B超引导下微创经皮肾穿刺钬激光碎石术治疗上尿路结石87例报告

目的探讨微创经皮肾穿刺钬激光碎石治疗上尿路结石的有效性和安全性。方法患侧输尿管置入输尿管导管,B超引导下建立经皮肾通道,输尿管镜直视下置入钬激光光纤将结石粉碎,利用灌洗泵将碎石冲出体外。结果微创经皮肾穿刺钬激光碎石成功率为88.5%（77/87）,手术时间35～190min,平均85min。9例肾盏内残余结石（〉4mm）配合体外冲击波碎石及口服排石药,均成功排净残余结石。治疗成功率为97.7%（86/87）。术后住院4～16d,平均6.3d。1例术后严重出血,超选择性肾小血管栓塞止血成功。86例随访3～18个月,平均6.3月,术后残余结石均排净,肾积水均较术前明显改善。结论B超引导下微创经皮肾穿刺钬激光碎石是治疗上尿路结石的一种简便、安全、有效的方法。     

Surgical Management of Epiphrenic Diverticula in the Minimally Invasive Era

Background:

Epiphrenic diverticula are rare outpouchings of the distal esophagus that infrequently require surgical intervention for the treatment of symptoms. In cases where surgical therapy is indicated, the traditional approach is through a thoracotomy. Advances in minimally invasive techniques have led to thoracoscopic and more recently laparoscopic management of epiphrenic diverticula. The purpose of this article is to review the literature on minimally invasive surgery for epiphrenic diverticula with particular attention to the operative approach and technique, surgical mortality and morbidity, and symptomatic outcomes.

Methods:

A review of the literature limited to studies in the English language and performed on humans was conducted on PubMed using the following key words: “esophageal diverticula” and “epiphrenic”. Articles retrieved by the PubMed search were reviewed.

Conclusions:

A minimally invasive approach to epiphrenic diverticula offers reduced operative mortality, decreased length of stay, and similar symptom relief compared with open surgery in the hands of experienced laparoscopic surgeons.     

椎体骨折不愈合微创治疗手术方式的选择

目的评估2种微创手术方式(经皮椎体成形术和经皮椎体后凸成形术）对骨质疏松性椎体骨折不愈合疗效的影响。 方法本组24例(24椎)椎体骨折不愈合患者,均为女性。分成2组:A组12例（12椎）.局麻下行经皮椎体成形术治疗。B 组12例（12椎）,局麻下行经皮椎体后凸成形术治疗。术前骨密度检查示:A、B组均存在重度骨质疏松。A、B组手术由同一 组医生完成,术后予密固达及密盖息行规范抗骨质疏松治疗。比较2组手术前后患者主观满意度,骨水泥充填量及渗漏率,椎 体前、中份高度,脊柱后凸角度等指标。结果A、B组年龄、术前胸腰段后凸角度无统计学差异（P >0.05)。B组椎体复位效 果优于A组(P < 0. 05);B组后凸改善优于A组(P <0. 05); A组骨水泥渗漏7椎(58.3%),B组骨水泥渗漏3椎(25%),A组 骨水泥渗漏率显著高于B组(P < 0. 01); A、B组患者的主观满意度无显著性差异(P > 0. 05)。结论对于骨质疏松性椎体骨 折不愈合,经皮椎体成形术及经皮椎体后凸成形术均能有效缓解患者的胸腰背部疼痛。但前者术中骨水泥渗漏率发生风险 较高,后者可获得较为满意的椎体复位效果。     

微创负压抽吸术治疗腋臭的临床效果

目的 探究微创负压抽吸术治疗腋臭的可行性。方法 选取烟台市奇山医院医疗美容科2022年 6月-2023年8月收治的60例腋臭患者为研究对象,采用随机数字表法分为参照组和研究组,各30例。参照 组予以小切口汗腺切除术治疗,研究组予以微创负压抽吸术治疗,比较两组临床疗效、手术指标、日常活 动评分及并发症发生情况。结果 研究组治疗总有效率为96.67%,高于参照组的76.67%,差异有统计学意 义（P＜0.05）;研究组手术用时、术后固定时间、切口愈合时间以及术后住院天数短于参照组,差异有统 计学意义（P ＜0.05）;研究组HDSS评分低于参照组,差异有统计学意义（P ＜0.05）;研究组术后并发症 发生率为3.33%,低于参照组的26.67%,差异有统计学意义（P＜0.05）。结论 腋臭治疗中应用微创负压抽 吸术的效果较小切口汗腺切除术更优,可促进康复,降低并发症发生几率,临床应用价值较高。     

