CUSA联合超声止血刀在肝细胞癌切除术中的应用效果

目的 :观察CUSA联合超声止血刀在肝细胞癌切除中的应用效果。方法 :选取于2012年12月~2014年6月在本院应用CUSA和超声止血刀实施肝细胞癌切除术的患者28例为实验组,42例实施钳夹法行肝癌切除术的患者为对照组,分析比较两组患者术中及术后的情况。结果 :两组患者在院死亡率、并发症发生率率等无统计学差异;肝门阻断时间、术中出血量,术后引流管留置时间、引流量、术后第3天的C-反应蛋白(CRP)等存在着显著差异。结论 :CUSA联合超声止血刀的应用效果明显优于钳夹法手术治疗效果。     

Pure laparoscopic pancreas parenchymal dissection using CUSA for distal pancreatectomy

Although stapler dissection and closure is commonly used for laparoscopic distal pancreatectomy (LDP), it is risky in patients with thick pancreatic parenchyma or titanium allergy. We performed laparoscopic pancreatic parenchymal dissection with cavitron ultrasonic surgical aspirator (CUSA) successfully in a patient with titanium allergy. Slinging the pancreas with nylon tape delineates the surgical plane. Pancreatic parenchyma was transected by CUSA in an almost bloodless field. Pancreatic duct branches and vessels were adequately exposed and dissected with a vessel sealing system. The main pancreatic duct was closed with Hem-O-lock. CUSA is an alternative to stapler dissection during LDP in select patients.     

In vitro decalcification of aortic valve leaflets with the Er:YSGG laser,Ho:YAG laser,and the cavitron ultrasound surgical aspirator

This study was designed to compare the efficacy of the erbium: yttrium-scandium-gallium-garnet (Er:YSGG) laser and the holmium:yttrium-aluminum-garnet (Ho:YAG) lasers in debriding calcium from freshly explanted aortic valve leaflets and to compare the Er:YSGG laser with the Cavitron ultrasonic surgical aspirator (CUSA). Aortic valve leaflets were freshly explanted from patients undergoing aortic valve replacement for aortic stenosis. Initially, 4 leaflets each were debrided with the Er:YSGG and the Ho:YAG lasers to attempt removal of calcium deposits while preserving the underlying integrity of the leaflets and minimizing thermal damage. The Er:YSGG laser was more effective in doing so with less thermal and photoacoustic damage when compared with the Ho:YAG laser. Twelve more leaflets each were then debrided with the Er:YSGG laser and the CUSA. The Er:YSGG laser again proved less injurious to the underlying leaflet. The CUSA-treated leaflets demonstrated shattering and disruption of adjacent tissue as well as collagen fiber exposure. These changes were not seen with the Er:YSGG laser. Because of these properties, the Er:YSGG laser merits further evaluation as a tool for aortic valvuloplasty procedures in selected patients with senescent calcific aortic stenosis. © 1993 Wiley-Liss, Inc.     

Surgical approach to large thalamic gliomas

Summary Fifteen cases of large thalamic gliomas were treated by laser surgery and CUSA under × 8 magnification and subsequently they were subjected to radiotherapy. More than 50% of the tumours were located in the dominant hemisphere and therefore an interhemispheric approach was carried out to avoid disturbances of speech and field defects. Nine patients had astrocytomas grade II and the remaining six had astrocytomas grades III–IV. The quality and survival has been gratifying in the less malignant gliomas. The operative technique and use of Laser and CUSA is highlighted.     

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.     

New technique in hepatic parenchymal transection for living related liver donor and liver neoplasms

BackgroundMany different surgical techniques have been described for hepatic parenchymal transection. A retrospective analysis of perioperative mortality, length of hospitalization and blood transfused during operation in two patient groups undergoing liver resection was carried out. In group A, we developed a new technique to resect hepatic parenchyma, using an ultrasonic surgical aspirator with monopolar floating ball cautery, while in group B the crushing clamp technique was used.MethodsIn all, 42 patients with liver resection were enrolled in group A and 107 resections in group B. All patients had hepatic neoplasms except for seven living transplant donors. In group A 43% of resections involved ≥3 segments and 57% involved ≤2 segments; in group B 36.4% involved ≥3 segments and 63.6% consisted of ≤2 segments. Statistical analysis utilised independent T square (Pearson Q square) and Mann-Whitney U test.ResultsIn group A 2.4% of patients died perioperatively, while 3.7% died in group B; mean length of stay (LOS) was 10.9 days in group B and 8.0 days in group A. The length of procedure was 7.5 h in group B and 6.7 h in group A. In group A, 79% did not undergo blood transfusion intraoperatively as opposed to 61% in group B. A mean of 0.5 U of blood was utilized in group A and 1.60 U in group B.DiscussionThe new method of parenchymal transection seems to reduce the LOS, length of procedure and need for intraoperative blood transfusion.     

An innovative surgical tool: air jet dissector

Abstract

Objectives: This study aims to demonstrate and test a new surgical tool which is designed and manufactured in our institution for neurosurgical operations. The device is referred as 'air jet dissector'.

Methods: After fabrication of the device, we tested it on 32 New Zealand rabbits. The effectiveness of the device was compared with a well-known ultrasonic aspirator (CUSA) in an experimental design of cranial corticotomies. Dissection quality, intracranial hemorrhage, edema formation and astroglial and microglial reactions were compared for both devices.

Results: Regarding post-operative edema formation and intracranial hemorrhage, the air jet dissector was found superior to the CUSA system. Additionally, the pre-operative comfort of the device was also better than the CUSA.

Conclusion: In our opinion, this new design has a future in neurosurgical operating rooms. Further refinements and experimental testing is required.     

岛叶胶质瘤的显微手术治疗（附35例分析）

目的探讨体感诱发电位监测下利用超声刀瘤内切除岛叶胶质瘤的临床效果。方法自2009年11月至2012年6月收治岛叶胶质瘤患者35例,采用翼点入路开颅手术,广泛暴露外侧裂,术中进行体感诱发电位监测,利用超声刀首先从瘤内切除部分肿瘤,缩小肿瘤体积,进而从周围分离并切除肿瘤。结果本组肿瘤全切除21例,次全切除8例,大部分切除6例。术后病理学结果显示星形细胞瘤19例,少突胶质细胞瘤6例,间变星形细胞瘤5例,星形细胞瘤混合少突胶质细胞瘤3例,胶质母细胞瘤2例。术后25例症状较术前好转,8例无变化,2例较术前加重（1例出现永久性瘫痪）。本组无手术死亡患者。26例术后随访3个月~2年,9例失访（包括2例胶质母细胞瘤）;均经过尼莫斯汀化疗2~4个疗程,正规放疗1个疗程;肿瘤全切除病例未见肿瘤复发,症状较术前明显好转。结论在体感诱发电位监测下,充分暴露外侧裂,利用超声刀先行瘤内部分切除,缩小肿瘤体积,进而从四周分离切除肿瘤,可以提高岛叶胶质瘤的全切率,减少血管损伤引起的术后功能障碍。