甲状腺良性肿瘤手术常规解剖喉返神经与否的探讨

目的研究甲状腺良性肿瘤手术中是否需要常规解剖喉返神经，常规解剖神经与减少神经损伤有无必然联系。方法选取180例甲状腺良性肿瘤，分别采用不显露喉返神经和常规显露喉返神经的手术方法进行手术。结果两组手术方式对喉返神经的保护无明显差别。结论减少喉返神经损伤的关键是要具备良好的颈部解剖知识，熟悉喉返神经的正常解剖及变异，术中根据患者的具体情况进行仔细操作，以及直视下稳妥地处理神经周围组织。是否常规暴露喉返神经应根据手术方式、术中情况进行选择，没有必要遵循一个固定模式。     

桥小脑角肿瘤神经内镜辅助显微镜的临床治疗

[目的]为神经内镜辅助下桥小脑角肿瘤的手术提供解剖学支持。[方法]交替使用神经内镜及手术显微镜,进行该区域神经内镜下解剖,并应用于临床手术。[结果]神经内镜经小脑外侧间隙顺利到达桥小脑区及脑干前方,清晰显示5～11脑神经及附近走行的血管,手术明显改善深部术野的照明和显微解剖结构的识别,减少对小脑/脑干牵拉。[结论]神经内镜在该区手术中弥补手术显微镜的不足,对显微手术起到重要辅助作用。     

儿童复杂脉管畸形的分子诊断和靶向治疗的研究进展

脉管畸形是由于胚胎时期血管和(或)淋巴管异常发育所致, 不伴有内皮细胞增殖。既往因对其致病机制尚未明确, 多数以手术和硬化剂注射等对症治疗为主。随着分子生物学进展, 脉管畸形的致病机制被认为是生殖细胞种系突变和/或体细胞突变, 最终激活PI3K/ATK/mTOR、Ras/Raf/MEK/ERK通路所致, 相关研究也促进了靶向抑制剂的应用。本文对目前儿童脉管畸形致病基因和靶向药物进行阐述, 旨在为推动此类疾病的精确分子诊断和精准靶向治疗提供参考依据。     

传统医学之最

据《汉书．王莽传》记载：新莽天凤三年(公元16年)王莽令太医尚方与巧屠一起解剖被处死者公孙庆的尸体。不仅量度其五脏，而且以竹筵(竹笺)寻其脉研究脉管的起始部位，循行走向．以及脉管长度等。     

彭氏多功能手术解剖器在妇科恶性肿瘤手术中的应用

目的探讨彭氏多功能手术解剖器在妇科恶性肿瘤手术中的应用效果。方法选择我院2011年3月²013年3月应用彭氏多功能手术解剖器开展妇科恶性肿瘤手术62例为观察组,选择以往用传统的开腹手术器械行妇科恶性肿瘤手术62例为对照组,比较两组在手术时间、术中出血量、留置腹腔引流管时间、术后肛门排气时间、术后并发症的差异、术后1个月、2个月门诊复查的情况等。结果观察组手术时间、术中出血量,明显少于对照组;术后留置腹腔引流管时间、术后肛门排气时间,明显短于对照组;术后并发症发生率低于对照组。结论彭氏多功能手术解剖器集多种手术操作功能于一身,术中一器多功用,不需频繁转换器械。术野清晰,使复杂的手术难度降低,手术时间显著缩短,减少了术中损伤,明显减少术中出血量,减少手术并发症,提高了手术质量,值得基层医院临床推广应用。     

解剖异常的阑尾炎3例手术体会

目的:探讨解剖异常阑尾炎的手术技巧。方法:回顾性分析假环状阑尾和乙状结肠右侧转位的阑尾手术技巧。结果:3例解剖异常的阑尾均完成了阑尾切除术。结论:解剖异常的阑尾通过术者细致的解剖与手术,均能圆满的完成手术。     

