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递增扩张内切开微创治疗尿道狭窄

【摘 要】 目的 总结联合应用输尿管镜、电切镜、肾筋膜扩张器及钬激光治疗尿道狭窄的临床疗效。 方法 2003年8月－2009年3月，收治18例尿道狭窄男性患者。年龄22～75岁，平均52.5岁。病程3～24个月，平均11.6个月。尿道狭窄原因：前列腺切除术后10例，外伤4例，尿道感染4例。尿道狭窄部位：阴茎段2例，球部5例，膜部5例，膀胱颈部6例。狭窄长度5～21 mm。术中首先置入斑马导丝；然后依次使用8F～22F肾筋膜扩张器，沿斑马导丝扩张尿道狭窄段；最后更换24F 或27F等离子电切镜，直视下扩张狭窄段，电切至正常尿道宽度。 结果 患者均获随访2年。1例患者未定期行尿道扩张，术后6个月再次狭窄，再次手术后恢复正常排尿。术后6个月行尿动力及尿道造影检查：最大尿流率为12～17 mL/s，膀胱剩余尿量0～30 mL。狭窄段尿道宽度5～10 mm。 结论 综合应用输尿管镜、电切镜、肾筋膜扩张器及钬激光治疗尿道狭窄可获得满意疗效。

肱骨螺旋内固定器治疗肱骨外科颈骨折16例

目的 分析肱骨螺旋内固定器对肱骨外科颈骨折的治疗效果。 方法 2001年5月~2004年12月,应用螺旋内固定器治疗肱骨外科颈骨折16例，男4例，女12例；年龄50～85岁。稳定骨折11例，不稳定骨折（移位gt;1 cm，成角gt;45°）5例；外展型13例，内收型3例。采用Neer评分系统行患肩功能评估。 结果 获随访4～36个月，平均23个月。手术时间25～50 min，平均35 min；术中出血量50～80 ml，平均60 ml。术后患者疼痛均缓解。最后随访时，肩关节主动前屈120°（80～160°），外展110°（80～150°）；后伸45°（30～60°）。肩关节功能优8例，满意6例，不满意2例。无神经、血管损伤；无骨延迟愈合及不愈合；无固定失效，螺旋内固定器无退钉；术后肱骨头无坏死征象。 结论 肱骨螺旋内固定器闭合复位髓内固定方法简便，不侵及肩肘关节，创伤小，并发症少可使肱骨外科颈骨折稳定固定。

Further Discussion of Indications for Laparoscopic Hepatectomy

机器人体外通道螺钉定位系统联合骨盆随意外架辅助复位微创治疗复杂骨盆骨折一例

目的介绍1例机器人体外通道螺钉定位系统联合骨盆随意外架辅助复位微创治疗复杂骨盆骨折的经验。 方法2015年8月收治1例因交通事故伤致复杂骨盆骨折的30岁女性患者。影像学检查示骨盆骨折Tile分型C3型，Young-Burgess分型左侧LC-2型、右侧APC-3型。伤后48 h生命体征平稳后手术，通过骨盆随意外架、骨牵引定向术中复位、机器人导航引导通道螺钉固定。 结果患者术中出血量50 mL，术后切口愈合良好。术后次日影像学检查显示内固定物位置满意，术后3个月骨折愈合，随访6个月内无内固定物松动。术后6个月根据Majeed功能评分标准评价为89分，达优。 结论采用机器人体外通道螺钉定位系统联合骨盆随意外架辅助复位微创治疗复杂骨盆骨折可行，能获得较好疗效。

经导管二尖瓣置换术治疗功能性二尖瓣反流一例

关节镜辅助下空心螺钉固定治疗新鲜腕舟骨骨折

目的 探讨关节镜辅助下空心螺钉固定治疗新鲜腕舟骨骨折的疗效。方法 2022年5月—2023年2月，采用关节镜辅助下空心螺钉固定治疗30例腕舟骨骨折患者。男15例，女15例；年龄22～64岁，平均44.1岁。致伤原因：运动伤9例，交通事故伤9例，跌倒伤12例。骨折根据Herbert分型标准为B1型9例、B2型21例，均未合并三角纤维软骨复合体及韧带损伤。受伤至手术时间2～14 d，平均6.0 d。记录手术时间、术中出血量以及并发症发生情况。影像学复查骨折愈合情况，12个月时行改良Mayo腕关节评分及Herbert和Fisher腕舟骨骨折评价，测量腕关节主动屈、伸及桡偏、尺偏活动度并与健侧进行比较。结果 手术时间40～65 min，平均53.5 min；术中出血量5～20 mL，平均11.2 mL。患者均获随访，随访时间12～15个月，平均13.3个月。术后切口均Ⅰ期愈合，未出现感染、神经血管损伤等并发症。影像学复查示术后6个月时骨折均达骨性愈合，随访期间未出现螺钉松动等并发症。术后12个月，改良Mayo腕关节评分达优27例、良3例；Herbert和Fisher腕舟骨骨折评价达0级27例、1级3例；患侧腕关节主动屈、伸、桡偏、尺偏活动度均小于健侧，差异有统计学意义（P<0.05）。结论关节镜辅助下空心螺钉固定具有微创、精确复位及快速康复的优势，是治疗新鲜腕舟骨骨折有效方法。

MINIMALLY INVASIVE APPROACH FOR CERVICAL SPONDYLOTIC RADICULOPATHY

Objective To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). Methods The recent l iterature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. Results There were two techniques of minimally invasive approach for CSR at peresent: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneouspuncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopicdiscectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local l igamentum flavum thickening and spondylotic foraminal stenosis. Conclusion The minimally invasive procedure has the advantages of simple handl ing, minimally invasive and low incidence of compl ications. But the scope of indications is relatively narrow at present.

