内镜腔内手术胃内通道的猪模型的实验研究

目的 探讨内镜腔内手术的可行性。 方法 4只家猪经皮建立胃内通道。结果 4只家猪均很好地耐受了手术。术后开腹检查所有胃壁缝合处无渗漏及其它脏器损伤。建立胃内通道时间为15-30min。 结论 内镜腔内手术胃内通道在技术上是可行的。     

经自然腔道内镜手术实验研究

目的探讨NOTES完成动物腹部多种手术成功与失败的原因,为其应用于临床提供实验依据。方法回顾分析2007年8月～2009年9月完成的全部动物实验数据。研究分为急性实验和存活实验2部分,采用雌性小型猪和成年杂种犬,分别开展了单纯NOTES和腹腔镜辅助的NOTES。进行诊断性腹腔探查和肝脏活检术,治疗性胆囊切除、输卵管结扎切除、卵巢切除、脾切除和胃空肠吻合等腹部手术。记录术中和术后并发症的发生情况,以及操作过程中遇到的技术难题。结果采用37只小型猪和16只杂种犬,完成急性实验22例,存活实验31例。共开展各种NOTES手术91例次,其中单一经胃路径25例次,单一经结肠路径8例次,经胃和结肠联合路径16例次,经胃和阴道联合路径6例次,传统腹腔镜辅助经胃路径26例次,单孔腹腔镜辅助经胃路径10例次。完成诊断性腹腔探查术33例,成功率100%（33/33）,肝脏活检术11例,成功率100%（11/11）,输卵管结扎切除术11例,成功率100%（11/11）,卵巢切除术6例,成功率100%（6/6）,胆囊切除术27例,成功率44.4%（12/27）。另行脾切除术1例和胃空肠吻合术2例,均未成功。总的并发症发生率为39.6%（21/53）,其中穿孔8例,脏器损伤5例,出血4例,腹腔感染3例,腹压过高导致动物死亡1例。结论NOTES用于诊断性腹腔探查和简单治疗是安全有效的,但完成腹部较复杂的手术尚不可行。腹腔镜辅助NOTES的方法或许是此项技术从动物实验过渡到临床应用的桥梁。     

血管腔内治疗手术并发症

血管外科作为一门新兴学科,在微创手术方面,血管腔内治疗取得了可喜的发展。1912年,Carrel等第1次报道了血管腔内治疗的动物试验;1964年Dotter等第1次实施了股胴动脉血管成形术;     

腔内手术在膀胱颈部梗阻的应用

目的 :评价腔内手术治疗膀胱颈部梗阻 (BNO)的疗效。方法 :采用经尿道膀胱颈部切除术 (TURN)治疗 17例。结论 :17例随访 3～ 18个月。一次性手术全部解除梗阻 ,排尿顺畅 ,无明显残余尿 ,术后 3个月的尿流率 (UFR)测定均 >2 0ml/L。结论 :TURN治疗BNO效果满意 ,是不同于开放性手术的微创方法 ,值得推广。     

高血压性脑内血肿的内镜手术清除

本报道纤维内镜辅助下小骨窗开颅清除13例脑内血肿，术后第2天及第7天复查CT，术后6月根据GOS量表及Barthel评分表进行远期疗效评价，优6例，良2例，中2例，死亡3例，远期疗效评定优良率达62％(8／13)。     

腔镜甲状腺手术的动物实验及临床应用研究

目的 探索用腔镜进行甲状腺手术的可行性及其应用价值。方法 利用杂交狗进行腔镜甲状腺切除的操作训练。在此基础上，2002年3－10月对12例甲状腺良性肿物患者用超声刀行腔镜甲状腺良性肿物切除术。结果 手术成功11例，中转开刀1例。手术时间40－120min，术中出血5－20ml。术后6h下床活动，进流质饮食，无恶心，呕吐。颈部引流管于术后第2天拔除，术后3－4d出院。2例术后前胸部出现小面积的淡黄色瘀斑。无皮下气肿。结论 腔镜甲状腺手术切口隐蔽，颈部无疤痕，安全可行。     

