耳后窄蒂皮下蒂皮瓣修复耳廓内软组织缺损

目的探讨应用耳后窄蒂皮下蒂皮瓣修复耳廓内软组织缺损的方法及疗效。方法 2008年6月-2011年7月,收治11例耳廓内肿物切除后软组织缺损患者。男7例,女4例;年龄26～75岁,平均50岁。其中色素痣5例,基底细胞癌2例,混合性血管瘤2例,皮肤乳头状瘤2例。病程3～50年,平均35年。彻底切除肿物后,软组织缺损范围为1.5 cm×1.0 cm～3.5 cm×3.0 cm。沿颞浅动脉及耳后动脉走向,设计耳后"乒乓球拍状"窄蒂皮下蒂皮瓣,通过隧道移位修复缺损,皮瓣切取范围1.8 cm×1.3 cm～3.8 cm×3.3 cm,蒂宽0.4～0.7 cm、长2～5 cm。供区直接拉拢缝合或局部皮瓣移位修复。结果术后供、受区皮瓣均顺利成活,切口均Ⅰ期愈合。术后8例获随访,随访时间6个月～1年。皮瓣质地、弹性、色泽良好,耳廓外形良好。肿瘤患者无复发。结论耳后窄蒂皮下蒂皮瓣蒂部窄长、旋转角度大、修复范围广、不含知名血管,手术操作简便,供区隐蔽,是修复耳廓内软组织缺损的理想方法之一。     

Application of humanistic care to the reengineering of nursing process at maternity hospital

目的 从流程管理入手,探讨保证护理服务与人文关怀有机融合的有效途径.方法 依据卓越护理流程设计的原则、华生人文关怀理论、患者需求、患者权利,对所有直接服务于患者的护理项目中的人文关怀措施进行个性化设计,对设计后的流程试运行3个月,并在实施过程中不断征求患者的意见,定稿后进行培训和执行.结果 流程再造实施后患者对护理服务11项指标评价及舒适达标、护理质量、安全评价显著优于实施前(均P＜0.01).结论 将人文关怀融入各项护理流程再造中,有利于提高护理服务质量和患者满意度.     

A review of the safety and clinical utility of contrast echocardiography

There are limitations to the sensitivity and specificity of conventional two-dimensional echocardiograms in making an accurate diagnosis in certain patient populations. This led to the development of specific contrast-enhancing agents with the following characteristics: small enough to cross the pulmonary capillary bed, remain stable throughout the length of the procedure, do not dissolve in blood, and rapidly cleared from the body with low toxicity. Unfortunately, the use of contrast echocardiography has not taken off as expected. The low take-up rate among clinicians can largely be attributed to the black box warning by the United States Food and Drug Administration in 2007, after the coincidental occurrence of four patient deaths and about 190 severe cardiopulmonary reactions shortly after contrast agent administration. In this article, we address the clinical safety of contrast agents, share our institution’s experience in using it and elaborate on the clinical indications of contrast echocardiography.     

原发性甲状腺淋巴瘤17例临床分析

目的：探讨原发性甲状腺淋巴瘤（primary thyroid lymphoma,PTL）的临床特点、诊断、治疗及预后。方法：回顾性分析2013年1月至2019年9月北京协和医院收治的17例PTL患者临床资料。结果：9例患者出现甲减,16例患者合并桥本甲状腺炎（Hashimoto’s thyroiditis,HT）,7例患者通过甲状腺穿刺活检确诊,10例患者通过甲状腺部分切除术确诊。弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）11例,黏膜相关淋巴瘤（mucosa associated lymphoid tissue lymphoma,MALT）,DLBCL、MALT转化和滤泡型淋巴瘤（follicular lymphoma,FL）各2例。DLBCL组患者平均年龄（61.7±13.0）岁,DLBCL、MALT转化组患者平均年龄（59.0±2.8）岁,MALT组患者平均年龄（61.5±3.5）岁,均明显大于FL组患者的（31.0±14.1岁）。DLBCL组患者血LDH为（380.3±197.9）U/L,高于MALT组和FL组。FL组国际预后指数（international prognostic index,IPI）为 0分,低于其他3组。DLBCL组患者Ki-67为（70.0±16.1）%,高于MALT组的（16.25±8.80）%。结论：原发性甲状腺淋巴瘤与HT关系密切,诊断依靠病理,DLBCL为最常见病理类型,治疗方案根据病理类型及临床分期决定。     

