切除刀

The uncovered tracts and the liver wound surface were managed by some of the methods combined such as high frequency electrocoagulation, titanium clamp, suture, hemostatic gauze oppression, argon-beam coagulation, protein glue adherence, and Endo-GIA switcher. The total operative outcome, operating time, blood loss, postoperative complications and postoperative hospital stay were summarized in order to assess feasibility and safety of the clinical laparoscopic liver resection.Results: 1. Laparoscopic liver resection with clamp dissection method needs only the ordinary laparoscopic equipment. It has a low cost but causes a little more bleeding. 2. Laparoscopic liver resection operated by microwave tissue coagulation method had very little bleeding when dissecting hepatic parenchyma. The operative field is clear and the cost is low. It is a safe, convenient and effective method. 3. Ultrasound dissector is a relatively ideal appliance for laparoscopic liver resection at present because ofless bleeding during operation. But the speed is slow thus prolongs the operation time. Its separating intensity is not strong enough, and it can only be applied to patients without hepatic cirrhosis. 4. Ligsure has clamp dissection and electrocoagulation functions. It can carbonize hepatic tissue including the tracts whose diameters are less than 7mm. It has some advantage in dissecting. However, it has the shortcomings of the clamp dissector during coagulating. 5. Hand-assisted laparoscopic liver resection can make use of the flexibility and feeling of the operators left hand.

结果：1、钳夹分离切肝法不需特殊仪器设备，只要具备常规的腹腔镜器械即可实施，成本低，肝断面较易渗血；2、微波固化切肝法肝实质出血很少，视野清晰，成本低，操作简单，是一种安全、简便、有效的方法；3、超声刀是目前较为理想的切肝器械，术中出血少，但是，切割速度慢，手术时间长，而且，切割强度有限，适用于无肝硬化的肝切除；4、Ligsure具有挤压粉碎及高频电凝止血两大功能，可使包括7~以下管道的肝组织碳化、形成焦痴，具有一定的优势，但是，也存在分离钳电凝止血的缺点；5、手辅助腹腔镜肝切除可以利用术者左手的灵活性及手感，便于术中显露、分离、控制出血等，可随意协助右手及助手的主要操作，缩短了手术时间，大大提高了腹腔镜肝切除的安全性，李朝龙等的改良方法，同样达到了手辅助目的，又节省了费用；6、小切口腹腔镜辅助切肝法可以使用剖腹肝切除常规器械及剖腹肝切除技术，操作简单、可靠，适用于肝左外叶切除及右肝第V段切除；7、Endo一GIA切肝法在离断肝组织的同时闭合管道结构，多用于肝左静脉、门静脉分支、管径较大胆管的切割，缺点是不能用于较厚肝组织的切割，而且价格昂贵；8、临床巧例腹腔镜肝切除均获得成功，手术时间最短1.5h，最长sh，平均125 min，多数在100 min左右，手术出血量最少50 ml，最多500 ml，平均1 78 ml，除2例合并严重肝硬化的原发性肝癌患者术后出现少量腹水，1例术后发生胆漏外，其余无并发症，发生胆漏的1例患者术后住院40d，多数在术后一周左右出院，术后住院时间5一40d，平均gd。

