【摘要】 目的 探索显微眼内窥镜在后段眼内异物取出及玻璃体切除术中的应用。 方法 将2005年7月-2006年3月38例眼内异物患者分为试验组（15例）及对照组（23例）。试验组采用显微眼内窥镜下完成对外伤性视网膜玻璃体病变等的处理及眼内异物的取出；对照组采用显微镜直视下行常规玻璃体切割及眼内异物取出术。 结果 试验组术后角膜透明度及眼压恢复、视力提高及视网膜复位等情况均优于对照组；异物取出情况、手术时间和并发症两组无差异。 结论 在观察困难或异物处于极周边时应用显微眼内窥镜，能够在手术中直接取出眼内各个部位异物，及时发现视网膜裂孔并同时行抗青光眼手术，减少对角膜材料的依赖和对角膜的损伤，为及时、准确和安全地手术提供了条件。【Abstract】 Objective To investigate the application of the intraocular micro-endoscope in extracting intraocular foreign bodies (IOFB) and vitrectomy. Methods A total of 38 patients with IOFB from July 2005 to March 2006 were divided into a trial group (15 patients) and control group (23 patients). The treatment for traumatic retinal vitreous lesions and extraction of IOFB were performed under the intraocular micro-endoscope in the trial group; while the conventional vitrectomy and IOFB extraction were performed under the microscope in the control group. Results The degree of corneal recovery, improvement of intraocular pressure, visual acuity, and retinal reattachment were better in the trial group than that in the control group. There was no difference in removal of IOFB, surgical time and complications between the two groups. Conclusion In patients with intraocular foreign bodies and cloudy cornea or other conditions that made the observation difficult, intraocular micro-endoscope is a useful convenience without relying on donated cornea. The practice made the judge of size, location and the distance more and more accurate through the monitor.
目的 探讨经胸骨前径路内镜甲状腺手术的方法及其临床效果。 方法 采用经胸骨前径路内镜甲状腺手术治疗24例甲状腺良性肿瘤患者，并进行定期随访。 结果 23例手术顺利完成，1例因术中快速冰冻病理诊断为乳头状甲状腺癌而追加常规甲状腺癌根治术。平均手术时间为150 min，术中平均出血量30 ml。2例出现皮下气肿，4例出现胸部皮肤麻木。无喉返神经及甲状旁腺损伤,无术后出血、甲状腺危象等并发症出现。随访1~6个月，所有患者对美容效果非常满意，无近期肿瘤复发者。 结论 经胸骨前径路内镜甲状腺手术是一种美容效果较好的手术方法，手术操作空间的建立和术中控制出血是该术式的两大关键技术。
ObjectiveTo discuss the indication, therapeutic effect, complication of endoscopic surgery for pancreatic pseudocyst and its defect and merit.MethodsThe pertinent literatures about pancreatic pseudocyst treated by endoscopic technique were summarized. ResultsEndoscopic technique possessed the peculiarities of less trauma, convenience to operate and could be repeatedly used. The number of patients with pancreatic pseudocyst suitable for endoscopic therapy was increasing. When pancreatic pseudocyst was accompanied with complication, polycystic or failed in endoscopic treatment, surgical intervention was the only choice. Endoscopic technique would be considered firstly in other conditions.ConclusionIndividual scheme should be advocated according to the size, number location and complication of the pancreatic pseudocyst.
Objective To explore the feasibility and effectiveness of spinal pedicle screw internal fixation through endoscope-assisted posterior approach for the treatment of traumatic atlantoaxial instability. Methods Between September 2008 and September 2010, 44 patients with traumatic atlantoaxial instability received spinal pedicle screw internal fixation through endoscope-assisted posterior operation (micro-invasive surgical therapy group, n=22) or traditional surgical therapy (control group, n=22). There was no significant difference in gender, age, type of injury, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between 2 groups (P gt; 0.05). The blood loss, operation time, length of the incision, improvement rate of JOA, and graft fusion rates were compared between 2 groups to assess the clinical outcomes. Results The blood loss, operation time, and length of the incision in the micro-invasive surgical therapy group were better than those in control group (P lt; 0.05). All incisions were primary healing. Of 88 pedicle screws, 7 pedicle screws penetrated into the interior walls of cervical transverse foramen in the micro-invasive surgical therapy group and 8 in the control group, but there was no syndrome of vertebral artery injury. All patients of the 2 groups were followed up 12 to 37 months (mean, 26 months). Bony fusion was achieved in all cases within 3 to 12 months (mean, 5.3 months). No loosening or breakage of screw occurred. At 6 months to 1 year after operation, the internal fixator was removed in 6 cases and the function of head and neck rotary movement were almost renewed. The JOA score was significantly improved at last follow-up when compared with preoperative score (P lt; 0.05), and no significant difference in JOA score and improvement rate between the 2 groups at last follow-up (P gt; 0.05). Conclusion The micro-invasive surgical therapy can acquire the same effectiveness to the traditional surgical therapy in immediate recovery of stability, high graft fusion rate, and less complication. Moreover, it can significantly reduce the operation time, blood loss, and soft tissue injury, so this approach may be an ideal way of internal fixation to treat traumatic atlantoaxial instability.
ObjectiveTo investigate the feasibil ity and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation. MethodsBetween July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L4, 5 in 22 cases and at L5, S1 in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L4 level in 9 cases and at L5 level in 8 cases, at posterior superior edge at L5 level in 13 cases and in S1 level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments. ResultsAccurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%. ConclusionPercutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.