一种中小型动物颈椎手术解剖台的研制

目的:研制一种用于中小型动物颈椎手术的解剖台,以方便术中调节角度,充分暴露颈椎,提高手术效率。方法:解剖台包括工作台主体、头架和脚架3个主要部分。头架和工作台主体之间通过活页轴相连,头架上设有半圆柱状垫枕,垫枕下设置螺钉1枚,螺钉嵌入垫枕滑槽,用于调节和固定垫枕的位置。工作台主体台面4个角分别装有一条用以固定实验动物四肢的四肢绑带,通过螺钉调节或固定于4个斜向的绑带滑槽上。结果:该解剖台能够个体化地摆放中小型实验动物的头部,使其在颈椎手术中充分暴露术野,缩短手术时间,降低术中出血量,有效固定头部,减少术者和助手的工作量。结论:该解剖台提高了手术效率和安全性,操作简便、成本低廉,值得在中小型动物颈椎实验中推广使用。     

内窥镜经鼻一蝶手术人路及显微解剖研究

目的回顾内窥镜经鼻蝶手术入路发展,研究经蝶手术入路显微解剖,为内窥镜经蝶手术提供解剖学参考依据。方法采用20具成人尸体头颅,按经蝶手术人路方式解剖邻近血管神经,并进行显微解剖学观测,为临床内窥镜经蝶入路提供解剖学资料。结果对鞍底、蝶窦口、视神经、颈内动脉、垂体窝、海绵窦的结构构成及其邻近血管神经进行描述测量。结论熟悉蝶鞍区显微解剖结构有助于内窥镜经鼻蝶入路手术准确定位及术中安全操作。     

解剖锁定钢板与普通钢板治疗跟骨骨折效果分析

目的探讨解剖锁定钢板与普通钢板治疗跟骨骨折效果。方法采集山东省德州市武城县医院骨科收治的60例跟骨骨折患者,采用随机数字表法分为解剖锁定钢板治疗组和普通钢板内固定治疗组各30例,普通钢板内固定治疗组进行普通钢板内固定治疗,解剖锁定钢板治疗组进行解剖锁定钢板手术。分析比较两组治疗效果;手术切口长度、达到骨性愈合周数、因创伤导致的出血量、使用止痛药天数;手术前后跟骨骨折患者Gissane角以及Bohler角和生活质量评分;并发症。结果解剖锁定钢板治疗组手术总有效率为100.00%,高于普通钢板内固定治疗组的70.00%;手术后,解剖锁定钢板治疗组Gissane角以及Bohler角和生活质量评分优于普通钢板内固定治疗组,手术切口长度、达到骨性愈合周数、因创伤导致的出血量、使用止痛药天数优于普通钢板内固定治疗组;术后并发症发生率为3.33%,低于普通钢板内固定治疗组的23.33%,差异均有统计学意义(P<0.05)。结论采取解剖锁定钢板手术效果确切,其应用可加速骨折的愈合,减少创伤和出血,改善解剖结构以及跟骨骨折患者的生活质量。     

减重手术患者的营养缺乏及管理现状

近年来全球肥胖、超重的发病率不断增高,超重或肥胖是多种慢性代谢性疾病的主要危险因素之一,减重手术是目前实现长期减重的有效方法之一。然而,国内外针对减重术前是否应该进行减重管理尚无明确定论。此外,手术改变了正常消化道解剖和功能,使胃容量减少、肠道吸收面积减少或胃酸分泌减少,减重手术在使患者获得满意的减重效果的同时也伴随着许多术后并发症的风险,减重术后患者面临着各种营养素缺乏及营养不良带来的并发症的风险,例如蛋白质的缺乏,铁、维生素B族等微量元素的缺乏,营养素缺乏预防以及长期营养随访可以避免术后并发症、营养不良和心理问题的出现,因此专业的营养管理必不可少。本文就减重手术前后营养缺乏及营养管理的内容和方法进行了综述,为探索符合我国减重手术患者特点的长期随访管理模式提供参考。     

Dynamic interaction of a downward plane jet and a cough jet with respect to particle transmission: An analytical and experimental study

