应用腹腔镜技术治疗阑尾残端瘘5例分析

正阑尾残端瘘是阑尾切除术后严重的并发症之一,其发生率在0.7%～3.7%~([1]),一旦发生,往往不能自愈,治疗周期长,给病人带来严重的身心损害和经济负担。研究认为,70%～80%的病人能够通过冲洗引流、肠内肠外营养支持、内镜下阑尾残端夹闭等方法治愈,但仍有近20%的病人在接受3～6个月的保守治疗仍无法治愈,须接受二次手术~([2])。笔者医院将腹腔镜技术应用于阑尾残端瘘病人的再次手术中。现报告如下。     

The side effects and mother or child related physical harm from massage during pregnancy and the postpartum period: An observational study

IntroductionWomen commonly use massage therapy during pregnancy for pregnancy-related health conditions such as lower back and neck pain; however, there is little to no research related evidence on the side effects or mother or child physical harm of massage during pregnancy and the postnatal period.ObjectivesThis study aims to report on the side effects and mother or child physical harm of massage during pregnancy and the postnatal period.DesignAn observational study methodology.Setting and time frameTwo massage clinics, one in Sydney and one in Melbourne recruited participants from December 2016 to December 2017.InterventionMassage.Main outcome measureSide effects and mother or child physical harm from massage.ResultsOne hundred and one participants were recruited to the study. Two fifths of the participants (n = 32, 40%) experienced one of more post-massage side effects. There were no mother or child physical harm events. Low back pain was the most common condition women sought massage treatment for 34 (33.7.%). A significant benefit (p < 0.001) was seen pre-massage to post-massage and pre-massage to 1-week post massage in decreasing stress, decreasing pain, increasing range of motion and improving sleepDiscussionSimilar to previous research, low back pain was the most common condition that women sought massage treatment for followed by hip pain, shoulder pain, neck pain and to improve mental health. Ninety-seven percent of the cohort received a full body massage including the feet leading credence that ‘massage on the feet during pregnancy is harmful’ is mythic in nature.ConclusionWhile our findings lead credence that massage on the feet during pregnancy is a myth the study was not powered to determine the safety of pregnancy massage and further research is needed. Massage was commonly sought for low back pain with promising benefits in decreased pain and improved range of movement and further research on the effectiveness of massage for low back pain in pregnancy.     

Lung protective ventilation during pulmonary resection in children: a prospective,single-centre,randomised controlled trial

Background

Perioperative ventilatory strategies for lung protection in children are underexplored. This study evaluated the effects of lung protective ventilation (LPV) on postoperative clinical outcomes in children requiring one-lung ventilation (OLV) for pulmonary resection.

Surgical outcomes of gastrectomy with D1 lymph node dissection performed for patients with unfavorable clinical conditions

BackgroundGastric cancer (GC) patients with advanced age and/or multiple morbidities have limited expected survival and may not benefit from extended lymph node resection. The aim of this study was to evaluate the surgical outcomes of these GC patients who underwent gastrectomy with D1 dissection.MethodsWe retrospectively reviewed all GC patients who underwent gastrectomy with curative intent from 2009 to 2017. The decision to perform D1 was based on preoperative multidisciplinary meeting, and/or intraoperative clinical judgment.ResultsAmong 460 enrolled patients, 73 (15.9%) underwent D1 lymphadenectomy and 387 (84.1%) D2 lymphadenectomy. Male gender, older age, American Society of Anesthesiologists score (ASA) III/IV, higher neutrophil-to-lymphocyte ratio (NLR) and higher Charlson Comorbidity Index (CCI) were more common in the D1 group. Postoperative major complications were significantly higher in D1 group (24.7% vs 12.4%, p < 0.001) and mostly related to clinical complications. Locoregional recurrence was higher in the D1 group (53.8% vs 39.5%, p = 0.330) however, without statistical significance. No difference was found in disease-free survival (DFS) between D1 and D2 patients with positive lymph nodes (p = 0.192), whereas overall survival was longer in the D2 group (p < 0.001). Multivariate analysis showed a statistically significant impact on survival of age ≥70 years, CCI ≥5, total gastrectomy, D1 lymphadenectomy and advanced stages (III/IV).ConclusionsFrail patients had high surgical mortality even when submitted to D1 dissection. DFS was comparable to D2. Extent of lymphadenectomy in high-risk patients should take in account the expectation of a decrease in surgical risk with the possibility of impairment of long-term survival.     

