B超引导下的乳腺纤维腺瘤微创旋切术

目的探讨B超引导下Mammotome微创旋切系统在乳腺纤维腺瘤微创手术中的应用价值。方法对43例53处0.6cm～2.2cm乳腺纤维腺瘤进行了B超引导下Mammotome微创旋切切除术,评价其手术效果。结果乳腺纤维腺瘤均被Mammotome微创旋切切除,平均每处旋切17次,用时31min。操作全部成功。皮肤伤口仅3mm,并发症轻微。15例(21处)经术后6～21(13.5±4.0)个月的随访,临床及B超复查均无复发迹象。结论B超引导下Mammotome微创旋切系统进行乳腺小纤维腺瘤的切除术,操作简易,切除彻底,创伤小。     

Minimally Invasive Ventricular Assist Device Surgery

The use of mechanical circulatory support to treat patients with congestive heart failure has grown enormously, recently surpassing the number of annual heart transplants worldwide. The current generation of left ventricular assist devices (LVADs), as compared with older devices, is characterized by improved technologies and reduced size. The result is that minimally invasive surgery is now possible for the implantation, explantation, and exchange of LVADs. Minimally invasive procedures improve surgical outcome; for example, they lower the rates of operative complications (such as bleeding or wound infection). The miniaturization of LVADs will continue, so that minimally invasive techniques will be used for most implantations in the future. In this article, we summarize and describe minimally invasive state‐of‐the‐art implantation techniques, with a focus on the most common LVAD systems in adults.     

澳大利亚微创胆道外科

目的 从20世纪末期以来,澳大利亚腹腔镜手术已经快速发展进步并且逐渐扩展到各个外科手术领域.一些外科医生也完成并发表了关于腹腔镜胆总管探查技术的报道.在本文中,作者介绍了目前澳大利亚的微创外科手术治疗胆管疾病的现状,包括：常规或选择性胆管造影;胰腺胆道疾病中ERCP的作用;腹腔镜胆总管探查术的手术技巧以及胆源性胰腺炎的治疗.作者还介绍了澳大利亚目前胆总管探查的现状,并且提到他们倾向于每例腹腔镜胆囊切除术都进行术中胆道造影.如果胆总管内发现小结石而且胆囊管足够粗,则进行经胆囊管的胆总管探查术.然而,如果狭窄的胆总管内有较大的结石,则进行术后ERCP治疗.作者还进一步介绍了胆道疾病相关的其他的微创治疗手术方法.总的来说,腹腔镜手术进行胆总管取石是可行和安全的.在有足够经验的医疗中心,这种手术方法可以常规使用.同时,成功进行腹腔镜胆总管探查术也需要多种方法综合进行.ERCP也没有被腹腔镜胆总管探查术所取代,而且成为一种重要的补充性的胆总管结石治疗方法.     

下肢静脉性溃疡的外科微创治疗

目的探讨下肢静脉性溃疡外科微创治疗的效果。方法对31例(33侧患肢)下肢静脉性溃疡通过静脉造影检查明确引起溃疡的原发病变,根据患肢血流动力学异常的种类和程度对10例(11侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗术;17例(18侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗、内镜深筋膜下交通静脉离断术;4例(4侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗、内镜深筋膜下交通静脉离断和股浅静脉瓣膜包窄术。溃疡一律行周缘环行缝扎。结果术后33侧患肢浅静脉曲张均消失,色素沉着、湿疹样病变均明显减轻;24侧小腿酸胀沉重感、疼痛、水肿12~16d消失;溃疡18~40d内愈合。随访1~36个月,平均14.8月,3侧(9.1%)肢体溃疡复发。结论纠正浅静脉、交通支静脉、深静脉功能不全和重视溃疡创面的处理是治疗下肢静脉性溃疡的有效疗法,静脉腔内激光治疗、内镜深筋膜下交通静脉离断术操作简便、微创、安全,联合股浅静脉瓣膜包窄术可以有效地减少下肢静脉性溃疡的复发。     

Minimally Invasive Cardiac Surgery: Current Status and Perspective

Recently, the minimally invasive approach has become a growing aspect in the field of cardiac surgery with the goal of eliminating cardiopulmonary bypass (CPB) and/or median sternotomy. In coronary bypass surgery, the application of this approach is direct anastomosis, primarily of the left internal thoracic artery to the left descending coronary artery under a beating condition without the use of CPB through a small left thoracotomy minimally invasive direct coronary artery bypass (MIDCAB). In the repair of intracardiac lesions, CPB cannot be excluded, but a small right parasternal incision or small partial sternotomy (ministernotomy) has been applied for congenital defects and mitral and aortic valve lesions. With technological advances in CPB, these approaches may become more popular in the near future.     

内镜下微创外科技术在声带疾病的临床应用

目的探讨经内镜支撑喉镜下微创外科技术在声带疾病的临床应用效果。方法 2005年1月～2008年1月,对小声带息肉及声带小结58例,广基底息肉30例,任克层水肿25例,声带囊肿36例,声带白斑11例共160例声带疾病患者采用内镜下微创外科治疗,采用显微切除技术58例、外侧微瓣技术67例、内侧微瓣技术24例、黏膜下注射技术及黏膜表皮剥脱技术11例。结果声带小结26例及声带息肉62例均一次切除病变。声带囊肿病变有2例(2/36,5.6%)术后发生黏膜瓣下端断裂漂移,后在电子喉镜下切除断裂黏膜瓣;另34例一次切除病变。任克层水肿25例全部消除声带浅固有层下水肿。150例(94%)术后1周经嗓音分析检查恢复正常嗓音,另10例在术后2周～3个月恢复正常嗓音。声带白斑11例全部随访1～3年,平均1.6年,术后2个月经电子喉镜检查均未见病变复发,病理报告为不典型增生的7例中有2例术后1年复发。结论内镜引导支撑喉镜下微创外科技术治疗声带疾病符合微创原则,近期疗效良好。     

Past,Present, and Future of Minimally Invasive Abdominal Surgery

Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927–2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques.