损伤控制性外科理念在胃肠外科中的应用

目的?研究探讨损伤控制性外科理念在胃肠外科包括非创伤急症、创伤外科中的应用.方法?对该院32例损伤控制性手术及16例行常规手术患者的临床资料进行回顾性分析,综合对比两组患者术后表现及康复情况.结果?损伤控制组与常规手术组患者术后的体温、氧饱和度等方面差异无显著意义,凝血酶原时间差异具有统计学意义.结论?损伤控制性外科理念在胃肠外科急、重病症中具有着重要的意义.     

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.     

Evidence-based surgery

Authority-based surgery is slowly being replaced by evidence-based surgery. New and existing interventions are increasingly being studied in randomised controlled trials (RCTs). RCTs allow not only for comparison of different types of surgical interventions but also for comparison with non-surgical interventions and adjuvant therapies. Surgical RCTs have many methodological limitations, such as inherent difficulties with randomisation and blinding, and ethical limitations in using placebo controls. Choosing appropriate intervention groups, providing adequate training for participating surgeons and ensuring a high volume per surgeon reduces the risk of complications due to inexperience. Unplanned cross-over is a potential source of bias in explanatory RCTs comparing surgical interventions. Conducting a surgical RCT requires good collaboration between large and small hospitals due to organisational complexity, ethical limitations, funding and long term follow-up. Acceptance and implementation of the results from surgical RCTs through evidence-based guidelines depends heavily on local opinion leaders and the training of surgical residents.     

Plastic surgery

Plastic surgery is all too often thought of as an indulgence of the rich and famous with little attention paid to the repair of bodies and limbs disfigured or deformed by accident or illness. Surgeons look to management to address those issues that create an insecure base for planning the service and for its organisation nationwide.     

Craniofacial surgery

Craniofacial surgery is concerned with the treatment of congenital and acquired conditions affecting the head, face and jaws (Tessier, 1971a). Previously these were treated individually by plastic, neurological and faciomaxillary surgeons. This type of surgery was associated with a high risk of morbidity and mortality (Goldin, 1975). Following the pioneering work of Dr Paul Tessier in Paris during the mid-1960s, using a multidisciplinary team approach has allowed for more radical treatment of these abnormalities with an acceptable morbidity rate within established craniofacial units (Munro, 1975).     

Wrong-site surgery

Despite all the attention on this tragic problem and the emergence of proven protocols to prevent it, wrong-site surgeries persist. It's time to make them stop.     

Day surgery

Costing half as much as inpatient treatment, with good results and advantages to patients, day surgery might be expected to be more widespread than it is. Purchasers may be those who push for more by specifying targets for day surgery for certain procedures. How can managers respond?     

Kodama手术在乳腺癌改良根治术中的应用探讨

目的 探讨Kodama手术在乳腺癌改良根治术中的应用价值.方法 90例乳腺癌改良根治术患者按分层抽样法随机分为两组,研究组（45例）采用Kodama手术行淋巴结清扫;对照组（45例）采用Patey手术行淋巴结清扫.比较两组术中、术后情况.结果 研究组淋巴结清扫数目、术中出血量与对照组比较差异无统计学意义（P＞0.05）.研究组手术时间长于对照组[（82.5±13.1）min比（66.9± 11.2） min];术后6个月患侧上肢运动障碍、感觉异常发生率均显著低于对照组[6.7％（3/45）比42.2％（19/45）,4.4％（2/45）比22.2％（10/45）],差异有统计学意义（P＜0.01或＜0.05）;研究组轻、重度胸大肌萎缩发生率分别为4.4％ （2/45）和2.2％（1/45）,均低于对照组的31.1％（14/45）和37.8％（17/45）,差异有统计学意义（P＜0.01）.结论 Kodama手术保留功能神经在乳腺癌改良根治术中有较高的应用价值.     

小儿外科的加速康复外科应用现状

加速康复外科(EARS)是指采用一系列有循证医学证据的围手术期优化措施,以减少或降低病患的心理和生理创伤应激,促进病人术后的快速康复。目前,国内外ERAS的研究主要集中在成人外科相关领域,关于小儿外科的相关研究和临床实践较少,而这一人群往往面临更为复杂的外科应激,优化围术期处理措施显得更为重要和迫切。小儿加速康复外科实施过程还有较多的困难和挑战,如传统理念如何突破、麻醉科和外科之间如何协调配合、术前禁食时间问题、目标导向性输液问题如何实施、麻醉方式选择、术后镇痛模式和用药问题等,需要进行前瞻性、多中心的研究来探索和解决。以下就小儿外科中EARS的应用现状、困难和展望作一综述。     

Tailored antireflux surgery

Background: With increasing age, the functional condition of the lower esophageal sphincter is getting weaker. Recent progress in peri-operative intensive care and the development of laparoscopic technique makes antireflux surgery a safe choice of GERD treatment in the elderly.Aim: This work evaluated the long-term results of tailored antireflux surgery in a group of elderly (more than 60 years old) patients.Results: Five hundred and eighty one patients underwent antireflux surgery in our department from 1999 to 2005. Seventy of them (12,0%) were older than 60 years. Exclusion criteria of surgery were ASA IV classification and high grade esophageal dysmotility. Toupet’s wrap was offered to patients with esophageal dysmotility or esophageal sphincter pressure higher than 15mm Hg (16 cases). The rest were offered Nissen-Rossetti’s complete wrap (54 cases). There was zero mortality and no further significant dysphagia. Pathological gastro-esophageal reflux after the surgery was detected in 6 patients (8,6%), which was a higher proportion than in the group of patients under 60 years.Conclusion: Good results of antireflux surgery with zero mortality and low morbidity can be achieved even in the elderly (more frequent use of incomplete Toupet’s wrap).     

Cosmetic breast surgery

This contribution discusses the history of breast implants and the materials used, and provides a review of the risks associated with implants. The surgical techniques, clinical applications and complications of augmentation mammaplasty and breast reduction and mastopexy are covered, in addition to reduced scar breast reduction and mastopexy techniques.