巡回医疗对农村艾滋病患者的护理干预

对1例老年慢性淋巴细胞甲状腺炎（桥本病）并发晚期甲状腺癌（癌肿侵及气管）患者行手术治疗。经周密细致的护理，患者临床康复出院。提出术前做好心理护理、气道护理，术后做好气管切开护理、并发症的观察是手术成功的保证。     

桥本病并发甲状腺癌11例诊治体会

目的探讨桥本病并发甲状腺癌的诊断及手术方法。方法回顾1982年1月至2003年12月109例桥本病中同时并存甲状腺癌11例的病例资料,对其术前检查、诊断及治疗进行分析研究。结果桥本病与甲状腺癌并发率为10%(11/109),甲状腺癌术前确诊率46%(7/15);均经手术治疗。局部复发2例、转移2例、经再次手术均存活。5、10年生存率分别为63%(7/11)和57%(4/7),3例死于远处转移。术后甲状腺机能减退3例,一侧声带麻痹1例,低钙抽搐2例。结论桥本病并发甲状腺癌术前确诊率低,病史、细针针吸活检、CT等综合分析有利于术前诊断,手术是其最有效的治疗方法。     

老年心脏粘液瘤患者围术期护理

对27例老年心脏粘液瘤患者在全麻低温体外循环下行粘液瘤摘除术，结果患者住院8～20d痊愈出院，无术后并发症。提出积极术前准备，做好心理护理及术前宣教；术后注意观察神志，加强循环、呼吸系统管理，保持水、电解质、酸碱平衡，调控血压及预防栓塞是保证手术效果的主要措施。     

老年胃癌患者围手术期护理探讨

胃癌是我国最常见的消化道恶性肿瘤,占全部肿瘤首位。外科手术治疗是治疗胃癌的主要手段。围手术期护理对确保手术成功起着关键的作用。老年患者常合并多种慢性疾病且机体抵抗力和免疫功能减低,往往导致严重的合并症。所以,围手术期护理对老年患者显得尤为重要。现总结我院对68例老年胃癌患者围手术期护理体会。 1 临床资料 我院肿瘤外科于1997年10月～2002年6月共收治老年胃癌患者68例,其中男性59例,女性9例,最小年龄57岁,最大年龄89岁,平均73.5岁。51例患者出现临床症状:食欲减     

老年心脏粘液瘤患者围术期护理

对27例老年心脏粘液瘤患者在全麻低温体外循环下行粘液瘤摘除术,结果患者住院8～20 d痊愈出院,无术后并发症.提出积极术前准备,做好心理护理及术前宣教;术后注意观察神志,加强循环、呼吸系统管理,保持水、电解质、酸碱平衡,调控血压及预防栓塞是保证手术效果的主要措施.     

老年胆石病的围手术期护理

老年胆石病成为影响老年健康的突出问题之一，胆石病随着年龄的增加，胆囊外并发症增加，手术危险性增高。我院自１９９０～２０００年完成老年胆石病２４７例，其中胆囊结石１８５例，占７４．９％；胆管结石１５例，占６．０７％；胆囊胆管均有结石４７例，占１９．０３％。通过实践与探索，我们总结老年胆石病围手术期的护理方法，现介绍如下。临床资料本组２４７例老年胆石病患者，手术方式分别采取腹腔镜胆囊切除术（１４２例）、开腹胆囊切除术（４３例）、胆囊切除术＋胆总管切开引流术（３２例）、经乳头括约肌切开取石术（８例）、…     

老年胆石症患者的围手术期护理

老年患者患胆石症行手术治疗时，手术风险增大，术后并发症发病率增加。我科从2001年2月～2004年5月共收治458例老年胆石症患者，通过加强对患者围手术期的护理，均取得了较满意的效果，报告如下。     

