Objective:To investigate the safety and efficacy of combined laparoscopic gastroscopy（LECS）in the treatment of difficult gastric stromal tumors（GST）.Methods:Sixty cases of GST at difficult sites that received radical surgery from January 2013 to January 2023 were retrospectively included. The patients were divided into two groups according to the operation methods：double-lens group（28 cases）and laparotomy group（32 cases）. SPSS 20.0 software was used for statistical analysis. Perioperative indicators and other measurement data were expressed by（xˉ±s），and independent sample t test was performed. The statistical data of postoperative complications were χ2 or Fisher test. P<0.05 was considered statistically significant.Results:Compared with the laparotomy group，patients in the double-lens group had less blood loss and faster postoperative recovery time. There were no significant differences in operative time，positive margin，postoperative complications and postoperative exhaust time（P>0.05）.Conclusion:LECS is a precise，minimally invasive，safe and reliable method for GST treatment of difficult sites. It has the advantages of less bleeding and faster postoperative recovery，and can achieve the radical effect of tumor treatment equivalent to open surgery，which has great potential for clinical promotion.

背景 螺钉内固定术是治疗单纯腰椎峡部裂的有效手术方法 ,但传统开放手术创伤与置钉难度较大,技术要求较高."天玑"骨科手术机器人辅助下置钉具有精准、微创的特点,在其辅助下行腰椎峡部螺钉内固定术的临床效果有待分析.目的 探讨"天玑"骨科手术机器人辅助下经皮螺钉内固定术治疗单纯腰椎峡部裂的疗效及应用价值.方法 回顾性分析2019年1-6月于北京积水潭医院行峡部螺钉内固定治疗的单纯腰椎峡部裂患者47例,其中24例行传统开放手术,23例在"天玑"骨科机器人辅助下行经皮微创固定手术.比较两组的手术时间、出血量、术后下地时间、术后住院日,分析术前、术后3 d、术后3个月、6个月的腰痛视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI),术后6个月行三维CT扫描评估螺钉位置,分析手术效果.结果 47例患者中,传统开放组男性14例,女性9例,平均年龄23岁;机器人辅助微创手术组男性15例,女性9例,平均年龄24岁.机器人辅助微创手术组在手术时间[(87.5±9.4)min vs(100.6±12.3)min]、出血量[(5.2±1.1)mL vs(38.7±5.2)mL]、术后下地时间[(16.1±5.6)h vs(21.9±5.7)h]、术后住院日[(1.3±0.5)d vs(2.0±0.5)d]方面明显优于传统开放组(P均<0.05).两组均无并发症,术后6个月无内固定失败病例,无腰椎滑脱发生,无腰椎不稳.两组术后各时间点的腰痛VAS评分和ODI均明显优于术前(P<0.01),术后3 d机器人微创手术组腰痛VAS评分明显低于传统开放手术组(2.04±1.15 vs 3.04±1.12,P<0.01).结论 "天玑"骨科手术机器人辅助经皮螺钉内固定治疗单纯腰椎峡部裂损伤小、恢复快、稳定性可靠,对于年轻的单纯腰椎峡部裂患者有良好的早期治疗效果.

高山滑雪赛事的救援难度大,防疫工作要求高.本文通过总结2021年高山滑雪系列测试赛医疗保障过程中对新型冠状病毒肺炎(简称新冠肺炎)疫情防控的对策,分析新冠肺炎疫情给高山滑雪赛事医疗保障工作带来的困难,制定救援、转运的流程,探索医疗站的设置和防疫流程等工作.医疗保障部门应当在完善各项预案的前提下,对相关工作人员进行系统培训,并与属地疾病防治中心配合,保障过程中严格按照各项防疫规定,应对突发情况,做好防疫工作,保障赛事顺利进行.