微创小切口与传统切口在全髋关节置换术中应用的系统评价

目的 评价全髋关节置换术应用小切口是否优于传统长切口.方法 收集所有关于微创小切口与传统切口在全髋关节置换术中应用比较的随机对照试验(RCT),按Cochrane协作网标准逐个进行质量评价和Meta分析.结果 共纳入3篇RCT,包括339例患者.3个研究显示微创小切口组在术中失血量、总失血量、手术用时方面少于传统长切口,术中、术后并发症发生率无统计学意义,而对于术后镇痛药物用量、患肢功能恢复、术后影像学评价及远期手术效果由于各试验采用了不同的评价指标,不能进行合并分析.结论 微创小切口和传统长切口都可以用于全髋关节置换术,采用微创小切口在术中失血量、总失血量、手术用时方面少于传统长切口.在术中及术后并发症方面,两种切口的差异无统计学意义.因本研究的样本量较小,纳入的研究数量少,缺乏足够的证据,尚需更多设计严格的研究以增加证据的强度.     

微创侧路病灶清除融合内固定治疗腰椎结核

目的探讨微创侧方入路病灶清除椎间融合术治疗腰椎结核的疗效。方法回顾性分析2013年1月~2014年6月15例腰椎结核患者的资料,男6例,女9例,年龄25~72岁,平均48.5岁。受累节段均为单间隙2个椎体,发病部位L2/36例,L3/45例,L4/54例。采用微创通道下病灶清除、植骨骨融合内固定治疗。术后应用异烟肼、利福平、乙胺丁醇、吡嗪酰胺抗结核治疗1年。结果随访8~12个月,平均10.3月,末次随访时疼痛视觉模拟评分(2.3±1.4)分,与术前(8.2±1.1)比较有显著性差异(配对t检验,t=25.23,P=0.00)。2例一侧大腿一过性前方麻木。植骨均获融合,融合时间6~12个月,平均9.2月。结论微创侧方入路病灶清除椎间融合术是治疗活动期腰椎结核有效和安全的方法。     

微创经皮肾镜取石术治疗输尿管上段嵌顿结石(附49例报告)

目的探讨微创经皮肾镜取石术（min im ally invasive percutaneous nephrolithotomy,MPCNL）治疗输尿管上段嵌顿结石的疗效。方法膀胱镜下患侧输尿管逆行留置输尿管导管,B超或X线引导下穿刺肾中盏,建立皮肤肾脏通道,输尿管镜下采用气压弹道碎石术。结果气压弹道碎石成功率100%。术后肉眼血尿55.1%（27/49）,26例持续1-3 d后停止,1例造瘘管血尿明显并有血块,持续8 d后停止;术后发热10.2%（5/49）。1周结石清除率93.9%（46/49）,1个月后结石清除率98.0%（48/49）。49例随访1-12个月,平均5个月,未发生输尿管狭窄及其他手术并发症。结论MPCNL治疗输尿管上段嵌顿结石操作简单、并发症少,疗效满意。     

微创经皮肾穿刺取石术并发严重出血的原因分析及处理

目的探讨微创经皮肾穿刺取石术并发严重出血的原因及防治措施。方法 2006年3月～2011年4月行482例微创经皮肾镜取石术,21例并发严重出血,16例采用夹管等保守治疗有效,5例保守治疗无效后行超选择性肾动脉栓塞术。结果术中严重出血13例,9例经过相应处理后,继续碎石取石;3例中止手术,行二期碎石取石;1例保守治疗无效行介入栓塞治疗。术后发生严重出血8例,4例经保守治疗有效,3例行肾动脉造影并选择性肾血管栓塞止血一次性治愈,1例3d后再次行栓塞治疗后治愈。21例术后随访3～24个月,平均12个月,血尿素氮及肌酐均正常,血压无明显改变。结论微创经皮肾取石术并发出血应以预防为主,准确穿刺定位及提高通道扩张技巧,可减少出血;出血不止或反复出血首选介入栓塞治疗。     

高位结扎并点式微创剥脱术治疗原发性下肢静脉曲张

目的探讨高位结扎并点式微创剥脱术治疗原发性下肢静脉曲张的临床效果。方法 2006年10月～2009年6月,对原发性大、小隐静脉曲张236例,术前应用彩色多普勒超声进行CEAP分类诊断,定位标记病变曲张浅静脉及贯通静脉走行,在静脉麻醉联合局部浸润麻醉下行高位结扎剥脱术,局部做1～3mm小切口,用静脉钩取出局部曲张血管或结扎功能不全的贯通静脉。结果 236例术后切口均正常愈合,曲张静脉全部消失,186例下肢浮肿术后1个月消退,40例术后3个月内皮肤色素沉着消退,10例下肢皮肤溃疡于2个半月全部愈合。无深静脉血栓及肺动脉栓塞等严重并发症,209例随访0.5～3年,平均12个月,无复发。结论术前彩色多普勒标记定位大、小隐静脉高位结扎并点式微创剥脱术治疗效果良好,具有损伤小、恢复快、治疗彻底、术后皮肤美观等优点。     

Indirect Reduction Maneuver and Minimally Invasive Approach for Displaced Proximal Humerus Fractures in Elderly Patients

Background

This study examined the clinical outcomes of indirect reduction maneuver and minimally invasive approach for treating displaced proximal humerus fractures in patients older than 60.

