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Application of preoperative registration and automatic tracking technique for image-guided maxillofacial surgery 图像引导颌面外科手术术前配准与自动跟踪技术的应用
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1187767
Wenbin Zhang, Xudong Wang, Jianfei Zhang, G. Shen
Abstract Objective: To investigate the practicality of preoperative registration technique in navigational surgery of facial skeleton. Methods: Five cases were underwent navigational surgery with the preoperative registration technique. The accuracy of registration process was determined, and the deviation between planning model and postoperative computed tomography (CT) model was detected. Results: In each case, the preoperative registration was successful for navigational surgery. Preoperative registration and automatic tracking enabled registration free in the operation procedure. The registration precision measured by the system was less than 0.8 mm. The deviation between the intraoperative anatomy and the CT image was less than 1.5 mm. Conclusions: Preoperative registration technique demonstrates the potential for improved workflow and accuracy in navigational surgery procedures. This technique was found to be particularly advantageous in cases of mandible navigational surgery in which the dynamic reference frame's hard to be fixed.
摘要目的:探讨面骨导航手术术前配准技术的实用性。方法:采用术前定位技术对5例患者行导航手术。确定配准过程的准确性,检测计划模型与术后CT模型之间的偏差。结果:所有病例的术前登记均顺利进行导航手术。术前登记和自动跟踪,使登记在手术过程中免费。系统测量的配准精度小于0.8 mm。术中解剖与CT图像偏差小于1.5 mm。结论:术前登记技术显示了在导航手术过程中改善工作流程和准确性的潜力。这项技术被发现是特别有利的情况下,下颌骨导航手术中,动态参考框架难以固定。
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引用次数: 8
Flexible robotic endoscopy: current and original devices 柔性机器人内窥镜:当前和原始设备
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1242654
K. Kume
Abstract Two current major research topics concern the incorporation of flexible robotic endoscopy systems developed for natural-orifice translumenal endoscopic surgery (NOTES), primarily for the purpose of remote forceps operation, into endoscopic submucosal dissection (ESD) and other flexible endoscopic treatments and the use of robots for the manipulation of flexible endoscopes themselves with the aim of enabling the remote insertion of colonoscopes, etc. However, there are still many challenges that remain to be addressed; the ideal robotic endoscope has not yet been realized. This article reviews the ongoing developments and our own efforts in the area of flexible robotic endoscopy.
目前的两个主要研究课题是将用于自然口腔内内镜手术(NOTES)的柔性机器人内镜系统(主要用于远程钳操作)与内镜下粘膜剥离(ESD)和其他柔性内镜治疗相结合,以及利用机器人操纵柔性内窥镜本身以实现远程结肠镜插入等。然而,仍有许多挑战有待解决;理想的机器人内窥镜尚未实现。本文综述了柔性机器人内窥镜领域的最新进展和我们自己的努力。
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引用次数: 17
Effect of soft-tissue impingement on range of motion during posterior approach Total Hip Arthroplasty: an in vivo measurement study 后路全髋关节置换术中软组织撞击对活动范围的影响:一项体内测量研究
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1223347
N. Nakamura, Y. Maeda, M. Hamawaki, T. Sakai, N. Sugano
Abstract Purpose: While implant impingement and bony impingement have been recognized as causes of poor outcomes in total hip arthroplasty (THA), reports of soft-tissue impingement are rare. To clarify the issue, the effect of anterior capsule resection on hip range of motion (ROM) was quantitatively measured in vivo during posterior approach THA using a CT-based hip navigation system. Materials and methods: For 47 patients (51 hips), hip ROM was measured intraoperatively before and after resection of the anterior hip capsule, and the difference was compared. Results: Resection of the anterior hip capsule brought about an average 6° increase of ROM in the direction of flexion with internal rotation and did not markedly change ROM in other directions. Conclusions: During THA through a posterior approach, soft-tissue impingement by the anterior hip capsule can occur. Clinically, we expect that resection of the anterior hip capsule can reduce the risk of posterior instability without increasing the risk of anterior instability.
