数字化是医院现代化建设的必由之路

进入21世纪的信息化社会，医院如何把握机遇，加速数字化建设步伐，是医院求生存、谋发展的重大战略任务。本文从医院数字化建设的意义、医院数字化建设存在的主要问题及加强医院数字化建设的措施等方面进行了探讨。     

批量伤病员救治排队系统的建模与仿真

对批量伤病员送至医院进入排队系统，实施分级救治，是降低伤死、伤残以及使伤员得到及时治疗的重要措施。本文运用离散事件系统建模的方法、仿真策略和排队系统的仿真方法，建立了伤病员在医院救治的排队论模型，并以武汉汉口遭袭进行仿真和结果分析。     

乳腺肿块针吸细胞学可疑癌的诊断体会

 目的　探讨乳腺肿块针吸细胞学( FNAC) 可疑癌的临床特点与细胞病理学的关系。方法　回顾总结1 115 例乳腺肿块FNAC 中63 例可疑癌的细胞学特点和诊断标准。结果　1 115 例乳腺肿块FNAC 中,63 例可疑癌获病理组织学对照, 占乳腺肿瘤的5. 65 %(63/ 1115) ,正确率96. 8 %(61/ 63) ,误诊率3. 2 %(2/ 63) 。结论　FNAC 对乳腺可疑恶性病变的早期发现、诊断和手术方式的选择具有独特价值。     

昆明山海棠胶囊对小鼠的生殖毒性研究

目的：探讨昆明山海棠胶囊的生殖系统毒性.方法：根据卫生部《中药新药研究指南》,进行该制剂的特殊毒理实验研究.结果：显性致死试验阳性;雌鼠均不能受孕;精子畸形率显著增高,随剂量增加而精子畸形率增高;对孕鼠重量、活胎重量及平均胎仔数等各项指标均无影响.结论：昆明山海棠胶囊具有低-中度的遗传毒性和一般生殖毒性,而无胚胎毒性.     

56例患者肾移植术后他克莫司治疗窗浓度范围再探讨

目的:探讨适合中国人的肾移植术后他克莫司(FK506)治疗窗浓度范围。方法:采用微粒子酶免疫法测定56例肾移植术后患者口服FK506后12h的全血谷浓度,并观察排斥反应及肾毒性反应的发生情况。结果:肾移植术后FK506的推荐治疗窗浓度范围0mo~1mo为9~14μg/L,2mo~3mo为8~12μg/L,4mo~6mo为6~10μg/L,7mo~12mo为4~6μg/L。结论:在上述治疗窗浓度范围内,既能达到满意的免疫抑制效果,又能减少排斥反应和肾毒性反应的发生。     

Usefulness of a Three‐Dimensional‐Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate

ObjectiveTo evaluate the usefulness of a 3D‐printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD).MethodsA retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non‐3D group (11 patients). A preoperative simulation process was undertaken for the patients in the 3D group, with preselection of the TARP system using a 3D‐printed 1:1 scale model, while only imaging data was used for the non‐3D group. Complications, clinical outcomes (Japanese Orthopaedic Association [JOA] and visual analogue score [VAS]), and image measurements (atlas–dens interval [ADI], cervicomedullary angle [CMA], and clivus‐canal angle [CCA]) were noted preoperatively and at the last follow up.ResultsA total of 23 patients with a follow‐up time of 16.26 ± 4.27 months were included in the present study. The surgery duration, intraoperative blood loss, and fluoroscopy times in the 3D group were found to be shorter than those in non‐3D group, with statistical significance. The surgery duration was 3.29 ± 0.45 h in the 3D group and 4.68 ± 0.90 h in the non‐3D group, and the estimated intraoperative blood loss was 131.67 ± 43.03 mL in the 3D group and 185.45 ± 42.28 mL in the non‐3D group. No patients received blood transfusions. The intraoperative fluoroscopy times were 5.67 ± 0.89 in the 3D group and 7.91 ± 1.45 in the non‐3D group. Preoperatively and at last follow up, JOA and VAS scores and ADI, CCA, and CMA were improved significantly within the two groups. However, no statistical difference was observed between the two groups. However, surgical site infection occurred in 1 patient in the 3D group, who underwent an emergency revision operation of the removal of TARP device and posterior occipitocervical fixation; the patient recovered 2 weeks after the surgery. In 2 patients in the traditional group, a mistake occurred in the placement of screws, with no neurological symptoms related to the misplacement.ConclusionPreoperative surgical simulation using a 3D‐printed real‐size model is an intuitive and effective aid for TARP surgery for treating IAAD. The 3D‐printed biomodel precisely replicated patient‐specific anatomy for use in complicated craniovertebral junction surgery. The information was more useful than that available with 3D reconstructed images.     

皮下结节病

皮下结节病是一种少见的结节病皮肤损害，病因不明，免疫反应是主要发病机制。临床表现为四肢的无痛性皮下结节，多伴有双侧肺门淋巴结肿大等系统损害。组织病理表现为皮下脂肪层和真皮深层的非干酪性上皮细胞样结节，周围有结缔组织包裹，结节周围少量淋巴细胞浸润。结合组织病理检查和影像学检查可明确诊断。糖皮质激素是首选治疗方法。肿瘤坏死因子-α拮抗剂、免疫抑制剂和光动力治疗也是可供选择的治疗手段之一。     

Laparoscopic resections of colorectal cancer and synchronous liver metastases: a case controlled study

Purpose: To investigate the efficacy and safety of laparoscopic simultaneous resections of colorectal cancer and synchronous colorectal liver metastases (SCRLM), relative to open surgery.

Methods: Between 1 January 2009 and 20 April 2014, 20 of 25 patients who underwent laparoscopic simultaneous colorectal cancer and SCRLM resections were matched with 20 of 29 patients who underwent an open approach, based on prognostic propensity scores. Perioperative results and survival outcomes were compared.

Results: The laparoscopic and open groups were comparable in demographics, cancer characteristics, surgery characteristics, and chemotherapy treatment. No postoperative mortality occurred in either group. The estimated blood loss and postoperative stay were significantly greater in the open group than in the laparoscopic group (all, p?Conclusions: The postoperative complications and survival rates of patients given laparoscopic simultaneous colorectal cancer and SCRLM resections were similar to those treated with an open approach, but with greater short-term benefits. Laparoscopy in this setting by an experienced surgical team appears safe and effective, and is a feasible alternative to an open approach for selected patients.     

大剂量甲氨蝶呤在急性淋巴细胞白血病应用后两种解毒方法的比较

目的探讨大剂量甲氨蝶呤(MTX)治疗急性淋巴细胞白血病的有效解救方法。方法选取我院收治的急性淋巴细胞白血病患者45例,随机分成观察组(23例)和对照组(22例)。45例患者均应用大剂量MTX进行治疗,观察组患者监测血药浓度并随时调整解救药的剂量,对照组患者应用固定剂量的解救药进行解救。比较两组患者不良反应的发生情况。结果观察组皮肤黏膜损害、胃肠道反应、肝功能损害、肾功能损害、骨髓抑制的发生率均低于对照组,且两组胃肠道反应、肝功能损害、骨髓抑制发生率的差异具有统计学意义(P<0.05)。结论在应用大剂量MTX进行治疗的过程中进行血药浓度的密切监测并及时调整解救药浓度能够达到更好的治疗效果。