儿童肾移植围手术期护理规范专家共识

儿童肾移植受者在原发病、生理、心理、器官功能和免疫状态等方面具有不同于成人的特点,其围手术期的治疗与护理过程与成人肾移植也不尽相同。为规范儿童肾移植围手术期的整体护理方案,上海市护理学会外科护理专业委员会组织全国移植领域相关医疗、护理专家共同撰写《儿童肾移植围手术期护理规范专家共识》（以下简称“共识”）,经过3轮线上专家函询,对所有修改意见采用聚焦讨论联合文献佐证的方式形成一致意见,最终形成共识。共识针对儿童肾移植围手术期的治疗和护理重点予汇总和陈述,包含儿童肾移植术前评估、术前与术后护理3部分内容,具有较好的科学性和实用性。     

加速康复外科理念的老年髋部骨折围手术期护理研究进展

加速康复外科(ERAS)在疾病治疗、营养、麻醉等学科领域已达成共识并很好应用,护理领域缺少相应的共识。但在诸多领域的应用研究中,护理学科又充当着重要角色。本文通过复习ERAS理念下老年髋部骨折围手术期管理文献,总结ERAS理念应用于老年髋部骨折围手术期护理的管理策略。     

急性缺血性脑卒中介入治疗围手术期护理

目的总结急性缺血性脑卒中介入治疗患者的围手术期护理方法。方法对32例接受介入治疗的急性缺血性脑卒中患者,围手术期给予整体护理,回顾性分析患者的护理资料。结果 32例均顺利完成介入溶栓治疗,良好23例(72%)。9例患者遗留较重神经功能障碍,肢体肌力<Ⅲ级。结论积极有效围手术期护理,能减少急性缺血性脑卒中介入术后并发症的发生,促进患者康复。     

乳房良性肿块应用麦默通微创手术治疗的护理体会

目的探讨麦默通微创旋切术围手术期的护理方法。方法回顾性分析60例乳腺肿块患者行超声引导下麦默通微创旋切手术临床围手术期护理资料。结果本组乳腺病灶均被准确切除,术后无活动性出血、局部淤血及切口感染等并发症发生,均痊愈出院。结论乳腺麦默通微创旋切术安全、有效、创伤,加强围手术期护理措施,可降低术后并发症发生率,缩短患者住院天数。     

食管癌围手术期护理体会

目的探讨全麻下食管癌手术围手术期护理的效果及要点。方法对47例行食管癌手术的患者,做好围手术期护理,不断总结和改进护理措施。结果 47例患者中46例临床治愈,术后恢复良好,并对护理满意。1例因突发肺栓塞死亡。结论完善食管癌患者围手术期护理工作,能明显改善手术效果,促进患者早期康复。     

介入术治疗急性下肢缺血围手术期监护的整体护理

目的探讨整体护理方法在介入联合取栓术治疗急性下肢缺血围手术期的作用。方法 2004年9月～2008年12月,对24例下肢急性动脉栓塞患者进行介入技术结合动脉取栓手术治疗,并在围手术期中采取整体化、无缝隙的监护护理措施。结果本组除3例患者出现手术后下肢再栓塞需再次行取栓手术外,余21例经一次性介入联合取栓术治愈,无1例发生并发症。结论术前做好针对性的心理护理和密切观察病情;术后加强并发症的观察及护理,进行详细的出院指导,对保证良好的手术效果起着作用。     

脊柱外科围手术期血糖管理专家共识

血糖异常与脊柱外科围手术期并发症的发生和预后密切相关。围手术期血糖控制是脊柱外科患者临床管理的一个重要方面，是降低手术并发症发生率、促进术后快速康复的重要内容之一。目前，尚缺乏针对脊柱外科围手术期血糖管理的专家共识和指南。为了进一步规范脊柱外科围手术期血糖管理，本文通过参考现有的关于围手术期血糖管理的指南及共识，并对血糖管理领域已发表的文献进行系统评价，结合脊柱外科特点，组织专家进行讨论，提出规范的脊柱外科围手术期血糖管理共识，以期为脊柱外科围手术期血糖管理提供指导。     

CT引导下肺肿瘤微创介入治疗围术期护理

肺癌占我国肿瘤致死病因的第1位[1],微创介入作为重要局部治疗手段[2]逐渐受到认可,射频消融、冷冻消融、化学消融[3]、微波消融、放射粒子植入等技术的应用越来越广泛。CT引导下肺肿瘤微创介入围术期护理既有围术期护理的共性,也有其特殊要点。本文就围术期护理要点进行探讨。     

