高压氧联合化疗对卵巢上皮性癌疗效研究

Objective To discuss the therapentic efficacy of hyperbaric oxygen combined with PC program in newly diagnosed epithelial ovarian cancer patients. Methods Fifty-eight patients with epithelial ovarian cancer were divided into two groups by random digits table: HBO group(30 cases) and PC group(28cases). HBO group were exposed to hyperbaric oxygen of 2 standard atmospheric pressure 60 min, then given chemotherapy 25-30 min after extravehicular: cyclophosphamide 1000 mg/m2 + cisplatin 75 mg/m2.PC group with the same regimen without hyperbaric oxygen therapy were analyzed. The two groups were compared in the efficacy and 3-year survival rate, progression-free survival and adverse reactions. Results The total effective rate, not controlled rate, recurrence rate,recurrence time, 3-year survival rate in HBO group [83.3%(25/30),6.7%(2/30),33.3%(10/30), (21.0 ± 0.8) months,43.3%(13/30)] were better than those in PC group [67.9% (19/28), 17.9% (5/28), 46.4% (13/28), (18.0 ± 0.6) months, 17.9% (5/28)] (P ＜0.05), progression-free survival and overall survival time in HBO group were longer than those in PC group (P ＜0.05) and adverse reactions rate in HBO group was lower than that in PC group (P ＜0.05).Conclusions The hyperbaric oxygen combined with PC programs are better than PC programs in advanced epithelial ovarian cancer chemotherapy response rate, progression-free survival time and 3-year survival rates in ovarian cancer adjuvant chemotherapy. HBO can significantly reduce the PC's hematological toxicity and toxicity of the digestive system.     

快速康复方案在肛肠外科围手术期的临床研究

目的 研究快速康复方案在肛肠外科围手术期的安全性及有效性.方法 将169例结直肠、肛管恶性肿瘤围手术期患者按随机数字表法分为快速康复治疗方案组(观察组)86例与传统治疗方案组(对照组)83例,比较两组患者术后开始下床活动时间、首次肠道排气时间、停止静脉输液时间、住院时间、治疗费用及术后并发症的发生情况.结果 观察组术后首次肠道排气时间(33.6±12.9)h,停止静脉输液时间(4.5±1.3)d,住院时间(5.6±1.2)d,治疗费用(1.5±0.3)万元,对照组分别为(81.7±20.1)h、(7.4±1.6)d、(8.9±2.7)d、(1.6±0.4)万元,两组比较差异均有统计学意义(P＜0.01或＜0.05);观察组术后并发症的发生率[5.8%(5/86)]明显低于对照组[16.9%(14/83)](P＜0.05).结论 快速康复方案在肛肠外科围手术期的应用安全、有效、有益.

Abstract：

Objective To study the safety and efficacy of fast track program in anorectal surgery perioperative period. Methods One hundred and sixty-nine cases of rectal cancer were divided into the study group of 86 patients with fast track program, and the control group of 83 patients with traditional programs by random digits table. Both groups were compared from the time out of bed, the first intestinal discharge time,intravenous fluids stopping time,length of hospital stay,total cost of treatment and the incidence of postoperative complications. Results The study group compared with the control group: the first intestinal discharge time [(33.6 ± 12.9) h vs. (81.7 ± 20.1) h], intravenous fluids stopping time [(4.5 ±1.3) d vs.(7.4 ± 1.6) d],and length of hospital stay [(5.6 ± 1.2) d vs.(8.9 ±2.7) d],the total cost of treatment [(15 000 ± 3000) yuan vs. (16 000 ± 4000) yuan], the differences were statistically significant (P ＜ 0.01 or ＜ 0.05),and had less incidence of postoperative complications in study group than that in control group [5.8% (5/86) vs. 16.9% (14/83)], the difference was statistically significant (P ＜ 0.05).Conclusions Fast track program in anorectal surgery perioperative period is safe and effective, beneficial,conducive to rehabilitation of patients.     

多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床研究

目的 探讨多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床疗效.方法 将86例复杂性肾结石患者分为两组,研究组(46例)采用多通道微创经皮肾镜结合钬激光碎石术,对照组(40例)行单通道微创经皮肾镜结合体外冲击波碎石术治疗.比较两组碎石取出时间、结石清除率、术后血红蛋白下降率、术中输血率、术后住院时间及并发症发生率.结果 研究组的碎石取出时间为(102±23)min,对照组为(121±28)min,两组比较差异无统计学意义(P＞0.05).研究组术后血红蛋白下降率为6.5%(3/46)、术中输血率为17.4%(8/46)、结石清除率为82.6%(38/46)、术后住院时间为(5.6±1.7)d,对照组分别为12.5%(5/40)、22.5%(9/40)、72.5%(29/40)、(7.4±1.8)d,两组比较差异均有统计学意义(P＜0.05).结论 多通道微创经皮肾镜结合钬激光治疗复杂性肾结石手术时间短、术中出血少、结石清除率高,且并发症相对较少,值得临床推广应用.

