这项工作由中国国家自然科学基金 (81300810 号)、上海市青年医生培训计划 (20141057 号)、上海自然科学基金 (16ZR1405100) 和上海市资助。卫生和计划生育委员会 (201740187 号)。我们感谢 LetPub (www.letpub.com) 在编写本手稿期间提供语言援助。

这一程序涉及人类的主题, 是由中国复旦大学眼科和耳鼻喉科医院的机构审查委员会批准的。所有登记的病人都提供书面知情同意。
1. 手术准备
<ol><li>手术前, 检查病人的鼻腔与前 rhinoscopy, 内窥镜, 和计算机断层扫描 (CT), 以确认和定位的偏差和确定的迹象15。</li>
	<li>让病人评估整个鼻子的通畅性, 并在手术前用视觉模拟量表 (VAS) 表示这一点。 注: 总长度的比例是10厘米, 一个极端是一个完全清晰的鼻子 (即0 厘米评分 0%), 另一种极端完全阻断鼻子 (10 厘米评分 100%), 和中心鼻子与50% 堵塞。</li>
	<li>手术前1天切除两鼻门廊的触须。</li>
	<li>手术当天, 对病人进行全身麻醉后, 将其放置在手术台上16。 注: 诱导麻醉与 2-2.5 毫克/千克丙泊酚, 0.2 µg/公斤 sulfentanyl, 0.6 毫克/千克罗库溴铵。持续静脉输注瑞芬太尼0.1 µg/千克/分, 吸入七氟醚 (0.8 最小肺泡浓度), 保持麻醉。</li>
	<li>将手术台的位置倾斜 (到背高的部位), 将病人的头部置于中性位置 (既不弯曲也不伸展)。</li>
</ol>2. 手术方法
注: 在整个手术过程中使用0度内窥镜。
<ol><li>陡峭的8片纱布 (6 厘米 x 60 厘米), 混合溶液为20毫升1% 丁卡因和4毫升的0.1% 肾上腺素。将1根纱布浸泡在每个鼻腔内5分钟, 收缩鼻腔粘膜。</li>
	<li>在手术结束时, 用电梯将下鼻甲朝向鼻腔侧壁。</li>
	<li>在隔膜两侧的 subperichondrial 和骨膜平面上, 用一根针附着在5毫升注射器上, 用几毫升混合溶液的20毫升0.9% 氯化钠和0.05 毫升0.1% 肾上腺素, 渗入隔膜。 注: 如果隔膜偏离两侧, 我们将凸侧定义为前偏移侧。</li>
	<li>在间隔软骨的最大偏差 (即凸侧) 的一侧, 在黏膜交界处 ipsilaterally 基利安切口, 15 刀片。垂直切口在隔膜上尽可能高, 继续到鼻腔的底部, 当它到达鼻腔的底部时, 曲线向后。 注: 切口需要穿透鼻中隔粘膜软骨膜构建。</li>
	<li>在 subperichondrial 平面上用吸入式升降机在出血时提高粘膜瓣。不流血, 用2毫米或5毫米的电梯抬起皮瓣。将海拔尽可能高的高度伸展至鼻腔底部, 以充分暴露凸侧的软骨和骨隔膜。</li>
	<li>垂直切口使用2毫米升降机的尖端, 或15刀片的软骨, 低于背侧和筛骨的四角软骨和垂直板的交界处 (即, 第一行2LoRs). 同样, 在软骨上进行水平切口, 使其优于四角软骨、犁骨骨和上颌嵴 (即第二行) 的交界处 (图 2A)。 注: 以这种方式, 间隔软骨从其后部和下附着体被动员至骨间隔, 前、上级附着保持完好。</li>
	<li>提高对侧 mucoperiosteum, 以暴露与吸入电梯双边的骨质隔膜。</li>
	<li>切除间隔软骨和相邻骨间隔的后缘和下边缘两条 (图 1B)。<ol>
<li>切除1/4 到 1/3 (偶尔地1/3 到 1/2) 软骨的原始的宽度在前后维度在第一条线 (图 2B)。</li>
		<li>切除1/4 到 1/3 (偶尔地1/3 到 1/2) 软骨的原始的高度在第二条线的垂直维度 (图 2C)。</li>
	</ol>
</li>
	<li>除去增厚的骨间隔偏差, 并进行部分骨折移位, 将偏差移回中线。 注: 广泛切除后和下骨间隔是清除该地区的所有厚度和畸形。</li>
	<li>通过电凝控制术中出血。</li>
	<li>用可吸收材料对两条间断缝合的粘膜瓣进行近似 (图 2D)。<ol>
<li>开始缝合后的切口, 通过他们通过隔膜到相反的一侧, 然后拉他们从皮肤前到切口部位。</li>
		<li>分别缝合缝线。将两条缝合线平行, 一个以上。</li>
	</ol>
</li>
</ol>3. 手术后的程序和评估
<ol><li>用 nasopore 包鼻腔。</li>
	<li>在手术后1周复查患者检查是否有血肿或隔膜感染。</li>
	<li>用前 rhinoscopy 和0度内窥镜检查鼻腔, 并要求患者在手术后6月内用输精管对其鼻通畅进行评估。</li>
	<li>记录术后鼻中隔血肿, 暂时性牙疼, hypesthesia, 粘连, 鼻出血, 鼻中隔脓肿, 鼻中隔摆动, 间隔穿孔, 背部塌陷为手术并发症。</li>
</ol>

