腔镜甲状腺手术中CO_2充气对大脑影响的实验研究
|
摘要
研究背景
甲状腺疾病发病率女性高于男性,传统的甲状腺手术由于颈部留有手术瘢痕,给女性患者造成很大的心理负担,使得切口的美容要求在甲状腺手术中体现得尤为重要。近年来腔镜手术在许多领域取得了长足的发展,使这一微创技术应用于甲状腺手术具备了一定的基础和条件。腔镜甲状腺切除术是近年来随着腹腔镜内镜技术的发展而逐渐开展起来的一种新的术式,通过借助腔镜和一些特殊操作器械的辅助作用,在取得传统甲状腺手术相同治疗效果的同时,追求最大限度地缩小或隐蔽手术瘢痕以达到美容目的。
腔镜甲状腺手术开展的初期,由于在颈部建立的手术腔隙狭窄、手术空间小、手术操作和止血均较困难,中转开放手术比例高。同时,腔镜甲状腺手术中CO_2充气对机体的不良影响等因素也制约着这项新技术的发展。但随着腔镜技术和器械以及配套设备的不断发展,经验的不断丰富,越来越多的医生加入到腔镜甲状腺手术的行列中,甲状腺手术的适应证范围越来越广,手术技巧已经日趋完善,已有大量甲状腺恶性肿瘤成功施行腔镜甲状腺手术的报道。
目前在腔镜下甲状腺手术中,手术空间的维持,多采用皮下灌注CO_2的方法。CO_2具有不助燃烧、在血中溶解度高、吸收和排泄快、形成气栓可能性小的特点,是目前临床广泛应用的充气介质。但随手术时间延长,在手术过程中CO_2气体灌注时机体发生的病理生理变化明显显现出来,已引起众多学者的注意。
二氧化碳充气对机体的负面影响,特别是潜在的对心肺功能和大脑等重要脏器的影响,其风险性正在受到越来越多地重视。继续深入研究其对机体的影响,特别是对重要脏器的影响,尽量减少这种副作用,对于具有特定基础疾病的患者,有重要的临床意义;对于甲状腺外科的发展有重要的推动作用。
目前研究发现,腔镜甲状腺手术中CO_2气体灌注可以引起颅内压的改变,而且这种改变与充气压力和时间关系密切。这说明,二氧化碳充气对大脑存在某种程度的影响。这种影响能否造成脑损伤?脑损伤的程度与充气压力是否相关?如何避免或减少脑损伤的发生?这是腔镜甲状腺外科中急需回答的问题,同时也是腔镜甲状腺手术基础研究的一个薄弱环节。基于腔镜甲状腺手术的发展需要和其基础研究的现状,研究二氧化碳充气对大脑的影响以及可能导致的脑损伤具有十分重要的临床意义。
以上研究需要一个稳定的、可以重复的、与人类相似的实验动物模型供研究。猪的解剖、生理学特性、营养代谢等方面与人类非常相似。中国实验用小型猪是中国农业大学封闭培育的实验用猪,具有体重轻、抗逆性强、遗传性状稳定等优点。我们选择中国实验用小型猪为实验动物,试图建立腔镜甲状腺手术的动物模型,并通过此模型来研究颈部腔镜手术中二氧化碳充气对大脑的影响以及可能导致的脑损伤。
目的
1.建立腔镜甲状腺手术的中国小型猪动物模型。
2.了解小型猪对手术的耐受性,腔镜甲状腺手术动物模型的安全性、稳定性和可重复性。
方法
中国实验用小型猪9只,随机分为3组。A组为无损伤对照组,仅实施麻醉而不做手术;B组为传统甲状腺手术组,行开放手术;C组为腔镜甲状腺手术组,采取改良的胸骨上窝径路,在CO_2充气维持的人造空间中行腔镜甲状腺切除术。每组动物在麻醉成功后,手术开始前解剖右侧股动静脉,分别向近端穿刺留置针,以备术中监测动脉血压和中心静脉压。于右侧顶骨用开颅钻钻孔,向硬脑膜下穿刺置管,监测颅内压。以手术开始前为基础值,于1小时、2小时、3小时、4小时和停止充气后30分钟测量上述指标并记录。手术后切除甲状腺组织称重,并做病理检查。用SPSS 16.0统计分析软件对数据进行分析。各组计量结果数据均采用均数±标准差(Mean±Std.)进行统计。两组间均数比较采用独立样本t检验,多组间均数比较采用方差分析,P＜0.05为差异有显著性意义。
结果
所有动物都较好地耐受了整个过程,开放手术组和腔镜手术组手术均顺利完成手术,无严重并发症发生,成功建立了腔镜甲状腺小型猪动物模型。腔镜手术组动物24小时内对外界反应稍差。通过实验确定了所有监测指标的基础值,作为小型猪的正常生理参考值。
各组颅内压比较无显著性差异(P＞0.05)。无损伤对照组和传统手术组比较,各时点血流动力学参数无显著性差异(P＞0.05)。而腔镜甲状腺手术组与开放手术组手术时间(P＜0.01)、切口长度(P＜0.05)有显著性差异,切除甲状腺组织重量及出血量无显著性差异(P＞0.05)。腔镜甲状腺手术组手术手术过程中,心率、平均动脉压、中心静脉压、动脉二氧化碳分压、PH值等均有不同程度改变。
各组动物(n=9)在实验开始前测定各基础监测值的变异系数除中心静脉压(CV=12.43%)外,其余均低于10%。
结论
1.所有小型猪都较好地耐受了麻醉和手术,确定了所有监测指标的正常参考值。
2.成功建立了中国小型猪的腔镜甲状腺手术动物模型,此模型具有较好的安全性、稳定性和可重复性,能够比较灵敏地反应机体血流动力学和颅内压的情况,是一种理想的腔镜甲状腺手术模型,可用于研究腔镜甲状腺手术中CO_2充气对大脑的影响。
研究背景
腔镜甲状腺手术因其创伤小、出血少、恢复快、美容效果好等优势,逐渐被广大患者所接受。颈部不像腹腔和胸腔,没有自然存在的腔隙,如果颈部行腔镜手术必需人工建立一个操作空间。腔镜甲状腺手术中手术操作空间建立后的维持,目前多采取皮下充入一定压力的二氧化碳气体来实现,此法的优点在于空间开阔,视野清楚,应用简单。CO_2具有不助燃烧、在血中溶解度高、吸收和排泄快、形成气栓可能性小的特点,是目前临床广泛应用的充气介质。
随腔镜甲状腺外科的发展,手术难度和种类都有所增加。随手术时间延长,在手术过程中CO_2气体灌注时机体发生的病理生理变化明显显现出来。这种CO_2在组织中吸收和其直接压力造成的对机体的负面影响,特别是潜在的对心肺功能和大脑等重要脏器的影响,其风险性正在受到越来越多地重视。继续深入研究其对机体的影响,特别是对重要脏器的影响,尽量减少这种副作用,对于具有特定基础疾病的患者,有重要的临床意义;对于甲状腺外科的发展有重要的推动作用。
文献报道腹腔镜腹部术后患者头痛与恶心发生率高于开腹手术,分析其原因可能与颅内压增高有关。动物实验和临床观察表明,无论是腹腔镜腹部手术还是颈部手术,依靠CO_2维持手术操作空间都有可能引起颅内压增高,而且这种改变与充气压力和时间关系密切。这说明,二氧化碳充气对大脑存在某种程度的影响。但目前腔镜甲状腺手术中二氧化碳充气对机体影响的动物实验研究仅局限于对颅内压的影响,而对于二氧化碳充气引起的颅内高压可能引起的脑损伤,以及脑损伤的的病理和电镜表现研究很少。这也是腔镜甲状腺手术基础研究的一个薄弱环节。
鉴于甲状腺腔镜手术的发展需要和其基础研究的现状,我们通过腔镜甲状腺手术的实验动物模型来研究颈部腔镜手术中二氧化碳充气对大脑的影响,了解是否会产生脑损伤,脑损伤的病理及电镜表现以及如何避免脑损伤的发生,填补腔镜甲状腺手术基础研究的空白。
目的
1.观察腔镜甲状腺手术中,不同CO_2充气压力对机体血流动力学和颅内压的影响。
2.观察脑组织的病理和电镜下表现,了解腔镜甲状腺手术中不同CO_2充气压力可能导致的脑损伤。
3.确定对大脑负面影响相对较小的CO_2安全充气压力。
方法
将12只中国小型猪随机分成A、B、C、D共4组,每组3只动物。A组为对照组采用开放切口行传统甲状腺切除术;B、C、D组均采用腔镜甲状腺切除术,CO_2充气气压分别为5mmHg、10mmHg和15mmHg。分别于充气前、充气后1h、2h、3h、4h及充气结束后30min监测HR、CVP、MAP、PaCO_2、PH值和ICP。腔镜甲状腺切除术采取胸骨上窝径路、三戳孔技术。在充分显露甲状腺后,行左叶甲状腺全切,并解剖显露同侧的颈血管鞘,清除周围脂肪组织和淋巴结。
手术后一周在静脉麻醉下开颅完整取出脑组织。立即于左顶叶大脑皮质切取1×1×1mm组织块,用3%戊二醛固定后,用于电子显微镜检查。剩余脑组织用10%中性甲醛固定,用于病理检查。
用SPSS 16.0统计分析软件对数据进行分析。各组计量结果数据均采用均数±标准差(Mean±Std.)进行统计。两组间比较采用独立样本t检验,多组间均数比较采用方差分析,P＜0.05认为差异有显著性意义。
结果
所有动物都较好地耐受了整个过程。开放手术组和腔镜手术组手术均顺利完成,未出现严重并发症。手术后所有动物清醒后均有自主排尿,但D组动物相对于B组和C组动物,手术区域附近(颈部和胸部)皮下气肿发生率高、皮下气肿面积大,且手术后48-72小时内活动明显减少、嗜睡、对外界反应差、进食少或不进食。
腔镜甲状腺手术中,10mmHg二氧化碳充气时,可引起轻度高碳酸血症和酸中毒,动脉血压和中心静脉压轻度升高;15mmHg时,可引起明显高碳酸血症和酸中毒,动脉血压和中心静脉压升高。
A组、B组在各时间点观测值比较均无显著性差异(P＞0.05);C组随充气时间延长,PaCO_2逐渐升高、pH值逐渐下降,有统计学意义;颅内压有所上升,但无统计学意义(P＞0.05);D组随充气时间延长,PaCO_2逐渐升高、pH值逐渐下降以及颅内压增高,且均有统计学意义。
病理观察,与A组相比,B、C、D组具有脑水肿表现,B组轻微,C、D组较明显。A组、B组胶质细胞数比较无统计学意义;C组、D组之间及其分别与另两组之间均有显著差异(P＜0.05)。电镜观察,C组、D组神经元及胶质细胞凋亡明显增多。
结论
1.长时间高压力CO_2充气可引起高碳酸血症和酸中毒,并引起血流动力学和颅内压的改变。
2.在颈部腔镜手术中运用CO_2气体长时间维持颈部手术空间,在较高气压(15mmHg)甚至是压力为10mmHg时,可以导致脑水肿,并可诱发脑神经细胞的凋亡。
3.腔镜甲状腺手术中CO_2充气应尽量低于10mmHg,为保证对脑组织的影响降到最低,我们推荐5mmHg是相对安全的压力值。
Part one
Establishment of animal model for endoscopic thyroidectomy
Background
The incidence rate of thyroid disease in female is higher than in male. The postoperative incisional scar, paraesthesia and complaint in the neck (near the wound region) brought some serious psychological problems to female patients who accepted traditional thyroidectomy. The cosmetic requests of the incision in thyroid operations had been proposed by more and more female patients. In recent years the endoscopic surgery developed rapidly and it is the time for this minimally invasive technique used in thyroid surgery. Endoscopic thyroidectomy is the new technique to comply with the cosmetic requests. The targets of this minimally invasive surgery could be summarized by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results.
At the beginning of this new technique, conversion to the traditional approach was often occurred due to the bleeding from the vessels or the thyroid dimension. But accompanying with the development of new technique and matched instruments of endoscopy, endoscopic thyroidectomy became more and more consummate. The indication of endoscopic thyroidectomy gradually enlarged. Many reports indicated thyroid carcinoma had been treated by endoscope, although it limited in those small differentiated carcinoma without lymph node involvement.
At present the operative cavity during endoscopic thyroidectomy is usually established and maintained by CO_2 insufflation. CO_2 insufflation proved to be a feasible, safe and convenient method for setting up the operative cavity by its rapid absorptive nature. But along with the prolong of the operative time, the pathophysiological changes caused by CO_2 insufflation was apparently observed.
The negative influence to cardiopulmonary function and cerebrum caused by CO2 insufflation was gradually noticed. It is very important that lucubrate and decrease these negative effects to the development of endoscopic throid surgery and to the patients who combine with some specific disease.
Now the researches revealed CO_2 insufflation during endoscopic thyroidectomy could affect intracranial pressure and those effects were related closely to the insufflation pressure and time. Could those effects lead to cerebral injury according to the different pressure? How to avoid or minimize the cerebral injury? All these problems have to be solved for the advancement of endoscopic thyroid surgery. It is necessary to study the effects of CO2 insufflation to cerebrum during endoscopic thyroidectomy.
Then we need a stable animal model which could be repetitive and similar to the mankind for above destinations. The anatomy, physiological and metabolism characteristics of the swine are similar to the mankind. The Chinese experimental minipigs which reared closely by Chinese Agriculture University just possess these advantages such as light weight, perfect antireversion force and stable inheritable character and fit for the research. We choose them to establish the endoscopic thyroidectomy porcine model and study the effects of CO_2 insufflation to cerebrum.
Objective
1. To establish the animal model for endoscopic thyroidectomy in Chinese experimental minipigs.
2. Validating the security, stability and repeatability of this animal model.
Methods
Nine Chinese minipigs were randomly divided into 3 groups. Group A underwent tracheal intubation general anesthesia without operative procedure and served as the matched controls, Group B underwent traditional thyroidectomy and Group C underwent endoscopic thyroidectomy with CO_2 pressure at 10 mm Hg. Hemodynamics parameters including heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP), arterial partial pressure of CO_2 (PaCO_2), pH and intracranial pressure (ICP) were measured at baseline, 1 h, 2 h, 3 h, 4 h and 30 min after desufflation. Excisional thyroid tissue was weighed and performed pathological examinations. All values are expressed as mean±standard deviation. Independent t-test and ANOVA were used followed by Bonferroni post hoc analysis using SPSS 16.0 analysis software. A probability value <0.05 was regarded as statistically significant.
Results
All animals tolerated the whole procedure, the traditional thyroidectomy and endoscopic thyroidectomy were successfully performed in all cases with no serious complications. The animal model for endoscopic thyroidectomy was established successfully. But subcutaneous emphysema near operative region appeared in the animals of Group C while the extremity activities diminished within 24 hours postoperatively.All monitored index of the baseline could be served as the normal reference value of mimipigs.
Comparison of ICP and the weight of excisional thyroid tissue among different groups were no significant difference (P>0.05). The operative time (P<0.01) and the length of the incisions (P<0.05) between Group B and C were significantly different. The hemodynamics parameters of Group C varied in different time and some of them were statistical significance.
Coefficient variation of the baseline monitored values of different index in all animals (n=9) were all lower than 10% except central venous pressure (CV=12.43%). Conclusions
1. All animals tolerated the anesthesia and operation, the baseline values of all parameters which could be served as the normal reference value were determinded.
2. The endoscopic thyroidectomy porcine model with comparative security, stability and repeatability was established successfully, it could respond the changes of hemodynamics and ICP sensitively during the operative procedure.
Part two
Effects of CO_2 insufflation on cerebrum during endoscopic thyroidectomy in a porcine model
Background
Endoscopic thyroidectomy is accepted gradually by patients due to its advantages including minimal invasion, fewer bleeding, better post-operative recovery course, early discharge from hospital and improved cosmetic results. Unlike the abdominal and thoracic cavity, there is no natural cavity in the neck. A man-made operative cavity in the neck must be established before endoscopic thyroidectomy. At present the operative cavity during endoscopic thyroidectomy is usually maintained by CO_2 insufflation after its establishment. CO_2 insufflation proved to be a feasible, safe and convenient method for maintaining the operative cavity by its rapid absorptive nature.
