腹部术中输尿管实时识别研究进展

在腹部外科手术过程中,医源性输尿管损伤虽然较罕见,但是一旦发生损伤将会产生严重的并发症,如腹腔感染、输尿管瘘、肾衰竭等。为了降低腹部术中医源性输尿管损伤的风险,术中实时在体输尿管可视化的医学成像技术被广泛地研究与应用,如预防输尿管导管置入术（或发光输尿管支架置入术）、gamma探测技术、荧光成像技术。然而这些技术目前仅有荧光成像技术可以达到无创、无电离辐射、可实时在体获取输尿管的位置信息。相关研究已证实了应用荧光成像技术结合外源荧光染料的使用在腹部术中实时在体可视化输尿管位置信息的可行性,并取得重要的进展。本文就近年来应用荧光成像技术和外源荧光染料（荧光素钠、亚甲基蓝、吲哚、CW800-CA、ZW800-1）在腹部术中输尿管实时识别的研究进展做一综述。      

吲哚菁绿荧光影像技术在肝胆胰外科疾病诊治中的应用进展

近年来, 吲哚菁绿分子荧光影像技术在肝胆胰外科中的应用日益广泛, 该技术应用日趋成熟, 在肝胆胰外科围手术期中扮演着重要角色。吲哚菁绿在肝脏外科中的应用主要包括术前评估和术中进行微小癌灶的侦测、肿瘤边界界定和左右半肝界定, 可使肝切除手术更为精准、安全, 尤其是在肿瘤切除术中可以有效减低手术风险并提高R0切除率; 在胆道外科中对肝内胆管癌、胆囊切除和胰腺肿瘤的应用较为广泛, 可避免胆道的损伤和提高胰腺肿瘤的诊治效果。故本文通过查阅近几年国内外关于吲哚菁绿在肝胆胰外科应用的研究成果, 如在肝切除术前评估肝脏功能, 在肝切除术中用于侦测肝断面边缘残余肿瘤及术中微小癌灶, 以及在肝肿瘤边界、左右半肝界定、腹腔镜胆囊切除术、肝内胆管癌、胰腺外科等中的应用, 标题全方位地阐述吲哚菁绿分子荧光影像技术在肝胆胰外科疾病中的相关应用。      

应用心血管外科技术治疗胸部晚期肿瘤的术后护理

目的：探讨心血管外科技术在胸部肿瘤切除术中的应用及护理措施。方法：11例肿瘤侵犯心脏或大血管病例,均在体外循环下修补血管,术后患者进监护室,应用心血管外科护理技术和经验,在循环、呼吸及血管活性药物的使用等方面,结合肿瘤外科护理技术,为术后减少并发症及患者顺利恢复提供护理措施。结果：11例中除1例死于心肺功能衰竭外,余均存活。结论：应用心血管外科技术能扩大胸部局部晚期肿瘤根治性切除范围,提高手术安全性,患者获得长期生存和良好的生活质量成为可能。     

胸腔镜微创手术在胸部肿瘤中的应用

目的：探讨胸腔镜胸部肿瘤手术的可行性，并介绍手术操作方法。方法：1997年7月以来，应用胸腔镜治疗胸部肿瘤102例，其中良性肿瘤35例，恶性肿瘤67例。行肺叶切除54例，全肺切除4例，肺楔形切除12例，纵隔肿瘤切除10例，胸腺切除5例，单发胸膜间皮瘤切除3例，胸膜活检加固定术2例，食管癌切除9例，胸部手术时间60－240min，平均126.5min，术后平均住院9.6d。恶性肿瘤病例术后根据病情辅以化疗或放疗等综合治疗。结果：除3例因胸膜广泛粘连转传统开胸手术外，其余病例均顺利完成手术。术后发生并发症6例，其中死亡1例，其余均治愈。结论：胸腔镜治疗胸部肿瘤就技术操作而言是可行的，创伤小，恢复快，效果好，对胸部恶性肿瘤只要严格掌握手术适应症，能达到与常规开胸肿瘤根治同等的治疗目的。     