Methods

Thirty-two patients (11 male and 21 female) who had undergone treatment for displaced proximal humerus fracture were evaluated. The mean age of the patients was 72.4 years (range, 60 to 92 years). All cases were followed up for at least 12 months. All patients were interviewed and evaluated on the visual analog scale, with gender-specific constant score correction for age, standardized X-rays to check the neck-shaft angle (NSA) and the presence of medial support, and bone mineral density. Statistical analysis was performed with a multiple regression analysis.

Results

The average visual analog scale score was 2.4, and the average gender-specific constant score correction for age was 80.6 points. Final functional outcomes were 8 excellent, 15 good, 7 fair, and 2 poor. The average NSA was 122.8°; and the radiological results were 20 good, 11 fair, and 1 poor. There was significant difference of the gender-specific constant score for age between the group of NSA more than 110° and the group of NSA less than 110° (p = 0.00). There were 26 cases with and 6 cases without medial support, with significant difference between the gender-specific constant score correction for age of these groups (p = 0.01). Complications occurred in 4 patients (12.5%).

Conclusions

The indirect reduction maneuver and minimally invasive approach were safe and reliable options for the treatment of displaced proximal humerus fractures in the elderly patients. An inadequate reduction (i.e., less than 110° NSA) or lack of medial support (e.g., no cortical or screw support) were significant factors contributing to poor functional outcomes.     

微创胸骨沉降术矫治鸡胸

摘要：目的探讨微创胸骨沉降术矫治鸡胸的手术适应证、手术方法、安全性和效果。方法回顾性分析2009年7月至2012年8月上海交通大学医学院新华医院40例鸡胸患者行微创胸骨沉降矫治术的临床资料,其中男39例,女1例;平均年龄14．5（12～22）岁;均为初次手术矫治。所有患者前胸明显向前突出,其中21例患者胸骨呈对称性突出,19例呈不对称性突出。术前检查包括心电图、胸部CT、超声心动图、肺功能,Hailer指数为1．91±0．23,其中16例患者存在轻度限制性通气障碍。所有患者均采用Nuss矫形钢板行微创胸骨沉降术,术后3个月限制剧烈活动,2年后取出矫形钢板。结果所有患者均顺利完成手术,术后胸廓外形明显改善,患者和家属对矫正效果均非常满意。手术时间65～115（82．0±15．6）min,平均出血量〈10ml,术后住院时间3～5（3．5±0．8）d．术后Hailer指数为2．39±0．17,较术前显著增加（P〈0．01）。术后并发症包括伤口感染2例,气胸1例（胸腔闭式引流后好转）,皮下积液3例,2例持续疼痛〉14d,围术期未发生严重并发症。40例患者术后随访3～36个月,1例患者因伤口感染提前拆除固定钢板,其余39例患者矫形钢板的位置良好,无钢板移位,无固定片滑脱。其中8例患者已经拆除内固定钢板,未出现鸡胸复发。结论胸廓顺应性较好的青少年鸡胸患者是微创胸骨沉降术的最佳适应证,采用微创胸骨沉降术矫治鸡胸操作简单、安全可靠、创伤小、外形美观,矫形效果满意。     

微创手术治疗食管癌的现状

食管切除、系统淋巴结清扫仍然是可切除食管癌的有效治疗方式,但传统食管癌手术为开放性手术,术后具有较高的并发症发生率和死亡率。为达到降低食管癌术后并发症发生率及死亡率的目的,许多医学中心将各种术式的微创手术应用于食管癌手术,微创食管切除术（minimally invasive esophagectomy,MIE）在胸外科得到广泛发展。MIE已经被证实是一种安全、可行的食管癌治疗方式,与传统手术相比,MIE可减少手术失血量,做到完整规范的肿瘤切除及淋巴结清扫,获得与传统手术相当的长期生存结果。尽管如此,MIE治疗食管癌的优越性仍未得到明显体现,目前仍存在一些争议。本文就MIE治疗食管癌的手术技术、围术期结果、肿瘤切除的完整规范性、长期生存结果及应注意的问题等5个方面进行综述。     

Minimally Invasive Cardiac Surgery in the Adult: Surgical Instruments, Equipment, and Techniques

To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.