术前肌肉减少症对胃癌病人临床预后的影响:一项前瞻性队列研究

目的:探讨胃癌病人术前存在肌肉减少症对术后病人临床预后的影响。方法:前瞻性纳入93例胃癌病人,使用生物电阻抗法检测骨骼肌质量,分为两组:肌肉减少症组和非肌肉减少症组,比较分析术前存在肌肉减少症对胃癌病人术后总并发症发生率、住院时间、住院费用、60天再入院及病死率等指标的影响。结果:术前存在肌肉减少症的病人与正常对照组相比:总并发症发生率、总住院天数和术后住院天数具有显著性差异(P0.05)。60天再入院率、60天病死率和总住院费用方面肌肉减少症组略高于正常对照组,但无统计学差异(P0.05)。单因素和多因素分析显示,术前存在肌肉减少症及存在营养风险是增加术后并发症发生率的独立危险因素。结论:术前存在肌肉减少症可导致胃癌病人术后不良临床预后,肌肉减少症是胃癌病人术后并发症增加的独立危险因素,术前应常规进行筛查与评估并及时纠正。     

肠内营养支持治疗原发性肝癌肝动脉化疗栓塞术后病人的营养状况变化

目的:观察肠内营养(EN)支持治疗对原发性肝癌肝动脉化疗栓塞术(TACE)术后病人的营养状况的影响。方法:将56例行TACE术后的原发性肝癌病人,随机分为EN组和对照组,每组各28例。术前进行营养筛查评估,术后均按照进食流质、半流质和普通饮食为顺序的过程,其中EN组病人给予短肽型EN支持治疗,分析比较两组病人在术后1个月内营养状况和并发症发生率的差异。结果:EN组病人的营养状况明显优于对照组,差异有显著性统计学意义(P0.05),并且其并发症的发生率低于对照组。结论:原发性肝癌TACE术后给予EN支持治疗不仅能改善病人的营养状况,而且还可减少病人的并发症。     

术前隧道标记法在经黏膜下隧道内镜切除术中的应用

目的探讨术前隧道标记法缩短经黏膜下隧道内镜切除术(STER)手术时间的临床效果。方法回顾性分析自2018年1月—12月医院消化内科收治的食管中下段及贲门固有肌层良性肿瘤患者40例临床资料,所有患者均行黏膜下隧道内镜切除术治疗。将术前行隧道黏膜下注射标记后再行黏膜下隧道内镜发现瘤体的20例患者作为A组,将常规经黏膜下隧道内镜发现瘤体的20例患者作为B组。比较A、B组从发现病灶、建立隧道至找瘤体时间,全程手术时间,手术瘤体大小以及距门齿平均距离;比较术后住院天数,术后有无感染、穿孔、出血等并发症,以及术后1、3、6月随访情况等指标。结果 A组患者寻找瘤体时间、全程手术时间、并发症总发生率明显低于B组,且差异有统计学意义(P <0. 05); A组患者术后1、3、6个月肿瘤残留或复发情况与B组相比,无统计学差异(P>0. 05)。结论术前隧道标记法作为改良的经黏膜下隧道内镜切除术在缩短食管胃黏膜下肿瘤手术时间有一定优势,有助于减少发现瘤体时间,从而减少手术时间,减少术后并发症。     

胃大部分切除术后早期肠内营养支持及护理

目的了解早期肠内营养支持对胃大部分切除术后病人营养状况的影响及总结护理要点。方法将2002年1月-2006年12月行胃大切手术的65例病人,随机分成实验组34例和对照组31例,对照组按胃大部分切除术后留置胃管、禁食、输液、肠外营养等治疗护理,实验组在实施对照组措施外,同时于术后16～20h给予肠道内营养支持;比较两组病人营养指标、并发症的发生率及住院天数。结果实验组病人术后8d的营养指标较对照组好(P均<0.01),并发症总发生率及住院天数与对照组比较,差异有统计学意义(P均<0.05)。结论术后早期肠内营养支持能提高胃大部分切除病人营养指标,降低并发症的发生率,缩短住院天数,明显提高病人的生存质量。     

