高频电刀在宫颈癌根治术中的应用

目的 :探讨高频电刀在宫颈癌根治术中的应用价值。方法 :采用单极高频电刀调视电切功率为80W～ 90W ,电凝功率为 5 0W～ 6 0W ,按照张志毅[1] 的方法进行子宫广泛切除和盆腔淋巴结清扫手术。结果 :该方法与传统手术方法比较 ,出血少时间短 (P <0 0 5 ) ;清扫淋巴结数目无差异 ,术中副损伤无差异 ,术后淋巴囊肿和输尿管坏死无差异 (P >0 0 5 )。结论 :只要术者盆腔解剖清楚 ,手术技术良好 ,使用高频电刀进行宫颈癌根治术能够达到安全 ,快捷 ,彻底。     

超声刀与高频电刀在腹腔镜胆道探查术中的对比研究

目的:对比研究超声刀(ultrasonic harmonic scalpel,UHS)与高频电刀(high-frequency mono-polar electronic scalpel,HMES)在腹腔镜胆道探查术(laparoscopic common bile duct exploration,LCBDE)中的应用价值。方法:回顾分析216例LCBDE患者的临床资料,其中98例术中应用UHS(A组),118例术中应用HMES(B组);对比分析两组手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间;检测两组患者术前及术后第1天、第3天、第5天ALT、AST、TBIL、DBIL、GGT、ALP水平。结果:两组患者手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间差异均无统计学意义(P>0.05);肝功能检测显示,与术前比较,A组术后第1天,B组术后第1天、第3天ALT、AST明显升高(P<0.05),第5天两组均恢复至正常水平;术后第3天两组间差异有统计学意义(P<0.05)。两组患者术后第3天、第5天TBIL、DBIL水平较术前及术后第1天显著降低,术后第5天较第3天显著下降(P<0.05);术后第5天两组ALP、GGT较术前显著下降,两组间相比差异无统计学意义(P>0.05)。结论:LCBDE术中应用UHS、HMES均是安全、有效的,可有效解除胆道梗阻。     

电刀、超声刀在腹腔镜直肠癌手术中的联合应用体会

目的:探讨电刀、超声刀在腹腔镜直肠癌手术中联合应用的临床价值及手术方法。方法:回顾分析联合应用电刀、超声刀为61例患者行腹腔镜直肠癌手术的临床资料(联合组),并与同期42例单纯使用电刀(电刀组)及50例单纯使用超声刀(超声刀组)的患者进行对比分析。结果:手术均顺利完成,术中无输尿管、膀胱、阴道损伤发生,术后无死亡病例及腹腔出血、吻合口漏、腹腔感染、切口感染等并发症发生,其中55例行腹腔镜辅助直肠癌前切除术,6例行腹腔镜辅助Miles术;手术游离时间平均(53.3±7.46)min,术中出血量平均(42.10±10.93)ml,平均清扫淋巴结(10.92±2.39)枚。3组患者手术游离时间差异有统计学意义,联合组术中出血量少于电刀组,淋巴结清扫数量3组相比差异无统计学意义。结论:腹腔镜直肠癌手术中联合应用电刀、超声刀进行游离既可获得充分、干净的显露,亦可使解剖更精细安全、术中出血少、游离速度加快。     

Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method

Surgical treatment is considered to be the best therapeutic modality for severe hemorrhoidal disease. Different surgical methods of hemorrhoidectomy aim to decrease pain, bleeding, stenosis and discharge. The aim of this study was to evaluate the efficacy of harmonic scalpel hemorrhoidectomy. During a period of seven months, 54 consecutive patients with third- and fourth-degree hemorrhods were prospectively randomized for harmonic scalpel hemorrhoidectomy (HS) or Milligan-Morgan procedure (MM). These patients were examined at one, two, and six weeks after the operation. All patients had a lower gastrointestinal investigation prior to operation to exclude other colorectal pathologies. All patients had the same kind of preoperative preparation and analgesia during the postoperative course. Pain was assessed using a visual analog scale from 0 to 10. Patient satisfaction was defined as decrease or absence of symptoms and return to normal daily activities. HS groups included 29 patients, while the MM group had 25 patients. There as no difference between the groups in terms of age, gender, hemorrhoidal degree and indication for operation. The types of intra-operative anesthesia administered to the two groups were similar. Duration of surgery was significantly higher in the MM group (p<0.0001). Postoperative hospitalization was longer in the MM group (p<0.0001), and the pain degree was higher in MM group (p<0.0001). No significant difference was noted in the overall amount of analgesics used in the two groups at week 1, although it was significantly higher in the MM group 2 and 3 weeks after the operation. Early complication occurred more frequently in the MM group but overall the difference was not statistically significant. In conclusion, harmonic scalpel hemorrhoidectomy is virtually a bloodless operation with minimal tissue damage. It is associated with significant less postoperative pain and a fast return to normal activity. Received: 11 February 2002 / Accepted: 12 June 2002 Correspondence to Z. Dreznik     

