KTP／Nd：YAG激光治疗慢性泪囊炎术后两种冲洗方法的对比观察

目的：探讨KTP激光治疗慢性泪囊炎术后的冲洗方法。方法：389例慢性泪囊炎行泪道KTP激光鼻泪管阻塞疏通术的患者随机分为A组（178例）和B组（211例）。术后A组常规用易妥芬眼液滴眼，每周生理盐水冲洗泪道；B组常规易妥芬眼液滴，加易妥芬眼液每天1次连续冲洗7d，观察两组疗效。结果：A组治愈87例（48．88％），好转14例（7．87％），无效67例（37．64％），有效率56．74％。B组治愈134例（63．51％），好转37例（17．54％），无效40例（18．96％），有效率81．04％。两组疗效比较P〈0．05，差异有显著性意义。结论：KIP激光泪道疏通是治疗慢性泪囊炎的有效方法，联合术后应用易妥芬眼液冲洗泪道，可进一步提高手术疗效。     

微型钛血管吻合夹吻合血管的生物力学研究

目的从生物力学角度评价应用微型钛血管吻合夹吻合小血管的安全可靠性。方法对80只新西兰大白兔的双侧颈动脉一侧应用微型钛血管吻合夹行端-端吻合,另一侧行间断端-端缝合吻合作对照,测定术后第1h、7、14及30d离体血管吻合口的平均最大抗张强度和平均最大破裂压。结果术后7d内吻合夹法的吻合口最大抗张强度高于针线吻合法(P<0.05),14d后无统计学差异(P>0.05);术后30d内两种吻合法吻合口的最大破裂压无统计学差异(P>0.05)。结论从生物力学角度表明应用微型血管吻合夹吻合小血管是安全可靠的。     

Laparoscopic laser perforation of the urinary bladder

Risk factors for urologic complications of gynaecologic surgery include pelvic adhesions, poor haemostasis, cancer and large pelvic masses. Newer minimally invasive technologies of laparoscopy and laser surgery are not without complications. We report a case of potassium titanyl phosphate laser perforation of the urinary bladder during laparoscopy. To our knowledge this is the first case report of such an occurrence. The mechanism of injury, diagnosis and management of laparoscopic bladder perforation is discussed.     

经纤维支气管镜KTP激光在支气管结核治疗中的应用价值探讨

目的探讨钛氧磷酸钾(potassiumtitanylphosphate,KTP)激光在支气管结核治疗中的应用价值。方法36例支气管结核病例使用KTP激光汽化或炭化、凝固支气管内干酪样坏死物和部分肉芽组织,疏通支气管,同时行全身正规抗结核治疗,局部点洒异烟肼100mg+丁胺卡那霉素200mg+地塞米松2mg。KTP激光治疗2￣5周,每周1次,每次治疗时间1、2s×10￣20s,间歇2、3s,治疗电流10A+,导光纤维0.4mm或0.6mm,脉搏血氧计监视患者术前、术中、术后的心率和血氧饱和度的变化。选取同时期病况基本相同的36例病例作为对照组,除不接受KTP激光治疗外,其他治疗方法相同,包括每周1次病变管腔内的冲洗、抽吸、钳夹、注药。8周和6个月后纤支镜复查病变支气管的管腔、管壁的变化,同时复查胸片了解肺不张的完全恢复与否。结果8周后纤支镜复查,管腔恢复率为86.1%(31/36),肺不张恢复率为81.0%(17/21),阻塞性感染恢复率为81.8%(9/11),并发症发生率为8.3%(3/36),与对照组比较差异均有显著性。而术前、术中及术后的血氧饱和度和心率则无明显变化。6个月后支气管狭窄和肺不张发生率以及其他后遗症均明显低于对照组。结论KTP激光治疗支气管结核疗效较好,对正常组织损伤小,创面恢复快,并发症少,可作为治疗支气管结核的有效手段之一,值得推广。     