Accompanying with the development of endoscopic thyroidectomy. the operative time extends with the increasing difficulty and types of this operation. Long time CO_2 insufflation causes apparent pathophysiological changes of the organism. These changes led by CO_2 absorption in the tissue and its direct pressure are noticed by scholars.The negative influence to cardiopulmonary function and cerebrum caused by CO_2 insufflation is the obstacle to the development of endoscopic thyroidectomy. It is very important that lucubrate and decrease these negative effects as far as possible to the development of endoscopic thyroid surgery and to the patients who combine with any other specific disease.
Some studies showed that the incidence rate of headache and vomiting after laparoscopic abdominal operations was higher than that after traditional abdominal operations and believed that it was related with the increase of the intracranial pressure. The clinical observations and animal experiments revealed the increase of ICP would happen whatever in the abdominal or cervical endoscopic operations when the operative cavity was maintained by CO_2 insufflation. The increase of ICP was correlated with the pressure and time of CO_2 insufflation. This showed CO_2 insufflation influenced the cerebrum to some degree. But at present the researches about these effects to cerebrum limited in the intracranial pressure and seldomly to the cerebral injury and its pathological and electronic microscopic changes. It is necessary for the development of endoscopic throid surgery to study the effects of CO2 insufflation to cerebrum during endoscopic thyroidectomy.
In view of the current status of the fundamental research on endoscopic thyroid surgery, we plan to explore the effects to cerebrum caused by CO2 insufflation during endoscopic thyroidectomy through the porcine model.
Objective
1. To observe the effects on the hemodynamics and intracranial pressure causing by different CO_2 insufflation pressure during endoscopic thyroidectomy using the animal model.
2. To observe the pathological and electronic microscopic findings of the cerebral tissue and explore the cerebral injury caused by CO2 insufflation.
3. To validating the suitable pressure for CO2 insufflation during endoscopic thyroidectomy.
Methods
Twelve Chinese minipigs were randomly divided into 4 groups. Group A underwent traditional thyroidectomy and served as the matched controls. Group B, C and D underwent endoscopic thyroidectomy and respectively with CO_2 pressure at 5 mm Hg, 10 mm Hg and 15 mm Hg. HR, CVP, MAP, Arterial partial pressure of CO_2 (PaCO_2), pH and Intracranial pressure (ICP) were measured respectively at baseline, 1 h, 2 h, 3 h, 4 h and 30 min after desufflation. Three trocars' inserted technique and suprasternal fossa approach was used during endoscopic thyroidectomy. After exposing the thyroid glands, left thyroid lobe and the fatty tissue and lymph nodes near right cervical vaginae vasorum was removed completely.
Removed the whole cerebrum from the skull under intravenous anesthesia after a week postoperatively. The brain tissue was observed by pathological and electronic microscopic examinations respectively. All values are expressed as Mean±Std.. Independent t-test and ANOVA was used followed by Bonferroni post hoc analysis using SPSS 16.0 analysis software. A probability value <0.05 was regarded as statistically significant.
Results
Endoscopic thyroidectomy was successfully performed in all cases with no serious complications such as bleedings, gas embolism and postoperative death. But the incidence of subcutaneous emphysema near operative region (neck and upper thorax) in the animals of Group D were higher than those of Group B and C. In addition, extremity activities obviously diminished with lower reaction and food ingested in the animals of Group D within 48-72 hours postoperatively.
In Group C, mild hypercarbia and acidosis, light increase of the arterial blood pressure and central venous pressure were observed; In Group D, obvious hypercarbia and acidosis, increase of the arterial blood pressure and central venous pressure were observed.
All measured values in Group A and B were no significant difference (P>0.05); In Group C the increase of PaCO_2 and the decrease of pH value in different time were significantly different while the mild increase ICP without statistical significance (P>0.05). In Group D the increase of PaCO_2 and ICP, decrease of PH value were significantly different.
Compared with Group A, mild cerebral edema was found in Group B while obvious cerebral edema in Group C and D. Comprison of the count of glial cells between Group A and B was not significantly different (P>0.05); Comparisons between other each group have significantly changes (P<0.01). Obvious increased apoptosis neurons and glial cells were observed in Group C and D under electron microscopy.
Conclusions
1. Long time CO_2 insufflation at high pressure (15 mm Hg) during endoscopic thyroidectomy could cause hypercarbia, acidosis and increase of ICP.
2. CO_2 insufflation during endoscopic thyroidectomy could cause cerebral edema and the increase of the neuron and glial cells apoptosis.
3. We suggest the pressure of CO_2 insufflation should be lower than 10 mm Hg, 5 mm Hg is the relatively safe and recommended pressure to minimize the negative effects of the cerebrum.
甲状腺疾病发病率女性高于男性,传统的甲状腺手术由于颈部留有手术瘢痕,给女性患者造成很大的心理负担,使得切口的美容要求在甲状腺手术中体现得尤为重要。近年来腔镜手术在许多领域取得了长足的发展,使这一微创技术应用于甲状腺手术具备了一定的基础和条件。腔镜甲状腺切除术是近年来随着腹腔镜内镜技术的发展而逐渐开展起来的一种新的术式,通过借助腔镜和一些特殊操作器械的辅助作用,在取得传统甲状腺手术相同治疗效果的同时,追求最大限度地缩小或隐蔽手术瘢痕以达到美容目的。
腔镜甲状腺手术开展的初期,由于在颈部建立的手术腔隙狭窄、手术空间小、手术操作和止血均较困难,中转开放手术比例高。同时,腔镜甲状腺手术中CO_2充气对机体的不良影响等因素也制约着这项新技术的发展。但随着腔镜技术和器械以及配套设备的不断发展,经验的不断丰富,越来越多的医生加入到腔镜甲状腺手术的行列中,甲状腺手术的适应证范围越来越广,手术技巧已经日趋完善,已有大量甲状腺恶性肿瘤成功施行腔镜甲状腺手术的报道。
目前在腔镜下甲状腺手术中,手术空间的维持,多采用皮下灌注CO_2的方法。CO_2具有不助燃烧、在血中溶解度高、吸收和排泄快、形成气栓可能性小的特点,是目前临床广泛应用的充气介质。但随手术时间延长,在手术过程中CO_2气体灌注时机体发生的病理生理变化明显显现出来,已引起众多学者的注意。
二氧化碳充气对机体的负面影响,特别是潜在的对心肺功能和大脑等重要脏器的影响,其风险性正在受到越来越多地重视。继续深入研究其对机体的影响,特别是对重要脏器的影响,尽量减少这种副作用,对于具有特定基础疾病的患者,有重要的临床意义;对于甲状腺外科的发展有重要的推动作用。
目前研究发现,腔镜甲状腺手术中CO_2气体灌注可以引起颅内压的改变,而且这种改变与充气压力和时间关系密切。这说明,二氧化碳充气对大脑存在某种程度的影响。这种影响能否造成脑损伤?脑损伤的程度与充气压力是否相关?如何避免或减少脑损伤的发生?这是腔镜甲状腺外科中急需回答的问题,同时也是腔镜甲状腺手术基础研究的一个薄弱环节。基于腔镜甲状腺手术的发展需要和其基础研究的现状,研究二氧化碳充气对大脑的影响以及可能导致的脑损伤具有十分重要的临床意义。
以上研究需要一个稳定的、可以重复的、与人类相似的实验动物模型供研究。猪的解剖、生理学特性、营养代谢等方面与人类非常相似。中国实验用小型猪是中国农业大学封闭培育的实验用猪,具有体重轻、抗逆性强、遗传性状稳定等优点。我们选择中国实验用小型猪为实验动物,试图建立腔镜甲状腺手术的动物模型,并通过此模型来研究颈部腔镜手术中二氧化碳充气对大脑的影响以及可能导致的脑损伤。
目的
1.建立腔镜甲状腺手术的中国小型猪动物模型。
2.了解小型猪对手术的耐受性,腔镜甲状腺手术动物模型的安全性、稳定性和可重复性。
方法
中国实验用小型猪9只,随机分为3组。A组为无损伤对照组,仅实施麻醉而不做手术;B组为传统甲状腺手术组,行开放手术;C组为腔镜甲状腺手术组,采取改良的胸骨上窝径路,在CO_2充气维持的人造空间中行腔镜甲状腺切除术。每组动物在麻醉成功后,手术开始前解剖右侧股动静脉,分别向近端穿刺留置针,以备术中监测动脉血压和中心静脉压。于右侧顶骨用开颅钻钻孔,向硬脑膜下穿刺置管,监测颅内压。以手术开始前为基础值,于1小时、2小时、3小时、4小时和停止充气后30分钟测量上述指标并记录。手术后切除甲状腺组织称重,并做病理检查。用SPSS 16.0统计分析软件对数据进行分析。各组计量结果数据均采用均数±标准差(Mean±Std.)进行统计。两组间均数比较采用独立样本t检验,多组间均数比较采用方差分析,P＜0.05为差异有显著性意义。
结果
所有动物都较好地耐受了整个过程,开放手术组和腔镜手术组手术均顺利完成手术,无严重并发症发生,成功建立了腔镜甲状腺小型猪动物模型。腔镜手术组动物24小时内对外界反应稍差。通过实验确定了所有监测指标的基础值,作为小型猪的正常生理参考值。
各组颅内压比较无显著性差异(P＞0.05)。无损伤对照组和传统手术组比较,各时点血流动力学参数无显著性差异(P＞0.05)。而腔镜甲状腺手术组与开放手术组手术时间(P＜0.01)、切口长度(P＜0.05)有显著性差异,切除甲状腺组织重量及出血量无显著性差异(P＞0.05)。腔镜甲状腺手术组手术手术过程中,心率、平均动脉压、中心静脉压、动脉二氧化碳分压、PH值等均有不同程度改变。
各组动物(n=9)在实验开始前测定各基础监测值的变异系数除中心静脉压(CV=12.43%)外,其余均低于10%。
结论
1.所有小型猪都较好地耐受了麻醉和手术,确定了所有监测指标的正常参考值。
2.成功建立了中国小型猪的腔镜甲状腺手术动物模型,此模型具有较好的安全性、稳定性和可重复性,能够比较灵敏地反应机体血流动力学和颅内压的情况,是一种理想的腔镜甲状腺手术模型,可用于研究腔镜甲状腺手术中CO_2充气对大脑的影响。
研究背景
腔镜甲状腺手术因其创伤小、出血少、恢复快、美容效果好等优势,逐渐被广大患者所接受。颈部不像腹腔和胸腔,没有自然存在的腔隙,如果颈部行腔镜手术必需人工建立一个操作空间。腔镜甲状腺手术中手术操作空间建立后的维持,目前多采取皮下充入一定压力的二氧化碳气体来实现,此法的优点在于空间开阔,视野清楚,应用简单。CO_2具有不助燃烧、在血中溶解度高、吸收和排泄快、形成气栓可能性小的特点,是目前临床广泛应用的充气介质。
随腔镜甲状腺外科的发展,手术难度和种类都有所增加。随手术时间延长,在手术过程中CO_2气体灌注时机体发生的病理生理变化明显显现出来。这种CO_2在组织中吸收和其直接压力造成的对机体的负面影响,特别是潜在的对心肺功能和大脑等重要脏器的影响,其风险性正在受到越来越多地重视。继续深入研究其对机体的影响,特别是对重要脏器的影响,尽量减少这种副作用,对于具有特定基础疾病的患者,有重要的临床意义;对于甲状腺外科的发展有重要的推动作用。
文献报道腹腔镜腹部术后患者头痛与恶心发生率高于开腹手术,分析其原因可能与颅内压增高有关。动物实验和临床观察表明,无论是腹腔镜腹部手术还是颈部手术,依靠CO_2维持手术操作空间都有可能引起颅内压增高,而且这种改变与充气压力和时间关系密切。这说明,二氧化碳充气对大脑存在某种程度的影响。但目前腔镜甲状腺手术中二氧化碳充气对机体影响的动物实验研究仅局限于对颅内压的影响,而对于二氧化碳充气引起的颅内高压可能引起的脑损伤,以及脑损伤的的病理和电镜表现研究很少。这也是腔镜甲状腺手术基础研究的一个薄弱环节。
鉴于甲状腺腔镜手术的发展需要和其基础研究的现状,我们通过腔镜甲状腺手术的实验动物模型来研究颈部腔镜手术中二氧化碳充气对大脑的影响,了解是否会产生脑损伤,脑损伤的病理及电镜表现以及如何避免脑损伤的发生,填补腔镜甲状腺手术基础研究的空白。
目的
1.观察腔镜甲状腺手术中,不同CO_2充气压力对机体血流动力学和颅内压的影响。
2.观察脑组织的病理和电镜下表现,了解腔镜甲状腺手术中不同CO_2充气压力可能导致的脑损伤。
3.确定对大脑负面影响相对较小的CO_2安全充气压力。
方法
将12只中国小型猪随机分成A、B、C、D共4组,每组3只动物。A组为对照组采用开放切口行传统甲状腺切除术;B、C、D组均采用腔镜甲状腺切除术,CO_2充气气压分别为5mmHg、10mmHg和15mmHg。分别于充气前、充气后1h、2h、3h、4h及充气结束后30min监测HR、CVP、MAP、PaCO_2、PH值和ICP。腔镜甲状腺切除术采取胸骨上窝径路、三戳孔技术。在充分显露甲状腺后,行左叶甲状腺全切,并解剖显露同侧的颈血管鞘,清除周围脂肪组织和淋巴结。
手术后一周在静脉麻醉下开颅完整取出脑组织。立即于左顶叶大脑皮质切取1×1×1mm组织块,用3%戊二醛固定后,用于电子显微镜检查。剩余脑组织用10%中性甲醛固定,用于病理检查。
用SPSS 16.0统计分析软件对数据进行分析。各组计量结果数据均采用均数±标准差(Mean±Std.)进行统计。两组间比较采用独立样本t检验,多组间均数比较采用方差分析,P＜0.05认为差异有显著性意义。
结果
所有动物都较好地耐受了整个过程。开放手术组和腔镜手术组手术均顺利完成,未出现严重并发症。手术后所有动物清醒后均有自主排尿,但D组动物相对于B组和C组动物,手术区域附近(颈部和胸部)皮下气肿发生率高、皮下气肿面积大,且手术后48-72小时内活动明显减少、嗜睡、对外界反应差、进食少或不进食。
腔镜甲状腺手术中,10mmHg二氧化碳充气时,可引起轻度高碳酸血症和酸中毒,动脉血压和中心静脉压轻度升高;15mmHg时,可引起明显高碳酸血症和酸中毒,动脉血压和中心静脉压升高。
A组、B组在各时间点观测值比较均无显著性差异(P＞0.05);C组随充气时间延长,PaCO_2逐渐升高、pH值逐渐下降,有统计学意义;颅内压有所上升,但无统计学意义(P＞0.05);D组随充气时间延长,PaCO_2逐渐升高、pH值逐渐下降以及颅内压增高,且均有统计学意义。
病理观察,与A组相比,B、C、D组具有脑水肿表现,B组轻微,C、D组较明显。A组、B组胶质细胞数比较无统计学意义;C组、D组之间及其分别与另两组之间均有显著差异(P＜0.05)。电镜观察,C组、D组神经元及胶质细胞凋亡明显增多。
结论
1.长时间高压力CO_2充气可引起高碳酸血症和酸中毒,并引起血流动力学和颅内压的改变。
2.在颈部腔镜手术中运用CO_2气体长时间维持颈部手术空间,在较高气压(15mmHg)甚至是压力为10mmHg时,可以导致脑水肿,并可诱发脑神经细胞的凋亡。
3.腔镜甲状腺手术中CO_2充气应尽量低于10mmHg,为保证对脑组织的影响降到最低,我们推荐5mmHg是相对安全的压力值。
Part one
Establishment of animal model for endoscopic thyroidectomy
Background
The incidence rate of thyroid disease in female is higher than in male. The postoperative incisional scar, paraesthesia and complaint in the neck (near the wound region) brought some serious psychological problems to female patients who accepted traditional thyroidectomy. The cosmetic requests of the incision in thyroid operations had been proposed by more and more female patients. In recent years the endoscopic surgery developed rapidly and it is the time for this minimally invasive technique used in thyroid surgery. Endoscopic thyroidectomy is the new technique to comply with the cosmetic requests. The targets of this minimally invasive surgery could be summarized by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results.
At the beginning of this new technique, conversion to the traditional approach was often occurred due to the bleeding from the vessels or the thyroid dimension. But accompanying with the development of new technique and matched instruments of endoscopy, endoscopic thyroidectomy became more and more consummate. The indication of endoscopic thyroidectomy gradually enlarged. Many reports indicated thyroid carcinoma had been treated by endoscope, although it limited in those small differentiated carcinoma without lymph node involvement.
