新型冠状病毒肺炎疫情期间男科实验室生物安全

2019年12月新发现的新型冠状病毒感染的肺炎(2019冠状病毒病)疫情来势迅猛,临床发现新型冠状病毒感染者和无症状感染者均可能成为传染源。尽管经呼吸道飞沫和密切接触传播被认为是主要的传播途径,但在相对封闭的环境中存在经气溶胶传播的可能。现已发现鼻咽拭子、痰和其他下呼吸道分泌物、血液、粪便、尿液等标本中可检测出新型冠状病毒核酸,精液中是否可检出新型冠状病毒核酸尚无定论。有报道发现新型冠状病毒可能影响血管紧张素转化酶2(ACE2)高表达的睾丸,同时精液与尿液的排出有着共同通道。因此,理论上精液也有可能携带病毒。男科实验室不仅可能接触包含精液在内的以上多数的体液标本,而且男科实验室的许多操作为开放性操作,有产生气溶胶的风险。因此,在新型冠状病毒疫情期间有必要采取相应的防护措施以降低感染风险。通过参照现有的疫情认知并借鉴其他相关经验,结合男科实验室的工作特点,我们将疫情期间男科实验室工作需要注意的生物安全问题进行总结,供同行参考。     

新型冠状病毒肺炎疫情形势下原发性肝癌破裂出血的诊治策略

在新型冠状病毒肺炎(简称:新冠肺炎;WHO定名:COVID-19)疫情下,如何处理危及患者生命的原发性肝癌(简称肝癌)破裂出血是目前临床上亟需解决的问题之一。笔者认为,该病的临床处置应在筛查新冠肺炎的前提下,遵循操作流程,做好充分防护。对于疑似或确诊新冠肺炎患者,需综合考虑新冠肺炎分型、肝癌破裂出血的程度、肿瘤情况、肝功能情况等因素,慎重制定具体治疗方案,开展个体化治疗。遵从既保证患者的安全及疗效,又要降低医护人员感染风险的诊治原则。     

新型冠状病毒肺炎疫情下实施普通外科手术的思考和建议

由2019新型冠状病毒(2019-nCoV)引起的肺炎(简称新冠肺炎)目前正在我国肆虐。已经证实,新冠肺炎可以在人际间传播。根据最新的临床报道,由医院相关性传播导致的新冠肺炎并不少见,给外科医护人员和住院患者造成严重威胁。在此疫情之下,普通外科医生应掌握新冠肺炎的临床表现和流行病学特点,尤其是了解新冠肺炎可能引起的消化道和腹部症状,避免误诊漏诊。针对急诊手术和限期手术,应在积极排查和防控新冠肺炎的基础上,合理有序开展。为新冠肺炎患者实施紧急手术时,必须严格遵照当地卫生行政主管部门或所在医疗机构的相关防护规定,密切协调手术各方,所有人员均应做好二级或三级防护,手术必须在负压手术间进行。对于不具备上述医疗条件的单位,宜尽快将需要紧急手术的新冠肺炎患者转诊至有条件的医疗单位。     

新型冠状病毒肺炎疫情期间创伤骨折的诊治原则

2019年12月底,新型冠状病毒肺炎(COVID-19)从湖北省武汉市向全国各地及境外蔓延[1]。2020年1月20日,中华人民共和国国家卫生健康委员会将COVID-19列入《中华人民共和国传染病防治法》规定的乙类传染病,并按甲类传染病进行防控[2]。COVID-19传染病极强,具人传人特点,发病隐匿、传播速度快、扩散范围广,无症状者亦可传染,给防控工作带来巨大挑战。虽然在疫情期间,创伤骨科以低能量骨折为主,但在物资转运、协调疏导等工作时仍不可避免有高能量创伤骨折发生,以四肢、骨盆和脊柱骨折最为多见,严重者危及生命;因此,优化诊疗方案、及时施治较平时更为严格,也更加重要。在COVID-19和创伤骨科急症处理的双重考验下,《中华创伤骨科杂志》本期刊登了多篇新型冠状病毒肺炎与骨科的相关文章,总结了疫情期间创伤骨科的诊疗规范,并报道了几例严重骨折、尤其是1例确诊COVID-19的腰椎爆裂骨折的手术救治,收到非常好的效果。本文针对疫情防控期间开展的创伤骨科诊疗和护理工作进行点评和总结,以期达到抛砖引玉的效果。     

