整体护理联合加速康复外科应用于小儿尿道下裂修复术的效果

目的探讨整体护理联合加速康复外科(ERAS)措施应用于小儿尿道下裂修复术的效果。方法选择2019年3月至2021年5月中山市博爱医院收治的80例尿道下裂修复术的患儿作为研究对象,按照随机数字表法将其分为参照组(40例)与实验组(40例)。参照组采取传统护理方案,实验组采取整体护理联合ERAS,比较两组干预后并发症发生率、满意度及下床活动时间、切口愈合时间、术后首次排便时间、住院时间,使用儿童疼痛评估量表(FLACC)评估患儿疼痛程度。结果实验组并发症总发生率低于参照组,总满意度高于参照组,差异有统计学意义(P<0.05);实验组下床活动时间、切口愈合时间、术后首次排便时间、住院时间均短于参照组,10 d内排便次数低于参照组,差异有统计学意义(P<0.05)。护理前两组FLACC评分比较,差异无统计学意义(P>0.05);两组护理后FLACC评分低于护理前,且护理后实验组FLACC评分低于参照组,差异有统计学意义(P<0.05)。结论在小儿尿道下裂修复术中给予整体护理联合ERAS措施,可促进患儿尽快康复,减轻其疼痛程度,降低并发症发生率,缩短住院时间,提升患儿家属满意度,值得临床借鉴。     

单孔加一孔联合ERAS在高位直肠及乙状结肠癌中的应用

目的 探讨单孔加一孔腹腔镜手术联合 ERAS 治疗高位直肠及乙状结肠癌的近期疗效。方法 回顾性分析 2017 年 11 月至2018 年 10 月在福建省肿瘤医院胃肠肿瘤外科进行加速康复外科干预的 92 例高位直肠及乙状结肠癌患者资料，根 据手术方式的不同，分为单孔加一孔手术联合快速康复外科组39 例及常规腹腔镜手术联合ERAS 组 53 例，对比两组围术 期情况。结果 两组患者基线资料无明显统计学差异（P ＞ 0.05），且在手术时间、出血量、上下切缘、清扫淋巴结数量及 并发症方面无明显统计学差异（P ＞ 0.05）。但单孔加一孔手术联合ERAS 组较常规手术联合ERAS 组，总切口长度更短 [（6.7±1.1）cm 比（8.5±1.3）cm，P=0.000]，术后首次下床时间更早 [（22.2±5.2）h 比（27.1±7.9）h，P=0.001]，首次排便 时间更早[（70.2±19.8）h比（83.1±20.4）h，P=0.005]，术后第一天C反应蛋白值更低[（43.5±28.6）mg/L比（57.2±33.2） mg/L，P=0.038]，术后住院时间更短 [（7.0±1.7）d 比（8.1±2.1）d，P=0.010]，且术后 2~4 天疼痛评分更低（P ＜ 0.05）。 结论 经验丰富的腔镜医师采用单孔加一孔手术治疗高位直肠及乙状结肠癌并联合 ERAS 干预是安全可行的，且单孔加一孔 手术可减低操作难度，具有疼痛轻、术后恢复快等优势，值得临床推广。     

三种不同引流方式对食管癌术后颈部吻合口瘘引流效果的研究

目的:探讨三种不同引流方式对食管癌术后颈部吻合口瘘的引流效果。方法:收集从2013年1月到2016年9月在我科行食管癌手术并术后发生颈部吻合口瘘患者，比较入组患者所采用的不同颈部引流方式的优劣。结果:共有83例患者纳入研究，有34例进入A组，行纱布条引流组；28例进入B组，行造瘘袋引流组；21例进入C组，行胃管负压引流组。所有入组患者一般资料和手术资料对比无明显统计学差异（P>0.05）。观察指标对比结果显示，C组患者瘘口愈合时间较其他两组时间短［（15.90±4.18）天vs（14.60±4.41）天vs（9.65±3.80）天］，住院时间较其他两组短［（18.10±4.17）天vs（16.20±3.78）天vs（12.30±3.29）天］，换药次数较其他两组少［（37.55±8.75）天vs（14.5±3.23）天vs（10.00±2.05）天］，抗生素使用时间也较其他组明显减少［（13.10±2.49）天vs（10.85±1.84）天vs（7.20±1.74）天］。结论:颈部放置负压引流有助于食管癌术后颈部吻合口瘘愈合，值得临床推广与进一步研究。     

