Laparoscopic hernia surgery has developed rapidly in China for 20 years. Its characteristics of minimal invasive, fast recovery, and low complications have been highly sought after by doctors and patients.The proportion of laparoscopic surgery has also significantly increased, not only in the field of inguinal hernia,but also in other abdominal wall hernias such as incisional hernia, parastomal hernia, and hiatal hernia. The progress in technology and materials, as well as the application of new technologies such as single-incision hernia repair, robotic surgery, and MINIM technique, have led to continuous improvement in the efficacy of laparoscopic hernia surgery. However, there are still many problems, such as mesh related complications,general anesthesia trauma, and new technology learning curve related issues, which restrict the development of laparoscopic hernia surgery. In the future, laparoscopic technology will become the preferred method for most hernia surgeries, and telemedicine and artificial intelligence will provide broader development space for minimally invasive technology.
【视频简介】 细胞外基质 （ECM）是肿瘤微环境的重要组分。实体瘤具有独特的ECM，即大部分实体瘤会形成肿瘤纤维化，而这种特征主要由ECM 中的胶原蛋白所赋予。基于胶原蛋白沉积和肿瘤浸润免疫细胞丰度，本团队将实体肿瘤分为三种亚型：软热肿瘤 （soft & hot tumor，低胶原蛋白沉积和高免疫浸润）、硬冷肿瘤 （armored & cold tumor，高胶原蛋白沉积和低免疫浸润）和静默肿瘤 （quiescent tumor，低胶原蛋白沉积和免疫浸润）。
由于硬冷肿瘤ECM 中大量胶原蛋白沉积，阻碍了免疫细胞浸润，因此硬冷肿瘤的预后较差。针对硬冷肿瘤的治疗策略有“直接靶向ECM 中已经存在的胶原蛋白”和“抑制胶原蛋白的产生”两种方式。后者的靶点包括血管生成靶点、成纤维细胞生长因子受体、血小板衍生生长因子受体、免疫检查点B7-H3等。硬冷肿瘤的防治研究尚处于起步阶段，后续工作将着力解决以下三个问题：复杂的纤维化机制、评估方法的标准化和个体差异的影响。随着研究的不断深入，未来胶原蛋白有望成为解决肿瘤免疫逃逸、预防肿瘤复发和转移等难题的有效靶点。
【视频简介】 根治性膀胱切除术联合肠道重建新膀胱是治疗肌层浸润性膀胱癌及高危非肌层浸润性膀胱癌的常用手术方法。近年来，该术式在肿瘤控制与保留控尿、排尿功能方面取得良好平衡，应用日益广泛。对于器官局限性肿瘤患者，可选择保留控尿功能和性神经的保留功能术式，提高患者术后生活质量。根治性膀胱切除的功能保护手术方式在很大程度上参考了根治性前列腺切除手术，如强调保留面纱状前列腺筋膜的超级面纱技术和保留Retzius 间隙及其内结构的HOOD 技术。然而，需要注意的是，去管化肠道重建的新膀胱缺乏逼尿肌和控尿神经的支配。在进行根治性膀胱切除原位新膀胱术时，如何最大程度地保留控尿和排尿功能，目前仍存在争议。中山大学孙逸仙纪念医院泌尿外科何旺主任医师团队，基于尿道鞘及其与周围筋膜延续融合的解剖学基础，创新性地提出了保留功能漏斗的根治性膀胱切除原位新膀胱术。该术式通过保留并折叠狄氏筋膜，同时保留尿道鞘及其与狄氏筋膜之间的连接，并在全筋膜内切除前列腺，最后行尿道鞘-新膀胱的解剖复位吻合操作。在手术过程中，全程妥善保护性神经和控尿相关张力结构。中山大学孙逸仙纪念医院泌尿外科的探索经验表明，该术式可有效保护勃起神经、维持控尿力学的效果，最终达到保留控尿功能与性功能的目的。
本例患者为41 岁男性，诊断为膀胱高级别浸润性尿路上皮癌伴腺性分化（cT3aN1M0），经行新辅助化疗联合免疫治疗（吉西他滨+顺铂+替雷利珠单抗）4 周期后部分缓解，且有强烈的性功能需求。行保留功能漏斗的根治性膀胱切除原位新膀胱术，术后病理提示膀胱固有层少量高级别尿路上皮癌残留（ypT1N0M0）。术后2 周拔除尿管，即刻完全控尿。术后1 周恢复勃起，术后3 个月性生活恢复至术前，复查残余尿<50 ml，整体术后恢复情况较理想。