目的 探讨肠镜下自膨胀金属支架(SEMS)置入序贯手术与急诊手术(ES)在梗阻性结直肠癌患者的治疗效果.方法 回顾性分析2014年至2019年接受手术治疗的梗阻性结直肠癌患者55例,其中SEMS组25例,术前接受肠道支架置入,梗阻解除后1周左右行根治性切除;ES组30例接受急诊手术治疗.采用SPSS24.0统计软件处理和分析数据.术中术后各项指标采用(珋x±s)表示,独立t检验;术后并发症、肿瘤根治性切除率等采用 χ2检验.P<0.05为有统计学意义.结果 原发肿瘤根治性切除:ES组22例(73.3％)明显低于SEMS组25例(100％);ES组切除淋巴结为(9.6±5.5)个明显低于SEMS组(18.7±7.7)个;一期手术造口:ES组26例(86.7％),SEMS组11例(44.0％);造口还纳率ES组38.4％,SEMS组90.9％;永久性造瘘率ES组16例(53.3％),SEMS组1例(4.0％);手术切口感染:ES组4例(13.3％),SEMS组0例(0.0％),上述各项指标两组差异均有统计学意义(P<0.05).结论 肠镜下放置SEMS,然后序贯手术治疗结直肠癌梗阻是安全、有效的备选治疗方案之一.

目的 探讨基于膜解剖理论,腹腔镜下左半结肠完整系膜切除治疗脾区结肠癌的安全性、可行性及临床疗效.方法 自2016年1月至2019年6月,我中心33例脾曲结肠癌患者接受了腹腔镜下左半结肠切除术,所有患者均于术前经结肠镜下行活检病理确诊,同时给予纳米碳和(或)钛夹标记,腹部增强CT/立位腹平片确认病变位于脾曲,术前TNM分期为Ⅰ期5例、Ⅱ期19例、Ⅲ期9例.根据膜解剖理论,术中采取头侧-中间-外侧入路相结合的方式进行,注意保持层面优先及结肠系膜的完整性,于根部结扎、切断左结肠动脉、结肠中动脉左支和肠系膜下静脉,清扫223和253淋巴结.计量资料包括患者一般资料、手术参数、术后康复数据以((x)±s)表示,术后并发症发生率以％表示,采用SPSS 20.0统计软件进行数据分析.结果 33例手术均在腹腔镜下完成,无中转开腹.手术时间为(160.0±25.4)min,术中出血量为(70.6±46.4)ml,清扫淋巴结数目为(19.3±3.2)枚,标本肠管长度(23.0±2.8)cm,术后排气时间(4.5±1.2)d,术后进食时间(5.5±1.3)d,术后住院时间为(7.8±1.1)d.术后TNM分期为Ⅰ期4例、Ⅱ期21例、Ⅲ期8例.33例患者均未发生脾脏损伤,其中3例有不同程度的脾下极缺血,术后2例患者出现炎症性肠梗阻,保守治疗后康复出院.无术后腹腔出血、无吻合口漏、狭窄、出血等并发症发生.随访8～49个月(中位随访时间26个月),目前患者均健康存活,未见肿瘤复发、转移.结论 对于脾曲结肠癌,在遵循膜解剖理论、层面优先原则的前提下,采用头侧-中间-外侧入路进行腹腔镜下左半结肠切除术,可以将操作化繁为简,具有安全、微创、可靠等优点,值得在临床推广应用.

