B型超声胎囊定位吸引刮宫200例分析

为探索早孕胎囊好发的着床部位,进一步提高人流手术质量,减少并发症,本文对200例早孕妇女于人流术前常规进行B型超声(以下简称B超)胎囊定位与对照组200例术前未进行胎囊定位者比较。定位组人流术时出血量减少、手术时间短,人流综合反应发生率显著下降,200例中一例空刮,空刮率0.5％;未定位组200例中空刮5例、空刮率2.5％,经手术核实,胎囊定位准确率99.5％。本文对以上结果进行了讨论。     

贲门区癌可手术切除的相关X线征象

为探讨贲门癌的 X线征象在病变范围的确定及评估手术可能性中的价值 ,收集 10 6例采用双对比检查并经手术及病理证实的贲门癌 ,对其 X线表现与手术、病理所见进行对照分析。结果 :10 6例中 ,90例行开腹探查术 (其中病变切除 70例 ,未能手术切除 2 0例 ) ,16例因失去探查机会而采用非手术疗法。提示 :贲门癌的有些 X线征象在决定能否手术切除具有重要的意义。     

肾移植术后B超检查的价值(附42例报告)

本文通过42例移植肾患者的B超检查,根据移植肾术后的体积大小、肾孟积水,肾周积液等,着重讨论了各自的图象特点。认为术后进行B超动态观察,可及时发现移植肾的排异反应及手术合并症的发生,对临床诊断和及时治疗具有重要价值。     

经Quadrant通道椎管内肿瘤切除与传统半椎板椎管内肿瘤切除术的对比研究

目的对比分析经Quadrant通道显微镜下椎管内肿瘤切除与传统显微手术椎管内肿瘤切除的手术相关指标和疗效。方法回顾自2013年7月至2015年7月本院33例病变长度小于5cm的椎管内肿瘤患者,其中16例接受经Quadrant通道显微镜下椎管内肿瘤切除,另外17例接受传统半椎板椎管内肿瘤切除。比较两组患者相关指标,包括手术切口长度、手术时间、术中出血量、术后首次下地活动时间、术后住院时间、术后1周视觉疼痛模拟(VAS)评分、JOA评分治疗改善率等。结果与传统手术相比,Quadrant通道手术组患者在手术切口长度、术中出血量、术后首次下地活动时间、术后住院时间、术后1周视觉疼痛模拟(VAS)评分等方面均优于传统组(P<0.05)。结论经Quadrant通道显微镜下椎管内肿瘤切除术具有创伤小、出血少、恢复快、疗效肯定的优点,是一种安全有效的治疗椎管内较小肿瘤的方法。     

术中放射治疗的麻醉过程及其监测

恶性肿瘤特别是中晚期癌症的术中放疗技术及其效果已成为当今癌症的治疗热点．国外开展此项技术已有30余年的历史，而我国只有5年多。我院于1996年11月至今共施行术中放疗手术33例．现将其麻醉管理体会报告如下．资料和方法一般资料本组33N中，男14例，女19例，年龄27～64岁，平均51．6岁．腹部手术26例，其中胃癌3例，胰腺癌根治术6例，宫颈癌根治术17例，外阴癌切除1倒．普胸手术6例，其中全肺切除3例，肺叶切除3例，全部为中晚期肺癌．麻醉方法全胃切除或腹部难度大的手术及开胸手术选用气管内插管静吸复合麻醉，用上海SC－M3A型麻醉机…     

