吲哚菁绿荧光实时导航达芬奇Xi机器人肝切除术初步探讨

目的总结达芬奇Xi机器人联合吲哚菁绿荧光定位肝脏肿瘤实现精准肝切除的经验。 方法回顾分析2021年1～5月期间20例吲哚菁绿荧光定位联合达芬奇Xi机器人肝肿瘤切除术患者的临床资料。 结果20例均在达芬奇Xi机器人下完成肝肿瘤切除,无中转开腹,手术时间85 min(70～105 min),术中出血量110 ml(50～200 ml ),术后住院时间7 d(5～9 d)。术后患者肝功能恢复良好,均未出现出血、胆漏等并发症。术后病理结果：肝细胞肝癌10例、肝细胞异型增生和胆管异形增生1例、胆管细胞癌6例、肝硬化伴肝脏炎性改变1例、腺癌(胃肠道转移)2例。20例均为R0切除,愈合良好出院。 结论在熟练完成腹腔镜肝肿瘤切除术的基础上,开展吲哚菁绿荧光定位联合达芬奇Xi机器人手术系统精准肝切除是安全、可行的,具有较高的临床价值及推广意义。     

连续式和跳跃式颈椎前路椎间盘切除融合术治疗多节段颈椎病

目的探讨连续式和跳跃式颈椎前路椎间盘切除融合术(ACDF)治疗多节段颈椎病的疗效及安全性。方法回顾性分析2013年1月-2018年12月收治的经非手术治疗无效的78例多节段颈椎病患者临床资料,其中36例采用跳跃式ACDF治疗(观察组),42例采用连续式ACDF治疗(对照组)。比较2组手术时间、术中出血量、住院时间等临床指标及并发症发生情况。记录2组C_2~7活动度(ROM)、矢状位垂直距离(SVA)、T₁倾斜角、植骨融合率、邻近及中间保留节段椎间盘退行性变加重率等影像学指标。采用日本骨科学会(JOA)评分及JOA评分改善率评估神经功能改善情况。结果所有手术顺利完成。所有患者随访8~19个月,中位随访时间为13个月。观察组手术时间和术中出血量明显少于对照组,差异有统计学意义(P < 0.05);2组住院时间差异无统计学意义(P > 0.05)。2组术后各随访时间点JOA评分均较术前改善,差异有统计学意义(P < 0.05),组间差异无统计学意义(P > 0.05);2组JOA评分改善率差异无统计学意义(P > 0.05)。2组术后12周C_2~7 ROM较术前降低,SVA及T₁倾斜角较术前增加,差异均有统计学意义(P < 0.05),组间差异无统计学意义(P > 0.05);末次随访时C_2~7 ROM、SVA及T₁倾斜角均较术后12周有所改善,接近术前水平。2组植骨融合率、邻近及中间节段椎间盘退行性变加重率比较,差异无统计学意义(P > 0.05)。2组植骨融合率、邻近及中间节段椎间盘退行性变加重率差异无统计学意义(P > 0.05)。观察组术后发生吞咽困难2例、声音嘶哑1例,并发症发生率为8.33%;对照组术后发生吞咽困难2例,并发症发生率为4.76%;组间差异无统计学意义(P > 0.05)。结论跳跃式ACDF用于经非手术治疗无效的多节段颈椎病患者可获得与连续式ACDF相近的术后疗效及安全性,并能够有效缩短手术时间,减少术中医源性创伤。     

基于诺丁斯关怀理论临床护士人文关怀能力评价指标体系的构建

目的基于诺丁斯关怀理论构建临床护士人文关怀指标体系,为评估临床护士人文关怀能力提供方法和策略。方法在诺丁斯关怀理论的基础上,结合文献研究法和质性访谈法,并选取来自安徽省的29名专家进行2轮德尔菲专家咨询,以确立临床护士人文关怀能力评价的指标体系。结果2轮德尔菲专家咨询的积极系数分别为96.67%和100%,专家权威程度系数为0.86、0.87,第一轮专家函询的Kendall协调系数为0.282,第二轮为0.276;各指标赋值均数为4.69~4.93;变异系数为0.052~0.169,分值均符合要求。经过2轮德尔菲初步构建了一套4个一级指标、12个二级指标、92个三级指标的临床护士人文关怀能力评价的指标体系。结论运用德尔菲法构建的临床护士人文关怀能力评价指标体系,其函询结果可靠,专家的积极程度、权威程度、协调程度及集中程度均较高,可作为临床护士人文关怀能力的评价工具。     

视网膜中央静脉血流彩色多普勒检测

本文应用彩色多普勒血流显像（ＣＤＦＩ）对１０５例正常人２１０只眼的视网膜中央静脉（ＣＲＶ）各项血流参数进行检测。结果：各血流参数与年龄之间无密切相关性Ｐ＞０．０５，性别及眼别之间亦无显著性差异Ｐ＞０．０５，描述了正常ＣＲＶ彩色血流及血流频谱特点。ＣＲＶ血流频谱形态随视网膜中央动脉（ＣＲＡ）呈搏动性、周期性变化。认为该血管的解剖特点决定了其血流动力主要来源于ＣＲＡ血流驱使力或搏动，其它因素影响不大。这是研究ＣＲＶ血流动力学的有利条件。提出了各项指标的正常值范围。     