Abstract：

Objective To investigate the effect of multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in complex renal calculi operation. Methods Eighty six complex renal calculi patients were divided into two groups, study group (46 cases) was treated with multi-channel minimally invasive percutaneous nephrolithotomy combined with Yag laser, control group was treated with single-channel minimally invasive percutaneous nephrolithotomy combinated with extracorporeal shock wave treatment. Comparison of gravel removed time, stone clearance rate,postoperative hemoglobin decreasing rate, blood transfusion rate of surgery,length of stay time and operative complications were done between the two groups, the results were analysed statistically. Result The gravel removed time was (102±23) min in study group, and ( 121 ± 28) min in control group, there was no significant difference between the two groups(P ＞ 0.05 ). In study group, postoperative hemoglobin decreasing rate was 6.5%(3/46), blood transfusion rate of surgery was 17.4% (8/46), stone clearance rate was 82.6%( 38/46 ), length of stay time was (5.6 ± 1.7) d,while those in control group was 12.5%(5/40),22.5%(9/40),72.5%(29/40), (7.4 ± 1.8) d,respectively. There was statistical significance between the two groups(P＜ 0.05 ). Conclusion Multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in the treatment of complex renal calculi has the shorter operation time, less blood loss,less complications and higher stone clearance rate, and is worthy of promotion.     

三种小切口行胸腺切除治疗重症肌无力的对照分析

目的 比较三种小切口行胸腺切除治疗重症肌无力的手术效果,合理选择手术方式.方法 回顾性分析行胸腺切除术治疗109例重症肌无力患者的临床资料,根据手术切口方式的不同分为胸骨部分劈开组、横断胸骨组和胸腔镜组,比较三组的手术时间、术中出血量、术后胸腔引流量及时间、术后住院时间、术后肺部感染及切口感染、术后肌无力危象、术后慢性疼痛上肢运动障碍和疗效.结果 胸腔镜组术中出血量[(77.5±18.0)ml]、术后胸腔引流量[(100.8±11.8)ml]、术后胸腔引流时间[(2.3±0.5)d]、术后切口感染率(0)优于横断胸骨组[分别为(97.4±14.3)ml、(175.8±18.3)ml、(3.1±0.7)d、6.2%(2/32)]及胸骨部分劈开组[分别为(130.1±24.0)ml、(379.0±45.6)ml、(4.2±0.6)d、13.8%(9/65)](P＜0.05),同时横断胸骨组又优于胸骨部分劈开组(P＜0.05);胸腔镜组术后肺部感染、术后肌无力危象、术后慢性疼痛上肢运动障碍的发生率及术后住院时间均优于横断胸骨组及胸骨部分劈开组(P＜0.05).结论 三种小切口手术方式安全可行,疗效显著,胸腔镜切口手术有着显著的优越性,值得在各大中型医院广泛推广;而对于技术设备不发达的基层医院,横断胸骨切口为更好的选择.

Abstract：

Objective To investigate the best operative approach in the treatment of myasthenia gravis (MG) by comparing surgical effects of median sternotomy, trans-sternal surgery and video-assisted thoracoscope surgery (VATS). Methods One hundred and nine patients who received thymectomy for MG were divided into median sternotomy group,trans-sternal group and VATS group according to the way of operative incision. The clinical features, such as operative time, operative blood loss, postoperative drainage volume and drainage time, postoperative hospitalization time, postoperative pulmonary infection, incisional infection, MG crisis, postoperative chronic pain and upper limb's movement disorder were retrospectively analyzed to evaluate the effect of the surgery. Results The operative blood loss, postoperative drainage volume and drainage time,and incisional infection in VATS group [(77.5 ± 18.0) ml, ( 100.8 ± 11.8) ml,( 2.3 ± 0.5 ) d, 0 ] were superior to those in trans-sternal group[ (97.4 ± 14.3 ) ml, ( 175.8 ± 18.3 ) ml, ( 3.1 ±0.7 ) d, 6.2% ( 2/32 ) ] and median stemotomy group [ ( 130.1 ± 24.0) ml, ( 379.0 ± 45.6 ) ml, (4.2 ± 0.6) d,13.8% (9/65)] (P ＜0.05),and median sternotomy group was the worst. The incidence of postoperative pulmonary infection, MG crisis, upper limb's movement disorder and postoperative hospitalization time in VATS group were superior to those in trans-sternal group and median sternotomy group (P ＜0.05).Conclusions Three mini-incision surgical approaches are safe, feasible and effective. VATS is more advantageous and is worth popularizing in large and medium-sized hospitals. Trans-sternal surgery is the better choice for primary hospitals without advanced technology and equipments.     