58例达芬奇机器人系统辅助肺部手术的临床分析

目的探讨及总结采用达芬奇机器人系统行肺部手术的初期经验。方法回顾性收集西安交通大学第一附属医院胸外科行达芬奇机器人手术系统辅助肺部手术病例的临床资料并进行统计分析。结果 2016年3月-2017年11月我院应用达芬奇机器人系统行肺部手术58例,其中男42例,女16例,年龄25～79(59±11)岁。所有病例均顺利完成机器人手术,包括肺叶切除41例,肺段切除7例,肺楔形切除6例,肺袖式切除2例,联合肺段切除、楔形+肺段各1例;术后病理诊断为良性病变17例,肺癌41例;手术时间分别为,肺叶切除(169.93±66.88)min,肺段切除(165.43±56.37)min;术中清扫淋巴结5～26(15.1±8.7)枚;术后留置胸腔引流管2～15(6.0±2.6)d,术后住院时间2～21(7.95±3.23)d。除1例患者出现支气管胸膜瘘接受二次手术外,余均无严重术后并发症,顺利出院。患者住院期间总费用为32 015.57～127 087.89(78 483.19±15 925.18)元。结论达芬奇机器人系统辅助肺部手术在具有丰富常规胸腔镜手术经验的医疗中心可顺利开展,其效果安全、可行,并且在一些复杂操作中具有优势,但是相对昂贵的费用是限制其使用的一个重要因素。     

钼靶X线导丝定位活检诊断T0期乳腺癌

目的探讨钼靶X线导丝定位下乳腺活检对临床T0期乳腺癌的诊断价值。方法25例钼靶X线乳腺摄片显示有结节或有恶性可能的乳腺结构紊乱、簇状钙化灶而临床不能触及肿块的患者,手术活检前2 h在钼靶X线引导下行乳腺病灶细导丝定位,然后在局麻下行病灶活检。结果25例均一次性定位成功,手术顺利。病理示乳腺癌8例,纤维腺瘤4例,乳腺增生症8例,导管内乳头状瘤2例,慢性炎症1例,囊肿1例,脂肪坏死1例。乳腺癌检出率为32.0%,诊断准确率100%。结论钼靶X线导丝定位下乳腺活检,定位准确,诊断明确,能确定乳腺微小病变的性质,提高T0期乳腺癌的诊断率。     

胸壁结核术后复发15例分析

胸壁结核是青少年多发的一种继发性疾病 ,自1 981年～ 1 997年间 ,我院共收治胸壁结核术后复发病人 1 5例。本文对其复发原因进行分析和探讨 ,并提出了避免复发的方法和体会。1　临床资料1 5例患者中 ,男 9例 ,女 6例 ;年龄 1 0～ 51岁。复发至前次手术时间 2周至 1 6个月。其中合并寒性脓肿 6例 ,有瘘道者 1 0例 ,包裹性脓胸 1例。前次手术术后服用抗结核药物小于 3月者 9例 ,3～ 6个月者 4例 ,6个月以上者 2例。本组病人在正规抗结核治疗两周后 ,全部进行了手术治疗。手术均采用气管插管麻醉。行病灶彻底清除术 1 4例 ,行局限性胸部改良术…     

冠状动脉内球囊扩张式支架的临床应用

报告我院１９９５年临床应用８例冠脉内球囊扩张式支架的经验，全部手术成功，狭窄血管病变由平均９０％扩张至－１０％，随访无合并症，讨论了支架适应症选择、支架植入术操作技巧、术后抗凝治疗和随访观察。     

95例卵巢肿瘤的B超诊断

<正> 卵巢肿瘤临床检查方法甚多,由于B超检查无损伤、操作简便,快速可靠,已成为目前妇科卵巢肿瘤的主要诊断方法。现就我院1982～1986年间卵巢肿瘤经B超检查,手术病理证实的95例报告如下。本文95例卵巢肿瘤中。年龄最小15岁,最大67岁,平均年龄41岁。全部病例检查时常规采用膀胱充盈     

Diagnosis and excision of breast multi-focal lesions by ultrasound-guided vacuum-assisted biopsy: a comparative evaluation

Objective To compare and evaluate the efficacy of diagnosis and excision for appropriately selected breast multi-focal lesions and solitary lesion by ultrasound-guided vacuum-assisted biopsy (UGVAB). Methods Among 392 appropriately selected patients, 187 patients with multi-focal lesions and 205 patients with solitary lesion were treated by the 8-gauge UGVAB from May 2007 to June 2009. All lesions were removed as completely as possible. The patients with benign pathology underwent physical and ultrasound examinations at one week and 6 months after procedure. Results During the procedure, only three patients had vasovagal syncope and twenty others complained of other intraoperative discomfort. An accurate pathological diagnosis was obtained in all lesions. There was no apparent false-negative result among the 696 lesions with benign pathology at a follow-up of 6 months after procedure. The rates of malignant or premalignant pathology, postoperative complications and residual lesions in patients with multi-focal lesions were higher than those in patients with solitary lesion. If each lesion was considered as a subject of study, there was no significant difference between the two groups. Conclusion UGVAB is an effective method for diagnosis and excision of appropriately selected breast multi-focal lesions and can be used routinely.     

