面部年轻化的综合微创技术

目的探求微创有效的上、中面部年轻化方法。方法2006年7月～2009年9月,对38例采用内镜下额部和颞部发际内小切口行上、中面部除皱结合面部吸脂等综合治疗,对其中25例进行3个月～2年的随访,通过观察面部皱纹的消失/减少程度、面部下垂的改善程度及患者的满意度等来综合评价该术式的效果。结果内镜辅助下经额部小切口和颞部发际内切口行上、中面部除皱结合面部吸脂等综合手段可以有效地去除或减轻面部皱纹,改善面部下垂,对额纹(2.3±07vs0.8±0.4)、眉间纹(2.3±0.6vs0.9±0.5)、鱼尾纹(2.0±0.7vs0.6±0.5)、鼻唇沟纹(2.3±0.6vs1.1±0.6)改善明显(t值分别为9.4,11.4,8.3,6.4,P=0.00),患者满意度高。结论内镜辅助下经额部小切口和颞部发际内切口行上、中面部除皱结合面部吸脂等综合手段,能微创、有效减少或去掉面部皱纹,改善面部下垂,对面部皮肤弹性较好的中年人是理想的选择。     

Minimally Invasive Techniques for the Management of Adult UPJ Obstruction

Ureteropelvic junction obstruction (UPJO) is a common congenital abnormality that often presents in adulthood. Open dismembered pyeloplasty was considered the gold standard for the management of this condition; however, recent advancements in laparoscopic and robotic surgery have dramatically shifted the landscape to more minimally invasive techniques. A literature search of ureteropelvic junction obstruction, pyeloplasty, endopyelotomy, laparoscopic pyeloplasty, robotic pyeloplasty, and microlaparoscopic pyeloplasty was performed. A focus was placed on literature published since 2013. Minimally invasive laparoscopic and robotic techniques have become the gold standard for the management of UPJO. With the rise of robotic pyeloplasty, open repairs are becoming less frequent, while endoscopic treatments have remained stable. Minimally invasive (robotic) techniques have become the gold standard for the management of UPJO. Newer, even less-invasive techniques are also showing promise, but technical challenges still exist.     

新辅助介入化疗联合微创手术治疗浸润性膀胱癌

目的 探讨新辅助介入化疗联合腔内手术治疗浸润性膀胱癌的临床效果.方法 对31例确诊为肌层浸润性膀胱癌（T2~4/G1~3）的患者行新辅助性介入化疗,先经股动脉入髂内动脉,尽可能到达供应肿瘤血管,给予丝裂霉素10 mg,吉西他宾1.0/m2,顺铂90 mg,明胶海绵暂时性封堵后拔管,1周后行经尿道膀胱肿瘤汽化电切术,术后即刻用丝裂霉素200 mg或吡柔比星40 mg膀胱灌注.结果 21例治疗1次,7例治疗2次（间隔1个月）,3例治疗3次（间隔1~2个月）.31例随访4个月~4年,平均36个月,2例术后6、10个月复发,再次重复治疗,1例因盆腔转移治疗2次后拒绝治疗,半年后死于肺转移,其余未见肿瘤复发.结论 对于局限浸润性膀胱癌的患者,采用新辅助性经髂内动脉插管介入化疗联合腔内手术治疗疗效满意.     

微创外科技术在结直肠癌伴梗阻治疗中的临床应用

目的探讨记忆金属支架置入技术、腹腔镜手术及植入用缓释氟尿嘧啶局部化疗3种微创外科方法在治疗结直肠癌伴梗阻中的临床应用价值。方法对解放军第251医院、河北北方学院附属第一医院和第三医院2000年5月至2010年5月期间收治的68例结直肠癌伴梗阻患者分别采用下列2种方法治疗:①对可手术根治的结直肠癌伴梗阻患者,先在结肠镜引导下置入记忆金属肠管支架解除梗阻,施行暂时性过渡治疗,再经充分肠道准备后,腹腔镜下施行根治性切除手术;②对失去手术根治机会的晚期(TNMⅣ期)直肠癌患者,主要采用支架置入技术,施行永久性姑息治疗,并经支架网眼穿刺植入缓释氟尿嘧啶局部化疗。结果①采用支架置入技术施行过渡治疗,解除梗阻后采用腹腔镜手术52例,其中51例施行根治性切除,1例因侵袭、转移的乙状结肠癌未能切除。获随访41例,随访时间3~36个月,平均15个月。其中施行根治性切除40例,均无局部复发、切口肿瘤种植及吻合口狭窄,另1例未能切除者于术后93 d死亡。②对15例失去手术根治机会的晚期直肠癌和1例因患严重肺心病不能耐受手术的直肠癌,采用支架置入和植入用缓释氟尿嘧啶治疗,全部获随访,时间为3~24个月,平均14个月;现已死亡11例,其生存时间为(350±222)d(101~720 d);其余5例已存活3~13个月(平均9个月),未再发生肠梗阻。结论利用记忆金属支架与腹腔镜手术联合治疗可手术根治的结直肠癌伴梗阻患者,具有微创、安全等优点;利用记忆金属支架与植入用缓释氟尿嘧啶联合治疗失去手术根治机会的晚期直肠癌伴梗阻,可使患者避免结肠造口,延长其生存期。     

Minimally Invasive Vertebral Augmentation Techniques in Osteoporotic Fractures

Abstract Minimally invasive vertebral augmentation techniques fill the gap between conservative treatment and open surgical fusion in the treatment of osteoporotic vertebral fractures. Both vertebroplasty (VP) and kyphoplasty (KP) have proven to be effective in the reinforcement of a fractured vertebral body and provide pain relief, but both procedures have technical differences. Furthermore, patient selection criteria are still under debate, as no randomized comparison trials of VP and KP exist. A competitive environment has arisen between both methods. In the authors’ opinion, VP and KP do not replace, but complement each other and offer both potential benefits. It is the purpose of this article to outline the different kinds of application of both methods.     

