经脐单孔法腹腔镜下治疗小儿腹股沟斜疝临床观察

目的：：探讨小儿腹股沟斜疝的简便、有效治疗方法。方法：采用经脐单孔法腹腔镜下行小儿腹股沟斜疝疝囊高位结扎术共60例。结果：60例手术均成功,平均手术时间为16.8 min,平均住院时间为3.3 d。术后随访未见复发及并发症出现。结论：经脐单孔法腹腔镜治疗小儿腹股沟斜疝对患儿损伤小,手术时间短,恢复快,术后复发率很低,是治疗小儿腹股沟斜疝的首选治疗方法。     

经脐单部位腹腔镜下自制雪橇穿刺针治疗小儿腹股沟斜疝的体会

目的 探讨经脐单部位腹腔镜下应用自制雪橇穿刺针高位结扎疝囊的临床应用价值。方法 回顾性分析2016年1月至2018年12月阜阳市妇女儿童医院小儿外科收治的366例，采用自制雪橇穿刺针经脐单部位腹腔镜技术治疗小儿腹股沟斜疝患者的临床资料，包括年龄、性别、手术时间、术中出血量、术后并发症，分析自制雪橇穿刺针的治疗疗效。结果 双侧腹股沟斜疝159例（包含隐匿性斜疝98例），单侧腹股沟斜疝207例。所有患儿手术均成功，术中无大出血及腹腔脏器损伤发生，单侧平均手术时间（11.5±3.5）min，双侧平均手术时间（18.3±3.2）min。住院时间1.5~3.0 d，术后随访4个月~1年，其中364例恢复良好，复发2例，无医源性隐睾、睾丸萎缩及线结反应等并发症。结论 经脐单部位腹腔镜下应用自制雪橇穿刺针治疗小儿腹股沟斜疝操作简单，手术时间短，住院时间短，结扎线经同一隧道穿入与穿出，避免了结扎多余组织导致结扎变松而降低复发率等优点，值得基层医院推广应用。     

改良的经脐单孔腹腔镜手术治疗小儿腹股沟斜疝临床效果观察

目的观察改良的经脐单孔腹腔镜手术治疗小儿腹股沟斜疝的临床效果。方法对600例男性腹股沟斜疝患儿采取腹腔镜手术治疗,其中改良经脐单孔术式（改良组）、常规经脐单孔术式（对照组）各300例;比较两组患儿手术时间、住院费用、术后并发症及疝复发情况。结果两组患儿均顺利完成手术,术中均无需增加操作孔或中转改传统疝囊高位结扎术。与对照组比较,改良组手术时间较短,术后并发症较少,差异均有统计学意义（均P＜0.05）;而住院费用比较,差异无统计学意义（P＞0.05）。术后随访9~24（15.4±5.7）个月,两组患儿均无睾丸生长发育异常、会阴部疼痛,手术创面无明显瘢痕;改良组疝复发率为0.0%,明显低于对照组的2.0%（P＜0.05）。结论改良的经脐单孔腹腔镜手术治疗小儿腹股沟斜疝安全、有效,术后复发率低。     

单孔微型腹腔镜小儿腹股沟疝高位结扎术

目的探讨单孔法微型腹腔镜手术治疗小儿腹股沟斜疝的临床疗效.方法采用疝针腹腔镜下单孔法手术治疗小儿腹股沟斜疝93例,其中右侧79例,左侧14例,双侧8例.术前诊断单侧斜疝中有3例存在对侧隐性疝,术中发现6例均在腹腔镜下行内环口高位缝扎术.结果手术时间单侧疝平均12min,双侧疝20min.术后平均3d出院.2例有阴囊积气、2例腹膜外小血肿,1例复发,无其他严重并发症.结论单孔法微型腹腔镜下小儿腹股沟斜疝疝囊内环口高位缝扎术安全可靠、创伤小、美观且操作简便,术后恢复快,值得临床推广应用.     

自制器械联合常规器械行单孔腹腔镜小儿腹股沟斜疝内环口关闭术36例体会

目的 探讨自制器械联合常规器械行单孔腹腔镜小儿腹股沟斜疝内环口关闭术的经验和临床应用价值.方法 回顾分析2011年1月至2013年6月36例3～11岁腹股沟斜疝患儿使用自制器械联合常规器械进行的单孔腹腔镜腹股沟斜疝内环口关闭术.结果 经该技术治疗的36例患儿全部治愈,平均住院天数1～3天.结论 应用该项技术治疗小儿腹股沟斜疝,无需另行购置器械,具有创伤小、手术时间短、恢复快、住院时间短、不留手术疤痕等优点.     