肠内免疫营养对老年食管癌病人术后免疫水平的影响

目的:研究肠内免疫营养(EIN)制剂对老年食管癌病人术后免疫水平的影响。方法:选取老年食管癌病人92例,随机分为两组,试验组给予EIN,对照组给予普通肠内营养(EN)。两组病人术后均给予同等的热量和氮量,于术前1 d、术后第1和第8天分别检测相关的营养和免疫指标,包括血清总蛋白(TP)、前清蛋白(PA)、清蛋白(ALB)、转铁蛋白(TF)、Ig G、Ig A、Ig M、CD3、CD4、CD4/CD8、NK细胞,并对各项指标进行比较和分析。结果:两组病人术前各项免疫和营养指标均无显著性差异(P0.05)。术后第1天,各组血清蛋白指标和免疫指标均明显低于术前1 d。术后第8天,两组病人血清蛋白水平较术后第1天明显上升,但组间差异无统计学意义(P0.05),试验组免疫指标Ig G、CD3、CD4、CD4/CD8、NK细胞明显高于对照组,差异有显著性统计学意义(P0.05)。试验组病人的住院时间缩短,感染并发症的发生率降低。结论:老年食管癌术后应用EIN制剂可提高病人的免疫功能,降低术后感染并发症的发生率,缩短住院时间。     

食管癌术后早期肠内营养支持的临床研究

目的:探讨早期肠内营养(EEN)在食管癌术后病人营养支持的优越性。方法:将70例食管癌术后病人随机分为对照组和EEN组,每组各35例。分别给予肠外营养(PN)和EEN支持。病人于术前和术后第10天测体重(BW)、血清清蛋白(ALB),观察胃肠道反应,记录术后住院天数和住院费用。结果:两组病人术后BW和ALB均有所下降,但两组间有显著性差异(P0.05)。EEN明显缩短术后住院天数(P0.05)和减少住院费用(P0.05)。结论:营养支持能改善食管癌病人术后的营养状况,EEN能明显缩短住院时间和减少住院费用。     

短肽制剂在结直肠癌围手术期病人的应用观察

目的:观察结直肠癌病人应用短肽肠内营养(百普素)制剂辅助术前肠道准备的效果、相关营养指标以及对肠功能和术后免疫功能的影响。方法:将60例结直肠癌病人随机分为试验组和对照组,每组各30例。试验组病人于术前3天至术后第7天给予口服百普素营养支持,对照组病人入院后采用传统方式术前常规膳食、清洁灌肠法和术后PN营养支持。两组病人分别于术前1天、术后第1、3、7天分别检测ALB、Hb、免疫球蛋白(IgG、IgA、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)水平,观察两组病人术中肠黏膜和肠道清洁情况,术后营养状况、免疫功能、感染性并发症和住院时间的差异。结果:两组病人术中肠黏膜状况、肠道清洁度无显著性差异;术后两组病人各项营养指标和免疫指标水平均有不同程度下降,但试验组下降幅度明显低于对照组(P<0.01)。试验组病人术后第7天IgG、IgA、IgM明显高于对照组(P<0.01),术后感染性并发症的发生率低于对照组(P<0.01),术后平均住院时间较对照组缩短(P<0.01)。结论:结直肠癌病人围手术期应用短肽肠内营养制剂,更有利于营养状况和术后免疫功能的恢复,改善预后。     