腹主动脉瘤腔内手术治疗进展

我国血管外科事业在近五十年里取得了前所未有的发展 ,这是广大血管外科专业人员共同努力的结果。进入 2 1世纪后 ,血管外科将得到更加迅速的发展。本专题特邀国内在此领域有突出贡献的专家 ,就目前血管外科的现状与发展趋势作一讲座 ,希望这一方小小的论坛 ,能对血管外科新技术的推广起一点的推动作用 ,并能吸引更多的有志青年加入到血管外科专业医师的队伍中来     

改良Miccoli模式内镜手术的工作腔室:WSM-Ⅰ型建腔器所成腔室的空间形态特征研究

目的 观测WSM-I型建腔器所成腔室的空间形态特征.方法 2010年1月至8月在我院接受改良Miccoli模式内镜甲状腺手术40例.入路制备完成后,统一采用建腔器建腔.手术包括一侧腺叶及峡部切除13例,腺叶部分切除27例.于建腔操作中运用空间测量针测量建腔器所成腔室的长、宽、高度等参数.结果①腔室底面的基本长度为(4....     

腹主动脉瘤腔内治疗的实验研究

目的　探讨腹主动脉瘤的腔内血管外科治疗方法。方法　将健康杂种犬 9只通过剖腹手术建立 4个肾动脉平面以下的腹主动脉瘤模型 (Ⅰ组 ) ,5个肾动脉平面以上的腹主动脉瘤模型 (Ⅱ组 ) ,然后经髂动脉给Ⅰ组置入支架型人工血管隔绝其腹主动脉瘤 ,对Ⅱ组则先重建双侧肾动脉和肠系膜上动脉的血流 ,然后再自髂动脉置入支架型人工血管 ,隔绝瘤体。术后观察血管通畅情况及动物存活情况 ,2 ,3个月后处死动物 ,检查支架型人工血管通畅及血管内皮生长情况。结果　腹主动脉瘤成模率为 10 0 % ,术后Ⅰ组 4只犬成活良好 ;Ⅱ组中 1只成活良好 ,另 4只分别于术后 4h ,1d ,3d ,4d后死亡。 2 ,3个月后处死动物 ,解剖发现支架型人工血管通畅 ,主动脉瘤体萎缩 ,光镜和电镜检查显示支架内及支架两端血管内皮生长良好。结论　腔内血管外科技术能有效地治疗主动脉瘤 ,特别是为肾动脉平面以上的主动脉瘤的治疗提供了一种新的方法。     

改良Miccoli模式内镜手术的工作腔室:WSM-Ⅰ型建腔器所成腔室的空间形态特征研究

Objective To comprehend spatial characteristics of the cavity created by a working space market.Methods 40 patients were successively operated according to the surgJical mode of minimally invasive video-assisted thyroidectomy from Jan.2010 to Aug.2010.Instead of hand-retraction.a mechanical arm-working space marker type I(WSM-I(R),MIEO Medinstr Co.Ltd,China),was applied to establish a working space.After the pathway making,a cavity above the gland was created and adjusted properly by the space maker,and then,endoscopic view was built and manipulation in the cavity was progressed throughout the later process.Geometric measurement of the cavity were performed at a"basic space position"just after the initial cavitation,and parameters such as length,width and height of the cavity were measured with a specifically scale-marked puncture needle(MC1820,Bard4(R)Max·Cor(R)Instrument)through mini-holes lay in the lifting hook(φ4mm,middle point and distant point).Results 13 cases received a lobectomy and isthmectomy.The other 27 cases received a partial thyroidectomy.Dimensional parameters were calculated as below.①The basic length of cavity button was(4.35±0.39)cm.The basic width of cavity button(distance at central point)was(4.66±0.53)cm.The basic central height of cavity was( 1.36±0.34)cm.The maximal central height archived by readjusting was(1.66±0.32)cm and a height increase of0.3 cm can be achieved(22.1％).②The basic peripheral height was(0.98±0.29)cm.The maximal peripheral height archived by readjusting directionally was(1.33±0.14)cm and a height increase of 0.35 cm can be achieved(35.7％).③Statistic analysis yielded a negative correlation between the cavity volume and the size of the nodule.Conclusions The working space created by WSM-I appears to be an laigh and irregular trapezoid stock with oblique roof formed by lifting hook.Although vertical height,especially the peripheral height,is a major restrictive dimension,the cavity can still be usable and enough for factual observation and manipulation,due to"compensating effect"of endoscope,finite space requirement of harmonica and"directional volume shifting"of WSM.     