目的 比较胸腰椎骨折内固定手术中机器人辅助(robot-assisted,RA)与徒手(free-hand,FH)置入椎弓根螺钉的精度及手术即时效果.方法 采用前瞻性研究,选择我院2015年5月～2020年1月146例椎弓根内固定术,其中65例选择RA螺钉置入(RA组),81例选择FH螺钉置入(FH组).根据Gertzbein与Robbins量表评价椎弓根螺钉置入的准确性,对2组螺钉置入准确性和围手术期指标包括手术时间、术中出血量、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、骨折节段Cobb角、椎体前缘相对高度和是否翻修等进行比较.结果 RA组置入331枚螺钉,其中325枚螺钉A级,5枚B级,1枚C级;FH组置入484枚螺钉,其中431枚螺钉A级,44枚B级,9枚C级.RA组螺钉位置优秀(A级)率明显高于FH组[98.2％(325/331)vs.89.0％(431/484),χ2=24.442,P=0.000].FH组475枚螺钉(98.1％)的位置在临床上是可接受的(A+B级),RA组为330枚(99.7％).RA组手术时间(119.8±38.9)min,显著多于FH组(92.6±25.0)min(t=4.822,P=0.000);术中出血量中位数50.0(25.0,100.0)ml,显著少于FH组100.0(100.0,200.0)ml(Z=-6.261,P=0.000).2组内术后1 d疼痛VAS评分中位数较术前明显降低[RA组:3.0(3.0,3.5)分vs.6.0(6.0,7.0)分,Z=-7.066,P=0.000;FH组:3.0(3.0,4.0)分vs.6.0(6.0,7.0)分,Z=-7.939,P=0.000],但2组间比较差异无显著性(P>0.05).2组内骨折节段Cobb角术后3～5 d较术前明显改善[RA组:9.4° ±3.3°vs.20.3° ±3.8°,t=23.173,P=0.000;FH组:9.7° ±3.4°vs.20.0° ±3.8°,t=23.407,P=0.000],但2组间比较差异无显著性(P>0.05).2组内骨折椎体前缘相对高度出院前较术前明显改善[RA组:(89.2±4.6)％vs.(63.6±4.6)％,t=-174.651,P=0.000;FH组:(89.4±4.9)％vs.(64.1±5.2)％,t=-169.251,P=0.000],但2组间比较差异无显著性(P>0.05).2组患者均未出现手术并发症、术式变更或因手术并发症造成的术后翻修.结论 胸腰椎骨折椎弓根螺钉内固定术中,RA置钉是准确和安全的.

背景:颈椎后纵韧带骨化症(OPLL)在亚洲高发,连续型或混合型OPLL常采用颈椎后路椎板成形术治疗.此类病例中有骨化灶侵及C2或C2以上水平造成脊髓压迫的情况,需进行手术减压.但同时可能破坏颈半棘肌和头半棘肌的肌肉附着点,造成颈椎前凸丢失和术后轴性疼痛.目的:观察保留或重建棘突肌肉附着点的C2椎板穹窿状减压联合棘突纵割式椎板成形术(SLAC)治疗高位颈椎OPLL的临床及影像学疗效.方法:采用回顾性病例系列研究的方法,选取2017年1月至2018年12月在我院因颈椎后纵韧带骨化症且骨化灶压迫侵及C2/3椎间盘水平及以上的手术患者,对该组患者行C2椎板穹隆状减压联合SLAC术.对比术前及末次随访的颈椎JOA评分、颈椎功能障碍指数(NDI)、颈肩痛视觉模拟评分(VAS)、颈椎前凸角等指标,并记录并发症情况.部分患者行术后CT,测量脊髓容纳空间(SAC),并与术前对比,评价影像学效果.结果:共27例患者纳入本研究,其中男21例,女6例,年龄40～81岁,平均(63.9±8.3)岁.随访时间6～20个月,平均(12.9±4.0)个月.与术前比较,末次随访时颈椎JOA评分显著增加(10.8±1.2vs 12.9±1.7,P=0.001),NDI(26.3±6.2 vs 14.4±5.9,P＜0.001)、颈椎前凸角(11.6°±6.9° vs 8.3°±6.2°,P=0.004)显著降低,差异均有统计学意义;但颈肩痛VAS评分(2.4±1.0 vs 2.9±1.3,P=0.131)差异无统计学意义.13例患者术后即刻行CT扫描,手术前后C2水平SAC差异有统计学意义[(6.1±1.9)mm vs (15.3±2.5)mm,P＜0.001].结论:保留或重建棘突肌肉附着点的C2椎板穹窿状减压联合棘突纵割式椎板成形术的临床及影像学结果满意,并不增加术后颈肩部轴性疼痛,可作为治疗高位颈椎后纵韧带骨化症的手术选择.