胃癌病人术前有营养风险是临床预后不良的危险因素

目的:探讨胃癌病人术前存在营养风险对术后临床结局的影响以及预后不良的危险因素分析。方法:前瞻性观察140例胃癌病人,术前进行NRS 2002营养风险筛查,分析术前存在营养风险对术后并发症、住院时间、入住ICU时间、住院费用、60 d再入院及病死率的影响。运用单因素和多因素分析研究围手术期并发症的危险因素。结果:NRS 2002≥3分与NRS 20023分的病人总并发症发生率、肺部感染发生率、总住院天数和术后住院天数均有显著性差异(P0.05);而吻合口瘘、胸腔积液发生率、60 d再入院率、60 d病死率和住院费用等方面,虽然有营养风险组略高于无营养风险组,但无统计学差异(P0.05)。单因素和多因素分析显示,术前高总胆固醇水平和术前存在营养风险是影响病人预后的危险因素,也是发生术后并发症的独立危险因素。结论:术前存在营养风险病人的临床结局明显差于无营养风险病人,术前高总胆固醇水平和存在营养风险是围手术期并发症的独立危险因素。     

术后早期肠内营养对食管癌病人预后的影响

目的:通过比较早期肠内营养(EEN)和常规肠内营养(EN)组间围手术期病人的营养状况、细胞免疫功能、术后并发症以及临床指标,探讨EEN对食管癌病人预后的影响. 方法:前瞻性分析98例食管癌术后病人,按照不同时间EN支持分为EEN组(n=48)和EN组(n=50).比较两组病人术前、术后第3和第7天的体重、体重指数、血红蛋白、血清总蛋白、清蛋白、转铁蛋白、总淋巴细胞计数以及外周T淋巴细胞亚群等指标,同时观察病人并发症的发生率和临床指标. 结果:EEN组病人术后第3、7天营养指标和细胞免疫指标大多高于EN组,且差异有显著性统计学意义(P＜0.05).EN组病人术后吻合口瘘、肺部感染、切口感染、腹泻发生率略高于EEN组.另外,EEN组病人心律失常发生率低于EN组,且术后肛门排气时间短于EN组(P＜0.05). 结论:围手术期合理、早期使用EN支持能有效地提高食管癌病人的营养状况和免疫功能,降低并发症的发生率,缩短术后住院时间.     

临床路径对提升子宫平滑肌瘤行子宫切除术医疗服务品质的效用研究

目的探讨临床路径对提升子宫平滑肌瘤子宫切除术医疗服务品质的效用。方法将实施临床路径的子宫平滑肌瘤手术患者138例设为路径组,未实施临床路径的136例患者作为对照组,两组均行子宫全切除术或子宫次全切除术。比较分析两组患者的住院天数、术前住院天数、住院总费用、药品费用、检查费用、术后并发症发生率及满意度等。结果路径组住院天数、术前住院天数缩短;用药规范性增强,住院费用结构发生改变,药品费用减少;患者满意度明显提高。在术后并发症发生率方面,两组患者相比无统计学差异。结论临床路径的实施,规范了医疗服务行为,提高了医疗服务效率,提升了医疗服务品质。     

Prevalence of Sarcopenia and Its Impact on Postoperative Outcome in Patients With Crohn's Disease Undergoing Bowel Resection

Background: Sarcopenia has been proposed to be a prognostic factor of outcomes for various diseases but has not been applied to Crohn's disease (CD). We aimed to assess the impact of sarcopenia on postoperative outcomes after bowel resection in patients with CD. Materials and Methods: Abdominal computed tomography images within 30 days before bowel resection in 114 patients with CD between May 2011 and March 2014 were assessed for sarcopenia as well as visceral fat areas and subcutaneous fat areas. The impact of sarcopenia on postoperative outcomes was evaluated using univariate and multivariate analyses. Results: Of 114 patients, 70 (61.4%) had sarcopenia. Patients with sarcopenia had a lower body mass index, lower preoperative levels of serum albumin, and more major complications (15.7% vs 2.3%, P = .027) compared with patients without sarcopenia. Moreover, predictors of major postoperative complications were sarcopenia (odds ratio [OR], 9.24; P = .04) and a decreased skeletal muscle index (1.11; P = .023). Preoperative enteral nutrition (OR, 0.13; P = .004) and preoperative serum albumin level >35 g/L (0.19; P = .017) were protective factors in multivariate analyses. Conclusion: The prevalence of sarcopenia is high in patients with CD requiring bowel resection. It significantly increases the risk of major postoperative complications and has clinical implications with respect to nutrition management before surgery for CD.     