Key words epiglottis , cyst,argon plasma coagulator

氩气刀总体治疗效果优于高频电刀和传统手术切除，有较高的临床应用价值。

Methods: 1. Experimental laparoscopic liver resection: We selected pigs as experimental models aiming to approach human beings physiological and anatomical condition. After CO2 pneumoperitoneum was established, the ligaments around liver were dissociated. Livers were cut off by the methods such as clamp dissection, microwave tissue coagulator, ultrasound dissector, Ligsure dissection, hand-assisted, short abdominal incision laparoscopy-assisted, and Endo-GIA switcher. The operation time and bleeding volume were compared between different methods of laparoscopic liver resection. The advantages and limitations of different methods were summarized. 2. Clinical laparoscopic liver resection: 15 cases with tumors in segment V of anterior right lobe or segments II, III of left lateral lobe or segment IV of left internal lobe were selected in this study. The liver diseases included hepatocellular cancer, hepatic cavernous hemangioma and hepatic focal nodular hyperplasia. The ligaments around liver were dissociated after CO2 pneumoperitoneum established. Laparoscopic liver resection were carried out by some of the methods combined such as clamp dissection, microwave tissue coagulator, hand-assisted, short abdominal incision laparoscopy-assisted, ultrasound dissector, rotation and suction dissector.

1、实验性腹腔镜肝切除：以猪为实验动物，旨在接近人体的生理、解剖环境下进行实验，建立操作空间后游离肝脏周围韧带，采用钳夹分离切肝法、微波刀切肝法、超声刀切肝法、Ligsure切肝法、手辅助腹腔镜肝切除法、小切口腹腔镜辅助切肝法、Endo-GIA切肝法等方法实施腹腔镜下肝切除，比较不同切肝方法的手术时间、出血量，总结各种方法的优越性及其局限性。2、临床腹腔镜肝切除：选择肿瘤位于肝右前叶第Ⅴ段、肝左外叶第Ⅱ、Ⅲ段及左内叶第Ⅳ段的15例患者，病种包括原发性肝癌、肝海绵状血管瘤、肝脏局灶性增生，建立气腹后游离肝脏周围韧带，采用钳夹分离断肝、微波刀固化后断肝、手辅助腹腔镜肝切除、小切口腹腔镜辅助肝切除、超声刀断肝、旋吸断肝等多种方法分离切线肝组织，暴露管道结构，再采用高频电凝、钛夹夹闭、缝扎止血、止血纱布覆盖、氩气刀止血、生物胶止血、Endo-GIA处理等多种方法相结合处理肝断面，统计手术完成情况、手术时间、手术出血量、术后并发症及术后住院时间等，评价腹腔镜肝切除的可行性及安全性。

Tumor excision was performed using ultrasonic shears, maintaining an adequate parenchymal margin. Bleeding from the tumor bed was controlled by bipolar diathermy . The renal artery was occluded when necessary. The edges of the renal parenchyma were approximately with 4 to 6, 2-zero absorbable sutures over hemostatic mesh.

超声刀沿瘤体边缘外0.5厘米处分离，由浅入深，边切割边止血，直到完全切除肿瘤，如切除肿瘤过程中肾脏创面出血过多影响操作，可暂时阻断肾动脉并计时，迅速切除肿瘤，双极电凝止血后，即可开放肾动脉。

Resuts: The tumors were reduced in 15 patients after radiosurgery at 6 months, has not change in 6 patients.

结果：21例胶质瘤中，15例在治疗后6个月肿瘤缩小，6例无变化，2例在X-刀治疗后2个月内行开颅肿瘤切除术；11例脑转移瘤X-刀治疗后病灶全部消失7例，明显缩小4例(≥5%)。

The operating time and blood loss duing operation and the degree of pain and the region of inflammation tumidity as well as hospitalization days were observed.

目的 探讨超声刀实施扁桃体切除术的可行性方法鼻内镜直视下放，对41例扁桃体切除术患者分别采用超声刀及常规手术方法，观察术中出血量、疼痛程度、炎性水肿范围、手术时间及住院天。

Methods:Thyroidectomy,total or subtotal lobectomy of thyroid had been performed at 716 patients with thyrotoxicosis, thyroid adenoma, nodule thyrocele and papillary thyroid cancer by UAS in place of the conventional method such as deligation suture and hematischesis through thecervical minimal incision.Results:Mean operating time with the UAS was 72(42～134) minutes.

