自制极简PORT在单孔腹腔镜子宫肌瘤切除术中的应用初步探讨

目的:初步探讨自制极简入路通道（PORT）在单孔腹腔镜子宫肌瘤切除术中应用的可行性及安全性。方法:回顾性分析空军军医大学西京医院妇产科于2017年3月至2018年12月共完成的46例单孔腹腔镜子宫肌瘤切除术患者，其中24例使用商品化PORT，22例使用我科自制极简PORT，所有患者均配合使用常规腹腔镜器械顺利完成手术。比较两组患者年龄、体质量数、手术时间、术中出血量、子宫肌瘤直径、术中及术后相关并发症、手术前后血红蛋白差值、术后排气时间、术后疼痛模拟评分、住院时间、术后随访情况等指标。结果:所有患者均顺利完成手术，无中转开腹或增加穿刺孔，无并发症发生。商品化PORT组和自制极简PORT组患者的一般资料具有可比性。手术相关指标包括手术时间［（75±56.9）min vs （74±55.7）min］、术中出血量［（55±67.9）ml vs （56±65.8）ml］、子宫肌瘤直径［（6±2.8）cm vs （6±3.4）cm］，两组比较无明显统计学差异（P＞0.05）。术后恢复指标包括术后排气时间［（12.6±4.4）h vs （13.5±3.4）h］、术后疼痛模拟评分［（2.1±1.3）分 vs （2.0±1.2）分］、住院时间［（3.4±2.8）d vs （3.5±2.6）d］，同样无统计学差异（P＞0.05）。两组手术效果相同，但术中使用自制极简PORT几乎不增加耗材。结论:自制极简PORT在单孔腹腔镜子宫肌瘤切除术中的应用安全性好，效果确切，节约成本，值得推广。     

腹腔镜下直肠癌保肛术治疗直肠癌的效果观察

目的探讨腹腔镜下直肠癌保肛术治疗直肠癌的效果。方法选定2018年9月-2019年4月本院收诊的94例直肠癌患者,等距抽样法分为对照组(47例,套入式吻合保肛术)与观察组(47例,腹腔镜下直肠癌保肛术)2组,比较2组排气时间、术中出血量、手术时间、并发症发生率指标。结果观察组排气时间、术中出血量、手术时间、并发症发生率均低于对照组(P<0.05)。结论腹腔镜下直肠癌保肛术可提高直肠癌患者预后质量与治疗效果。     

真菌性、细菌性和病毒性肺炎的若干凝血指标变化分析

探讨真菌性、细菌性和病毒性肺炎的若干凝血指标差异性研究。方法 回顾性分析2017 年7 月～2019 年11 月本院肺炎患者128 例与同期门诊健康体检者50 例，分析患者血浆纤维蛋白原（FIB）、凝血酶原时间（PT）和活化部分凝血酶时间（APTT）的水平。结果 三类肺炎组与对照组在FIB、PT 和APTT 水平比较，差异均有统计学意义（P＜0.01）；FIB、PT 水平与病原感染呈正相关，APTT 与病原感染呈负相关。结论FIB、PT、APTT 可以间接提示肺炎感染病原体类型，具有临床意义。     

Adult groin hernias

A groin hernia is a common presenting complaint for adults and surgical repair is usually recommended. Patients may present with swelling or pain in the groin and one should be cognisant of the surgical emergency of a strangulating or obstructing hernia. A careful history and examination will help determine differential diagnoses and with planning the potential approach for repair. Surgical techniques have developed in recent years with a swing towards favouring laparoscopy in the elective patient. For both open and laparoscopic approaches, there are recognized techniques to consider. It is crucial to have a clear understanding of the anatomy in order to develop the skills required for accurate dissection, reduction and repair. Complications, although rare, can lead to severe morbidity. Laparoscopy has the advantage of reducing postoperative chronic pain but requires greater skill and experience to perform successfully. This chapter outlines the key considerations and surgical techniques for groin hernia repair and should be used in conjunction with practical training.     

Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review

Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.