Image‐guided video assisted thoracoscopic surgery (iVATS) ‐ phase I‐II clinical trial

Purpose

To facilitate localization and resection of small lung nodules, we developed a prospective clinical trial ( ClinicalTrials.gov number NCT01847209) for a novel surgical approach which combines placement of fiducials using intra‐operative C‐arm computed tomography (CT) guidance with standard thoracoscopic resection technique using image‐guided video‐assisted thoracoscopic surgery (iVATS).

Methods

Pretrial training was performed in a porcine model using C‐arm CT and needle guidance software. Methodology and workflow for iVATS was developed, and a multi‐modality team was trained. A prospective phase I‐II clinical trial was initiated with the goal of recruiting eligible patients with small peripheral pulmonary nodules. Intra‐operative C‐arm CT scan was utilized for guidance of percutaneous marking with two T‐bars (Kimberly‐Clark, Roswell, GA) followed by VATS resection of the tumor.

Results

Twenty‐five patients were enrolled; 23 underwent iVATS, one withdrew, and one lesion resolved. Size of lesions were: 0.6–1.8 cm, mean = 1.3 ± 0.38 cm.. All 23 patients underwent complete resection of their lesions. CT imaging of the resected specimens confirmed the removal of the T‐bars and the nodule. Average and total procedure radiation dose was in the acceptable low range (median = 1501 μGy*m², range 665–16,326). There were no deaths, and all patients were discharged from the hospital (median length of stay = 4 days, range 2–12). Three patients had postoperative complications: one prolonged air‐leak, one pneumonia, and one ileus.

Conclusions

A successful and safe step‐wise process has been established for iVATS, combining intra‐operative C‐arm CT scanning and thoracoscopic surgery in a hybrid operating room. J. Surg. Oncol. 2015 111:18–25. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.     

手术室量化评估干预策略对胃肠道肿瘤手术患者应激反应及术后康复的影响

目的探讨手术室量化评估干预策略对胃肠道肿瘤手术患者应激反应和术后康复的影响。方法选择200例行胃肠道肿瘤手术患者,采用随机数字表法分为观察组100例和对照组100例。对照组患者接受常规干预,观察组患者接受手术室量化评估干预。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估两组患者的心理应激状态,并比较两组患者手术前后的心理应激状态评分及躯体应激反应指标[血清内皮素(ET)、一氧化氮(NO)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平、手术时间、术后康复效果及护理满意度。结果术后,观察组患者的SAS、SDS评分及ET、NO、CRP、IL-6水平均低于对照组(P﹤0.05);手术时间及术后首次排气时间、首次排便时间、首次下床时间、总住院时间均明显短于对照组(P﹤0.01);观察组患者及医师对手术室护理工作的满意度均明显高于对照组(P﹤0.01)。结论与常规干预比较,对胃肠道肿瘤患者实施手术室量化评估干预,可改善护理质量,减轻患者的心理应激状态和躯体应激反应,有利于患者术后康复,值得临床推广。     

手术室定量化护理对子宫内膜癌根治术患者康复及应激的影响

目的探讨手术室定量化护理子宫内膜癌根治术患者康复及应激的影响。方法选取2018年3月至2020年1月间复旦大学附属妇产科医院收治的78例行子宫内膜癌根治术患者,采用随机数表法分为观察组(38例)和对照组(40例)。对照组患者采用手术室常规护理,观察组患者在对照组基础上采用手术室定量化护理,比较两组患者心理应激状态、术后康复效果和护理满意度。结果术后,两组患者焦虑和抑郁评分均低于术前,且观察组均低于对照组,差异均有统计学意义(均P <0.05)。观察组患者术后首次排气时间、首次排便时间、首次下床时间及总住院时间均较对照组短,差异均有统计学意义(均P <0.05)。观察组患者手术室定量化护理总满意度为94.7%,高于对照组的75.0%,差异有统计学意义(P <0.05)。结论手术室定量化护理可改善子宫内膜癌根治术患者心理应激,促进患者术后康复,患者护理满意度较高。     

Laparoscopic Partial Nephrectomy After Selective Embolization and Robot-Assisted Partial Nephrectomy: A Comparison of Short-Term Oncological and Functional Outcomes

Background

Partial nephrectomy (PN) is the standard treatment for localized renal tumors. Laparoscopic PN (LPN) after selective embolization of tumor (LPNE) in a hybrid operating room has been developed to make LPN easier and safer. The aim of this study was to compare outcomes of LPNE and robot-assisted PN (RAPN).

