美国胃肠内镜外科医师协会关于腹(胸)腔镜手术准入制度的指南

1 授权原则 前言美国胃肠内镜外科医师协会（Society of American Gastrointestinal Endoscopic Surgeons，SAGES）推荐使用以下指南用以授予能单独完成腹（胸）腔镜操作，或同时进行手或机器人辅助腔镜手术操作的医师从事该项工作的资格。授权的基本前提是该医师必须有充分的判断力并经过严谨培训，从而一旦参与该项手术便能安全顺利地完成，而且必须具备当出现中转开放手术指征时即能完成开放手术的能力。     

内镜技术在颌面骨畸形修复术中的应用进展

自1983年法国巴黎大学国际医院外科的Dubois首先将内镜技术应用于阑尾切除术之后,1987年法国的Mouret成功地通过内镜行胆囊切除术,开创了内镜在外科疾病治疗应用的新时代,1992年美国整形外科医师Vasconez首次报道用内镜实施额部除皱术。短短20来年,内镜技术已经广泛应用于腹腔外科、胸腔外科、泌尿外科、妇产科、整形外科等。与传统手术相比,应用内镜技术进行手术,具有切口小、创伤轻等诸多的优越性。以内镜外科代替传统外科,     

美国胃肠内镜外科医师协会关于诊断及治疗性内镜下逆行胰胆管造影术培训指南

1培训 美国胃肠内镜外科医师协会（Society of American Gastrointestinal Endoscopic Surgeons，SAGES）认为有志于从事肝胆胰疾病诊治工作并已接受相关培训的医师方是接受诊断及治疗性内镜下逆行胰胆管造影术（ERCP）培训的适宜对象。欲接受ERCP培训的医师应对自己的能力有充分自信，在往后工作中应完成足量的手术例数以维持其手术熟练程度，并应有志于在此不断前进的领域中努力不懈以提高自身水平。     

上海国际消化内镜切除新技术研讨会暨第五届中日ESD高峰论坛

由中华医学会消化内镜分会、中国医师协会内镜医师分会和上海医学会共同主办，复旦大学附属中山医院承办的“2012年上海国际消化内镜切除新技术研讨会暨第五届中日ESD高峰论坛大会”将于2012年4月6—8日在上海举行。     

美国腹腔镜内镜外科医师协会（SLS）22届年会将于2013年8月底在美国华盛顿特区Virginia州Reston市召开

由美国腹腔镜内镜外科医师协会和其附属协会[The Society of Laparoendoscopic Surgeons（SLS）and Affiliated Societies]主办的2013微创外科与内镜展示周将于2013年8月在美国Virginia州Reston市举办。这是一个微创外科领域多学科的重大学术会议，内容包括：     

美国腹腔镜内镜外科医师协会与《美国腹腔镜内镜外科医师协会杂志》简介

The Society of Laparoendoscopic Surgeons（SLS）（美国腹腔镜内镜外科医师协会）是北美也许是全世界最大的微创或腹腔镜协会，正式会员超过6000人。包括腹腔镜和微创外科各专业，主要有3个：普通外科、妇科、泌尿外科的腹腔镜内镜。SLS的重点是多专业化，为医师更好决策和使患者得到更好的效果，从全面、     

内镜甲状腺手术现状与评价

内镜甲状腺手术充分体现了内镜外科技术的美容和微创理念,其克服了传统甲状腺手术的一些缺陷,如术后颈部瘢痕、颈前皮肤感觉异常以及吞咽不适等。该技术得益于Gagner 1996年开创性的内镜甲状旁腺次全切除术．并由Huscher等于1997年率先开展。近年内镜甲状腺手术的临床应用日益广泛。这与外科医师对内镜下颈部解剖结构的深入了解、对手术径路选择的多元化探索以及内镜手术器械的不断改进密不可分。     

2013上海国际消化内镜研讨会暨第六届中日ESD高峰论坛

近年来．随着消化内镜各项新的诊断技术的开展，胃肠道肿瘤的发现率逐年提高，但内镜治疗整体水平和地区差异仍然较大。为进一步提高我国胃肠道肿瘤的内镜治疗水平、促进内镜切除新技术在中国的推广开展。由中华医学会消化内镜学分会、中国医师协会内镜医师分会主办．上海市医学会、复旦大学内镜诊疗研究所和复旦大学附属中山医院承办的2013上海国际消化内镜研讨会暨第六届中日ESD高峰论坛于4月5—7日在上海如期举行。会议期间，     

单孔腔镜技术及其在泌尿外科的应用

以尽可能小的创伤和尽可能美容的切口完成手术,是每个外科医师的美好愿望。自1987年Mouret等完成了世界首例电视腹腔镜胆囊切除术后^[1],外科学便进入了一个全新的微创外科时代。随后于1991年Clayman等^[2]。首次应用腹腔镜技术完成了肾切除术,在此之后泌尿外科医师在微创外科的道路上不断探索,并逐渐成为了应用微创技术解决患者病痛的先行者。随着科学技术的进步,加之外科医师创造性的不断展现,单孔腔道腹腔镜内镜手术（1aparo endoscopicsingle sitesurgery,LESS）和经自然腔道内镜手术（naturalorificetransluminalendoscopicsurgery,NOTES）技术应运而生,使微创外科的发展再次向前迈进了一大步,很有可能给外科领域带来革命性的突破。LESS手术理论上的优势在于隐藏瘢痕而达到美容效果、减轻患者术后疼痛、缩短术后恢复时间和减少手术切口相关并发症等方面,目前该技术已经得到外科医师的认可并得以应用于临床。本文就LESS技术及其在泌尿外科的临床应用现状加以论述。     