社区高血压患者健康管理药物治疗和直接医疗费用分析

目的 调查社区高血压患者健康管理的药物治疗费用、住院费用及直接医疗费用的现状,为进一步评估国家基本公共卫生服务项目中的社区高血压患者健康管理是否具有卫生经济学上的成本效益奠定基础.方法 通过整群抽样的方法在5省10个调查点调查了8326例高血压患者,其中参与社区高血压患者健康管理1年以上的管理组对象3967例,未参与该管理的对照组4359例.通过问卷调查收集研究对象基本信息,并回顾性收集其在过去1年内(2009年11月至2010年11月)的医疗成本信息.分别对比分析两组患者的年度药物治疗费用、住院治疗费用和直接医疗费用.结果 高血压患者年均药物治疗费用为(621.50±1337.78)元,管理组为(616.13±1248.40)元,对照组为(626.44±1414.30)元.高血压服药患者年均药物治疗费用为(702.05±1401.79)元,管理组为(688.50±1300.70)元,对照组为(714.64±1489.60)元.城市高血压服药患者年均药物治疗费用[(731.88±1403.31)元]高于农村[(407.44±1171.44)元].高血压患者的年住院率为12.2%(1014/8326),高血压住院患者年人均住院费用为(9264.47±18 088.49)元,管理组[(7583.70±13 267.00)元]低于对照组[(11 028.00±21 919.00)元].高血压患者年人均住院费用为(1064.87±6804.83)元,管理组[(936.73±5284.90)元]低于对照组[(1181.50±7937.90)元].高血压患者年人均直接医疗费用为(2275.08±8225.66)元,管理组为(2165.10±6564.60)元,对照组为(2375.20±9487.60)元;城市地区患者年人均直接医疗费用[(2801.06±9428.54)元]高于农村[(1254.70±4990.27)元].结论 高血压社区健康或规范化管理能降低高血压服药患者年均药物治疗费用和患者年人均住院费用约26元和245元;节省高血压患者年人均直接医疗费用约210元.国家医疗卫生体制改革和发展中,应进一步加强和推广社区高血压患者健康或规范化管理.

Abstract：

Objective To investigate the current situation of drug cost,hospitalization cost and direct medical expense in community health management of hypertensive patients,in order to lay foundation for evaluating whether the community health management in basic public health service has cost-effect in Health Economics.Methods A total of 8326 hypertensive patients from 10 survey pilots in 5 provinces were selected by cluster sampling methods,including 3967 patients who took part in community health management for over 1 year as management group and 4359 cases who have never taken part in community health management as control group.The essential information of research objects were collected by questionnaire; and the medical cost information in the last year(from November 2009 to November 2010) were collected retrospectively.The different annual medical treatment cost,hospitalization cost and direct medical expense in the two groups were compared and analyzed.Results The average annual drug cost in hypertension was(621.50±1337.78) yuan per patient; while the cost was(616.13±1248.40) yuan in management group and(626.44±1414.30) yuan in control group respectively.The average annual drug cost of hypertensive patients who took medicine therapy was(702.05±1401.79) yuan per person,while the cost in the management group ((688.50±1300.70)yuan) was much lower than it in control group ((714.64±1489.60)yuan).The annual average drug cost in urban was(731.88±1403.31) yuan per person,which was higher than it in rural as(407.44±1171.44) yuan per person.The average hospitalized rate was 12.2%(1014/8326),and the average annual cost among the hospitalized patients was(9264.47±18 088.49) yuan per person; while the cost was(7583.70±13 267.00) yuan in management group,which was lower than it in control group as(11 028.00±21 919.00) yuan.The average annual hospitalized cost in hypertensin was(1064.87±6804.83) yuan per person; while the cost was(936.73±5284.90) yuan in management group,which was lower than it in control group as(1181.50±7937.90) yuan.The average annual direct medical expense in hypertension was(2275.08±8225.66)yuan per person; while the expense was(2165.10±6564.60)yuan in management group and(2375.20±9487.60)yuan in control group.The average annual direct medical expense in urban((2801.06±9428.54)yuan per person) was higher than it in rural((1254.70±4990.27)yuan per person).Conclusion The community health or standardized managment of hypertensive patients can reduce the average annual drug cost and hospitalization cost (around 26 yuan and 245 yuan separately); and thereby save the annual direct medical expense per capita in hypertension (around 210 yuan). In the reform and development of national medical health system, we should enhance and promote the standardized community health management of hypertensive patients.     