2例胸部肿瘤切除并人造血管置换术的术后护理

胸部肿瘤侵犯上腔静脉、双侧无名静脉时，以往被认为是外科手术的禁忌证。随着血管外科技术在胸部肿瘤外科治疗中的应用，使部分肿瘤侵犯上腔静脉和／或无名静脉的患者得到了根治性手术治疗。2006年4月至2006年10月，本院胸外科为2例患者成功实施了胸部肿瘤切除并行人造血管置换术，现将术后护理体会报告如下。     

电视胸腔镜外科手术55例报告

目的：总结电视胸腔镜手术(VATS)在胸外科临床应用的经验。方法：回顾分析该院1996--2002年应用VATS技术治疗55例病人的临床资料，手术包括肺大疱切除，肺叶或肺楔形切除，不明胸水的诊治，胸部外伤的诊治，纵隔肿瘤切除，动脉导管结扎术等。结果：全组病人无死亡，并发症少，全部痊愈出院。结论：VATS具有创伤小、痛苦轻、恢复快和术后并发症少等优点，符合美容要求，更适合于高龄心肺功能差的患者。     

心血管外科技术在胸部肿瘤中的应用及护理对策

目的：探讨心血管外科技术在胸部肿瘤中的应用及护理措施，为疑难、重症患者提供新的救治手段。方法：选取18例过去被视为外科禁忌证的以肺癌为主的局部晚期胸部肿瘤，应用心血管外科理论和技术使其能够做到整块切除。应用心血管外科护理技术和经验，为术后患者顺利恢复打下良好的基础。结果：18例患者中除1例死于心肺功能衰竭外，余均存活且获得了良好的手术效果。结论：通过理论与实践的研究，提高心胸外科联合手术后患者的护理水平，为将来患者采用更合理的治疗手段和如何联合治疗并顺利康复，提供一些理论和实践依据。     

弥散张量成像在周围神经损伤中的应用进展

弥散张量成像是基于水分子的弥散运动获取不同组织各向异性信息的一种磁共振成像技术,在周围神经损伤修复、微病变识别和神经肿瘤等方面中发挥重要作用。弥散张量成像在周围神经损伤中临床应用尚不广泛,测量参数受技术设置和序列规范等多种因素的影响,测定方案的标准化和不同功能参数的定量仍有待进一步研究。     

心血管外科技术在胸部肿瘤中的应用及护理对策

目的：探讨心血管外科技术在胸部肿瘤中的应用及护理措施，为疑难、重症患者提供新的救治手段。方法：选取18例过去被视为外科禁忌证的以肺癌为主的局部晚期胸部肿瘤，应用心血管外科理论和技术使其能够做到整块切除。应用心血管外科护理技术和经验，为术后患者顺利恢复打下良好的基础。结果：18例患者中除1例死于心肺功能衰竭外，余均存活且获得了良好的手术效果。结论：通过理论与实践的研究，提高心胸外科联合手术后患者的护理水平，为将来患者采用更合理的治疗手段和如何联合治疗并顺利康复，提供一些理论和实践依据。     

2例腹腔镜大肠癌切除的手术配合

随着医学科学的发展，腹腔镜已广泛地应用于临床，与传统的开腹手术相比，它具有创伤小、术中出血少、术后疼痛轻、肠梗阻发生率低等优点已被越来越多的人所认可，并广泛地运用于外科、妇科等常见手术。我院于2003年3月，应用腹腔镜技术行大肠癌切除手术2例，现将手术配合介绍如下。     

胸段食管癌颈、胸、腹三区域淋巴结清扫术临床应用

目的通过颈、胸、腹三区域淋巴结清扫提高胸段食管癌的手术根治性和外科的正确分期。方法49例胸段食管癌患者在切除肿瘤的同时接受了颈、胸、腹三区域淋巴清扫术,清扫范围包括双侧下颈中央区,锁骨上区,和全纵隔及上腹部区域淋巴结。结果47例患者获根治性切除,术后并发症6例(12.8%),无手术死亡,34例(72.3%)淋巴结受累。颈部、纵隔、和腹部淋巴结转移率分别为38.3%、53.2%、12.7%(P>0.05)。结论胸段食管癌早期即可发生广泛及跳跃性淋巴结转移,扩大淋巴结清扫范围有利于提高手术根治性和外科分期的正确性。     