<ol>
	<li>Chung, B. J., Batra, P. S., Citardi, M. J., Lanza, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+revisitation+of+the+technique,+indications,+and+outcomes.">Endoscopic septoplasty: revisitation of the technique, indications, and outcomes.</a> The American Journal of Rhinology. 21 (3), 307-311 (2007).</li><li>Hwang, P. H., McLaughlin, R. B., Lanza, D. C., Kennedy, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+indications,+technique,+and+results.">Endoscopic septoplasty: indications, technique, and results.</a> Otolaryngology-Head and Neck Surgery. 120 (5), 678-682 (1999).</li><li>Fettman, N., Sanford, T., Sindwani, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+the+deviated+septum:+techniques+in+septoplasty.">Surgical management of the deviated septum: techniques in septoplasty.</a> Otolaryngologic Clinics of North America. 42 (2), 241-252 (2009).</li><li>Killian, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+submucous+window+resection+of+the+nasal+septum.">The submucous window resection of the nasal septum.</a> Annals of Otology, Rhinology &amp; Laryngology. 14, 363-393 (1905).</li><li>Freer, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+correction+of+deflections+of+the+nasal+septum+with+a+minimum+of+traumatism.">The correction of deflections of the nasal septum with a minimum of traumatism.</a> The Journal of The American Medical Association. 38, 636-642 (1902).</li><li>Aaronson, N. L., Vining, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+of+the+deviated+septum:+from+ancient+Egypt+to+the+endoscopic+era.">Correction of the deviated septum: from ancient Egypt to the endoscopic era.</a> International Forum of Allergy &amp; Rhinology. 4 (11), 931-936 (2014).</li><li>Bloom, J. D., Kaplan, S. E., Bleier, B. S., Goldstein, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Septoplasty+complications:+avoidance+and+management.">Septoplasty complications: avoidance and management.</a> Otolaryngologic Clinics of North America. 42 (3), 463-481 (2009).</li><li>Rettinger, G., Kirsche, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+in+septoplasty.">Complications in septoplasty.</a> Facial Plastic Surgery. 22 (4), 289-297 (2006).</li><li>Cottle, M. H., Loring, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Newer+concepts+of+septum+surgery;+present+status.">Newer concepts of septum surgery; present status.</a> Eye, Ear, Nose &amp; Throat Monthly. 27 (9), 403-406 (1948).</li><li>Gibson, T., Davis, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+distortion+of+autogenous+cartilage+grafts:+Its+causes+and+prevention.">The distortion of autogenous cartilage grafts: Its causes and prevention.</a> British Journal of Plastic Surgery. 10, 257-274 (1958).</li><li>Kenedi, R. M., Gibson, T., Abrahams, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+characteristics+of+skin+and+cartilage.">Mechanical characteristics of skin and cartilage.</a> Human Factors. 5, 525-529 (1963).</li><li>Stenstroem, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+&amp;#34;natural&amp;#34;+technique+for+correction+of+congenitally+prominent+ears.">A &amp;#34;natural&amp;#34; technique for correction of congenitally prominent ears.</a> Plastic and Reconstructive Surgery. 32, 509-518 (1963).</li><li>Fry, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interlocked+stresses+in+human+nasal+septal+cartilage.">Interlocked stresses in human nasal septal cartilage.</a> British Journal of Plastic Surgery. 19 (3), 276-278 (1966).</li><li>Wang, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+septoplasty+with+three+high+tension+lines+resection.">A modified septoplasty with three high tension lines resection.</a> Acta Oto-Laryngologica. 130 (5), 593-599 (2010).</li><li>Trimarchi, M., Bellini, C., Toma, S., Bussi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Back-and-forth+endoscopic+septoplasty:+analysis+of+the+technique+and+outcomes.">Back-and-forth endoscopic septoplasty: analysis of the technique and outcomes.</a> International Forum of Allergy &amp; Rhinology. 2 (1), 40-44 (2012).</li><li>Kilicaslan, A., Acar, G. O., Tekin, M., Ozdamar, O. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+the+long-term+effects+of+septoplasty+surgery+on+olfactory+function.">Assessment the long-term effects of septoplasty surgery on olfactory function.</a> Acta Oto-Laryngologica. 136 (10), 1079-1084 (2016).</li><li>Meeuwis, J., Verwoerd-Verhoef, H. L., Verwoerd, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+and+abnormal+nasal+growth+after+partial+submucous+resection+of+the+cartilaginous+septum.">Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum.</a> Acta Oto-Laryngologica. 113 (3), 379-382 (1993).</li><li>Lopatin, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Do+laws+of+biomechanics+work+in+reconstruction+of+the+cartilaginous+nasal+septum.">Do laws of biomechanics work in reconstruction of the cartilaginous nasal septum.</a> European Archives of Oto-Rhino-Laryngology. 253 (4-5), 309-312 (1996).</li><li>D'Ascanio, L., Manzini, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quick+septoplasty:+surgical+technique+and+learning+curve.">Quick septoplasty: surgical technique and learning curve.</a> Aesthetic Plastic Surgery. 33 (6), 814-818 (2009).</li></ol>