Comparison of the early follicular long-term protocol and antagonist protocol in unexplained infertility patients北大核心CSCD

Objective To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of unexplained infertility patients. Methods From January 2018 to January 2019, 642 cases of unexplained infertility patients with early follicular long-term protocol and antagonist protocol in in vitro fertilization/ intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were collected using the clinical assisted reproductive technologies management system software database of the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into early follicular long-term protocol (n=283) and antagonist protocol (n=359) groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, the clinical pregnancy rate, and the live birth rate. Furthermore, the pregnancy outcomes of different age and body mass index (BMI) patients were further analyzed. Results 1) The BMI in the antagonist protocol group was higher than that in early follicular long-term protocol group [(22.17±2.96) kg/m2vs. (21.68±2.29) kg/m2, P=0.018]. The other based data did not exhibit remarkable difference between the two groups (P>0.05). 2) The starting dosage of gonadotropin (Gn) in early follicular long-term protocol group was less than that of antagonist group [(149.74± 36.24) IU vs. (177.97±38.85) IU, P<0.001]. While the total duration and dosage of Gn used in early follicular long-term protocol group were significantly higher than those in antagonist group [(11.93± 2.26) d vs. (8.86±1.45) d, P<0.001; (1 908.35±632.36) IU vs. (1 638.57±497.23) IU, P<0.001). The cleavage embryo implantation rate, the clinical pregnancy rate and the live pregnancy rate in fresh cycle in early follicular long-term protocol group were significantly higher than those in the antagonist group [57.14% (152/266) vs. 39.53% (68/172), P<0.001; 66.48% (121/182) vs. 51.72% (60/116), P=0.011; 59.89% (109/182) vs. 40.52% (47/116), P=0.001]. The incidence of moderate and severe ovarian hyperstimulation syndrome between the two groups were not statistically different (P>0.05). Multivariate logistic regression analysis showed that different protocols and age were both risk factors for clinical pregnancy and live birth of cleavage embryo transfer [2.261 (95% CI=1.333-3.836), P=0.002; 0.928(95% CI=0.869-0.991), P=0.026; 2.598(95% CI=1.535-4.397), P<0.001; 0.906(95% CI=0.849-0.967), P=0.003]. 3) In patients under 35 years old, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were higher than those of the antagonist group, but there was no statistical difference (all P>0.05). The fresh embryo cycle implantation rate, the clinical pregnancy rate and the live birth rate of 35-39 years old patients in the early follicular long-term protocol group were higher than those in the antagonist group, but there was no statistical difference (all P>0.05). 4) In normal BMI group, the implantation rate, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [55.71% (122/219) vs. 37.82% (45/119), P=0.002; 63.58% (96/151) vs. 46.99% (39/83), P=0.014; 58.94% (89/151) vs. 39.76% (33/83), P=0.005]. In the overweight population, the implantation rate and the clinical pregnancy rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [68.09% (32/47) vs. 43.40% (23/53), P=0.013; 81.25% (26/32) vs. 57.14% (20/35), P=0.034], but there was no statistically significant difference in the live birth rate (P>0.05). Conclusion Compared with the antagonist protocol, early follicular long-term protocol for unexplained infertility patients may achieve higher clinical pregnancy outcomes in IVF fresh cycle, but it could increased the duration of descending, the duration and dosage of Gn used. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

内镜腹腔镜联合与腹腔镜下治疗胆囊并胆总管结石临床分析评价

目的 比较内镜腹腔镜联合与腹腔镜下治疗胆囊结石合并胆总管结石的临床疗效.方法 76例胆囊结石合并胆总管结石患者按随机数字表法分为观察组和对照组,每组38例,分别采用腹腔镜下胆囊切除术(LC)+内镜下括约肌切开术(EST)和LC+胆总管切开取石+T管引流术(LCTD),对比观察两组的手术时间、住院时间、术中出血量和并发症情况.结果 观察组手术时间和住院时间分别为(105.3±13.2)min和(11.3±3.2)d,均显著短于对照组[分别为(140.5±15.6)min、(14.2±4.6)d],差异有统计学意义(P<0.05).两组均未发生严重并发症.结论 LC+EST治疗胆囊结石合并胆总管结石疗效肯定、创伤小、术后恢复快且并发症少,值得临床推广应用.

