Adenocarcinoma complicating restorative proctocolectomy for ulcerative colitis with mucosectomy performed by Cavitron Ultrasonic Surgical Aspirator®

This is a report of adenocarcinoma arising in an ileal pouch after restorative proctocolectomy (RPC) with rectal mucosal stripping performed by Cavitron Ultrasonic Surgical Aspirator (CUSA®) for ulcerative colitis. The CUSA® was introduced to simplify and optimize ileal pouch–anal anastomosis with mucosectomy and has been shown to shorten the operative time and reduce blood loss. Its use however, may increase the number of pathology specimens made uninterpretable on account of tissue ablation. In the present case, even though preoperative colonoscopy had clearly shown dysplasia, the surgical pathology report could not detect any neoplasia in the specimen; hence, the patient was not surveyed for pouch cancer. Six years later, the patient presented with intestinal obstruction caused by cancer. While protocols for universal pouch surveillance remain somewhat controversial, we conclude on the basis of this case and a review of the literature that in RPC with mucosectomy performed by CUSA®, pouch cancer surveillance is particularly important because remnants of rectal epithelium may have been left behind and tissue ablation may have made the surgical pathology report uninterpretable.     

颈部内镜颌下腺切除术和传统手术的对照研究

目的通过与传统手术临床对照研究,评估颈部小切口电视内镜颌下腺切除术的可行性及其优点。方法术前评估为良性肿瘤的病例26例,手术于颈部皮纹内长2．O～2．5cm的小切13下,内镜辅助完成颌下腺切除术。与同期进行的传统手术病例65例,进行对照研究。对两组病例切口长度、手术时间、术中出血量进行统计分析,比较有无统计学差异。结果两组91倒手术完成顺利,内镜组切1：2（2．3±0．2）cm;术中出血（9．4±4．2）mL;手术时间（74±12）min;术后总引流量平均（21．2±5．7）mL。1例术后出现同侧舌部麻木,2周后恢复。无面神经及舌下神经损伤病例。与传统手术比较,手术切口缩短（P〈0．01）,出血减少（P〈0．01）,术后引流量减少（P〈0．05）,差异有统计学意义。而手术时间差别无统计学意义（P〉0．05）。全部病例随访1～5年,平均29个月,均未见复发。结论内镜下颈部小切口颌下腺切除术手术切口明显缩小,术后美观效果好,并发症少,是一种较为理想的颌下腺切除方法。     

Technology and application of the reusable Olympus Ultrasonic Dissector

Summary

With US scalpels a new era of laparoscopic surgery has begun. We have given instances of the striking advantages of modern ultrasonic dissectors in general, and of the SonoSurg system in particular. Key aspects are reusability, modularity and multi-functionality. Modularity allows for extension of the basic scalpel e.g. to an aspirator, reusability results in cost effectiveness. Nevertheless, ultrasonically activated devices are not limited to the well-known scalpels and aspirators. New technologies such as the SonoSurg ultrasound trocar and combination instruments are currently under development.     

超声吸引装置在脂肪瘤型脊髓拴系综合征中的应用研究

目的探讨超声吸引装置(Cavitron ultrasonic surgical aspirator,CUSA)在脂肪瘤型脊髓拴系综合征中的应用价值。方法收集2016年5月至2018年11月于湖南省儿童医院神经外科收治的62例脂肪瘤型脊髓拴系综合征患儿作为研究对象,按是否采用CUSA技术分为常规组(n=47)和CUSA组(n=15),对比两组患儿手术时间、术后并发症及预后情况。结果 CUSA组手术时间为(120±43)min,常规组为(220±40)min,差异有统计学意义(t=8.281,P<0.05)。CUSA组并发症发生率为0 (0/15),常规组并发症发生率为12.7%(6/47),差异无统计学意义(X^2=2.12,P=0.321)。常规组中症状加重4例,分别为大小便功能障碍和双下肢畸形,改善10例,稳定33例。CUSA组无一例症状加重;需间歇导尿1例,3个月随访时排尿功能恢复;改善4例;稳定11例。结论通过采用显微外科技术,术中使用CUSA切除脂肪瘤组织等综合措施,可缩短手术时间,减少脂肪瘤型脊髓拴系患儿术后并发症。     