责任制分组管理在胸腔镜下肺癌根治术患者中的应用效果

目的探讨责任制分组管理在胸腔镜下肺癌根治术患者中的应用效果。方法依据管理方法的不同将96例胸腔镜下肺癌根治术患者分为观察组和对照组,每组48例,对照组患者接受常规管理模式,观察组患者接受责任制分组管理模式。比较两组的护理技能、术前1天和术后1天患者的心理状态及护理满意度。结果观察组病历书写、物品管理、消毒隔离、健康宣教、专业技能和基础护理评分均明显高于对照组(P﹤0.05)。术后1天,两组患者的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较本组术前1天降低,且观察组患者的SAS、SDS评分均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的护理满意度为93.75%(45/48),高于对照组的72.92%(35/48),差异有统计学意义(P﹤0.05)。结论对于胸腔镜下肺癌根治术患者,责任制分组管理模式相较于传统管理模式能够提高护理技能,减轻患者应激反应,提高患者护理满意度,值得临床推广应用。     

手术室细节护理在肾癌后腹腔镜根治性肾切除术安全管理中的应用

目的探讨手术室细节护理在肾癌后腹腔镜根治性肾切除术安全管理中的应用效果。方法选取2017年1月至2019年12月间驻马店市中心医院收治的行经腹腔镜根治性肾切除术治疗的96例肾癌患者,根据采用的护理方法不同进行分组,其中,采用手术室常规护理的48例患者纳入对照组,采用手术室细节护理的48例患者纳入观察组。比较两组患者护理质量及安全、护理满意度、患者术后疼痛感受及术后恢复状况。结果观察组患者消毒麻醉、器械准备、设备管理、医护配合以及护理安全评分均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者护理态度、责任、适感以及护患关系评分均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者术后24h、48h疼痛评分均低于对照组,差异均有统计学意义(均P<0.05)。术后72h时,两组患者疼痛评分比较,差异无统计学意义(P>0.05)。观察组患者尿道管拔除、引流管拔除、下床活动和住院时间均短于对照组,差异均有统计学意义(均P<0.05)。结论在肾癌后腹腔镜根治性肾切除术安全管理中,手术室细节护理应用效果较好,可有效提高手术室护理质量及安全,提升患者护理满意度,改善护患关系,且有利于患者术后恢复,具有临床应用价值。     

手术室应急小组对肝癌破裂出血术后患者生理状况及生活质量的影响

目的 探讨手术室应急小组对肝癌破裂出血术后患者生理状况及生活质量的影响.方法 选取2017年1月至2019年11月间上海市闵行区中心医院收治的75例肝癌破裂出血患者,采用随机数字表法分为观察组(40例)和对照组(35例).两组患者均行正常手术治疗,观察组患者成立手术室应急小组进行围术期护理,比较两组患者术后生理状况、生...     

充气式保温毯对腹腔镜胃癌根治术患者术中体温及围术期预后的影响

目的:探讨充气式保温毯对腹腔镜胃癌根治术患者术中体温、低体温发生率、麻醉苏醒期气管插管拔管时间、并发症发生率以及住院时间的影响。方法:采取横断面整群抽样的方法选取西安市某三甲医院手术室行腹腔镜胃癌根治术的患者98例,根据随机数字表法将试验对象分为试验组与对照组,每组49例。比较两组患者术中体温、低体温发生率、麻醉苏醒期气管插管拔管时间、并发症发生率以及住院时间。结果:试验组患者术中体温、低体温发生率、麻醉苏醒期气管插管拔管时间、并发症发生率以及住院时间均优于对照组,两组间有统计学差异（P＜0.05）。结论:充气式保温毯可减轻腹腔镜胃癌根治术患者术中体温降低、降低低体温发生率、缩短麻醉苏醒期气管插管拔管时间、减少并发症发生率以及缩短住院时间,为保障患者围术期安全及预后提供参考依据。     

