简介：BACKGROUND&OBJECTIVE:Themajorityofintramedullaryspinalcordtumors(IMSCT)arelow-gradegliomas.RadicalresectionforIMSCTsremainschallenging.Recently,improvedneuroimagingandadvancedmicrosurgicaltechniquehavemadegreatsuccessinsurgicalmanagementoftheintramedullaryspinalcordtumors.METH-ODS&RESULTS:Twenty-ninepatientswithintramedullaryspinalcordtumorsweretreatedbyradicalresectiondur-ingthepast4yearsinourinstitute.Thehistologicalresultswereasfollows:12ependymomas,4astrocytomas,4heman-gioblastomas,4epidermoids,1cavernoma,2lipomas,2metastatics.Agross-totalresection(>95%)wasachievedin25surgicalprocedures.Subtotalresections(80-95%)wereperformedin4cases.Therewasnosurgicaldeath.Whencomparingthepreoperativeand3-monthpostoperativefunctionalgrades,12patientswerestable14improved,and3deteriorated.Patientswitheithernodeficitoronlymilddeficitbeforesurgerywererarelyimpairedbytheproce-dure,reinforcingtheimportanceofearlydiagnosisandtreatment.Themajordeterminantoflong-termsurvivalwashistologi-calcompositionofthetumor.PatientsinwhomanIMSCTwasonlypartiallyresected(<80%)faredsignificantlyworse.CONCLUSIONS:Thelong-termsurvivalandqualityoflifeforpatientswithlow-gradegliomastreatedbyradi-calresectionaloneiscomparableorsuperiortominimalresectionplusradiotherapy.Theoptimaltherapyforpatientswithhigh-gradegliomaisyettobedetermined.Forbenignlesion,suchashemangioblastomaandcavernomacouldbecuredbytotalresectionofthetumor.Forlipomaandepidermoid,fibrousadhesionstothecordmaketotalremovaldifficult,andthus,removalisnotthegoalofsurgery.Thecarbondioxidelaserisparticularlyusefulduringsurgeryforthislesion.

简介：AbstractPurpose:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis.Results:The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2= 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001).Conclusion:These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

简介：Amongallcongenitalheartdisease,Ebsteinanomalyisthelesionwiththewidestspectrumofpresentation.Itcanpresentasearlyastheneonatalperiodwhereimmediateinterventionisoftenneededtotheadultwithnodiscernablesymptoms.Itisalsoonewhereoveralloutcomegreatlyrelatestoageatpresentation.Generally,presentationintheneonatalperiodisassociatedwithpooroutcomeswhilepresentationbeyondtheneonatalperiodhasexcellentoutcomeswithlowoperativemortality.ItisthusapparentthatunderstandingeveryaspectoftheanatomyandphysiologyofEbsteinanomalyandhowitmanifestsclinicallyisparamounttosuccessfultreatment.ThepurposeofthisreviewistooutlinethecurrentconceptsandstrategiesinthesurgicalmanagementofEbsteinanomaly,andtodiscussthecurrentexpertconsensusonhowbesttotacklethiscongenitalheartdiseaseatdifferentagesofdiagnosis.

简介：Primaryesophagealadenocarcinoma(PEAC)isararemalignantdiseaseofesophagus.Becauseofitslowerincidence,theknowledgeaboutitislimitedandtherearesomeproblemsrequiringfurtherstudy.Duringrecent30years,106patientswithPEAChadbeentfeatedsurgicallyinourdepartment...

简介：<正>OtitisMediaisacommondiseaseinthepracticeofotolaryngologyandoneofthefamous"threeinflammationsandonedeafness".Otitismediahasbeenwithhumansfromtheverybeginning.Treatmentforotitismediastartedinthewestin1774andmuchlaterinChina.

简介：AbstractThe petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.

简介：摘要目的延长神经外科手术器械仪器的使用寿命，充分满足手术需要，提高手术医生的满意度。方法实施专人管理，保证器械质量，改进器械管理流程，注重器械管理细节，确保仪器性能完好。结果节约成本，物尽其用，对手术的顺利进行提供了有力的保证。结论对手术室器械仪器实行科学化、规范化的管理，在提高手术室护理质量的同时提高了手术医生的满意度。

简介：微创脊柱外科(minimallyorlessinvasivespinesurgery,MISSorLISS)这一概念目前已为大多数骨科医师所熟悉,但又很难给出准确定义.我们认为,MISS是通过运用一些新的特殊设备如内窥镜、计算机导航系统、高分辨X光机、特殊穿刺针、自动拉钩和内固定器材等,以获得比传统手术切口小、组织损伤少而精确率高、效果肯定、术后恢复快为目的新技术和新科学.MISS的价值在于:①损伤小,单纯的小切口并不一定是微创,还必须组织损伤也比传统手术小;②疗效肯定,MISS的疗效不一定要显著高于传统手术,但至少要达到或稍高于传统手术;③恢复快,MISS的真正意义在于在获得良好疗效的前提下以微小的损伤使患者获得更快的恢复.任何以牺牲疗效为代价而片面强调微创的方法都是不可取的.