【视频简介】下腔静脉后输尿管（retrocaval ureter，RU）是一种因下腔静脉发育异常而导致输尿管位置及走行异常的罕见先天性泌尿系畸形。RU 形成的原因与胚胎发育过程中后主静脉异常持续存在密切相关。当腔静脉后输尿管引起输尿管梗阻时，可出现腰痛、腰胀、反复泌尿系感染或并发结石等症状。对于合并肾、输尿管积水及出现相关临床症状的RU 患者，腹腔镜下腔静脉后输尿管矫形术是目前RU 主要的治疗方式。
本视频患者为右侧下腔静脉后输尿管，且合并右侧肾、输尿管积水。结合患者实际情况，我们制定了下列手术策略：（1）选择经腹腔途径，因其解剖标志明显、操作空间大、可充分暴露下腔静脉及输尿管；（2）切开侧腹膜，将降结肠和十二指肠向中线游离以暴露下腔静脉；在髂血管处切开腹膜，分离输尿管；沿输尿管往上游离，可见输尿管走行入腔静脉后；在腔静脉外侧分离出扩张的上段输尿管和肾盂；（3）游离腔静脉后段的输尿管，尽量分离腔静脉与输尿管，在扩张输尿管段用剪刀斜面切断近端输尿管，将梗阻远端输尿管从腔静脉后牵至腔静脉前，若输尿管与腔静脉粘连而分离困难，可在腔静脉两段切断输尿管，旷置腔静脉后输尿管；（4）适当剪除远端多余输尿管，劈开输尿管，用4-0 可吸收线间断或连续全层Y-V 缝合两输尿管断端；创缘必须对合整齐，切勿外翻或内翻，确保吻合口无张力；（5）关闭侧腹膜，留置腹腔引流管一根，缝合腹壁戳孔。
本例患者因输尿管与腔静脉严重粘连，我们旷置了腔静脉后段输尿管，并对右肾进行了下降固定术，以确保输尿管无张力吻合。总之，在下腔静脉后输尿管矫形术中，术者需确保输尿管无张力吻合，同时尽可能保护输尿管血供。结合手术经验和患者的实际情况制定个体化手术策略，是手术成功的重要保证。
【视频简介】本例患者男性，54 岁。以“体检发现左肾囊实性占位1 个月”为主诉入院，无不适症状。双肾CT 提示：左肾上极病变，以低密度为主，病灶边缘及内部可见多发斑片状钙质密度影，大小约8.9 cm×9.3 cm×8.5 cm，其内可见结节状轻度-中度强化，大部分区域未见明显强化。术前诊断：左肾囊实性占位（Bosniak Ⅲ-Ⅳ级）。
患者及家属积极要求保肾。手术难点包括：（1）肿瘤巨大，占位效应明显，操作空间严重受限；（2）囊性肿瘤易破裂，增加肿瘤种植转移风险；（3）手术切除创面大，切除及缝合时间延长，热缺血时间延长；（4）瘤体位置深，紧贴集合系统。手术策略：采用达芬奇机器人辅助腹腔镜左侧巨大囊性肿瘤肾部分切除术（经腹腔入路）。注意事项：（1）对于囊性巨大瘤体，采用经腹入路可获得较大的操作空间，结合达芬奇机器人手术系统，可更精准辨别肿瘤包膜，精准切割与快捷缝合，有效缩短热缺血时间；（2）游离及切除囊性巨大瘤体时，操作需轻柔，采用“排雷式”方法，谨慎分离，避免包膜破裂；（3）切除囊性瘤体时，根据术前阅片确定安全切开位置，运用“钝锐结合、小步快走”手法，完整分离瘤体；（4）需游离动静脉，彻底阻断血管，保持术野清晰，以便在不切破瘤体的同时，最大限度保留正常肾实质；（5）集合系统破损及血管断端处缝合需精细，髓质破损处为缝合重点，可适度密缝，防止术后内漏或动静脉瘘。术后病理显示切缘阴性，诊断为肾细胞癌。
Our team frequently confronts problems such as inadequate exposure and time-consuming adjustment during single-port laparoscopic cholecystectomy.Recently，our team has employed T-shaped shape memory alloy wires in single-port laparoscopic cholecystectomy，which entails penetrating the basal layer of the gallbladder and the mesothelium of the cystic duct to pull the gallbladder at different angles for enhanced exposure.This procedure is denominated the marionette single-port laparoscopic cholecystectomy.With the assistance of this instrument，the operation becomes less arduous，the exposure effect is more pronounced，and in comparison with the conventional single-port laparoscopic liver resection，it adds three 1.1mm port holes.The assistant port heals without leaving scars，and its postoperative aesthetic outcome is comparable to that of conventional single-port laparoscopic surgery，and even the umbilical incision is smaller.This video showcases the marionette single-port laparoscopic cholecystectomy，which is a suitable technique worthy of promotion.