At present the operative cavity during endoscopic thyroidectomy is usually established and maintained by CO_2 insufflation. CO_2 insufflation proved to be a feasible, safe and convenient method for setting up the operative cavity by its rapid absorptive nature. But along with the prolong of the operative time, the pathophysiological changes caused by CO_2 insufflation was apparently observed.
The negative influence to cardiopulmonary function and cerebrum caused by CO2 insufflation was gradually noticed. It is very important that lucubrate and decrease these negative effects to the development of endoscopic throid surgery and to the patients who combine with some specific disease.
Now the researches revealed CO_2 insufflation during endoscopic thyroidectomy could affect intracranial pressure and those effects were related closely to the insufflation pressure and time. Could those effects lead to cerebral injury according to the different pressure? How to avoid or minimize the cerebral injury? All these problems have to be solved for the advancement of endoscopic thyroid surgery. It is necessary to study the effects of CO2 insufflation to cerebrum during endoscopic thyroidectomy.
Then we need a stable animal model which could be repetitive and similar to the mankind for above destinations. The anatomy, physiological and metabolism characteristics of the swine are similar to the mankind. The Chinese experimental minipigs which reared closely by Chinese Agriculture University just possess these advantages such as light weight, perfect antireversion force and stable inheritable character and fit for the research. We choose them to establish the endoscopic thyroidectomy porcine model and study the effects of CO_2 insufflation to cerebrum.
Objective
1. To establish the animal model for endoscopic thyroidectomy in Chinese experimental minipigs.
2. Validating the security, stability and repeatability of this animal model.
Methods
Nine Chinese minipigs were randomly divided into 3 groups. Group A underwent tracheal intubation general anesthesia without operative procedure and served as the matched controls, Group B underwent traditional thyroidectomy and Group C underwent endoscopic thyroidectomy with CO_2 pressure at 10 mm Hg. Hemodynamics parameters including heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP), arterial partial pressure of CO_2 (PaCO_2), pH and intracranial pressure (ICP) were measured at baseline, 1 h, 2 h, 3 h, 4 h and 30 min after desufflation. Excisional thyroid tissue was weighed and performed pathological examinations. All values are expressed as mean±standard deviation. Independent t-test and ANOVA were used followed by Bonferroni post hoc analysis using SPSS 16.0 analysis software. A probability value <0.05 was regarded as statistically significant.
Results
All animals tolerated the whole procedure, the traditional thyroidectomy and endoscopic thyroidectomy were successfully performed in all cases with no serious complications. The animal model for endoscopic thyroidectomy was established successfully. But subcutaneous emphysema near operative region appeared in the animals of Group C while the extremity activities diminished within 24 hours postoperatively.All monitored index of the baseline could be served as the normal reference value of mimipigs.
Comparison of ICP and the weight of excisional thyroid tissue among different groups were no significant difference (P>0.05). The operative time (P<0.01) and the length of the incisions (P<0.05) between Group B and C were significantly different. The hemodynamics parameters of Group C varied in different time and some of them were statistical significance.
Coefficient variation of the baseline monitored values of different index in all animals (n=9) were all lower than 10% except central venous pressure (CV=12.43%). Conclusions
1. All animals tolerated the anesthesia and operation, the baseline values of all parameters which could be served as the normal reference value were determinded.
2. The endoscopic thyroidectomy porcine model with comparative security, stability and repeatability was established successfully, it could respond the changes of hemodynamics and ICP sensitively during the operative procedure.
Part two
Effects of CO_2 insufflation on cerebrum during endoscopic thyroidectomy in a porcine model
Background
Endoscopic thyroidectomy is accepted gradually by patients due to its advantages including minimal invasion, fewer bleeding, better post-operative recovery course, early discharge from hospital and improved cosmetic results. Unlike the abdominal and thoracic cavity, there is no natural cavity in the neck. A man-made operative cavity in the neck must be established before endoscopic thyroidectomy. At present the operative cavity during endoscopic thyroidectomy is usually maintained by CO_2 insufflation after its establishment. CO_2 insufflation proved to be a feasible, safe and convenient method for maintaining the operative cavity by its rapid absorptive nature.
Accompanying with the development of endoscopic thyroidectomy. the operative time extends with the increasing difficulty and types of this operation. Long time CO_2 insufflation causes apparent pathophysiological changes of the organism. These changes led by CO_2 absorption in the tissue and its direct pressure are noticed by scholars.The negative influence to cardiopulmonary function and cerebrum caused by CO_2 insufflation is the obstacle to the development of endoscopic thyroidectomy. It is very important that lucubrate and decrease these negative effects as far as possible to the development of endoscopic thyroid surgery and to the patients who combine with any other specific disease.
Some studies showed that the incidence rate of headache and vomiting after laparoscopic abdominal operations was higher than that after traditional abdominal operations and believed that it was related with the increase of the intracranial pressure. The clinical observations and animal experiments revealed the increase of ICP would happen whatever in the abdominal or cervical endoscopic operations when the operative cavity was maintained by CO_2 insufflation. The increase of ICP was correlated with the pressure and time of CO_2 insufflation. This showed CO_2 insufflation influenced the cerebrum to some degree. But at present the researches about these effects to cerebrum limited in the intracranial pressure and seldomly to the cerebral injury and its pathological and electronic microscopic changes. It is necessary for the development of endoscopic throid surgery to study the effects of CO2 insufflation to cerebrum during endoscopic thyroidectomy.
In view of the current status of the fundamental research on endoscopic thyroid surgery, we plan to explore the effects to cerebrum caused by CO2 insufflation during endoscopic thyroidectomy through the porcine model.
Objective
1. To observe the effects on the hemodynamics and intracranial pressure causing by different CO_2 insufflation pressure during endoscopic thyroidectomy using the animal model.
2. To observe the pathological and electronic microscopic findings of the cerebral tissue and explore the cerebral injury caused by CO2 insufflation.
3. To validating the suitable pressure for CO2 insufflation during endoscopic thyroidectomy.
Methods
Twelve Chinese minipigs were randomly divided into 4 groups. Group A underwent traditional thyroidectomy and served as the matched controls. Group B, C and D underwent endoscopic thyroidectomy and respectively with CO_2 pressure at 5 mm Hg, 10 mm Hg and 15 mm Hg. HR, CVP, MAP, Arterial partial pressure of CO_2 (PaCO_2), pH and Intracranial pressure (ICP) were measured respectively at baseline, 1 h, 2 h, 3 h, 4 h and 30 min after desufflation. Three trocars' inserted technique and suprasternal fossa approach was used during endoscopic thyroidectomy. After exposing the thyroid glands, left thyroid lobe and the fatty tissue and lymph nodes near right cervical vaginae vasorum was removed completely.
Removed the whole cerebrum from the skull under intravenous anesthesia after a week postoperatively. The brain tissue was observed by pathological and electronic microscopic examinations respectively. All values are expressed as Mean±Std.. Independent t-test and ANOVA was used followed by Bonferroni post hoc analysis using SPSS 16.0 analysis software. A probability value <0.05 was regarded as statistically significant.
Results
Endoscopic thyroidectomy was successfully performed in all cases with no serious complications such as bleedings, gas embolism and postoperative death. But the incidence of subcutaneous emphysema near operative region (neck and upper thorax) in the animals of Group D were higher than those of Group B and C. In addition, extremity activities obviously diminished with lower reaction and food ingested in the animals of Group D within 48-72 hours postoperatively.
In Group C, mild hypercarbia and acidosis, light increase of the arterial blood pressure and central venous pressure were observed; In Group D, obvious hypercarbia and acidosis, increase of the arterial blood pressure and central venous pressure were observed.
All measured values in Group A and B were no significant difference (P>0.05); In Group C the increase of PaCO_2 and the decrease of pH value in different time were significantly different while the mild increase ICP without statistical significance (P>0.05). In Group D the increase of PaCO_2 and ICP, decrease of PH value were significantly different.
Compared with Group A, mild cerebral edema was found in Group B while obvious cerebral edema in Group C and D. Comprison of the count of glial cells between Group A and B was not significantly different (P>0.05); Comparisons between other each group have significantly changes (P<0.01). Obvious increased apoptosis neurons and glial cells were observed in Group C and D under electron microscopy.
Conclusions
1. Long time CO_2 insufflation at high pressure (15 mm Hg) during endoscopic thyroidectomy could cause hypercarbia, acidosis and increase of ICP.
2. CO_2 insufflation during endoscopic thyroidectomy could cause cerebral edema and the increase of the neuron and glial cells apoptosis.
3. We suggest the pressure of CO_2 insufflation should be lower than 10 mm Hg, 5 mm Hg is the relatively safe and recommended pressure to minimize the negative effects of the cerebrum.
引文
1.胡三元,亓玉忠,于文滨,等.腔镜甲状腺手术的临床应用研究[J].腹腔镜外科杂志,2003,8(2):65-68.
2.Dulguerov P,Leuchter I,Szalay-Quinodoz I,Allal AS,Marchal F,Lehmann W,et al.Endoscopic neck dissection in human cadavers.Laryngoscope 2001;111:2135-2139.
3.Terris DJ,Monfared A,Thomas A,Kambham N,Saenz Y.Endoscopic selective neck dissection in a porcine model.Arch Otolaryngol Head Neck Surg 2003;129:613-617.
4.Cho YU,Park IJ,Choi KH,Kim SJ,Choi SK,Hur YS,et al.Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.Yonsei Med J 2007;48:480-487.
5.Inukai M,Usui Y.Clinical evaluation of gasless endoscopic thyroid surgery.Surg Today 2005;35:199-204.
6.Carreno OJ,Wilson WR,Nootheti PK.Exploring endoscopic neck surgery in a porcine model.Laryngoscope 1999;109:236-240.
7.Rubino F,Pamoukian VN,Zhu JF,Deutsch H,Inabnet WB,Gagner M.Endoscopic endocrine neck surgery with carbon dioxide insufflation:the effect on intracranial pressure in a large animal model.Surgery.2000;128:1035-1042.
8.SJ Cooke and S Paterson-Brown.Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure.Surg Endosc 2001;15:723-725.
9.Rosenthal RJ,Hiatt JR,Phillips EH,Hewitt W,Demetriou AA,Grode M.Intracranial pressure.Effects of pneumoperitoneum in a large-animal model.Surg Endosc 1997;11:376-380.
10.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coll Surg 2003;196:189-195.
11.Critser JK,Laughlin MH,Prather RS,Riley LK.Proceedings of the Conference on Swine in Biomedical Research.ILAR J 2009;50:89-94.
12.Schook L,Beattie C,Beever J,Donovan S,Jamison R,Zuckermann F,et al.Swine in biomedical research:creating the building blocks of animal models.Anim Biotechnol 2005;16:183-190.
13.罗刚,张乐,刘连生,等.我国实验用小型猪的应用研究前景[J].实验动物科学与管理,2004,21(2):37-38.
14.裴德智.简述中国实验用小型猪[J].实验动物科学与管理,1997,14(1):36-37.
15.马立业.无创心脏血流动力学监测仪的工作原理、参数意义和临床价值[J].中国心血管杂志,2008,13(1):72-73.
16.杨勇,杨义,王任直.颅内压监测技术的进展[J].中国微侵袭神经外科杂志,2008,13(6):284-286.
17.黄晓明,郑亿庆,龚坚,等.甲状腺微创手术的动物实验研究及临床应用初探[J].临床耳鼻咽喉科杂志,2005,19(6):269-270.
18.周争,谢明,王家东.颈部内镜手术充和氦气对代谢和血流动力学的影响[J].临床耳鼻咽喉科杂志,2006,20(14):652-655.
19.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13(12):807-810.
20.魏泓.我国小型猪研究的现状[J].中国实验动物学杂志,1997,7(4):252-255.
21.商海涛,魏泓.我国小型猪品系资源状况初浅分析[J].中国实验动物学报,2007,15(1):70-75.
22.Suzuki T,Yamada T,Ochiai R,Takeda J.Anesthetic management for endoscopic surgery in two patients with goiter.Masui 2000;49:896-898.
23.彭雪梅,孙婵,王仲红,等.腔镜下甲状腺手术二氧化碳对呼吸及血气的影响[J].中华麻醉学杂志,2003,23(10):775-776.
24.孙婵,王仲红,邹鹏,等.腔镜下甲状腺手术病理生理变化的临床观察[J].广东医学,2005,26(1):26-27.
25.Bae JS,Cho YU,Sung GY,Oh S J,Jung EJ,Lee JB,et al.The current status of endoscopic thyroidectomy in Korea.Surg Laparosc Endosc Percutan Tech 2008;18:231-235.
26.Shimizu K,Kitagawa W,Akasu H,Tanaka S.Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method. J Surg Oncol 2001; 77: 217-220.
27. Ohshima A, Simizu S, Okido M, Shimada K, Kuroki S, Tanaka M. Endoscopic neck surgery: current status for thyroid and parathyroid diseases. Biomed Pharmacother 2002; 56 Suppl 1: 48s-52s.
28. Terris DJ, Haus BM, Nettar K, Ciecko S, Gourin CG. Prospective evaluation of endoscopic approaches to the thyroid compartment. Laryngoscope 2004; 114: 1377-1382.
29. Lemson J, Hofhuizen CM, Schraa O, Settels JJ, Scheffer GJ, van der Hoeven JG. The reliability of continuous noninvasive finger blood pressure measurement in critically ill children. Anesth Analg 2009; 108: 814-821.
30. Zacek P, Kunes P, Kobzova E, Dominik J. Thoracic electrical bioimpedance versus thermodilution in patients post open-heart surgery. Acta Medica (Hradec Kralove) 1999; 42: 19-23.
31. Gama de Abreu M, Winkler T, Pahlitzsch T, Weismann D, Albrecht DM. Performance of the partial CO2 rebreathing technique under different hemodynamic and ventilation/perfusion matching conditions. Crit Care Med 2003; 31: 543-551.
32. Ishida T, Lee T, Shimabukuro T, Niinami H. Right ventricular end-diastolic volume monitoring after cardiac surgery. Ann Thorac Cardiovasc Surg 2004; 10: 167-170.
33. Melanson SE, Szymanski T, Rogers SO, Jarolim P, Frendl G, Rawn JD, et al. Utilization of arterial blood gas measurements in a large tertiary care hospital. Am J Clin Pathol 2007; 127: 604-609.
34. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O'Connor CM, Sopko G, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005; 294: 1664-1670.
35. Pinsky MR, Vincent JL. Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med 2005; 33: 1119-1122.
36. Firsching R, Schutze M, Motschmann M, Behrens-Baumann W. Venous opthalmodynamometry: a noninvasive method for assessment of intracranial pressure. J Neurosurg 2000; 93: 33-36.
37. Motschmann M, Miiller C, Kuchenbecker J, Walter S, Schmitz K, Schiitze M, et al. Ophthalmodynamometry: a reliable method for measuring intracranial pressure. Strabismus 2001; 9: 13-16.
38.Schmidt EA,Czosnyka M,Gooskens I,Piechnik SK,Matta BF,Whitfield PC,et al.Preliminary experience of the estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography.J Neurol Neurosurg Psychiatry 2001;70:198-204.
39.Desch LW.Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus.Dev Med Child Neurol 2001;43:113-117.
40.Samuel M,Burge DM,Marchbanks RJ.Quantitative assessment of intracranial pressure by the tympanic membrane displacement audiometric technique in children with shunted hydrocephalus.Eur J Pediatr Surg 1998;8:200-207.
41.Lingwood BE,Dunster KR,Colditz PB,Ward LC.Noninvasive measurement of cerebral bioimpedance for detection of cerebral edema in the neonatal piglet.Brain Res 2002;945:97-105.
42.杨勇,杨义,王任直.颅内压监测技术的进展[J].中国微侵袭神经外科杂志,2008,13(6):26-27.
43.Stendel R,Heidenreich J,Schilling A,Akhavan-Sigari R,Kurth R,Picht T,et al.Clinical evaluation of a new intracranial pressure monitoring device.Acta Neurochir (Wien) 2003;145:185-193;discussion 193.
44.Vassilyadi M,Ventureyra EC.Neuroendoscopic intracranial pressure monitoring.Childs Nerv Syst 2002;18:147-148.
45.Itkis ML,Roberts JK,Ghajar JB,Hariri RJ.A square signal wave method for measurement of brain extra- and intracellular water content.Acta Neurochir Suppl (Wien) 1994;60:574-576.