Objective To investigate the clinical outcome of laparoscopic distal or total gastrectomy with Braun anastomosis for gastric cancer. Methods From January 2012 to September 2018, clinical data of 116 patients were analyzed retrospectively, including 45 patients received laparoscopic radical total gastrectomy with Braun anastomosis, and 71 patients underwent distal gastrectomy with with Braun anastomosis. Results All of 116 patients received successful laparoscopic surgery without conversion. Gastric emptying disorder occurred in 3 cases (2.6%) after operation. After sufficient gastrointestinal decompression, nutrition support from nasojejunal feeding tube and other conservative treatment, the gastric emptying disorder were relieved ranging 5~21 days. There was no emptying disorder in 45 cases of total gastrectomy with Braun anastomosis. There were 6 cases (5.2%) of pulmonary infection, which were cured by antibiotic treatment, 1 case (0.8%) of cerebral thrombosis and 4 cases (3.4%) of atrial fibrillation, which were alleviated by symptomatic treatment without perioperative death. The follow-up period of 116 patients ended September 2018 (6~109 months). Four patients (3.4%) had recurrence after operation. Conclusion Laparoscopic total gastrectomy with Braun anastomosis could effectively reduce the incidence of postoperative complications, accelerate the rapid recovery of patients, and have better digestive and absorption function and quality of life. Key words: Stomach Neoplasms; Laparoscopy; Gastrectomy; Treatment Outcome

目的 探讨骨科机器人辅助技术在颈前路齿状突螺钉内固定手术中的安全性. 方法 2017年11月～2018年8月对9例Ⅱ型齿状突骨折全麻下行齿状突骨折复位,术中三维CT扫描,齿状突螺钉路径规划,骨科机器人引导齿状突螺钉导针植入,齿状突空心螺钉固定. 结果 平均手术时间178.3 min(120～240 min),平均术中估计出血量36.7 ml(20～50ml),术后平均住院时间4.3 d(3～5 d).共置入齿状突螺钉10枚,根据Neo评级量表,10枚螺钉均为0级.所有患者均未发生围手术期并发症.术后3个月随访,所有患者骨折愈合情况良好,无明显骨折不愈合或硬化带形成.Smiley-Webster量表7例优,2例良. 结论 骨科机器人辅助颈椎前路齿状突螺钉内固定术安全、有效,可以作为Ⅱ型齿状突骨折的手术方法.

目的 比较经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)中机器人辅助(robot-assisted,RA)与徒手(free-hand,FH)置入椎弓根螺钉的准确性和安全性.方法 采用前瞻性队列研究的方法,共纳入2016年6月 ～2018年6月TLIF手术116例,由患者选择手术方式,其中RA 57例,FH 59例.比较置钉准确性和围手术期相关指标.根据Gertzbein-Robbins量表和小关节侵犯,评价椎弓根螺钉置入的准确性.围手术期相关指标主要包括手术时间、术中出血量、辐射暴露和是否翻修等.结果 在RA组234枚螺钉中,A级220枚,B级10枚,C级3枚,D级1枚;在FH组的278枚螺钉中,A级244枚,B级20枚,C级10枚,D级2枚,E级2枚.RA组螺钉位置优秀(A级)率高于FH组[94.0％(220/234)vs.87.8％(244/278),χ2=5.837,P=0.016].RA组螺钉的临床可接受(A+B级)率高于FH组[98.3％(230/234)vs.95.0％(264/278),χ2=4.145,P=0.042].RA组螺钉侵犯近端小关节更少[1.7％(4/234)vs.6.5％(18/278),χ2=7.016,P=0.008].RA组辐射剂量更低[(33.3±24.4)μSv vs.(56.8±30.9)μSv,t=-4.563,P=0.000].FH组2枚螺钉需要二次手术翻修,RA组无螺钉需要翻修(P=0.503).结论 与徒手置钉相比,骨科机器人辅助TLIF腰椎置钉具有更高的准确性和安全性.