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目的 研究适合升主动脉夹层的支架型血管，探讨支架型血管放置的合理途径和方法；观察支架型血管放置后模型动物的病理生理变化及评估临床腔内治疗升主动脉夹层的可行性。方法 以国产镍钛记忆合金和人造血管为材料制作支架型血管系统，以犬制作升主动脉夹层动物模型，通过输送器在透视下将支架型血管经主动脉弓的头臂分支动脉释放在模型犬升主动脉适当的集团内，使支架型血管覆盖犬升主动脉夹层模型的内膜撕裂处，使夹层内口封闭，再经髂股动脉在降主动脉起始段放置合适的裸支架一枚，用来纠正或预防夹层在远处的产生和蔓延。结果 7例实验动物升主动脉夹层模型均相当于DeBakeyⅡ型；7实验动物中有5例经右锁骨下动脉，1例经头臂干动脉（预先行右颈总动脉、主动脉弓人造血管临时性转流），1例经左锁骨下动脉途径送入输送系统；支架型血管均准确迅速地旋转在升主动脉内，覆盖夹层内破口位置，即刻造影显示，无明确的主动脉瓣关闭不全影象，术后观察7例实验动物，2例由于失血过多等原因术后未能复苏外，另5例均于术后24h内复苏，3天内恢复正常饮食，观察期间内，神态、视听反射正常，四肢动脉搏动正常。术后第一周内尸检观察5只实验动物显示升主动脉内支架型血管完好，有1只支架型血管向远端移位约1cm，夹层内破口被支架型血管完好封闭。结论 此实验设计制作的国产支架型血管系统及选择的输送途径合理、可行；并主动脉夹层动物模型的制作有待进一步完善；选择合适的升主动脉夹层病例进行腔内修复治疗的临床应用应是安全、可行的，交给升主动脉夹层的临床治疗带来新的选择和希望。     

Toward totally endoscopic coronary artery surgery

Background: Here we explore a method of using robotics to reduce morbidity and mortality in conventional coronary surgery. Methods: Using a robotic surgical system two surgeons completed five steps: (1) 80 synthetic suture exercises; (2) 76 left internal thoracic artery to left anterior descending (LIMA-to-LAD) on porcine hearts; (3) cadaveric port placement for assessing optimal access; (4) endoscopic stabilization in the live porcine model; and, finally (5) eight clinical LIMA-to-LADs performed robotically. Results: After 70 hours training, mean dry lab times fell from 7.0 and 5.8 min to 5.7 and 5.1 min in the two surgeonstab series. Wet lab times fell from 40.1 and 28.5 min to 28.8 and 19.2 min. In the clinical series of eight patients there were no mortalities; all had uncomplicated postoperative recovery and all were angina free at 6-week follow-up. Conclusion: The learning curve for robotic training is short, and reproducible results can be achieved clinically, after appropriate training, resulting in real patient benefit.     

Gastric bypass pouch and stoma reduction using a transoral endoscopic anchor placement system: A feasibility study

Background Weight regain after Roux-en-Y gastric bypass may be caused by pouch enlargement or dilatation of the gastrojejunostomy (stoma). In order to avoid the substantial morbidity of revisional bariatric surgery, investigators have recently demonstrated the feasibility of reducing stoma diameter using transoral endoscopic suturing techniques. Our aim was to demonstrate the feasibility of performing both pouch and stomal reduction using transoral endoscopically placed tissue anchors in an ex vivo and acute animate model. Methods Part I: We created an ex vivo model of a dilated gastric pouch and stoma using four explanted porcine stomachs. The stomach was divided to create an upper pouch of approx. 100 ml volume, which was reconnected to the lower portion of the stomach (gastric remnant) via an anastomosis of 18 to 20 mm diameter. Endoscopically placed anchors were then used to create plications of the stoma and reduce its diameter. In two stomachs, anchor plications were also used to decrease pouch volume. Pouch volumes and stoma diameters were measured pre- and post-procedure. Part II: A similar experimental model was created in vivo using three pigs. Anchors were placed in the stoma and pouch. The animals were immediately sacrificed and similar measurements were obtained. Results In the ex vivo model, stoma diameter was successfully reduced in all four stomachs by a mean of 8 mm (41%). This represented a mean decrease in cross-sectional area of 65%. Pouch volume was reduced by a mean of 28 ml (30%) in two stomachs. Stomal plications were successfully placed in two of the live animals, with a mean stoma diameter reduction of 11.5 mm (53%). Feasibility of pouch reduction using plicating anchors was confirmed. Conclusions This is the first study to demonstrate the feasibility of using endoscopically placed tissue anchors to reduce both stoma diameter and pouch volume. This technique may ultimately be clinically useful in treating weight regain after gastric bypass surgery.     

