An Operating Microscope with Higher Magnification and Higher Resolution for Cerebral Aneurysm Surgery: Preliminary Experience—Technical Note

We describe a higher magnifying power operating microscope system to improve one method of high-quality microsurgical clipping for cerebral aneurysm in some cases. This higher magnification is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnifications (distinctiveness of 7 μm). This higher-resolution operating microscope system provides the surgeon with higher-magnified images (at the maximum of more than 30× magnifications as each working distance) in the operating field. The magnifications can be changed from low power (2.9×) to high power (62.0×) depending on the circumstances in a given procedure. We have used this operating microscope system on 11 patients with microsurgical clipping for cerebral aneurysms. Microsurgical treatment could be performed safely and precisely. All aneurysms were treated without any technical complications. We think that the use of this microscope would have potential benefits for microsurgical treatment for cerebral aneurysms because of better visualization.     

三叉神经鞘瘤的诊断和显微外科治疗策 略简

目的探讨三叉神经鞘瘤的诊断及治疗策略。方法回顾性分析41例三叉神经鞘瘤的病例资料。最常见症状为面部麻木或感觉减退。按肿瘤位置分为5型：颅中窝型3例,颅后窝型8例,颅中后窝哑铃型26例,颅中窝颅外型2例,颅中后窝颅外型2例。采用额颞硬膜外入路13例,颞底经天幕入路14例,乙状窦后入路11例,乙状窦前入路3例。结果肿瘤全切35例,次全切除5例,大部分切除1例。随访13例,时间3～84个月,复发2例。结论影像学检查对三叉神经鞘瘤诊断具有重要意义。个体化手术入路可获得满意的切除程度和较少并发症。     

直肠癌经肛门内镜微创手术(TEM)治疗后的疗效评价

目的 探讨经肛门内镜微创手术（TEM）对直肠癌的疗效情况及TEM适应证.方法 对2006年9月至2012年9月在本院行手术治疗的86例临床患者进行回顾性分析.结果 本组直肠癌pTis 26例、pT1期42例、pT2期18例.全部病变均达到全层切除,未残留肿瘤组织,切除面阴性.无重大手术并发症及手术死亡病例.术后随访12～72个月（平均37.6个月）.失访9例（10.47％）,肿瘤原发部位复发9例（10.47％）,其中pTis复发1例（3.85％）,pT1期复发2例（4.76％）,pT2期复发6例（33.3％）;死亡3例（3.48％）.死亡3例均出现在T2期肿瘤内.pT2期肿瘤复发比例显著高于pT1期肿瘤患者（x2=9.806,P＜0.05）.52例肿瘤直径＜3cm患者中复2例（3.85％）,34例肿瘤直径＞3cm患者中复发7例（20.59％）,显著高于肿瘤直径＜3cm患者（x2 =4.493,P＜0.05）.结论 TEM针对pTis及pT1期,直径＜3cm的早期直肠癌患者有较好的疗效,值得推广.     

Outcome of Transanal Endoscopic Microsurgery and Adjuvant Radiotherapy in Patients with T2 Rectal Cancer

Purpose The use of transanal endoscopic microsurgery for local excision of rectal cancer has recently gained wide acceptance as a valid and safe alternative for the surgical treatment of T1 tumors. The adequacy of such treatment for T2 tumors, however, is still controversial. This study was designed to evaluate our results with local excision of T2 cancers. Methods Patients with T2 cancer admitted to our hospital between 1995 and 2005 were offered surgery by transanal endoscopic microsurgery if found medically unfit or were unwilling to undergo radical surgery. Patients who were preoperatively staged as T1 tumor but were found to be pathologically T2 also were included. Results Overall, we performed 59 transanal endoscopic microsurgery operations for rectal cancers, of which 21 were for T2 cancers. In 16 (76 percent) of the T2 patients, the tumors were completely removed with clear margins by transanal endoscopic microsurgery and no additional surgery was performed, except for 2 patients who developed radiation-induced complications. Radical surgery was performed in a second operation in five patients because of involved margins and residual disease was found in two. At a median follow-up of three years, all 12 patients who received local excision and radiotherapy remained disease free, whereas a 50 percent recurrence rate was observed in patients who refused adjuvant radiotherapy. Conclusions The results of this study support the feasibility of transanal endoscopic microsurgery for the treatment of selected patients with T2 rectal cancer. The addition of radiotherapy may decrease the rates of early local recurrence. However, at present, this treatment strategy should not be routinely considered for patients who may undergo radical procedures.     