大剂量乌司他丁对大面积烧伤患者凝血功能的影响及意义

目的：观察大剂量乌司他丁对大面积烧伤患者凝血功能的影响。方法：4例大面积烧伤患者入院后第3天起每天给予大剂量乌司他丁(60万U,4次/d),用药前及用药后1d、3d、7d、10d、14d,抽血观察血浆纤维蛋白原含量(Fib-c)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)及血浆D-二聚体含量的变化。结果：用药前血浆D-二聚体及纤维蛋白原含量明显升高,PT时间显著延长;给予大剂量乌司他丁1d后,血浆D-二聚体及纤维蛋白原含量明显减低,PT时间迅速恢复。结论：大面积烧伤患者早期应用大剂量乌司他丁可显著改善凝血功能,预防播散性血管内凝血的发生。     

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical-site wound infection: A meta-analysis

A meta-analysis was conducted to assess the impact of robotic and laparoscopic pancreaticoduodenectomies on postoperative surgical site wound infections. A comprehensive computerised search of databases, such as PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data, was performed to identify studies comparing robotic pancreaticoduodenectomy (PD) with laparoscopicPD. Relevant studies were searched from the inception of the database construction until April 2023. The meta-analysis outcomes were analysed using odds ratios (OR) with corresponding 95% confidence intervals (CI). The RevMan 5.4 software was used for the meta-analysis. The findings of the meta-analysis showed that patients who underwent laparoscopic PD had a significantly lower incidence of surgical-site wound (16.52% vs. 18.92%, OR: 0.78, 95% CI: 0.68–0.90, P = .0005), superficial wound (3.65% vs. 7.57%, OR: 0.51, 95% CI: 0.39–0.68, P < .001), and deep wound infections (1.09% vs. 2.23%, OR: 0.53, 95% CI: 0.34–0.85, P = .008) than those who received robotic PD. However, because of variations in sample size between studies, some studies suffered from methodological quality deficiencies. Therefore, further validation of this result is needed in future studies with higher quality and larger sample sizes.     

骨关节炎滑液中肿瘤坏死因子α活性检测及滑膜组织超微结构观察

目的进一步探讨滑膜参与骨关节炎病理进程的机理。方法采用Ｌ９２９细胞毒活性法检测了２４例急、慢性关节内损伤及晚期骨关节炎（ＯＡ）患者关节滑液中肿瘤坏死因子（ＴＮＦ－α）生物活性，并用光镜和电镜观察比较三者滑膜组织间的形态学差异。结果ＯＡ滑液中所含ＴＮＦ－α水平较高；ＯＡ滑膜细胞性内膜，细胞增殖与脱落同时发生，内膜下层呈现明显的纤维增生性变、滑膜增厚；Ｂ型和Ａ型滑膜细胞的超微结构变化分别呈现旺盛的蛋白分泌相和活跃的吞噬功能。结论ＯＡ滑膜细胞的功能改变是其滑液中ＴＮＦ－α升高的原因之一；滑膜的变性既可受变性软骨产物的介导，又可导致ＯＡ的进展。     