Preoperative Sleep Questionnaires Identify Medical Emergency Team Activation in Older Adults

Patients with obstructive sleep apnea (OSA) have increased postoperative complications that are important for patient safety and healthcare utilization. Questionnaires help identify patients at risk for OSA; however, among older adults who preoperatively self-administered OSA questionnaires, the frequency of postoperative Medical Emergency Team Activation (META), rapid response, code blue, code stroke, is unknown.ObjectivesIdentify whether having OSA questionnaires completed by patients is feasible in the preoperative clinic. Determine the frequency of META among older patients at risk for OSA.Design and interventionCohort of prospective patients independently completed 2 OSA questionnaires in a preoperative clinic, STOP-Bang (SB) and ISNORED (IS). Observers blinded to questionnaire responses recorded incidence of META.setting and participantsOf the 898 consecutive patients approached in the preoperative assessment clinic and surgical navigation center, 575 (64%) consented and completed the questionnaires in <5 minutes and were included in the analysis.MeasuresSleep questionnaire responses and frequency of inpatient postoperative META.ResultsWith an affirmative response to ≥3 questions on either questionnaire, 65% of patients enrolled were at risk for OSA. Of these, 3.1% sustained an META. In patients at risk for OSA, META occurred in 7.6% (SB+) and 7.2% (IS+) vs 2.5% (SB+) and 1.7% (IS+) for low risk. METAs were disproportionately higher among patients aged ≥65 years (6.3% vs 1.7%; P < .018), American Society of Anesthesiologists (ASA) physical status class ≥3, and IS+. All patients with META positively answered ≥3 of 15 components of the 2 questionnaires.Conclusions/ImplicationsPreoperative, self-administration of SB and IS questionnaires is feasible. Overall, 65% of those with affirmative responses to ≥3 questions were at risk for OSA and associated with a disproportionate number of postoperative META in older patients. Additionally, risk of OSA identified by preoperative sleep questionnaires was associated with postoperative META among older adults. Use of clinical tools and OSA questionnaires may improve preoperative identification of META in this population.     

辨证论治联合西药治疗IgA肾病的临床研究

目的研究辨证分型联合西药治疗免疫球蛋白a(Ig A)肾病的临床效果。方法选取收治的74例Ig A肾病患者,采用均衡分组法分为西药组和联合组,各37例。西药组采用氯沙坦钾片治疗,联合组辅以辨证分型治疗,治疗6个月后开展随访观察疗效。结果联合组治疗总有效率94.59%高于西药组的64.86%,联合组并发症发生率2.70%低于西药组的21.62%,联合组不良反应发生率2.70%低于西药组的24.32%,对比差异有统计学意义(P<0.05)。治疗后,联合组血肌酐高于西药组和治疗前,尿红细胞、尿蛋白指标低于西药组和治疗前,对比有统计学意义(P<0.05)。结论辨证分型联合西药治疗Ig A肾病的临床效果显著,可降低并发症及不良反应发生风险,改善其血液指标,具有较高临床推广价值。     

微创穿刺抽吸术与开颅手术治疗脑出血的疗效

目的探讨微创穿刺抽吸术与开颅手术治疗脑出血的疗效。方法选择2017年1月-2018年1月治疗的脑出血患者80例作为对象,根据住院时间先后顺序随机数字表分为对照组(n=40)和观察组(n=40)。观察组给予患者微创穿刺抽吸术治疗,对照组给予患者开颅手术治疗,比较两组患者术后总治愈效率和手术开展时间、住院天数。结果观察组手术开展时间、住院天数短于对照组(P<0.05);观察组的总治愈效率为90%高于对照组75%(P<0.05);观察组患者术后意识恢复时间短于对照组(P<0.05)观察组患者术后肢体障碍及肺部感染、伤口感染发生率均略低于对照组,但差异不具有统计学意义(P>0.05)。结论微创穿刺抽吸术在脑出血临床治疗中比开颅手术总治愈率高、安全性高、恢复快。     

至阳八阵穴隔附子饼灸治疗糖尿病胃轻瘫临床研究

目的观察至阳八阵穴隔附子饼灸治疗脾胃气虚型糖尿病胃轻瘫的疗效及对胃泌素(GAS)、胃动素(MTL)和血管活性肠肽(VIP)水平的影响。方法86例脾胃气虚型糖尿病胃轻瘫患者随机分为对照组和治疗组,每组43例。治疗组给予至阳八阵穴隔附子饼灸;对照组口服枸橼酸莫沙必利片。治疗12周后观察胃轻瘫主要症状指数量表症状积分改善情况、胃排空率及血清GAS、MTL、VIP水平。结果治疗组治疗后在胃轻瘫主要症状指数量表症状积分及胃排空率方面明显高于对照组,差异均有统计学意义(P<0.05)。治疗组治疗后血清GAS、MTL水平明显高于对照组,血清VIP水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗组总有效率为90.7%,明显高于对照组的72.1%(P<0.05)。结论采用至阳八阵穴隔附子饼灸能快速促进糖尿病胃轻瘫患者胃功能的恢复,改善症状和体征,其作用机制可能与升高患者血清GAS和MTL水平,降低VIP水平有关。     

综合护理干预对肺癌胸腔镜术后患者的影响

目的探讨对肺癌胸腔镜术后患者行综合护理干预对于并发症以及生存质量的临床影响。方法抽取到本院接受治疗的132例肺癌胸腔镜术后患者,研究时间为2017年1月—2018年12月,将其按照双盲法分成综合组和对照组,分别为66例患者。综合组行综合护理措施,对照组行常规护理措施,观察两组患者的临床资料,并且比较两组患者的并发症以及生存质量。结果综合组患者接受护理后并发症发生率3例(4.55%),明显低于对照组11例(16.67%),综合组生存质量评分均高于对照组,P<0.05。结论对肺癌胸腔镜术后患者行综合护理干预,降低并发症的发几率,提高了生存质量。