摘要目的:虽然假体撞击和骨撞击被认为是全髋关节置换术(THA)预后不良的原因,但软组织撞击的报道很少。为了澄清这个问题,使用基于ct的髋关节导航系统在体内定量测量了后路THA期间前囊切除术对髋关节活动范围(ROM)的影响。材料与方法:对47例患者(51髋)进行术中髋关节前囊切除术前后的ROM测量,并比较其差异。结果:切除髋关节前囊可使屈曲内旋方向ROM平均增加6°,其他方向ROM无明显改变。结论:经后路髋关节置换术时,可能发生髋前囊的软组织撞击。临床上,我们期望切除髋关节前囊可以在不增加前路不稳定风险的情况下降低后路不稳定的风险。
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引用次数: 5
Simulation of multi-probe radiofrequency ablation guided by optical surgery navigation system under different active modes 不同主动模式下光学外科导航系统引导下的多探头射频消融模拟
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1210679
Leyi Xu, Ken Cai, Rongqian Yang, Qinyong Lin, Hongwei Yue, Feng Liu
ABSTRACT Radiofrequency ablation (RFA) is a crucial alternative treatment for liver cancer with the advantages of minimal invasion and a fast prognosis. However, two problems limit its further application: the orientation of the puncture point and the ablation of large tumors. The optical surgery navigation system in the RFA presents a promising approach for solving the localization problem in the puncturing process, which greatly increases puncture accuracy and has overcome the disadvantages of traditional RFA surgery. In addition, the use of multiple electrodes in the RFA (multi-probe RFA) is proposed and is applied clinically to deal with large tumors. In this study, we present a multi-probe RFA model using the finite element method (FEM) combined with a self-developed optical surgical navigation system. A real 3D liver model was adopted as an effective reference. Based on this model, two-probe RFA simulations were performed under different active modes. An analysis was conducted from the perspective of the temperature and electric potential fields and cell necrosis. The simulation results showed that different active modes had separate advantages and were suitable for different situations. Understanding their advantages can not only help doctors make surgical plans that fit the patients’ conditions, but also the understanding can offer a virtual surgery platform for further development in the preoperative planning of RFA incorporated with the surgery navigation system.
射频消融术(RFA)是肝癌的重要替代治疗方法,具有侵袭小、预后快的优点。然而,两个问题限制了它的进一步应用:穿刺点的定位和大肿瘤的消融。RFA中的光学手术导航系统为解决穿刺过程中的定位问题提供了一种很有前景的方法,大大提高了穿刺精度,克服了传统RFA手术的缺点。此外,提出了在RFA中使用多个电极(multi-probe RFA),并在临床上应用于处理大肿瘤。在这项研究中,我们提出了一个多探头RFA模型,该模型采用有限元法(FEM)结合自主开发的光学外科导航系统。采用真实的三维肝脏模型作为有效参考。基于该模型,进行了不同主动模式下的双探头RFA仿真。从温度场、电位场和细胞坏死角度进行分析。仿真结果表明,不同的主动模式各有优势,适用于不同的情况。了解它们的优势不仅可以帮助医生制定适合患者情况的手术方案,还可以为结合手术导航系统的RFA术前规划的进一步发展提供虚拟手术平台。
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引用次数: 4
Computer-assisted virtual preoperative planning in orthopedic surgery for acetabular fractures based on actual computed tomography data 基于实际计算机断层数据的髋臼骨折骨科手术计算机辅助虚拟术前规划
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1240235
Guangye Wang, Wen-jun Huang, Q. Song, Y. Qin, Jinfeng Liang
Abstract Acetabular fractures have always been very challenging for orthopedic surgeons; therefore, appropriate preoperative evaluation and planning are particularly important. This study aimed to explore the application methods and clinical value of preoperative computer simulation (PCS) in treating pelvic and acetabular fractures. Spiral computed tomography (CT) was performed on 13 patients with pelvic and acetabular fractures, and Digital Imaging and Communications in Medicine (DICOM) data were then input into Mimics software to reconstruct three-dimensional (3D) models of actual pelvic and acetabular fractures for preoperative simulative reduction and fixation, and to simulate each surgical procedure. The times needed for virtual surgical modeling and reduction and fixation were also recorded. The average fracture-modeling time was 45 min (30–70 min), and the average time for bone reduction and fixation was 28 min (16–45 min). Among the surgical approaches planned for these 13 patients, 12 were finally adopted; 12 cases used the simulated surgical fixation, and only 1 case used a partial planned fixation method. PCS can provide accurate surgical plans and data support for actual surgeries.