Microsurgical technique used in right anterior segmentectomy and pancreatoduodenectomy with reconstruction of the right posterior hepatic artery for widespread bile duct cancer involving the hepatic hilus

A microsurgical technique was used in performing anterior hepatic segmentectomy and pancreatoduodenectomy with reconstruction of the posterior hepatic artery in a 64-year-old man with widespread bile duct cancer from the intrapancreatic bile duct over the hepatic hilus. The anterior hepatic artery was obviously involved and the posterior hepatic artery just behind common hepatic duct was very close to the cancer. Microsurgical anastomosis between the remnant gastroduodenal artery and the posterior hepatic artery at the hepatic hilus made it possible to preserve the posterior segment of the liver and to perform a curative resection of the cancer. The patient had pyrexia because of suprahepatic abscess after the operation, but the abscess drained spontaneously. Postoperative arteriogram showed neither obstruction nor kinking of the reconstructed artery. He was discharged 2 months after surgery and has been enjoying a normal quality of life for 10 months since, with no signs of recurrence. It is suggested that a microsurgical technique is useful for performing an accurate anastomosis with good patency that allows not only a safe but also a highly curative operation for advanced bile duct cancer.     

表现为动眼神经麻痹的垂体腺瘤卒中的诊治(附15例分析)

目的探讨垂体腺瘤卒中所致颅神经麻痹的手术疗效,提高术前诊断率。方法总结从2002年4月到2012年6月,15例合并动眼神经麻痹的垂体腺瘤患者的临床资料。男10例,女5例,年龄18~68岁,平均49.6岁;病程从6 d到7年;临床症状表现为头痛,视力下降,视野缺损,动眼神经麻痹,外展神经麻痹,垂体前叶功能低下等内分泌功能紊乱等;术前均行内分泌激素测定、垂体增强磁共振;所有患者均行经蝶入路手术切除垂体肿瘤。结果术后病理结果证实15例患者均存在垂体卒中,无手术死亡病例。术后动眼神经麻痹完全恢复9例,部分恢复3例,另外3例合并外展神经麻痹术后眼肌麻痹均未恢复。66.7%的患者视力改善(6/9),83.3%的视野缺损术后改善(5/6)。所有患者均获随访,平均随访时间12.4个月(6个月至2年)。结论垂体卒中合并动眼神经麻痹需尽快手术治疗,经蝶窦入路手术减压,肿瘤切除是治疗垂体卒中所致颅神经麻痹的安全有效的治疗方法。     

单侧扩大翼点人路显微手术治疗颅内多发动脉瘤

目的探讨单侧扩大翼点入路显微手术治疗颅内多发动脉瘤的适应症、手术时机及手术入路。方法对本院经单侧扩大翼点人人路一期手术治疗的颅内多发动脉瘤患者进行回顾性研究,总结显微手术治疗方法。结果13例患者共28个动脉瘤均一期手术夹闭,其中后交通动脉瘤14个,前交通动脉瘤6个,大脑中动脉瘤5个,脉络膜前动脉瘤2个,颈内动脉分又部1个,术后CTA复查示多发动脉瘤消失,载瘤动脉通畅,无死亡病人。结论单侧扩大翼点人路显微手术可治疗部分颅内多发动脉瘤,根据多发动脉瘤的特征设计个体化治疗方案可达到良好效果。