46.The brain trauma foundation.The Brain Trauma Foundation.The American Association of Neurological Surgeons.The Joint Section on Neurotrauma and Critical Care.Recommendations for intracranial pressure monitoring technology.J Neurotrauma 2000;17:497-506.
47.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Comparative study of thyroidectomies.Endoscopic surgery versus conventional open surgery.Surg Endosc 2002;16:1741-1745.
48.H(u|¨)scher CS,Chiodini S,Napolitano C,Recher A.Endoscopic right thyroid lobectomy.Surg Endosc 1997;11:877.
49. Bellantone R, Lombardi CP, Rubino F, Perilli V, Sollazzi L, Mastroianni G, et al. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg 2001; 136: 822-827.
50. Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, et al. Cardiac function and hypercarbia. Arch Surg 1978; 113: 1196-1200.
1.Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg 1996;83:875.
2.H(u|¨)scher CS,Chiodini S,Napolitano C,Recher A.Endoscopic fight thyroid lobectomy.Surg Endosc 1997;11:877.
3.Yeung HC,Ng WT,Kong CK.Endoscopic thyroid and parathyroid surgery.Surg Endosc 1997;11:1135.
4.Shimizu K,Tanaka S.Asian perspective on endoscopic thyroidectomy - a review of 193 cases.Asian J Surg 2003;26:92-100.
5.Miccoli P,Berti P,Conte M,Bendinelli C,Marcocci C.Minimally invasive surgery for thyroid small nodules:preliminary report.J Endocrinol Invest 1999;22:849-851.
6.Bellantone R,Lombardi CP,Raffaelli M,Rubino F,Boscherini M,Perilli W.Minimally invasive,totally gasless video-assisted thyroid lobectomy.Am J Surg 1999;177:342-343.
7.仇明,丁尔迅,江道振,等.颈部无瘢痕内镜甲状腺腺瘤切除术一例[J].中华普通外科杂志,2002,17(2):127.
8.Dulguerov P,Leuchter I,Szalay-Quinodoz I,Allal AS,Marchal F,Lehmann W,et al.Endoscopic neck dissection in human cadavers.Laryngoscope 2001;111:2135-2139.
9.Terris D J,Monfared A,Thomas A,Kambham N,Saenz Y.Endoscopic selective neck dissection in a porcine model.Arch Otolaryngol Head Neck Surg 2003;129:613-617.
10.Carreno OJ,Wilson WR,Nootheti PK.Exploring endoscopic neck surgery in a porcine model.Laryngoscope 1999;109:236-240.
11.Rubino F,Pamoukian VN,Zhu JF,Deutsch H,Inabnet WB,Gagner M.Endoscopic endocrine neck surgery with carbon dioxide insuffiation:the effect on intracranial pressure in a large animal model.Surgery 2000;128:1035-1042.
12.Nguyen NT,Anderson JT,Budd M,Fleming NW,Ho HS,Jahr J,et al.Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass.Surg Endosc 2004;18:64-71.
13.O'Malley C,Cunningham AJ.Physiologic changes during laparoscopy.Anesthesiol Clin North America 200l;19:1-19.
14.Gupta A,Watson DI.Effect of laparoscopy on immune function.Br J Surg 2001;88:1296-1306.
15.Ziprin P,Ridgway PF,Peck DH,Darzi AW.Laparoscopic enhancement of tumour cell binding to the peritoneum is inhibited by anti-intercellular adhesion molecule-1monoclonal antibody.Surg Endosc 2003;17:1812-1817.
16.Richter S,Olinger A,Hildebrandt U,Menger MD,Vollmar B.Loss of physiologic hepatic blood flow control("hepatic arterial buffer response") during CO2-pneumoperitoneum in the rat.Anesth Analg 2001;93:872-877.
17.Hawasli A,Oh H,Schervish E,Frontera R,Gonsherova I,Khoury H.The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy.Am Surg 2003;69:300-303;discussion 303.
18.Junghans T,B(o|¨)hm B,Gr(u|¨)ndel K,Schwenk W.Effects ofpneumoperitoneum with carbon dioxide,argon,or helium on hemodynamic and respiratory function.Arch Surg 1997;132:272-278.
19.Goodale RL,Beebe DS,McNevin MP,Boyle M,Letoumeau JG;Abrams JH,et al.Hemodynamic,respiratory,and metabolic effects of laparoscopic cholecystectomy.Am J Surg 1993;166:533-537.
20.Wittgen CM,Andrus CH,Fitzgerald SD,Baudendistel L J,Dahms TE,Kaminski DL.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg 1991;126:997-1000;discussion 1000-1001.
21.Ochiai R,Takeda J,Noguchi J,Ohgami M,Ishii S.Subcutaneous carbon dioxide insuffiation does not cause hypercarbia during endoscopic thyroidectomy.Anesth Analg 2000;90:760-762.
22.Rasmussen JP,Dauchot PJ,DePalma RG,Sorensen B,Regula G,Anton AH,et al.Cardiac function and hypercarbia.Arch Surg 1978;113:1196-1200.
23.Choi SH,Lee SJ,Rha KH,Shin SK,Oh YJ.The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia.Anaesthesia 2008;63:1314-1318.
24.Pollock JM,Deibler AR,Whitlow CT,Tan H,Kraft RA,Burdette JH,et al.Hypercapnia-induced cerebral hyperperfusion:an underrecognized clinical entity.AJNR Am J Neuroradiol 2009;30:378-385.
25.周争,谢明,王家东.颈部内镜手术充和氦气对代谢和血流动力学的影响[J].临床耳鼻咽喉科杂志,2006,20:652-655.
26.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13:807-810.
27.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Comparative study of thyroidectomies.Endoscopic surgery versus conventional open surgery.Surg Endosc 2002;16:1741-1745.
28.SJ Cooke and S Paterson-Brown.Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure.Surg Endosc 2001;15:723-725.
29.Rosenthal RJ,Hiatt JR,Phillips EH,Hewitt W,Demetriou AA,Grode M.Intracranial pressure.Effects of pneumoperitoneum in a large-animal model.Surg Endosc 1997;11:376-380.
30.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coil Surg 2003;196:189-195.
31.Bellantone R,Lombardi CP,Rubino F,Perilli V,Sollazzi L,Mastroianni G,et al.Arterial PCO_2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation.Arch Surg 2001;136:822-827.
32.Sharma KC,Kabinoff G,Ducheine Y,Tiemey J,Brandstetter RD.Laparoscopic surgery and its potential for medical complications.Heart Lung 1997;26:52-64.
33.Liem MS,Kallewaard JW,de Smet AM,van Vroonhoven TJ.Does hypercarbia develop faster during laparoscopic hemiorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring.Anesth Analg 1995;81:1243-1249.
34.Gottlieb A,Sprung J,Zheng XM,Gagner M.Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation.Anesth Analg 1997;84:1154-1156.
35.Worrell JB,Cleary DT.Massive subcutaneous emphysema and hypercarbia:complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery-case studies.AANA J 2002;70:456-461.
36.Van den Bos GC,Drake AJ,Noble MI.The effect of carbon dioxide upon myocardial contractile performance,blood flow and oxygen consumption.J Physiol 1979;287:149-161.
37.Karger S,F(u|¨)hrer D.Thyroid storm--thyrotoxic crisis:an update.Dtsch Med Wochenschr 2008;133:479-484.
38.Kim JS,Kim KH,Aim CH,Jeon HM,Kim EG,Jeon CS.A clinical analysis of gasless endoscopic thyroidectomy.Surg Laparosc Endosc Percutan Tech 2001;11:268-272.
39.Leighton TA,Liu SY,Bongard FS.Comparative cardiopulmonary effects of carbon dioxide versus helium pneumoperitoneum.Surgery 1993;113:527-531.
40.Guo FQ,Xu YC,Chen LY,Yang YS,Dong LL,Dai HY,et al.The relationship between the aquaporin-4 and brain edema,pathologic change,ultrastructure in perihematoma tissue in patients with intracerebral hemorrhage.Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2008;20:674-677.
41.Adelson PD,Jenkins LW,Hamilton RL,Robichaud P,Tran MP,Kochanek PM.Histopathologic response of the immature rat to diffuse traumatic brain injury.J Neurotrauma 2001;18:967-976.
42.Del Bigio MR,da Silva MC,Drake JM,Tuor UI.Acute and chronic cerebral white matter damage in neonatal hydrocephalus.Can J Neurol Sci 1994;21:299-305.
43.吴发印,谢文扬,李华林,等.颈清扫术中不同方式颈静脉结扎对颅内压影响的实验研究[J].临床耳鼻咽喉科杂志,2005,19:173-175.
44.Kuroiwa T,Miyasaka N,Fengyo Z,Yamada I,Nakane M,Nagaoka T,et al.Experimental ischemic brain edema:morphological and magnetic resonance imaging findings.Neurosurg Focus 2007;22:E11.
45.Arismendi-Morillo GJ,Castej6n OJ,Castellano-Ramirez A.Ultrastructural features of the synaptic plasticity in peritumoral cerebral oedema in humans.Afismendi-Morillo GJ,Castejon OJ,Castellano-Ramirez A.Rev Neurol 2007;45:587-593.
46.张世荣,姬西团,张胡金,等.外伤后急性弥漫性脑肿胀合并二次脑损伤的超微结构观察[J].中华创伤杂志,2004,20:264-266.
47.Yang Y,Zhang XJ,Yin J,Li LT.Brain damage related to hemorrhagic transformation following cerebral ischemia and the role of K ATP channels.Brain Res 2008;1241:168-175.
48.Garcia JH,Liu KF,Ho KL.Neuronal necrosis after middle cerebral artery occlusion in Wistar rats progresses at different time intervals in the caudoputamen and the cortex.Stroke 1995;26:636-642;discussion 643.
49. Johnson EM Jr, Greenlund LJ, Akins PT, Hsu CY. Neuronal apoptosis: current understanding of molecular mechanisms and potential role in ischemic brain injury. J Neurotrauma 1995; 12: 843-852.
50. Kosteljanetz M: Intracranial pressure. cerebrospinal fluid dynamics and pressure-volume relations. Acta Neurol Scand Suppl 1987; 111: 1-23.
51. Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 1978; 48: 332-344.
52. Short BL, Bender K, Walker LK, Traystman RJ. The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb. J Pediatr Surg 1994; 29: 887-891.
53. Ito H, Kanno I, Ibaraki M, Hatazawa J, Miura S. Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J Cereb Blood Flow Metab 2003; 23: 665-670.
54. Levy B, Bollaert PE, Nace L, Larcan A. Intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation. J Trauma 1995; 39:799-801.
55. Clark RM, Capra NF, Halsey JH Jr. Method for measuring brain tissue pressure. J Neurosurg 1974; 43: 1-8.
56. Yang GY, Chen SF, Kinouchi H, Chan PH, Weinstein PR. Edema, cation content, and ATPase activity after middle cerebral artery occlusion in rats. Stroke 1992; 23: 1331-1336.
57. de Zwart LL, Meerman JH, Commandeur JN, Vermeulen NP. Biomarkers of free radical damage applications in experimental animals and in humans. Free Radic Biol Med 1999; 26: 202-226.
58. Marmarou A. The pathophysiology of brain edema and elevated intracranial pressure. Cleve Clin J Med 2004; 71: S6-8.
59. Knudsen GM, Paulson OB, Hertz MM. Kinetic analysis of the human blood-brain barrier transport of lactate and its influence by hypercapnia. J Cereb Blood Flow Metab 1991; 11: 581-586.
60. Del Bigio MR, Zhang YW. Cell death, axonal damage, and cell birth in the immature rat brain following induction of hydrocephalus. Exp Neurol 1998; 154: 157-169.
61. Yamaki T, Murakami M, Iwamoto Y, Sakakibara T, Kobori N, Ueda S, Uwahodo Y, Kikuchi T. Cognitive dysfunction and histological findings in rats with chronic stage contusion and diffuse axonal injury. Brain Res Brain Res Protoc 1998; 3: 100-106.
62. Ragaisis V. Brain contusion: morphology, pathogenesis and treatment. Medicina (Kaunas) 2002; 38: 243-249; quiz 354.
63. Yang XF, Liu WG, Shen H, Gong JB, Yu J, Hu WW, et al. Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury. Chin J Traumatol 2005; 8:96-100.
64. Conti AC, Raghupathi R, Trojanowski JQ, McIntosh TK. Experimental brain injury induces reagionally distinct apoptosis during the acute and delayed post-traumatic period. J Neurosci 1998; 18: 5663-5672.
65. Lossi L, Merighi A. In vivo cellular and molecular mechanisms of neuronal apoptosis in the mammalian CNS. Prog Neurobiol 2003; 69: 287-312.
1. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 1996; 83: 875.
2. Huscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc 1997; 11: 877.
3. Yeung HC, Ng WT, Kong CK. Endoscopic thyroid and parathyroid surgery. Surg Endosc 1997;11:1135.
4. Shimizu K, Tanaka S. Asian perspective on endoscopic thyroidectomy - a review of 193 cases. Asian J Surg 2003; 26: 92-100.
5. Kitagawa W, Shimizu K, Akasu H, Tanaka S. Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method. J Am Coll Surg 2003; 196: 990-994.
6. Nguyen NT, Anderson JT, Budd M, Fleming NW, Ho HS, Jahr J, et al. Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 2004; 18: 64-71.
7. O'Malley C, Cunningham AJ. Physiologic changes during laparoscopy. Anesthesiol Clin North America. 2001; 19: 1-19.
8. Gupta A, Watson DI. Effect of laparoscopy on immune function. Br J Surg 2001; 88: 1296-1306.
9. Ziprin P, Ridgway PF, Peck DH, Darzi AW. Laparoscopic enhancement of tumour cell binding to the peritoneum is inhibited by anti-intercellular adhesion molecule-1 monoclonal antibody. Surg Endosc 2003; 17: 1812-1817.
10. Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B. Loss of physiologic hepatic blood flow control ("hepatic arterial buffer response") during CO_2-pneumoperitoneum in the rat. Anesth Analg 2001; 93: 872-877.
11. Hawasli A, Oh H, Schervish E, Frontera R, Gonsherova I, Khoury H. The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy. Am Surg 2003; 69: 300-303; discussion 303.
12. Junghans T, Bohm B, Griindel K, Schwenk W. Effects of pneumoperitoneum with carbon dioxide, argon, or helium on hemodynamic and respiratory function. Arch Surg 1997; 132: 272-278.
13. Goodale RL, Beebe DS, McNevin MP, Boyle M, Letourneau JG, Abrams JH, et al. Hemodynamic, respiratory, and metabolic effects of laparoscopic cholecystectomy. Am J Surg 1993; 166: 533-537.
14. Sharma KC, Kabinoff G, Ducheine Y, Tierney J, Brandstetter RD. Laparoscopic surgery and its potential for medical complications. Heart Lung 1997; 26: 52-64.
15. Liem MS, Kallewaard JW, de Smet AM, van Vroonhoven TJ. Does hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring. Anesth Analg 1995; 81: 1243-1249.
16. Gottlieb A, Sprung J, Zheng XM, Gagner M. Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 1997; 84: 1154-1156.
17. Worrell JB, Cleary DT. Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery-case studies. AANA J 2002; 70: 456-461.
18. Bellantone R, Lombardi CP, Rubino F, Perilli V, Sollazzi L, Mastroianni G, et al. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg 2001; 136: 822-827.
19. Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT. Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy. Surg Endosc 1998; 12: 202-205; discussion 206.
20. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 2002; 16: 1741-1745.
21. Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991; 126: 997-1000; discussion 1000-1001.
22. Kent RB 3rd. Subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy. Arch Surg 1991; 126(9): 1154-1156.
23. Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, et al. Cardiac function and hypercarbia. Arch Surg 1978; 113: 1196-1200.
24. Ochiai R, Takeda J, Noguchi J, Ohgami M, Ishii S. Subcutaneous carbon dioxide insufflation does not cause hypercarbia during endoscopic thyroidectomy. Anesth Analg 2000; 90: 760-762.
25. Van den Bos GC, Drake AJ, Noble MI. The effect of carbon dioxide upon myocardial contractile performance, blood flow and oxygen consumption. J Physiol 1979; 287: 149-161.
26. Karger S, Fiihrer D. Thyroid storm-thyrotoxic crisis: an update. Dtsch Med Wochenschr 2008; 133: 479-484.
27. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2004; 21: 95-105.
28. Leighton TA, Liu SY, Bongard FS. Comparative cardiopulmonary effects of carbon dioxide versus helium pneumoperitoneum. Surgery 1993; 113: 527-531.
29. Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M. Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery 2000; 128: 1035-1042.