Predicting Consistency of Meningioma by Magnetic Resonance Imaging

Objective Meningioma consistency is important because it affects the difficulty of surgery. To predict preoperative consistency, several methods have been proposed; however, they lack objectivity and reproducibility. We propose a new method for prediction based on tumor to cerebellar peduncle T2-weighted imaging intensity (TCTI) ratios. Design The magnetic resonance (MR) images of 20 consecutive patients were evaluated preoperatively. An intraoperative consistency scale was applied to these lesions prospectively by the operating surgeon based on Cavitron Ultrasonic Surgical Aspirator (Valleylab, Boulder, Colorado, United States) intensity. Tumors were classified as A, very soft; B, soft/intermediate; or C, fibrous. Using T2-weighted MR sequence, the TCTI ratio was calculated. Tumor consistency grades and TCTI ratios were then correlated. Results Of the 20 tumors evaluated prospectively, 7 were classified as very soft, 9 as soft/intermediate, and 4 as fibrous. TCTI ratios for fibrous tumors were all ≤ 1; very soft tumors were ≥ 1.8, except for one outlier of 1.66; and soft/intermediate tumors were > 1 to < 1.8. Conclusion We propose a method using quantifiable region-of-interest TCTIs as a uniform and reproducible way to predict tumor consistency. The intraoperative consistency was graded in an objective and clinically significant way and could lead to more efficient tumor resection.     

吸引器在腹腔镜胆囊切除术胆囊三角区分离中的应用

目的探讨吸引器在腹腔镜胆囊切除术(LC)的临床应用价值。方法将前后两个阶段的病例分为A组和B组进行LC。胆囊三角区的解剖分离:A组使用电凝钩,而B组则主要采用吸引器,对比分析两组手术时间、术中出血量及并发症发生率。结果平均手术时间分别为A组28.5±7.6min,B组为21.1±4.3min;平均出血量分别为13.9±4.7ml、8.8±2.5ml。A组出现胆道损伤2例,B组术中术后没有出现任何并发症。所有患者均痊愈出院。结论吸引器在LC术中适合用来骨骼化胆囊管及胆囊动脉,且是十分安全的。     

剖宫产率升高和指征变化的多因素分析

目的:探讨导致剖宫产率升高及指征变化的原因,寻求降低剖宫产率的措施。方法:回顾性分析8年间在我院住院产妇的病例资料,分为三种分娩方式:顺产、阴道助产(包括吸引产和产钳助产)和剖宫产。结果:1996年至1999年剖宫产率显著低于2000年至2003年的,分别为31.4%和42.0%,差异有极显著性(P<0.01);而前者阴道助产率(9.5%)显著高于后者(3.1%)(P<0.01)。在剖宫产指征中,难产和胎儿宫内窘迫占据第1和2位,社会因素近4年上升到第3位。结论:社会因素的增加、阴道助产的下降是导致剖宫产率升高的主要原因,因此严格掌握剖宫产指征和严密观察产程同时适当提高阴道助产的比率是降低剖宫产率有效措施。     

Increased osteogenic capacity of Reamer/Irrigator/Aspirator derived mesenchymal stem cells

IntroductionDonor-site morbidity, complications and availability remain concerns in autologous bone grafting today. The Reamer/Irrigator/Aspirator system (RIA) provides an alternative method to overcome these problems. According to literature, RIA graft possesses a higher osteogenic potency. This study compares iliac crest and RIA graft performance by determining their in vitro osteogenic capacity in a porcine model.MethodsOsteogenic capacity and cell content was determined in RIA and iliac crest bone grafts harvested from six female domestic white pigs. Cells initially washed off, and cells harvested with collagenase were analysed separately and in combination. Alkaline phosphatase expression (ALP) and cell numbers were evaluated after 7 and 14 days of culture. Matrix mineralisation was quantified after 14 days.ResultsCell cultures showed a significant increase of matrix mineralisation by RIA-derived cells compared to iliac crest bone graft (p = 0.0313). The yield of collagenase derived cells was increased in the RIA group and a synergy between washed off and collagenase derived cells was observed. Cell proliferation was similar in both groups.DiscussionThe osteogenic differentiation capacity of cell populations isolated from the RIA derived bone graft surpasses that of iliac crest derived cells. It is proposed that the observed effect can be attributed to the origin of the cells and to the specific action of the RIA system. This study provides further evidence indicating that RIA bone graft provides superior osteogenic properties compared to iliac crest bone graft.