神经导航辅助下的微创显微手术处理颅内病变

背景与目的：微创手术是神经外科手术的发展趋势和基本要求，计算机神经导航系统使手术更精确。本文探讨了神经导航在颅内病变微创显微手术中的应用价值，以最小的手术创伤来达到最好的手术疗效。方法：对27例颅内病灶患者进行3mm层厚的CT或MRI扫描，利用导航工作站进行术前计划、切口设计、术中指示病灶部位及重要颅内结构。结果：所有病灶定位准确，全切22例，次全切除2例，大部切除3例。术后神经功能保留良好。结论：神经导航辅助下的微创显微神经外科手术可以达到准确定位及切除病灶，减少功能损害的目的。     

胃癌的淋巴转移

本文收集并分析了1964～1989年间国内文献五篇、国外文献十八篇中有关胃癌淋巴转移的资料,旨在掌握胃癌淋巴转移规律,进行合理的淋巴切除,以减少手术并发症和死亡率,提高术后生存率。 胃癌淋巴转移概况 综合1,657例胃癌资料,淋巴转移率在52％～88.7％之间。收集淋巴结43,818枚。转移度14.5％～32.5％。淋巴转移率和转移度与病期早晚成正比。分站转移率为Ⅰ站41％,Ⅱ站41％,Ⅲ站18％。     

活性炭吸附抗癌剂在胃癌淋巴转移治疗中的应用

转移是恶性肿瘤主要死因之一。大多数实体癌均沿淋巴途径转移,胃癌亦是如此。在术前用活性炭吸附抗癌剂,经内窥镜注入癌肿周围胃壁组织,可以达到预防和治疗淋巴转移的目的,是胃癌术前辅助化疗方法之一。     

微创技术在脊柱肿瘤中的研究进展

脊柱微创技术是目前治疗脊柱疾病的主要手术方式,其技术范围包括小切口手术、非直视下的微创手术以及内镜下手术等,经过较长时间的发展,术者可根据患者不同疾病采用相应的微创技术进行治疗操作。肿瘤是脊柱中较为特殊的一类疾病,随着微创技术的发展,逐渐在脊柱肿瘤中得到尝试应用,并取得了不错的手术效果,但结合肿瘤疾病的特殊性,目前相关研究多为病例报道或是技术说明,缺少统一的手术使用条件及相关的中长期随访证据支持。本文就目前在脊柱肿瘤中使用较多的微创技术进行综述,详细说明各项技术的优缺点以及相应研究者给出的意见,为今后脊柱微创技术在脊柱肿瘤中的开展提供建议。     

胃癌淋巴化疗的研究现状

淋巴化疗是胃癌辅助化疗的合理途径之一,它较常规的全身化疗更明显地提高胃癌周围淋巴组织的化学药物浓度,可减少全身化疗副作用,提高化疗效果.本文总结了胃癌淋巴化疗的意义、机制、常用剂型、给药途径及其临床应用现状.     

胃癌根治术后腹腔淋巴漏的诊治（附4例临床分析）

目的：探讨胃癌根治手术后腹腔淋巴漏的发生原因及治疗方法。方法：对本院1992年4月至2002年4月胃癌根治术后发生腹腔淋巴漏4例患者的临床资料进行回顾分析。结果：胃癌根治术后腹腔淋巴漏发生率为0．9％（4／442），全部病例均经非手术治疗痊愈：手术后引流量300ml-1600ml／日，平均900ml／日。引流时间15天～37天，平均26天。结论：胃癌根治手术在进行腹膜后淋巴管网的清扫时，应重视残余管网的结扎，预防淋巴漏的发生，一旦出现淋巴漏则多可经保守疗法治愈。     

微创技术在胸外科食管癌手术中的应用效果

目的探讨微创手术在胸外科食管癌手术中的应用效果。方法以郑州大学第一附属医院2018年1月至2019年9月收治的40例食管癌患者为研究对象,20例采取开放手术者为开放手术组,20例采取微创手术者为微创手术组,比较比较2组治疗效果。结果微创手术组手术时间为(144.225±8.782)min,长于开放手术组的(149.538±6.47)min,差异有统计学意义(t=1.928,P=0.058)。微创手术组术中出血量、胸管留置时间、住院时间分别为(111.231±25.823)mL、(3.833±0.105)d、(12.462±2.354)d,均少于开放手术组的(175.542±27.211)mL、(5.321±0.247)d、(16.813±2.512)d,差异有统计学意义(t=7.667,P<0.001;t=24.794,P<0.001;t=5.652,P<0.001)。结论与开放手术比较,微创技术在食管癌手术中出血少,安全性高,有助于术后恢复,是一种较有效的胸外科食管癌治疗方法。     