EFFECTIVENESS OF MINIMALLY INVASIVE SURGERY FOR PECTUS EXCAVATUM IN ADULTS

ObjectiveTo investigate the effect of anterior chest wall depression on the cardiac function and the effectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between pre- and post-operation. MethodsBetween August 2009 and December 2010, 102 adult patients with pectus excavatum were treated with minimally invasive surgery, including the primary operation in 95 cases and the reoperation in 7 cases. There were 84 males and 18 females, aged 18-57 years (mean, 23.4 years). The haller index (HI) was 4.59 ± 1.51. Of 102 patients, 59 were classified as pectus excavatum type I and 43 as type II; 42 had clinical symptoms and 19 had the physical sign of heart. The preoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients. The left ventricular ejection fraction (LVEF) was 68.9% ± 6.2%. ResultsThe procedure was successful in all patients, and no death or serious complication occurred. The patients were followed up 12-28 months (mean, 21 months). The clinical symptoms and cardiac physical sign of the patients disappeared after operation. HI was 2.70 ± 0.33 at 12 months after operation, showing significant difference when compared with preoperative HI (t=5.83, P=0.00). According to Nuss’s evaluation method, the results were excellent in 99 patients and good in 3 patients. CT examination showed complete relief of cardiac compression in 101 patients and mild cardiac compression in 1 patient; the heart position was normal at 12 months after operation. Electrocardiogram returned to normal in 4 patients having abnormal electrocardiogram. LVEF was 70.5% ± 4.8% after operation, showing no significant difference when compared with preoperative LVEF (t=1.08, P=0.30). ConclusionThe main effects of pectus excavatum in adults on heart are compression and displacement. Cardiac compression may be relieved efficiently and the patient’s clinical symptoms can be abated by minimally invasive surgery.

Effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate combined with platelet-rich plasma in treatment of delayed fracture healing

ObjectiveTo analyze the effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate (cBMA) combined with platelet-rich plasma (PRP) in the treatment of delayed fracture healing.MethodsA prospective, randomized, controlled, single-blind case study was conducted. Between March 2016 and July 2018, 66 patients who met the inclusion and exclusion criteria for delayed fracture healing but had solid internal fixation of the fracture end were randomly divided into control group (31 cases, treated with percutaneous autogenous bone marrow blood injection) and study group (35 cases, treated with percutaneous autogenous cBMA+PRP injection). General data such as gender, age, body mass index, site of delayed fracture healing, length of bone defect at fracture end, and preoperative radiographic union score for tibia (RUST) showed no significant difference between the two groups (P>0.05). Before injection, Kirschner wire was used in both groups to stimulate the fracture end and cause minor injury. The fracture healing time, treatment cost, and adverse reactions were recorded and compared between the two groups. Visual analogue scale (VAS) score was used to evaluate pain improvement. The tibial RUST score was extended to the tubular bone healing evaluation.ResultsNo infection of bone marrow puncture needle eyes occurred in both groups. In the control group, local swelling was obvious in 5 cases and pain was aggravated at 1 day after operation in 11 cases. In the study group, postoperative swelling and pain were not obvious, but 2 cases presented local swelling and pain. All of them relieved after symptomatic treatment. Patients in both groups were followed up, the follow-up time of the control group was 16-36 months (mean, 21.8 months), and the study group lasted 14-33 months (mean, 23.2 months). The amount of bone marrow blood was significantly lower in the study group than in the control group (t=4.610, P=0.000). The degree of postoperative pain in the study group was less than that in the control group, and the treatment cost was higher than that in the control group. But the differences between the two groups in VAS score at 1 day after operation and treatment cost were not significant (P>0.05). Fracture healing was achieved in 19 cases (61.3%) in the control group and 30 cases (85.7%) in the study group. The difference in fracture healing rate between the two groups was significant (χ2=5.128, P=0.024). Fracture healing time and RUST score at last follow-up were significantly better in the study group than in the control group (P<0.05). At last follow-up, RUST scores in both groups were significantly improved when compared with those before operation (P<0.05).ConclusionAutogenous cBMA combined with PRP percutaneous injection can provide high concentration of BMSCs and growth factors, and can improve the fracture healing rate and shorten the fracture healing time better than autogenous bone marrow blood injection.

Progress of Minimally Invasive Diagnosis and Treatment of Patients with Choledocholithiasis

ObjectiveTo summarize recent progress of minimally invasive diagnosis and treatment of patients with choledocholithiasis.Method The literatures relevant to progress of minimally invasive diagnosis and treatment of patients with choledocholithiasis at home and abroad in recent years were summarized and reviewed. ResultsThe preoperative diagnosis of patients with choledocholithiasis was very important, and it still needed to combine with the clinical symptoms, biochemical indicators, and imaging examination and so on. Combined or single application of laparoscopy, endoscopy, biliary endoscopy to reflect their respective advantages in the treatment of choledocholithiasis, it had become the most important minimally invasive treatment method. ConclusionEarly diagnosis and proper minimally invasive approach are important for good therapeutic efficacy, and realize modern surgical idea for damage control and rapid recovery.