超声刀在前臂皮瓣制备术中的应用研究

目的探讨超声刀在前臂皮瓣制备术中的应用及疗效评价。方法 2014年8月至2015年12月在南京医科大学附属口腔医院行前臂皮瓣修复口腔组织缺损的患者26例,随机分为两组,每组13例,试验组运用超声刀制备,对照组运用普通手术刀制备,分析两组患者手术时间、术中出血量及术中术后并发症发生情况。结果术后前臂皮瓣全部存活,试验组手术时间少于对照组(P<0.05),试验组术中出血少于对照组(P<0.05)。两组均未出现并发症。结论运用超声刀行前臂皮瓣制备术可以缩短手术时间、减少手术中出血量,可在临床推广应用。     

Improved efficiency in laparoscopic herniorrhaphy

Summary

Through discreet selection of instrumentation for any laparoscopic procedure, effectiveness and cost containment benefits accrue. We report 200 laparoscopic herniorrhaphy procedures which were performed with increased efficiency, shortened operative time and reduced resource requirements. Our technique uses a minimum of instrumentation (three instruments), minimizes instrument exchanges (avoidance of defocusing by personnel), incorporates instruments with maximum versatility and simultaneously allows use of 5 mm ports (with the exception of the umbilical port).     

超声刀在直肠癌根治术中的临床应用价值

目的 探讨超声刀在直肠癌根治术中的临床应用价值。方法 通过观察我院2002年9月至2003年9月直肠癌根治术病人68例，38例采用超声刀，30例为传统术式。主要观察指标有：手术时间、术中出血量、术中输血例数、术后第1个24h引流量、放置引流管时间以及术后并发症。结果 超声刀组手术时间较传统手术组有明显缩短；超声刀组平均减少出血量98．2ml。超声刀组术后第1个24h引流量和引流管放置时间等均较传统手术组显著减少。结论 超声刀在直肠癌根治术中具有很好的应用前景。     

腮腺肿瘤切除术中高频电刀的应用

目的:观察在保留面神经腮腺肿瘤切除术中电刀的应用。方法:对32例腮腺肿瘤患者应用高频电刀行浅叶切除或区域切除术。术后面神经功能采用H-B系统进行评价。结果:应用电刀切除腮腺肿瘤可造成短时神经失用,但长期观察未见有永久损伤。结论:腮腺肿瘤切除术中应用高频电刀具有副作用小、手术时间短和减少出血的优点。     

Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine

Different methods to reduce blood loss during spinal surgery have been described already. Although the use of the harmonic scalpel (HS), an ultrasonically activated coagulator, has been described in endoscopic spinal surgery, its efficacy in posterior instrumentation of the spine remains unclear. The aim of this study was to determine if blood loss was lower using the HS than electrocauterization (EC) and to evaluate the cost effectiveness of the HS in reducing the need for transfusion in patients undergoing posterior instrumentation of the spine. The two groups were matched in a blinded manner, without knowledge of blood loss and were similar with respect to mean age, diagnosis and operation data. All instrumentations were done by the same surgeon. After matching was completed (HS group n=50, EC group n=50) blood loss and overall costs for blood products were analyzed by independent observers. The following were significantly lower with the HS than with EC: (1) blood loss (1106±985 ml vs 2176±1764 ml, P<0.001), (2) frequency of cell saver use (13 vs 28 patients, P=0.001), (3) average cost of blood products (€72 vs €219, P<0.001), (4) predonation of autologous fresh frozen plasma (2.58±2.78 vs 4.5±2.2 U, P=0.002) and red blood cells (0.38±0.75 vs 0.88±1.1 U, P=0.009). The overall costs, including the costs for the HS, remained neutral. The use of the HS in posterior spinal surgery leads to significantly lower blood loss, and less need for and cost of blood products, compared to EC in cases with major anticipated blood loss.No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.     

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目的 探讨在胃癌根治术中使用新型超声刀（枪、剪式手控弯头超声刀）清扫淋巴结的技术及效果。方法 采用随机对照分组研究方法对复旦大学附属中山医院普外科在2006年4月至2007年3月期间完成的胃癌根治术49例病人（其中使用超声刀26例，常规手术23例）的临床资料进行分析，比较淋巴结清扫所用手术时间、出血量及术后引流量。结果 使用新型超声刀进行胃癌淋巴结清扫所用手术时间、术中出血量及术后3d引流量均明显少于常规手术组，两组淋巴结检出率差异无统计学意义。结论 在胃癌根治术中用新型超声刀进行淋巴结清扫安全、有效，且更加符合肿瘤根治原则。