A cough jet can travel beyond the breathing zone of the source person, and thus, infectious viral- and bacterial-laden particles can be transported from the source person to others in close proximity. To reduce the interpersonal transmission of coughed particles, the objective of this study was to analytically and experimentally investigate the performance of downward plane jets with various discharge velocities. Chamber measurements were conducted to examine the interaction between a transient cough jet (discharge velocities of 12 m/sec and 16 m/sec) and a steady downward plane jet (discharge velocities from 1.0–8.5 m/sec) with respect to the transport of and human exposure to coughed particles. The results show that a relatively high-speed cough can easily penetrate a downward plane jet with a discharge velocity of less than 6 m/sec. A downward plane jet with a discharge velocity of 8.5 m/sec can bend the cough jet to a certain extent. In this study, momentum comparison of the cough jet and the downward plane jet shows that the value of personal exposure to coughed particles depends on the ratio of jet momentums. The results show that when the two momentums are equivalent or if the downward plane jet has a greater momentum, the cough jet is deflected downward and does not reach the breathing zone of the target thermal dummy. Using the ratio of the two momentums, it may be estimated whether the transmission of a cough jet can be controlled. A trajectory model was developed based on the ratio of the two momentums of a cough jet and a downward jet and was validated using the experimental data. In addition, the predicted trajectory of the cough jet agreed well with the results from smoke visualization experiments. This model can be used to guide the design of downward plane jet systems for protection of occupants from coughed particles.     

CO2无针喷射注射装置的设计特点与应用

介绍了以液态CO2为动力源的无针喷射注射装置的结构。原理及其设计特点，此装置适用于皮下（SC）或肌内（IM）以及大量人群免疫程序及快速多剂量疫苗的注射，也可用于其它可注射给药。     

一种切割清洗式创面清创机的设计研究

目的:设计一种切割清洗式创面清创系统的外科手术器械,介绍清创机的机械结构、电控系统以及软件设计流程,并测试其性能。方法:按照切割清洗式创面清创机的设计原则,设计并构建系统模块,采用低压水射流技术完成创面清洗、高压水射流技术进行组织切除,在集成负压吸引器作用下保持手术视野的清晰和创面的洁净。结果:该清创机最大清洗压力达到1.2MPa,最大清洗流量为1.5L/min;最大切割压力达到10MPa,最大切割流量为500ml/min,压力精度范围控制在±3%以内,负压吸引器流量为5L/min。结论:该清创机是一种集清洗与手术于一体的手术器械,具有组织选择性好、对切除器官及组织残端损伤少、手术时间短等优点。     

病案首页实现国家手术分级目录的方法和作用

目的：利用病案首页实现国家手术分级目录。方法通过电子病案手术分级管理流程或首页信息实现。结果建立权威性和公正性的手术分级目录,使不同科室和个人手术数量具备可比性,采用手术数量、三四级手术所占构成比、手术并发症、非计划二次手术等指标,实现对医师手术能力和手术质量的评估,促使手术分级管理相关制度落到实处。结论利用病案首信息建立手术评价指标体系,实现医疗手术行为有效监管。     

高频喷射通气对单肺通气患者氧化应激反应的影响

目的 研究高频喷射通气(HFJV)对单肺通气患者氧化应激反应的影响.方法 择期行食管癌根治术患者45例,按随机数字表法分为双肺通气组(A组)、单肺通气组(B组)、单肺通气时非通气侧给予HFJV(驱动压力1 kg/cm2,频率100次/min)组(C组),每组15例.分别于开胸前(T0),单肺通气后(A组于开胸后)30 min(T1)、90 min(T2)、150 min(T3),手术结束时(T4)测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、一氧化氮(NO)浓度.结果 T2～T4时B、C组SOD活性[B组:(47±10)、(37±9)、(41±7)kU/L;C组:(58±12)、(51±11)、(49±9)kU/L]低于A组[(78±8)、(75±7)、(79±6)kU/L](P＜0.05),T1～T4时B、C组MDA、NO浓度高于A组(P＜0.05);T3时C组SOD活性明显高于B组(P＜0.05),T1～T4时C组MDA浓度及T2～T4时NO浓度低于B组(P＜0.05).结论 HFJV能在一定程度上抑制单肺通气患者的氧化应激反应.