犬急性心肌缺血后左室功能变化与心肌细胞凋亡

目的观察犬急性心肌缺血后左心室壁动度、射血功能、细胞凋亡与心肌组织中caspase3活性的变化。方法犬30只随机分为实验组15只及对照组15只,实验组结扎左冠状动脉前降支近端,结扎时间分别为10min、30min、60min,每一时间点5只,对照组游离左冠状动脉前降支近端,不结扎。心肌组织行三苯四氮唑(TTC)染色,梗死区为黄白色,非梗死区为砖红色。超声心动图测定左室前壁增厚率及左心室射血分数,原位末端脱氧核苷酸转移酶介导的生物素脱氧尿嘧啶核苷酸缺口末端标记法(TUNEL)检测梗死区心肌组织凋亡细胞数,行caspase3活性测定。结果TTC染色示左室前壁及部分前间隔染色为黄白色,其余区域为砖红色。实验组冠脉结扎后10min,左室前壁增厚率降低,与对照组比较有显著性差异(P<0.05)。左心室射血分数未发生明显改变,与对照组比较无显著性差异(P>0.05)。冠脉结扎后30min至60min,前壁增厚率降低与左心室射血分数进一步下降,与对照组比较有非常显著性差异(P<0.01)。实验组冠脉结扎后10min,梗死区心肌TUNEL阳性细胞数与对照组比较无显著性差异;冠脉结扎后30min至60min,梗死区心肌TUNEL阳性细胞数明显增加,与对照组比较有非常显著性差异(P<0.01)。实验组冠脉结扎后10min,梗死区心肌caspase3荧光值升高,与对照组比较有显著性差异(P<0.05)。30min至60min梗死区心肌caspase3荧光值明显升高,与对照组比较有非常显著性差异(P<0.01)。结论急性心肌缺血后早期,促凋亡基因caspase3激活,缺血心肌细胞凋亡可能为急性心肌缺血的早期病理改变,并且与心肌室壁动度与左室收缩功能降低有一定关系。     

Debakey III型主动脉夹层腔内隔绝术后近期CT评估及价值

目的　探讨DebakeyIII型主动脉夹层进行腔内隔绝术 (EVE)后CT评估的方法及价值。 方法　 5 1例De bakeyIII型主动脉夹层患者接受了EVE手术治疗。主要检查内容为移植物的形态、位置 ;移植物内的血流通畅度 ;有无内漏及夹层变化情况。结果　术后近期CT所见 :1例术后 7天CTA检查发现移植物中段少量内漏。 4例于术后 7天发现假腔血栓化不彻底 ,有远端血液反流入假腔。 1例移植物失去正常形态 ,但血流通畅 ,未处理。其余均未发现真腔外异常血流影像。结论　主动脉夹层EVE术后CT评估具有图像重建方式多样、提供的信息量大、可准确测量、图像直观易理解、成像清晰、可观察周围组织、易检出并发症等优点 ,应作为首选的术后评估方法。     

Single scrotal incision orchiopexy versus the inguinal approach in children with palpable undescended testis: a systematic review and meta-analysis

Purpose

We performed a systematic review and meta-analysis to compare the efficacy and safety between single-incision, transscrotal orchidopexy, and the traditional inguinal orchidopexy in children.

Methods

A systematic search of the electronic databases was conducted to identify studies compared the transscrotal orchidopexy (SO) and inguinal orchidopexy (IO) for children. Parameters, such as operative time, the incidence of patent processus vaginalis, and postoperative complications, including wound infection, testicular atrophy, testicular reascent, hernia, or hydrocele, were pooled and compared by meta-analysis.

Results

Among the 1376 children with palpable undescended testes (UDTs) included in the eight studies, 697 had received SO and 679 IO. There were shorter operative times with the SO approach compared with IO. However, no significant difference was found between SO and IO in the incidence of patent processus vaginalis and postoperative complications, including wound infection, testicular atrophy, testicular reascent, and hernia.

Conclusion

SO is a safe and effective surgical approach alternative to IO for pediatric UDTs. Compared with IO, SO has the advantage of shorter operative times. Besides, the incidence of postoperative wound infection may be slightly lower in SO. We suggest that SO should be considered as an acceptable option for children with UDTs.

     

Application of FLEEOX Preoperative Chemotherapy via Intra-arterial and Intravenous Administration in Treatment of Unresectable Locally Advanced Gastric Cancer

Background

The prognosis of unresectable locally advanced gastric cancer is poor. We applied preoperative chemotherapy via intra-arterial and intravenous administration to convert an initially unresectable gastric cancer to a resectable cancer.

Methods

From January 2005 to December 2010, 105 patients with unresectable locally advanced gastric cancer (T3-4N1-3M0) were selected for preoperative chemotherapy with 5-FU + leucovorin + etoposide + oxaliplatin + epirubicin (FLEEOX) regimen. 5-Fu (370 mg/m²) and leucovorin (200 mg/m²) were administered by intravenous infusion on days 1–5. Intra-arterial administration of etoposide (80 mg/m²), oxaliplatin (80 mg/m²), and epirubicin (30 mg/m²) was performed by Seldinger method on days 6 and 20, repeated two cycles. Patients who achieved partial response (PR) or complete response (CR) underwent D2 dissection, followed by four to six cycles of XELOX chemotherapy. The response rate, 1- and 3-year survival rate, and R0 resection rate were evaluated.

Results

The response rate of preoperative chemotherapy was 78.1 % (82 of 105 patients), with 7 cases of CR and 75 cases of PR, respectively. After chemotherapy, a total of 78 patients (74.3 %) underwent surgery, and 67 cases achieved R0 resection (85.9 %). The 1- and 3-year overall survival (OS) rate of all 105 patients was 71.9 and 31.7 % (median survival time, 18 months). The 1- and 3-year OS rate among the 78 patients treated with chemotherapy plus surgery was 84.5 and 40 % (median survival time, 30 months). Patients treated with chemotherapy plus surgery had significantly longer OS times than patients who underwent chemotherapy alone (P?<?0.01).

Conclusions

Patients with unresectable gastric cancer may obtain a survival benefit from preoperative chemotherapy via intra-arterial and intravenous administration and subsequent surgery.