简介：Objective:Tosummarizesurgicaltreatmentsandtheircorrespondingcurativeeffectsonsciaticnerveinjuries.Methods:Surgicaltreatmentsonsciaticnerveinjurywereperformedin28patientsfromJanuary1990toJuly2000.Thetreatmentsincludedneurolysis,neurolysispluspartialnerveanastomosis,nerveanastomosisandnervetransplantation.ThecurativeeffectwasevaluatedaccordingtoSunderlandcriteria.Results:Of28cases,22patientswerefollowedupwithafollow-upperiodof13monthsto5years(average30months).Of22nerves,7wereexcellent,5good,7fairand3poor,withanexcellencerateof54.5%.

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简介：Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.

简介：<正>Thefacialnervepassesthroughthetemporalboneandisthelongestnervethattravelsinabonycanalwithacomplexcourseandhighsusceptibilitytoinjury.Whenfacialnervebecomesswollenfrominsultssuchastrauma,inflammation,tumororiatrogenicinjury,itsdistal

简介：<正>AcousticNeuroma(AN)arisesfromtheeighthcranialnerve.Itprimarilyinvolvesthevestibularbranchofthenerveandisthereforealsocalledvestibularschwannoma(VS).Tothedate,diagnosisandsurgicaltreatmentofANhaveadvancedsignificantly.Alongwithadvancesinaudiologyandimagingtechnologies,casesofdiagnosedANhavebeenincreasing,makingitacommon

简介：Objective:Toprobeintoeffectivesurgicalproceduresandimprovetheoutcomeoftreatmentforpatientswithseverehepaticinjury.Methods:Aretrospectivestudyinvolving113patientswithseverehepatictrauma(AASTgradeIVandV)duringthepast12yearswascarriedout.Ninety-eightpatientsunderwentsurgicaltreatment.SurgicalinterventionsincludinghepatectomyordirectcontrolofbleedingvesselsbyfingerfracturetechniquewithPringlemaneuver,selectiveligationofhepaticartery,retrohepaticcavalrepairwithtotalhepaticvascularocclusion,andperihepaticpackingweremainlyused.Results:Inthe98patientstreatedoperatively,thesurvivalratewas69.4%(68/98).Among40patientswithjuxtahepaticvenousinjury(JHVI),15werecuredwiththemaximumbloodtransfusionof12000ml.EightcasesofGradeIVinjurytreatednonoperativelywerecured.Thepercentageoffailureofnonoperativemanagementwas42.9%(6/14).Theoverallmortalityratewas32.7%(37/113),and57%ofthedeathswereduetoexsanguination.Conclusions:Reasonablesurgicalproceduresbasedonclassificationofhepaticinjuriescanincreasethesurvivalrateofseverelivertrauma.AccurateperihepaticpackingiseffectiveindealingwithJHVI.

简介：摘要目的探讨以妇产科为例的外科手术器械实施专科专人管理的效果。方法选择2012年8月～2014年7月514例妇产科手术分为对照组和观察组，观察组实行专科专人管理，手术室和供应室执行严格的岗位培训制度，通过考核发现存在问题，对存在问题进行原因分析，提出切实可行的改进措施，对照组采用常规外科器械管理，比较两组器械在清洗质量、器械保养、包装方法、术前物品准备和器械使用五方面的合格率。结果对照组清洗质量合格率85.4%、器械保养合格率89.5%、包装方法正确率87.2%、术前物品准备正确率82.6%和器械使用合格率90.7%；实验组清洗质量合格率98.4%、器械保养合格率99.2%、包装方法正确率95.2%、术前物品准备正确率98.4%和器械使用合格率99.6%，两组比较差异有统计学意义（P＜0.01）。结论外科手术器械实行专科专人管理，精细贵重手术器械专人清洗，提高了手术室和供应室的工作质量，有效地保障了手术的顺利进行。

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简介：摘要目的调查与分析影响外科手术设备器械清洗质量的因素。方法研究时间为2016年4月到2016年12月，选择我院已使用与污染过的外科手术设备器械1600件作为研究样本，调查清洗质量合格情况，并分析相关危险因素。结果1600件外科手术设备器械清洗质量合格1534例，不合格66例，合格率为95.9%。以清洗质量不合格作为应变量，以调查的内容作为自变量，条件性Logistic回归法结果显示酶的选择、超声时间、手术器械结构为外科手术设备器械清洗质量的主要危险因素(P＜0.05)。结论酶的选择、超声时间、手术器械结构为外科手术设备器械清洗质量的主要危险因素，对于外科手术设备器械必须注重影响清洗效果的因素，积极加强管理，从而确保达到最佳的清洗质量。

简介：自1989年法国Mouret开展第一例现代腹腔镜手术,17年来,腹腔镜外科取得了巨大的进步.回首现代腹腔镜外科的发展史,从最初的简单的腹腔镜胆囊手术设备和LC术,发展到拥有超声刀,LigaSure,腹腔镜机器人等的现代腹腔镜设备器械,手术种类几乎涵盖普外科,泌尿外科,妇科所有手术,更实现了远程手术和腹腔镜仿真模拟的梦想.

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