由于胸椎黄韧带骨化症的压迫来自于脊髓后方,因此后路手术的难度是胸椎管狭窄中相对较小的….手术的目的是彻底去除神经压迫,保持脊柱的稳定,维持脊柱的正常生理功能.在减压手术的同时,根据脊柱的稳定性和生理功能要求,以及考虑远期骨化灶再生的预防,建议实施坚强的内固定融合术. 一、手术历史及发展 1912年,Le Double最早报道了黄韧带骨化的现象.1920年,Polgar首次对黄韧带骨化的X线影像表现进行了描述.1960年,Yamaguchi和Fujita首次报道了由胸椎黄韧带骨化引起的脊髓功能障碍.

Objective To investigate the safety, feasibility and clinical outcome of laparoscopic radical resection of low rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.Methods From Mar 2010 to Dec 2017,102 patients with low rectal cancers,including 43 males and 59 females with an average age of 59.6 years(ranging from 36 to 81 years)underwent laparoscopic radical resection of low rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.The distance between the anus and inferior margin of the tumor ranged from 5 cm to 7 cm(85 cases)and 4 cm(23 cases).TNM staging showed that 79 patients had cT1N0M0staging, 23 had cT2N0M0staging.Through the middle approach,the sigmoid mesentery was freed at the root with an ultrasonic scalpel, and the inferior mesenteric artery and vein was clamped and cut.Following the total mesorectal excision(TME)principle,the rectum was dissected to the anorectal ring and 3-5 cm from the distal end of the tumor.The electric knife was used to cut open the mucosa 1.5-2.0 cm above the dentate line.Sharp dissection was performed along the rectal mucosa, upwards, to peel off the rectal mucosa for 2-4 cm,to reach the levator ani muscles, and the rectum was cut circularly.The rectal tumor and distal sigmoid colon were removed from the anus together, then telescopic anastomosis of proximal sigmoid colon and the distal colon and rectal muscle sheath were performed. Results All of 102 patients received successful laparoscopic surgery without conversion.The average operation time was 179 min and the average harvested lymph nodes was 13.There were 3 cases(2.9%)of stoma leakage,who were cured by temporary colostomy and closure of the stoma 3 months later.The postoperative follow-up ranged from 6 to 84 months (average of 45 months), with 2 cases(1.9%)of stoma stenosis who received expansion treatment. Postoperative pathological results showed that 49 patients had pT1-2N0M0staging,53 had pT2N1M0staging. Twelve months after surgery,94.1% patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal.There were 4 cases(3.9%)of local recurrence within 3 years after surgery,with 100% 3-years-survival. Conclusion Laparoscopic radical resection of low rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe, reliable and mini-invasive,without incision and scar on the abdominal wall with satisfactory clinical outcome.

目的 比较机器人导航与三维导航行微创单节段经椎间孔减压腰椎融合内固定术的手术效果.方法 选择单一节段腰椎退变性疾病患者60例,随机分为两组,各30例;分别行机器人导航与三维导航辅助下微创经椎间孔减压腰椎融合内固定术.结果 60例患者均成功完成手术.两组从手术切皮至缝合的手术时间、术中出血量、术后引流量、手术切口长度和术中放射量比较,差异均无统计学意义(P>0.05);机器人导航组总手术时间长于三维导航组(P<0.01),术后住院时间短于三维导航组(P<0.05).术后随着时间推移,两组患者疼痛程度逐渐减轻(P<0.05);术后两组患者JOA评分逐渐升高(P<0.05),症状明显缓解;术后3 d和3个月同期两组VAS评分和JOA评分比较,差异均无统计学意义(P>0.05).结论机器人导航与三维导航行微创经椎间孔减压腰椎融合内固定术均可取得良好效果,机器人导航可以按自行设计路线固定融合,选择最优通道,肌肉损伤小,出血少,前景良好.