Objective To study the methods and techniques of the treatment forextensive suprasellar pituitary adenona and repairing hole.Methods From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via Ⅰand Ⅱ space of optic chiasma. The small bone flap was fixed with Ti clamp. Results After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. Conclusion Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.
This consensus aims to introduce the applications of 4K high-definition technology and fluorescence technology in thoracic surgery, summarize and categorize the technical support for pulmonary segment surgery, and innovatively propose technical support for precise sleeve resection of pulmonary segments. It provides a reference for clinical use, points out the direction for the research and innovation of domestically produced high-end endoscopes, promotes the widespread application of excellent domestically produced medical endoscopes, and facilitates the development of domestically produced medical equipment.
ObjectiveTo observe the effectiveness and safety of percutaneous endoscopic transforaminal bilateral decompression for severe central lumbar spinal stenosis.MethodsA retrospective analysis of 44 patients with single-segment severe central lumbar spinal stenosis with bilateral lower extremity symptoms between October 2015 and December 2017 was performed. Among them, 36 cases underwent bilateral decompression through bilateral transforaminal approach, and 8 cases underwent bilateral decompression through unilateral transforaminal approach. There were 25 males and 19 females, the age ranged from 56 to 89 years with an average of 68.6 years. The disease duration was 5-39 months with an average of 14.5 months. Involved segments: L3, 4 in 6 cases, L4, 5 in 33 cases, and L5, S1 in 5 cases. The dural sac cross-sectional area (DSCA) of the MRI was (66.36±8.48) mm2. Morphological grading (MG) classification: 29 cases of grade C, 15 cases of grade D. The visual analogue scale (VAS) score of preoperative low back pain was 2.3±1.0 and the VAS score of lower extremity pain was 7.8±1.2; the Oswestry disability index (ODI) was 77.8±7.3. Postoperative VAS scores, ODI scores, MG classification, and DSCA were recorded and compared with preoperative ones, and clinical outcomes were assessed by using the modified MacNab criteria.ResultsAll patients successfully underwent surgery and the wounds healed by first intention. All 44 patients were followed up 13-46 months with an average of 24.8 months. One patient developed postoperative lower extremity paralysis and 1 patient developed a dural tear. There was no infection, recurrence, or revision surgery during the follow-up. Postoperative imaging showed that the central spinal canal was enlarged and the area of the dural sac was significantly increased compared with preoperative one. The VAS score of low back pain was 2.4±0.6 and 2.5±0.8 at 1 month after operation and at last follow-up, showing no significant difference when compared with preoperative scores (P>0.05). The VAS of lower limb pain was 2.1±0.6 and 2.0±1.1 at 1 month after operation and at last follow-up, which was significantly improved when compared with preoperative scores (P<0.05); but no significant difference was found between at 1 month after operation and at last follow-up (P>0.05). At last follow-up, the ODI score was 19.7±6.4, and the DSCA was (104.93±12.56) mm2, which was significantly improved when compared with preoperative values (P<0.05). The MG classification was also significantly higher than preoperative one (Z=−5.789, P=0.000). According to the modified MacNab criteria, the results were excellent in 32 cases, good in 9 cases, and fair in 3 cases, with an excellent and good rate of 93.2%.ConclusionPercutaneous endoscopic transforaminal bilateral decompression for treating severe central lumbar spinal stenosis has the advantages of less trauma, adequate decompression, and rapid recovery. The short-term effectiveness is good.
With the development of capsule endoscopy, developing active capsule endoscopy robot becomes a growing trend. Although stomach diagnosis with robot has been put into clinical test, the realization of the complete intestinal capsule endoscopy is still a difficulty. This paper reports the status quo of the research process for intestinal capsule endoscopy robot, and analyzes their advantages, defects and prospects for development, which provides reference for the research of intestinal capsule endoscopy robot.
To evaluate the effectiveness of interrupt percutaneous endoscopy lumbar discectomy (PELD) through interlaminar approach for L5, S1 disc protrusion. Methods Between November 2006 and August 2010, 115 patients with L5, S1 disc protrusion were treated, including 79 males and 36 females with an average age of 38 years (range, 14-79 years). All patients showed the dominated symptom of the S1 nerve root. The working channel was establ ished by puncturing through interlaminar approach under the local anesthesia. After the needle was used to make sure no nerve root or dural sac on working face, the disc tissue was excised directly by bl ind sight. Then the nerve root decompression was observed through the endoscope. In patients with free type, fragment compression was observed through the endoscope, and the disc tissue around the nerve roots was removed, then the free disc tissue around intervertebral space was excised. Results One patient who failed to puncture changed to miniopen discectomy; 3 patients who failed changed to post lateral approach; and the others underwent interrupt PELD through interlaminar approach. Eighty patients were followed up 18 months on average (range, 12-36 months). The average Oswestry Disabil ity Index (ODI) was reduced to 13% ± 5% at 12 months after operation and to 12% ± 8% at last follow- up from 73% ± 12% at preoperation, showing significant differences (P lt; 0.01). According to modified Macnab ,s criterion, the results were excellent in 59 cases, good in 15 cases, fair in 3 cases, and poor in 3 cases at last follow-up, and the excellent and good rate was 92.5%. Conclusion For the treatment of disc protrusion at the L5, S1 level, interrupt PELD through interlaminar approach should be ideal with short operation time, small trauma, and quick recovery.