Name: management of the uncinate process in no-touch laparoscopic pancreaticoduodenectomy
Uploaded: 2023-05-05T12:20:00
Description: Watch this Scientific Journal Video about Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy at JoVE.com

我们的文章 #64904 得到了广东省中医药局研究项目 （ID：20222077） 的支持。

本研究经广州中医药大学第二附属医院伦理委员会批准，并取得参与本研究的患者的知情书面同意。
1. 术前检查
<ol><li>进行高分辨率对比增强 CT12,13（见材料表）以评估肿瘤的范围并寻找任何异常的脉管系统。</li>
	<li>确定患者的纳入和排除标准。<ol><li>选择符合以下标准的患者：（1） 位于钩突的肿瘤需?...

<ol>
	<li>L&#233;ger, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pancreatic+Surgery.">Pancreatic Surgery.</a> Chugai-Igakusha. , (1984).</li><li>O'Sullivan, A. W., Heaton, N., Rela, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cancer+of+the+uncinate+process+of+the+pancreas:+Surgical+anatomy+and+clinicopathological+features.">Cancer of the uncinate process of the pancreas: Surgical anatomy and clinicopathological features.</a> Hepatobiliary and Pancreatic Diseases International. 8 (6), 569-574 (2009).</li><li>Corcione, F., 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=Laparoscopic+pancreaticoduodenectomy:+Experience+of+22+cases.">Laparoscopic pancreaticoduodenectomy: Experience of 22 cases.</a> Surgery Endoscopy. 27 (6), 2131-2136 (2013).</li><li>Kuroki, T., Eguchi, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=No-touch+isolation+techniques+for+pancreatic+cancer.">No-touch isolation techniques for pancreatic cancer.</a> Surgery Today. 47 (1), 8-13 (2017).</li><li>Gall, T. M., 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=Reduced+dissemination+of+circulating+tumor+cells+with+no-touch+isolation+surgical+technique+in+patients+with+pancreatic+cancer.">Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer.</a> Journal of the American Medical Association Surgery. 149 (5), 482-485 (2014).</li><li>Tien, Y. W., 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+high+circulating+tumor+cell+count+in+portal+vein+predicts+liver+metastasis+from+periampullary+or+pancreatic+cancer:+A+high+portal+venous+CTC+count+predicts+liver+metastases.">A high circulating tumor cell count in portal vein predicts liver metastasis from periampullary or pancreatic cancer: A high portal venous CTC count predicts liver metastases.</a> Medicine. 95 (16), 3407 (2016).</li><li>Hirota, M., 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=Pancreatectomy+using+the+no-touch+isolation+technique+followed+by+extensive+intraoperative+peritoneal+lavage+to+prevent+cancer+cell+dissemination:+A+pilot+study.">Pancreatectomy using the no-touch isolation technique followed by extensive intraoperative peritoneal lavage to prevent cancer cell dissemination: A pilot study.</a> Journal of the Pancreas. 6 (2), 143-151 (2005).</li><li>Shen, Z., 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=Laparoscopic+pancreatoduodenectomy+for+pancreatic+cancer+using+in-situ+no-touch+isolation+technique.">Laparoscopic pancreatoduodenectomy for pancreatic cancer using in-situ no-touch isolation technique.</a> Journal of Visualized Experiments. (180), e63450 (2022).</li><li>Tan, Z. J., 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=Clinical+experience+of+laparoscopic+pancreatoduodenectomy+via+orthotopic+resection.">Clinical experience of laparoscopic pancreatoduodenectomy via orthotopic resection.</a> Zhonghua Wai Ke Za Zhi. 58 (10), 782-786 (2020).</li><li>Nagakawa, Y., 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=Surgical+approaches+to+the+superior+mesenteric+artery+during+minimally+invasive+pancreaticoduodenectomy:+A+systematic+review.">Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review.