作者没有什么可透露的。

2LoRs 程序是基于胚胎和解剖知识的歪鼻隔膜。鼻中隔由三种不同成分组成: 前膜、中间软骨、后骨和下骨骼。在鼻中隔发育过程中, 不同的组分僵化不同的时间序列。通常认为, 当软骨仍在生长时, 骨骼就能完成伸展。因此, 应力堆积在相邻的骨间隔软骨的边缘, 导致最初的力量, 可能会变形的鼻中隔。因此, 在大多数情况下, 鼻中隔偏离一定程度从中线位置14。因此, 2LoRs 的原则是改...

内镜鼻中隔成形术是耳鼻咽喉部常见的手术方法, 用于治疗鼻中隔偏1引起的鼻气道梗阻。鼻中隔成形术鼻气道梗阻的目的是为鼻气道通畅提供功能性改善, 其原则是矫正间隔偏差, 以最小的手术侵袭率2。
鼻中隔成形术的起点, 今天仍然使用的做法, 追溯到自由和基利安出版的技术在第二十世纪初, 叫黏膜下切除 (SMR)3。SMR 的特点是它直接去除了 subperichondrial 平面上的鼻软骨的偏差, 留下一个 L 形的支撑结构支持鼻子4,5的外观。SMR 在当时的技术上表现出优势, 因此逐渐得到了认可。二十世纪九十年代, 内窥镜应用于鼻中隔成形术1。手术现场的光照和可视化程度均有明显提高, 切除术可直接、准确地进行6。在此之后, 对 SMR 的适应症进行了扩展, 并开发了各种鼻中隔成形术技术。虽然这些技术可以在切口、皮瓣抬高、切除、缝合或包装等方面多样化, 但直接去除的本质并没有改变。因此, 一旦软骨明显切除, 并发症如大间隔穿孔或鞍鼻畸形将发生7,8。
正如卡托和洛林在1948年提出的, 偏软骨切除术应保守9。不同于直接去除软骨的偏差, 软骨的生物力学应用于鼻中隔成形术需要利用软骨的固有弹性特性, 以矫正软骨的偏差由有限的手术干预, 如部分切口 (如划伤或薄片) 和全切口 (例如, 全切或楔形)。在 1958年, 吉布森和戴维斯首次报道, 由于其生长模式10, 软骨有一个内部的自锁应力系统。部分切口在凹边将释放重音, 从而减少软骨的鞠躬, 而凸边切口将增加鞠躬。在 1963年, Kenedi, 吉布森和亚伯拉罕进一步展示了自锁应力系统通过一系列的研究绘制的力量分布在肋骨软骨截面11。同年, 史丹斯壮验证了部分切口对 antihelix12的影响。几年后, 南联盟公布的结果, 在人鼻中隔软骨, 是一致的13。换句话说, 软骨的生物力学可以通过释放软骨中的力量来改变软骨的形态。在此基础上, 提出了利用软骨生物力学特征的外科手术方法14。
结合以前的手术程序与鼻中隔的胚胎和解剖学知识, 在这里, 一个改良内镜鼻中隔成形术程序与技术的有限两线切除 (2LoRs) 在后和下连接软骨和骨间隔 (图 1) 详细介绍。本程序建议在外部鼻畸形缺席时矫正鼻中隔偏鼻, 改善鼻腔通畅, 或改善进入中鼻道或中部鼻甲腋区作为术前手术的途径。这一程序也可以用于儿童纠正间隔偏差, 因为它的微创方法。

