The foundation for natural orifice transluminal endoscopic surgery(NOTES) is to access the peritoneal and other body cavities through the wall of the alimentary tract via natural orifices,with the goal of performing p...The foundation for natural orifice transluminal endoscopic surgery(NOTES) is to access the peritoneal and other body cavities through the wall of the alimentary tract via natural orifices,with the goal of performing procedures within the peritoneum and other cavities,without the need to make incisions in the abdominal wall.We have made great progress in the field of NOTES since the publication of the White Paper in 2006.There are still major fundamental goals as outlined by the Society of American Gastrointestinal and Endoscopic Surgeons/American Society for Gastrointestinal Endoscopy joint committee that need to be evaluated and answered before NOTES is ready for widespread clinical use.These include prevention of infection,instrument development,creation of a multitasking platform,and the ability to recognize and treat intraperitoneal complications such as hemorrhage and other physiological adverse events.In response to this need,recent abstracts and papers have focused on the management of intraoperative complications.The next phase is to focus on controlled prospective multicenter clinical trials that compare defined NOTES procedure to standard laparoscopy.The goal is to produce reliable and convincing data for the United States Food and Drug Administration,insurance companies,the physician community and the general public.At the present time,we still have many important milestones that still need to be met.Most investigators agree that a hybrid technique and not a pure NOTES practice should be advocated until devices can meet the current and new challenges in this f ield.展开更多
目的:探讨在SandersⅡ、Ⅲ型跟骨骨折治疗中,复元活血汤配合切开复位内固定(ORIF)加植骨术的临床效果观察。方法:选取我院接诊病例24例,随机分为对照组与观察组,分别行ORIF加植骨术治疗与复元活血汤配合ORIF加植骨术治疗,观测足踝部疼...目的:探讨在SandersⅡ、Ⅲ型跟骨骨折治疗中,复元活血汤配合切开复位内固定(ORIF)加植骨术的临床效果观察。方法:选取我院接诊病例24例,随机分为对照组与观察组,分别行ORIF加植骨术治疗与复元活血汤配合ORIF加植骨术治疗,观测足踝部疼痛及功能评估评估。结果:治疗后,观察组与对照组AOFAS评估结果比较(87.25±13.61 VS 71.25±15.75)(P<0.05);观察组总有效率为91.67%,对照组总有效率为66.67%。结论:复元活血汤配合ORIF加植骨术治疗SandersⅡ、Ⅲ型跟骨骨折,效果确切,值得推广。展开更多
AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on...AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl StorzTM, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model. RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence. CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.展开更多
目的探究改良缝合技术联合差异引流策略对跟骨骨折开放性复位内固定术(open reduction and internal fixation,ORIF)后切口愈合并发症的效果。方法选取2022年10月至2024年12月浙江省绍兴市中医院收治的82例SandersⅡ~Ⅳ型跟骨骨折患者,...目的探究改良缝合技术联合差异引流策略对跟骨骨折开放性复位内固定术(open reduction and internal fixation,ORIF)后切口愈合并发症的效果。方法选取2022年10月至2024年12月浙江省绍兴市中医院收治的82例SandersⅡ~Ⅳ型跟骨骨折患者,用随机数字表法分为观察组(41例,改良缝合技术联合差异引流)与对照组(41例,传统间断缝合联合单一引流),比较分析两组切口愈合、并发症及功能恢复情况。结果观察组与对照组比较表现为切口愈合更快、引流时间更短、引流量更少,差异显著(P<0.05);观察组患者的表皮坏死、深部感染和切口裂开总发生率显著低于对照组(P<0.05);术后3个月,观察组疼痛和功能维度评分改善明,且总分显著更高,与对照组患者相比差异无统计学意义(P<0.05)。结论改良缝合技术联合差异引流策略通过优化切口张力分布和引流效率,有效降低术后切口并发症风险,改善关节功能,具有重要临床意义。展开更多
文摘The foundation for natural orifice transluminal endoscopic surgery(NOTES) is to access the peritoneal and other body cavities through the wall of the alimentary tract via natural orifices,with the goal of performing procedures within the peritoneum and other cavities,without the need to make incisions in the abdominal wall.We have made great progress in the field of NOTES since the publication of the White Paper in 2006.There are still major fundamental goals as outlined by the Society of American Gastrointestinal and Endoscopic Surgeons/American Society for Gastrointestinal Endoscopy joint committee that need to be evaluated and answered before NOTES is ready for widespread clinical use.These include prevention of infection,instrument development,creation of a multitasking platform,and the ability to recognize and treat intraperitoneal complications such as hemorrhage and other physiological adverse events.In response to this need,recent abstracts and papers have focused on the management of intraoperative complications.The next phase is to focus on controlled prospective multicenter clinical trials that compare defined NOTES procedure to standard laparoscopy.The goal is to produce reliable and convincing data for the United States Food and Drug Administration,insurance companies,the physician community and the general public.At the present time,we still have many important milestones that still need to be met.Most investigators agree that a hybrid technique and not a pure NOTES practice should be advocated until devices can meet the current and new challenges in this f ield.
文摘目的:探讨在SandersⅡ、Ⅲ型跟骨骨折治疗中,复元活血汤配合切开复位内固定(ORIF)加植骨术的临床效果观察。方法:选取我院接诊病例24例,随机分为对照组与观察组,分别行ORIF加植骨术治疗与复元活血汤配合ORIF加植骨术治疗,观测足踝部疼痛及功能评估评估。结果:治疗后,观察组与对照组AOFAS评估结果比较(87.25±13.61 VS 71.25±15.75)(P<0.05);观察组总有效率为91.67%,对照组总有效率为66.67%。结论:复元活血汤配合ORIF加植骨术治疗SandersⅡ、Ⅲ型跟骨骨折,效果确切,值得推广。
文摘AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl StorzTM, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model. RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence. CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.
文摘目的探究改良缝合技术联合差异引流策略对跟骨骨折开放性复位内固定术(open reduction and internal fixation,ORIF)后切口愈合并发症的效果。方法选取2022年10月至2024年12月浙江省绍兴市中医院收治的82例SandersⅡ~Ⅳ型跟骨骨折患者,用随机数字表法分为观察组(41例,改良缝合技术联合差异引流)与对照组(41例,传统间断缝合联合单一引流),比较分析两组切口愈合、并发症及功能恢复情况。结果观察组与对照组比较表现为切口愈合更快、引流时间更短、引流量更少,差异显著(P<0.05);观察组患者的表皮坏死、深部感染和切口裂开总发生率显著低于对照组(P<0.05);术后3个月,观察组疼痛和功能维度评分改善明,且总分显著更高,与对照组患者相比差异无统计学意义(P<0.05)。结论改良缝合技术联合差异引流策略通过优化切口张力分布和引流效率,有效降低术后切口并发症风险,改善关节功能,具有重要临床意义。
