血清β2—微球蛋白测定在消化系统疾病中的应用价值

目的：探讨血清β2－微球蛋白（β2-Microglobulin,β2-MG）在消化系统疾病中的变化水平和诊断价值。方法：采用放射免疫分析法检测112例消化系统恶性肿瘤和173例消化系统良性疾病患和60例正常人的血清β2-MG水平，结果：消化系统恶性肿瘤比消化系统良性疾病和正常人的血清β2-MG明显增高（P＜0．05），高β2-MG血症发生率消化系统恶性肿瘤（63．39％）较良性疾病（16．76％）明显增高（P＜0．01），血清β2-MG增高在进展期肿瘤中占92．86％，相对稳定期肿瘤中仅占53．57％（P＜0．01），结论：血清β2-MG有助于鉴别消化系统良、恶性疾病，而动态观察肿瘤患的血清β2-MG变化对判断病程进展，评价预后有一定的临床实用价值。     

惠东县5141例儿童血铅检测的结果与分析

目的调查本地区儿童血铅水平及其影响因素,为制定干预措施提供依据。方法采用BH-2100钨舟原子吸收仪共检测5141份3～6岁儿童末梢血血铅含量,并对不同区域儿童的血铅水平、男女童血铅检测结果进行比较分析。结果城区组血铅水平为（69．05±23．90）μg／L;鞋工业乡镇组血铅水平为（75．85±26．40）μg／L;海岛山区组血铅水平为（65．29±22．00）μg／L;受检儿童中血铅浓度≥100μg／L有328例（6．38％）;男童血铅水平高于女童,差异有显著性（P〈0．01）。结论儿童的血铅水平存在明显的区域差异,鞋工业乡镇组较高;应加强对儿童血铅筛查,防止铅污染环境而影响儿童健康;在儿童保健中应科学合理地推行铅中毒的防治,改善儿童健康教育状况。     

不同下肢深静脉血栓形成患者并发肺栓塞的CT肺血管造影的评估价值

目的探析CT肺血管造影(CTPA)在不同下肢深静脉血栓形成(LDVT)患者并发肺栓塞(PE)中的临床评估价值。方法以我院2012年1月至2015年10月期间行CTPA检查的下肢深静脉血栓患者105例作为研究对象,分为A组(左下肢LDVT,n=58)、B组(右下肢LDVT,n=30)、C组(双下肢LDVT,n=17),均行CTPA检查,比较三组PE检出率,计算CT肺动脉栓塞指数(CTI)并比较CTI≥40%患者所占百分率。结果 A、B、C三组的PE检出率分别为41.4%(24/58)、53.3%(16/30)、76.5%(13/17),C组PE检出率明显高于A组,差异有统计学意义(P0.05)。结论 CT肺血管造影在不同LDVT患者中的应用对并发PE的诊断具有较大评估价值,尤其对于双下肢DVT患者,值得推广应用。     

面部侧貌美学特征的调查分析与研究(第二部分)--软硬组织指标的相关性研究

目的：进一步分析对侧貌美学指标有影响的硬组织指标,为临床诊治提供参考。方法：硬组织项目对筛选的５项软组织侧貌美学指标进行多元逐步回归分析,研究硬组织指标与美学指标的相关性。结果：颌骨位置、上下切牙倾斜度对侧貌美学指标均有相关性。结论：硬组织指标对侧貌是否美学观有影响,治疗中要通过改善不协调的牙颌关系使侧美观。     

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??Analysis of risk factors for prognosis of postoperative hemorrhage after pancreaticoduodenectomy: a report of 60 cases ZHU Qi-cong??WU Peng-fei??LU Zi-peng??et al. Pancreas Center??the First Affiliated Hospital of Nanjing Medical University??Nanjing 210029??China
Corresponding authors??JIANG Kui-rong??E-mail??jiangkuirong@njmu.edu.cn??MIAO Yi??E-mail??miaoyi@njmu.edu.cn
Abstract Objective To analyze common risk factors and treatment strategy for prognosis of postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 60 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Nanjing Medical University from January 1??2012 to December 31??2015 were analyzed retrospectively. The risk factors for prognosis of postoperative hemorrhage were analyzed. Results Among them, 8 patients died after surgery??others were alive. Early bleeding appeared in 10 patients and delayed hemorrhage occurred in 50 patients. Bleeding site included 23 gastrointestinal hemorrhage patients and 37 abdominal hemorrhage patients. Mild bleeding occurred in 37 patients and severe bleeding in 23 patients. Among them, 3 patients were grade A??40 patients grade B??17 patients grade C. Postoperative complications included postoperative pancreatic fistula in 28 patients??intra-abdominal infection in 5 patients and biliary fistula in 3 patients. Treatment strategies contained 41 patients with bleeding were treated conservatively, 9 patients received endoscopy or angioembolization while 10 patients underwent reoperation. Intra-abdominal infection and bleeding degree were important risk factors of clinical outcomes of hemorrhage after pancreaticoduodenectomy. ROC curve analysis showed that the 5th day of after surgery was a clear demarcation point of clinical prognosis. Conclusion Intra-abdominal infection, bleeding degree and grade are important risk factors of hemorrhage after pancreaticoduodenectomy. The 5th day after surgery may be a clear demarcation point of clinical prognosis, which has certain significance for the bleeding grade.     