<table border="0" cellpadding="0" cellspacing="0" style="width:755px;" width="755">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Nasal Endoscopy (0o)</td>
			<td style="width:221px;">Karl Storz-Endoskope</td>
			<td style="width:127px;">7230 AA</td>
			<td style="width:180px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Tetracaine</td>
			<td style="width:221px;">Eye &#38; ENT Hospital of Fudan University</td>
			<td style="width:127px;">180130</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Epinephrine Hydrochloride Injection</td>
			<td style="width:221px;">Shanghai Harvest Pharmaceutical Co., Ltd</td>
			<td style="width:127px;">10170405</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Number 15 blade</td>
			<td style="width:221px;">Shanghai Pudong Jinhuan Medical Products Co., Ltd</td>
			<td style="width:127px;">35T1205</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Suction Elevator</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2117.1</td>
			<td>Width: 4 mm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Electrocoagulation</td>
			<td style="width:221px;">Shanghai Hutong Electronics. Co.,Ltd</td>
			<td style="width:127px;">GD350-B5</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">4-0 Brided Absorbable Suture</td>
			<td style="width:221px;">Covidien Healthcare</td>
			<td style="width:127px;">SL-691</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Rongeur forcep</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2300.3</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Nasopore</td>
			<td style="width:221px;">Nasopore, Stryker, USA</td>
			<td style="width:127px;"></td>
			<td>Lengh: 8 cm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Gauze</td>
			<td style="width:221px;">Ningbo Shenyuan Medical Material Co., Ltd</td>
			<td style="width:127px;"></td>
			<td>6 cm x 60 cm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">5mm Elevator</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2067</td>
			<td>Width: 5 mm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">2mm Elevator</td>
			<td style="width:221px;">Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory</td>
			<td style="width:127px;">HBL020</td>
			<td>Width: 2 mm</td>
		</tr>
	</tbody>
</table>

endoscopic septoplasty with limited two-line resection: minimally invasive surgery for septal deviation

内镜鼻中隔成形术是耳鼻喉科的一种外科手术, 通常用于治疗鼻中隔偏压引起的鼻气道梗阻。它的历史悠久, 有多种变体。本文以胚胎和解剖知识为基础, 采用有限的双线切除 (2LoRs) 技术, 在软骨和骨间隔的后、下交界处进行了改良的内镜鼻中隔成形术手术。鼻中隔和软骨行为的生物力学。采用此方法可以尽可能地保留四边形软骨, 有利于保留隔膜的支撑框架和刚度。2LoRs. 经证实, 鼻间隔偏差的矫正与少见的并发症是有效和合理的。本修改后的程序可适用于矫正鼻中隔不存在任何外部鼻畸形, 以改善鼻腔通畅或改善进入中道或腋窝地区的中鼻甲。它也可能被用来扩大鼻中隔成形术的迹象, 因为它的微创方法的儿童和青少年。

本研究包括成人患者 (> 18 岁) 鼻中隔偏差。鼻间隔偏差患者伴有慢性鼻窦炎、鼻肿瘤、外鼻畸形以及以前鼻中隔成形术手术史的病人除外。患者的直背部, 但谁有骶部软骨脱臼的大鼻翼, 已突出成一个鼻门廊也排除了。
本研究包括三十二例患者。患者的平均年龄为44.7 岁 (19-72 岁), 68% 为男性, 32% 为女性。输精管评分显示为平均?...