美国腹腔镜内镜外科医师协会（SLS）22届年会将于2013年8月底在美国华盛顿特区Virginia州Reston市召开

由美国腹腔镜内镜外科医师协会和其附属协会[TheSocietyof LaparoendoscopicSurgeons（SI。S）andAffiliated Sotieties]主办的2013微创外科与内镜展示周将于2013年8月存美旧Virginia州Reston市举办。这是一个微创外科领域多学科的重大学术会议，内容包括：全体会议和硕士学位研究生级课程（PostgraduateMastcrkClasses）；多主题的腹腔镜进展（I。apUpdatesofmultipletopics）；手术视频（Video）以及其中的突发事件／事故的处理和专家点评、讨论；困际大师级外科医生手术录像观摩、专家点评和论文展示；最佳论文、最佳VIDEO和最佳板报（POSTERS）的评比等多个部分组成。通过对未来技术发展的研讨（FutureTechnologySessions），将使与会者对腹腔镜、内镜和微创外科技术的基础知识和基本原则有充分的理解和提高，并了解和掌握腹腔镜、内镜和微创外科技术的最新进展，有助于提高我国腹腔镜的技术水平。《中国微创外科杂志》（CJMIS）编辑部为本次盛会的协办方之一，将努力争取我围微创外科医师优秀论文大会发言的机会，使此次会议Ⅱ王成为展示我国微创水平的一次良好机会。     

James Alison Glover (1874-963), OBE (1919) CBE (1941) MD (1905) DPH (1905) FRCP (1933)

James Allison Glover served in the Boer War and World War I. In 1917 he was appointed to the Cerebro-spinal Laboratory in London. There, his work on cerebrospinal fever resulted in the "spacing out" of beds in huts and earned him the name of "good friend of the private soldier". In 1919 he proceeded OBE for his work during the war. In 1920 he was appointed medical officer to the new Ministry of Health. He made significant contributions to rheumatology and the understanding and treatment of tonsillitis, and to public health more widely.     

Anaplastic (undifferentiated) thyroid carcinoma (ATC)

BACKGROUND: Old age, reduced general condition and far advanced tumor stage associated with poor prognosis induced the belief that, apart from verifying the diagnosis of anaplastic thyroid carcinoma (ATC) by biopsy, no additional surgery would be justified. However, in some cases, an ultraradical approach was recommended in order to improve the quality of life and survival. METHODS: These are the results of a retrospective analysis involving 120 patients subjected to restricted radical surgery (excising as much as possible of the tumor and local metastases, foregoing ultraradical removal of vital organs such as esophagus, larynx and trachea). RESULTS: Irrespective of the surgical approach used, 6+/-2% of the patients were alive after 5 years (median survival time: 3.1 months). Patients without tumor residues (R0-resections; extending to soft tissue only; Kaplan-Meier estimate - cumulative survival 15+/-5%) had a significantly better prognosis than patients with tumor residues (R1/R2-resections; no patient survived 5 years; P<0.001). Tumor morphology (spindle cells, giant cells, mixed cells) or differentiated parts of the tumor as well as lymph-node involvement had no statistically significant impact on the prognosis. CONCLUSIONS: In ATC, the objective should be to remove as much of the carcinoma as possible (in the ideal case, a thyroidectomy); if lymph nodes are affected, neck dissection should be the goal, if possible (restricted radical approach, improving quality of life). Ultraradical surgery to include segmental resection of larynx, trachea or esophagus do not seem to be indicated, as prolonged survival is questionable and quality of life is certainly diminished.     

热毒清对家兔内毒素性DIC急性肺损伤的保护作用

采用间隔２４小时两次注射大肠杆菌内毒素方法复制家兔急性肺损伤模型，检测血浆、肺组织及支气管肺泡灌洗液（ＢＡＬＦ）中白细胞介素８（ＩＬ－８）、硝酸盐／亚硝酸盐（ＮＯ２／ＮＯ３）水平及有关指标改变，观察中药制剂热毒清（ＲＤＱ）对家兔内毒素性肺损伤的保护作用。发现ＲＤＱ可降低肺系数及通透指数，减少ＢＡＬＦ中白细胞计数；ＩＬ－８、ＮＯ２－／ＮＯ３－水平、酸性磷酸酶（ＡＣＰ）活性亦显著降低（Ｐ＜０．０１），肺组织学损伤减轻。证实ＲＤＱ对内毒素所致的家兔急性肺损伤具有一定的保护作用。     

Endotoxin (LPS) increases mesenteric vascular resistance (MVR) and bacterial translocation (BT)

Endotoxemia is responsible for many of the pathophysiologic alterations that occur with Gram-negative sepsis. We utilized a chronic ovine model to determine the hemodynamic disturbances in the gastrointestinal tract during endotoxemia. Sheep with indwelling arterial, venous, and pulmonary arterial catheters were used. An ultrasonic flow probe was placed on the cephalic mesenteric artery. The animals were subjected to: 1) Ringer's lactate infusion (sham n = 6); or 2) 1.5 mcg/kg E. coli endotoxin (n = 6) over over a period of one half hour and were monitored for 48 hours. They were then sacrificed and specimens of mesenteric lymph node, liver, spleen, kidney, and lung obtained for bacteriologic cultures and histologic analysis. Sheep receiving endotoxin showed more than 50% reduction in the mesenteric blood flow. Mesenteric vascular resistance increased while non-mesenteric systemic vascular resistance decreased. The increase in the total systemic vascular resistance, noted during endotoxemia, was thus likely due to the increase in the mesenteric vascular resistance. At autopsy there were positive cultures for microorganism in the mesenteric lymph nodes in six out of six sheep with endotoxemia as compared to one out of six of control. Thus the vasoconstriction in the mesenteric areas may have resulted in bacterial translocation from the GI tract.