Abstract：

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

TKR系列呼吸机的研制及物理特点

本文介绍利用高频通气技术设计的高频喷射呼吸机,重点阐述了TKR系列高频呼吸机的设计特点及所具有的各种呼吸方式。该系列呼吸机功能全,可靠性高,使用方便。     

利用移动客户端APP实现手术精细化管理

手术环节质量控制是医疗质量安全管理的关键环节。建立移动智能化手术精细化管理模式,有利于合理配置医疗资源,把控手术质量,保障患者安全。从手术排班、手术监控、手术审批3大模块设计入手,实时显示手 术模块关键信息,把控手术全流程,实现手术精细化管理。实践后,2018年上半年较2017年手术例数同比增长8%,四级手术例数同比增长17%;针对不同科室首发准时率进行调整,预警非计划手术,达到了提升数量和监管质量 的目的。移动客户端APP为医护人员带来了便捷的信息提示,可助力医疗质量管理水平提升     

新型野战手术器械盒在海上救护手术中的应用

研发和应用新型野战手术器械盒,探索海上伤病员救治手术中手术器械的使用和管理经验,提高海上手术救治能力。该套器械盒结构新颖,配置合理,其硬质包装和消毒灭菌通道,有利于清洗消毒、长期无菌保存器械和迅速展开手术;盒内器械固定装置可有效防止海上手术时器械滑落,且方便清点和整理器械。新型野战手术器械盒能较好适应于海上伤病员救治手术,使用、消毒、贮存和携行十分方便。     

Insomnia, biological clock, and the bedtime decision: an economic perspective

While insomnia can be a symptom of numerous mental and physical illnesses, it is frequently diagnosed as a sleep disorder in its own right, caused mainly by stressful life events or by non-synchronization of individuals' biological sleep-wake cycle with the one they choose to practice. Because of irregular work schedules, late-night entertainment, or rapid crossing of several time zones, individuals might retire to bed earlier or later than their biological bedtime, experiencing difficulties in falling asleep. The present paper develops a simple economic model of the bedtime decision, viewing the individual as a rational decision-maker who determines her insomnia level through consciously weighing the cost and benefit of deviating from her biological bedtime. The model is then used to examine the individual's response to stress, yielding a prediction which is consistent with observed behavior, although not with sleep therapists' recommendations. Finally, the model is applied to the case of transmeridian flights, explaining jet lag as a rational adjustment to a misalignment between the individual's slow-to-adapt internal clock and her external environment.     

PLASMOSE - antimicrobial effects of modular atmospheric plasma sources

The technological potential of non-thermal plasmas for the antimicrobial treatment of heat sensitive materials is well known and has been documented in a great number of research activities, but the realisation of industrial plasma-based decontamination processes remains a great challenge. One of the reasons for this situation is the fact that an antimicrobial treatment process needs to consider all properties of the product to be treated as well as the requirements of the complete procedure, e.g. a reprocessing of a medical instrument. The aim of the BMBF-funded network project PLASMOSE is to demonstrate the applicability of plasma-based processes for the antimicrobial treatment on selected, heat sensitive products. Modular and selective plasma sources, driven at atmospheric pressure are used. This basic approach shall combine the technological advantages of atmospheric pressure plasmas (avoidance of vacuum devices and batch processing) with the flexibility and handling properties of modular devices. Two different objectives were selected: the outer surface treatment of medical products and the treatment of hollow packaging for pharmaceutical products. The outer surface treatment of medical products, in particular catheters for intracardial electrophysiological studies, is investigated by means of RF-driven plasma jets in argon. Due to its compact design they are predestined for modularisation and can be adapted to nearly any complex 3-dimensional structure as given by the medical products. The realisation of an antimicrobial treatment process of hollow packaging for pharmaceutical products has quite different demands. Such a process is needed to be implemented in in-line filling procedures and to work without additional process gases. The idea is to use an atmospheric air, microwave-driven self propagating discharge. The plasma process is optimized for the decontamination of 200 ml bottles by field simulation studies combined with optical emissions spectroscopy and micro-biological tests.