30. Choi SH, Lee SJ, Rha KH, Shin SK, Oh YJ. The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia. Anaesthesia 2008; 63: 1314-1318.
31. Pollock JM, Deibler AR, Whitlow CT, Tan H, Kraft RA, Burdette JH, et al. Hypercapnia-induced cerebral hyperperfusion: an underrecognized clinical entity. AJNR Am J Neuroradiol 2009; 30: 378-385.
32. SJ Cooke and S Paterson-Brown. Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure. Surg Endosc 2001; 15:723-725.
33. Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure.Effects of pneumoperitoneum in a large-animal model.Surg Endosc 1997;11:376-380.
34.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coll Surg 2003;196:189-195.
35.Kosteljanetz M.Intracranial pressure:cerebrospinal fluid dynamics and pressure-volume relations.Acta Neurol Scand Suppl 1987;111:1-23.
36.Marmarou A,Shulman K,Rosende RM.A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics.J Neurosurg 1978;48:332-344.
37.Short BL,Bender K,Walker LK,Traystrnan RJ.The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb.J Pediatr Surg 1994;29:887-891.
38.Sch(o|¨)b OM,Allen DC,Benzel E,Curet MJ,Adams MS,Baldwin NG,et al.A comparison of the pathophysiologic effects of carbon dioxide,nitrous oxide,and helium pneumoperitoneum on intracranial pressure.Am J Surg 1996;172:248-253.
39.Ito H,Kanno I,Ibaraki M,Hatazawa J,Miura S.Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography.J Cereb Blood Flow Metab 2003;23:665-670.
40.Levy B,Bollaert PE,Nace L,Larcan A.Intracranial hypertension and adult respiratory distress syndrome:usefulness of tracheal gas insuffiation.J Trauma 1995;39:799-801.
41.Clark RM,Capra NF,Halsey JH Jr.Method for measuring brain tissue pressure.J Neurosurg 1974;43:1-8.
42.朱武晖,王卫星,周丁华,等.颈部腔镜手术中CO_2压力对脑血流影响的实验研究[J].武汉大学学报(医学版),2005,26(2):238-242.
43.朱武晖,王卫星,周丁华,等.CO_2气压在颈部腔镜手术中对脑组织ET、nNOS影响的实验研究[J].微循环学杂志,2006,16(2):32-34.
44.张延龄.严重创伤后的免疫抑制及其调节治疗[J].国外医学外科学分册,2000.27(1):24.
45.Yadavalli GK,Auletta J J,Gould MP,Salata RA,Lee JH,Heinzel FP.Deactivation of the innate cellular immune response following endotoxic and surgical injury.Exp Mol Pathol 2001;71:209-221.
46.Pullicino EA,Carli F,Poole S,Rafferty B,Malik ST,Elia M.The relationship between the circulating concentrations of interleukin 6(IL-6),tumor necrosis factor (TNF) and the acute phase response to elective surgery and accidental injury.Lymphokine Res 1990;9:231-238.
47.Joris J,Cigarini I,Legrand M,Jacquet N,De Groote D,Franchimont P,Lamy M.Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy.Br J Anaesth 1992;69:341-345.
48.忻颖,胡海.腔镜与传统甲状腺手术对机体创伤的影响的比较[J].中国微创外科杂志,2007,7:454-455.
49.Lombardi CP,Raffaelli M,Princi P,Lulli P,Rossi ED,Fadda G,et al.Safety of video-assisted thyroidectomy versus conventional surgery.Head Neck 2005;27:58-64.
50.高峰,彭勃.腔镜甲状腺手术与传统手术创伤的比较研究[J].腹腔镜外科杂志,2007,12(6):470-471.
51.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13(12):807-810.
52.Shimizu K,Kitagawa W,Akasu H,Tanaka S.Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method.J Surg Oncol 2001;77:217-220.
53.Cho YU,Park IJ,Choi KH,Kim S J,Choi SK,Hur YS,et al.Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.Yonsei Med J 2007;48:480-487.
54.Komatsuzaki Y,Ochi K,Sugiura N,Hyodo M,Okamoto A.Video-assisted submandibular sialadenectomy using an ultrasonic scalpel.Auris Nasus Larynx 2003;30 Suppl:S75-78.
55.Yoon JH,Park CH,Chung WY.Gasless endoscopic thyroidectomy via an axillary approach:experience of 30 cases.Surg Laparosc Endosc Percutan Tech 2006;16: 226-231.
56 Inukai M,Usui Y.Clinical evaluation of gasless endoscopic thyroid surgery.Surg Today 2005;35:199-204.
1.Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg 1996;83:875.
2.H(u|¨)scher CS,Chiodini S,Napolitano C,Recher A.Endoscopic right thyroid lobectomy.Surg Endosc 1997;11:877.
3.Yeung HC,Ng WT,Kong CK.Endoscopic thyroid and parathyroid surgery.Surg Endosc 1997;11:1135.
4.仇明,丁尔迅,江道振,等.颈部无瘢痕内镜甲状腺腺瘤切除术一例[J].中华普通外科杂志,2002,17(2):127.
5.胡三元,亓玉忠,于文滨,等.腔镜甲状腺手术的临床应用研究[J].腹腔镜外科杂志,2003,8(2):65-68.
6.Dulguerov P,Leuchter I,Szalay-Quinodoz I,Allal AS,Marchal F,Lehmann W,et al.Endoscopic neck dissection in human cadavers.Laryngoscope 2001;111:2135-2139.
7.Terris DJ,Monfared A,Thomas A,Kambham N,Saenz Y.Endoscopic selective neck dissection in a porcine model.Arch Otolaryngol Head Neck Surg 2003;129:613-617.
8.Bae JS,Cho YU,Sung GY,Oh SJ,Jung EJ,Lee JB,et al.The current status of endoscopic thyroidectomy in Korea.Surg Laparosc Endosc Percutan Tech 2008;18:231-235.
9.Carreno OJ,Wilson WR,Nootheti PK.Exploring endoscopic neck surgery in a porcine model.Laryngoscope 1999;109:236-240.
10.Gottlieb A,Sprung J,Zheng XM,Gagner M.Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation.Anesth Analg 1997;84:1154-1156.
11.Rubino F,Pamoukian VN,Zhu JF,Deutsch H,Inabnet WB,Gagner M.Endoscopic endocrine neck surgery with carbon dioxide insuffiation:the effect on intracranial pressure in a large animal model.Surgery 2000;128:1035-1042.
12.Bellantone R,Lombardi CP,Rubino F,Perilli V,Sollazzi L,Mastroianni G,et al.Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insuffiation.Arch Surg 2001;136:822-827.
13.Monfared A,Saenz Y,Terris DJ.Endoscopic resection of the submandibular gland in a porcine model.Laryngoscope 2002;112:1089-1093.
14.Terris DJ,Haus BM,Gourin CG.Endoscopic neck surgery:resection of the submandibular gland in a cadaver model.Laryngoscope 2004;114:407-410.
15.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13:807-810.
16.Shimizu K,Kitagawa W,Akasu H,Tanaka S.Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method.J Surg Oncol 2001;77:217-220.
17.Cho YU,Park I J,Choi KH,Kim S J,Choi SK,Hur YS,et al.Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.Yonsei Med J 2007;48:480-487.
18.Komatsuzaki Y,Ochi K,Sugiura N,Hyodo M,Okamoto A.Video-assisted submandibular sialadenectomy using an ultrasonic scalpel.Auris Nasus Larynx 2003;30 Suppl:S75-78.
19.Sch(o|¨)b OM,Allen DC,Benzel E,Curet MJ,Adams MS,Baldwin NG,et al.A comparison of the pathophysiologic effects of carbon dioxide,nitrous oxide,and helium pneumoperitoneum on intracranial pressure.Am J Surg 1996;172:248-253.
20.Inukai M,Usui Y.Clinical evaluation of gasless endoscopic thyroid surgery.Surg Today 2005;35:199-204.
21. Ohshima A, Simizu S, Okido M, Shimada K, Kuroki S, Tanaka M. Endoscopic neck surgery: current status for thyroid and parathyroid diseases. Biomed Pharmacother 2002; 56 Suppl 1: 48s-52s.
22. Terris DJ, Haus BM, Nettar K, Ciecko S, Gourin CG. Prospective evaluation of endoscopic approaches to the thyroid compartment. Laryngoscope 2004; 114: 1377-1382.
23. Gagner M, Inabnet WB 3rd. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 2001; 11: 161-163.
24. Bellantone R, Lombardi CP, Raffaelli M, Rubino F, Boscherini M, Perilli W. Minimally invasive, totally gasless video-assisted thyroid lobectomy. Am J Surg 1999; 177: 342-343.
25. Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 1999; 188: 697-703.
26. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 2000; 10: 1-4.
27. Shimizu K, Tanaka S. Asian perspective on endoscopic thyroidectomy - a review of 193 cases. Asian J Surg 2003; 26: 92-100.
28. Ikeda Y, Takami H, Tajima G, Sasaki Y, Takayama J, Kurihara H, et al. Total endoscopic thyroidectomy: axillary or anterior chest approach. Biomed Pharmacother 2002; 56 Suppl l:72s-78s.
29. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J Am Coll Surg 2000; 191: 336-340.
30. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 2002; 16: 1741-1745.
31. Lee KE, Kim HY, Park WS, Choe JH, Kwon MR, Oh SK, et al. Postauricular and Axillary Approach Endoscopic Neck Surgery: A New Technique. World J Surg 2009; 7. [Epub ahead of print]
32.Kitagawa W,Shimizu K,Akasu H,Tanaka S.Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method.J Am Coll Surg 2003;196:990-994.
33.Shimizu K,Kitagawa W,Akasu H,Hirai K,Tanaka S.Indications for and limitations of endoscopic thyroid surgery.Nippon Geka Gakkai Zasshi 2002;103:708-712.
34.Kataoka H,Kitano H,Takeuchi E,Fujimura M.Total video endoscopic thyroidectomy via the anterior chest approach using the cervical region-lifting method.Biomed Pharmacother 2002;56 Suppl 1:68s-71s.
35.王存川,陈均,胡友主,等.内镜甲状腺切除术150例[J].中华外科杂志,2004,42:675-677.
36.Schabram J,Vorl(a|¨)nder C,Wahl RA.Differentiated operative strategy in minimally invasive,video-assisted thyroid surgery results in 196 patients.World J Surg 2004;28:1282-1286.
37.Miccoli P,Berti P,Conte M,Bendinelli C,Marcocci C.Minimally invasive surgery for thyroid small nodules:preliminary report.J Endocrinol Invest 1999;22:849-851.
38.王文栋,王可敬,赏金标.腔镜下甲状腺手术的研究进展[J].中国肿瘤,2008.17:211-213.
39.Kim JS,Kim KH,Ahn CH,Jeon HM,Kim EG,Jeon CS.A clinical analysis of gasless endoscopic thyroidectomy.Surg Laparosc Endosc Percutan Tech 2001;11:268-272.
40.Gauger PG,Reeve TS,Delbridge LW.Endoscopically assisted,minimally invasive parathyroidectomy.Br J Surg 1999;86:1563-1566.
41.Miccoli P,Bellantone R,Mourad M,Walz M,Raffaelli M,Berti P.Minimally invasive video-assisted thyroidectomy:multiinstitutional experience.World J Surg 2002;26:972-975.
42.王存川,吴东波,陈鋆,等.150例经乳晕入路的腔镜甲状腺切除术临床研究[J].中国内镜杂志,2003,9(11):50-52.
43.Miccoli P,Berti P,Raffaelli M,Materazzi G,Baldacci S,Rossi G.Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy:a prospective randomized study.Surgery 2001;130:1039-1043.
44.Chung YS,Choe JH,Kang KH,Kim SW,Chung KW,Park KS,et al.Endoscopic thyroidectomy for thyroid malignancies:comparison with conventional open thyroidectomy.World J Surg 2007;31:2302-2306;discussion 2307-2308.
45.Miccoli P,Berti P,Raffaelli M,Conte M,Materazzi G,Galleri D.Minimally invasive video-assisted thyroidectomy.Am J Surg 2001;181:567-570.
46.仇明.内镜甲状腺手术意外出血常见原因及防治对策.中国实用外科杂志[J],2007,27:690-692.
47.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coll Surg 2003;196:189-195.
48.Yamamoto M,Sasaki A,Asahi H,Shimada Y,Sato N,Nakajima J,et al.Endoscopic subtotal thyroidectomy for patients with Graves' disease.Surg Today 2001;31:1-4.
49.Dionigi G,Boni L,Rovera F,Annoni M,Villa F,Dionigi R.Defining the learning curve for video-assisted thyroidectomy.Int J Surg 2008;10.[Epub ahead of print]
50.Bellantone R,Lombardi CP,Raffaelli M,Boscherini M,De Crea C,Traini E.Video-assisted thyroidectomy.J Am Coll Surg 2002;194:610-614.
51.White WM,Randolph GW,Hartnick CJ,Cunningham MJ.Recurrent laryngeal nerve monitoring during thyroidectomy and related cervical procedures in the pediatric population.Arch Otolaryngol Head Neck Surg 2009;135:88-94.
52.Terris DJ,Anderson SK,Watts TL,Chin E.Laryngeal nerve monitoring and minimally invasive thyroid surgery:complementary technologies.Arch Otolaryngol Head Neck Surg 2007;133:1254-1257.
53 Yeung GH.Endoscopic thyroid surgery today:a diversity of surgical strategies.Thyroid 2002;12:703-706.
1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221-1231.
2. Inui Y, Kawata S, Tarui S. Laparoscopic findings of fatty liver using multiple regression analysis: "Spotty" and "diffuse" yellow color. Endoscopy 1990;22:27-30.
3. De la Revilla L, Martin-Vivaldi R, Cano Bueso F. Use of laparoscopy in the diagnosis of hepatic steatosis. Rev Esp Enferm Apar Dig 1982 ;61:218—224.
4. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 2006;43:S99-S112.
5. American Gastroenterological Association. American Gastroenterological Association Medical Position Statement: Nonalcoholic fatty liver disease. Gastroenterology 2002; 123:1702-1704.
6. Sanyal AJ, American Gastroenterological Association. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002;123:1705-1725.
7. Perez NE, Siddiqui FA, Mutchnick MG, et al. Ultrasound diagnosis of fatty liver in patients with chronic liver disease: A retrospective observational study. J Clin Gastroenterol 2007;41:624-629.
8. Tchelepi H, Rails P, Randall R, et al. Sonography of diffuse liver disease. J Ultrasound Med 2002;21:1023-1032.
9. Ghali P, Lindor KD. Hepatotoxicity of drugs used for treatment of obesity and its comorbidities. Semin Liver Dis 2004;24:389-397.
10. Haydon GH, Hayes PC. Diagnostic laparoscopy by physicians: We should do it. Q J Med1997;90:297-304.
11. Poniachik J, Bernstein DE, Reddy KR, et al. The role of laparoscopy in the diagnosis of cirrhosis. Gastrointest Endosc 1996;43:568-571.
12. Jalan R, Harrison DJ, Dillon JF, et al. Laparoscopy and histology in the diagnosis of chronic liver disease. Q J Med 1995;88:559-564.
13. Brunt EM, Janney CG, Di Bisceglie AM. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94:2467-2474.
14. Schwimmer JB, Behling C, Newbury R, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005;42:641-649.
15. Kleiner DE, Brunt EM, Van Natta M, et al. Nonalcoholic Steatohepatitis Clinical Research Network: Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-1321.
16. Bruguera M, Bordas JM, Mas P, et al. A comparison of the accuracy of peritoneoscopy and liver biopsy in the diagnosis of cirrhosis. Gut 1974; 15:799-800.
17. Holund B, Polsen H, Schlicting P. Reproducibility of liver biopsy diagnosis in relation to size of specimen. Scand J Gastroenterol 1980; 15:329-335.
18. Adams LA, Angulo P, Lindor KD. Nonalcoholic fatty liver disease. CMAJ 2005; 172:899-905.
19. Adams LA, Angulo P. Treatment of nonalcoholic fatty liver disease. Postgrad Med J 2006;82:315-322.
20. Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123:745-750.
21. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495-500.
22. Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes. J Clin Ultrasound 1996;24:25-29.
23. Mottin CC, Moretto M, Padoin AV, et al. The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg 2004;14:635-637.
24. Cardi M, Muttillo IA, Amadori L, et al. Superiority of laparoscopy compared to ultrasonography in diagnosis of widespread liver diseases. Dig Dis Sci 1997;42:546-548.
