QuillTM缝线在腹腔镜肾部分切除术中的应用

目的探讨QuillTM缝线在腹腔镜肾部分切除术应用中的安全性及有效性。方法回顾性分析2015年6月至2020年1月西藏自治区人民医院泌尿外科完成的腹腔镜肾部分切除术38例,根据应用缝合线的不同分为普通缝线组和QuillTM缝线组。普通缝线组20例,均采用2-0单乔线缝合内层,线尾固定Hem-o-lok夹,1-0可吸收线缝合肾缺损,出肾被膜每针均固定1个Hem-o-lok夹;QuillTM缝线组18例,均采用2-0倒刺线缝合内层,1-0倒刺线缝合肾缺损处,采用连续缝合,最后肾被膜出针处固定1个Hem-o-lok夹。比较2组的手术时间、热缺血时间、术中出血量、术后并发症情况。结果38例患者手术均顺利完成,无中转开放或肾切除病例,2组的手术时间、术中出血量比较差异无统计学意义(P>0.05)。普通缝线组平均热缺血时间[(25±5)min]大于QuillTM缝线组[(15±4)min],差异具有统计学意义(t=3.32,P=0.002)。2组均无术中并发症,普通缝线组1例因术后出血行选择性肾动脉栓塞,1例因漏尿留置D-J管。QuillTM缝线组术后无出血、漏尿等并发症。结论倒刺缝合在腹腔镜肾部分切除术中应用安全、有效,可减少平均热缺血时间及术后并发症的发生率。     

超细经皮肾镜对≤1 cm的无积水肾盏憩室结石的疗效

目的探讨超细经皮肾镜治疗无积水肾盏憩室内结石(≤1 cm)的效果及临床推广应用价值。方法回顾性分析徐州市中心医院2017年5月至2019年5月收治的31例无积水肾盏憩室结石患者资料,其中17例行超细经皮肾镜碎石取石术(肾镜组),14例行输尿管软镜钬激光碎石术(软镜组)。采用独立样本t检验比较2组患者手术时间、术后血红蛋白下降值、术后住院时间的差异,采用χ~2检验比较清石率、术后并发症Clavien系统分级的差异。结果肾镜组手术时间短于软镜组[(47.59±6.07)min vs (53.21±5.15)min,t=-2.746,P=0.010],清石率高于软镜组(94.118%vs57.142%,P=0.028),术后并发症Clavien系统分级优于软镜组(P=0.031),差异均具有统计学意义,但术后血红蛋白下降值和住院时间方面2组比较,差异无统计学意义(P>0.05)。结论对于≤1 cm的无积水肾盏憩室内结石采用超细经皮肾镜碎石取石术治疗是一种安全、有效、快速的方法。     

内镜与腹腔镜治疗胃黏膜下肿瘤的临床对比研究*

目的通过与腹腔镜手术比较,评价经内镜治疗胃黏膜下肿瘤(GSMTs)的安全性、有效性及经济性。方法回顾性收集2012年1月-2015年1月就诊于新疆医科大学第一附属医院并行内镜或腹腔镜治疗的GSMTs患者91例;其中61例行内镜治疗,30例行腹腔镜手术治疗,切除肿瘤术后均送病理学检查,可疑胃间质瘤(GSTs)的进一步行免疫组化等分子生物学检查,分析患者的性别、年龄、就诊原因、肿瘤位置、手术方式、手术时间、术中出血量、肿瘤直径大小、术后住院天数、手术成功率、术后并发症发生率、术后复发率和住院总费用等。结果与腹腔镜组比较,内镜组手术耗时短[(55.86±11.41)vs(71.33±9.90)min,t=-4.56,P0.01],术中出血少[(16.83±4.64)vs(26.33±4.81)ml,t=-6.40,P0.01],术后住院时间短[(5.03±2.47)vs(7.20±1.21)d,t=-2.17,P0.01],住院总费用低[(24 779.43±6 202.00)vs(45 689.42±10 318.47)元,t=-8.42,P0.01],而在手术成功率(96.72%vs86.67%,χ2=1.87,P0.05)、术后并发症发生率(3.27%vs 6.67%,χ2=0.04,P0.05)等方面差异无统计学意义,两组随访期间均未见GSTs复发和转移。结论经内镜治疗GSMTs疗效与腹腔镜相似,是安全、有效的,且创伤更小,恢复更快,费用更低。     