20世纪40年代,Michele Krueger首先描述椎弓根外科解剖并经椎弓根进椎体获取活体标本;20世纪50年代, Boucher利用椎弓根结构打入螺钉,开创了椎弓根螺钉固定技术;20世纪60年代,Roy Camille通过对椎弓根结构的系列研究,使得椎弓根螺钉固定这一技术得以推广.此后,椎弓根螺钉固定技术被广泛应用于脊柱外科的手术中,成为一种常用的脊柱外科内固定手段.然而,随着这一技术应用的增多,临床随访中发现一些病例存在椎弓根螺钉松动拔出的情况,继而一些学者将目光聚焦于有关椎弓根螺钉拔出的临床或基础研究之上,并在研究的过程中发现了众多针对椎弓根螺钉固定强度的影响因素.本文作者就螺钉固定强度的评价指标和椎弓根螺钉固定强度的具体影响因素综述如下.

目的 探讨三维导航引导下后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症的临床疗效及安全性.方法 选择胸椎间盘突出症患者19例,均接受术中即时三维导航引导下后外侧入路椎间盘摘除椎间融合术治疗.记录手术时间、术中出血量;术后12个月评价临床疗效,计算优良率和总有效率;记录患者术前、术后3个月及术后12个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表(ODI)评分、日本骨科协会(JOA)评分;记录患者术前及术后12个月Frankel分级情况;术后12个月行CT检查,观察椎间骨性融合情况,记录并发症发生情况.结果 19例患者手术时间(137.6 ±31.8)min,术中出血量(337.5 ±63.3)mL;疗效评价为优12例、良6例、改善1例、差0例,优良率为94.7%(18/19)、总有效率为100%(19/19).患者术后3个月及术后12个月VAS、ODI评分均较术前显著降低,JOA评分较术前显著提高,且术后12个月ODI评分变化更明显(P均 <0.05).1例Frankel B级患者改善到C级;4例C级患者中1例改善到D级,3例改善到E级;12例D级患者10例改善到E级, 2例Frankel分级无改善.患者术后12个月CT检查显示均获得良好的骨性融合,均未发生硬膜损伤、脑脊液漏、感染、脊髓损伤症状加重、内固定失效等并发症.结论 三维导航引导下后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症安全、有效.

Objective: To compare the clinical effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open TLIF in the treatment of lumbar spondylolisthesis. Methods: A total of 41 patients with lumbar spondylolisthesis accepted surgical treatment in Department of Spinal Surgery of Beijing Jishuitan Hospital From July 2015 to April 2016 were retrospectively analyzed. There were 16 cases accepted robot-assisted minimally invasive TLIF and 25 accepted traditional open TLIF. The operation time, X-ray radiation exposure time, perioperative bleeding, drainage volume, time of hospitalization, time for pain relief, time for ambulatory recovery, visual analogue scale (VAS), Oswestry disability index (ODI) and complications were compared. T test and χ(2) were used to analyze data. Results: There were no significant difference in gender, age, numbers, degrees, pre-operative VAS and ODI in spondylolisthesis (all P>0.05). Compared with traditional open TLIF group, the robot-assisted minimally invasive TLIF group had less perioperative bleeding ((187.5±18.4) ml vs. (332.1±23.5) ml), less drainage volume ((103.1±15.6) ml vs. (261.3±19.8) ml), shorter hospitalization ((7.8±1.9) days vs. (10.0±1.6) days), shorter time for pain relief ((2.8±1.0) days vs. (5.2±1.1) days), shorter time for ambulatory recovery ((1.7±0.9) days vs. (2.9±1.3) days) and less VAS of the third day postoperatively (2.2±0.9 vs. 4.2±2.4) (t=2.762-16.738, all P<0.05), but need more operation time ((151.3±12.3) minutes vs. (102.2±7.1) minutes) and more X-ray radiation exposure ((26.1±3.3) seconds vs. (5.5±2.1) seconds) (t=6.125, 15.168, both P<0.01). In both groups ODI was significantly lower in final follow-up than that of the pre-operation (t=12.215, 14.036, P<0.01). Intervertebral disc height of the final follow-up in both groups were significantly larger than that of the preoperation (robot-assisted minimally invasive TLIF group: (11.8 ± 2.8) mm vs. (7.5 ± 1.9) mm, traditional open TLIF group: (12.7 ± 2.5) mm vs. (7.9±2.0) mm), and so was the lumbar lordosis angle (robot-assisted minimally invasive TLIF group: (48.7±9.2)°vs. (39.6±7.9)°, traditional open TLIF group: (50.1±10.8)°vs. (41.4±8.8)°), the lordosis angle of the slippage segment (robot-assisted minimally invasive TLIF group: (18.7±5.6)°vs. (10.9±3.8)°, traditional open TLIF group: (17.6±6.1)°vs.(8.7±3.2)°) (t=4.128-16.738, all P<0.01). Slippage rate of the final follow-up in both groups were significantly smaller than those of the pre-operation (robot-assisted minimally invasive TLIF group: (5.3±2.3) % vs. (27.8±7.2) %, traditional open TLIF group: (6.6±2.8) % vs. (29.1±9.5) %) (t=11.410, 18.504, both P<0.01). There was no difference of the upper data between two groups (t=0.106-1.227, P>0.05). The results of the post-operative CT showed that the pedicle screws in the robot-assisted minimally invasive TLIF group were more precisely placed than traditional open TLIF group (χ(2)=4.247, P=0.039). The mean follow-up time was 8 months (ranging from 3 to 12 months). There were no significant difference in outcomes between the two groups (χ(2)=0.366, P=0.545). Conclusions: In the treatment of lumbar spondylolisthesis, Robot-assisted minimally invasive TLIF can lead to less perioperative bleeding, less post-operative pain, and quicker recovery than traditional open TLIF surgery, but it needs more operation time and radiation exposure.