25. Tanaka N, Ichijo T, Okiyama W, et al. Laparoscopic findings in patients with nonalcoholic steatohepatitis. Liver Int 2006;26:32-38.
1. Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M. Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery 2000; 128:1035-42.
2. Rocco Bellantone, Celestino Pio Lombardi, Francesco Rubino, Valter Perilli, Liliana Sollazzi, Gianmattia Mastroianni, Michel Gagner. Arterial PCO_2 and Cardiovascular Function During Endoscopic Neck Surgery With Carbon Dioxide Insufflation. Arch Surg 2001; 136:822-7.
3. SJ Cooke and S Paterson-Brown. Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure. Surg Endosc 2001; 15:723-5.
4. Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc 1997; 11:376-80.
5. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 2003; 196:189-95.
6. Ochiai R, Takeda J, Noguchi J, Ohgami M, Ishii S. Subcutaneous carbon dioxide insufflation does not cause hypercarbia during endoscopic thyroidectomy. Anesth Analg 2000; 90:760-2.
7. Kosteljanetz M. Intracranial pressure: cerebrospinal fluid dynamics and pressure-volume relations. Acta Neural Scand Suppl 1987; 111:1-23.
8. Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 1978; 48:332-44.
9. Short BL, Bender K, Walker LK, Traystman RJ. The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb. J Pediatr Surg 1994; 29:887-91.
10. Sharma KC, Kabinoff G, Ducheine Y, Tierney J, Brandstetter RD. Laparoscopic surgery and its potential for medical complications. Heart Lung 1997; 26:52-64.
11. Liem MS, Kallewaard JW, de Smet AM, van Vroonhoven TJ. Does hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring. Anesth Analg 1995; 81:1243-9.
12. Worrell JB, Cleary DT. Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery-case studies. AANA J 2002; 70:456-61.
13. Ito H, Kanno I, Ibaraki M, Hatazawa J, Miura S. Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J Cereb Blood Flow Metab 2003; 23:665-70.
14. Levy B, Bollaert PE, Nace L, Larcan A. Intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation. J Trauma 1995; 39:799-801.
15. Clark RM, Capra NF, Halsey JH Jr. Method for measuring brain tissue pressure. Response to alteration in pCO-2 systemic blood pressure, and middle cerebral artery occlusion. J Neurosurg 1975; 43:1-8.
16. Marmarou A. The pathophysiology of brain edema and elevated intracranial pressure. Cleve Clin J Med 2004; 71 :S6-8.
17. Knudsen GM, Paulson OB, Hertz MM. Kinetic analysis of the human blood-brain barrier transport of lactate and its influence by hypercapnia. J Cereb Blood Flow Metab 1991; 11:581-6.
18. Del Bigio MR, Zhang YW. Cell death, axonal damage, and cell birth in the immature rat brain following induction of hydrocephalus. Exp Neurol 1998; 154(1): 157-69.
19. Yamaki T, Murakami M, Iwamoto Y, Sakakibara T, Kobori N, Ueda S, Uwahodo Y, Kikuchi T. Cognitive dysfunction and histological findings in rats with chronic stage contusion and diffuse axonal injury. Brain Res Brain Res Protoc 1998; 3:100-6.
20. Ragaisis V. Brain contusion: morphology, pathogenesis and treatment. Medicina (Kaunas) 2002; 38:243-9.
21. Del Bigio MR, da Silva MC, Drake JM, Tuor UI. Acute and chronic cerebral white matter damage in neonatal hydrocephalus. Can J Neurol Sci 1994; 21:299-305.
22. Yang XF, Liu WG, Shen H, Gong JB, Yu J, Hu WW, Lu ST, Zheng XJ, Fu WM. Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury. Chin J Traumatol 2005; 8:96-100.
23. Conti AC, Raghupathi R, Trojanowski JQ, McIntosh TK. Experimental brain injury induces reagionally distinct apoptosis during the acute and delayed post-traumatic period. J Neurosci 1998; 18:5663-72.
24. Lossi L, Merighi A. In vivo cellular and molecular mechanisms of neuronal apoptosis in the mammalian CNS. Prog Neurobiol 2003; 69:287-312.
25. Kim JS, Kim KH, Ahn CH, Jeon HM, Kim EG, Jeon CS. A clinical analysis of gasless endoscopic thyroidectomy. Surg Laparosc Endosc Percutan Tech 2001; 11:268-72.
2.Dulguerov P,Leuchter I,Szalay-Quinodoz I,Allal AS,Marchal F,Lehmann W,et al.Endoscopic neck dissection in human cadavers.Laryngoscope 2001;111:2135-2139.
3.Terris DJ,Monfared A,Thomas A,Kambham N,Saenz Y.Endoscopic selective neck dissection in a porcine model.Arch Otolaryngol Head Neck Surg 2003;129:613-617.
4.Cho YU,Park IJ,Choi KH,Kim SJ,Choi SK,Hur YS,et al.Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.Yonsei Med J 2007;48:480-487.
5.Inukai M,Usui Y.Clinical evaluation of gasless endoscopic thyroid surgery.Surg Today 2005;35:199-204.
6.Carreno OJ,Wilson WR,Nootheti PK.Exploring endoscopic neck surgery in a porcine model.Laryngoscope 1999;109:236-240.
7.Rubino F,Pamoukian VN,Zhu JF,Deutsch H,Inabnet WB,Gagner M.Endoscopic endocrine neck surgery with carbon dioxide insufflation:the effect on intracranial pressure in a large animal model.Surgery.2000;128:1035-1042.
8.SJ Cooke and S Paterson-Brown.Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure.Surg Endosc 2001;15:723-725.
9.Rosenthal RJ,Hiatt JR,Phillips EH,Hewitt W,Demetriou AA,Grode M.Intracranial pressure.Effects of pneumoperitoneum in a large-animal model.Surg Endosc 1997;11:376-380.
10.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coll Surg 2003;196:189-195.
11.Critser JK,Laughlin MH,Prather RS,Riley LK.Proceedings of the Conference on Swine in Biomedical Research.ILAR J 2009;50:89-94.
12.Schook L,Beattie C,Beever J,Donovan S,Jamison R,Zuckermann F,et al.Swine in biomedical research:creating the building blocks of animal models.Anim Biotechnol 2005;16:183-190.
13.罗刚,张乐,刘连生,等.我国实验用小型猪的应用研究前景[J].实验动物科学与管理,2004,21(2):37-38.
14.裴德智.简述中国实验用小型猪[J].实验动物科学与管理,1997,14(1):36-37.
15.马立业.无创心脏血流动力学监测仪的工作原理、参数意义和临床价值[J].中国心血管杂志,2008,13(1):72-73.
16.杨勇,杨义,王任直.颅内压监测技术的进展[J].中国微侵袭神经外科杂志,2008,13(6):284-286.
17.黄晓明,郑亿庆,龚坚,等.甲状腺微创手术的动物实验研究及临床应用初探[J].临床耳鼻咽喉科杂志,2005,19(6):269-270.
18.周争,谢明,王家东.颈部内镜手术充和氦气对代谢和血流动力学的影响[J].临床耳鼻咽喉科杂志,2006,20(14):652-655.
19.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13(12):807-810.
20.魏泓.我国小型猪研究的现状[J].中国实验动物学杂志,1997,7(4):252-255.
21.商海涛,魏泓.我国小型猪品系资源状况初浅分析[J].中国实验动物学报,2007,15(1):70-75.
22.Suzuki T,Yamada T,Ochiai R,Takeda J.Anesthetic management for endoscopic surgery in two patients with goiter.Masui 2000;49:896-898.
23.彭雪梅,孙婵,王仲红,等.腔镜下甲状腺手术二氧化碳对呼吸及血气的影响[J].中华麻醉学杂志,2003,23(10):775-776.
24.孙婵,王仲红,邹鹏,等.腔镜下甲状腺手术病理生理变化的临床观察[J].广东医学,2005,26(1):26-27.
25.Bae JS,Cho YU,Sung GY,Oh S J,Jung EJ,Lee JB,et al.The current status of endoscopic thyroidectomy in Korea.Surg Laparosc Endosc Percutan Tech 2008;18:231-235.
26.Shimizu K,Kitagawa W,Akasu H,Tanaka S.Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method. J Surg Oncol 2001; 77: 217-220.
27. Ohshima A, Simizu S, Okido M, Shimada K, Kuroki S, Tanaka M. Endoscopic neck surgery: current status for thyroid and parathyroid diseases. Biomed Pharmacother 2002; 56 Suppl 1: 48s-52s.
28. Terris DJ, Haus BM, Nettar K, Ciecko S, Gourin CG. Prospective evaluation of endoscopic approaches to the thyroid compartment. Laryngoscope 2004; 114: 1377-1382.
29. Lemson J, Hofhuizen CM, Schraa O, Settels JJ, Scheffer GJ, van der Hoeven JG. The reliability of continuous noninvasive finger blood pressure measurement in critically ill children. Anesth Analg 2009; 108: 814-821.
30. Zacek P, Kunes P, Kobzova E, Dominik J. Thoracic electrical bioimpedance versus thermodilution in patients post open-heart surgery. Acta Medica (Hradec Kralove) 1999; 42: 19-23.
31. Gama de Abreu M, Winkler T, Pahlitzsch T, Weismann D, Albrecht DM. Performance of the partial CO2 rebreathing technique under different hemodynamic and ventilation/perfusion matching conditions. Crit Care Med 2003; 31: 543-551.
32. Ishida T, Lee T, Shimabukuro T, Niinami H. Right ventricular end-diastolic volume monitoring after cardiac surgery. Ann Thorac Cardiovasc Surg 2004; 10: 167-170.
33. Melanson SE, Szymanski T, Rogers SO, Jarolim P, Frendl G, Rawn JD, et al. Utilization of arterial blood gas measurements in a large tertiary care hospital. Am J Clin Pathol 2007; 127: 604-609.
34. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O'Connor CM, Sopko G, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005; 294: 1664-1670.
35. Pinsky MR, Vincent JL. Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med 2005; 33: 1119-1122.
36. Firsching R, Schutze M, Motschmann M, Behrens-Baumann W. Venous opthalmodynamometry: a noninvasive method for assessment of intracranial pressure. J Neurosurg 2000; 93: 33-36.
37. Motschmann M, Miiller C, Kuchenbecker J, Walter S, Schmitz K, Schiitze M, et al. Ophthalmodynamometry: a reliable method for measuring intracranial pressure. Strabismus 2001; 9: 13-16.
38.Schmidt EA,Czosnyka M,Gooskens I,Piechnik SK,Matta BF,Whitfield PC,et al.Preliminary experience of the estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography.J Neurol Neurosurg Psychiatry 2001;70:198-204.
39.Desch LW.Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus.Dev Med Child Neurol 2001;43:113-117.
40.Samuel M,Burge DM,Marchbanks RJ.Quantitative assessment of intracranial pressure by the tympanic membrane displacement audiometric technique in children with shunted hydrocephalus.Eur J Pediatr Surg 1998;8:200-207.
41.Lingwood BE,Dunster KR,Colditz PB,Ward LC.Noninvasive measurement of cerebral bioimpedance for detection of cerebral edema in the neonatal piglet.Brain Res 2002;945:97-105.
42.杨勇,杨义,王任直.颅内压监测技术的进展[J].中国微侵袭神经外科杂志,2008,13(6):26-27.
43.Stendel R,Heidenreich J,Schilling A,Akhavan-Sigari R,Kurth R,Picht T,et al.Clinical evaluation of a new intracranial pressure monitoring device.Acta Neurochir (Wien) 2003;145:185-193;discussion 193.
44.Vassilyadi M,Ventureyra EC.Neuroendoscopic intracranial pressure monitoring.Childs Nerv Syst 2002;18:147-148.
45.Itkis ML,Roberts JK,Ghajar JB,Hariri RJ.A square signal wave method for measurement of brain extra- and intracellular water content.Acta Neurochir Suppl (Wien) 1994;60:574-576.
46.The brain trauma foundation.The Brain Trauma Foundation.The American Association of Neurological Surgeons.The Joint Section on Neurotrauma and Critical Care.Recommendations for intracranial pressure monitoring technology.J Neurotrauma 2000;17:497-506.
47.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Comparative study of thyroidectomies.Endoscopic surgery versus conventional open surgery.Surg Endosc 2002;16:1741-1745.
48.H(u|¨)scher CS,Chiodini S,Napolitano C,Recher A.Endoscopic right thyroid lobectomy.Surg Endosc 1997;11:877.
49. Bellantone R, Lombardi CP, Rubino F, Perilli V, Sollazzi L, Mastroianni G, et al. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg 2001; 136: 822-827.
50. Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, et al. Cardiac function and hypercarbia. Arch Surg 1978; 113: 1196-1200.
1.Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg 1996;83:875.
2.H(u|¨)scher CS,Chiodini S,Napolitano C,Recher A.Endoscopic fight thyroid lobectomy.Surg Endosc 1997;11:877.
3.Yeung HC,Ng WT,Kong CK.Endoscopic thyroid and parathyroid surgery.Surg Endosc 1997;11:1135.
4.Shimizu K,Tanaka S.Asian perspective on endoscopic thyroidectomy - a review of 193 cases.Asian J Surg 2003;26:92-100.
5.Miccoli P,Berti P,Conte M,Bendinelli C,Marcocci C.Minimally invasive surgery for thyroid small nodules:preliminary report.J Endocrinol Invest 1999;22:849-851.
6.Bellantone R,Lombardi CP,Raffaelli M,Rubino F,Boscherini M,Perilli W.Minimally invasive,totally gasless video-assisted thyroid lobectomy.Am J Surg 1999;177:342-343.
7.仇明,丁尔迅,江道振,等.颈部无瘢痕内镜甲状腺腺瘤切除术一例[J].中华普通外科杂志,2002,17(2):127.
8.Dulguerov P,Leuchter I,Szalay-Quinodoz I,Allal AS,Marchal F,Lehmann W,et al.Endoscopic neck dissection in human cadavers.Laryngoscope 2001;111:2135-2139.
9.Terris D J,Monfared A,Thomas A,Kambham N,Saenz Y.Endoscopic selective neck dissection in a porcine model.Arch Otolaryngol Head Neck Surg 2003;129:613-617.
10.Carreno OJ,Wilson WR,Nootheti PK.Exploring endoscopic neck surgery in a porcine model.Laryngoscope 1999;109:236-240.
11.Rubino F,Pamoukian VN,Zhu JF,Deutsch H,Inabnet WB,Gagner M.Endoscopic endocrine neck surgery with carbon dioxide insuffiation:the effect on intracranial pressure in a large animal model.Surgery 2000;128:1035-1042.
12.Nguyen NT,Anderson JT,Budd M,Fleming NW,Ho HS,Jahr J,et al.Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass.Surg Endosc 2004;18:64-71.
13.O'Malley C,Cunningham AJ.Physiologic changes during laparoscopy.Anesthesiol Clin North America 200l;19:1-19.
14.Gupta A,Watson DI.Effect of laparoscopy on immune function.Br J Surg 2001;88:1296-1306.
15.Ziprin P,Ridgway PF,Peck DH,Darzi AW.Laparoscopic enhancement of tumour cell binding to the peritoneum is inhibited by anti-intercellular adhesion molecule-1monoclonal antibody.Surg Endosc 2003;17:1812-1817.
16.Richter S,Olinger A,Hildebrandt U,Menger MD,Vollmar B.Loss of physiologic hepatic blood flow control("hepatic arterial buffer response") during CO2-pneumoperitoneum in the rat.Anesth Analg 2001;93:872-877.
17.Hawasli A,Oh H,Schervish E,Frontera R,Gonsherova I,Khoury H.The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy.Am Surg 2003;69:300-303;discussion 303.
18.Junghans T,B(o|¨)hm B,Gr(u|¨)ndel K,Schwenk W.Effects ofpneumoperitoneum with carbon dioxide,argon,or helium on hemodynamic and respiratory function.Arch Surg 1997;132:272-278.
19.Goodale RL,Beebe DS,McNevin MP,Boyle M,Letoumeau JG;Abrams JH,et al.Hemodynamic,respiratory,and metabolic effects of laparoscopic cholecystectomy.Am J Surg 1993;166:533-537.
20.Wittgen CM,Andrus CH,Fitzgerald SD,Baudendistel L J,Dahms TE,Kaminski DL.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg 1991;126:997-1000;discussion 1000-1001.
21.Ochiai R,Takeda J,Noguchi J,Ohgami M,Ishii S.Subcutaneous carbon dioxide insuffiation does not cause hypercarbia during endoscopic thyroidectomy.Anesth Analg 2000;90:760-762.