腔镜甲状腺切除患者围术期护理

目的 探讨腔镜下甲状腺手术围术期的护理要点和方法。方法 选择28例经乳晕入路腔镜甲状腺切除术患者，进行围术期的质量跟踪，对可能发生的并发症进行分析和有针对性地处理。结果 28例患者均治愈出院，患者无严重并发症，术后住院时间平均4．6d。结论 腔镜甲状腺切除术围术期的护理要点主要有心理护理、相关健康知识宣教、积极的术前准备及对术后并发症的观察和护理，上述措施是安全实施腔镜甲状腺切除手术的重要保证。     

重症高龄高危食管癌患者围手术期护理

1986年1月至1997年12月，我科收治重症高龄高危食管癌患者139例，由于加强围手术期的护理，取得了良好的效果，总结如下。1！院床资料1．1诊断标准①重症：食管癌纵轴长度＞10cm者（根据X线造影和术中测量判定）；②高龄：年龄＞70岁者；③高危：术前重度呼吸功能不全，最大通气量（MVV）＜50％者［‘］1．2一般资料本组139例患者符合上述诊断标准2项和2项以上，男110例，女29例，年龄70～82岁。食管癌86例，贲门癌53例。术前有吸烟史者85例，最长50年。食管癌合并慢性支气管炎55例，贲门癌合并慢性支气管炎25例，其中35例有不同程度的肺…     

1例甲状旁腺癌患者的围术期护理

对1例甲状旁腺癌患者做好术前心理护理；加强血钙监测，防止术前高钙危象和术后低钙抽搐；针对血钙水平做好饮食指导；术后密切观察有无出血、皮下血肿、喉返神经损伤，并预防骨折，患者顺利接受手术，术后血钙恢复正常。     

Coexisting Chronic Lymphocytic Thyroiditis and Papillary Thyroid Cancer Revisited

The effect of chronic lymphocytic thyroiditis (CLT) on the behavior of papillary thyroid cancer (PTC) remains unclear. In recent studies the presence of CLT in patients with PTC was reported to be associated with a lower recurrence rate and an improved survival rate. Furthermore, patients with PTC and tumor infiltrating lymphocytes (TILs) have been reported to have lower recurrence rates and a lower frequency of distant metastases. Because of these and other observations, a tumor immune response in PTC has been suggested. The aim of our study was to determine: (1) the relative frequency of CLT in PTC; (2) the prognostic significance of CLT in patients with PTC; and (3) if TIL occurs independently or in association with CLT. A 10-year retrospective study of patients who underwent initial thyroidectomy for PTC from 1986 to 1996 was completed. The extent of thyroid lymphocytic infiltration was determined within the tumor, surrounding the tumor, and in the distant parenchyma by two independent observers blinded to the clinical data. Dense focal/diffuse lymphoid aggregates throughout the thyroid gland were diagnostic of CLT and when present within or surrounding the tumor were designated TILs. A total of 136 patients with PTC (typical and follicular variant of PTC histologic subtypes) were identified with a mean follow-up of 4.4 years and a 8% mortality rate at 10 years. Thirty percent of the patients with PTC had coexisting CLT, and 65% of these patients with CLT had positive anti-thyroglobulin antibodies. Patients with coexisting CLT and PTC were younger (p < 0.05), more likely to be female (p < 0.05), and more likely to have multicentric tumors (p < 0.001) compared to patients without CLT. Only 5% of patients had TILs without CLT, but 82.5% of patients with CLT had TILs identified (p < 0.0001). By univariate analysis CLT, age, gender, stage of PTC, tumor multicentricity, and tumor size were significant prognostic factors. Only age and TNM stage of PTC remained independent prognostic factors by multivariate analysis. We found a similar frequency (30%) of coexisting CLT and PTC as reported by others; but, more importantly, the presence of TILs primarily occurred in association with CLT. The presence of CLT in patients with PTC correlated with an improved prognosis. It was not an independent prognostic factor, however, and was not associated with a lower recurrence rate or a lower frequency of distant metastasis.     

The Association Between Chronic Lymphocytic Thyroiditis and the Progress of Papillary Thyroid Cancer

Background

Whether chronic lymphocytic thyroiditis (CLT) influences the risk of development and the progression of papillary thyroid cancer (PTC) remains uncertain. We investigated the effects of CLT on the clinicopathologic features and prognosis of PTC.