腹腔镜下粘连松解术对粘连性肠梗阻的临床应用效果观察

目的探讨腹腔镜肠粘连松解术治疗粘连性肠梗阻的临床疗效和安全性。方法回顾性分析95例手术治疗的粘连性肠梗阻患者的临床资料和随访资料,依手术方式将患者分为开腹组(43例)和腔镜组(52例),比较两组患者术中情况、术后并发症及复发情况。结果腔镜组的手术时间小于开腹组[(68.35±36.47)vs(82.54±23.27)min,t=2.21,P=0.029];术中出血量少于开腹组[(69.51±20.33)vs(198.37±50.04)ml,t=16.97,P=0.000];术后镇痛剂使用量少于开腹组[(1.01±0.99)vs(3.46±1.53)支,t=9.41,P=0.000];腔镜组术后离床活动时间短于开腹组[(11.05±1.32)vs(20.36±2.59)d,t=16.97,P=0.000];胃肠功能恢复时间低于开腹组[(2.30±1.38)vs(4.05±1.74)d,t=5.47,P=0.000];导尿管拔除时间低于开腹组[(3.04±2.11)vs(5.36±2.24)d,t=5.19,P=0.000];住院天数低于开腹组[(5.89±1.57)vs(10.36±2.65)d,t=10.02,P=0.000];腔镜组和开腹组患者术后并发症发生率分别为3.84%(2例)和16.27%(7例),差异无统计学意义(χ~2=4.24,P=0.074);随访观察8~36个月,腔镜组和开腹组分别有2和6例出现顽固性腹痛和粘连性肠梗阻复发,开腹组复发结局事件的累计函数高于腔镜组,但差异无统计学意义(χ~2=3.64,P=0.056)。结论腹腔镜粘连松解术治疗粘连性肠梗阻安全、有效,具有创伤小,对腹腔干扰少的特征,效果优于开腹手术。     

腹腔镜辅助远端胃癌D2根治术的疗效及安全性探讨

目的探讨腹腔镜辅助远端胃癌D2根治术(LADG)治疗进展期胃癌的临床疗效和安全性。方法回顾性分析198例手术治疗的进展期胃癌患者的临床资料和随访资料,依手术方式将患者分为开腹组(n=101)和腹腔镜组(n=97),比较两组患者术中情况、术后并发症及生存质量。结果腹腔镜组与开腹组间手术时间[(226.30±36.40)vs(220.50±29.90)min,t=1.23,P=0.221]、淋巴结清扫数目[(22.01±4.99)vs(20.69±4.53)个,t=1.95,P=0.053]差异无统计学意义;腹腔镜组术中出血量少于开腹组[(114.50±20.30)vs(168.30±40.04)ml,t=11.77,P=0.000];胃肠功能恢复时间低于开腹组[(72.30±7.91)vs(84.05±9.04)h,t=9.72,P=0.000];住院天数低于开腹组[(8.89±1.57)vs(10.36±2.65)d,t=4.72,P=0.000];腹腔镜组、开腹组术后肿瘤近端切缘[(5.07±2.04)vs(4.85±1.98)cm,t=0.77,P=0.442],远端切缘[(4.33±1.90)vs(3.90±2.02)cm,t=1.54,P=0.125]差异无统计学意义;腹腔镜组和开腹组患者术后并发症发生率分别为9例(9.27%)和8例(7.92%),差异无统计学意义(χ2=0.01,P=0.907);腹腔镜组术后7天Karnofsky评分(KPS)高于开腹组[(79.33±15.54)vs(73.49±13.37)分,t=2.84,P=0.005];术后30天两组患者KPS评分差异无统计学意义[(90.83±8.36)vs(89.57±7.98)分,t=1.09,P=0.279)。结论 LADG治疗进展期胃癌与开腹手术有相同的临床疗效,但其对患者创伤小,患者近期生存质量高于开腹组。     

微创经皮肾镜与后腹腔镜治疗输尿管上段结石的疗效比较

目的比较经皮肾镜与后腹腔镜治疗输尿管上段结石的临床疗效。方法回顾性分析2009年3月至2011年7月宜春市人民医院收治的输尿管结石43例临床资料,其中经皮肾镜气压弹道碎石术23例,后腹腔镜下输尿管上段切开取石20例,比较2组手术时间、术中出血量、住院时间及术后并发症发生率。结果经皮肾镜组手术时间明显短于后腹腔镜组[(75.3±18.5)min vs(91.8±21.7)min,P<0.05]。经皮肾镜组与后腹腔镜组术中出血量、术后住院时间、结石一次性清除率、术后并发症发生率分别为[(113±14)mL vs(35±7)mL,P<0.05]、[(7.3±1.3)d vs(7.6±1.7)d,P>0.05]、(95.6%vs 100.0%,P>0.05)、(13.6%vs 10.0%,P>0.05)。无一例中转开放手术。术后随访1～6个月,后腹腔镜组1例尿瘘,1例发热;经皮肾镜组2例术后发热,1例患者术后大出血,1例患者术后腹部平片示点状小于5mm的结石影,术后3个月随访B超示未见残留结石。结论输尿管上段结石的大小,结石嵌顿的时间,是否合并UPJ及息肉,肾脏有无积水及有无合并肾结石等是选择手术方式应该考虑的。经皮肾镜和后腹腔镜都是有效和安全的手术方式,后腹腔镜组手术时间、住院时间要长于经皮肾镜组,出血量要少于经皮肾镜组,术后并发症要少于经皮肾镜组。     