95%乙醇浸泡异体肌腱移植的实验研究

目的：研究用９５％乙醇浸泡处理后的异体肌腱移植对肌腱愈合的影响。方法：选用ＳＤ大鼠８０只，随机分为３组。乙醇浸泡异体肌腱组：切除大鼠跟腱全长，用９５％乙醇浸泡处理的异体肌腱桥接于腱缺损处。新鲜异体肌腱组：用新鲜异体肌腱移植于腱缺损处。自体肌腱组：用自体肌腱移植于腱缺损处，作为对照组。各组分别于术后２、３、４、６周观察肌腱形态学和组织学的变化；术后半年进行肌腱拉力试验。结果：乙醇浸泡处理的异体肌腱有明显降低组织抗原性的作用，移植后对肌腱愈合无明显影响，拉力和对照组相似。结论：乙醇浸泡处理后的异体肌腱可应用于临床     

经自然腔道内镜手术的研究进展

近年来,经自然腔道内镜手术已在全球取得了长足的发展.目前,已有大量经自然腔道内镜手术应用于实验动物及人体,如经阴道胆囊切除术、经阴道阑尾切除术、经胃阑尾切除术、经膀胱腹腔镜检术等.本文就目前经自然腔道内镜手术的研究进展及面临的挑战作一综述.     

Future endoscopic toolbox for endoluminal surgery

Differences between flexible GI endoscopy and laparoscopic surgery are mostly responsible for failure of NOTES and current technical difficulties of endoluminal interventions. A set of new tools will bridge gaps between endoscopy and laparoscopy, and may foster their positive integration toward next-generation endoscopic intervention.     

经乳晕入路腔镜良性甲状腺瘤切除术与开放手术的对比研究

目的:探讨经乳晕入路腔镜甲状腺切除术治疗良性甲状腺肿瘤的临床效果及优缺点。方法:回顾分析82例经乳晕入路腔镜甲状腺手术的临床资料,并与95例开放甲状腺手术进行对比,观察两组患者手术时间、失血量、并发症、术后引流管留置时间及引流量、术后C-反应蛋白、术后美容满意度评分、住院时间等。结果:两组患者手术时间、并发症、术后引流管留置时间、术后C反应蛋白、住院时间、复发率差异无统计学意义;腔镜组失血量明显少于开放组,引流量明显多于开放组,术后美容满意度评分明显优于开放组,差异有统计学意义(P<0.05)。结论:与传统开放手术相比,腔镜良性甲状腺瘤切除术具有微创、出血少、美容等优势,是较好的选择。     

Natural orifice surgery with an endoluminal mobile robot

Natural orifice transgastric endoscopic surgery promises to eliminate skin incisions and reduce postoperative pain and discomfort. Such an approach provides a distinct benefit as compared with conventional laparoscopy, in which multiple entry incisions are required for tools and camera. Endoscopy currently is the only method for performing procedures through the gastrointestinal tract. However, this approach is limited by instrumentation and the need to pass the entire scope into the patient. In contrast, an untethered miniature robot inserted through the mouth would be able to enter the abdominal cavity through a gastrotomy for exploration of the entire peritoneal cavity. In this study, the authors developed an endoluminal robot capable of transgastric abdominal exploration under esophagogastroduodenoscopic (EGD) control. Under EGD control, a gastrotomy was created, and the miniature robot was deployed into the abdominal cavity under remote control. Ultimately, future procedures will include a family of robots working together inside the gastric and abdominal cavities after their insertion through the esophagus. Such technology will help to reduce patient trauma while providing surgical flexibility.