复合手术室在脑脊髓血管病与富血供肿瘤治疗中的应用

目的:分析复合手术室在脑脊髓血管类疾病及富血供肿瘤治疗中应用情况及价值体现。方法:运用回顾性分析方式对2018年3月至2019年4月在郑州大学附属第一医院收治的193例病人进行分析,男性病人为101例,女性为92例,平均年龄为49.69岁;对复合手术的死亡率、致残率、感染率、住院时间及住院费用实施数据分析。结果:复合手术闭塞率、死亡率、致残率与传统肿瘤手术比较,数值差异不具有统计学意义（P>0.05）。19例富血供肿瘤中,彻底切除为89.47%（17/19）,死亡率为5.26%（1/19）,术后出现新发神经功能障碍发生率为21.05%（4/19）。复合手术术后感染率为15.54%（30/193）,中枢系统感染率为11.40%（22/193）,与传统手术比较,数值差异不具有统计学意义（P>0.05）。平均住院总天数和平均术后住院天数数值与传统手术数值比较,差异不具有统计学意义（P>0.05）;复合手术住院费用与传统手术数值比较,差异具有统计学意义（P<0.05）。结论:复合手术能够在脑脊髓血管类疾病及富血供肿瘤的手术过程中顺利开展实施,有效保证手术治疗预后效果及简化治疗流程,具有推广价值。     

Halcyon加速器机房的防护设计

目的 探讨新型封闭机架直线加速器机房的细节设计,优化机房的射线防护及布局。方法 根据放射防护最优化原则和国家辐射防护技术标准,结合Halcyon加速器结构特性,从机房空间布局、屏蔽计算、电器设施、净化通风和温湿度控制等因素进行讨论,分析该设备机房与传统加速器机房建设的区别。结果 Halcyon整机结构紧凑,采用封闭环形机架设计且自带主束屏蔽装置,提高机房空间利用率的同时极大降低辐射防护压力,经过优化的机房设计布局,可以排除隐患,避免设计缺陷,防止因设计失误给设备运行带来不良后果。结论 Halcyon加速器整机结构不同于以往常规加速器,应充分考虑细节设计,才能保证辐射防护最优化,为后期设备安装、调试及运行打下良好基础,保证投入使用后能够为患者及医护人员创造良好的治疗环境。     

Protection design of Halcyon accelerator room

Objective To discuss the design details of accelerator room for a novel enclosed O-ring linac Halcyon, and to optimize its protection and layout. Methods According to the optimization principle of radiation protection and the requirements of national radiation protection standards, and the structural characteristics of Halcyon accelerator, the differences between conventional and this novel accelerator rooms were analyzed by discussing the space layout of the machine room, shielding calculation, electrical facilities, purifying ventilation, temperature and humidity control and other factors. Results The Halcyon machine had a compact structure, a closed ring frame design and a main beam shielding device, which could greatly reduce the radiation protection pressure while improving the space utilization rate of the machine room. The optimized design layout of the machine room could eliminate hidden dangers, avoid design defects, and prevent adverse consequences caused by design errors. Conclusions The overall structure of Halcyon accelerator is different from that of conventional accelerators. The design details should be taken into full consideration to ensure the optimization of radiation protection, lay a good foundation for subsequent installation, debugging and operation of the equipment and create a good treatment environment for patients and medical staff.     

常温下对骨肉瘤真空干燥灭活的探讨*

目的:分析常温下对骨肉瘤组织进行真空干燥灭活的可行性。方法:体内实验对VX2 肿瘤块进行真空干燥处理及冰水复水后,行体内种植,确定灭活处理的安全时间。体外实验对骨肉瘤组织进行真空干燥灭活,测定脱水率,观察肿瘤组织形态学改变,检测肿瘤组织ATP 酶活性;检测兔骨、肌腱进行真空灭活处理后生物力学强度的变化。结果:常温下VX2 肿瘤真空干燥灭活的安全时间为60min;骨肉瘤组织接受真空干燥灭活后,明显皱缩,内部呈多孔状,脱水率达93.98% ,镜下见细胞明显变小,结构破坏,透射电镜下见肿瘤细胞膜破坏,细胞器崩解,染色体分解;肿瘤组织的ATP 酶活性明显较对照组降低;骨、肌腱的生物力学强度并未发生明显下降。结论:室温下真空干燥处理60min,对骨、肌腱力学强度无明显影响,却可以使骨及软组织肿瘤内肿瘤细胞完全灭活。      

肿瘤医院门诊诊间预约挂号服务的

开展诊间预约挂号服务后,预约量、患者满意度明显提高,就诊环境改善;还可以优化门诊流程,缓解患者“挂号难”“看病难”,提高服务质量和医疗质量,提升医院管理水平.     