腹腔镜直肠癌根治术保留左结肠动脉与高位根部离断肠系膜下动脉对患者术后并发症及预后的影响

目的探讨腹腔镜直肠癌根治术保留左结肠动脉(LCA)与高位根部离断肠系膜下动脉(IMA)对患者术后并发症及预后的影响。方法回顾性分析2016年1月—2019年1月陇西县第二人民医院收治的行腹腔镜根治术的84例直肠癌患者临床资料,按照选择的术式分为观察组36例(保留LCA行低位结扎)和对照组44例(不保留LCA,行高位结扎)。比较两组患者围术期状况、术后病理情况和术后并发症发生率,随访12个月,观察记录患者术后复发转移情况。结果两组患者围术期状况、术后病理各项指标比较,差异均不显著(P0.05);观察组吻合口漏、吻合口出血、吻合口狭窄、肺部感染、泌尿系统感染、低位前切除综合征发生率、复发转移率及死亡率与对照组无显著性差异(P0.05),但观察组术后并发症总发生率更低(P0.05)。结论腹腔镜直肠癌根治术保留LCA与高位结扎IMA患者预后状况相近,但前者有利于降低患者术后并发症的发生风险。     

Transhiatal or transthoracic resection of esophageal carcinoma based on tumor location, positive high-thoracic lymph nodes and preoperative physical condition

The limited transhiatal resection for the surgical treatment of oesophageal cancer is aimed at limiting early postoperative complications by not performing lateral thoracotomy and formal lymphadenectomy. The extended transthoracic approach with two-field lymphnode dissection is intended to improve long-term survival. The recurrence pattern after transhiatal resection suggests that a subgroup of patients might benefit from the more extended approach. In a large randomized trial in two high-volume Dutch academic hospitals, extended resection resulted in more postoperative (pulmonary) complications and a prolonged postoperative recovery time, but when compared to transhiatal resection, had only a limited impact on quality of life. The estimated 5-year survival advantage after extended resection was 10% (95% confidence interval: -3% to +23%). Subgroup analysis indicated a 17% 5-year survival advantage for patients with oesophageal cancer, but only a 1% advantage for patients with cancer of the cardia or gastro-oesophageal junction. The individualized operative approach for patients with potentially curable oesophageal cancer is based on tumour location, positive high-thoracic lymph nodes and preoperative physical condition.     

老年直肠癌晚期患者行XELOX联合贝伐单抗治疗后腹腔镜辅助根治术的临床疗效

目的探讨老年直肠癌晚期患者行XELOX和贝伐单抗治疗后腹腔镜辅助根治术的临床疗效。方法回顾性研究老年患者66例,手术方式均为腹腔镜辅助根治直肠癌切除术。随机将患者分为治疗组(33例)和对照组(33例)。治疗组在术前行XELOX和贝伐单抗(bevacizumab,Bev)治疗(Bev 7.5 mg/kg+XELOX方案),而对照组在术前行常规化疗XELOX方案。比较两组术中术后基本情况、术后不良反应和并发症、术后复发率、术后生存期以及术后生存质量。结果两组患者术中术后基本情况比较差异不显著,因此术后不同化疗方案治疗疗效具有可比性。两组患者术后出现并发症的差异不显著,但术后不良反应中,治疗组患者的便秘以及出血不良发生率明显高于对照组。两组患者术后1年复发率无显著性差异,但治疗组的2年、3年和5年复发率均显著低于对照组。治疗组患者术后2年、3年和5年生存期均高于对照组,且有显著性差异。结论在老年直肠癌患者中行XELOX联合贝伐单抗治疗后腹腔镜辅助根治术,能有效控制肿瘤复发,增加老年患者的2年无病生存期,提高老年患者生存质量,对老年直肠癌患者具有重要临床意义。     