CT引导下125I粒子植入治疗肺癌术后气胸发生率的相关因素分析

目的 分析影响CT引导下经皮肺穿刺¹²⁵I粒子植入治疗肺癌术后气胸发生率的因素.方法 观察821例CT引导下经皮肺穿刺肺癌¹²⁵I粒子植入术后患者198例发生气胸的情况,分析其出现的相关因素.结果 术后CT发现气胸198例,发生率为24.1%.发现植入针进针平均深度、患者是否合并慢性阻塞性肺疾病(COPD)、是否合并肺不张、植入针道数目、手术时间、进针角度及肿瘤直径7个因素与术后气胸发生率相关(χ² =10.293、11.463、5.310、8.868、13.348、9.326、16.504,P<0.05).其中COPD患者176 例术后发生气胸65例(36.9%);植入针进针的深度<6 cm(205例)、8~12 cm(378例)及>12 cm(238例)患者术后发生气胸分别为29例(14.1%)、98例(25.9%)、71例(29.8%);植入针道数目<5(183例)、5~10 (408例)、>10(230例)的患者术后发生气胸例数分别是31例(16.9%)、92例(22.5%)、75例(32.6%);手术时间<10 min(198例)、10~20 min(412例)、>30 min(211例)的患者术后发生气胸分别为27例(13.6%)、101例(24.5%)、70例(33.2%);合并肺不张患者132例术后发生气胸的19例(14.4%).其中前4项经多因素logistic回归分析是气胸发生的危险因素(OR=1.676、2.147、1.827、2.368,P<0.05),最后1项是气胸的保护因素(OR=0.367,P<0.05).结论 当病灶离胸壁远,患者合并有COPD,术中植入针道较多的患者,粒子植入前要充分考虑到气胸发生的可能,减少穿刺针数目及加快手术时间,可使CT引导下经皮肺癌¹²⁵I粒子植入术后气胸发生率大为降低.     

Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves’ Disease

Background

There is an ongoing debate about whether robotic thyroidectomy (RT) is appropriate for Graves’ disease. The aim of this study was to compare the safety of bilateral axillo-breast approach (BABA) RT with that of open thyroidectomy (OT) in patients with Graves’ disease.

Methods

From January 2008 to June 2014, 189 (44 BABA RT and 145 OT) patients underwent total thyroidectomy for Graves’ disease. Recurrence of Graves’ disease, intraoperative blood loss, hospital stay, and complication rates including recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism were analyzed between BABA RT and OT groups, after propensity score matching according to age, gender, body mass index, surgical indication, the extent of operation, excised thyroid weight, and follow-up period.

Results

No patient experienced recurrence of Graves’ disease after median follow-up of 35.0 months. Intraoperative blood loss (151.8 ± 165.4 mL vs. 134.5 ± 75.4 mL; p = 0.534) and hospital stay (3.4 ± 0.7 day vs. 3.3 ± 0.7 day; p = 0.564) were not different between BABA RT and OT groups. Complication rates including transient RLN palsy (11.4 vs. 11.4 %; p = 1.000), transient hypoparathyroidism (18.2 vs. 20.5 %; p = 0.787), permanent RLN palsy (0 vs. 2.3 %; p = 0.315), and permanent hypoparathyroidism (2.3 vs. 2.3 %; p = 1.000) were also comparable between groups.

Conclusions

BABA RT for Graves’ disease showed comparable surgical completeness and complications to conventional OT. BABA RT can be recommended as an alternative surgical option for patients with Graves’ disease who are concerned about cosmesis.

     

CT引导下穿刺活检及介入治疗的临床应用(附56例分析)

目的：探讨ＣＴ引导下穿刺活检及介入治疗的临床应用价值。方法：ＣＴ引导下行诊断目的２９例,治疗目的１７例,诊断及治疗双目的的１０例病人。穿刺部位包括胸部１７例,腹部２７例,躯干及四肢１２例,共５６例６０个病灶。ＣＴ扫描确定穿刺点、角度及深度。局麻进针后,ＣＴ再次扫描确认针尖到达预定位置再进行活检取材或介入治疗。结果：６０ 个病灶穿刺６１针次,穿刺一次成功率１００％ ,确诊率９７．４％ ,治疗有效率８８．９％ ,并发症５．４％ 。结论：ＣＴ引导下穿刺活检及介入治疗属微创伤性技术,简便易行,安全有效,成功率高,并发症少。