髋臼骨折一直是困扰骨科医生的难题;因此,适当的术前评估和规划尤为重要。本研究旨在探讨术前计算机模拟(PCS)在骨盆髋臼骨折治疗中的应用方法及临床价值。对13例骨盆、髋臼骨折患者行螺旋CT扫描,并将DICOM数据输入Mimics软件,重建实际骨盆、髋臼骨折的三维模型,进行术前模拟复位和固定,并模拟各手术过程。同时记录虚拟手术建模、复位和固定所需时间。骨折建模平均时间为45 min (30 ~ 70 min),骨复位固定平均时间为28 min (16 ~ 45 min)。在这13例患者计划的手术入路中,最终采用了12例;12例采用模拟手术固定,仅有1例采用部分计划固定。PCS可以为实际手术提供准确的手术方案和数据支持。
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引用次数: 19
Patient-specific modeling of the trochlear morphologic anomalies by means of hyperbolic paraboloids 利用双曲抛物面对滑车形态异常进行患者特异性建模
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1178330
P. Cerveri, G. Baroni, N. Confalonieri, A. Manzotti
Abstract Diagnostic and therapeutic purposes are issuing pressing demands to improve the evaluation of the dysplasia condition of the femoral trochlea. The traditional clinical assessment of the dysplasia, based on Dejour classification, recognized 4 increasing (A, B, C, D) levels of severity. It has been extensively questioned in the literature that this classification methodology can be defective suggesting that quantitative measures can ensure more reliable criteria for the dysplasia severity assessment. This study reports on a novel technique to model the trochlear surface (TS), digitally reconstructed by 3D volumetric imaging, using three hyperbolic paraboloids (HP), one to describe the global trochlear aspect, two to represent the local aspects of the medial and lateral compartments, respectively. Results on a cohort of 43 patients, affected by aspecific anterior knee pain, demonstrate the consistency of the estimated model parameters with the morphologic aspect of the TS. The obtained small fitting error (on average lower than 0.80 mm) demonstrated that the ventral aspect of the trochlear morphology can be modeled with high accuracy by HPs. We also showed that HP modeling provides a continuous representation of morphologic variations in shape parameter space while we found that similar morphologic anomalies of the trochlear aspect are actually attributed to different severity grades in the Dejour classification. This finding is in agreement with recent works in the literature reporting that morphometric parameters can only optimistically be used to discriminate between the Grade A and the remaining three grades. In conclusion, we can assert that the proposed methodology is a further step toward modeling of anatomical surfaces that can be used to quantify deviations to normality on a patient-specific basis.
摘要对股骨滑车发育不良的诊断和治疗提出了迫切的要求。传统的临床评估以Dejour分级为基础,分为4级(A、B、C、D)严重程度。文献中广泛质疑这种分类方法可能存在缺陷,这表明定量措施可以确保更可靠的标准来评估发育不良的严重程度。本研究报告了一种新的技术来模拟滑车表面(TS),通过三维体积成像进行数字重建,使用三个双曲抛物面(HP),一个描述滑车的整体方面,两个分别代表内侧和外侧室的局部方面。在43例受特定膝关节前侧疼痛影响的患者队列中,结果证明了估计的模型参数与TS形态学方面的一致性,得到的拟合误差很小(平均小于0.80 mm),表明HPs可以高精度地模拟滑车的腹侧形态学。我们还发现,HP模型在形状参数空间中提供了形态变化的连续表示,同时我们发现滑车方面的类似形态异常实际上归因于Dejour分类中不同的严重等级。这一发现与最近的文献报道一致,即形态计量参数只能乐观地用于区分A级和其余三个等级。总之,我们可以断言,所提出的方法是解剖学表面建模的又一步,可用于量化患者特定基础上的正常偏差。
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引用次数: 6
How deep can straight instruments be inserted into the femoral canal: a simulation study based on cadaveric femora* 直器械能插入股管多深:基于尸体股骨的模拟研究*
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1185466
D. Putzer, S. Klug, J. Moctezuma, E. Mayr, M. Nogler
Abstract Determining how deep instruments can be inserted into the femoral canal without touching adjacent structures is a fundamental necessity for navigating instruments in primary and revision total hip arthroplasty. The aim of the study was to determine the reachable depth of a straight instrument inserted into the femur canal during primary and revision total hip arthroplasty. Based on the three-dimensional data of twenty-six femurs, obtained from a CT scan, the insertion depth of a virtual, straight instrument was accessed by a simulation. The effect of the diameter of the virtual instrument and the extension of the osteotomy were evaluated. Without extending the osteotomy, 100% of the femoral canal was reachable to a depth of 5.1–6.3 cm for instruments with a diameter of 10 mm. The depth was measured from the lower edge of the osteotomy. A maximum lateral extension of the osteotomy by 1 cm enlarges the access to a depth of 8.8 cm. The results provide a theoretical basis for the limitations of guiding instruments used for the preparation of the femoral canal. Bone preserving methods need the development of angulated instruments to reach deep areas in the femoral canal.
