Surgical application of low-power laser: experimental study, development of equipments and clinical application

We carried out experimental and clinical studies with low-power laser to perform the surgical application. The developed device for microvascular anastomosis with semiconductor laser diode made of In-Ga-As-P was used to perform 15 end-to-end laser assisted microvascular anastomoses of carotid arteries in rabbits. In four of 7 cases which were irradiated with power output 50mW showed patency immediately after surgery with no wound disruption. A new medical device with Ga-A1-As semiconductor laser diode was developed for pain relief. A double-blind evaluation of the test was initiated in 124 patients suffering from chronic inflammatory pain. Result is that of 63 patients irradiated laser, 45(71%) were effective and of 61 cases not irradiated laser, 8(13%) were relieved pain. The data were analyzed statistically by chi square, and criterion for statistical significance was the 0.01 level. The spectral properties of laser-excited fluorescence of three photosensitizers, namely tetracycline, hematoporphyrin free base and chlorin e6Na, taken up in human arterial intima were detected. Photosensitizers were administrated to resected human arteries for 2 hours in vitro. The main results are following: 1) Photosensitizers are confirmed to be taken up in arterial intima and the fluorescence intensity decreases as the time goes on. 2) The fluorescence intensity from atheromatous plaque is usually stronger than that from normal region.     

Clinical application of collagen sheet, YCWM, as a burn wound dressing

In the Linkou Burn Unit, a recently developed new wound dressing derived from porcine skin was evaluated. This newly designed porcine dressing, called young collagenous wettable membrane (YCWM) was developed by the staff of the Department of Cellular and Molecular Biology of Chang Gung Memorial Hospital. Many specific characteristics, such as negligible antigenicity, semitransparency, sterilizability, good pain relief and low costs, have been associated with it. The results of a clinical trial on 59 wounds on 50 burn patients proved encouraging. Some disadvantages such as maceration and delayed eschar separation were noted. We conclude that YCWM is suitable for the treatment of the clean, dry donor sites and superficial partial skin loss burn wounds of non-infected, non-immunocompromised patients.     

The brachioradialis muscle flap: anatomy,flap variation,modes of application

Summary Due to its superficial course and axial vascular supply, the brachioradialis muscle is particularly suitable for soft tissue defect grafting in the elbow region. The vascular and nervous supply are illustrated by an anatomical study. A review of the literature and two case reports emphasize the merits of this surgical modality.     

Jefferson骨折复位钢板的设计、改良及初步临床应用

 目的介绍Jefferson骨折复位钢板系统（Jefferson-fracture reduction plate, JeRP）及其相关参数,评估其改良前后的临床疗效。方法对Jefferson骨折患者应用螺旋CT三维重建排除寰椎横韧带断裂后,采用原型JeRP系统进行手术治疗,分析其初步临床应用的疗效及出现的问题。根据应用中的不足,通过寰椎三维重建模型,进行应用解剖学研究并测量相关解剖数据,重新确定寰椎侧块上、下位螺钉的最佳进钉点和长度,根据该数据设计、改良JeRP钢板并予以临床应用。术后采用颈椎过伸、过屈位X线片评估是否存在寰枢椎不稳,应用CT扫描观察骨折愈合情况。结果8例Jefferson骨折患者行经口咽寰椎骨折复位、原型JeRP钢板内固定术,术后平均随访6.3个月,所有患者术后枕颈部疼痛逐渐改善,咽后壁切口愈合良好,未见感染,骨折均达到解剖复位及骨性愈合,术后随访未见寰枢椎失稳,但其中3例患者因寰椎侧块上位螺钉穿破寰枕关节而导致颈椎活动受限。针对此问题,并通过应用解剖学测量,模拟置钉显示寰椎侧块外1/3平分线与寰椎上、下关节面交点所形成线段的中点作为寰椎侧块上位螺钉的进钉点,可保证JeRP钢板侧块上位螺钉不穿透上关节面,同时可保证足够空间置入下位螺钉,具备临床可行性。根据此结果设计出改良JeRP钢板,应用于4例Jefferson骨折患者,术后影像学检查证实所有螺钉均位于寰椎的侧块中。结论原型JeRP初步应用显示较好的疗效,但仍存在寰椎侧块上位螺钉穿透寰枕关节的可能;改良后钢板的设计更加符合寰椎的解剖结构,基本可以保证螺钉位于侧块中。     

History, evolution and application of robotic surgery in urology

Robotic is an antique concep. The first robots used in surgery were precise path systems in the 80's. Stereotactic neurosurgery was the first field applying this devices. Based on these more complex devices were built: AESOP and Endoassist help the surgeon during the surgery. The surgical assistant will not fatigue and there will be no tremor of the camera. Finally the master-slave devices were developed. They are the most commenly used all around the world. They are involved many types surgery in. To evaluate the cost-effectiviness of robotics in surgery is our responsability. Robotics provides many advantages but also has a few disadvantages including expense.     

小切口低负压共振吸脂技术的临床应用

目的：探讨小切口低负压共振吸脂技术临床应用的效果及优势。方法：利用该技术进行腹、腰、臀等部位局部肥胖的吸脂塑形47例,观察手术是否安全、微创、高效。结果：经3～12个月的随访,均达到了理想的减肥塑形目的,无严重并发症发生,就医者满意。结论：小切口低负压共振吸脂技术是一种安全、微创、高效的脂肪抽吸新技术,值得临床推广应用。     

Construction, application and biosafety of silver nanocrystalline chitosan wound dressing

A novel wound dressing composed of nano-silver and chitosan was fabricated using a nanometer and self-assembly technology. Sterility and pyrogen testing assessed biosafety, and efficacy was evaluated using Sprague-Dawley rats with deep partial-thickness wounds. Silver sulfadiazine and chitosan film dressings were used as controls. At intervals wound areas were measured, wound tissues biopsied and blood samples taken. Compared with the controls, the silver nanocrystalline chitosan dressing significantly (p<0.01) increased the rate of wound healing and was associated with silver levels in blood and tissues lower than levels associated with the silver sulfadiazine dressing (p<0.01). Sterility and pyrogen tests of the silver nanocrystalline chitosan dressing were negative. Thus this dressing should have wide application in clinical settings.     

腹腔镜在腹部外科、妇科和泌尿外科的应用

目的 :总结腹腔镜手术在腹部外科、妇科、泌尿外科临床应用的经验。方法 :回顾分析 2 2 0 1例腹腔镜手术的临床资料。结果 :胆囊切除 2 0 94例 ,同时切除阑尾 4例 ,手术成功 2 0 75例 ,中转开腹手术 19例 ,并发症 14例 (0 6 6 % )。妇科 6 5例中 6 4例手术顺利 ,1例开腹手术。泌尿外科 4 2例手术全部成功。结论 :腹腔镜手术的临床应用有广阔的前景     

脑和脊髓微透析技术的理论、方法和应用

全麻和疼痛机制的研究是麻醉学的热点。了解全麻下中枢神经系统活动机制，必须对神经细胞间隙中的化学物质进行动态监测。脑和脊髓微透析技术是研究活体神经递质释放的重要先进技术，它能将活体神经递质的变化与行为学有机联系起来，在全麻和疼痛机制的研究中具有重要价值。文中综述了脑和脊髓微透析技术的主要理论，实施方法以及在麻醉学领域的应用。