Objective To study the role of ultracision harmonic scalpel and skin flap in axillary fossa external fixation in operation of breast cancer. Methods One hundred and sixty-six patients with breast cancer were included in this study between May 2009 and November 2009. Combined group (n=51) applied ultracision harmonic scalpel combined with skin flap external fixation. External fixation group （n=52） used the skill of skin flap external fixation. Routine group included 63 patients. Operative time, accidental injury during operation， volume of bleed and drainage, time of drainage, detection amount of lymph node, and complications such like subcutaneous fluidity were observed and recorded. Results The operative time and detection amount of lymph node were not different among three groups （Pgt;0.05）. The volume of bleed in combined group was less than that in other groups （Plt;0.05）. The volume of drainage and the time of drainage were decreased or shorten by turns from routine group, external fixation group to combined group （Plt;0.05）. The incidence rate of subcutaneous fluidity in combined group was lower than that in routine group （Plt;0.05）. Conclusions Using ultracision harmonic scalpel in operation of breast cancer can remarkably reduce the volume of bleed and drain postoperatively. Ultracision harmonic scalpel combined with skin flap external fixation is safety and can reduce the incidence rate of subcutaneous fluidity, thus can be applied widely in breast cancer operation.
【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
Objective To introduce the total mesorectal excision (TME)under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10.3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis.Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.
Objective To investigate the clinical application of the right grstroepiploic artery (RGEA) in offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of the 38 patients who underwent RGEA grafts for OPCAB between December 2008 and July 2009 in the First Affiliated Hospital of Nanjing Medical University. According to the difference of grafts, 76 patients undergoing OPCAB were divided into two groups. In the RGEA group, there were 38 patients including 36 males and 2 females with an age of 65.87±6.29 years. For the patients in this group, OPCAB was carried out with RGEA and other routine conduits as grafts. The control group had 38 patients including 35 males and 3 females with an age of 66.68±6.24 years. They underwent OPCAB with left internal mammary artery (LIMA), radial artery (RA), or saphenous vein (SV) as grafts. The intraoperative and postoperative clinical data for patients in both groups were analyzed and compared. Results All operations were carried out without serious complications like reoperation for bleeding, functional delayed gastric emptying, or severe infection, and no operative death occurred. Compared with the control group, operative time in the RGEA group was longer (295.53±45.16 min vs. 262.50±42.44 min,P=0.001), the number of anastomotic stomas [CM(159mm]was less (4.71±0.56 vs. 5.29±0.92, P=0.002), and less intraoperative plasma was consumed (194.74±186.30 ml vs. 565.79±382.70 ml, P=0.000). The 24 h drainage loss (394.71±205.36 ml vs. 536.32±258.85 ml, P=0.008), the blood cell consumption (1.67±1.48 U vs. 2.81±2.48 U, P=0.010) and the postoperative hospital stay (12.47±3.20 d vs. 15.47±9.31 d, P=0.035) were significantly lower in the RGEA group compared with those in the control group. Meanwhile, the time of postoperative mechanical ventilation time was longer in the RGEA group than that in the control group (1 398.82±1 349.94 min vs. 985.39±170.30 min, P=0.036). Seventytwo patients were followed up for a period from 9 to 17 months with 4 cases lost. No myocardial ischemia occurred in both groups of patients. Conclusion RGEA is an effective arterial conduit for OPCAB. It needs high technology and takes long operative time to apply RGEA in OPCAB.
【摘要】 目的 比较在乳腺癌Auchincloss改良根治术中使用超声刀及电刀手术的优、缺点。 方法 2009年6月－2010年7月将176例乳腺癌患者通过信封法随机分为超声刀组和电刀组，每组88例，分别比较两组患者手术时间、术中出血量、淋巴结检出数目、术后引流量、皮下积液及术后出血量的差异。 结果 手术时间:超声刀组为（145.72±50.76） min，电刀组为（171.27±66.68） min，两组差异有统计学意义（P=0.005）；术中出血量:超声刀组为（71.56±31.34） mL，电刀组为（84.99±36.39） mL，两组差异有统计学意义（P=0.009）；清扫出的淋巴结个数:超声刀组为（20.92±9.09）个，电刀组为（17.90±6.74）个，两组差异有统计学意义（P=0.013）。而在术后平均引流量和术后积液例数方面两组的差异无统计学意义（Pgt;0.05）。两组均无术后出血的情况。 结论 在乳腺癌Auchincloss改良根治术中使用超声刀，较单独使用电刀能缩短手术时间，减少出血量，并增加淋巴结检出的数量。【Abstract】 Objective To compare the disadvantages and advantages between modified radical mastectomy with harmonic scalpel (HS) and conventional electro-scalpel (ES) for patients with breast cancer. Methods Between June 2009 and July 2010, 176 patients with breast cancer were randomly divided into two groups including the HS group and the ES group. The operation time, intra-operative bleeding volume, the number of lymph nodes detected, postoperative drainage volume, subcutaneous hydrops, and postoperative hemorrhage volume between the two groups of patients were compared. Results There were significant differences between the HS and ES groups in terms of operation time [(145.72±50.76) minutes vs. (171.27±66.68) minutes, P=0.005], intra-operative bleeding volume [(71.56±31.34) mL vs. (84.99±36.39) mL, P=0.009], and number of lymph nodes detected (20.92±9.09 vs. 17.90±6.74, Plt;0.05). The postoperative drainage volume and subcutaneous hydrops were not significantly different between the two groups (Pgt;0.05). No postoperative hemorrhage occurred in both groups. Conclusion Compared with ES, the use of HS can reduce operation time and intra-operative bleeding volume, and increase the number of lymph nodes detected during modified radical mastectomy.
Objective To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.Methods One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.Results There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.Conclusions The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.
目的 探讨超声刀（ultrasonic harmonic scalpel，UHS）在消化道恶性肿瘤开腹手术中的应用价值。方法 回顾性分析2009年10月至2011年10月期间广西壮族自治区人民医院普通外科-小儿外科收治并由同一手术者进行消化道恶性肿瘤开腹手术的186例患者的临床资料，根据接受手术的种类（UHS开腹手术或传统电刀开腹手术）将其分为UHS组（86例）和传统电刀组（100例），比较2组患者的手术切口长度、手术时间、术中出血量、术后3d引流量、术后住院时间以及住院总费用。结果 UHS组手术切口长度、手术时间、术中出血量以及术后住院时间均短于（少于）传统电刀组（P＜0.05）；术后3d引流量和住院总费用2组间比较差异均无统计学意义（P＞0.05）。结论 将UHS应用于消化道恶性肿瘤开腹手术可获得较好的效果，能提高手术操作的效率，具有很好的应用前景。
Objective To compare the mean operative time and complications between the LigaSure device and Harmonic Scalpel during video-assisted endoscopic approaches thyroidectomy. Methods The clinical data of 684 cases performed Miccoli thyroidectomy by the same operation team from January 2007 to December 2011 in the department of general surgery，Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were analyzed. Three hundred and forty-nine patients were used Harmonic Scalpel，335 patients were used LigaSure device. The mean operative time and complications （such as hematoma，transient hoarseness，permanent recurrent laryngeal nerve injury，and hypocalcemia） were compared between two groups. Results A total of 684 patients were included in the study，of whom 263 underwent total thyroidectomy and 421 underwent lobectomy. There were not significant differences of the operative time and the complications in both thyroidectomy and lobectomy between the LigaSure device and Harmonic Scalpel（P＞0.05）. Conclusions The uses of the LigaSure device and Harmonic Scalpel in thyroid surgery are safe and reliable，surgeons may choose surgical instruments by habits and medical equipments.