Study Design: This study was a retrospective review of prospectively collected clinical data.Objective: To evaluate the clinical and radiologic outcomes of computer-assisted minimally invasive spine surgery transforaminal lumbar interbody fusion (CAMISS-TLIF) and open TLIF for the treatment of 1-level degenerative lumbar disease.Summary of Background Data: Minimally invasive TLIF is becoming increasingly popular; however, the limited space and high rate of hardware complications associated with this method are challenging to surgeons. Computer-assisted navigation has the potential to dynamically show the fine anatomic structures, which could theoretically facilitate minimally invasive spine procedures.Methods: Sixty-one patients underwent 1-level TLIF procedures (30, CAMISS-TLIF; 31, open TLIF). The computer-assisted navigation system was used for CAMISS-TLIF, whereas conventional fluoroscopy was used for open TLIF. Demographic, operative, visual analog scale, and Oswestry disability index data were collected. Screw insertion was assessed by computed tomography, and radiologic fusion based on Bridwell grading was evaluated 2 years after surgery by independent investigators.Results: The CAMISS-TLIF group had significantly less blood loss, postoperative drain, need for transfusion, and initial postoperative back pain; earlier rehabilitation; and shorter postoperative hospitalization than the open TLIF group, whereas CAMISS-TLIF took longer surgical time than open TLIF. However, no significant differences between the 2 groups in visual analog scale scores and Oswestry disability index were observed at 3 months, 1 year, and 2 years postoperatively. A total of 93.33% and 73.39% of screws in the CAMISS and open groups, respectively, had no pedicle perforation (P = 0.016), and the fusion rate was similar in both groups (P = 0.787).Conclusions: Computer-assisted navigation facilitated minimally invasive spine surgery-TLIF. CAMISS-TLIF was superior to open TLIF for treating 1-level degenerative lumbar disease, although it required longer operation time in the initial stage. CAMISS-TLIF showed several benefits compared with open TLIF, including less intraoperative blood loss, postoperative drainage, and pain; earlier rehabilitation; and shorter postoperative hospitalization.

