Cirugía torácica por puerto único. Experiencia inicial / Uniportal thoracic surgery. Initial Experience / Cirurgia torácica de portal único. Experiência inicial

Resumen: Introducción: La cirugía torácica videoasistida es hoy un procedimiento aceptado por ser seguro, factible y efectivo para el tratamiento de casi todas las enfermedades del tórax. En el 2010 se comienzan a publicar procedimientos complejos por un solo puerto, con una gran expansión a nivel mundial. Esta vía de abordaje es al menos equiparable a la multiportal en lo que concierne a resultados en el postoperatorio, o incluso mejor en lo referente a dolor, neuralgia intercostal y estadía hospitalaria. Realizamos un análisis retrospectivo de los procedimientos uniportales entre septiembre de 2018 y agosto de 2020. Resultados: 40 pacientes fueron sometidos a procedimientos por vía uniportal torácica. De estos, 18 pacientes fueron sometidos a resecciones anatómicas (45%), 19 a resecciones atípicas (no anatómicas), una timectomía y dos biopsias pleurales. Se realizaron 12 lobectomías (30%), 3 neumonectomías (7,5%) y 3 segmentectomías (7,5%). Se convirtieron a cirugía abierta 6 pacientes (15%) y falleció un paciente por sepsis respiratoria. En cuanto a las complicaciones tuvimos en las resecciones anatómicas ocho complicaciones (cinco mayores), en las no anatómicas 4 complicaciones (2 mayores). Del postoperatorio un paciente con dolor de más de un mes de evolución, uno con parestesias en el territorio intercostal y dos con disnea. Las resecciones anatómicas tuvieron una media de internación de 8 días y 5.8 días de drenaje pleural, mientras que las no anatómicas 5,5 días de internación y 3.3 días de drenaje pleural. Conclusión: la cirugía uniportal es segura y practicable en centro de bajo volumen.

Abstract: Introduction: video assisted thoracic surgery is widely accepted today as a safe, feasible and effective procedure to treat almost all thoracic conditions. In 2010, uniportal complex procedures begin to appear in scientific publications around the world, evidencing major expansion. This surgical approach is at least comparable to the multiportal approach in terms of postoperative results or even in regards to pain, intercostal neuralgia and length of hospital stay. We performed a retrospective study of uniportal procedures between September 2018 and August 2020. Results: 40 patients underwent uniportal thoracic surgeries. 18 of these were subject to anatomic resections (45%), 19 to atypical resection (non-anatomic), one thymectomy and two pleural biopsies, 12 lobectomies (30%), 3 neumomectomies (7,5%) and 3 segmentomectomies (7,5%). In 6 patients the procedure was converted to an open surgery (15%) and one patient died for respiratory sepsis. As to the occurrence of complications, 8 complications were seen in anatomic resections (5 major complications) and 4 complications in non-anatomic resections (2 major complications). One patient reported pain that lasted over one week in the postoperative stage, another one referred paresthesia and two reported dyspnea. Length of stay in the hospital was 8 days in anatomic resections and 5.8 days of pleural drainage, whereas in non-anatomic resections it was 5.5 and 3.3 respectively. Conclusion: uniportal surgery is safe and feasible in a relatively small health center.

Resumo: Introdução: a cirurgia torácica videoassistida é hoje um procedimento aceito por ser seguro, viável e eficaz para o tratamento de quase todas as doenças torácicas. Em 2010, começaram a ser publicados procedimentos complexos por porta única com grande expansão mundial. Essa abordagem é pelo menos comparável à abordagem multiporta em termos de resultados pós-operatórios ou ainda melhor em termos de dor, neuralgia intercostal e internação hospitalar. Realizamos uma análise retrospectiva dos procedimentos uniportais entre setembro de 2018 e agosto de 2020. Resultados: 40 pacientes foram submetidos a procedimentos por via torácica uniportal. Destes, 18 pacientes foram submetidos a ressecções anatômicas (45%), 19 foram submetidos a ressecções atípicas (não anatômicas), uma timectomia e duas biópsias pleurais. Foram realizadas 12 lobectomias (30%), 3 pneumectomias (7,5%) e 3 segmentectomias (7,5%). Seis pacientes (15%) foram convertidos para cirurgia aberta e um paciente morreu de sepse respiratória. Em relação às complicações, tivemos 8 complicações (5 maiores) nas ressecções anatômicas, 4 complicações (2 maiores) nas ressecções não anatômicas. No pós-operatório, um paciente com dor há mais de um mês de evolução, um com parestesia em território intercostal e dois com dispneia. As ressecções anatômicas tiveram internação média de 8 dias e 5,8 dias de drenagem pleural, enquanto as não anatômicas tiveram 5,5 dias de internação e 3,3 dias de drenagem pleural. Conclusão: a cirurgia uniportal é segura e praticável em um centro de baixo volume.