Abstract：

Objectivc To compare the clinical effieacy of laparoscopic cholecystectomy(LC) combined with endoscopic sphincterotomy (EST) and LC in treatment of cholecystolithiasis associated with choledocholithiasls.Methods Seventy-six patients with cholecystolithiasis associated with choledocholithiasis were divided into observation group and control group by random digits table,38 cases in each group,and respectively received LC combined with EST and LC combined with choledocholithotomy and T drainage.Theoperative time,hospitalization time,blood loss and complications in the two groups were compared.Results The operative time and hospitalization time of observation group were(105.3±13.2)min and(11.3±3.2)d respectively,and which were significantly shorter than those in control group[(140.5±15.6)min,(14.2±4.6)d],the differences were statistically significant between the two groups(P<0.05).Both groups had no serious complications happened.Conclusion LC combined with EST in treatment of cholecystolithiasis associated with choledocholithiasis has advantages such as effective,litfle trauma,rapid recovecy and less comphcations,it is worthy of clinical application.     

Comparative analysis of perinatal outcome of intracytoplasmic sperm injection and frozen-thawed embryo transfer between donor and autologous oocytes北大核心CSCD

Objective To investigate the obstetric outcomes of intracytoplasmic sperm injection and frozen-thawed embryo transfer (ICSI-FET) between donor and autologous oocytes. Methods A retrospective cohort study was conducted to analyze the clinical data of pregnant patients who underwent ICSI-FET in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from June 2016 to January 2020. Totally 73 patients with donor oocytes, and 550 patients who used autologous oocytes in the same period, and the patients were matched at 1∶3 with propensity score matching (PSM), then there were 47 patients in donor group and 131 patients in autologous group. The general conditions and obstetric outcomes were compared among donor group and autologous group. Multivariate logistic regression and linear regression were applied to analyze the factors affecting perinatal complications. Results The bilateral antral follicle count (3.08±4.78) and basal estradiol level [(71.55±45.29) pmol/L] in donor group were significantly lower than those in autologous group [14.95±6.42, (132.84±74.89) pmol/L, all P<0.001]. The birth weight of singleton in donor group [(2 916.48±537.55) g] was lower than that in autologous group [(3 326.67±503.43) g], and there was significant difference (P<0.001). There were no significant differences in premature birth rate [21.28% (10/47) vs. 16.03% (21/131), P=0.416] and incidence of hypertensive disorder complicating pregnancy [12.77% (6/47) vs. 7.63% (10/131), P=0.448] between donor group and autologous group, but both of them had an increasing trend in donor group. Oocyte-donated ICSI-FET reduced the birth weight of singleton (MD=-388.225, 95% CI= -625.914-150.537, P=0.002). Conclusion The perinatal outcome of oocyte-donated ICSI-FET is relatively safe, but the birth weight of singleton is lower than that of self-oocyte ICSI-FET. © 2022 Chinese Journal of Endocrine Surgery. All rights reserved.     

吊带法双侧骶棘韧带固定术治疗盆腔器官脱垂的临床研究

目的 探讨吊带法双侧骶棘韧带固定术在治疗盆腔器官脱垂(POP)中的效果.方法 将60例POP患者按随机数字表法分为吊带法双侧骶棘韧带固定术组(研究组,30例)、经阴道后路悬吊带术组(P-IVS组,15例)、骶棘韧带固定术组(SSLF组,15例).比较三组手术情况、疗效及随访情况.结果 研究组手术时间[(30.5±5.3)min]较SSLF组[(43.5±10.6)min]缩短(P＜0.05),术后下床时间[(1.5±0.6)d]明显早于SSLF组[(3.1±0.7)d]和P-IVS组[(3.3±0.8)d](P＜0.05).三组患者出院时POP-Q分类法均为0度或Ⅰ度,达到治愈标准.随访3～16个月,研究组复发率和性生活质量下降率[0和3.3%(1/30)]均明显低于P-IVS组[20.0%(3/15)和13.3%(2/15)]和SSLF组[6.7%(1/15)和26.7%(4/15)](P＜0.05).结论 吊带法双侧骶棘韧带固定术是一种操作简单、坚固性强、术后阴道位置没有轴性改变,更符合解剖结构的术式,在治疗POP中有很高的实用价值,值得在临床中推广.