Effect of propolis on healing in experimental colon anastomosis in rats

Introduction Propolis is the generic name for the resinous substance collected by honeybees, which is known to have antioxidant, anti-inflammatory, apoptosis-inducible effects. Anastomotic dehiscence after colorectal surgery is an important cause of morbidity and mortality. We aimed to assess the effect of propolis on healing in an experimental colon anastomosis in rats. Methods Forty adult male Wistar albino rats were randomly assigned into 5 treatment groups with 8 rats in each: Group I, anastomosis+no treatment; Group II, anastomosis+oral propolis (600 mg/kg/d); Group III, anastomosis+oral ethyl alcohol (1 cc/d); Group IV, anastomosis+rectal propolis (600 mg/kg/d); Group V, anastomosis+rectal ethyl alcohol (1 cc/d). The bursting pressures, hydroxiproline levels and histopathological changes in each group were measured. Results When bursting pressures were compared between groups, we observed that they were increased in the groups treated with propolis in contrast to all other groups. Hydroxiproline levels in the propolis groups were also significantly increased in contrast to the other groups. There was also a statistically significant difference in histopathological changes between the treatment types. When propolis administration methods were compared, we did not observe a statistically significant difference. Conclusion Propolis has a significantly favourable effect on healing in experimental colon anastomosis, independent from the method of administration.     

Laparoscopic intracorporeal bowel anastomosis by a new suturing device: A study in a laparoscopic simulator with integrated animal organs

Summary

Laparoscopic bowel anastomosis is performed with increasing frequency either extracorporeally through a small incision or intracorporeally using special endoscopic staplers. Laparoscopic intracorporeal suturing is rarely used to perform anastomosis because it is difficult and time-consuming. The aim of this study is to assess a new suturing device for performing laparoscopic intracorporeal anastomosis. In a phantom experiment, three types of end-to-end monolayer anastomoses (open [O], laparoscopic suturing device [LD] and laparoscopic hand-suture [LH]) were performed in each of 10 segments of fresh cow small intestines. The mean anastomotic time for the (O) group was shorter than that for the (LD) and (LH) groups; the time needed was 13.8, 29 and 27.3 min, respectively. The initial bursting pressure for each of the (O), (LD) and (LH) groups was 55, 35.2 and 33.3 mmHg, respectively. There was no significant difference in anastomotic circumference between the three groups. The new laparoscopic suturing device can be used to perform bowel anastomosis. It needed a longer time and had a lower bursting pressure than open anastomosis, but it proved equal to laparoscopic hand-suture anastomosis. Considering that the suturing device is still in its development phase, better results can be expected in the future.     

Cutting characteristics of the Nd: YAG contact technique using a laser with tissue effect control,conical fibres and a normal bare fibre: First results of a physical,morphometrical and clinical study

Summary

In the present study, a Nd : YAG laser with tissue effect control (MediLas 4060-N-Fibertom, Dornier-Medizintechnik, Munich) and two newly developed conical bare fibres (Sharplase Conical Fibers, Sharplan Lasers, Freising) were used and the cutting effect compared to that of a conventional bare fibre. Methodology: The two conical fibres had a body diameter of 600 and 800 μm, a 400 μm bare fibre served as a reference. In the first step, radiation geometry was physically measured. Subsequently, in an in vivo experiment, linear uterotomies were performed on Wistar rats with the three types of fibres and the tissue effect control system at an initial power output of 10, 15 and 20 W. Serial cuts were HE-stained and the zones of tissue damage evaluated with the Cue-2 Image Analysis System. In the third step, operative hysteroscopies and laparoscopies were performed. Results: Physical measurements showed a characteristic radiation profile for each fibre. The tissue effect control system prevents melting of the distal end of the fibre in case of non-contact handling, but does not significantly improve tissue effect (P lt; 0.001). Both conical bare fibres resulted in considerably increased cutting depth while the zones of tissue lesion were significantly reduced as compared to the 400 μm control fibre (P lt; 0.001). Clinical application confirmed the cutting properties established in the experimental phase.     