Watch this Scientific Journal Video about Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation at JoVE.com

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜鼻中隔成形术是一种具有多种变异的具有悠久历史的外科手术方法。本文的重点是一步一步的手术方法执行一项改良的鼻中隔成形术程序称为有限的两线切除术。这种手术技术可用于矫正鼻中隔偏歪, 在没有外部鼻畸形。

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

endoscopic-septoplasty-with-limited-two-line-resection-minimally

Research

Education

JoVE Core

JoVE Journal

Anatomy and Physiology

Medicine

Unit 1

The Axial Skeleton

SCIENTISTS IN ACTION

16.5K 次观看.  Fudan University. 内镜鼻中隔成形术是一种具有多种变异的具有悠久历史的外科手术方法。本文的重点是一步一步的手术方法执行一项改良的鼻中隔成形术程序称为有限的两线切除术。这种手术技术可用于矫正鼻中隔偏歪, 在没有外部鼻畸形。

视频: Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

Murine Ileocolic Bowel Resection with Primary Anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.

Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

鼠回结肠肠管切除原发性吻合

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

科研

医学

Encapsulation Thermogenic Preadipocytes for Transplantation into Adipose Tissue Depots

Cell encapsulation was developed to entrap viable cells within semi-permeable membranes. The engrafted encapsulated cells can exchange low molecular weight metabolites in tissues of the treated host to achieve long-term survival. The semipermeable membrane allows engrafted encapsulated cells to avoid rejection by the immune system. The encapsulation procedure was designed to enable a controlled release of bioactive compounds, such as insulin, other hormones, and cytokines. Here we describe a method for encapsulation of catabolic cells, which consume lipids for heat production and energy dissipation (thermogenesis) in the intra-abdominal adipose tissue of obese mice. Encapsulation of thermogenic catabolic cells may be potentially applicable to the prevention and treatment of obesity and type 2 diabetes. Another potential application of catabolic cells may include detoxification from alcohols or other toxic metabolites and environmental pollutants.

Here, we present a protocol for encapsulation of catabolic cells, which consume lipids for heat production in intra-abdominal adipose tissue and increase energy dissipation in obese mice.

封装产热前脂肪细胞移植到脂肪组织仓库

Cell encapsulation was developed to entrap viable cells within semi-permeable membranes. The engrafted encapsulated cells can exchange low molecular ...

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.

Minimally invasive surgical (MIS) procedures rely on anatomical references to localize structures not directly visible to the surgeon. This manuscript describes a combined method of plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to locate the structures at risk during MIS procedures.

微创拇外翻手术中神经风险的解剖学研究

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional ...

A Minimally Invasive Model to Analyze Endochondral Fracture Healing in Mice Under Standardized Biomechanical Conditions

Bone healing models are necessary to analyze the complex mechanisms of fracture healing to improve clinical fracture treatment. During the last decade, an increased use of mouse models in orthopedic research was noted, most probably because mouse models offer a large number of genetically-modified strains and special antibodies for the analysis of molecular mechanisms of fracture healing. To control the biomechanical conditions, well-characterized osteosynthesis techniques are mandatory, also in mice. Here, we report on the design and use of a closed bone healing model to stabilize femur fractures in mice. The intramedullary screw, made of medical-grade stainless steel, provides through fracture compression an axial and rotational stability compared to the mostly used simple intramedullary pins, which show a complete lack of axial and rotational stability. The stability achieved by the intramedullary screw allows the analysis of endochondral healing. A large amount of callus tissue, received after stabilization with the screw, offers ideal conditions to harvest tissue for biochemical and molecular analyses. A further advantage of the use of the screw is the fact that the screw can be inserted into the femur with a minimally invasive technique without inducing damage to the soft tissue. In conclusion, the screw is a unique implant that can ideally be used in closed fracture healing models offering standardized biomechanical conditions.

This protocol describes a minimally invasive osteosynthesis technique using an intramedullary screw for standardized stabilization of femur fractures, which can be used to analyze endochondral bone healing in mice.

标准化生物力学条件下小鼠软骨骨折愈合的微创模型分析

Bone healing models are necessary to analyze the complex mechanisms of fracture healing to improve clinical fracture treatment. During the last decade, an ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

电磁导航经胸结节定位用于微创胸外科手术

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many areas of biomedical research due to its cost-effectiveness and its translation to humans. This protocol describes a method to create a preclinical free skin flap model in rats with ischemia-reperfusion injury. The described 3 cm x 6 cm rat free skin flap model is easily obtained after the placement of several vascular ligatures and the section of the vascular pedicle. Then, 8 h after the ischemic insult and completion of the microsurgical anastomosis, the free skin flap develops the tissue damage. These ischemia-reperfusion injury-related damages can be studied in this model, making it a suitable model for evaluating therapeutic agents to address this pathophysiological process. Furthermore, two main monitoring techniques are described in the protocol for the assessment of this animal model: transit-time ultrasound technology and laser speckle contrast analysis.