Abstract：

Objective To investigate the effect of bilateral sacrospinous ligament fixation by Pavlik harness method in the treatment of pelvic organ prolapse (POP). Methods Sixty patients with POP received operation were divided into bilateral sacrospinous ligament fixation by Pavlik harness method group (study group,30 cases),posterior intravaginal sling plasty group (P-IVS group, 15 cases) and sacrospinous ligament fixation group (SSLF group, 15 cases) by random digits table. The data of the three groups, such as operation time, bleeding during the operation, indwelling urinary catheter time, duration out of bed after operation, cure rate, recurrence rate and the quality of sexual life were observed. Results The operation time in study group [( 30.5 ± 5.3 ) min] was significantly shorter than that in SSLF group [(43.5 ± 10.6) min](P ＜ 0.05 ), and the duration out of bed in study group [( 1.5 ± 0.6) d] was earlier than that in SSLF group [(3.1 ±0.7) d] and P-IVS group [(3.3 ±0.8) d](P＜0.05). The POP-Q stage of all the patients being hospital was 0 or Ⅰ , approached the cure standard. Patients were followed up for 3-16 months after operation, the recurrence rate and the decrease of the quality of sexual life in study group [0,3.3%(1/30)]were lower than those in P-IVS group [20.0%(3/15),13.3%(2/15)] and SSLF group[6.7%(1/15),26.7%(4/15)] (P ＜ 0.05). Conclusion Bilateral sacrospinous ligament fixation by Pavlik harness method is a simple, firm operation, and the position of vagina does not axialitily change and suits the anatomy, so it is effective and worth spreading clinically to treat the POP.     

荧光定量PCR对血及痰培养物中结核分枝杆菌DNA的检测

Objective To evaluate if fluorescence quantitative PCR (FQ-PCR) detection for Mycobacterium tuberculosis in blood or sputum culture can help tuberculosis (TB) diagnosis. Methods A total of 81 patients with a clinical diagnosis of tuberculosis but sputum negative were enrolled, 40 were tuberculosis group and 41 coexisting HIV were HIV-TB group. Blood and sputum were cultured for bacilli or L-forms of Mycobacterium tuberculosis, and FQ-PCR was used to detected bacilli DNA. Results For pulmonary tuberculosis group, 54.1 %(20/37) were positive for bacilli or Informs of Mycobacterium tuberculosis in sputum by FQ-PCR, 27.5% (11/40) were positive in blood culture, 22.5%(9/40) were positive in blood by FQ-PCR, and the total positive rate of blood was 42.5% (17/40). But for HIV-TB group, only 2 positive cultures were found in 10 sputum, the positive rate of blood culture was 7.3% (3/41), and the positive rate of blood was 17.1%(7/41) by FQ-PCR. There was no significant difference between two groups in the positive rate of Mycobacterium tuberculosis by FQ-PCR after blood cultures (P > 0.05). The total positive rates detected by FQ-PCR of sputum or blood cultures were 65.0% (26/40) and 22.0% (9/41) respectively, and there was significant difference between two groups( χ2 = 15.305, P < 0.01). Conclusions FQ-PCR for blood or sputum culture detection appears to be a useful method to diagnose TB in persons with or without HIV infection. The use of FQ-PCR significantly enhance the efficiency of the etiological diagnosis of sputum negative pulmonary tuberculosis.     

快速康复外科在胃癌患者围手术期应用的临床效果

目的 评价围手术期快速康复外科方案在胃癌患者中应用的临床效果。方法根据入选标准,82例胃癌患者进入本研究并随机分为两组,每组41例,一组为应用快速康复外科方案的研究组,另一组为应用传统方法的对照组。比较两组术后首次排便时间、术后住院时间、住院总费用和术后并发症的发生率。结果研究组术后首次排便时间为（45．58±26．91）h,显著早于对照组的（58．01±23．5）h（P=0．0287）,术后住院时间为（9．4±3．3）d,显著短于对照组的（12．4±3．6）d（P=0．0002）,住院总费用为（2．96±0．44）万元,显著少于对照组的（3．46±0．34）万元（P〈0．0001）。研究组和对照组并发症发生率分别为7．3％和17．1％,差异无统计学意义（P=0．232）。结论围手术期应用快速康复外科方案可以明显加快胃癌患者术后康复,缩短术后住院时间,降低医疗费用。     