The prognostic relevance of histologic subtype in appendiceal adenocarcinoma

BackgroundThe aim of this population-based study was to determine the prognostic value of the histologic subtypes mucinous (MAC), non-mucinous (AC) and signet ring cell (SRCC) adenocarcinoma among patients with appendiceal cancer.Methods and materialsData from the Netherlands Cancer Registry (NCR) of patients with primary appendiceal adenocarcinomas with MAC, AC and SRCC histologic subtype, diagnosed between 2001 and 2015 were used (n = 675). To categorize patients according to the recent histopathological classification, the NCR was linked with the Dutch Pathology Registry (PALGA). Log-rank tests and Kaplan-Meier analyses were performed to estimate overall survival (OS), and the cox proportional hazards model was run to identify prognostic factors.ResultsAC was the most frequently encountered histologic subtype (50.9%), followed by MAC (35.8%) and SRCC (13.3%). In locoregional disease, histologic subtype was not a prognostic factor for OS with 5-year survival rates for patients with AC, MAC and SRCC of 60.0%, 60.5% and 69.6% respectively (p = 0.68). Metastatic disease was more common in SRCC (53.8%) than in MAC (38.8%) and AC (23.4%) (p < 0.0001). Median OS for patients with metastatic disease was 12.6, 27.7 and 18.2 months in AC, MAC and SRCC respectively (p < 0.005). MAC was associated with higher survival compared to AC (HR 0.48, 95%CI 0.34–0.69). In subanalyses, MAC was only a positive prognostic factor compared to AC in patients with peritoneal metastases (HR 0.42, 95%CI 0.28–0.62).ConclusionHistologic subtype had no prognostic relevance in locoregional or systemic metastatic disease in appendiceal adenocarcinoma. In peritoneal metastases, mucinous histologic subtype was a favorable prognostic factor, compared to non-mucinous and signet ring cell subtype.     

骨科大手术患者中医体质类型与静脉血栓栓塞症相关性研究

目的:探讨骨科大手术患者中医体质类型分布特点及其与静脉血栓栓塞症(VTE)的相关性。方法:选取220例骨科大手术患者,其中术后3个月内并发VTE患者102例为观察组,术后3个月内未发生VTE患者118例为对照组。对两组患者进行中医体质判定并分析。结果:220例骨科大手术患者中,平和质64例(29.09%),偏颇体质156例(70.91%)。骨科大手术患者最常见体质类型为气虚质、血瘀质、平和质。观察组最常见体质类型为气虚质、血瘀质,对照组最常见体质类型为平和质、气虚质。Logistic回归分析发现气虚质、血瘀质与VTE具有显著相关性(P<0.05,P<0.01)。结论:偏颇体质是骨科大手术患者的中医体质类型特征;气虚质、血瘀质是骨科大手术并发VTE患者的危险因素。     

Robotic-assisted pancreaticoduodenectomy with vascular resection. Description of the surgical technique and analysis of early outcomes

BackgroundDespite the potential benefits, the adoption of the minimally invasive surgery for the treatment of borderline resectable pancreatic cancer is still in the initial phase. We investigated the safety and feasibility of the robotic pancreaticoduodenectomy with venous resection/reconstruction (RPD SMV/PV).MethodsSince March 2013 to October 2019, a total of 73 RPD and 10 RPD SMV/PV were performed. The two groups were case-matched according to the preoperative characteristics.ResultsMean operative times and estimated blood loss were less in the RPD group in comparison to that in the RPD with SMV-PV group (525 vs 642 min, p = 0.003 and 290 vs 620 ml, p = 0.002, respectively). The mean length of hospital stay was similar in the RPD group in comparison to that in the RPD with SMV-PV group (10 days vs 13 days, p = 0.313). The two groups had similar overall postoperative morbidity rate (57.5% vs 60%, p = 0.686), although the severe complication rate was lower in the RPD group (11% vs 40%, p = 0.004).ConclusionsRPD with SMV-PV is associated with increased operative time, estimated blood loss, higher major complication rate compared with RPD.