Primary resection of obstructive left-sided colon and rectal tumors without intraoperative lavage]

Of the study is to show the results of early postoperative period of left-sided large bowel obstruction (LBO) and methods of decompression without colonic lavage and primary resection. Retrospective analysis of 28 patients admitted to the Surgical Department with LBO between years 1996 and 2000 were treated with ortograde decompression, and primary resection without on table colonic lavage. The surgical method, complications and mortality are pointed out. The patients average age were 71 +/- 9.7 years and only one was free of comorbidity. The average time of operative interventions was 116 +/- 42 minutes. 9 patients out of 28 had rectum cancer their anastomosis were made by instrumental way and the others by hand. The bowel movement was restored (in 89%) on the fourth day of operation. Surgical complications were observed at 3/28 patients (10.7%), and non surgical complication at three patients. Mortality rate 3.5%, one patient was lost. The average hospital stay was 12 +/- 5 days, 70% of the patients were at home within 11 days. The emergency surgical treatment of left-sided colonic obstruction caused by cancer treated by ortograde decompression and primary resection without colonic lavage is a safe method in experienced surgeon hand. The patients have a short recovery period and better quality of life.     

40例手助腹腔镜结直肠癌根治术术前及术后的护理

目的:总结手助腹腔镜结直肠癌根治术的护理.方法:分析40例手助腹腔镜结直肠癌根治术患者的临床资料.结果:40例患者均成功实施手助腹腔镜结直肠癌根治术,术前加强心理护理、营养支持、肠道准备、肠造口腹部定位及皮肤准备;术后注意生命体征监测、饮食活动指导、疼痛、引流管及造口护理;及时发现并处理肠梗阻、肺部感染、切口感染等并发症,患者均痊愈出院.结论:加强术前及术后护理,早期发现及时处理并发症,有利于患者早日康复.     

宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统治疗子宫内膜息肉的疗效及安全性分析

目的:探讨宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫内膜息肉的疗效及安全性。方法:总结、分析129例围绝经期患者经宫腔镜下切除及术后放置曼月乐治疗子宫内膜息肉的临床及随访资料。结果:全部患者宫腔镜手术均顺利完成,无手术并发症发生,术后病理结果为子宫内膜息肉,诊断性刮宫、子宫内膜病理结果排除子宫内膜恶性病变,于术后7～10日放置曼月乐。所有患者随访满2年,患者月经模式改变,月经过多者月经量明显减少,血红蛋白值明显升高,术前血红蛋白水平为(96.23±10.22)g/L,术后6、12、24个月血红蛋白值分别为(115.46±7.38)g/L、(120.16±8.23)g/L和(126.56±9.79)g/L,手术前与手术后各组血红蛋白值比较差异均有统计学意义(P<0.05);术前及术后6、12、24个月子宫内膜厚度分别为(1.48±0.36)cm、(0.78±0.22)cm、(0.69±0.16)cm和(0.58±0.13)cm,手术前与手术后子宫内膜厚度各组间比较差异均有统计学意义(P<0.001);无病例复发;术后患者血清雌、孕激素水平均无明显变化,无明显不良反应发生。结论:宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统治疗子宫内膜息肉临床效果肯定,可抑制子宫内膜增长,随访无复发病例,安全、有效,值得临床推广。     

Effects of Malnutrition on Neutrophil/Mononuclear Cell Apoptotic Functions in Children with Acute Lymphoblastic Leukemia