A comparative study of ureteroscopic lithotripsy combined with occlusion device and the supine and lithoto-my position mini-invasive percutaneous nephrolithotomy for the treatment of upper incarcerated ureteral stones / 实用医学杂志

Objective To compare the efficacy of ureteroscopic lithotripsy(URL)combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper incarcerated ureteral stones. No difference could be found in age,sex and size of stones between the two groups. Method From Jan. 2014 to Dec. 2016 in our hospital,all cases of upper incarcerated ureteral stones were diviede into two groups:52 in ureteroscopic lithotripsy combined with occlusion device group and 45 in mini-inva-sive percutaneous nephrolithotomy group. Result The hospitalization and operation time in URL group were(5.5 ± 1.4)days and(53.3 ± 12.4)mins,which were significantly shorter than that in mPCNL group with(9.1 ± 3.2)days and(78.2 ± 14.1)mins,(P 0.05),stone clearance rate(100% vs 91.8,P > 0.05)and complication rate (4.4%vs 3.9%,P>0.05). Conclusion URL combined with occlusion device can obtain satifactory results as well as the supine and lithotomy position mPCNL in the treatment of upper incarcerated ureteral stones.

Comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and PLIF treatment for lumber spondylolisthesis / 临床外科杂志

Objective To comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and open posterior lumbar interbody fusion (PLIF)treatment for lumber spondylolisthesis,to find a better treatment for lumbar spondylolisthesis.Methods A total of 65 cases who were under lumber spondylolisthesis were retrospectively selected from our hospital,26 cases in mini-invasive transforminal lumbar interbody fusion assisted by Quadrant system (mis-TLIF group).39 cases in open posterior lumbar interbody fusion(PLIF group).Record the incision length,intraoperative blood loss,opertive time,bed time,hospital time,pre-and post-operative visual analogue scale(VAS) and Oswestry disability index(ODI) score were recorded respectively.After surgery,the imaging(X-Ray) evalute the vertebral fusion status.Results There were no significant difference between mis-TLIF group and PLIF group in BMI [(22.77 ± 4.38) kg/m2 and (21.28 ± 5.24) kg/m2],preoperative VAS score [(6.46 ± 1.67) and (6.59 ± 1.56)],preoperative ODI score [(58.70 ± 7.19) ％ and (60.10 ± 9.56) ％] (all P ＞ 0.05).There were significant difference between two groups in incision length [(6.10 ± 0.95) cm and (11.12 ± 2.02) cm],intraoperative blood loss [(247.31 ± 36.72) ml and (340.51 ± 64.32) ml],opertive time[(179.96 ± 17.54) min and(151.85 ± 16.06) min],bed time[(3.62 ± 1.44) d and (4.98 ± 1.74) d],hospital time [(9.38 ± 2.60) d and (11.95 ± 3.61) d] (all P ＜ 0.05).Postoperatively VAS score was assesssd at 1 month [(3.15 ± 1.08]),3months [(1.58 ± 0.81)],6months [(1.08 ± 0.74)] and ODI score was(30.77 ± 6.45) ％,(25.54 ± 6.33) ％,(20.23 ± 7.05) ％,respectively in mis-TLIF group were lower than those of PLIF group (P ＜ 0.05).There were no significant difference between two groups in the fusion rate in 3 months,6 months after operation.Conclusion Mis-TLIF had a lot of advantages relative to PLIF in the treatment of lumber spondylolisthesis,be like less trauma,less bleeding,less hospital time,quick rehabilitation and good curative effect,provide a new minimally invasive method for lumber spondylolisthesis patient.