在初次和翻修全髋关节置换术中,确定器械在不接触邻近结构的情况下可插入股管的深度是导航器械的基本必要条件。该研究的目的是确定在初次和翻修全髋关节置换术中插入股骨管的直器械的可达深度。基于从CT扫描中获得的26根股骨的三维数据,通过模拟获得了虚拟直置仪器的插入深度。评估虚拟器械直径和截骨延伸的影响。在不延长截骨术的情况下,对于直径为10 mm的器械,100%的股骨管深度可达5.1-6.3 cm。深度从截骨的下边缘开始测量。截骨术最大向外侧延伸1厘米,使通道深度扩大至8.8厘米。该结果为股骨管预备时使用的引导器械的局限性提供了理论依据。保骨方法需要发展成角的器械以到达股管深处。
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引用次数: 1
High-fidelity haptic and visual rendering for patient-specific simulation of temporal bone surgery 高保真触觉和视觉渲染的患者特定模拟颞骨手术
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1189966
Sonny Chan, Peter Li, Garrett D. Locketz, K. Salisbury, N. Blevins
Abstract Medical imaging techniques provide a wealth of information for surgical preparation, but it is still often the case that surgeons are examining three-dimensional pre-operative image data as a series of two-dimensional images. With recent advances in visual computing and interactive technologies, there is much opportunity to provide surgeons an ability to actively manipulate and interpret digital image data in a surgically meaningful way. This article describes the design and initial evaluation of a virtual surgical environment that supports patient-specific simulation of temporal bone surgery using pre-operative medical image data. Computational methods are presented that enable six degree-of-freedom haptic feedback during manipulation, and that simulate virtual dissection according to the mechanical principles of orthogonal cutting and abrasive wear. A highly efficient direct volume renderer simultaneously provides high-fidelity visual feedback during surgical manipulation of the virtual anatomy. The resulting virtual surgical environment was assessed by evaluating its ability to replicate findings in the operating room, using pre-operative imaging of the same patient. Correspondences between surgical exposure, anatomical features, and the locations of pathology were readily observed when comparing intra-operative video with the simulation, indicating the predictive ability of the virtual surgical environment.
医学成像技术为手术准备提供了丰富的信息,但外科医生仍然经常将三维术前图像数据作为一系列二维图像进行检查。随着视觉计算和交互技术的最新进展,有很多机会为外科医生提供以外科有意义的方式积极操纵和解释数字图像数据的能力。本文描述了一个虚拟手术环境的设计和初步评估,该环境支持使用术前医学图像数据对颞骨手术进行患者特异性模拟。提出了在操作过程中实现六自由度触觉反馈的计算方法,并根据正交切削和磨料磨损的力学原理模拟了虚拟解剖。一个高效的直接体积渲染器同时提供高保真的视觉反馈在手术操作的虚拟解剖。由此产生的虚拟手术环境通过评估其在手术室中复制发现的能力来评估,使用同一患者的术前成像。在将术中视频与模拟进行比较时,很容易观察到手术暴露、解剖特征和病理位置之间的对应关系,表明虚拟手术环境的预测能力。
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引用次数: 49
Three-dimensional digitalized virtual planning for saphenous artery flap: a pilot study 隐动脉皮瓣三维数字化虚拟规划的初步研究
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1209243
Y. Zhang, Shu Z Wen, Hui Q. Zhang, Ya G Li, Jian M. Zhao, Yong Yang
ABSTRACT Objective: Since the 1970s, research and applications on flap and muscle flap had solved many problems in microsurgical reconstruction. However, the traditional flap design is completely dependent on two-dimensional (2D) images. The purpose of this study was to discuss the methods in the visualization of saphenous artery flap by digitalized technique and its applications by digitalized technique. Methods: Two adult fresh cadaver specimens, one male and one female, were subject to radiographic computerized tomography (CT) scanning before and after perfused with lead oxide–gelatine mixture, whose collimation are 0.625 mm (120 kV, 110 mA, 512 × 512 matrix). Through Amira 5.4.1 software, the 2D images in DICOM format were transformed into the 3D models of the entire region. The structures of saphenous artery were observed and the digitized visible models of saphenous artery flap were established through three-dimensional (3D) computerized reconstructions methods from these data using Amira 5.4.1 software. Next six cases of soft-tissue defects of the tibia region, involving the exposure bones underwent contrast-enhanced CT angiography of lower limbs utilizing a 64-row multi-slice spiral CT after median cubital vein injection with Ultravist (3.5 ml/s). 2D images from these data in DICOM format were transformed into computer. The structures of saphenous artery flap were observed and measured using Amira 5.4.1 software. Then, all cases were treated by saphenous artery flap. Results: The 3D reconstructed visible models established from these datasets perfectly displayed the saphenous artery flap anatomy. In six cases, the main trunk and branched of the blood vessels in the designed flap were consistent with the surgical findings. The starting point of the saphenous artery to the average distance of the knee clearance were 119.2 ± 9.6 mm, the average diameter of the saphenous artery from the starting point were 1.5 ± 0.3 mm. The range of flap was 8.0 × 5.0 cm to 20.0 × 8.0 cm. All flaps survived well. After 8–24 months’ follow-up the knee flexion was 120–140°, the straight 0–10°. There was no case appeared incision infection. Conclusions: The preoperative use of 3D digitalized virtual planning for the saphenous artery flap improves the surgical accuracy, decreases the operation time and increases the survival rate of the flap.