Monitoring Thermal Coagulation with Ultrasonic Textures

The feasibility of using B-mode ultrasound image textures and pattern recognition technique to characterize the thermal coagulation in vitro during radiofrequency ablation was investigated. The changes of ultrasonic textures in the different regions of samples varied with the heating time in the in-vitro experiments, which would result in that the coagulated and noncoagulated regions of tissue had different ultrasonic textures. Using support vector machine to extract the ultrasonic texture features and characterize the state of tissue, the size and boundaries of thermal lesions could be detected and measured more exactly than only using the gray scale information of B-mode ultrasound image. The proposed method would be applied to the image-guided radiofrequency ablation (IGRA) procedure for monitoring the thermal coagulation.     

Effects of Dynamic Changes in Ultrasound Attenuation and Blood Perfusion on Lesion Formation of Multiple-focus Pattern during Ultrasound Surgery

A nonlinear finite-element program was developed to simulate the dynamic evolution of coagulation in tissue considering temperature and thermal-dose dependence of the ultrasound attenuation and blood perfusion rate.The effects of these dynamic parameters on the lesion formation were investigated in the particular case of ultrasound hepatic ablation with bi-focus intensity pattern.The results of simulations were compared that incorporate dynamic changes of ultrasound attenuation and perfusion and results that neglect these effects.The result shows that thermal-dose-dependent ultrasound attenuation is the dominating factor in the full dynamic model.If the dynamic ultrasound attenuation is ignored, a relatively significant underestimation of the temperature rise appears in the focal plane and the region next to the focal plane, resulting in an underestimation in predicting diameter of coagulation.Higher heating intensity leads to greater underestimation.     

Depth Camera-Based Robot-Assisted Ultrasonic Lipolysis System

With many advantages such as non-invasive,safe and quick effect,focused ultrasound lipolysis stands out among many fat-removing methods.However,during the whole process,the doctor needs to hold the ultra-sound transducer and press it on the patient's skin with a large pressure for a long time;thus the probability of muscle and bone damage for doctors is greatly increased.To reduce the occurrence of doctors' occupational diseases,a depth camera-based ultrasonic lipolysis robot system is proposed to realize robot-assisted automatic ultrasonic lipolysis operation.The system is composed of RealSense depth camera,KUKA LBR Med seven-axis robotic arm,PC host,and ultrasonic lipolysis instrument.The whole operation includes two parts:preoperative planning and intraoperative operation.In preoperative planning,the treatment area is selected in the camera image by the doctor;then the system automatically plans uniformly distributed treatment points in the treat-ment area.At the same time,the skin normal vector is calculated to determine the end posture of the robot,so that the ultrasound transducer can be pressed down in the normal direction of skin.During the intraoperative operation,the robot is controlled to arrive at the treatment point in turn.Meanwhile,the patient's movement can be detected by the depth camera,and the path of robot is adjusted in real time so that the robot can track the movement of patient,thereby ensuring the accuracy of the ultrasonic lipolysis operation.Finally,the human body model experiment is conducted.The results show that the maximum error of the robot operation is within 5 mm,average error is 3.1 mm,and the treatment points of the robot operation are more uniform than those of manual operation.Therefore,the system can replace the doctor and achieve autonomous ultrasonic lipolysis to reduce the doctor's labor intensity.     

