Kato Motoi, Watanabe Azusa, Watanabe Shoji, Utsunomiya Hiroki, Yokoyama Takayuki, Ogishima Shinya
Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan.
Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
Arch Plast Surg. 2017 Nov;44(6):490-495. doi: 10.5999/aps.2017.01060. Epub 2017 Oct 26.
Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate.
We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed.
The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses.
Surgical microscopy was demonstrated to be useful during cleft operations.
唇腭裂修复手术需要一个深部且狭小的手术视野，通常由佩戴手术放大镜的外科医生进行操作。尽管在最深部的手术过程中需要头灯，但佩戴放大镜的外科医生能够获得更广阔的手术视野。手术显微镜提供了舒适的操作环境以及一个清晰且可调节放大倍数的手术部位，整个团队包括观察者都可以共享该视野，并且便于记录，有助于低年资外科医生的教育培养。放大倍数的调节对于诸如软腭肌肉解剖等精确手术操作很方便。
我们对18例使用手术放大镜或显微镜进行的腭裂手术进行了对比研究。护士填写纸质问卷，以评估每个手术过程中进展顺利的方面以及可以改进的方面。对手术时间、并发症发生率和问卷回复得分进行了统计分析。
使用显微镜时的手术时间并不显著长于使用手术放大镜时。通过与显微镜相连的监视器，手术视野能够清晰地与手术助手、护士、麻醉医生和学生共享。共享手术视野时传递手术器械更容易，并且术前显微镜准备工作不会干扰护士的工作。
手术显微镜在腭裂手术中被证明是有用的。