With the development of precision diagnosis and treatment and minimally invasive concepts, the treatment strategies for gastric cancer have gradually diversified and refined, but for patients with advanced gastric cancer, radical surgical resection is still the key process in the treatment. With the promotion and application of laparoscopic technology, laparoscopic total gastrectomy has been widely carried out in tertiary hospitals across China. Therefore, only a detailed and complete set of surgical lymph node dissection strategies for gastric cancer can be developed to guarantee the quality of laparoscopic gastric cancer surgery in hospitals of all levels. Laparoscopic total gastrectomy requires multi-level and multi-space separation and dissection around the stomach, accurate naked dissection of perigastric blood vessels, and thorough dissection of perigastric lymph nodes, in order to ensure the radical operation. The dissection of perigastric lymph nodes is usually divided into five regions: subpyloric region, suprapancreatic region, suprapyloric region, splenic hilum region and cardiac region. In the process of cleaning each area, the tacit cooperation of the surgeon, the assistant and the mirror holder is required to ensure the smooth progress of laparoscopic total gastrectomy lymph node dissection.
Systematic treatment of breast cancer can reduce the risk of recurrence and prolong the survival，which has been widely recognized in clinical practice. Chemotherapy for breast cancer patients often contains corrosive drugs. According to the Health Industry Standard of China，corrosive drugs should not be infused through peripheral vein. In order to standardize the clinical application of chemotherapy infusion pathway，the Chinese Society of Breast Surgery（CSBrS）issued the Clinical Practice Guide for Central Venous Access for breast cancer，and recommended totally implantable venous access port as a safe infusion access for chemotherapy. Due to the safe operation precedure and low incidence of serious complications such as pneumothorax and hemothorax，implantable venous access port via basilic vein can be used as one of the options for chemotherapy infusion pathway.
To achieve efficient, rational, safe and standardized ultrasound contrast infusion, relevant medical, and nursing experts in China summarized the domestic and international literature and clinical experience evidence. After a thorough discussion under the principles of evidence-based medicine, the consensus was proposed, aiming to provide reference opinions for achieving standardization of safe ultrasound contrast infusion in China. The consensus introduces the current situation and safety of ultrasound contrast agent application, relevant regulations and procedures, standardized care before, during, and after imaging, and proposes 16 recommendations. It suggests that the current ultrasound contrast agents approved for market use in China have a high safety profile, and it recommends that healthcare professionals should dispense and administer them according to the latest instructions or expert consensus and that they should be standardized in terms of contrast room management, risk planning, and personnel qualifications.
It has been more than one year since the General Office of the National Health Commission issued the notice on strengthening the diagnosis, treatment and management of chronic refractory wounds (ulcers) on the body surface (Medical Letter [2019] No. 865, hereinafter referred to as the "notice" ), and the establishment of wound repair departments has set off a fever all over the country. Although the National Health Commission has principled requirements for the construction of the wound repair department in the "notice" , in practical practice, many colleagues do not know how to configure the wound repair department to meet the basic needs of the diagnosis and treatment of wound patients. Aiming at the needs of tertiary hospitals (general wound repair department, research-based wound repair department) and secondary hospitals to carry out wound repair diagnosis and treatment, the basic configuration of wound repair department was put forward for the reference of colleagues and medical institutions preparing to establish wound repair department in China.