22.Rasmussen JP,Dauchot PJ,DePalma RG,Sorensen B,Regula G,Anton AH,et al.Cardiac function and hypercarbia.Arch Surg 1978;113:1196-1200.
23.Choi SH,Lee SJ,Rha KH,Shin SK,Oh YJ.The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia.Anaesthesia 2008;63:1314-1318.
24.Pollock JM,Deibler AR,Whitlow CT,Tan H,Kraft RA,Burdette JH,et al.Hypercapnia-induced cerebral hyperperfusion:an underrecognized clinical entity.AJNR Am J Neuroradiol 2009;30:378-385.
25.周争,谢明,王家东.颈部内镜手术充和氦气对代谢和血流动力学的影响[J].临床耳鼻咽喉科杂志,2006,20:652-655.
26.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13:807-810.
27.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Comparative study of thyroidectomies.Endoscopic surgery versus conventional open surgery.Surg Endosc 2002;16:1741-1745.
28.SJ Cooke and S Paterson-Brown.Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure.Surg Endosc 2001;15:723-725.
29.Rosenthal RJ,Hiatt JR,Phillips EH,Hewitt W,Demetriou AA,Grode M.Intracranial pressure.Effects of pneumoperitoneum in a large-animal model.Surg Endosc 1997;11:376-380.
30.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coil Surg 2003;196:189-195.
31.Bellantone R,Lombardi CP,Rubino F,Perilli V,Sollazzi L,Mastroianni G,et al.Arterial PCO_2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation.Arch Surg 2001;136:822-827.
32.Sharma KC,Kabinoff G,Ducheine Y,Tiemey J,Brandstetter RD.Laparoscopic surgery and its potential for medical complications.Heart Lung 1997;26:52-64.
33.Liem MS,Kallewaard JW,de Smet AM,van Vroonhoven TJ.Does hypercarbia develop faster during laparoscopic hemiorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring.Anesth Analg 1995;81:1243-1249.
34.Gottlieb A,Sprung J,Zheng XM,Gagner M.Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation.Anesth Analg 1997;84:1154-1156.
35.Worrell JB,Cleary DT.Massive subcutaneous emphysema and hypercarbia:complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery-case studies.AANA J 2002;70:456-461.
36.Van den Bos GC,Drake AJ,Noble MI.The effect of carbon dioxide upon myocardial contractile performance,blood flow and oxygen consumption.J Physiol 1979;287:149-161.
37.Karger S,F(u|¨)hrer D.Thyroid storm--thyrotoxic crisis:an update.Dtsch Med Wochenschr 2008;133:479-484.
38.Kim JS,Kim KH,Aim CH,Jeon HM,Kim EG,Jeon CS.A clinical analysis of gasless endoscopic thyroidectomy.Surg Laparosc Endosc Percutan Tech 2001;11:268-272.
39.Leighton TA,Liu SY,Bongard FS.Comparative cardiopulmonary effects of carbon dioxide versus helium pneumoperitoneum.Surgery 1993;113:527-531.
40.Guo FQ,Xu YC,Chen LY,Yang YS,Dong LL,Dai HY,et al.The relationship between the aquaporin-4 and brain edema,pathologic change,ultrastructure in perihematoma tissue in patients with intracerebral hemorrhage.Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2008;20:674-677.
41.Adelson PD,Jenkins LW,Hamilton RL,Robichaud P,Tran MP,Kochanek PM.Histopathologic response of the immature rat to diffuse traumatic brain injury.J Neurotrauma 2001;18:967-976.
42.Del Bigio MR,da Silva MC,Drake JM,Tuor UI.Acute and chronic cerebral white matter damage in neonatal hydrocephalus.Can J Neurol Sci 1994;21:299-305.
43.吴发印,谢文扬,李华林,等.颈清扫术中不同方式颈静脉结扎对颅内压影响的实验研究[J].临床耳鼻咽喉科杂志,2005,19:173-175.
44.Kuroiwa T,Miyasaka N,Fengyo Z,Yamada I,Nakane M,Nagaoka T,et al.Experimental ischemic brain edema:morphological and magnetic resonance imaging findings.Neurosurg Focus 2007;22:E11.
45.Arismendi-Morillo GJ,Castej6n OJ,Castellano-Ramirez A.Ultrastructural features of the synaptic plasticity in peritumoral cerebral oedema in humans.Afismendi-Morillo GJ,Castejon OJ,Castellano-Ramirez A.Rev Neurol 2007;45:587-593.
46.张世荣,姬西团,张胡金,等.外伤后急性弥漫性脑肿胀合并二次脑损伤的超微结构观察[J].中华创伤杂志,2004,20:264-266.
47.Yang Y,Zhang XJ,Yin J,Li LT.Brain damage related to hemorrhagic transformation following cerebral ischemia and the role of K ATP channels.Brain Res 2008;1241:168-175.
48.Garcia JH,Liu KF,Ho KL.Neuronal necrosis after middle cerebral artery occlusion in Wistar rats progresses at different time intervals in the caudoputamen and the cortex.Stroke 1995;26:636-642;discussion 643.
49. Johnson EM Jr, Greenlund LJ, Akins PT, Hsu CY. Neuronal apoptosis: current understanding of molecular mechanisms and potential role in ischemic brain injury. J Neurotrauma 1995; 12: 843-852.
50. Kosteljanetz M: Intracranial pressure. cerebrospinal fluid dynamics and pressure-volume relations. Acta Neurol Scand Suppl 1987; 111: 1-23.
51. Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 1978; 48: 332-344.
52. Short BL, Bender K, Walker LK, Traystman RJ. The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb. J Pediatr Surg 1994; 29: 887-891.
53. Ito H, Kanno I, Ibaraki M, Hatazawa J, Miura S. Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J Cereb Blood Flow Metab 2003; 23: 665-670.
54. Levy B, Bollaert PE, Nace L, Larcan A. Intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation. J Trauma 1995; 39:799-801.
55. Clark RM, Capra NF, Halsey JH Jr. Method for measuring brain tissue pressure. J Neurosurg 1974; 43: 1-8.
56. Yang GY, Chen SF, Kinouchi H, Chan PH, Weinstein PR. Edema, cation content, and ATPase activity after middle cerebral artery occlusion in rats. Stroke 1992; 23: 1331-1336.
57. de Zwart LL, Meerman JH, Commandeur JN, Vermeulen NP. Biomarkers of free radical damage applications in experimental animals and in humans. Free Radic Biol Med 1999; 26: 202-226.
58. Marmarou A. The pathophysiology of brain edema and elevated intracranial pressure. Cleve Clin J Med 2004; 71: S6-8.
59. Knudsen GM, Paulson OB, Hertz MM. Kinetic analysis of the human blood-brain barrier transport of lactate and its influence by hypercapnia. J Cereb Blood Flow Metab 1991; 11: 581-586.
60. Del Bigio MR, Zhang YW. Cell death, axonal damage, and cell birth in the immature rat brain following induction of hydrocephalus. Exp Neurol 1998; 154: 157-169.
61. Yamaki T, Murakami M, Iwamoto Y, Sakakibara T, Kobori N, Ueda S, Uwahodo Y, Kikuchi T. Cognitive dysfunction and histological findings in rats with chronic stage contusion and diffuse axonal injury. Brain Res Brain Res Protoc 1998; 3: 100-106.
62. Ragaisis V. Brain contusion: morphology, pathogenesis and treatment. Medicina (Kaunas) 2002; 38: 243-249; quiz 354.
63. Yang XF, Liu WG, Shen H, Gong JB, Yu J, Hu WW, et al. Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury. Chin J Traumatol 2005; 8:96-100.
64. Conti AC, Raghupathi R, Trojanowski JQ, McIntosh TK. Experimental brain injury induces reagionally distinct apoptosis during the acute and delayed post-traumatic period. J Neurosci 1998; 18: 5663-5672.
65. Lossi L, Merighi A. In vivo cellular and molecular mechanisms of neuronal apoptosis in the mammalian CNS. Prog Neurobiol 2003; 69: 287-312.
1. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 1996; 83: 875.
2. Huscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc 1997; 11: 877.
3. Yeung HC, Ng WT, Kong CK. Endoscopic thyroid and parathyroid surgery. Surg Endosc 1997;11:1135.
4. Shimizu K, Tanaka S. Asian perspective on endoscopic thyroidectomy - a review of 193 cases. Asian J Surg 2003; 26: 92-100.
5. Kitagawa W, Shimizu K, Akasu H, Tanaka S. Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method. J Am Coll Surg 2003; 196: 990-994.
6. Nguyen NT, Anderson JT, Budd M, Fleming NW, Ho HS, Jahr J, et al. Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 2004; 18: 64-71.
7. O'Malley C, Cunningham AJ. Physiologic changes during laparoscopy. Anesthesiol Clin North America. 2001; 19: 1-19.
8. Gupta A, Watson DI. Effect of laparoscopy on immune function. Br J Surg 2001; 88: 1296-1306.
9. Ziprin P, Ridgway PF, Peck DH, Darzi AW. Laparoscopic enhancement of tumour cell binding to the peritoneum is inhibited by anti-intercellular adhesion molecule-1 monoclonal antibody. Surg Endosc 2003; 17: 1812-1817.
10. Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B. Loss of physiologic hepatic blood flow control ("hepatic arterial buffer response") during CO_2-pneumoperitoneum in the rat. Anesth Analg 2001; 93: 872-877.
11. Hawasli A, Oh H, Schervish E, Frontera R, Gonsherova I, Khoury H. The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy. Am Surg 2003; 69: 300-303; discussion 303.
12. Junghans T, Bohm B, Griindel K, Schwenk W. Effects of pneumoperitoneum with carbon dioxide, argon, or helium on hemodynamic and respiratory function. Arch Surg 1997; 132: 272-278.
13. Goodale RL, Beebe DS, McNevin MP, Boyle M, Letourneau JG, Abrams JH, et al. Hemodynamic, respiratory, and metabolic effects of laparoscopic cholecystectomy. Am J Surg 1993; 166: 533-537.
14. Sharma KC, Kabinoff G, Ducheine Y, Tierney J, Brandstetter RD. Laparoscopic surgery and its potential for medical complications. Heart Lung 1997; 26: 52-64.
15. Liem MS, Kallewaard JW, de Smet AM, van Vroonhoven TJ. Does hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring. Anesth Analg 1995; 81: 1243-1249.
16. Gottlieb A, Sprung J, Zheng XM, Gagner M. Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 1997; 84: 1154-1156.
17. Worrell JB, Cleary DT. Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery-case studies. AANA J 2002; 70: 456-461.
18. Bellantone R, Lombardi CP, Rubino F, Perilli V, Sollazzi L, Mastroianni G, et al. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg 2001; 136: 822-827.
19. Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT. Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy. Surg Endosc 1998; 12: 202-205; discussion 206.
20. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 2002; 16: 1741-1745.
21. Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991; 126: 997-1000; discussion 1000-1001.
22. Kent RB 3rd. Subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy. Arch Surg 1991; 126(9): 1154-1156.
23. Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, et al. Cardiac function and hypercarbia. Arch Surg 1978; 113: 1196-1200.
24. Ochiai R, Takeda J, Noguchi J, Ohgami M, Ishii S. Subcutaneous carbon dioxide insufflation does not cause hypercarbia during endoscopic thyroidectomy. Anesth Analg 2000; 90: 760-762.
25. Van den Bos GC, Drake AJ, Noble MI. The effect of carbon dioxide upon myocardial contractile performance, blood flow and oxygen consumption. J Physiol 1979; 287: 149-161.
26. Karger S, Fiihrer D. Thyroid storm-thyrotoxic crisis: an update. Dtsch Med Wochenschr 2008; 133: 479-484.
27. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2004; 21: 95-105.
28. Leighton TA, Liu SY, Bongard FS. Comparative cardiopulmonary effects of carbon dioxide versus helium pneumoperitoneum. Surgery 1993; 113: 527-531.
29. Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M. Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery 2000; 128: 1035-1042.
30. Choi SH, Lee SJ, Rha KH, Shin SK, Oh YJ. The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia. Anaesthesia 2008; 63: 1314-1318.
31. Pollock JM, Deibler AR, Whitlow CT, Tan H, Kraft RA, Burdette JH, et al. Hypercapnia-induced cerebral hyperperfusion: an underrecognized clinical entity. AJNR Am J Neuroradiol 2009; 30: 378-385.
32. SJ Cooke and S Paterson-Brown. Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure. Surg Endosc 2001; 15:723-725.
33. Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure.Effects of pneumoperitoneum in a large-animal model.Surg Endosc 1997;11:376-380.
34.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coll Surg 2003;196:189-195.
35.Kosteljanetz M.Intracranial pressure:cerebrospinal fluid dynamics and pressure-volume relations.Acta Neurol Scand Suppl 1987;111:1-23.
36.Marmarou A,Shulman K,Rosende RM.A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics.J Neurosurg 1978;48:332-344.
37.Short BL,Bender K,Walker LK,Traystrnan RJ.The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb.J Pediatr Surg 1994;29:887-891.
38.Sch(o|¨)b OM,Allen DC,Benzel E,Curet MJ,Adams MS,Baldwin NG,et al.A comparison of the pathophysiologic effects of carbon dioxide,nitrous oxide,and helium pneumoperitoneum on intracranial pressure.Am J Surg 1996;172:248-253.
39.Ito H,Kanno I,Ibaraki M,Hatazawa J,Miura S.Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography.J Cereb Blood Flow Metab 2003;23:665-670.
40.Levy B,Bollaert PE,Nace L,Larcan A.Intracranial hypertension and adult respiratory distress syndrome:usefulness of tracheal gas insuffiation.J Trauma 1995;39:799-801.
41.Clark RM,Capra NF,Halsey JH Jr.Method for measuring brain tissue pressure.J Neurosurg 1974;43:1-8.
42.朱武晖,王卫星,周丁华,等.颈部腔镜手术中CO_2压力对脑血流影响的实验研究[J].武汉大学学报(医学版),2005,26(2):238-242.
43.朱武晖,王卫星,周丁华,等.CO_2气压在颈部腔镜手术中对脑组织ET、nNOS影响的实验研究[J].微循环学杂志,2006,16(2):32-34.
44.张延龄.严重创伤后的免疫抑制及其调节治疗[J].国外医学外科学分册,2000.27(1):24.
45.Yadavalli GK,Auletta J J,Gould MP,Salata RA,Lee JH,Heinzel FP.Deactivation of the innate cellular immune response following endotoxic and surgical injury.Exp Mol Pathol 2001;71:209-221.
46.Pullicino EA,Carli F,Poole S,Rafferty B,Malik ST,Elia M.The relationship between the circulating concentrations of interleukin 6(IL-6),tumor necrosis factor (TNF) and the acute phase response to elective surgery and accidental injury.Lymphokine Res 1990;9:231-238.
47.Joris J,Cigarini I,Legrand M,Jacquet N,De Groote D,Franchimont P,Lamy M.Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy.Br J Anaesth 1992;69:341-345.
48.忻颖,胡海.腔镜与传统甲状腺手术对机体创伤的影响的比较[J].中国微创外科杂志,2007,7:454-455.
49.Lombardi CP,Raffaelli M,Princi P,Lulli P,Rossi ED,Fadda G,et al.Safety of video-assisted thyroidectomy versus conventional surgery.Head Neck 2005;27:58-64.
50.高峰,彭勃.腔镜甲状腺手术与传统手术创伤的比较研究[J].腹腔镜外科杂志,2007,12(6):470-471.
51.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13(12):807-810.
52.Shimizu K,Kitagawa W,Akasu H,Tanaka S.Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method.J Surg Oncol 2001;77:217-220.
53.Cho YU,Park IJ,Choi KH,Kim S J,Choi SK,Hur YS,et al.Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.Yonsei Med J 2007;48:480-487.
54.Komatsuzaki Y,Ochi K,Sugiura N,Hyodo M,Okamoto A.Video-assisted submandibular sialadenectomy using an ultrasonic scalpel.Auris Nasus Larynx 2003;30 Suppl:S75-78.
55.Yoon JH,Park CH,Chung WY.Gasless endoscopic thyroidectomy via an axillary approach:experience of 30 cases.Surg Laparosc Endosc Percutan Tech 2006;16: 226-231.
56 Inukai M,Usui Y.Clinical evaluation of gasless endoscopic thyroid surgery.Surg Today 2005;35:199-204.
1.Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg 1996;83:875.