使用超声刀代替传统方法（结扎和缝合作为主要切割、止血的方法）对716例毒性甲状腺肿、甲状腺腺瘤、结节性甲状腺肿以及分化型甲状腺癌等多种甲状腺疾病，通过颈部小切口进行部分甲状腺切除术或腺叶全切术或根治性切除手术。

objective to explore the best method of nursing in laparoscopic operation of subtotal hysterectomy with pk scapel.methods ninety seven patients under going operation of laparoscopic subtotal hysterectomy with pk scapel were slected.the bleeding volume,operation time and methods of nursing including machine check,proceeding and maintenance of instruments.results bleeding volume was lessened significantly and good nursing during operation can improve safety and success rate of losh.conclusion good nursing with well knowledge of pk scapel,accurate proceeding and sterilization and skilled cooperation plays a key role in assurance of the success of losh.

摘 要］目的：探讨在腹腔镜下使用pk刀行子宫次全切除术配合的方法。方法：对97例使用pk刀在腹腔镜下行子宫次全切除术配合进行总结，主要是检查测试仪器功能，按操作程序密切配合手术，术后正确彻底的清洗、保养、消毒与灭菌。结果：在腹腔镜下应用pk刀切除子宫，出血量明显减少，组织损伤小，97例的手术中除1例粘连严重中转开腹外，其余手术均顺利完成，无并发症发生。结论：护士加强对pk刀的应用学习，正确掌握操作规程和灭菌方法，以及娴熟的腹腔镜配合技术是手术顺利进行的有力保证。［关键词］腹腔镜；pk刀；子宫次全切除术；护理配合

The resection electrode types include: a hand-crafted, temperature-resistant tungsten wire-cutting loop; a coagulating perforated resector that provides a 40% greater coagulation zone than standard cutting loops and performs cutting and coagulation simultaneously during tissue resection; a dimpled vaporization roller that offers a smoother area of vaporization than a grooved roller while providing deep-tissue coagulation; a roller ball and roller barrel, which are used for coagulation and ablation of soft tissue in the bladder and prostate (the roller ball may also be used for endometrial ablation in the uterus); and a Collings knife that allows urologists access to all areas of the prostate and is most commonly used for ureteral meatotomy and transurethral incision of the prostate.

切除电极包括：手动操作、耐受高温、钨丝切除线圈；凝固穿孔前列腺切除器，比标准切除线圈的凝固面积大出40%，能够在组织切除过程中同时进行切除和凝固；一种漩涡汽化转子，比槽式转子提供更加平滑的汽化区域，同时产生深部组织凝固；一个转子球和转子滚筒，用于膀胱和前列腺软组织的凝固和汽化(转子球还可以用于子宫内膜的消融)；一个Collings刀能够帮助泌尿科医生进入前列腺的所有区域，通常用于输尿管切除术和经尿道前列腺切开。

Reformed surgery had the following features: We firstly resected the uterus and then dissected the pelvic lymph node. Urinary bladder gap and rectum gap were opened. After exposing the route of ureter, we excised the uterus artery at the point between the ureter and the uterus artery. Cardinal ligament and uterosacral ligament were cut off by electric knives.

改良式手术具有以下特点：先切除子宫再清扫盆腔淋巴结；进腹后直接打开膀胱子宫反折腹膜，膀胱侧窝及直肠侧窝，暴露输尿管行程，在子宫动脉跨过输尿管处钳夹切断子宫动脉；用电刀直接切除主韧带、骶韧带；清扫盆腔淋巴结时，淋巴断端及小血管分支出血均以钛夹钳夹处理。

And Pharaoh spoke to Joseph, saying, Your father and your brothers have come to you.

47：5 法老对约瑟说，你父亲和你弟兄们到你这里来了。

Additionally, the approximate flattening of surface strip using lines linking midpoints on perpendicular lines between geodesic curves and the unconditional extreme value method are discussed.

提出了用测地线方程、曲面上两点间短程线来计算膜结构曲面测地线的方法，同时，采用测地线间垂线的中点连线和用无约束极值法进行空间条状曲面近似展开的分析。