快速康复与营养支持在老年胃癌围手术期联合应用的临床效果

目的评价围手术期快速康复与营养支持方案给老年胃癌患者联合应用后的临床效果。方法选取42例胃癌患者随机分为两组,每组21例,一组为应用快速康复外科方案的研究组,另一组为应用传统方法的对照组。比较两组术后首次排便时间、术后住院时间、住院总费用和术后并发症的发生率。结果研究组术后首次排便时间为（75．4±24．3）h,显著早于对照组的（98．0±22．6）h（P=0．0165）;研究组术后住院时间为（11．2±3．2）d,显著短于对照组的（14．4±4．6）d（P=0．0004）;研究组住院总费用为（3．66±0．48）万元,显著少于对照组的（4．56±0．78）万元（P=0．0001）。两组并发症的发生率差异具有统计学意义（9．5％比28．6％,P=0．0422）。结论围手术期应用快速康复外科方案可以明显加快老年胃癌患者的术后康复,缩短术后住院时间,降低医疗费用,减少术后并发症的发生率。     

子宫肌瘤患者分别行二氧化碳气腹和无气腹腹腔镜手术临床疗效比较

目的比较子宫肌瘤患者行二氧化碳(CO_2)气腹和无气腹腹腔镜手术的临床疗效。方法选择2013年6月至2015年6月解放军第一八一中心医院收治的360例子宫肌瘤患者,按随机数字表法分为两组,每组180例,分别行CO_2气腹和无气腹腹腔镜手术。比较两组患者术中及术后情况、住院时间及总费用、术后随访情况。结果两组手术时间和术中出血量比较差异无统计学意义(P0.05);无气腹组术后肛门排气时间(1.3±0.5)d、术后并发症8例(4.44%)、住院时间(4.2±3.4)d、住院总费用(7 143.7±512.6)元、术后短期复发率(10.56%)均少于CO_2气腹组[(2.4±0.6)d、19.44%、(6.3±1.8)d、(9 894.1±427.3)元、20.00%](P均0.05)。结论无气腹腹腔镜具有术后恢复快、费用低、住院时间短、复发率低等优点,是子宫肌瘤手术不错的选择。     

加速康复外科在结直肠癌手术病人的应用研究

目的:应用围手术期加速康复外科理念,观察结直肠癌手术病人临床应用的有效性、安全性及其优势. 方法:50例结直肠癌手术病人随机分成两组,使用加速康复外科方法21例作为加速康复外科组;使用常规围手术期方案手术29例作为常规对照组.分析研究两组病人术后肠道通气时间、住院天数、住院费用和人体组成等指标,并观察记录不良反应及并发症.结果:加速康复外科围手术期方案比常规围手术期方案,可更好地促进术后病人肠道功能恢复,缩短住院时间,降低住院费用,并可减少围手术期病人蛋白质、肌肉和体质量丢失,维持围手术期的水分平衡,减少病人因医源性操作引起的不适及手术相关并发症的发生. 结论:加速康复外科理念在结直肠癌择期手术病人中应用是安全、经济、有效和可靠的围手术期处理方案.     

快速康复外科在腹腔镜右半结肠癌根治手术中的应用

目的：探讨在腹腔镜右半结肠癌根治手术中应用快速康复外科（FTS）的安全性及治疗效果。方法：将2011年6月-2013年12月九江市第一人民医院普外科收治的68例行腹腔镜右半结肠癌根治手术患者随机分为FTS组34例和对照组34例,FST组应用快速康复外科,对照组应用传统方法,比较两组的首次排气时间、首次排便时间、住院天数、治疗费用、术后并发症发生率。结果：与对照组相比,FST组术后并发症发生率降低,首次排气时间、首次排便时间提前,住院时间缩短,住院费用降低,差异均有统计学意义。     

悬吊式腹腔镜手术与开腹手术治疗子宫肌瘤的效果比较

目的 比较悬吊式腹腔镜手术与开腹手术治疗子宫肌瘤的效果,评价悬吊式腹腔镜手术治疗子宫肌瘤的优缺点和适应证.方法 对166例子宫肌瘤患者行悬吊式腹腔镜手术(79例,腹腔镜组)和开腹手术(87例,开腹组)的临床资料进行回顾性分析,比较两组术中失血量、手术时间、肛门排气时间、术后住院时间、体温恢复正常时间、导管留置时间、术后镇痛药使用情况等.结果 腹腔镜组患者术中失血量、肛门排气时间、导管留置时间、体温恢复正常时间、术后住院时间[(58.4±31.6)ml、(19.5±2.5)h、(11.1±2.5)h、(1.3±0.8)d、(5.1±1.9)d]均低于开腹组[(99.1±45.6)ml、(35.8±4.0)h、(21.5±2.4)h、(2.6±1.3)d、(10.4±2.4)d](P＜0.01),术后镇痛药使用率低于开腹组[34.2%(27/79)比66.7%(58/87)](P＜0.01),且腹部瘢痕不明显.结论 悬吊式腹腔镜手术治疗子宫肌瘤优于传统开腹手术.     