2.H(u|¨)scher CS,Chiodini S,Napolitano C,Recher A.Endoscopic right thyroid lobectomy.Surg Endosc 1997;11:877.
3.Yeung HC,Ng WT,Kong CK.Endoscopic thyroid and parathyroid surgery.Surg Endosc 1997;11:1135.
4.仇明,丁尔迅,江道振,等.颈部无瘢痕内镜甲状腺腺瘤切除术一例[J].中华普通外科杂志,2002,17(2):127.
5.胡三元,亓玉忠,于文滨,等.腔镜甲状腺手术的临床应用研究[J].腹腔镜外科杂志,2003,8(2):65-68.
6.Dulguerov P,Leuchter I,Szalay-Quinodoz I,Allal AS,Marchal F,Lehmann W,et al.Endoscopic neck dissection in human cadavers.Laryngoscope 2001;111:2135-2139.
7.Terris DJ,Monfared A,Thomas A,Kambham N,Saenz Y.Endoscopic selective neck dissection in a porcine model.Arch Otolaryngol Head Neck Surg 2003;129:613-617.
8.Bae JS,Cho YU,Sung GY,Oh SJ,Jung EJ,Lee JB,et al.The current status of endoscopic thyroidectomy in Korea.Surg Laparosc Endosc Percutan Tech 2008;18:231-235.
9.Carreno OJ,Wilson WR,Nootheti PK.Exploring endoscopic neck surgery in a porcine model.Laryngoscope 1999;109:236-240.
10.Gottlieb A,Sprung J,Zheng XM,Gagner M.Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation.Anesth Analg 1997;84:1154-1156.
11.Rubino F,Pamoukian VN,Zhu JF,Deutsch H,Inabnet WB,Gagner M.Endoscopic endocrine neck surgery with carbon dioxide insuffiation:the effect on intracranial pressure in a large animal model.Surgery 2000;128:1035-1042.
12.Bellantone R,Lombardi CP,Rubino F,Perilli V,Sollazzi L,Mastroianni G,et al.Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insuffiation.Arch Surg 2001;136:822-827.
13.Monfared A,Saenz Y,Terris DJ.Endoscopic resection of the submandibular gland in a porcine model.Laryngoscope 2002;112:1089-1093.
14.Terris DJ,Haus BM,Gourin CG.Endoscopic neck surgery:resection of the submandibular gland in a cadaver model.Laryngoscope 2004;114:407-410.
15.周争,谢明,王家东.颈部内镜手术充二氧化碳和氦气对颅内压的影响[J].中国耳鼻咽喉头颈外科,2006,13:807-810.
16.Shimizu K,Kitagawa W,Akasu H,Tanaka S.Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method.J Surg Oncol 2001;77:217-220.
17.Cho YU,Park I J,Choi KH,Kim S J,Choi SK,Hur YS,et al.Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.Yonsei Med J 2007;48:480-487.
18.Komatsuzaki Y,Ochi K,Sugiura N,Hyodo M,Okamoto A.Video-assisted submandibular sialadenectomy using an ultrasonic scalpel.Auris Nasus Larynx 2003;30 Suppl:S75-78.
19.Sch(o|¨)b OM,Allen DC,Benzel E,Curet MJ,Adams MS,Baldwin NG,et al.A comparison of the pathophysiologic effects of carbon dioxide,nitrous oxide,and helium pneumoperitoneum on intracranial pressure.Am J Surg 1996;172:248-253.
20.Inukai M,Usui Y.Clinical evaluation of gasless endoscopic thyroid surgery.Surg Today 2005;35:199-204.
21. Ohshima A, Simizu S, Okido M, Shimada K, Kuroki S, Tanaka M. Endoscopic neck surgery: current status for thyroid and parathyroid diseases. Biomed Pharmacother 2002; 56 Suppl 1: 48s-52s.
22. Terris DJ, Haus BM, Nettar K, Ciecko S, Gourin CG. Prospective evaluation of endoscopic approaches to the thyroid compartment. Laryngoscope 2004; 114: 1377-1382.
23. Gagner M, Inabnet WB 3rd. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 2001; 11: 161-163.
24. Bellantone R, Lombardi CP, Raffaelli M, Rubino F, Boscherini M, Perilli W. Minimally invasive, totally gasless video-assisted thyroid lobectomy. Am J Surg 1999; 177: 342-343.
25. Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 1999; 188: 697-703.
26. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 2000; 10: 1-4.
27. Shimizu K, Tanaka S. Asian perspective on endoscopic thyroidectomy - a review of 193 cases. Asian J Surg 2003; 26: 92-100.
28. Ikeda Y, Takami H, Tajima G, Sasaki Y, Takayama J, Kurihara H, et al. Total endoscopic thyroidectomy: axillary or anterior chest approach. Biomed Pharmacother 2002; 56 Suppl l:72s-78s.
29. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J Am Coll Surg 2000; 191: 336-340.
30. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 2002; 16: 1741-1745.
31. Lee KE, Kim HY, Park WS, Choe JH, Kwon MR, Oh SK, et al. Postauricular and Axillary Approach Endoscopic Neck Surgery: A New Technique. World J Surg 2009; 7. [Epub ahead of print]
32.Kitagawa W,Shimizu K,Akasu H,Tanaka S.Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method.J Am Coll Surg 2003;196:990-994.
33.Shimizu K,Kitagawa W,Akasu H,Hirai K,Tanaka S.Indications for and limitations of endoscopic thyroid surgery.Nippon Geka Gakkai Zasshi 2002;103:708-712.
34.Kataoka H,Kitano H,Takeuchi E,Fujimura M.Total video endoscopic thyroidectomy via the anterior chest approach using the cervical region-lifting method.Biomed Pharmacother 2002;56 Suppl 1:68s-71s.
35.王存川,陈均,胡友主,等.内镜甲状腺切除术150例[J].中华外科杂志,2004,42:675-677.
36.Schabram J,Vorl(a|¨)nder C,Wahl RA.Differentiated operative strategy in minimally invasive,video-assisted thyroid surgery results in 196 patients.World J Surg 2004;28:1282-1286.
37.Miccoli P,Berti P,Conte M,Bendinelli C,Marcocci C.Minimally invasive surgery for thyroid small nodules:preliminary report.J Endocrinol Invest 1999;22:849-851.
38.王文栋,王可敬,赏金标.腔镜下甲状腺手术的研究进展[J].中国肿瘤,2008.17:211-213.
39.Kim JS,Kim KH,Ahn CH,Jeon HM,Kim EG,Jeon CS.A clinical analysis of gasless endoscopic thyroidectomy.Surg Laparosc Endosc Percutan Tech 2001;11:268-272.
40.Gauger PG,Reeve TS,Delbridge LW.Endoscopically assisted,minimally invasive parathyroidectomy.Br J Surg 1999;86:1563-1566.
41.Miccoli P,Bellantone R,Mourad M,Walz M,Raffaelli M,Berti P.Minimally invasive video-assisted thyroidectomy:multiinstitutional experience.World J Surg 2002;26:972-975.
42.王存川,吴东波,陈鋆,等.150例经乳晕入路的腔镜甲状腺切除术临床研究[J].中国内镜杂志,2003,9(11):50-52.
43.Miccoli P,Berti P,Raffaelli M,Materazzi G,Baldacci S,Rossi G.Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy:a prospective randomized study.Surgery 2001;130:1039-1043.
44.Chung YS,Choe JH,Kang KH,Kim SW,Chung KW,Park KS,et al.Endoscopic thyroidectomy for thyroid malignancies:comparison with conventional open thyroidectomy.World J Surg 2007;31:2302-2306;discussion 2307-2308.
45.Miccoli P,Berti P,Raffaelli M,Conte M,Materazzi G,Galleri D.Minimally invasive video-assisted thyroidectomy.Am J Surg 2001;181:567-570.
46.仇明.内镜甲状腺手术意外出血常见原因及防治对策.中国实用外科杂志[J],2007,27:690-692.
47.Ikeda Y,Takami H,Sasaki Y,Takayama J,Niimi M,Kan S.Clinical benefits in endoscopic thyroidectomy by the axillary approach.J Am Coll Surg 2003;196:189-195.
48.Yamamoto M,Sasaki A,Asahi H,Shimada Y,Sato N,Nakajima J,et al.Endoscopic subtotal thyroidectomy for patients with Graves' disease.Surg Today 2001;31:1-4.
49.Dionigi G,Boni L,Rovera F,Annoni M,Villa F,Dionigi R.Defining the learning curve for video-assisted thyroidectomy.Int J Surg 2008;10.[Epub ahead of print]
50.Bellantone R,Lombardi CP,Raffaelli M,Boscherini M,De Crea C,Traini E.Video-assisted thyroidectomy.J Am Coll Surg 2002;194:610-614.
51.White WM,Randolph GW,Hartnick CJ,Cunningham MJ.Recurrent laryngeal nerve monitoring during thyroidectomy and related cervical procedures in the pediatric population.Arch Otolaryngol Head Neck Surg 2009;135:88-94.
52.Terris DJ,Anderson SK,Watts TL,Chin E.Laryngeal nerve monitoring and minimally invasive thyroid surgery:complementary technologies.Arch Otolaryngol Head Neck Surg 2007;133:1254-1257.
53 Yeung GH.Endoscopic thyroid surgery today:a diversity of surgical strategies.Thyroid 2002;12:703-706.
1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221-1231.
2. Inui Y, Kawata S, Tarui S. Laparoscopic findings of fatty liver using multiple regression analysis: "Spotty" and "diffuse" yellow color. Endoscopy 1990;22:27-30.
3. De la Revilla L, Martin-Vivaldi R, Cano Bueso F. Use of laparoscopy in the diagnosis of hepatic steatosis. Rev Esp Enferm Apar Dig 1982 ;61:218—224.
4. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 2006;43:S99-S112.
5. American Gastroenterological Association. American Gastroenterological Association Medical Position Statement: Nonalcoholic fatty liver disease. Gastroenterology 2002; 123:1702-1704.
6. Sanyal AJ, American Gastroenterological Association. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002;123:1705-1725.
7. Perez NE, Siddiqui FA, Mutchnick MG, et al. Ultrasound diagnosis of fatty liver in patients with chronic liver disease: A retrospective observational study. J Clin Gastroenterol 2007;41:624-629.
8. Tchelepi H, Rails P, Randall R, et al. Sonography of diffuse liver disease. J Ultrasound Med 2002;21:1023-1032.
9. Ghali P, Lindor KD. Hepatotoxicity of drugs used for treatment of obesity and its comorbidities. Semin Liver Dis 2004;24:389-397.
10. Haydon GH, Hayes PC. Diagnostic laparoscopy by physicians: We should do it. Q J Med1997;90:297-304.
11. Poniachik J, Bernstein DE, Reddy KR, et al. The role of laparoscopy in the diagnosis of cirrhosis. Gastrointest Endosc 1996;43:568-571.
12. Jalan R, Harrison DJ, Dillon JF, et al. Laparoscopy and histology in the diagnosis of chronic liver disease. Q J Med 1995;88:559-564.
13. Brunt EM, Janney CG, Di Bisceglie AM. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94:2467-2474.
14. Schwimmer JB, Behling C, Newbury R, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005;42:641-649.
15. Kleiner DE, Brunt EM, Van Natta M, et al. Nonalcoholic Steatohepatitis Clinical Research Network: Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-1321.
16. Bruguera M, Bordas JM, Mas P, et al. A comparison of the accuracy of peritoneoscopy and liver biopsy in the diagnosis of cirrhosis. Gut 1974; 15:799-800.
17. Holund B, Polsen H, Schlicting P. Reproducibility of liver biopsy diagnosis in relation to size of specimen. Scand J Gastroenterol 1980; 15:329-335.
18. Adams LA, Angulo P, Lindor KD. Nonalcoholic fatty liver disease. CMAJ 2005; 172:899-905.
19. Adams LA, Angulo P. Treatment of nonalcoholic fatty liver disease. Postgrad Med J 2006;82:315-322.
20. Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123:745-750.
21. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495-500.
22. Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes. J Clin Ultrasound 1996;24:25-29.
23. Mottin CC, Moretto M, Padoin AV, et al. The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg 2004;14:635-637.
24. Cardi M, Muttillo IA, Amadori L, et al. Superiority of laparoscopy compared to ultrasonography in diagnosis of widespread liver diseases. Dig Dis Sci 1997;42:546-548.
25. Tanaka N, Ichijo T, Okiyama W, et al. Laparoscopic findings in patients with nonalcoholic steatohepatitis. Liver Int 2006;26:32-38.
1. Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M. Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery 2000; 128:1035-42.
2. Rocco Bellantone, Celestino Pio Lombardi, Francesco Rubino, Valter Perilli, Liliana Sollazzi, Gianmattia Mastroianni, Michel Gagner. Arterial PCO_2 and Cardiovascular Function During Endoscopic Neck Surgery With Carbon Dioxide Insufflation. Arch Surg 2001; 136:822-7.
3. SJ Cooke and S Paterson-Brown. Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure. Surg Endosc 2001; 15:723-5.
4. Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc 1997; 11:376-80.
5. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 2003; 196:189-95.
6. Ochiai R, Takeda J, Noguchi J, Ohgami M, Ishii S. Subcutaneous carbon dioxide insufflation does not cause hypercarbia during endoscopic thyroidectomy. Anesth Analg 2000; 90:760-2.
7. Kosteljanetz M. Intracranial pressure: cerebrospinal fluid dynamics and pressure-volume relations. Acta Neural Scand Suppl 1987; 111:1-23.
8. Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 1978; 48:332-44.
9. Short BL, Bender K, Walker LK, Traystman RJ. The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb. J Pediatr Surg 1994; 29:887-91.
10. Sharma KC, Kabinoff G, Ducheine Y, Tierney J, Brandstetter RD. Laparoscopic surgery and its potential for medical complications. Heart Lung 1997; 26:52-64.
11. Liem MS, Kallewaard JW, de Smet AM, van Vroonhoven TJ. Does hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring. Anesth Analg 1995; 81:1243-9.
12. Worrell JB, Cleary DT. Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery-case studies. AANA J 2002; 70:456-61.
13. Ito H, Kanno I, Ibaraki M, Hatazawa J, Miura S. Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J Cereb Blood Flow Metab 2003; 23:665-70.
14. Levy B, Bollaert PE, Nace L, Larcan A. Intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation. J Trauma 1995; 39:799-801.
15. Clark RM, Capra NF, Halsey JH Jr. Method for measuring brain tissue pressure. Response to alteration in pCO-2 systemic blood pressure, and middle cerebral artery occlusion. J Neurosurg 1975; 43:1-8.
16. Marmarou A. The pathophysiology of brain edema and elevated intracranial pressure. Cleve Clin J Med 2004; 71 :S6-8.
17. Knudsen GM, Paulson OB, Hertz MM. Kinetic analysis of the human blood-brain barrier transport of lactate and its influence by hypercapnia. J Cereb Blood Flow Metab 1991; 11:581-6.
18. Del Bigio MR, Zhang YW. Cell death, axonal damage, and cell birth in the immature rat brain following induction of hydrocephalus. Exp Neurol 1998; 154(1): 157-69.
19. Yamaki T, Murakami M, Iwamoto Y, Sakakibara T, Kobori N, Ueda S, Uwahodo Y, Kikuchi T. Cognitive dysfunction and histological findings in rats with chronic stage contusion and diffuse axonal injury. Brain Res Brain Res Protoc 1998; 3:100-6.
20. Ragaisis V. Brain contusion: morphology, pathogenesis and treatment. Medicina (Kaunas) 2002; 38:243-9.
21. Del Bigio MR, da Silva MC, Drake JM, Tuor UI. Acute and chronic cerebral white matter damage in neonatal hydrocephalus. Can J Neurol Sci 1994; 21:299-305.
22. Yang XF, Liu WG, Shen H, Gong JB, Yu J, Hu WW, Lu ST, Zheng XJ, Fu WM. Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury. Chin J Traumatol 2005; 8:96-100.
23. Conti AC, Raghupathi R, Trojanowski JQ, McIntosh TK. Experimental brain injury induces reagionally distinct apoptosis during the acute and delayed post-traumatic period. J Neurosci 1998; 18:5663-72.
24. Lossi L, Merighi A. In vivo cellular and molecular mechanisms of neuronal apoptosis in the mammalian CNS. Prog Neurobiol 2003; 69:287-312.
25. Kim JS, Kim KH, Ahn CH, Jeon HM, Kim EG, Jeon CS. A clinical analysis of gasless endoscopic thyroidectomy. Surg Laparosc Endosc Percutan Tech 2001; 11:268-72.