摘要目的:20世纪70年代以来,皮瓣和肌皮瓣的研究和应用解决了显微外科重建中的许多问题。然而,传统的皮瓣设计完全依赖于二维图像。本研究旨在探讨隐动脉瓣数字化显示的方法及其在隐动脉瓣数字化显示中的应用。方法:对2例成年新鲜尸体标本(男、女各1例)进行x线计算机断层扫描(CT),分别灌注准直为0.625 mm (120 kV, 110 mA, 512 × 512矩阵)的氧化铅-明胶混合物。通过Amira 5.4.1软件,将DICOM格式的二维图像转换为整个区域的三维模型。观察隐动脉结构,利用Amira 5.4.1软件通过三维(3D)计算机重建方法建立隐动脉皮瓣数字化可见模型。6例胫骨区软组织缺损,累及暴露骨,在肘正中静脉注射3.5 ml/s紫外线后,行64排多层螺旋CT下肢血管造影。将这些数据的二维图像以DICOM格式转换到计算机中。采用Amira 5.4.1软件对隐动脉皮瓣结构进行观察和测量。所有病例均行隐动脉皮瓣治疗。结果:建立的三维可视化重建模型能较好地显示隐动脉瓣的解剖结构。6例皮瓣的主干和分支血管与手术表现一致。隐动脉起始点至膝关节间隙的平均距离为119.2±9.6 mm,隐动脉起始点至膝关节间隙的平均直径为1.5±0.3 mm。皮瓣范围为8.0 × 5.0 cm ~ 20.0 × 8.0 cm。所有襟翼都完好无损。随访8-24个月,膝关节屈曲120-140°,直0-10°。无一例出现切口感染。结论:术前应用三维数字化虚拟规划进行隐动脉瓣手术,可提高手术精度,缩短手术时间,提高皮瓣成活率。
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引用次数: 3
Robot-assisted Heller’s myotomy for achalasia in children 机器人辅助Heller肌切开术治疗儿童失弛缓症
IF 2.1 4区 医学 Q3 SURGERY Pub Date : 2016-01-01 DOI: 10.1080/24699322.2016.1217352
T. Altokhais, Hala Mandora, Ayed Al-Qahtani, A. Al-Bassam
Abstract Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller’s myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller’s myotomy in children and presents a review of the literature. Methods: Included in this study are children who underwent robot-assisted Heller’s myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2–5 times before the definitive procedure. All patients underwent successful robot-assisted Heller’s myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Conclusion: Robotic-assisted Heller’s myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.
摘要背景:贲门失弛缓症在儿童中较为少见。手术选择包括开放、腹腔镜和机器人方法。然而,海勒肌切开术仍然是首选的治疗方法。本报告描述了机器人辅助儿童Heller肌切开术的经验,并对文献进行了回顾。方法:本研究纳入了2004年至2015年在沙特阿拉伯利雅得沙特国王大学医学城通过达芬奇手术系统接受机器人辅助海勒肌切开术治疗食管贲门失弛弛症的儿童。审查了这些患者的医疗记录,以了解人口统计数据、症状、诊断方式、手术程序、并发症、结果和随访情况。结果:确定了6例患者。手术患者年龄在2 - 12岁之间(平均7.1岁)。最常见的症状是吞咽困难、呕吐和夜间咳嗽。对比吞咽和上消化道内窥镜确定了所有患者食管贲门失弛缓症的诊断。4例患者在最终手术前行食管扩张2-5次。所有患者都成功地接受了机器人辅助的海勒肌切开术,并伴有部分后眼底复制。术后过程平淡无奇。5例患者症状完全缓解,1例患者病情改善。随访评估是一致的,随访时间为0.5年至11年(平均4.4年)。结论:机器人辅助Heller肌切开术治疗儿童食道失弛缓症安全有效,是开放和腹腔镜手术的理想选择。
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引用次数: 14
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Computer Assisted Surgery
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