经腹修补术治疗132例小儿腹股沟斜疝的临床疗效

目的 探讨经腹修补术治疗小儿腹股沟斜疝的临床疗效。方法 选择2013年8月至2017年3月在芜湖市中医医院施行经腹修补术的132例小儿腹股沟斜疝患儿的临床资料,回顾性性分析其手术方式、手术时间、住院时间、住院费用等临床资料。结果 本组患儿治愈率为100.00%,平均手术时间为（25.82±15.31）min,平均住院时间（2.74±0.72）d,平均住院费用（2 656.92±478.28）元。术后随访1年,无1例患者复发。结论 经腹修补术是治疗小儿腹股沟斜疝安全有效的方法,具有治愈率高、恢复快、低复发及费用低等优势。     

经脐单孔腔镜下应用自制双孔缝合针治疗小儿腹股沟斜疝

目的探讨自制双孔针＋单孔腹腔镜技术在小儿腹股沟斜疝手术中的临床意义。方法对36例腹股沟斜疝患儿采用自制双孔针＋Wolf-H型镜,行经脐单孔腹腔镜下疝囊高位结扎术,现对患儿的临床治疗资料进行回顾性分析。结果全组均在经脐单孔腹腔镜下完成疝囊高位结扎术,单侧手术时间8～10min,平均8.7min,双侧手术时间12～18min,平均15.1min。术后均无局部血肿、阴囊水肿、阴囊积气、切口感染及皮下异物感。术后无疝复发,腹部未见明显瘢痕。结论经脐单孔腹腔镜下应用自制双孔缝合针治疗小儿腹股沟斜疝,除具备普通腹腔镜手术的优点外,具有创伤更小,美容效果更佳的优势,是小儿疝外科的一个发展方向。     

经脐双孔法腹腔镜治疗小儿腹股沟斜疝的临床效果

目的：探讨经脐双孔法腹腔镜治疗小儿腹股沟斜疝的临床效果。方法选取70例小儿腹股沟斜疝患者作为研究对象,通过随机数字表法分为观察组和对照组,各35例。对照组患儿给予传统手术治疗,观察组患儿采用经脐双孔法腹腔镜治疗手段,观察和分析临床治疗效果。结果观察组患儿手术时间、住院时间、并发症发生率、VAS评分均低于对照组,预后优于对照组,差异有统计学意义（P<0.05）。结论经脐双孔法腹腔镜治疗小儿腹股沟斜疝具有安全性、可靠性及高效性,创伤小、手术操作简便、术后并发症发生率低,能明显提高临床治疗效果,具有重要的临床应用价值。     

经脐单孔腹腔镜治疗小儿腹股沟斜疝的护理配合和体会

目的 探讨经脐当空腹腔镜治疗小儿腹股沟斜疝的最佳手术配合的方法和流程.方法 对36例腹股沟斜疝患儿采用经单孔腹腔镜行疝囊高位结扎术的手术配合过程和胃手术期护理进行回顾分析和总结.结果 36例患儿均在经脐单孔腹腔镜下完成疝囊高位结扎术,术后患儿均安全返回病房并顺利康复出院.术后均无局部血肿,阴囊水肿,切口感染.术后无疝复发.结论 充分的器械准备是保障手术安全的必要因素;经单孔腹腔镜治疗小儿腹股沟斜疝,不但具备普通腹腔镜手术的优点,而且具有创伤更小,美容效果更佳的优势,是将来小儿疝外科的一个发展方向.     

腹腔镜手术在11例小儿特殊类型腹股沟嵌顿疝治疗中的应用

目的 探索经脐双孔法腹腔镜手术治疗小儿特殊类型腹股沟嵌顿疝的临床价值.方法 回顾性分析2012年12月至2015年11月华中科技大学同济医学院附属武汉儿童医院收治的11例行腹腔镜手术的特殊类型腹股沟嵌顿疝患儿的临床资料,对患儿的一般资料、手术方法、住院时间、术后并发症等进行分析.结果 4例Amyand疝均行腹腔镜手术;3例合并美克尔憩室,其中2例同时行全腹腔镜下美克尔憩室切除,1例为Littre疝,经脐小切口行美克尔憩室切除肠吻合术;1例腹股沟直疝伴大网膜嵌顿行腹腔镜手术;3例合并嵌顿肠管浆肌层撕裂行腹腔镜下肠修补术.所有患儿术后均无切口感染、阴囊血肿发生,平均住院时间(5.9±2.4)d.术后随访10个月至3年,无睾丸萎缩、复发等.结论 经脐双孔法腹腔镜手术治疗小儿特殊类型腹股沟嵌顿疝安全、微创、恢复快,值得推广应用.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.