Clinical evaluation of pedicle-scope assisted pedicle screw fixation and conventional percutaneous pedicle screw fixation for treating lumbar degenerative disease / 重庆医学

Objective To evaluate the accuracy and safety of pedicle-scope assisted pedicle screw fixation and percutaneous pedicle screw fixation for treating lumbar degenerative disease(LDD).Methods Thirty cases of LDD treated by mini-invasive transforaminal lumbar interbody fusion(TLIF) under microscope plus percutaneous pedicle screw fixation with fluoroscopy or pedicle-scope of lumbar spine from December 2013 to September 2015 were selected and divide into the percutaneous group and pediclescope group,15 cases in each group.The operative duration,intraoperative blood loss volume,hospital stay and complications were compared between the two groups.The clinical effects were assessed with visual analogue scale(VAS) and Oswestry disability index(ODI).The plain radiography,dynamic radiology and lumbar magnetic resonance imaging(MRI) and computed tomography (CT) were re-examined after operation for assessing the screw location and fusion rate.Results Eighty-four screws were placed in the percutaneous group and 70 screws in the pedicle-scope group.In the percutaneous group and pedicle-scope group,the mean intraoperative blood loss volume,mean operative duration,average times of C-arm fluoroscopy,mean length of hospital stay,mean time of off-bed and complication occurrence rate were measured,and the differences were not statistically significant (P＞ 0.05).In 6-month follow up,the VAS score and ODI score in the two groups were significantly improved compared with before operation(P＜0.01);the VAS score and ODI score were(2.50 ± 1.30) and (50.00-±-3.50) in pediclescope group,(3.00± 1.50) and (58.00 ±4.50) in percutaneous group,respectivehy,and the differences were statistically significant(P＜0.05);the improvement rates of clinical symptoms in the percutaneous group and pedicle-scope group were 73.33 ％ and 80.00 ％ respectively.The imaging reexamination showed that the placed screw location was good and lesion segment fusion was good without screw loosening.The location of 3 screws in the percutaneous group was deviated and adjusted by the second operation.Conclusion The accuracy and safety of pedicle-scope assisted screw placing for treating LDD are higher than those of conventional percutaneous pedicle screw fixation,moreover the operative time is shorter with less intraoperative bleeding.

Risk of postoperative deep venous thrombosis in patients with colorectal cancer treated with open or laparoscopic colorectal surgery: A meta-analysis.

INTRODUCTION: Whether the incidence rate of deep venous thrombosis (DVT) between laparoscopic and open colorectal cancer surgery the same or not were under the debated without conclusion. The aim of this study was to compare the incidence of DVT after laparoscopic or open colorectal cancer surgery by meta‑analysis. MATERIALS AND METHODS: The open published articles comparing the incidence of DVT after laparoscopic or open colorectal cancer were collected in the data bases of Medline, the Cochrane central register of controlled trials and CNKI. The relative risk (RR) was pooled by using random or fixed effect mode to evaluate the incidence of DVT between laparoscopic or open colorectal cancer surgery. RESULTS: After searching the databases, 9 randomized clinical studies with 2606 colorectal cancer cases were included in this meta‑analysis. The mean operation time was 201.8 ± 17.28 min with its range of 180.0–224.4 min in the laparoscopic surgery group and 148.1 ± 18.8 min with its range of 135.0–184.0 min in the open surgery group. The operation time for laparoscopic surgery group were significant lower than in the open surgery group (P < 0.05). The RR of DVT between the laparoscopy and open surgery groups was 0.71 with its 95% confidence interval of 0.35–1.45 (P = 0.35). CONCLUSIONS: The operation time in laparoscopic colorectal cancer surgery was statistical longer than in the open colorectal cancer surgery, but the DVT risk of the two surgery approach was not different according to this meta‑analysis.

Miniabordaje en la cirugía del túnel carpiano / Mini-approach in the carpal tunnel surgery

Introducción: diferentes técnicas se han empleado para la apertura del ligamento transverso del carpo, la clásica, la endoscopia y el miniabordaje. Objetivo: mostrar los resultados de la cirugía con miniabordaje utilizando 1 incisión y 2 incisiones. Métodos: se realizó un estudio prospectivo de una serie de 168 pacientes con diagnóstico de síndrome del túnel carpiano. A un grupo (n= 90) por 1 incisión transversa de 1 cm proximal al ligamento transverso del carpo y en el otro (n= 78) se realizaron 2 incisiones, una transversa proximal al ligamento transverso del carpo y la otra distal. Resultados: la evaluación del dolor posoperatorio al séptimo día, en operados con 1 incisión fue 0 en 57 de 90, con 2 incisiones 0 en 40 de 78. La satisfacción del paciente al mes de la cirugía, con 1 incisión resultaron satisfechos 88 de 90, satisfacción parcial 2 de 90; 2 incisiones, satisfechos 72 de 78 y satisfacción parcial en 5 de 78. La incorporación a las actividades cotidianas a la semana posoperatoria, 1 incisión, de forma parcial 80 de 90 y total 10 de 90; con 2 incisiones, parcial 65 de 78. Las complicaciones fueron 6 con ambos métodos, una mayor y una menor con 1 incisión y 4 menores con 2 incisiones. Conclusiones: la cirugía para la apertura del ligamento transverso del carpo por los miniabordajes propuestos permite obtener resultados similares a los endoscópicos en las primeras semanas, y superiores a los que se obtienen mediante la cirugía abierta, con bajo índice de complicaciones