结直肠癌病人应用加速康复外科的对照研究

目的:应用加速康复外科(FTS)和常规治疗方案的结直肠癌病人在医疗效率指标和费用方面进行对照研究.方法:选取结直肠癌病人100例,50例应用常规治疗方案作为对照组,50例应用FTS方案为FTS组,比较两组病人住院时间、费用和并发症.结果:FTS组病人住院时间明显短于对照组,差异有非常显著性意义(P<0.01).FTS组病人的平均住院费用亦远低于对照组(P <0.01).两组病人并发症的发生率无显著性差异(P>0.05).结论:结直肠癌病人围手术期经FTS方案治疗,术后康复加快,住院时间缩短,医疗费用下降.     

手术治疗高血压基底节脑出血立体定向钻空引流的疗效分析

目的比较非手术治疗与立体定向手术治疗中小量高血压基底节脑出血的临床疗效。 方法回顾性分析聊城市人民医院脑科医院神经内、外科2016年7月至2019年7月收治的182例高血压基底节性脑出血(20～40 mL)患者临床资料，其中男性102例，女性80例；年龄38～79岁，平均(52.9±1.9)岁。按照患者所接受的治疗方案将研究对象进行分组：90例采用了规范药物治疗者为非手术治疗组，92例接受了立体定向钻孔引流手术者为定向引流组。分别根据动态电子计算机断层扫描(CT)评价其排空率，在院期间再出血率和颅内感染率评价其临床安全性，平均住院日及费用评价其社会经济负担；全部随访6个月，根据病死率、改良Rankin量表评分(modified Rankin scale, mRs)评价其远期预后。 结果与非手术治疗组比较，定向引流组在发病后第7天的血肿排空率更高[(90.67±3.31)%比(25.23±2.41)%]、平均住院日缩短[(10.1±2.8)d比(20.3±3.9)d]、平均住院费降低[(18 158.1±2 171.3)元比(21 493.3±3 729.5)元]，差异均有统计学意义(P<0.05)，但两组的在院期间再出血率(6.7%比5.4%)和颅内感染率[1.1%(1/90)比3.3%(3/92)]的差异均无统计学意义(P>0.05)。治疗6月后，定向引流组的mRs[(2.57±0.56)分比(3.42±0.21)分]和病死率[10.0%(9/90)、2.2%(2/92)]均低于非手术治疗组，差异均有统计学意义(P<0.05)。 结论针对中小量高血压基底节性脑出血，与非手术治疗比较，立体定向手术在具备安全性的同时，临床预后更好、经济负担更低。     

经肛门改良Soave术和开腹先天性巨结肠根治术疗效比较

目的 探讨经肛门改良Soave术与开腹手术对先天性巨结肠患儿疗效的差别.方法 取2001年1月至2007年1月经肛门改良Soave术(改良组,2l例)及开腹手术(开腹组,25例)治疗先天性巨结肠患儿46例,分析比较两组患儿的临床疗效.结果 术后48h改良组白细胞介素-6、C反应蛋白水平[分别为(10.7±1.6)ng/L、(27.7±4.1)mg/L]低于开腹组[分别为(22.0±2.3)ng/L、(73.7±15.0)mg/L](P＜0.01),且手术时间[(94.0±11.7)min]、住院时间[(7.9±1.1)d]、胃肠功能恢复时间[(2.2±0.7)d]及住院费用[(9030.5±1203.3)元]均低于开腹组[分别为(110.6±10.2)min、(11.9±4.2)d、(3.9±0.7)d、(11350.6±2412.7)元](P＜0.01).改良组术后并发症总发生率(9.5%,2/21)明显低于开腹组(24.0%,6/25)(P＜0.05).术后1年肛管高压区长度、肛管静息压两组比较差异无统计学意义.结论 经肛门改良Soave术较开腹手术具有创伤小、费用低等优点,适用于治疗婴幼儿的短段型和常见型先天性巨结肠.