微切口超声乳化术对糖尿病合并白内障患者眼表的影响

目的：探讨白内障超声乳化手术中2.2及3.0mm透明角膜切口对2型糖尿病患者术后泪膜功能及眼表的影响。
　　方法：收集2015-01/10在我院接受超声乳化术的2型糖尿病患者150例150眼。按照随机数字表,将其分为两组,A组微切口组(75例75眼)行2.2mm透明角膜微切口白内障超声乳化术, B 组小切口组(75例75眼)行常规3.0 mm透明角膜切口白内障超声乳化术,两组资料的人口统计学特征差异无统计学意义。观察并比较两组患者术前及术后1wk,1、3、6mo的眼表疾病指数( ocular surface disease index,OSDI)、角膜知觉、泪膜破裂时间( break-up time,BUT)和基础泪液分泌试验( Schirmer’s Ⅰtest,SⅠt)指标的变化。
　　结果：术后1wk,1、3mo,两组患者的 OSDI 评分均高于术前,且B组的OSDI评分明显高于A组,差异有统计学意义(均P<0.05);两组患者的角膜知觉均较术前降低,且B组的角膜知觉明显低于A组,差异具有统计学意义(均P<0.05);两组患者的SⅠt均低于术前,且B组的SⅠt明显低于A组,差异具有统计学意义(均 P<0.05)。术后1wk,1mo,两组患者的BUT均低于术前,且B组的BUT明显低于A组,差异具有统计学意义(均 P<0.05)。术后6mo,A组患者的OSDI、角膜知觉、BUT和SⅠt与术前相比差异不明显,无统计学意义(均P>0.05);B组患者的OSDI评分和角膜知觉与术前相比差异明显,具有统计学意义(均P<0.05);BUT和SⅠt与术前相比差异不明显,无统计学意义(均P>0.05)。
　　结论：2.2mm透明角膜微切口对眼表及泪膜的影响较小,对并发白内障的2型糖尿病患者尤为适用。     

腕管镜及改良小切口松解法治疗糖尿病腕管综合征的疗效分析

目的 探讨腕管镜腕管松解术和改良小切口腕管松解术治疗糖尿病腕管综合征的临床疗效和安全性差异.方法 回顾性分析腕管综合征合并糖尿病患者86例,其中43例患者行双孔道腕管镜腕管松解术(A组),43例患者行改良小切口腕管松解术(B组),随访10 ～ 24个月,统计两组患者的手术时间、住院时间、恢复工作时间、术后并发症和临床疗效.结果 A组和B组患者的优良率分别为93.02％和90.70％,两组的优良率比较差异无统计学意义(P＞0.05);A组患者的住院时间[(5.5±2.7)vs(6.8±2.9)d]及术后恢复工作时间[(19.3±3.1)vs(21.5±3.3)d]少于B组,差异有统计学意义(P＜0.05),而两组患者的手术时间、术后并发症发生率比较均差异无统计学意义(P＞0.05).结论 腕管镜腕管松解法和改良小切口腕管松解法均是治疗糖尿病腕管综合征的有效且安全的手术方法,腕管镜腕管减压术患者住院时间短、术后恢复快,对于机体修补能力较差的糖尿病患者更为适合.     

Full-Endoscopic versus Minimally Invasive Lumbar Interbody Fusion for Lumbar Degenerative Diseases : A Systematic Review and Meta-Analysis

ObjectiveAlthough full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. MethodsWe systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. ResultsFour retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo-LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669–35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941–41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. ConclusionRelative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.     

关节镜辅助复位内固定与切开复位内固定治疗胫骨平台骨折的疗效比较

目的:比较关节镜辅助复位内固定（ARIF）和切开复位内固定（ORIF）治疗胫骨平台骨折的疗效。方法:回顾性分析2016年1月至2018年8月华中科技大学附属协和医院骨科收治的75例胫骨平台骨折患者的资料。男58例,女17例;年龄20~54岁,平均47岁。左侧42例,右侧33例。骨折根据Schatzker分型：Ⅰ型23例...     

我院Ⅰ类切口手术抗菌药物应用情况分析

目的 分析医院Ⅰ类切口手术抗菌药物预防性使用情况,加强Ⅰ类切口手术抗菌药物预防使用的控制和管理.方法 通过医院信息系统(HIS)统计2018年1-11月江苏省盐城市第一人民医院Ⅰ类切口手术数量和抗菌药物使用率,筛选出冠脉造影等血管介入诊断手术和重点监控Ⅰ类切口手术,统计其抗菌药物使用率,再通过电子信息化病历系统分析抗菌...     