</a> Journal of Hepatobiliary Pancreatic Sciences. 29 (1), 114-123 (2022).</li><li>Hermanek, P., Wittekind, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+tumor+(R)+classification+and+prognosis.">Residual tumor (R) classification and prognosis.</a> Seminars in Surgical Oncology. 10 (1), 12-20 (1994).</li><li>Chu, A. J., 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=Dual-source+dual-energy+multidetector+CT+for+the+evaluation+of+pancreatic+tumours.">Dual-source dual-energy multidetector CT for the evaluation of pancreatic tumours.</a> The British Journal of Radiology. 85 (1018), 891-898 (2012).</li><li>Mao, G. -. Q., 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=The+application+value+of+spectral+imaging+in+diagnosis+of+pancreatic+adenocarcinoma+by+dual+source+CT.">The application value of spectral imaging in diagnosis of pancreatic adenocarcinoma by dual source CT.</a> Journal of Medical Imaging. 26 (07), 1243-1246 (2016).</li><li>Higgs, A., 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=Guidelines+for+the+management+of+tracheal+intubation+in+critically+ill+adults.">Guidelines for the management of tracheal intubation in critically ill adults.</a> British Journal of Anaesthesia. 120 (2), 323-352 (2018).</li><li>Schultz, A., 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=Comparison+of+Narcotrend+Index,+Bispectral+Index,+spectral+and+entropy+parameters+during+induction+of+propofol-remifentanil+anaesthesia.">Comparison of Narcotrend Index, Bispectral Index, spectral and entropy parameters during induction of propofol-remifentanil anaesthesia.</a> Journal of Clinical Monitoring and Computing. 22 (2), 103-111 (2008).</li><li>Cole, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Problems+in+operability.">Problems in operability.</a> The Ulster Medical Journal. 23 (2), 102-116 (1954).</li><li>Liu, K. J., Zhao, X. X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+tumor-free+technique+in+laparoscopic+surgery+for+malignant+tumors.">Application of tumor-free technique in laparoscopic surgery for malignant tumors.</a> Chinese Journal of Laparoscopic Surgery. 11 (01), 17-19 (2018).</li><li>Osada, S., 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=Reconstruction+method+after+pancreaticoduodenectomy.+Idea+to+prevent+serious+complications.">Reconstruction method after pancreaticoduodenectomy. Idea to prevent serious complications.</a> Journal of the Pancreas. 13 (1), 1-6 (2012).</li><li>Li, M. Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+practice+guidelines+for+the+interventional+treatment+of+advanced+pancreatic+carcinoma+(on+trial)+(6th+edition).">Clinical practice guidelines for the interventional treatment of advanced pancreatic carcinoma (on trial) (6th edition).</a> Journal of Clinical Hepatology. 38 (06), 1242-1251 (2022).</li><li>Sugiyama, M., 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=Vascular+anatomy+of+mesopancreas+in+pancreatoduodenectomy+using+an+intestinal+derotation+procedure.">Vascular anatomy of mesopancreas in pancreatoduodenectomy using an intestinal derotation procedure.</a> World Journal of Surgery. 44 (10), 3441-3448 (2020).</li><li>Zhu, C. -. F., 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=Novel+morphological+classification+of+the+normal+pancreatic+uncinate+process+based+on+computed+tomography.">Novel morphological classification of the normal pancreatic uncinate process based on computed tomography.</a> Journal of International Medical Research. 48 (9), 300060520957453 (2020).</li></ol>

