期刊文献+

改良Miccoli模式内镜手术的工作腔室:WSM-I型建腔器成腔的力学特征研究 被引量:3

Working space establishment with Miccoli's approach: characteristics of the lifting force produced by a working space marker in the process of its cavity-forming
分享 导出
摘要 目的了解建腔器成腔力学变化特征。方法对接受改良Miccoli模式内镜甲状腺一侧腺叶及峡部切除22例,腺叶部分切除15例,行人路制备完成后,统一采用WSM-I型建腔器建腔。首次成腔后拆下提吊钩,换装上牵张力测定器,间插性地行模拟成腔实验:以0.5cm间距间断提升吊钩,同时测量钩端各高度位置时的肌皮组织牵张力。结果①牵张力的总体变化在0—27.5N。②当提升吊钩钩端至基础提吊位(Pe,腔室中心高度=1.5cm)时,对应的牵张力值为(11.2±3.5)N;继续提升吊钩钩端至极限提吊位(Pmax,19/37例的平均腔室中心高度为1.75cm,另18例为2.0cm)时,对应牵张力值为(17.5±4.3)N(腔室中心高度不同,但两组对应的力值相近)。③伴随成腔过程牵张力呈两阶段变化:当提吊钩钩端从初始位上提至Pe时,牵张力呈均匀的线性增长;当钩端继续上升至Pmax时,牵张力转呈类指数式的快速增长。最大力值出现在后一阶段。④切口长度对牵张力变化无明显影响,但肌皮组织厚度与牵张力大小呈正相关(P〈0.01)。结论①建腔器成腔时牵张力不大,其成腔近极限时的最大力值〈30N,远低于皮肤伸展术实施时所产生的力值。②整个成腔过程中力的增加呈二阶段变化,后一阶段增加明显。与之对应,肌皮组织逐步接近其粘弹性和延展性极限,而腔室空间高度也趋于最大值。③鉴于此时的成腔已近极限,再提升吊钩亦徒劳无益,而牵张力还将继续大幅增加。故此,极限提吊位所对应的牵张力值可能是成腔时整体力变化过程中的一个“拐点”。④实际成腔时的牵张力应≤Pmax的对应力值。此时不仅实现了有效成腔和最大化成腔,且可避免因不必要牵张所带来的肌皮组织损伤。 Objective To comprehend the change of the characteristics of lifting force produced by a working space marker in process of its cavity-forming. Methods 37 patients were successively operated with the surgical mode of minimally invasive video-assisted thyroidectomy (22/37 cases received a lobotomy and others underwent a partial thyroidectomy) from January to August, 2010. Instead of hand-retraction, a mechanical armworking space marker type I ( WSM-I, MIEO Medinstr Co. Ltd, China) was applied to establish a working space. After pathway making, an interlayer-cavity above the lobe was created by the space maker and endoscopic view was properly built. Following all these steps, a simulated space making procedure was performed in a way of stepwise hook-lifting (5 mm rising per time). The lifting force (LF)was measured during the process with a modified force-measure device (FB-50, DESIK company, Germen). Then recorded data were assessed and analyzed statistically. Results (1)Ascending scope of LF in the process of entire space-forming was 0-27.5 Newton (N). (2)Along with hook rising, LF ascended correspondingly and 2 specific values emerged: One was 11.2 ± 3.5 N, as the lifting height approached 1.5 cm ( also a approximate position of essential space-forming ( Pc), at which the musculo-cutaneous tissue just became tight) ; the other was 17.5 ±4.3 N , as the lifting height approached 1.75 cm ( also a approximate position of maximal space-forming (Pmax), at which the musculo-cutaneous tissue appeared real tight, but not in a status of extreme tightness). (3)Two types of LF ascending were found when the values transferred to a curve diagram: a palliative linearity increasing while lifting height varied from 0 to 1.5 cm (P0 to Pc) and a rapid exponent-like increasing while lifting height varied from 1.5 to 1.75cm (Pe to Pmax). (4) Dependability analyses yielded a diverse statistical outcome: negative significance of the comparison between incision len
作者 陈高翔 高力 宋春轶 CHEN Gao-xiang, GAO Li, SONG Chun-yi.( Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou 310016, China)
出处 《中华内分泌外科杂志》 CAS 2011年第4期 235-239,共5页
基金 浙江省科技厅项目(2007C23017)
关键词 甲状腺切除术 微创 内镜辅助 工作腔室 Thyroidectomy Minimally invasive Video-assisted Working space
作者简介 通信作者:高力,Email:srrs_gl@sina.com
  • 相关文献