Methods

Two thousand nine hundred twenty-eight consecutive patients with PTC treated between 2009 and 2017 were divided into two groups: one with chronic lymphocytic thyroiditis and one without; 1174 (40%) of the patients had coincident CLT.

Results

In univariate analysis, CLT correlated positively with small tumor size, frequent extrathyroidal extension, multifocal diseases, and p53 but negatively with central lymph node (LN) metastasis and BRAF mutation. In multivariate analysis, CLT was associated with extrathyroidal extension and multifocal disease; however, it was not a prognostic factor for recurrence even though it was associated with two aggressive factors. Compared with patients with PTC alone, there were more retrieved central LNs in the PTC + CLT group, and these patients also underwent more invasive diagnostic tests such as fine needle aspiration cytology and frozen biopsy of LN.

Conclusions

The CLT patients with PTC had better behavior features and prognoses than did those with PTC alone despite frequent multifocality and extrathyroidal extension. However, precaution may be necessary to avoid performing invasive diagnostic procedures for lateral LN metastasis and to manage the patients appropriately.

     

1例高龄淋巴瘤致高血钙危象病人的护理

对1例高龄淋巴瘤致高血钙危象病人进行抢救护理,结果病人转危为安。提示需警惕淋巴瘤所致骨破坏、骨溶解并发高血钙;严密生命体征及有关实验室检测指标的监测、适当的治疗及精心护理是抢救成功的关键。     

老年肝癌并存慢性疾病患者肝切除术的围术期护理

目的 总结老年肝癌并存慢性疾病患者肝切除术的围术期护理经验.方法 对126例老年肝癌并存慢性疾病患者实施肝切除术.术前做好机体功能评估,积极治疗并存疾病,加强功能锻炼,以期达到手术的要求;术后加强监护、并发症的护理及基础护理.结果 全组无围术期死亡.术后发生胸腔积液、膈下积液10例,肺部感染4例,腹腔出血3例,胆漏2例,经及时处理均治愈;患者平均住院16.7 d.结论 老年肝癌并存慢性疾病患者行肝切除手术治疗,配合精心护理,可使患者顺利渡过围手术期,有利于术后顺利康复.     

系统干预对老年痴呆患者激越行为的影响

目的 探讨脑膜瘤并存糖尿病患者围术期的护理措施。方法 对9例并存糖尿病的脑膜瘤患者进行心理护理，健康指导，加强术前、术后血糖监测，密切观察病情．保持呼吸道和创腔引流管的通畅，饮食管理。结果 患者术前、术后的血糖控制良好，均按预期目标康复出院。结论 心理护理和健康教育是患者康复的重要措施。严格监测血糖至关重要。     

脑膜瘤并存糖尿病患者围术期护理

目的探讨脑膜瘤并存糖尿病患者围术期的护理措施.方法对9例并存糖尿病的脑膜瘤患者进行心理护理,健康指导,加强术前、术后血糖监测,密切观察病情,保持呼吸道和创腔引流管的通畅,饮食管理.结果患者术前、术后的血糖控制良好,均按预期目标康复出院.结论心理护理和健康教育是患者康复的重要措施,严格监测血糖至关重要.     

1例甲状旁腺癌患者的围术期护理

对1例甲状旁腺癌患者做好术前心理护理;加强血钙监测,防止术前高钙危象和术后低钙抽搐;针对血钙水平做好饮食指导;术后密切观察有无出血、皮下血肿、喉返神经损伤,并预防骨折,患者顺利接受手术,术后血钙恢复正常.     

1例高龄念珠菌性食管炎患者的护理

介绍1例高龄患者因慢性喘息性气管炎住院治疗期间并发念珠菌性食管炎的护理经验,提出对有长期应用抗生素、服用抑制胃酸药物史的患者应密切观察病情,警惕念珠菌性食管炎的发生.做好服药指导、营养护理及心理护理是其护理重点.