胃肠道间质瘤的诊治：附38例报告

摘要：笔者回顾性分析10年间收治的38例胃肠道间质瘤(GISTS)患者的临床和病理资料。38例均通过光镜观察肿瘤的形态特征和免疫组化S P法检测CD117及CD34蛋白表达而确诊，并依据Fletcher风险分级的原则判定肿瘤危险程度。术前仅3例（3/38）确诊。38例均经行手术切除，包括胃大部分切除8例，肿瘤局部切除13例，病变肠段切除9例，扩大切除8例。结果示，肿瘤多位于胃部（23/38）。分级结果：危险程度极低3例，低度危险7例，中度危险13例，高度危险15例。CD117和CD34蛋白阳性表达率分别为86.8%，73.7%，其与肿瘤危险程度无关（P>0.05）。28例随访5个月至6年，15例（全部为中、高度危险病例）发生复发和转移，复发率为53.6%。其中因复发而行2次手术者9例，4次手术者1例。 提示：（1）GISTS术前确诊率低。病理组织学及免疫组化检查是确诊GISTS的可靠方法。（2）用Fletcher分级评价GISTS恶性潜能是合理的。（3）肿瘤完整切除是最有效的治疗手段，复发病例仍需手术治疗，效果较满意。     

原发性阑尾恶性肿瘤的诊治分析：附17例报告

目的探讨原发性阑尾恶性肿瘤的临床特点、治疗方法及预后。方法回顾性分析东南大学医学院附属徐州医院1993年3月至2008年11月的17例原发性阑尾恶性肿瘤的临床和病理资料。结果所有患者无一例术前确诊,均在术中及术后病理确诊,其中黏液腺癌6例,类癌9例,恶性淋巴瘤2例。3例术中快速病理回报后行右半结肠切除术,13例患者术后3     

新型冠状病毒肺炎疫情下方舱医院护理管理实践

目的总结新型冠状病毒肺炎疫情防控中方舱医院护理管理经验,以期为突发传染性公共卫生事件的应急管理提供参考。方法某综合性三甲医院以整建制接管1所方舱医院,对方舱医院进行结构布局及防护管理、护理人员管理、患者管理、消毒管理、方舱医院文化建设、智慧方舱医院构建的运维管理。结果方舱医院累计收治患者875例,治愈出院691例,转院184例,未发生患者跌倒、意外伤害等不良事件;医护人员均未发生感染。结论加强运行制度化、护理规范化、关怀人性化等管理,能确保方舱医院患者收治、救治工作有序进行,有效遏制疫情扩散蔓延。     

新型冠状病毒肺炎疫情防控中方舱医院的护理应急综合管理

目的总结新型冠状病毒肺炎防控中方舱医院护理应急综合管理方法。方法迅速组建护理应急管理团队,实施护理应急综合管理,包括统筹管理分组实施,建章立制优化流程,设置岗位明确职责,护理安全管理(保障患者安全管理、联合协作病区安全管理、护士职业防护安全管理),患者心理应激干预及救援护士心理危机干预。结果自2020年2月5日开舱至3月9日休舱,收治患者1 848例,转院521例,出院1 327例;核酸标本采集5 020例次;无医护人员职业暴露感染。结论通过规范和因地制宜的管理策略,精准实施各项护理工作,保证了方舱医院患者集中隔离和救护工作的有序、安全、高效开展。     

新型冠状病毒肺炎疫情下的乳腺疾病诊疗策略

新型冠状病毒肺炎的疫情对乳腺疾病患者的正常医疗需求产生了巨大影响,如何在安全的前提下进行有序有效的诊疗活动,是患者和医务工作者共同关注的问题。本文通过复习文献,对乳腺疾病,特别是乳腺癌的治疗时机和治疗方法进行总结,对不同的乳腺疾病类别、不同的乳腺癌分类提出了具体的诊疗时机和诊疗方案。     

Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).MethodsAll emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study’s COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.ResultsThe total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.ConclusionsUrological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.     

Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID‐19) pandemic: Wuhan and Toronto experience

The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID‐19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.     