巩膜隧道切口和透明角膜切口对白内障超声乳化摘除术患者术后泪膜的影响

目的 探究巩膜隧道切口和透明角膜切口对白内障超声乳化摘除术患者术后泪膜的影响。 方法 选取2014年2月至2015年10月接受白内障超声乳化摘除手术的白内障患者86例为研究对象,按手术切口不同分为实验组和对照组,每组43例。实验组患者采用透明角膜切口行白内障超声乳化摘除术,对照组患者采用巩膜隧道切口进行手术,分别于术后第1、7、15和30天观察两种切口白内障超声乳化摘除术对患者泪膜功能的影响。 结果 术后第1、7、15天,实验组患者的泪膜破裂时间均较术前缩短,且实验组患者的泪膜破裂时间显著短于对照组;术后第30天,两组患者的泪膜破裂时间均较术前明显延长,差异有统计学意义(P均<0.05);术后第1、7、15、30天,两组患者的泪液分泌量均较术前明显增多,且实验组患者的泪液分泌量明显多于对照组,差异均有统计学意义(P均<0.05)。 结论 与巩膜隧道切口行白内障超声乳化摘除术比较,透明角膜切口对患者术后泪膜功能的影响较小,是更值得在临床推广的白内障超声乳化摘除术的一种切口方式。     

90例防盲小切口白内障体会

目的：探讨经角膜缘后2mm“一字形”巩膜隧道切口行小切口非超声乳化+人工晶体植入术,在防盲中的治疗效果及应用价值。方法在开展防盲工作中90例（90眼）白内障手术,做“一字形”巩膜隧道小切口,连续环形撕囊或截囊,水分离,用圈套器脱出晶状体核,注吸皮质,囊袋内植入人工晶状体,切口不予缝合。结果术后第一天裸眼视力≥0.3者52眼(57.8％),0.05-0.3者29眼(32.2％),≤0.05者9眼(10％)。术后一月裸眼视力≥0.3者74眼(82.2％),0.05-0.3者11眼(12.2％),≤0.05者5眼(5.6％)。术后三个月时裸眼视力≥0.3者83眼(92.2％),0.05-0.3者6眼(6.7％),≤0.05者1眼(1.1％)。术后1个月角膜散光为(1.30±0.47)D,术后3个月角膜散光为(0.82±0.52)D,与术前比较（0.8.±0.64D）差异无统计学意义(P>0.05)。结论手法小切口自内障+人工晶体植入术,设备简单,易于掌握,手术费用低,疗效可靠。适合基层医院全面开展,是一种可行手术方式。     

迎接青光眼微创手术时代的到来

青光眼的手术治疗是目前青光眼治疗中的重要手段之一。复合式小梁切除术是目前最常用的抗青光眼手术,尽管其已接近完美,但仍具有潜在的并发症以及滤过泡带来的各种相关并发症。近年来,具有更高安全性、更符合眼生理结构的微创青光眼手术逐渐兴起,其在青光眼治疗中的地位也愈加重要。本文围绕微创青光眼手术的发生、发展和应用前景进行评述。（眼科,2014, 23: 1-3）     

Theatre of paediatric surgery

In the 50 years since the first edition of this journal, operative paediatric surgery has undergone radical change. Many of the most common instruments are unchanged, both as a testament to their utility and in recognition of past surgeons remembered eponymously. Surrounding that basic core of instruments, theatre has changed radically as new tools and techniques have arisen. Surgeons have come down from their pedestals, recognising surgery as a team sport rather than a solo performance. More than half of the current paediatric surgical trainees are women, a higher proportion than in any other craft group of the Royal Australasian College of Surgeons. The appearance, and rapid development, of laparoscopy is to many observers the most notable change in surgery over the last 50 years. Placed in its context though, it is simply the most prominent example of a frameshift in surgical thinking. The patient as a whole is now the focus, rather than just the disease. Recent developments are as much about minimising harm to normal tissues as they are about extirpating pathology. As a surgical maxim, ‘Primum non nocere’ is even more in evidence in 2015 than it was in 1965.