Application of the indocyanine green fluorescence imaging method in laparoscopic resection of a solitary retroperitoneal metastasis of renal cell carcinoma: A case report

Fluorescence image-guided surgery has improved intraoperative identification of anatomic structures including visualization of vascular anatomy. Herein, indocyanine green (ICG) fluorescence imaging was applied to identify of a recurrent small tumor of renal cell carcinoma (RCC) during laparoscopic surgery. The patient underwent left laparoscopic radical nephrectomy via the retroperitoneal approach for RCC (clear cell carcinoma, pT1bN0M0) at the age of 39 years. A solitary retroperitoneal mass (14 mm in diameter) was identified in a computed tomography scan 6 years after surgery. We performed laparoscopic resection with the application of the ICG angiography, because RCC is recognized as one of the most hypervascular cancers. The tumor was clearly visualized by fluorescence. Histopathological diagnosis of the resected tumor was recurrent RCC (low grade, G1). The patient remained free of disease at 2 years after surgery. The ICG fluorescence imaging would be a useful method for identification of metastatic small lesions of RCC during laparoscopic surgery.     

腹腔镜吲哚菁绿荧光显影指引淋巴结切除用于早期子宫内膜癌分期手术的临床价值

目的探究腹腔镜吲哚菁绿荧光显影指引淋巴结切除用于早期子宫内膜癌分期手术的临床价值。方法回顾性分析,选取2018年1月至2019年6月青海红十字医院收治的腹腔镜分期手术早期子宫内膜癌患者35例,术前给予吲哚菁绿注射,采集淋巴显影图,术后对显影、非显影淋巴结送检、分析,观察腹膜后淋巴显影情况、多区域淋巴显影的影响因素以及显影淋巴结对肿瘤转移状态的诊断效能,随访患者不良反应。结果35例患者中,共有33例成功显影,占94.29%,21例仅表现为盆腔淋巴结显影,11例为盆腔、腹主动脉旁淋巴结显影,1例仅腹主动脉旁区域显影;经过单因素Logistic回归分析,结果显示,显影效果与临床医师注射经验密切相关(P<0.05);显影淋巴结肿瘤状况对淋巴结转移预测灵敏度、假阴性率分别为85.67%、14.32%;阴性预测值为96.43%,准确率为97.12%。结论针对早期子宫内膜癌患者给予吲哚菁绿荧光显影安全、可行,能够有效预测腹膜后淋巴结有无肿瘤转移,在腹腔镜淋巴结切除术分期手术中有着较高的应用价值。     

Targeted Radionuclide and Fluorescence Dual-modality Imaging of Cancer: Preclinical Advances and Clinical Translation

In oncology, sensitive and reliable detection tumor tissue is crucial to prevent recurrences and to improve surgical outcome. Currently, extensive research is focused on the use of radionuclides as well as fluorophores to provide real-time guidance during surgery to aid the surgeon in the identification of malignant tissue. Particularly, dual-modality approaches combining radionuclide and near-infrared fluorescence (NIRF) imaging have shown promising results in preclinical studies. Radionuclide imaging allows sensitive intra-operative localization of tumor lesions using a gamma probe, whereas NIRF imaging allows more accurate real-time tumor delineation. Consequently, both radionuclide and NIRF imaging might complement each other, and dual-modality image-guided surgery may overcome limitations of the currently used single-modality imaging techniques. In this review, a comprehensive overview on recent preclinical advances in tumor-targeted radionuclide and fluorescence dual-modality imaging is provided. Subsequently, the clinical applicability of dual-modality image-guided surgery is discussed.     