参考文献15

二级参考文献30

  • 1高力,谢磊,李华,邵雁,叶学红,胡莹,宋春轶.应用高频超声刀实施小切口无气腔室内镜下甲状腺手术[J].中华外科杂志,2003,41(10):733-737. 被引量:76
  • 2高力,胡莹,邵雁,宋春轶,肖贵洲,李华,谢磊,叶学红.改进的Miccoli术式治疗甲状腺良性疾病(附530例报告)[J].外科理论与实践,2004,9(6):470-472. 被引量:46
  • 3宋儒耀 宋儒耀 主编.人体美学观察的标准与规范[A].宋儒耀,主编.美容整形外科学(增订版):第1版[C].北京:北京出版社,1990.31-37. 被引量:1
  • 4Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg,1996,83:875-875. 被引量:1
  • 5Ishii S,Ohgami M,Awisawa Y,et al.Endoscopic Thyroidectomy with anterior chest wall approach.Surg Endosc,1998,12:611. 被引量:1
  • 6Ikeda Y,Takami H,Sasaki Y,et al.Endoscopic neck surgery by the axillary approach.J Am Coll Surg,2000,191:336-340. 被引量:1
  • 7Miccoli P,Cecchini 0,Conte M,et al.Minimally invasive,video-assisted parathyroid surgery for primary hyperparathyroidism.J Endocrinol Invest,1997,20:429-430. 被引量:1
  • 8Yeh TS,Jan YY,Hsu BR,et al.Video-assisted endoscopic thyroidectomy.Am J Surg,2000,180:82-85. 被引量:1
  • 9Miccoli P.Minimally invasive surgery for thyroid and parathyroid diseases.Surg Endosc,2002,16:3-6. 被引量:1
  • 10Berti P,Materrazzi G,Galleri D,et al.Video-assisted thyroidectomy for Graves′ disease:rport of a preliminary experience,Surg Endosc,2004,18:1208-1210. 被引量:1

共引文献193

同被引文献23

  • 1黄晓明 ,郑亿庆 ,许庚 ,蔡翔 ,龚坚 ,刘翔 ,彭解人 ,许耀东 ,刘伟 .无注气甲状腺内镜外科手术[J].中华耳鼻咽喉科杂志,2004,39(8):456-459. 被引量:29
  • 2高力.Miccoli内镜术式与甲状腺手术操作的微创化[J].中华外科杂志,2006,44(1):10-13. 被引量:70
  • 3Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism [J]. Br J surg, 1996,83 ( 6 ) : 875. 被引量:1
  • 4Takami HE, Ikeda Y. Minimally invasive thyroidectomy [ J ]. Curr Opin Onco1,2006,18 ( 1 ) :43-47. 被引量:1
  • 5Bae JS, Cho YU, Sung GY, et al. The currenl status of endoscopic thyoiderctomy in Korea. [ J ]. Surg Laparose Endose Percutan Teeh, 2008,18 ( 3 ) :231-235. 被引量:1
  • 6Miccoli P, Cecchini G, Conte M, et al. Minimally invasive, video- assisted parathyroid surgery for primary hyperparathyroidism [ J ]. J Endocrinol Invest, 1997,20 (7) :429-430. 被引量:1
  • 7Alvarado R, McMullen T, Sidhu SB, et al. Minimally invasive thyroid surgery for single nodules:an evidence-based review of the lateral mini-ineision technique [J]. World J Surg, 2008,32 ( 7 ) : 1341-1348. 被引量:1
  • 8Tang ST, Yang Y, Man YZ, et al. Endoscopic transaxillary approach for congenital muscular torticollis [ J ]. J Pediatr Surg, 2010,45 ( 11 ) :2191-2194. 被引量:1
  • 9Burstein FD, Cohen SR. Endoscopic surgical treatment for congenital muscular torticollis [ J]. PIast Reconstr Surg, 1998, 101 ( 1 ) :20-24. 被引量:1
  • 10Burstein FD. Long-term experience with endoscopic surgical treatment for congenital muscular torticollis in infants and children: a review of 85 cases [ J ]. J Plast Reconstr Aesthet Surg ,2004,114 ( 2 ) :491 -493. 被引量:1

引证文献3

二级引证文献5

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部 意见反馈