目的 探讨术中即时三维导航辅助下后路半椎体切除术治疗完全分节型半椎体所致的先天性脊柱侧后凸畸形的临床治疗效果.方法 回顾性分析2006年3月至2012年2月北京积水潭医院脊柱外科接受术中即时三维导航辅助下一期后路半椎体切除术的13例先天性侧后凸畸形患者的临床资料.年龄7.5~39.0岁,平均19.1岁;其中,胸椎半椎体6例,腰椎7例.通过术前、术后2周及末次随访时站立位X线的影像资料来评价冠状面和矢状面的矫正效果.结果 随访2.5~8.0年,平均4.3年.节段性侧凸角由术前的49.1°矫正到术后2周时的13.4°,平均矫正率为73.8%,末次随访时为15.6°.总侧凸角由术前的51.7°矫正到术后2周时的15.2°,平均矫正率为71.6%,末次随访时为15.5°.后凸角由术前的37.2°矫正到术后2周时的9.8°,平均矫正率为75.1%,末次随访时为11.0°.术后及末次随访时患者躯干平衡良好,未发现神经、血管损伤及内固定失效等相关并发症.本研究共使用了96枚椎弓根螺钉,也未发现椎弓根螺钉穿破椎弓根内侧壁或外侧壁病例.结论 三维实时导航系统引导下的后路一期半椎体切除术可以安全、精确地切除半椎体,减少手术创伤及术后并发症,有效矫正脊柱畸形,临床效果显著.

Objectives This study aimed to explore the effects of vascular endothelial growth factor A (VEGFA) gene polymorphisms (rs699947 and rs833061) on Bevacizumab (BEV) treatment in colorectal cancer (CRC) patients. Methods 125 CRC cases receiving BEV plus FOLFIRI treatment were recruited in this study. VEGFA polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Correlation of VEGFA gene polymorphisms with the response rate and progression free survival (PFS) was evaluated. Multivariate analyses were performed to estimate the effects of VEGFA polymorphisms on the therapeutic effects of BEV treatment in CRC patients. Results Rs699947 variants did not show significant association with BEV treatment. For rs833061 analysis, TT and TC genotype carriers had significantly higher ORR (objective response rate) than CC carriers (P=0.048 and P=0.021, respectively). Moreover, TT carriers underwent a well DCR (disease control rate) compared to CC carriers (P=0.002). PFS time also showed obvious correlation with rs833061 polymorphism (log rank test, P=0.002). Multivariate analyses demonstrated that TT and TC genotypes of rs833061 polymorphism were significantly correlated with enhanced therapeutic effects and prolonged PFS in CRC patients. Conclusion VEGFA rs833061 polymorphism is significantly associated with the therapeutic efficiency of bevacizumab in CRC patients.

Objective To investigate the infiltration of tumor-associated neutrophils (TANs) in tumor tissue and to explore its clinical significance in patients with rectal cancer before and after neoadjuvant chemoradiotherapy.Methods Preoperative and postoperative pathological results of 47 patients with rectal cancer (cT3-4NxM0,tumor margin from the anal verge ＜ 10 cm) were compared.The infiltration of TANs in tumor tissue before and after neoadjuvant chemotherapy was detected by immunohistochemical streptavidin avidin-peroxidase (SP) method.Statistical analysis was performed to investigate the relationship between infiltration of TANs in tumor tissue and the sensitivity of patients to neoadjuvant therapy,as well as its relationship with prognosis.Results The infiltrating TANs in preoperative biopsy specimens were significantly more than those in postoperative pathological specimens (43.87 ± 4.65,n =47 vs.10.39 ± 1.62,n =47;P =0.003).There was no correlation between the number of the infiltrating TANs in preoperative biopsy specimens and the response to neoadjuvant chemoradiotherapy,according to ypT stage (x2 =0.430,P =0.662),or grade classification (x2 =0.060,P =0.806).The multivariate analysis showed that the number of TANs in the pathological specimens after neoadjuvant chemoradiotherapy was associated with a good prognosis (3-years-disease-free survival rate was 83.9％ vs.25.0％,P =0.015).Moreover,ypT staging was also an independent prognostic factor in patients with rectal cancer after neoadjuvant therapy.Conclusion Neoadjuvant chemoradiotherapy could significantly decrease TANs infiltration in rectal cancer.The amount of TANs in the tumor after neoadjuvant therapy is associated with favorable prognosis.