改良Devine治疗小儿隐匿性阴茎158例分析

目的总结改良Devine治疗小儿隐匿性阴茎的效果。方法对158例小儿隐匿性阴茎患者采用改良Devine术式治疗,阴茎皮肤完全脱套后,切除发育异常的纤维肉膜组织,阴茎根部皮肤固定成角。结果 158例患儿术后阴茎均显露良好。随访105例,随访2~38个月,105例患儿阴茎均发育正常,效果满意。结论改良Devine术式是治疗小儿隐匿性阴茎的理想术式。该术式操作简单,术后恢复快,并发症少,治疗效果满意。     

Concomitant ablation of atrial fibrillation in rheumatic mitral valve surgery

Objective

Efficacy of atrial fibrillation ablation in rheumatic mitral valve disease has been regarded inferior to that in nonrheumatic diseases. This study aimed to evaluate net clinical benefits by the addition of concomitant atrial fibrillation ablation in rheumatic mitral valve surgery.

围手术期外科之家模式在肝移植中的应用

围手术期外科之家（PSH）是一种以病人为中心的创新性围手术期管理模式，强调以医生为主导、以多学科团队为基础，基于循证医学证据，协调医疗资源，促进病人接受不同专业处理时平稳过渡，围手术期始终获得正确的处理方案，尤其适合存在器官功能障碍的外科病人。肝移植病人大多病情危重，手术复杂，围手术期管理困难。将PSH引入肝移植，可以为这类高手术风险的特殊病人群体提供一种全新的围手术期管理方式。     

达芬奇机器人与传统腹腔镜在治疗小儿先天性胆总管囊肿的对比研究

目的对比达芬奇机器人与传统腹腔镜在治疗小儿先天性胆总管囊肿的优劣势。方法回顾性收集2018年3月至2019年9月郑州大学第一附属医院诊断为胆总管囊肿的103例患儿的临床资料,其中行达芬奇机器人手术的21例患儿作为机器人组,行传统腹腔镜治疗的82例患儿为腹腔镜组,所有手术均由同一团队完成。其中,机器人组患儿的年龄为(3.85±0.79)岁,范围为1~11岁;Todani分型为胆总管囊性扩张型(Ⅰ型)17例,其他分型4例;囊肿最大径为(36.76±10.13)mm,范围为16~79 mm。腹腔镜组患儿的年龄为(3.71±0.67)岁,范围为3个月至12岁;Todani分型为Ⅰ型70例,其他分型12例;囊肿最大径为(35.98±8.25)mm,范围为10~82 mm。分析两组在一般资料及术前情况、术中及术后等方面的差异。结果①机器人组与腹腔镜组患儿在年龄、性别、体重、临床表现、Todani分型、囊肿最大径、术前C反应蛋白(C-reactive protein,CRP)值、术后并发症发生率、术后疼痛评分方面差异无统计学意义(P>0.05);②机器人组的术中失血量、术后第一天及第三天腹腔引流液量、术后CRP值、术后禁食时间、术后出院时间均小于腹腔镜组,差异具有统计学意义(P<0.05)。结论达芬奇机器人在治疗小儿先天性胆总管囊肿方面较传统腹腔镜具有术中出血量少、组织损伤小、恢复快、愈合好等优点,具有可行性、安全性、有效性等优点。不足之处为手术总时间较长、费用较高。随着技术的进步及手术医生经验的积累,机器人治疗小儿先天性胆总管囊肿将会发挥更大的优势。     

Initiatives to reduce postoperative surgical site infections of the head and neck cancer surgery with a special emphasis on developing countries

Introduction: Surgery in patients with head and neck cancers is frequently complicated by multiple stages of procedure that includes significant surgical removal of all or part of an organ with cancer, tissue reconstruction, and extensive neck dissection. Postoperative wound infections, termed ‘surgical site infections’ (SSIs) are a significant impediment to head-and-neck cancer surgery and recovery, and need to be addressed.

Areas covered: Approximately 10–45% of patients undergoing head-and-neck cancers surgery develop SSIs. SSIs can lead to delayed wound healing, increased morbidity and mortality as well as costs. Consequently, SSIs need to be avoided where possible, as even the surgery itself impacts on patients’ subsequent activities and their quality of life, which is exacerbated by SSIs. Several risk factors for SSIs need to be considered to reduce future rates, and care is also needed in the selection and duration of antibiotic prophylaxis.

Expert commentary: Head and neck surgeons should give personalized care especially to patients at high risk of SSIs. Such patients include those who have had chemoradiotherapy and need reconstructive surgery, and patients from lower and middle-income countries and from poorer communities in high income countries, who often have high levels of co-morbidity because of resource constraints.     

Percutaneous radiofrequency ablation versus open surgical resection for spinal osteoid osteoma

BACKGROUND CONTEXT

Both open surgical resection (OSR) and radiofrequency ablation (RFA) have been reported for spinal osteoid osteoma (OO).