一期多通道微创经皮肾镜钬激光碎石和单通道经皮肾镜碎石治疗鹿角形肾结石的对照研究

目的 比较一期多通道微创经皮肾镜联合输尿管镜钬激光碎石(multi-MPCNL组)与单通道MPCNL结合ESWL(single-MPCNL组)治疗鹿角形肾结石的疗效.方法 2005年9月～2007年9月对48例鹿角形肾结石患者进行随机分组,其中multi-MPCNL组治疗27例、single-MPCNL组治疗21例,比较两组的手术时间、术中出血量、住院时间、输血率、并发症发生率,术后3个月随访并评价结石清除率和治疗费用.结果 与single-MPCNL组相比,muld-MPCNL组手术时间短[(123±26)min vs(167±31)min,t=5.35,P=0.0001.术后住院时间短[(4.62±1.42)d vs(5.90±1.81)d,t=2.74,P=0.009],总治疗费用低[(79.11±9.87)vs(98.81±10.34)x 100元,t=6.71,P=0.000];但手术前后血红蛋白下降、输血率和并发症发生率等差异均无显著性.术后3个月,multi-MPCNL组结石清除率稍高于single-MPCNL组[88.89%(24/27)vs 76.19%(16/21),χ 2=0.610,P=0.435].结论 一期多通道微创经皮肾镜联合输尿管镜钬激光碎石治疗鹿角形肾结石取石速度快,住院时间短,恢复快,结石清除率较高,并发症低,经济方便,可作为较大鹿角形肾结石治疗的首选治疗方法 .     

后腹腔镜下结核肾切除术与开放手术的比较

目的 通过时后腹腔镜下结核肾切除术与开放手术的比较,探讨后腹腔镜结核肾切除术的临床应用价值.方法 通过对该院2003年5月-2007年10月的46例无功能结核肾切除患者的回顾性分析,比较两组在手术时间、术中出血量、术后住院时间、并发症等方面的差异.结果 两组手术均获成功,A组平均手术时间(154.0±23.8)min显著长于B组(106.0±13.5)min(t=8.19;P＜0.001);A组术中出血量(182.0±27.0)mL显著少于B组(267.0±20.3)mL(t=11.87;P＜0.001);A组术后住院天数(7.2±1.3)d比B组(11.8±2.4)d显著缩短(t=14.84;P＜0.001).结论 后腹腔镜是治疗无功能性结核肾切除的可选择手术方法 之一,具有术后恢复快、创伤小等优点.对于一些肾自截或完全钙化的萎缩小肾脏效果更好.     

腹腔镜与开放手术切除>4cm肾血管平滑肌脂肪瘤的效果比较

目的比较腹腔镜与开放手术切除4 cm肾血管平滑肌脂肪瘤的效果和安全性。方法回顾性分析自2005年2月～2009年2月18例接受手术治疗直径4 cm肾血管平滑肌脂肪瘤病例资料,其中腹腔镜手术11例,开放手术7例。结果两组病例年龄和肿瘤直径的差异无统计学意义(P0.05)。与开放手术组相比,腹腔镜手术术中出血量较少[平均出血量分别为(122.7±65)和(301.4±173)mL;P=0.035],术后住院天数较短[术后平均住院天数分别为(11.5±1.4)和(14.9±2.4)d;P=0.002]。腹腔镜组和开放手术组平均手术时间分别为([163.4±33)和(151.3±23)min],术后平均引流量分别为([210.5±118)和(187.1±26)mL],并发症发生率分别为9.1%和14.3%,差异无显著性(P0.05)。结论腹腔镜切除4 cm肾血管平滑肌脂肪瘤的术中出血量和术后住院天数较开放手术有优势,并且并发症发生率不增加。     

3D与2D腹腔镜在复杂性胆囊切除术中的前瞻性对比研究

目的前瞻性对比3D与2D腹腔镜在复杂性胆囊切除术中的临床应用价值。方法采用前瞻性随机对照的研究方法,选取2014年1月-2016年1月根据入组和排除标准连续收集的需行复杂性胆囊切除术的患者的临床病例资料。利用随机数表随机分为3D腹腔镜组和2D腹腔镜组,由同一组手术医生完成手术,比较两组患者手术情况和远期随访情况。结果依据入组条件,共计入组患者96例,3D组48例,2D组48例。①手术情况:所有患者均顺利完成手术,无围手术期死亡及二次手术患者;3D组的手术时间和术中出血量均少于2D组[(132.2±76.4)vs(156.5±89.3)min,P=0.000;(35.6±35.4)vs(55.9±44.1)ml,P=0.000],差异有统计学意义;两组的中转开腹率(6.3%vs 10.4%,P=0.203)和并发症发生率(20.8%vs 25.0%,P=0.445)无明显差别;3D与2D组的术后排气时间[(48.7±13.2) vs (49.6±14.1)h,P=0.692]、腹腔引流管留置时间[(3.5±1.1)vs (3.6±1.3)d,P=0.394]和住院时间[(5.1±1.5) vs (5.2±1.7)d,P=0.311]差异均无统计学意义;②远期随访:全部患者获得随访,随访时间12～40个月,中位随访时间28个月;3D组6例出现消化不良,4例出现右上腹不适,2例出现残余胆囊结石;2D组4例出现消化不良,5例出现右上腹不适,1例出现残余胆囊结石。结论 3D腹腔镜依靠其高清的视野和良好的纵深感,在复杂胆囊切除术中安全有效,并有利于减少患者的出血量和缩短手术时间,值得临床推广应用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."