加速康复外科理念在脊柱外科手术中的应用与展望

加速康复外科(enhanced recovery after surgery,ERAS)是近几年应用于临床的外科新理念,通过加强术前宣教、缩短禁食水时间、控制疼痛、优化麻醉方式、术中控制体温、补液量和速度等,减轻患者疼痛、生理和心理创伤应激,使患者快速康复。在整个围术期需要医生、护理人员、麻醉医师、患者及家属均参与并统筹安排,并将这种合作贯穿治疗始终。最近的研究表明ERAS理念在减轻脊柱外科围手术期应激反应有重要作用并取得可喜进展。本文简要总结国内外学者关于ERAS理念在脊柱外科手术围手术期中的新进展,加深对ERAS理念的认识和理解,从而为临床脊柱外科围手术期患者带来益处。     

加速康复外科理念在围手术期患儿中的应用进展

加速康复外科指在多学科合作基础上,采取基于循证的围手术期系列优化措施,旨在减少手术患者生理及心理的创伤应激,从而实现手术患者的加速康复。该文综述了加速康复外科理念在国内外围手术期患儿中的应用现状,包括术前护理、术中精准管理和术后护理3个方面,并指出存在的不足和未来发展方向,旨在为国内加速康复在围手术期患儿中的进一步研究奠定基础。     

急诊Ⅰ期手术和控制性手术治疗肝胆外科损伤的临床效果比较

目的比较急诊Ⅰ期手术和控制性手术治疗肝胆外科损伤的临床效果。方法以2017年5月至2018年5月我院接收的68例肝胆外科损伤患者作为研究对象,根据治疗方法的不同将其分为参照组和控制性手术组,各34例。参照组采用常规急诊Ⅰ期手术治疗,控制性手术组采用控制性手术治疗。观察两组治疗前及治疗1周后的pH值、体温、血浆凝血酶原时间(PT)、手术时间、住院时间、治疗1周后的并发症发生情况及治疗2周后的死亡率。结果治疗1周后,两组pH值、体温明显高于治疗前,PT明显短于治疗前,且控制性手术组优于参照组(P<0.05)。控制性手术组的手术时间明显短于参照组,住院时间明显长于参照组(P<0.05)。治疗1周后,控制性手术组的并发症总发生率明显低于参照组(P<0.05)。治疗2周后,控制性手术组的死亡率明显低于参照组(P<0.05)。结论相比于常规急诊Ⅰ期手术,肝胆外科损伤患者通过控制性手术治疗的临床价值显著,值得在临床上推广应用。     

Laparoscopic surgery in the elderly

Summary

Patients over the age of 65, undergoing either laparoscopic cholecystectomy or laparoscopic groin hernia repair in two centres, were retrospectively reviewed. 114 patients (median age 73) case-notes were reviewed. 94 patients had undergone laparoscopic cholecystectomy and 20 laparoscopic hernia repair. 81 % were American society of Anaesthesiologists (ASA) Grade I or II, with 17% Grade III and 2% Grade IV. 8% of the laparoscopic cholecystectomy patients had unsuspected common bile duct stones detected on cholangiography. There was a 5% conversion to open procedure in the cholecystectomy group and 0% in the hernia group. Median hospital stay was 2 days. Mortality was 0% in both groups. Major post-operative morbidity occurred in 4% of the laparoscopic cholecystectomy patients, delaying their discharge. We conclude that laparoscopic surgery is a safe procedure in the elderly patient when accompanied by good patient selection and anaesthetic care.     

Nursing the cruciate surgery patient

This article aims to give an understanding of the canine cruciate ligament and its relationship with the tibial plateau, and to provide guidance on nursing care following the repair of cranial cruciate ligament rupture.     

Endoscopic surgery in the rectum

A new transanal endoscopic operative technique permits microsurgery in the rectal cavity and the placing of surgical sutures. Compared with other procedures this one is non-aggressive, and there were not postoperative complications in twelve cases. A stereoscopic optical system, a new operating rectoscope and special surgical instruments, as well as a modification to an insufflation device are necessary for the endoscopic operation.     

Arthroscopic surgery of the ankle

Arthroscopic surgery of the ankle is one new surgical technique that has been very helpful in the treatment of selected orthopaedic problems of the ankle. The development of small arthroscopes and other surgical equipment has made the procedure more accessible. This article will review the orthopaedic conditions wherein ankle arthroscopy has utility, the advantages and disadvantages of arthroscopy, and nursing considerations for preoperative, intraoperative, and postoperative patient care.     

Parotid surgery and the otolaryngologist

Otolaryngologists are performing more parotid surgery and are using otologic landmarks and methods to identify and preserve the facial nerve. Over the past 15 years in the Department of Otolaryngology-Head and Neck Surgery at Tulane Medical School, use of the tympanomastoid fissure as a guide to the facial nerve has reduced the incidence of immediate facial paralysis from 60% to 14% in benign parotid disease.     

Laser surgery of the skin

The carbon dioxide laser, the argon laser and the pulse-dye laser are used to remove a variety of skin lesions. Advantages of laser surgery include a relatively bloodless operating field and minimal postoperative discomfort and swelling. Warts, tattoos, actinic cheilitis, skin cancer, xanthelasma, ingrown toenails, keloids and port-wine stains are among the lesions that can be removed with laser surgery. The tunable pulse-dye laser is particularly useful in the treatment of vascular lesions.     

Present and future developments of the virtual surgery and tele-virtual surgery system

One of the applications available now in the medical field is the virtual surgery system. This system allows surgeons a safe place to master surgical techniques and to plan surgical procedures before the operation. To provide the system for use in a clinical situation, a soft tissue model and a force feedback device suited for the surgery is required. In this paper, we would like to introduce our virtual surgery system, which possesses a soft tissue model that can show accurate, real-time deformation and is equipped with a force feedback device that allows the user to experience the tactile sensations. In addition, we will introduce our tele-virtual surgery simulation system for training in the procedures used in robotic surgery.     

经胸腔手术治疗胸椎结核的围手术期护理

脊柱结核占全身骨结核的首位，近年来发病率有上升的趋势。其中胸椎、腰椎椎体结核占绝大多数，约99％。由于胸椎结核病变所产生的脓液、干酪样物质、肉芽组织、坏死间盘或死骨都可压迫脊髓，造成截瘫，给患者带来极大的痛苦。经胸腔手术可在直视下同时清除脊柱两侧的病灶，同时进行植骨或内固定，增加脊柱的稳定性、消除疼痛、缓解神经压迫症状。我科自2002年1月～2006年12月共收治胸椎结核患者23例均进行经胸腔手术治疗，现将围手术期护理报道如下。[第一段]