New concepts for a compression anastomosis: Superelastic clips and rings

Gastrointestinal anastomosis is a crucial step in many operative procedures, and responsible for a major portion of early and late post‐operative complications. In order to improve on the results of current tools to perform an anastomosis, such as sutures and staplers, new concepts are being developed. One of these concepts is compression anastomosis. Compression anastomosis has been tried in the past but did not become popular mostly because of technical reasons. Recently, trials to accomplish compression anastomosis using Nitinol devices were conducted.

Two devices were made and tested in the past three years: A side‐to‐side device and an end‐to‐end device. The common principle in both devices is the compression of two bowel loops through the constant pressure of a Nitinol device, thus producing a dual process of necrosis and healing until the lumens of both bowels fuse, and the device falls into the lumen and is excreted. Both devices have been tested in animals and humans, with encouraging results. In animals, the anastomoses were shown to demonstrate minimal inflammation and no foreign body reaction, with perfect healing of the mucosa. The side‐to‐side device was tested in over 500 human patients, and the end‐to‐end device is currently used in a large, multi‐centric human trial.     

低功率半导体激光照射对大鼠损伤神经功能恢复的实验研究

目的：研究不同输出功率的半导体激光对大鼠神经功能恢复的影响。方法：采用半导体激光照射ＳＤ 大鼠损伤的坐骨神经,观察５ｍ Ｗ、１０ｍ Ｗ、１５ｍ Ｗ 不同剂量的半导体激光照射对神经功能恢复的影响及病理变化。结果：半导体激光照射促进损伤神经轴突及髓鞘的再生过程,１５ｍ Ｗ 的半导体激光照射对神经功能的恢复作用较明显。结论：１５ｍ Ｗ 的半导体激光可用于大鼠神经损伤的治疗     

应用激光扫描共聚焦显微镜观察骨组织微损伤的实验研究

目的建立一种可以用于激光扫描共聚焦显微镜观察的骨微破裂荧光染色方法.方法取8月龄猪髂骨1块,锯成0.90 cm×0.81 cm×1.89 cm的规则矩形,沿长轴方向进行压缩疲劳损伤(负载大小40N,负载频率2.33 Hz,负载次数30万次,湿度60%,工作温度28℃),锯成0.2 cm厚骨片,0.5 mmol/L茜素红、吖啶橙、钙黄绿素、二甲酚橙、碱性品红和10 g/L碱性品红染色.另取人股骨头1个锯出1.5 cm×1.0 cm×0.25 cm大小骨片3块,分别应用0.5 mmol/L钙黄绿素、茜素红和10 g/L碱性品红溶液进行染色.所有骨片常规塑料包埋,磨片至40～100μm,在激光扫描共聚焦显微镜下观察.结果在疲劳损伤后的猪髂骨和未经疲劳损伤的人股骨头骨小梁上均可以观察到微破裂.所有荧光染料中,以钙黄绿素染色后观察效果为佳,在波长为522 nm的激光扫描下发出绿色荧光.茜素红在波长为605 nm的激光扫描下发出红色荧光.结论应用钙黄绿素和茜素红染色可以对骨微破裂进行荧光染色,在激光扫描共聚焦显微镜下能够观察到清晰的骨微破裂图像.     

532 nm laser treatment of molluscum contagiosum

Objective

This retrospective study was undertaken to examine the efficiency of a 532 nm laser device in the treatment of molluscum contagiosum.

Material and methods

The medical records were analyzed of 32 patients with molluscum contagiosum who had been treated in our clinic with a 532 nm laser (IDAS; Quantel Derma GmbH) in the time period 09/2005 to 04/2011.

Results

Of all the patients treated, a total of 84% required only one treatment, 13% required two and only one patient (3%) needed three laser sessions. The treatment was well-tolerated and only a few of the patients developed side effects, such as hypopigmentation and atrophic skin texture changes.