Introduction: different techniques have been used to opening of the carpal transverse ligament including the surgical, endoscopy and the mini-approach. Objective: to show the results surgery with mini-approach using one and two incisions. Methods: a prospective study was conducted in168 patients diagnosed with carpal tunnel syndrome. In a group (n= 90) by transverse incision of 1 cm proximal to carpal transverse ligament and in the other (n= 78) were necessary two incisions, one transverse proximal to carpal transverse ligament and the other distal to it. Results: the postoperative assessment at 7 days in operated on using one incision was of 0 in 57 of 90, with two incisions was of 0 in 40 of 78. The patient's satisfaction after one month of surgery using one incision were satisfied 88 of 90, partial satisfaction 2 of 90; two incisions, satisfied 72 of 78 and a partial satisfaction in 5 of 78. A whole incorporation to daily activities was achieved at a postoperative week, one partial incision 80 of 90 and a total of 10 of 90; with two incisions, partial 65 of 78. Tue complications included 6 with both methods one leading and other slight with one incision and 4 slights with two incisions. Conclusions: surgery for opening of carpal transverse ligament by means using the proposed mini-approaches allow the obtaining of results similar to that endoscopy during the first weeks and higher those obtained by open surgery with a low rate of complications

Double atrial ablation with monopolar irrigated radiofrequecy for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy: A clinical controlled study / 第二军医大学学报

Objective: To evaluate the safety and efficacy of radiofrequecy ablation for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy. Methods: From Jan. 2008 to Dec. 2011, 30 patients underwent radiofrequecy Maze EI procedure for atrial fibrillation during mini-invasive mitral valve surgery (study group). Another 30 patients with atrial fibrillation undergoing mitral valve surgery through median sternotomy without Maze procedure during the same period were taken as controls. The pre-treatment data of the patients were matchable between the two groups. The study group received mitral valve repair/replacement and radiofrequecy Maze HI procedure for atrial fibrillation. The operative outcome, postoperative complication and elimination rate of atrial fibrillation were compared between the two groups. Results: No patient in the study group was transferred to median sternotomy during operation, and there was no reoperation, prolonged incubation, failure of important organs, hemoglobinuria or death. Compared with the control group, the study group had significantly longer mean circulation arrest time and cardiopulmonary bypass time, significantly reduced chest drainage and blood transfusion volume, and significantly shortened hospital study (P<0. 05). The elimination rates of atrial fibrillation at immediately after operation,discharge and 6 months after operation were 96. 7%, 66. 7% and 73. 3% in the study group, and 50%, 23. 3% and 16. 7% in the control group, respectively, with significant difference found between the two groups (P< 0.01). Compared with the control group, better heart function recovery was achieved in the study group at 6 month after operation. Conclusion: Radiofrequecy ablation for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy is safe and effective. Importantly, it does not increase risks and complications of surgery. The early and middle term effects are satisfactory.

Abordaje miniinvasivo lateral en fracturas supracondileas del humero en los niños / Lateral mini invasive approach in supracondylar humeral fractures in children

Introducción: La fractura supracondílea inestable cerrada del húmero en los niños es una patología que puede requerir la reducción abierta. El objetivo de este trabajo es presentar el abordaje quirúrgico miniinvasivo lateral como una excelente alternativa de tratamiento. Materiales y métodos: Se trataron 46 niños de 2 a 12 años, con mayor incidencia entre los 5 y los 7 años, y una distribución 3:2 entre varones y niñas, que presentaban una fractura cerrada de tipo III de Gartland, sin compromiso neurovascular, que no se pudo reducir mediante la manipulación externa, dada la inestabilidad de la fractura, la interposición de los tejidos blandos o la carencia de radioscopia. El abordaje miniinvasivo lateral fue de 3 a 4 cm en la piel a través de un espacio intermuscular y demandó un tiempo quirúrgico de 14 ± 2 minutos. Resultados: Todas las fracturas consolidaron, la movilidad se recuperó por completo, con buena alineación del ángulo de carga del codo. No se registraron lesiones nerviosas permanentes, miositis osificante ni infecciones profundas. Conclusiones: El abordaje miniinvasivo lateral, utilizado para el tratamiento de estas fracturas, es simple, rápido, reproducible, no requiere instrumental o equipamiento especial, produce mínima pérdida sanguínea, tiene escasa morbilidad, y determina una rápida recuperación y retorno a las actividades escolares.