成都379例新型冠状病毒肺炎的临床分析

目的分析新型冠状病毒肺炎(COVID-19)患者的临床特征及预后。方法纳入成都市公共卫生临床医疗中心2020年1月16日至11月30日收治的379例COVID-19确诊病例,按照年龄分为老年组(42例,年龄≥60岁)和非老年组(337例,年龄<60岁),比较两组患者的流行病学、临床特征、实验室检查、治疗及预后。结果379例患者年龄2个月至87岁,平均41.2岁,其中男286例(75.5%),女93例。老年组平均年龄为69.5岁,女性更多见(占61.9%),大多为武汉输入和本土续发(占73.8%),以普通型和危重型为主(88.1%)。非老年组的平均年龄为37.8岁,男性更多见(80.1%),主要来自境外输入(75.7%),以轻型和普通型为主(95.0%)。179例患者(47.2%)合并一种或多种基础疾病,老年组以高血压病(15例,35.7%)及糖尿病(11例,26.2%)多见,而非老年组则以非酒精性脂肪性肝炎(132例,39.2%)多见。最常见的临床表现是发热(138例,36.4%)和咳嗽(129例,34.0%),但老年组的发热、咳嗽、呼吸困难及乏力等症状较非老年组更多见(P<0.05)。与非老年组相比,老年组的总淋巴细胞计数、CD4⁺及CD8⁺T淋巴细胞计数更低,而心肌损伤标志物及炎症指标更高(P<0.05)。139例患者(36.7%)的心脏彩色超声心动图异常,主要为左室舒张功能降低(22.7%)及心脏瓣膜反流(14.0%),且老年组患者的心脏彩色超声心动图异常率明显高于非老年组(85.7%vs.30.6%,P<0.05)。经治疗后,除老年组死亡3例外,其余均已治愈出院;但老年组的住院时间较非老年组更长(22.1 d vs.18.8 d,P=0.033)。结论成都老年COVID19患者主要来自武汉输入和本地续发,以普通型和危重型为主,常合并高血压或糖尿病等基础疾病;成都非老年COVID-19患者主要来自境外输入,以轻型和普通型为主,常合并非酒精性脂肪性肝炎;经治疗后,患者大多预后良好。     

甲状腺癌颈部淋巴结清扫术后双侧乳糜胸2例并文献复习

目的:探讨甲状腺癌颈部淋巴结清扫术后双侧乳糜胸的诊断及治疗。方法:回顾性分析2例甲状腺癌颈部淋巴结清扫术后出现的双侧乳糜胸患者的临床资料,并复习相关文献。结果:2例患者均因甲状腺乳头状癌行颈部淋巴结清扫术,术中均未发现淋巴液渗漏。均于术后第4天出现气促、呼吸困难,经胸部X线检查为双侧胸腔积液,行双侧胸腔闭式引流出乳白色乳糜液,证实为双侧乳糜胸。2例患者经禁食、奥曲肽等积极治疗后,引流量逐渐减少,复查胸部X线胸部无积液后拔除引流管。结论:双侧乳糜胸是甲状腺癌颈淋巴结清扫术后罕见的并发症,早期发现后给予积极的保守治疗是安全有效的。     

新型冠状病毒肺炎疫情下胸外科择期手术患者收治及术前管理策略

新型冠状病毒(SARS-CoV-2)肺炎(COVID-19)蔓延的严峻形势给胸外科择期手术患者的收治及管理带来了巨大的挑战。为保证患者能够及时接受手术治疗,同时又有效杜绝疫情在外科科室的发生及蔓延,科室应结合具体情况从多个方面梳理相关内容。重新制订疫情期间择期手术患者入院收治流程、患者及家属COVID-19排查流程,完善疫情期间陪伴管理制度及疑似患者管理制度。对于拟开展择期手术的患者需医护合作严格排查COVID-19后方可安排手术。本文总结了我院胸外科疫情期间择期手术患者收治及管理策略。     

肿瘤误诊为颈腰腿痛疾病6例分析

颈腰腿痛是骨伤科的常见病和多发病,也正因为如此,在临床工作中,往往在惯性思维的影响下,将大部分的颈腰腿痛都归结为颈椎病、腰椎间盘突出、腰肌劳损等病名,而忽视了对每例患者疾病特点的分析,忽视了必要的鉴别诊断,导致误诊。     

Necrotizing fasciitis in the head and neck region: a case report

Necrotizing fasciitis is a potentially lethal disease. It starts as an infection of muscle fascia and soft tissue. The head and neck region is rarely involved. Spreading of the disease is very rapid and can lead to serious complications. This paper reports a patient with necrotizing fasciitis of the right upper eyelid which required debridement and intensive care admission.     

Status and strategies for the management of head and neck cancer during COVID‐19 pandemic: Indian scenario

In India, oral cancer is the most common head and neck cancer (HNC) in men, mainly caused by the consumption of smoked and smokeless tobacco. During the current pandemic, delaying surgery for even 1 or 2 months may lead to more extensive surgery or inoperability, where only supportive care can be provided. Being semi‐emergent in nature, treatment for these patients is currently on hold or delayed in most centers across the country. This study was conducted to assess the impact of COVID‐19 pandemic and inability of the health system to treat HNC in a timely fashion and how surgeons are coping to this emergent situation. This article highlights the situation in India, a country burdened with one of the highest incidence rates of HNC.