【内容简介】 烧伤患者尤其是重度烧伤患者的护理中，体位护理、气道护理、静脉置管护理是极为重要的关键措施。
翻身床广泛应用于烧伤患者的治疗，尤其是大面积烧伤患者，已成为我国烧伤患者治疗中必不可少的治疗性仪器设备，对重度烧伤患者体位管理尤为重要。由铁/钢制材料制成，通过改变体位来满足烧伤患者体位引流、创面减压、方便换药、方便手术等诸多益处。熟练掌握烧伤翻身床技术，是每一位烧伤专科护士的核心技能，创面修复期每日翻身4~6次。翻身前，需要先与患者进行充分沟通，取得配合后，开始准备。翻身时，需要整理所有管道和监护设备导线，同时监测患者的生命体征、意识、气道通畅情况以及脉搏氧饱和度等。一般翻身时，尤其是特别危重的烧伤患者，在翻身床转动前一刻移除呼吸机，翻身到位后第一时间检查气道同时连接呼吸机，保留脉搏氧饱和度导联监测。翻身后，立即解除翻身床片，摆放体位，检查各个管道的在位情况，做好患者安抚工作。
烧伤患者，尤其是发生头面颈部或大面积烧伤时，早期预防性建立人工气道，做好人工气道的护理已成为烧伤专科护士重要的护理工作，也是患者救治成功的重要举措之一。烧伤休克期，因组织严重水肿造成窦道形成较晚，防止导管异位及脱管是早期烧伤患者气道维护的重中之重。套管绳的松紧度以1指为宜，必要时可于患者耳垂下方或颈后垫无菌敷料。如遇颈部烧伤创面时，采用衬带外套上柔软塑料管作为气管切开固定器具，以防止衬带被颈部烧伤创面的渗液浸渍、变硬，引起患者不适，甚至加重颈部烧伤创面。
烧伤这一特殊致伤因素，致使患者正常皮肤大面积缺失，表浅静脉严重受损，而休克期快速补液、回吸收期抗感染药物的应用及静脉高营养需求等，致使患者在治疗过程中通常更加依赖中心静脉置管，而经创面或近创面置管更是无法避免。因此，保持导管通畅、预防导管相关性血流感染的发生并制定适用于重度烧伤患者静脉通路的护理流程至关重要。经/近创面置管时多采用缝合固定，可采用吸附性较好的含银敷料包绕穿刺点及固定翼、无菌纱布垫于创面与穿刺导管之间，每4~8 h换药1次，若有污染随时更换；局部烤灯照射，保持干燥。应用10~20 mL 0.9%氯化钠溶液以脉冲式每8 h冲管1次(冲管前抽回血确认导管在位)，正压封管，双腔中心静脉导管采用2枚20 mL注射器由同一人冲、封管。输液接头每周更换1次，被渗血、渗液污染则随时更换。加强培训，严格无菌操作。
【视频简介】 当今世界下，国际细胞相关研究正如火如荼的开展，目前细胞研究方向除了细胞治疗、组织器官移植修复、基因治疗之外，还向着药物研发、毒性评估工具、发育生物学模型等领域转变。随着细胞基本原理和相关技术的成熟和更新，以及监管政策的不断转暖，各国已纷纷加快细胞的临床研究，并将其列入国家科技战略必争领域。
本视频介绍了如今国际细胞治疗产业发展的现状及面临的机遇与挑战，从A面来看：产业链条相对完善，投融资活动活跃，资本市场看好，不断有新产品获批上市；从B面来讲这种发展是一种非理性繁荣，在这背后更是面临"未被满足"的临床需求。基于国际发展的现状，刘沐芸博士对国内细胞治疗产业"未来该何去何从"提出了几点看法与建议，应当将产业发展的A、B面进行协调统一，通过数字化、自动化与智能化实现细胞产业发展的提质增效，提供终极解决方案。
近年来，二氧化碳激光辅助深层巩膜切除术(CLASS)已成为青光眼手术治疗方式之一。由于缺少操作规范，国内各级眼科医师的应用水平存在一定的差异。为此，专家团队结合国内现状及手术经验并参考国内外文献，从CLASS术式的原理、适应证和禁忌证、一般要求、术前准备、操作步骤及要点、术后随访及处理六个部分共同制定此专家共识，以供眼科医师在临床工作中参考使用。
痉挛性斜颈（ST）是较为常见的局灶性肌张力障碍，临床症状主要表现为头颈部运动障碍，严重影响患者生活质量及社交信心，患者往往对治疗该病具有极大的期望。自Keen（1891年）创建外科切断局部神经治疗ST以来，已形成了多种术式，而每种术式各有其自身的优缺点。近年来，中日友好医院在结合传统术式基础上，探索的改良Foerster-Dandy手术，通过个体化治疗，取得了良好的手术疗效。本文就改良Foerster-Dandy术治疗ST的研究进展进行论述，旨在为临床医生提供对ST的诊疗及手术方式的切实可行的建议。