Background: Closed, unstable supracondylar humeral fractures in children may require an open reduction. We present the lateral mini invasive surgical approach as an excellent treatment alternative. Methods: Forty six children aged 2 to 12, presenting Gartland Type III closed fractures were treated. The incidence was higher in those aged 5 to 7, with a 3:2 male-female distribution, no neurovascular involvement, irreducible with external manipulation because of fracture instability, soft tissue interposition, or no radioscopy available. The lateral mini invasive approach was three to four centimeters long, and proceeded through an inter-muscular plane. The surgery lasted 14+/-2 minutes. Results: All fractures healed, and motion was fully recovered, with good alignment of the elbow load angle, no permanent nerve lesions, ossifying myositis or deep infections.Conclusions: The lateral mini invasive approach used to treat these fractures is simple, fast, reproducible, does not require special instrumentation or equipment, involves minimal blood loss, low morbidity, good recovery and fast return to school.

Mini-invasive treatment of cystitis glandularis with affected ureteric meatus / 中国综合临床

Objective To investigate the minimal invasive management of cystitis glandularis with invasion of the ureteric meatus.Methods The clinical data of 18 cases were reviewed.Among the 18 cystitis glandularis patients,12 cases were invasion of bilateral ureteric meatus and 6 of unilateral ureteric meatus.Operation or drug treatment was performed on the diseases that can cause cystitis glandularis such as bladder stone,bladder neck stegnosis,external urethral meatus stegnosis and benign prostate hyperplasia.Sensitive antibiotic was administrated in all cases.After placing ureter catheter,transurethral plasma electro-resection was carried out in five patients whose ureteric meatus could be identified.In addition,of thirteen patients with ureteral orifice unable to be identified,there were ten cases with normal renal function,mitomycin was injected under affected membrana mucosa,and then the patient with ureteral orifice identified underwent transurethral plasma electro-resection after placing ureter catheter.On the other hand,the patient whose ureteral orifice still could not be recognized undertaken transurethral electro-resection at first,during which the ureter catheter was put once ureteral orifice had been detected,otherwise,the ureter catheter should be placed through cystoscope if nephritic colic emerged and hydronephrosis aggravated after operation.In those patients with kidney dysfunction,the ureter catheter was put by ureter discission or ureter replantation at first,the transurethral electro-resection could not be executed until the renal function recovered.Following all these procedure above,bladder instillation of drugs regularly,anti-infection and symptomatic treatment were administrated.Results One patient combined with bladder adenocarcinoma received cystectomy,of the other patients,six cases recurred and underwent electrotomy again resulting in no relapse.All nephrohydrops vanished or relieved obviously,nevertheless,urinary tract infection,haematuria and bladder-ureter backstreaming as the cardinal complication developed in some cases.Conclusion In the management of cystitis glandularis encroaching ureteric meatus,total or partial cystectomy can be avoided if ureter draining freely can be ensured,motivation removal,antiinfection,injection of drug under mucosa and preoperative diuresis conduce to the achievement of ureter catheter placing,transurethral plasma electro-resection is still effective methods in treating these cystitis glandularis.

A clinical study of Ilizarov's technique for correcting severe flexion contracture of knee joint / 中国矫形外科杂志