随着肠道的旋转，腹侧胰腺向背侧翻转，并在人类胚胎的整个发育过程中与背侧胰腺结合，腹侧胰腺也生长到胰头下部和钩突1。胰腺钩突被描述为位于 SMA 和 SMV 后面的胰头左下角的突出物1. 
同时，胰系膜围绕SMA旋转成螺旋状，同时肠旋转20。由于IPDA和IPDV起源于SMA和SMV的后部区域，由于肠系膜血管轴的旋转，它们的长度?...

胰钩突是胰头左下角的突起，位于 SMA 和肠系膜上静脉 （SMV） 后面1。钩突的管理是胰腺手术中一个具有挑战性的领域，因为它具有深厚的解剖结构和具有挑战性的暴露;因此，特别是对于位于钩突的胰腺癌，手术容易导致手术切缘阳性、淋巴结清扫不全和预后不良2.因此，迫切需要改进手术技术和策略。
胰头和钩突的大多数切除手术都是沿着 SMV 和 SMA3 的右侧进行的。虽然这种方法主要适用于壶腹肿瘤，但它对胰头癌也有缺点，特别是对于钩状突中的大肿瘤2。在此过程中，经常需要旋转和拉动 SMV 和 SMA 以暴露它们。使用这种方法无法清楚地解剖 IPDA，这通常会导致出血或该区域清洁不足。在这项工作中，作者描述了一种可以支持IPDA早期控制的方法，该方法可以更好地控制出血，减少失血，并更好地解剖钩突。
同时，传统的剖腹手术或腹腔镜胰十二指肠切除术需要 Kocher 操作来广泛动员十二指肠和胰头4。然而，通过这种操作，肿瘤细胞具有通过门静脉 （PV） 转移的潜在能力，因为外科医生可能会在手术过程中握住肿瘤时挤压肿瘤 4,5,6。非接触式隔离技术是胰十二指肠切除术中流行的概念之一。虽然尚未通过大型临床试验证明这种手术干预是否可以增强胰腺癌患者的癌症相关预后，但 Hirota 等人的研究 7 报道了非接触技术通过使用分子标记物 （CEA mRNA） 检测门静脉血液中的癌细胞来预防癌细胞转移的重要性。在他们的研究中，与传统技术组相比，非接触技术组的门静脉癌细胞扩散率较低，3 年生存率较高。目前作者的团队先前已经报道了非接触式LPD是符合“无肿瘤”原则的理想肿瘤手术过程8,9。
本文介绍了非接触式LPD中钩骨过程的管理。对 SMA 进行正中前和左后入路以精确处理 IPDA。为了实现LPD的非接触式隔离技术，必须在手术的早期阶段切断十二指肠和胰头的血液供应，之后可以完整地分离肿瘤， 原位切除，最后 整体切除。
该策略的目的和优点是确保基于多角度动脉入路的钩突和胰系膜的安全和完全切除10。本文旨在探讨该技术在非接触式 LPD 中治疗钩突的疗效和安全性，这可能会提高 R0 切除率11。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3D Laparoscope</td>
			<td>STORZ</td>
			<td>TC200,TC302</td>
			<td></td>
		</tr>
		<tr>
			<td>Cisatracurium Besylate Injection</td>
			<td>Hengrui Pharma</td>
			<td>H20183042</td>
			<td></td>
		</tr>
		<tr>
			<td>Dual-source dual-energy&#160; CT</td>
			<td>SOMATOM</td>
			<td>Definition FLASH</td>
			<td></td>
		</tr>
		<tr>
			<td>Echelon Flex Powered Plus Articulating Endoscopic Linear Cutter and Endopath Echelon Endoscopic Linear Cutter Reloads with Gripping Surface Technology</td>
			<td>Ethicon Endo-Surgery</td>
			<td>ECR60G/GST60G</td>
			<td></td>
		</tr>
		<tr>
			<td>ENDOPATH XCEL Trocars</td>
			<td>Johnson &#38; Johnson</td>
			<td>CB5LT/CB12LT</td>
			<td></td>
		</tr>
		<tr>
			<td>HARMONIC ACE Ultrasonic Surgical Devices</td>
			<td>Ethicon Endo-Surgery</td>
			<td>HAR36</td>
			<td></td>
		</tr>
		<tr>
			<td>Laparoscopic bulldog clamps</td>
			<td>Aesculap</td>
			<td>FB367R,FB369R</td>
			<td></td>
		</tr>
		<tr>
			<td>Ligating Clips</td>
			<td>Teleflex Medical</td>
			<td>5,44,22,05,44,23,05,44,000</td>
			<td></td>
		</tr>
		<tr>
			<td>Nacrotrend anaesthesia monitoring system&#160;</td>
			<td>Monitor Technik,Bad Bramsted</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>PROLENE Polypropylene Nonabsorbable Suture/5/0</td>
			<td>Johnson &#38; Johnson</td>
			<td>W8556</td>
			<td></td>
		</tr>
		<tr>
			<td>Propofol Injectable Emulsion</td>
			<td>Aspen Pharma Trading Limited</td>
			<td>H20171275</td>
			<td></td>
		</tr>
		<tr>
			<td>Remifentanil Hydrochloride for injection</td>
			<td>Humanwell Healthcare</td>
			<td>H20030197</td>
			<td></td>
		</tr>
		<tr>
			<td>Sevoflurane for Inhalation</td>
			<td>Hengrui Pharma</td>
			<td>H20070172</td>
			<td></td>
		</tr>
		<tr>
			<td>Sufentanil Citrate Injecton</td>
			<td>Humanwell Healthcare</td>
			<td>H20054171</td>
			<td></td>
		</tr>
		<tr>
			<td>Trocars</td>
			<td>AOFO</td>
			<td>FQ-D1/5.5mm 10.5mm</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasonic Surgical &#38; Electrosurgical Generator</td>
			<td>Ethicon Endo-Surgery</td>
			<td>GEN11CN</td>
			<td></td>
		</tr>
	</tbody>
</table>

management of the uncinate process in no-touch laparoscopic pancreaticoduodenectomy