胃癌微创治疗之路

外科手术是目前唯一可能治愈胃癌的手段,但传统的开腹手术通常伴随较高的并发症率和死亡率,还会对患者术后的生活质量产生较大影响。而微创外科技术由于可有效减少手术创伤,加快术后恢复,因此对于医生和患者均具有很大的吸引力,今后或将替代传统的开腹手术。目前,胃癌微创外科技术主要向着两个不同的方向发展,即内镜下肿瘤切除和腹腔镜手术。不久的将来,前哨淋巴结导航技术和机器人手术也将为胃癌治疗提供更多选择。随着各种微创技术的不断发展,胃癌患者术后的生活质量将显著改善。目前,许多有关各种微创技术的高水平临床研究正在进行当中,胃癌微创外科必将在世界范围内广为接受,并快速发展。      

低水平呼气末正压通气对胃癌微创手术患者脑血流的影响

目的 研究低水平呼气末正压通气对胃癌微创手术患者脑血流的影响.方法 选择胃癌微创手术患者100例,采用随机数字表法分为观察组和对照组各50例,其中观察组的通气参数是潮气量8 ml/kg,呼吸频率每分钟12次、呼气末正压5 cmH2O.对照组潮气量及呼吸频率同观察组.分别在气腹前和气腹1h后记录两组患者的血流动力学指标.结果 两组患者气腹前和气腹后1h的平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)含量比较,差异均无统计学意义(P＞0.05).气腹前两组患者的Vm、SjvO2、Da-jvO2、PaCO2含量相比,差异无统计学意义(P＞ 0.05);气腹1h后,观察组Vm、PaCO2低于对照组,且SjvO2、Da-jvO2高于对照组,差异有统计学意义(P＜0.05).结论 低水平呼气末正压通气,有利于胃癌微创手术患者脑血流动力学的稳定,维持患者的脑供血平衡,是一种值得在临床上推广的治疗方式.     

胃癌根治术后腹腔淋巴漏的诊治(附4例临床分析)

目的:探讨胃癌根治手术后腹腔淋巴漏的发生原因及治疗方法.方法:对本院1992年4月至2002年4月胃癌根治术后发生腹腔淋巴漏4例患者的临床资料进行回顾分析.结果:胃癌根治术后腹腔淋巴漏发生率为0.9%(4/442),全部病例均经非手术治疗痊愈.手术后引流量300ml～1600ml/日,平均900 ml/日.引流时间15天～37天,平均26天.结论:胃癌根治手术在进行腹膜后淋巴管网的清扫时,应重视残余管网的结扎,预防淋巴漏的发生,一旦出现淋巴漏则多可经保守疗法治愈.     

保留左结肠动脉对直肠癌微创手术效果的影响

目的探讨保留左结肠动脉(LCA)对直肠癌微创手术效果的影响。方法将行微创手术治疗的直肠癌患者58例,根据手术时是否保留LCA分为保留组(n=31例)和未保留组(n=27例)。收集患者病例资料,观察比较2组患者的一般情况、围手术期情况和术后复发转移情况。结果 2组患者性别、年龄、肿瘤长径、距肛缘距离、病理类型、TNM分期比较,差异无统计学意义(P>0.05)。2组患者围手术期术中出血量、术后排气时间、吻合口出血发生率比较,差异无统计学意义(P>0.05);保留组手术时间较未保留组长(P<0.05);双腔造口比例、吻合口漏发生率较未保留组低(P<0.05)。2组患者术后复发和转移率比较,差异无统计学意义(P>0.05)。结论保留左结肠动脉能够改善直肠癌微创手术患者结肠残端的血供,降低预防造口比例和吻合口漏的发生率,且对患者预后无明显影响。     

微创手术治疗妊娠合并卵巢肿瘤的疗效及安全性分析

目的 探讨微创手术治疗妊娠合并卵巢肿瘤的疗效及安全性.方法 回顾性分析16例妊娠合并卵巢肿瘤患者在行腹腔镜治疗后的效果及妊娠结局,并与74例健康孕妇的妊娠结局进行比较.结果 16例妊娠合并卵巢肿瘤患者在孕中期实施腹腔镜手术,实施手术时的孕周(11~24)周,平均孕周(16.03±4.45)周,手术所用时间(37.66±9.28)min,术中出血量(50.44±10.61)ml,所有手术患者均无手术并发症,手术较为成功.术后对卵巢肿瘤病理情况进行分类:上皮性肿瘤3例,巧克力囊肿5例,生殖细胞瘤1例,成熟畸胎瘤6例,瘤样病变1例.妊娠合并卵巢肿瘤患者中87.50%产妇于妊娠足月娩出胎儿,胎儿Apgar评分(9.09±2.61)分,胎儿状况健康,与健康产妇分娩结局比较无统计学差异(P＞0.05).结论 对妊娠合并卵巢肿瘤患者于妊娠中期给予腹腔镜微创手术治疗对产妇治疗卵巢肿瘤并顺利完成妊娠有一定的积极作用,疗效显著,新生儿娩出情况良好,有效改善母婴结局,安全有效.     