[Objective]To explore the methods and effect of using Ilizarov'techniques for correcting severe flexion contracture of the knee joint.[Method]According to Ilizarov's tension-stress principle and its applying technique,the knee joint distraction apparatus was designed and fixed individually.The joint hinges of the apparatus on the two sides were consistent with the rotational center of the knee joint.Joint distraction of 5 to 10 mm was initially performed and followed by gradual correction of the knee joint flexion contracture at an average rate of 1 mm per day at the level of the knee joint by turning the nuts on the distraction rods at 3～4 rounds per day,with the distraction rate modified according to the patient's tolerance.Regular x-ray exams should be carried out to prevent knee joint dislocation and compression of the articular cartilage.The final requirement of correcting the soft tissue flexion deformity of the knee joint was to overcorrect the joint deformity into 5～10 degrees of hyperextension.As for the joint flexion with anterior bowing deformity of the distal femur,the degree of correcting the knee joint flexion contracture should deduce the degree of the bony deformity.The frame was left on for an additional 2 to 4 weeks.When the frame was removed,the knee joint was immediately casted in full extension for 3 to 4 weeks followed by the range of motion exercise on CPM to regain the knee motion and a long-leg brace was provided simultaneously to maintain the correction for 3 months.Secondary osteotomy was performed on anterior bowing deformity of the distal fermur in 8 patients.[Result]More than 30 degrees of severe flexion contracture of knee joint (mean?sd 58.50?21.28?) in 49 patients (52 knees ) were corrected to an average of 4.12?4.61 degrees after treatment.40 joints of 38 cases were followed for an average of 6.8 months,in which 28 joints maintain the postoperative effect.,while 12 joints had partial relapse of 9.30??8.24?.[Conclusion]Ilizarov's technique for correcting severe flexion contracture of the knee joint,can have satisfactory effect with little complications.It is mini-invasive,reliable and safe.

Percutaneous hepatocholangiostomy in treatment of recurrence hepatobiliary stones / 中国医师进修杂志

Objective To explore the potential predominance and value of percutaneous hepatocholangiostomy (PCH) in treatment of recurrence hepatobiliary stones (RHS). Methods Seventeen cases with RHS were treated by PCH from February 2001 to October 2005, which was an improved technology of percutaneous transhepatic cholangioscopy (PTCS) and made reference to the methods of percutaneous nephrostomy (PCN). Results Seventeen cases were successfully treated. The average blood loss was 40 ml (ranging from 15 to 100 ml), and stones were removed completely in 88.2% (15/17). The average hospital stay was 14 (ranging from 10 to 59) days. No one required postoperative analgesic. No postoperative bleeding and biliary leakage were found. Conclusions PCH has significant advantages of minimal invasion, little blood loss, less pain, less complications and quick recovery in the treatment of RHS.

Application of Right Subaxillary Small Incision to Open Heart Surgery / 中国微创外科杂志

Objective To summarize our experiences on open heart surgery through the right subaxillary small incision. Methods Between March 2001 and June 2008,612 patients with congenital heart diseases were treated by open surgery trough a right subaxillary small incision via hypothermic cardiopulmonary bypass. The incision was made from the posterior axillary line at the axilla to the middle axillary line a the fifth intercostal space (4-8 cm in length),and then the intercostal muscle was cut at the inferior edge of the fourth rib for the entrance into the chest cavity. In this series,165 patients had ASD,403 had VSD,35 had ASD complicated with VSD,3 showed PECD,and 6 were found as PAPVC. Results The mean cardiopulmonary bypass time was (25.0?5.5) min,402 of the patients (65.6%) need no blood transfusion. The mean hospital stay was (6.0?4.5) d,no patient died in hospital. The 420 patients were followed up for 5 to 80 months (mean 47 months). During the period,cardiac ultrasonography showed good outcomes in the patients. No complications or death were detected. Conclusions Right subaxillary small incision is a safe and minimally invasive method for the treatment of ASD and VSD with quick recovery,less hemorrhage,shorter hospital stay,less complications,and satisfying cosmetic outcomes.

Advance of mini-invasive treatments of uterine leiomyoma / 医学研究生学报

Uterine leiomyoma is the most common benign tumour of reproductive system of wommen.In recent years,the mini-trauma technology represented by laparoscope and hysteroscope is popularized in the application to treatment of uterine leiomyoma,such as LH,LM,HM and UAE put forward recently,etc.They all have many advantages,little trauma,less pain,rapid recovery and shorter duration of hospitalization.But indication,method of operation and complication have nothing in common with each other.This text is a survey at the point.

Advance of mini-invasive treatments of hepatic portal hypertension in cirrhosis / 医学研究生学报

The therapeutic management of hepatic portal hypertension in patients with cirrhosis is still a challenge. At present surgical devascularization and shunting play the important roles in treatment of portal hypertension. While some cirrhotic patients can not bear the stress of operation and anesthesia because of inadequat potential hepatic function. So the mortality of operation is very high. With the development of endoscopy,radiological techniques and new materials and equipments, the mini invasive treatments become more important. This review summarizes the current advances of mini invasive treatments of portal hypertension in cirrhosis.