颅内动脉瘤围手术期整体护理体会

目的总结介入栓塞术治疗颅内动脉瘤的护理体会。方法对接受介入栓塞术治疗颅内动脉瘤的46例患者实施术前心理、术中配合、术后护理及预防血管痉挛等整体护理措施。结果 46例患者均预后良好,未发生与护理不当有关的并发症。结论围手术期实施整体护理可提高介入栓塞术治疗效果,减少术后并发症,改善患者术后生活质量。     

分析脑动脉瘤介入栓塞术围术期精准护理的效果

目的探讨脑动脉瘤介入栓塞术围术期精准护理的效果。方法研究对象来自2018-02-2019-02间我院收治的94例接受脑动脉瘤介入栓塞术的患者。随机分为2组,各47例。对照组围术期采取常规护理措施,观察组在此基础上行围术期精准护理。比较2组术中失血量、手术时间,以及不良事件的发生情况。结果观察组术中失血量、手术时间及不良事件发生率均少(或短)于对照组,差异有统计学意义(P<0.05)。结论脑动脉瘤介入栓塞术围手术期开展精准护理效果显著。     

MRI-guided needle localization in the head and neck using contemporaneous imaging in an open configuration system

BACKGROUND: MRI-guided procedures have previously been limited by technical difficulties, including the need for MRI-compatible instruments, slow image acquisition time, and the closed nature of conventional MRI scanners. The development of open configuration MRI systems with in-room, contemporaneous imaging has greatly increased the potential for MRI-guided interventional procedures. We evaluate our clinical experience applying this technology to the head and neck. METHODS: An open design 0.2T magnet combined with an in-room monitor was used for 24 MRI-guided needle localization procedures in the head and neck. Success of the procedures was based on the ability to accurately position the instrument in the target region to allow biopsy or treatment. RESULTS: In all 24 cases placement of the instrument within the target tissue was successful. CONCLUSION: MRI-guided needle-localization procedures in an open design magnet with in-room, contemporaneous image monitoring offer advantages over previous conventional interventional MRI systems by allowing interactive guidance with near real-time imaging feedback. As a result, procedure time is reduced and accuracy of instrument positioning is increased.     

MR imaging-guided prostate interventional imaging: Ready for a clinical use?

Prostate interventional magnetic resonance imaging (MRI) is now routinely performed in many centers. Its more widespread acceptance is limited by the cost of the use of MRI largely related to the long duration time of the procedures. However, the benefit of a robotic assistance has generated a new interest, because it substantially shortens the procedure time, while improving the accuracy. MRI-guided biopsy is considered as an appealing alternative to transrectal ultrasound (TRUS)-guided fusion biopsy, given the limitations of TRUS-MRI image registration systems. MRI-guided focal treatment also benefits from robotic assistance and from the unique property of MRI, which allows the measurement of the temperature in real-time during tumor ablation. The transrectal and transperineal approaches can be used and the respective indications of each pathway will depend on several factors, including the location of the tumor and the examination time, which will condition the occupation time of the MR room, a major factor influencing the overall cost of MRI-guided procedures. This review addresses the current practice of prostate MRI-guided interventional procedures and potential future applications.     

胰十二指肠切除术围术期规范化开展加速康复外科的几点争议

胰十二指肠切除术(PD)是普通外科最为复杂的手术之一,手术吻合口多,出现胰瘘、胆瘘、腹腔感染等并发症的风险大,围术期管理困难。近年提倡并应用的精准、微创、损伤控制的现代外科理念为加速康复外科(ERAS)的施行奠定了基础,尽管国际上已发布纲要性的共识指南,国内对于PD围手术期管理中实施ERAS仍存在不少争议。为了在PD围术期规范化开展ERAS,笔者就术前禁食禁饮时间、术后鼻胃管和腹腔引流管拔除时机、术后生长抑素使用与否等几个关键的争议问题进行讨论和阐释。     

Anesthesia for endovascular neurosurgery and interventional neuroradiology

This review outlines the roles of anesthesiologists in the management of patients undergoing invasive endovascular procedures to treat vascular diseases, primarily of the central nervous system. This practice usually is termed interventional neuroradiology or endovascular neurosurgery. The discussion emphasizes perioperative and anesthetic management strategies to prevent complications and minimize their effects if they occur. Planning anesthetic and perioperative management is predicated on understanding the goals of the therapeutic intervention and anticipating potential problems.     