非小细胞肺癌患者微创手术短期和长期效果及相关因素研究

目的：分析非小细胞肺癌患者微创手术短期和长期效果及相关因素。方法选取60例非小细胞肺癌患者,随机分为两组,比较两组患者短期和长期疗效观察指标,并对胸腔镜组1年生存率的单因素、多因素进行分析。结果胸腔镜组手术时间为（143．2±20．1）min,切口长度为（4．3±1．2）cm,术中出血量为（119．7±23．4）ml,清扫淋巴结数为（10．2±3．7）个,术后住院时间为（7．4±3．2）d;常规组手术时间为（139．7±2．3）min,切口长度为（14．9±3．8）cm,术中出血量为（142．3±21．1）ml,清扫淋巴结数为（10．4±2．9）个,术后住院时间为（10．9±5．1）d。胸腔镜组与常规组切口长度、术中出血量及术后住院时间组间比较差异明显,具有统计学意义（ P＜0．05）。胸腔镜组Ⅰ期、Ⅱ期、Ⅲa期1年、3年生存率分别为（98．7％,86．3％）、（92．1％,58．4％）、（87．8％,36．2％）;常规组Ⅰ期、Ⅱ期、Ⅲa期1年、3年生存率分别为（98．4％,86．7％）、（92．3％,57．9％）、（88．1％,36．0％）。以上差异均无统计学意义（ P＞0．05）。单因素分析结果显示,患者年龄、性别、病理分期、纵膈淋巴结转移情况、清扫淋巴结个数、清扫淋巴结组数均为胸腔镜手术疗效的主要影响因素;多因素分析结果显示,病理分期、纵膈淋巴结转移情况、清扫淋巴结个数及清扫淋巴结组数是影响胸腔镜手术疗效的独立因素。结论胸腔镜手术能够取得良好的短期和长期效果,且手术疗效受多种因素影响。     

Minimally invasive surgery for gastric cancer — toward a confluence of two major streams: a review

The minimalization of therapeutic invasiveness in order to preserve quality of life (QOL) is a major topic in the management of early gastric cancer. After laparoscopic surgery for gastric cancer was introduced by Kitano et al. in 1991, an enthusiasm to develop laparoscopic procedures has grown steadily. In the initial phase, early gastric cancer limited to the mucosal layer with no risk of lymph node metastasis was treated by laparoscopic wedge resection or intragastric mucosal resection. Since technical and instrumental advances in endoscopic treatment were achieved by gastroenterologists, these cases can be managed by intraluminal endoscopic approaches. The attention of surgeons then shifted to more radical procedures such as laparoscopic gastrectomy with lymph node dissection, which is comparable to open surgery and can be indicated even in advanced cancer. Although this paradigm shift has already been realized in the field of colorectal surgery, we must pay attention to the particular biological nature of gastric cancer in terms of the potential of peritoneal dissemination. While early-phase recovery after surgery has been improved by laparoscopic surgery, preservation of late-phase QOL by function-preserving surgery is also essential in this regard; therefore, the sentinel node (SN) concept has been a much-discussed topic in gastric cancer surgery to approach this aspect. Recently, the validity of the SN concept has been demonstrated by a number of single institutional studies, and prospective multicenter trials are currently ongoing. Theoretically, various types of function-preserving surgery could be applied in cases of early gastric cancer with negative SNs as less invasive surgery to improve long-term QOL. Although we still have to solve several remaining issues in the treatment of gastric cancers, a confluence of these two major streams, laparoscopic surgery and sentinel node navigation surgery, would enable us to apply a novel individualized minimally invasive approach, both in terms of degree of incisional access and extent of function preservation.     

食管癌的微创术

Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as preparation for transthoracic en bloc esophagectomy is described in detail and preliminary results are briefly mentioned.     

Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

IntroductionTextbook outcome (TBO) is a composite measure of a number of peri-operative and clinical outcomes in oesophagogastric malignancy. It has previously been shown that TBOs are associated with improved overall survival in both oesophageal and gastric cancer. The influence of a minimally invasive approach (MIA) on TBO is not well defined. The purpose of this study is to validate TBO in our population, examine the influence of a MIA on achieving a TBO, and the impact of TBO on long-term survival.Methods269 patients undergoing oesophagectomy and 258 patients undergoing subtotal or total gastrectomy were included in this study. Demographic, clinical and pathological differences between patients with and without a TBO were compared using univariable and multivariable analysis. Overall survival for those with and without a TBO was examined. The influence of MIA on overall survival and TBO was determined using Cox proportional hazard models.ResultsPatients undergoing oesophagectomy and gastrectomy were significantly more likely to achieve a TBO when MIA was used (p = 0.01 and 0.001 respectively). When MIA is included as an outcome measure patients achieving a TBO show improved overall survival in both oesophageal and gastric cancer. MIA, clear resection margins and no unplanned admission to critical care are the strongest predictors of overall survival from the putative bundle of TBO parameters.ConclusionMinimally invasive surgery is associated with improved TBO. Completion of a minimally invasive approach should be considered for inclusion as a textbook parameter.     

Minimal Invasive Surgery for Esophageal Cancer

Thoracoscopic esophagectomy is only established in some centers and affords a cervical anasto-mosis because intrathoracic anastomosis as a routine is technically too difficult.Laparoscopic mobilisationof the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the constructionof a comparable gastric conduit like by open surgery.The technique of laparoscopic gastrolysis as prepa-ration for transthoracic en bloc esophagectomy is described in detail and preliminary results are brieflymentioned.