腹腔镜胰十二指肠切除术 （LPD） 是一项要求苛刻的腹部手术，需要细致的手术技巧和团队合作。胰腺钩突的管理是LPD中最重要和最困难的过程之一，因为它的解剖位置很深，暴露困难。完全切除钩突和胰系膜已成为LPD的基石。特别是，当肿瘤位于钩突时，更难避免手术切缘阳性和淋巴结清扫不完全。非接触式LPD是符合“无肿瘤”原则的理想肿瘤手术过程，我们小组之前已经报道过。本文介绍了非接触式LPD中钩骨过程的管理。在多角度动脉入路的基础上，在该方案中，采用SMA的正中前和左后入路正确处理重要的血管结构，即胰十二指肠下动脉（IPDA），以确保钩突和胰系膜的安全完全切除。为了在LPD中实现非接触式隔离技术，必须在手术的早期阶段切断胰头和十二指肠区域的血液供应;之后，可以完整地分离肿瘤，可以 原位切除，最后，可以 整体切除组织。本文旨在展示在非接触式LPD中管理钩状过程的独特方法，并研究这种方法的可行性和安全性。此外，该技术可能会提高 R0 切除率。

一名男性患者，59岁，出现上腹痛、黄疸等症状，在我科住院。他既往无病史，体重指数相对适中（23.94 kg/m2）。进行对比增强CT扫描，在胰腺头部和钩突处发现直径约为5.5 cm x 4.6 cm x 6.3 cm的肿瘤（图10）。未发现远处转移的证据，术前行经皮经肝胆管引流19 。总胆红素从201.4 μmol/mL下降到36.0 μmol/mL。
代表性结果如 表1所示?...

Watch this Scientific Journal Video about Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy at JoVE.com

Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy

完全切除钩突和胰系膜是腹腔镜胰十二指肠切除术（LPD）中最重要和最困难的过程之一。本文介绍了一种使用肠系膜上动脉 （SMA） 的正前和左后入路管理非接触式 LPD 钩突的方法。

非接触式腹腔镜胰十二指肠切除术中未接触突的管理

Laparoscopic pancreatoduodenectomy (LPD) is a demanding abdominal operation that necessitates meticulous surgical skills and teamwork. The management of ...