Impact of Minimally Invasive Techniques in Colorectal Surgery

Minimally invasive techniques have had a marked impact on colorectal surgery despite the limited adoption of such techniques. Patients stay in the hospital a shorter time, experience less pain, and have less chance of developing a wound infection, an incisional hernia, a bowel obstruction, or difficulty becoming pregnant. Training courses have undergone metamorphosis from ad hoc animate courses to highly defined educational opportunities, and fellowships have had to respond to the educational demands of trainees demanding to be exposed to minimally invasive techniques.     

微创外科技术在脾脏相关疾病中的应用

19世纪初期，开腹脾切除术（open splenectomy，OS）治疗血液系统疾病开始应用于临床，取得一定疗效，但由于其创伤较大、术后并发症较多，仅用于一些严重的、顽固性疾病患者。自从20世纪80年代末腹腔镜手术在临床推广应用以来，各种腹腔镜手术的数量迅速增多，腹腔镜脾切除术（laparoscopic splenectomy，LS）也很快开展起来。1991年Delaitre等完成了首例LS，此后该项技术逐渐成熟并得到国内、外学者的广泛认同。随后国内许红兵、     

髂腹股沟微创切口内固定技术在骨盆骨折中的应用

目的研究采用髂腹股沟微创切口内固定技术治疗髋臼前柱或耻骨支骨折的疗效及特点。方法自2007年7月至2011年9月,对31例骨盆骨折患者（其中耻骨支骨折23例,髋臼前柱骨折8例）采用髂腹股沟微创切口内固定技术治疗。患者采用全麻或腰硬联合麻醉,取传统髂腹股沟入路的内外侧两端切口,分别自内外两个切口紧贴骨面向中间潜行剥离,相互贯通,形成耻骨支、髋臼前柱相通的隧道,并用骨膜剥离器撬拨扩大通道。根据通道内骨面预弯重建钛板,自外侧切口紧贴骨面插入预弯钛板,分别于钛板远近端钻孔拧入3枚左右螺钉固定钢板。结果本组患者获得5～29个月随访,平均14.1个月。骨折全部临床愈合。按照Matta复位标准,术后解剖复位14例,复位良好16例,复位较差1例,优良率96.7%。按照Majeed评分,优19例,良11例,可1例,优良率96.7%。无感染、股神经或股血管损伤、静脉血栓、异位骨化及骨关节炎和股骨头缺血坏死等并发症发生。结论应用髂腹股沟微创切口内固定技术治疗骨盆骨折,手术创伤小、手术时间短、手术安全性高、术后并发症少、功能恢复好。     

微创脊柱外科新器械与新技术

微创脊柱外科(minimally or less invasive spine surgery．MISS or LISS)这一概念目前已为大多数骨科医师所熟悉，但又很难给出准确定义。我们认为，MISS是通过运用一些新的特殊设备如内窥镜、计算机导航系统、高分辨X光机、特殊穿刺针、自动拉钩和内固定器材等，以获得比传统手术切口小、组织损伤少而精确率高、效果肯定、术后恢复快为目的新技术和新科学。     

肝脏切除术中的微创策略及技术

手术本身所附带的创伤与外科手术相伴而生、形影不离,理想的外科手术应该是在达到有效治疗病变损伤这一目的的同时尽量减少手术本身造成的损伤所带来的危害,因而手术微创化一直是外科医生的不懈追求和永久的目标。     

Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery

Background Recently there has been a strong impetus to develop minimally invasive techniques in endocrine neck surgery. This study was designed to investigate the potential benefits of two minimally invasive thyroidectomy procedures, namely video-assisted and open minimal-incision thyroidectomy (VAT and MIT, respectively) when compared with conventional thyroidectomy. Methods Between May 2000 and June 2006, a prospective, nonrandomized study was performed on 957 consecutive patients undergoing thyroid surgery. Fifty-six (5.8%) patients underwent VAT, 214 (22.4%) underwent MIT, and 687 (71.8%) underwent a conventional procedure. Results Patients were selected for VAT when total thyroid volume was ≤30 ml and for MIT when total thyroid volume was >30 but ≤80 ml as determined by ultrasonography. The length of the central neck skin incision was 1.5–2 cm for VAT, 2.5–3.5 cm for MIT, and 6–10 cm for the conventional operation. The incidence of definitive hypoparathyroidism or recurrent laryngeal palsy after VAT or MIT was comparable with that occurring after conventional treatment. Patients having VAT or MIT experienced significantly less postoperative pain than patients undergoing conventional treatment. Less pain was also registered in the VAT patient cohort when compared with the MIT cohort. Patients having VAT or MIT were more satisfied with the cosmetic result than patients who underwent conventional treatment, but no significant differences in patient satisfaction were found between the VAT and MIT groups. Conclusions When compared with conventional treatment, VAT and MIT provided significant benefit in terms of cosmetic results and postoperative pain. Nevertheless, the main limiting factor for minimally invasive thyroid surgery still remains the size of the thyroid. This study was supported by grants from the Italian Ministry of University, Scientific and Technological Research.     

Minimally Invasive Right Heart Operations: Techniques for Bicaval Occlusion and Cardioplegia

Peripheral cardiopulmonary bypass with cardioplegia has facilitated minimally invasive coronary artery bypass grafting and mitral valve replacement. The cardiopulmonary bypass system was modified to allow bicaval occlusion for right heart operations. In 4 canine studies, three variants of bicaval cannulation techniques were successfully used for atrial septal defect repair via a right minithoracotomy.