肺吸虫病神经系统损害的临床及脑电图

作者总结了20例肺吸虫病神经系统损害的临床及其脑电图变化,神经系统受损者占同期肺吸虫病的30.3%。同时具有肺部、及皮下或肌肉的结节,临床表现有头痛、偏瘫、失语、癫痫发作,蛛网膜下腔出血,多颅神经损害,截瘫等。脑损害者脑电图异常率高达95.45%,病变范围及异常程度不一,以脑实质受损者重,脑膜受损者较轻。局限性肉芽肿形成的脑电图显示局灶性异常,动态观察脑电图变化可推测其病变的转归,对判断病情及有无脑损害有一定价值。     

肝硬化合并食道静脉曲张破裂出血危险因素的研究

本研究目的在于探索导致肝硬化食道静脉出血的各种危险因素。病例来源于我院1983～1985年收治的部分门脉性肝硬化合并食道静脉曲张患者共100例,按其是否伴有食道静脉曲张出血分为出血组和非出血组各50例,对导致出血的各种危险因素进行了回顾性调查。最后本文提出了引起静脉曲张出血的始发危险因素是门脉高压的程度;门静脉游离压>3.49Kpo,或B超探测门静脉(总干)直径>1.9cm,脾静脉(脾门处)>1.3cm。促发因素;男性,年龄>40岁,合并肺部感染,脾功能亢进(血色素<70g/L,白细胞计数<5×10~9/L,血小板<60×10~9/L)。具备上述始发危险因素二项和促发危险因素二项以上的食道静脉曲张患者,提示出血高度可能性。建议用B型超声探测门静脉、脾静脉和肠系膜上静脉直径作为判断门静脉压的一种手段,可使肝硬化患者避免导管检测或食道镜检查带来的危险和不便。     

Application of Deep Learning Method on Ischemic Stroke Lesion Segmentation

Although deep learning methods have been widely applied in medical image lesion segmentation,it is still challenging to apply them for segmenting ischemic stroke lesions,which are different from brain tumors in lesion characteristics,segmentation difficulty,algorithm maturity,and segmentation accuracy.Three main stages are used to describe the manifestations of stroke.For acute ischemic stroke,the size of the lesions is similar to that of brain tumors,and the current deep learning methods have been able to achieve a high segmentation accuracy.For sub-acute and chronic ischemic stroke,the segmentation results of mainstream deep learning algorithms are still unsatisfactory as lesions in these stages are small and diffuse.By using three scientific search engines including CNKI,Web of Science and Google Scholar,this paper aims to comprehensively understand the state-of-the-art deep learning algorithms applied to segmenting ischemic stroke lesions.For the first time,this paper discusses the current situation,challenges,and development directions of deep learning algorithms applied to ischemic stroke lesion segmentation in different stages.In the future,a system that can directly identify different stroke stages and automatically select the suitable network architecture for the stroke lesion segmentation needs to be proposed.     

Criteria of human-computer interface design for computer assisted surgery systems

In recent years, computer assisted surgery (CAS) systems become more and more common in clinical practices, but few specific design criteria have been proposed for human-computer interface (HCI) in CAS systems. This paper tried to give universal criteria of HCI design for CAS systems through introduction of demonstration application, which is total knee replacement (TKR) with a nonimage-based navigation system. A typical computer assisted process can be divided into four phases: the preoperative planning phase, the intraoperative registration phase, the intraoperative navigation phase and finally the postoperative assessment phase. The interface design for four steps is described respectively in the demonstration application. These criteria this paper summarized can be useful to software developers to achieve reliable and e?ective interfaces for new CAS systems more easily.     

彩色多普勒超声在动态监测移植肝及其并发症中的应用

目的探讨彩色多普勒超声在动态监测肝移植术后血流动力学变化及并发症诊治中的应用价值。方法回顾我中心107例原位肝移植术后应用彩色多普勒超声资料,汇总后行统计学分析。结果肝移植术后早期门脉流速较正常对照组升高,而肝动脉流速降低,后逐渐恢复正常。107例中发现肝动脉血栓形成2例(1.87%),肝动脉狭窄5例(4.67%),门脉血栓形成3例(2.80%),肿瘤复发7例(6.54%),诊断为急性排斥反应18例次(16.82%),慢性排斥反应10例次(9.34%),胸腔积液105例(98.13%),腹腔积液65例(60.74%),假性动脉瘤1例,胰漏1例,胆道感染4例(3.74%),胆道狭窄4例(3.74%),胆漏5例(4.67%),胆总管结石1例。结论彩色多普勒超声在动态监测肝移植术后血流动力学变化及并发症诊治中具有重要的临床意义。