心理护理对老年股骨粗隆间骨折术后的影响

目的探讨围手术期心理护理对老年股骨粗隆间骨折手术后的影响。方法选择在我院手术治疗的老年股骨粗隆间骨折患者62例,随机分为观察组和对照组,每组31例。观察组在实施骨科常规护理措施的基础上,配合有针对性的心理护理措施．对照组则仅实施骨科常规护理措施。比较两组患者手术后的疼痛视觉模拟评分情况及对患者护理的满意程度。结果观察组手术后的疼痛程度明显低于对照组,护理满意度则明显高于对照组,两组差异均有统计学意义（P〈0．05）。结论心理护理能明显减轻老年股骨粗隆间骨折患者手术后的疼痛程度,促进患者的身心康复,改善护患关系,提高护理满意度。     

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??Application of straight needle three-tail non-kontting suture in peritoneal closure in transabdominal preperitoneal inguinal hernia repair ZHOU Tai-cheng, YU Hong-yan, JIANG Zhi-peng, et al. Department of Gastroenterological Surgery and Hernia Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655??China
Corresponding author??CHEN Shuang??E-mail??sysusc@126.com
Abstract Objective To investigate efficiency of straight needle three-tail non-kontting suture in peritoneal closure in transabdominal preperitoneal inguinal hernia repair (TAPP). Methods A total of 238 patients with inguinal hernia performed TAPP in the Sixth Affiliated Hospital of Sun Yat-sen University between December, 2013 and December, 2015 were enrolled into the study, including 120 patients in control group with traditional suture and 118 patients in experiment group with straight needle three-tail non-kontting suture. All the patients received TAPP operation under general anaesthesia. The difference between tow groups were compared in age, gender, BMI, hernia type, defective area, hernia sac handling, operative time, peritoneal closure time, hospitalization cost, postoperative complications, VAS score and recurrence rate. Results The mean operative time was ??44.8±2.7??min for experimental group and??50.3±3.1??min for control group??t =7.243??P=0.025??. The mean peritoneal closure time was ??4.2±0.7??min for experimental group and??9.8±1.1??min for control group??t =9.833??P=0.010??. The mean cost was ??8927.4±135.2??yuan for experimental group and??9232.5±159.8??yuan for control group??t =4.782??P=0.041??. There was no difference in mesh infection??P=0.759??, recurrence ??P=0.759??, seroma??P=0.899??and VAS score??P=0.375?? between two groups. Conclusion Compared with traditional method, straight needle three-tail non-kontting suture could reduce operative cost as well as shorten operative and peritoneal closure time, without increasing postoperative complications, pain and recurrence.     

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??Updates and interpretations of PODF definition and grading system (2016 edition) by ISGPS SHI Si, XIANG Jin-feng, XU Jin, et al. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
Corresponding author: YU Xian-jun, E-mail: yuxianjun@
fudanpci.org
Abstract The definition and grading system of postoperative pancreatic fistula (PODF) developed by the International Study Group of Pancreatic Fistula (ISGPF) in 2005 has been widely accepted. However, the use of the process found that the version of the definition and classification system, there are still some problems and shortcomings. Based on this, the International Pancreatic Surgery Research Group (ISGPS) updated the relevant content, published 2016 version ,which is more concise and has clinical value than 2005 version. In 2005 version , PODF was emphasized as a complication that closely associated with the clinical management. A former grade A has been renamed as Biochemical Leak (BL) which is no longer considered as a fistula in 2016 version. Besides, grades B and C are defined more strictly. In particular, grade B requires a change in the postoperative management. Drains either left in place >3 weeks or repositioned through endoscopic or percutaneous is definitely considered as grade B. On the other hand, grade C refers to POPF that needs reoperation or leads to single/multiple organ failure and/or mortality.     

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??Analysis on the relationship between methods of reconstruction after gastrectomy and digestive tract obstruction LIU Tong??QI Feng??ZHAO Zhong-zhi. Department of Gastraintestinal Surgery, Tianjin Medical University General Hospital??Tianjin General Surgery Institute??Tianjin 300052??China
Corresponding author??LIU Tong??E-mail??liutonga@126.com
Abstract The progress of surgical techniques and surgical instruments has brought a variety of innovation for gastric surgery. The causes of postoperative digestive tract obstruction also become diversified??involving primary disease??choice of procedure??anastomosis method and other factors. Anastomotic stenosis or obstruction after gastrectomy mainly occurs in stomach-duodenum??stomach-jejunum??esophagus-jejunum, esophagus-residual stomach and other anastomosis??closely related to the selection of anastomosis, procedures and instruments??scar or tumor relapse. The afferent loop and efferent loop obstruction are still one of the important complications. It is more afferent loop obstruction in clinic. The Roux limb of Roux-en-Y anastomosis may also have some unique obstructions, such as intussusception??internal hernia??Roux stasis syndrome. In addition??gastric paralysis or adhesive intestinal obstruction may also occur. Therefore??with the changes in disease spectrum and the development of gastrointestinal surgery??the causes and characteristics of digestive tract obstruction after gastrectomy have undergone great changes. Surgeons need to carry forward the artisan spirit??strive for excellence??and constantly sum up clinical experience.