Cystotomy and peroperative irradiation for bladder cancer: Long-term results

The long-term results were investigated in 46 patients of bladder cancer treated by cystotomy and peroperative irradiation. This combination therapy appears to produce grossly comparable long-term survival results with surgery and radiotherapy. There were ten complications during a ten-year period after the treatment. We think that cystotomy and peroperative irradiation could still be used for the treatment of bladder cancer especially when the tumor is not too large, is situated at the base of the bladder, and segmental resection cannot be performed, and the patient wants to spare the bladder function.     

手术室个性化舒适护理在甲状腺癌手术患者中的应用

目的：了解甲状腺癌患者的焦虑、抑郁现况,探讨手术室个性化舒适护理在甲状腺癌手术患者中的应用效果。方法：选择接受甲状腺癌手术的患者326例,将其随机分为干预组和对照组,对照组采用常规护理,干预组患者实施手术室个性化舒适护理。在入院时、术前一天、术后一天对患者的焦虑、抑郁情况进行调查,同时监测患者的血压、心率、睡眠情况。结果：甲状腺癌患者入院时存在明显的焦虑抑郁情况,81.9%的甲状腺癌患者存在焦虑情绪,71.8%的患者存在抑郁情绪,以轻度焦虑抑郁为主。与入院时相比,术前一天患者的焦虑抑郁得分明显升高（P<0.001）,但干预组焦虑得分低于对照组（t =-4.643, P<0.001）,术后一天患者的焦虑得分较术前一天明显下降（P<0.001）。干预组患者术前、术后血压、心率均低于对照组（P<0.001）。手术当日干预组和对照组均出现不同程度的血压升高、心率加快,干预组变化比例明显低于对照组（血压升高：47.9% vs. 76.7%;心率加快：22.1% vs. 33.7%）。干预组和对照组在术前一天、术后当晚均存在不同程度的睡眠障碍,其中对照组失眠比例大于干预组（P<0.05）。结论：手术室个性化舒适护理可明显改善患者的焦虑、抑郁情绪,提高治疗效果。     

Litigation suits in otorhinolaryngology — Areas of concern

The factors that separate an otolaryngology related law suit from others are manifold. The definition of standard of care, the patient’s expectation of a surgical outcome and the psychological consequence that results from the surgical complications are unique to this specially. As this specially deals with one of the most sensitive part of a human body, patient’s expectations of any treatment is bound to differ from that of the doctor. Unlike other fields, the definition of standard of care is constantly evolving due to continuous introduction and modification of the techniques and instruments. Statistics shows that the most common allegation in law suits relating to this branch is inadequate consent for the proposed treatment followed by wrong techniques used for operation. Negligence in postoperative care, failure to diagnose early and faulty maintenance of medical words are the other major areas that concern a doctor in a court room. The present article aims at reviewing some major problem areas and addressing the legal aspects concerning those areas.     

术后感染溯源预控模式在胶质瘤患者手术室护理中的应用

目的探讨术后感染溯源预控模式在脑胶质瘤患者手术室护理中的应用效果。方法选取2015年1月至2018年7月间山东省立第三医院收治的86例脑胶质瘤患者,根据采用的护理方法不同进行分组,采用常规围术期护理的43例患者纳入对照组,在常规围术期护理基础上加用术后感染溯源预控模式护理的43例患者纳入观察组。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价患者的焦虑和抑郁程度。比较两组患者的并发症发生情况和护理满意度。结果护理后,观察组患者SAS和SDS得分均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者并发症发病率为9.3%,低于对照组的18.6%,差异有统计学意义(P<0.05)。观察组患者的护理满意度为95.4%,高于对照组患者的76.7%,差异有统计学意义(P<0.05)。结论将术后感染溯源预控护理模式应用于脑胶质瘤手术患者,可降低患者的术后感染率,改善焦虑和抑郁程度,提高护理满意度,是一种较好的护理模式。