Background: Recent studies claim that apoptosis may explain immune dysfunction observed in malnutrition. Objective: The objective of this study was to determine the effect of malnutrition on apoptotic functions of phagocytic cells in acute lymphoblastic leukemia (ALL). Materials and Methods: Twenty-eight ALL patients (13 with malnutrition) and thirty controls were enrolled. Neutrophil and mononuclear cell apoptosis of ALL patients and the control group were studied on admission before chemotherapy and repeated at a minimum of three months after induction of chemotherapy or when the nutritional status of leukemic children improved. Results: The apoptotic functions of both ALL groups on admission were significantly lower than those of the control group. The apoptotic functions were lower in ALL patients with malnutrition than those in ALL patients without malnutrition, but this was not statistically significant. The repeated apoptotic functions of both ALL groups were increased to similar values with the control group. This increase was found to be statistically significant. Conclusions: The apoptotic functions in ALL patients were not found to be affected by malnutrition. However, after dietary intervention, increased apoptotic functions in both ALL patient groups deserve mentioning. Dietary intervention should always be recommended as malnutrition or cachexia leads to multiple complications. Enhanced apoptosis might originate also from remission state of cancer.     

快速康复外科在结直肠癌手术中的应用

目的 探讨快速康复外科在结直肠癌手术中的应用.方法 选取80例结直肠癌手术患者,按随机数字表法分为观察组和对照组,每组40例,分别采用快速康复外科治疗及传统方法 治疗,比较两组术后首次排气、排便时间及住院时间、术后并发症发生率、再住院率及住院费用.结果 观察组首次排气、排便时间及住院时间[分别为(2.7±0.9)、(2.9±0.1)、(5.8±1.0)d]明显短于对照组[分别为(3.9±0.5)、(4.2±0.3)、(8.3±1.2)d],术后并发症发生率[7.5%(3/40)]及住院费用[(1.83±0.22)万元]也明显低于对照组[分别为27.5%(11/40)、(2.35±0.36)万元],差异均有统计学意义(P＜0.05).结论 采用快速康复外科技术可以有效促进结直肠癌患者术后胃肠道功能的恢复,减少并发症的发生并节省住院费用.

Abstract：

Objective To investigate the feasibility of fast-track surgery in colorectal surgery.Methods Eighty consecutive patients with colorectal cancer admitted for colorectal surgery were divided into two groups by random digits table with 40 cases each. Group A was treated with the new concept of fasttrack surgery and group B was treated with the traditional methods of operation. The time of postoperative bowel venting and defecation,hospital stay time, the rate of complication, the rate of readmission and the total cost during hospitalization were compared. Results The time of postoperative bowel venting and defecation,hospital stay time were shorter in group A [(2.7 ± 0.9), (2.9 ± 0.1 ), (5.8 ± 1.0) d,respectively]than those in group B [( 3.9 ± 0.5 ), (4.2 ± 0.3 ), ( 8.3 ± 1.2) d, respectively] and the rate of complication and the total cost during hospitalization in group A [7.5%(3/40), ( 1.83 ± 0.22) ten thousand yuan] were lower than those in group B[27.5%(11/40), (2.35 ± 0.36) ten thousand yuan](P＜ 0.05). Conclusion The new concept of fast-track surgery can accelerate recovery after colorectal resection,reduce the rate of overall complications and total cost during hospitalization.     

预防性护理干预在女性垂体瘤切除术患者围手术期的应用效果

目的探讨预防性护理干预在女性垂体瘤切除术患者围手术期的应用效果。方法选取2019年11月至2020年12月中国科学技术大学附属第一医院南区收治的84例女性垂体瘤切除术患者作为研究对象,根据护理方法的不同分为观察组(42例)和对照组(42例),分别实施预防性护理干预和常规护理,比较两组患者术后并发症发生率、护理满意度及护理前后焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果观察组患者术后并发症总发生率低于对照组,差异有统计学意义(P<0.05)。两组护理后的SAS和SDS评分低于护理前,观察组护理后SAS和SDS评分低于对照组,差异有统计学意义(P<0.05)。观察组患者的护理总满意度高于对照组,差异有统计学意义(P<0.05)。结论女性垂体瘤切除术患者实施预防性护理干预,可提高术后并发症的防治效果,促进患者快速、良好康复。