改良Ivor-lewis与经左胸一切口手术治疗胸中段食管鳞癌的临床分析

目的比较改良Ivor-lewis和经左胸一切口两种手术方式治疗胸中段食管鳞状细胞癌的疗效,并对两种手术方式进行临床评价。方法回顾性分析本院胸外科2004年3月~2006年8月间进行的273例食管中段鳞癌手术临床资料,改良Ivor-lewis术式(改良Ivor-lewis组)189例,经左胸一切口术式(经左胸组)84例。对两组的3年和5年生存率、3年肿瘤局部复发率、淋巴结清扫数目、切缘阳性率、围术期并发症、手术时间等进行对比研究。结果改良Ivor-lewis组3年生存率为59.5%,经左胸组为60.3%(P=0.312),5年生存率分别为37%和38.1%(P=0.868);改良Ivor-lewis组3年肿瘤局部复发率为33.9%,经左胸组为46.4%(P=0.048);改良Ivor-lewis组和经左胸组平均清扫淋巴结数分别是(16.5±2.5)枚和(11.1±2.5)枚(P<0.001);上切缘阳性率分别为1.1%和7.1%(P=0.018);改良Ivor-lewis组和经左胸组的并发症发生率分别是38.6%和44%(P=0.399),其中改良Ivor-lewis组的胃潴留发生率较高(P=0.015),而经左胸组的吻合口瘘发生率较高(P=0.040);手术时间分别为(3.15±0.5)h和(3.07±0.49)h(P=0.216)。结论改良Ivor-lewis术式和经左胸一切口术式均可作为胸中段食管鳞癌的候选手术方式,但在3年肿瘤局部复发率、平均清扫淋巴结的数目、切缘阳性率及术后吻合口瘘严重并发症发生率方面,改良Ivor-lewis手术有一定优势。     

Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report

BACKGROUNDRectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARYA 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse. CONCLUSIONICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.     

四肢骨巨细胞瘤保肢术后的局部影像学评价

目的探讨四肢骨巨细胞瘤保肢术后局部正常转归与并发症的影像学表现及其价值。方法分析104例因四肢骨巨细胞瘤而接受外科保肢治疗的患者的影像学随访资料,其中74例接受肿瘤刮除术(包括植骨术44例和骨水泥填充术30例),30例接受瘤段切除术(包括单纯切除术4例、移植骨重建术9例和肿瘤型假体关节置换重建术17例),术后平均随访时间(45.65±10.32)个月,分析术后随访的影像表现。结果 104例患者中,因手术方式不同,66例术后正常转归的影像学表现不尽相同。术后3年总并发症发生率为36.54%(38/104),随手术方式而有所不同;肿瘤复发率为28.85%(30/104)。结论在骨巨细胞瘤保肢术后随访中,影像学检查可较早发现局部并发症。     

Needlescopic Video-assisted Thoracic Surgery for Primary Spontaneous Pneumothorax

Minimally invasive surgery is the current trend of approach in various fields. Since May 2006, our team has started implementing needlescopic video-assisted thoracic surgery as the standard surgical treatment for primary spontaneous pneumothorax.

During a seventeen-month period, 62 consecutive patients with primary spontaneous pneumothorax were operated on. The ages, sex ratio, operative times, blood loss, postoperative pain in visual analog scale (VAS), length of stay and hospital costs were recorded and compared with that of another 62 consecutive patients who received conventional video-assisted thoracic surgery between July 2004 and April 2006. Only the postoperative pain in VAS was significantly lower in the needlescopic video-assisted thoracic surgery group; the rest remained the same. Also the wounds were almost undetectable in the needlescopic video-assisted thoracic surgery patients. There were no major complications, mortality or recurrence in either group.

Needlescopic video-assisted thoracic surgery is a high-tech technique which provides safety, effectiveness, economy and outcome comparable to that of conventional techniques. It is also associated with less pain and better cosmetics.     

胰十二指肠切除术胰漏发生与治疗相关因素的关系

目的探讨胰十二指肠切除术（PD）胰漏的发生与给予临床治疗相关因素的关系。方法收集2002年1月至2007年10月135例行PD术患者的临床资料,对其进行回顾性分析。结果135例中术后发生胰漏6例（4.44%）,死亡5例（3.70%）。6例胰漏患者中死亡1例,经二次手术治疗痊愈1例,其余经保守治疗痊愈。手术方式（切除范围）、胰管吻后方式、胰管支架放置方式、手术时间与胰漏发生无明确关系（P均〉0.05）。术中出血量〉1 000 mL可增加胰漏发生率（P〈0.05）;早期肠内营养支持及生长抑素的应用可预防胰漏的发生。结论胰十二指肠切除术术后胰漏发生与术中技术因素及术后一些积极的处理措施有明显关系。精湛的手术技巧和术后处理措施的合理采用是预防或减少术后胰漏发生的重要手段。