Conclusion

The efficiency of the 532 nm laser is comparable with the dye laser, but the 532 nm laser is lower in price and more commonly available than the dye laser. We recommend further prospective studies about the 532 nm laser in the treatment of molluscum contagiosum.     

Laparoscopic gastro-jejunal anastomosis using novel r2 deflectable instruments in an ex vivo model

Objective A novel 5?mm steerable instrument system (r2-DRIVE) was developed with active tip deflection and tip and shaft rotation. The feasibility and training effect of the r2 instruments were determined in a phantom model. Material and methods Experienced laparoscopic surgeons and untrained novices performed laparoscopic gastro-jejunal anastomoses using porcine tissue and r2 DRIVE-instruments. Mean anastomosis time, anastomosis width and burst pressure were measured. Number of stitches, skipped stitches and dropped needles were counted. Results of trained and untrained subjects were compared. Results Mean time for suturing decreased rapidly for all participants, but was more evident for untrained persons. After five anastomoses no relevant improvement in anastomotic time was seen for the skilled group. The ease of use, efficacy of manipulation and swift training effect with the novel r2 instruments for both experienced laparoscopic surgeons and untrained non-surgeons could be demonstrated and after few cases stable anastomosis times and a fast learning curve were obtained. Conclusions This study demonstrates the ease of use, efficacy of manipulation and swift training effect with the novel r2 instruments for both experienced laparoscopic surgeons and untrained non-surgeons. After few cases stable anastomosis times and a fast learning curve were obtained.     

用于椎体造影的纤维蛋白胶基造影剂的相关研究

目的：制备适用于椎体造影的纤维蛋白胶基造影剂,并对其性状进行初步研究。方法：将纤维蛋白原按体积比1∶1溶解于纤维蛋白溶解酶抑制剂,凝血酶按体积比1∶1溶解于氯化钙溶液后与不同比例的造影剂结合,分别测定不同实验组的造影剂的显影性和粘度值,以期获得最佳配比。结果：试验Ⅷ组的配比在保证较高的粘滞度的前提下保持了良好的显影性,更加有助于对骨水泥渗漏的判断。结论：纤维蛋白胶与水溶性碘造影剂以最佳配比组合所获得的纤维蛋白胶基造影剂在保持其显影性的同时,极大的提高了粘滞度,为椎体造影提供了更加有利的手段。     

Isoperistaltic vs antiperistaltic anastomosis after right hemicolectomy: A comprehensive review

To optimize the efficiency of ileocolic anastomosis following right hemicolectomy, several variations of the surgical technique have been tested. These include performing the anastomosis intra- or extracorporeally or performing a stapled or hand-sewn anastomosis. Among the least studied is the configuration of the two stumps (i.e., isoperistaltic or antiperistaltic) in the case of a side-to-side anastomosis. The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature. High-quality literature is scarce, with only three studies directly comparing the two alternatives, and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage, stenosis, or bleeding. However, there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis. Finally, existing data do not identify a certain anastomotic configuration (i.e., isoperistaltic or antiperistaltic) as superior over the other. Thus, the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.     

Alternative wavelengths for sutureless laser microvascular anastomosis: a preliminary study on acute samples

Attempts to improve the speed and patency of microvascular anastomosis with laser-assisted techniques have provided a modest reduction in operative time and comparable success rates. Using sutureless microvascular anastomoses, 30 end-to-end anastomoses were created in the rat carotid artery using the gallium-aluminum-arsenide diode laser (808 nm). Indocyanine green and fibrinogen were applied to enhance tissue absorption of the laser energy and strengthen the bond created. These were compared with previously reported welds using the THC:YAG laser (2150 nm). Mean welding times were 140 and 288 s, and mean bursting pressures immediately after welding were 515 and 400 mmHg for the diode and THC:YAG laser groups, respectively. Histologically, both lateral and vertical spread of thermal damage was limited. Since both lasers create welds of adequate initial strength without stay sutures and are faster and easier to use than existing systems, evaluation of long-term patency would be worthwhile.