当肿瘤位于钩突时，避免手术切缘阳性和淋巴结清扫不完全是非常具有挑战性的。本研究介绍了非接触式腹腔镜胰十二指肠切除术中钩突的管理。该策略的优点是确保基于多角度动脉入路的钩突和胰系膜的安全和完全切除。这种技术可能会提高R-零切除率。在开始外科手术之前，检查腹膜表面和腹膜内器官是否有潜在的胰腺外转移。通过去除大网膜获得更好的曝光。然后切断胃结肠韧带以打开小囊。使用超声波刀解剖胆囊三角形。切除并切断胆囊动脉和胆囊管。然后切除胆囊并悬浮肝脏。暴露肝十二指肠韧带和肝门。检查胰颈和肠系膜上静脉之间的间隙，以评估手术切除的可能性。将横结肠及其肠系膜悬吊在头侧，以建立足够的暴露。以回结肠动脉为标志物，打开横结肠系膜，保护回结肠和中结肠动脉。暴露十二指肠的第二节和第三节。然后，沿肠系膜上静脉右侧解剖，将十二指肠的第二段和第三节与横系膜结肠分开。暴露肠系膜上静脉的主干和肠系膜上静脉和肠系膜上动脉之间的近端背空肠静脉。然后，解剖结扎的胰十二指肠下静脉。要对肠系膜上动脉进行正中前入路，请将肠系膜上静脉向右拉并扩大手术野。暴露肠系膜上动脉搏动以确定其轨迹。暴露肠系膜上动脉的右半部。然后，在右前缘肠系膜上动脉的动脉鞘外解剖，将其与胰腺系膜系膜分离。接下来，沿肠系膜上动脉右侧暴露胰十二指肠下动脉或空肠动脉的主要分支。进行左后入路。将小肠放在右侧，在十二指肠第四节和下腔静脉之间留出空间。然后，解剖融合筋膜，露出左肾静脉，建立肠系膜上动脉的后部空间。使用超声手术刀，仔细解剖空肠起始部分和横结肠肠系膜之间的Treitz韧带。然后，使用吻合器将近端空肠分开。接下来，放置一根 FR8 导管，悬吊肠系膜上动脉和肠系膜上静脉的背侧。将导管拉到右上方，在肠系膜上动脉的左后侧形成足够的暴露空间。这有利于左前缘周围平面上的动脉夹层，以及其与胰系膜的分离。沿第一空肠动脉追踪肠系膜上动脉至根部。在左前缘的外膜周围平面上解剖肠系膜上动脉，将其与胰腺系膜系膜分离。然后，环形夹层肠系膜上动脉。解剖结扎的胰十二指肠下动脉。如果第一空肠动脉受累于肿瘤，则将其处死。将肠系膜上动脉和肠系膜上静脉与钩突和胰系膜中完全分离。要返回结肠上区，请从肠系膜上动脉背侧向右拉出近端空肠。使用超声刀，显示右侧胃肠道静脉、侧支右侧结肠静脉和肠系膜上静脉干。接下来，暴露 Henle 的胃结肠主干静脉，断开其在肠系膜上静脉干右侧的远端和近端。然后，使用吻合器装置，将胃分开，距离幽门三到五厘米。暴露胰颈上缘的肝总动脉。沿肝总动脉向第一肝门解剖，以显示正确的肝动脉和右侧胃动脉。然后，切断结扎的右胃动脉。使用腹腔镜斗牛犬夹，暂时闭塞分离的胆总管。然后，解剖肝十二指肠韧带。沿肝总动脉、门静脉和适当的肝动脉进行淋巴结清扫术。最后，解剖结扎的右胃动脉。接下来，将胃十二指肠动脉定位在肝右动脉和肝总动脉的交界处。小心地用 5-0 缝合线或结扎线绑扎胃十二指肠动脉，以降低糜烂或出血的风险。探索胰颈和肠系膜上静脉之间的隧道。解剖结扎的胰背动脉。放置两根 FR14 导管以阻断胰颈血供应以减少出血。用剪刀解剖胰颈的实质。用 5-0 缝合线缝合切除面的出血点。结扎并解剖肠系膜上静脉的左第一分支后，悬吊脾静脉以建立暴露。解剖脾静脉后面结扎的钩突动脉。然后，识别并保留源自钩突动脉肠系膜上动脉的右肝另一动脉。最后，解剖结扎门静脉的分支。使用Kocher动作，切断淋巴管并从腹膜后解剖十二指肠。原位切除肿瘤，并按照非接触的肿瘤学原则将其整体切除。使用 Childs 方法重建消化道。使用 4-0 可吸收缝合线从头到侧进行单层缝合肝空肠吻合术。然后，使用内部支架进行导管到粘膜、端到端的胰空肠吻合术 对患者进行的对比增强 CT 扫描显示头部有肿瘤，胰腺钩突 组织病理学结果证实胰腺导管内状粘液性肿瘤伴局灶性中分化浸润性腺癌。重要的是要记住，胰头和十二指肠区域的血液供应必须在手术的早期切断。之后，可以完整地分离肿瘤，并可以原位进行切除。

Research

JoVE Journal

Medicine

Surgical Management of Meatal Stenosis with Meatoplasty

管理与Meatoplasty尿道外口狭窄的外科治疗

Meatal stenosis is a common urologic complication after circumcision.  Children present to their primary care physicians with complaints of deviated ...

科研

医学

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

利用视觉和叙事方法，以实现公平的进程中，在临床护理

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

呼吸控制电气的刺激（BreEStim）的神经性疼痛和痉挛的管理

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

Modified Single-Loop Reconstruction for Pancreaticoduodenectomy

胰腺切除术的改性单循环重建

Modified single-loop reconstruction in pancreaticoduodenectomy separates pancreatic secretion from bile. It is performed in cases of high-risk pancreatic ...

The Dyspepsia Educational Tool As a Novel Aid in Dyspepsia Management

消化不良教育工具作为消化不良管理中的一种新帮助

Digital educational tools have a well-established role in current healthcare. In particular, disorders that are managed non-pharmacologically benefit from ...

Technical Detail for Robot Assisted Pancreaticoduodenectomy

机器人辅助胰腺切除术的技术细节

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique

使用改进的非接触技术在前臂中创建放射性头动静脉瘘

Autologous arteriovenous fistula (AVF) is the primary and best option to obtain vascular access for hemodialysis treatment; other options are ...

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

腹腔镜胰十二指肠切除术使用原 位 非接触式隔离技术治疗胰腺癌

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic ...

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse

腹腔镜非网片环扎胸肌固定术治疗盆腔器官脱垂

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore ...

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉 入路治疗 胰腺颈体癌

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who ...