Nd-YAG-laser is suitable as a coagulator whenever the site and vascularity make the removal of a tumour difficult. For the various surgical techniques in Neurosurgery using the Nd-YAG laser, special laser attachments have been developed including micro-surgical and endoscopic instruments.     

Current uses of the laser for fertility-promoting procedures

The addition of lasers to the gynecologist's surgical armament has been heralded by some and scoffed at by many. Only through scientific assessment of published data using this new technique is one able to obtain an intelligent perspective of the clinical applicability for the laser in fertility-promoting procedures. A review of the literature, with stated pregnancy rates, describing the delivery of the carbon dioxide, argon, and Nd:YAG lasers via laparotomy or laparoscopy is presented. It is hoped that as this new surgical modality evolves, additional studies will further define its role in preserving or enhancing reproductive potential.     

The influence of hands-on laser training on usage of the CO2 laser

A questionnaire was distributed to all participants in the Rochester General Hospital CO2 laser training workshops for surgeons (1982 to January 1985). The results of this study indicate that, while laser training is necessary prior to being able to use the laser, only a small fraction of trainees actually use the laser in their clinical practice. Surgeons who are using the laser do so in a minority of their cases. New incentives for laser usage must be investigated.     

The establishment of precise physical parameters for the treatment of the port wine stain with the argon laser

The use of the argon laser in the treatment of the port wine stain is discussed and its mode of action and the features of a port wine stain, which may be used to predict a good response to therapy, are described. Reference is made to the wide variation in techniques used in treatment in different centers and the need to establish precise physical parameters for therapy is stressed. An attachment to the standard handpiece is described that will enable accurate power densities to be recorded.     

SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application

This case study describes our initial laboratory experience using the SPIDER surgical system (TransEnterix, Morrisville, NC, USA) for laparoendoscopic single-site surgery (LESS) urologic procedures and reports its first clinical application. The SPIDER system was tested in a laboratory setting and used for a clinical case of renal cyst decortication. Three tasks were performed during the dry lab session, and different urologic procedures were conducted in a porcine model. The time to complete the tasks and penalties were registered during the dry lab session. Perioperative outcomes and subjective assessment by the surgeons were registered.The surgeons had a positive experience with the SPIDER system, with a mean overall score of 3.6 (on a scale of 1-5). The surgeons were able to gain proficiency in performing tasks regardless of their level of expertise. The highest scores recorded were for ease of device insertion, instrument insertion and exchange, and triangulation. The lowest scores were for retraction. During the clinical case, the platform provided good triangulation without instrument clashing. However, retraction was challenging because of the lack of strength and precise maneuverability with the tip of the instruments fully deployed. The SPIDER system offers intuitive instrument maneuverability and restored triangulation without external instrument clashing. Further refinements are awaited to define its role in the urologic LESS armamentarium.     

193 nm excimer laser ablation of bone

The argon fluoride excimer laser is investigated as a cutting-ablating tool for bone surgery. Quantitative measurements are presented for various fluences of laser energy and number of pulses. Histological data are presented that demonstrate the minimal damage to the surrounding material from the laser interaction. Comparisons are made for non-decalcified and decalcified bone. The differences observed, as a function of decalcification in the fluences required for specified depth penetration, are noted and a possible explanation is suggested.     

输尿管结石三种治疗方法的疗效比较

目的:探讨对输尿管结石治疗方法如何进行选择.方法:对经ESWL、输尿管镜下气压弹道碎石术(URSL)及输尿管切开取石术3种方法、治疗的360例输尿管结石患者的疗效进行比较.结果:ESWL174例,碎石率为90.3%,URSL150例,一次碎石率为92.2%,手术切开输尿管取石36例,取石成功率100%.输尿管镜失败改切开取石12例(8%);ESWL失败改切开取石或输尿管镜下气压弹道碎石56例(32.2%).结论:URSL治疗输尿管结石可以避免开放手术对患者造成的痛苦,减少术后并发症,但也不能盲目采用;对于复杂性输尿管结石,开放手术仍是可供选择的重要的治疗手段.     

Use of lasers in acute management of surgical and traumatic incisions on the face

This article is a clinically practical review structured around the specific applications of laser technologies used in acute management of soft tissue injuries in surgical incisions and trauma. Surgical and traumatic incisions and injuries provide the clinician with the unique opportunity to follow the progression and maturation of the wound healing response from a very early stage. There has been a recent interest in early cosmetic optimization of surgical and traumatic wounds on the face using optical technologies. Early clinical results for acute laser intervention starting immediately after suture removal or the first several weeks after repair have been very promising.