Anesthesia for endovascular neurosurgery and interventional neuroradiology

This article outlines the roles of the anesthesiologist in the management of patients undergoing invasive endovascular procedures to treat vascular diseases, primarily of the central nervous system. This practice is usually termed interventional neuroradiology or endovascular neurosurgery. The article emphasizes perioperative and anesthetic management strategies to prevent complications and minimize their effects if they occur. Planning the anesthetic and perioperative management is predicated on understanding the goals of the therapeutic intervention and anticipating potential problems.     

巨脾型晚期血吸虫病临床路径探讨

参考国外最新临床指南,结合笔者多年的实践经验,制定巨脾型晚期血吸虫病的临床路径。路径包括诊断、药物治疗、内镜治疗、介入治疗、手术适应证、手术方式、围手术期处理、总体住院时间以及出院后治疗、护理、随访等,从而为晚期血吸虫病的外科治疗建立一套标准化流程、路线。     

腹主动脉瘤伴高血压患者介入治疗围手术期血压的护理干预

目的总结腹主动脉瘤伴高血压患者介入治疗围手术期血压护理干预的具体措施、经验。方法对8例实施腔内隔绝术治疗的腹主动脉瘤伴高血压的患者，实施积极的血压治疗及护理干预。结果本组患者在围手术期血压保持平稳，能顺利接受治疗。结论围手术期积极的护理干预措施，能有效预防并发症的发生，保证治疗的顺利进行。     

Controversies in perioperative management and antimicrobial prophylaxis in urologic surgery

Abstract:   The Japanese Urological Association (JUA) recently published guidelines for the prevention of perioperative urologic infections. Although the general remarks in the JUA guidelines are almost similar to those in guidelines previously published by the Centers for Disease Control and Prevention (CDC) and in the European Association of Urology (EAU) guidelines, their differences leave several questions that need to be answered. To clarify agreements and differences in guidelines for perioperative management in urologic interventions for development of more optimal guidelines, reports and reviews previously published were overlooked and discussed. In terms of surgical site infections (SSI) in urologic surgery, consensus for open and endoscopic-instrumental procedures is still somewhat controversial, while a consensus has not yet emerged for its use in laparoscopic procedures. Further research is required to determine what is an optimal prophylactic protocol to effectively prevent both SSI and remote infections (RI).     

Magnetic resonance imaging-guided core needle biopsy and needle localized excision of occult breast lesions.

BACKGROUND: Breast magnetic resonance imaging (MRI) has been reported to be twice as sensitive and three times more specific in detecting breast cancer. We report a series of MRI-guided stereotactic breast biopsies (SCNBB) and needle localized breast biopsies (NLBB) to evaluate MRI as a localization tool. METHODS: Forty-one breast lesions were identified in 39 patients who subsequently had SCNBB or NLBB. Suspicious areas of enhancement were stereotactically biopsied with 16-G core biopsy needles or localized with 22-G wires for excision under laser guidance. RESULTS: Forty-one breast lesions were identified from 1,292 breast MRIs. SCNBB identified three malignancies and two areas of atypia. Two additional cancers were found after NLBB. In patients having NLBB alone, five cancers and two areas of atypia were identified. CONCLUSIONS: In this initial series, breast MRI-guided SCNBB and NLBB were valuable tools in the management of patients with suspicious abnormalities seen only on MRI.     

Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group

Purpose

Correct diagnosis, surgical treatment, and perioperative management of patients with esophageal carcinoma remain crucial for prognosis within multimodal treatment procedures. This study aims to achieve a consensus regarding current management strategies in esophageal cancer by questioning a panel of experts from the German Advanced Surgical Treatment Study (GAST) group, comprised of 9 centers specialized in esophageal surgery, with a combined total of >220 esophagectomies per year.

Materials and methods

The Delphi method, a systematic and interactive, evidence-based approach, was used to obtain consensus statements from the GAST group regarding ambiguities and disparities in diagnosis, patient selection, surgical technique, and perioperative management of patients with esophageal carcinoma. After four rounds of surveys, agreement was measured by Likert scales and defined as full (100% agreement), near (??66.6% agreement), or no consensus (<66.6% agreement).

Results

Full or near consensus was obtained for essential aspects of esophageal cancer staging, proper surgical technique, perioperative management and indication for primary surgery, and neoadjuvant treatment or palliative treatment. No consensus was achieved regarding acceptability of minimally invasive technique and postoperative nutrition after esophagectomy.

Conclusion

The GAST consensus statement represents a position paper for treatment of patients with esophageal carcinoma which both contributes to the development of clinical treatment guidelines and outlines topics in need of further clinical studies.