Here, we describe a pre-clinical animal model for studying the pathophysiology of ischemia-reperfusion injury in reconstructive microsurgery. This free skin flap model based on the superficial caudal epigastric vessels in the rat may also allow for the evaluation of different therapies and compounds to counteract ischemia-reperfusion injury-related damage.

重建显微外科缺血再灌注损伤研究的临床前大鼠模型

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment of end-tidal CO2 (ETCO2), its accuracy is commonly validated using commercial kits composed of a capnography monitor and its matching disposable nasal cannula sampling lines. The purpose of this study was to assess the compatibility and accuracy of cross-paired capnography sampling lines with a single portable bedside capnography monitor. A series of 4 bench tests were performed to evaluate the tensile strength, rise time, ETCO2 accuracy as a function of respiratory rate, and ETCO2 accuracy in the presence of supplemental O2. Each bench test was performed using specialized, validated equipment to allow for a full evaluation of sampling line performance. The 4 bench tests successfully differentiated between sampling lines from different commercial sources and suggested that due to increased rise time and decreased ETCO2 accuracy, not all nasal cannula sampling lines provide reliable clinical data when cross-paired with a commercial capnography monitor. Care should be taken to ensure that any cross-pairing of capnography monitors and disposable sampling lines is fully validated for use across respiratory rates and supplemental O2 flow rates commonly encountered in clinical settings.

The goal of this study was to evaluate the accuracy of capnography sampling lines used in conjunction with a portable bedside capnography monitor. Sampling lines from 7 manufacturers were evaluated for tensile strength, rise time, and ETCO2 accuracy as a function of respiratory rate or supplemental oxygen flow rate.

与便携式刻度学监视器一起使用时，评估卡光采样线兼容性和准确性

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

Endoscopic Cholesteatoma Surgery

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. Compared to the microscopic approach with an excellent but straight-line view and limited illumination, the introduction of endoscopes provides a wide-angled panoramic view. Moreover, angled lenses allow the surgeon to visualize the middle ear and its hidden recesses through a transcanal, minimally-invasive approach. The endoscope enables the surgeon to remove limited cholesteatoma of the middle ear and its recesses using an exclusive endoscopic technique by taking advantage of these benefits. This reduces the rate of residual disease and sparing external incisions and excessive temporal bone drilling as in a transmastoid approach. Since transcanal endoscopic access is mainly a one-handed technique, it implies the need for specific procedures and technical refinements. This article describes a step-by-step guide as a surgical manual for endoscopic removal of epitympanic cholesteatoma. Different techniques for cholesteatoma dissection and bone removal for epitympanectomy, including curettage and powered instruments such as drills and ultrasonic devices with their outcomes, are discussed. This may offer ear surgeons insight into technical refinements and the latest technological developments and open the horizon for different techniques.

The present protocol describes a step-by-step guide for the complete endoscopic removal of epitympanic cholesteatoma with different techniques for cholesteatoma dissection and bone removal for epitympanectomy.

内窥镜胆脂瘤手术

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. ...

Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for minimally invasive anterior lumbar interbody fusion (Mini-ALIF). This article is a technical description of anterior lumbar spine surgery under a microscope. We retrospectively collected information on patients who underwent microscope-assisted Mini-ALIF surgery at our hospital between July 2020 and August 2022. A repeated-measures ANOVA was used to compare imaging indicators between periods. Forty-two patients were included in the study. The mean volume of intraoperative bleeding was 180 mL, and the mean operative time was 143 min. The mean follow-up time was 18 months. Apart from one case of peritoneal rupture, no other serious complications occurred. The postoperative foramen and disc height were both higher on average than before surgery. The spreader-assisted micro-Mini-ALIF is simple and easy to use. It can provide good intraoperative disc exposure, good discrimination of important structures, adequate spreading of the intervertebral space, and the restoration of the necessary intervertebral height, which is very helpful for less experienced surgeons.

The technique described in this article is well-suited to the Mini-ALIF procedure, allows for excellent exposure and decompression, and facilitates microscope-assisted manipulation.

显微镜辅助微创前腰椎椎间融合术的临床应用

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for ...