针孔腹腔镜经腹腹膜前疝修补术治疗腹股沟疝的临床疗效

目的探讨针孔腹腔镜经腹腹膜前疝修补手术（NP-TAPP）治疗腹股沟疝的安全性与可行性。 方法回顾性分析2019年1月至2019年12月,大庆油田总医院行腹腔镜手术治疗的85例单侧腹股沟疝患者的临床资料。其中腹腔镜经腹腹膜前疝修补手术（TAPP）组患者53例,NP-TAPP组患者32例,观察记录2组的手术时间、术中出血量、术后住院时间、疼痛评分、腹壁瘢痕满意度及手术并发症等指标并进行对比分析。 结果85例患者均顺利完成手术,2组手术时间、术中出血量、术后住院时间比较,差异均无统计学意义（P>0.05）;NP-TAPP组术后疼痛程度、腹壁瘢痕满意度均优于TAPP组,差异有统计学意义（P<0.05）。2组术后并发症发生率及复发率比较,差异均无统计学意义（P>0.05）。 结论NP-TAPP治疗腹股沟疝安全有效,能最大程度减少手术创伤,提高术后腹壁切口美容效果。     

三种疝修补术治疗成人腹股沟疝的疗效比较

目的比较腹腔镜下经腹腹膜前疝修补术与传统腹股沟疝修补术、疝环充填式无张力疝修补术治疗成人腹股沟疝的疗效。 方法选取2016年4月至2020年4月芜湖市第一人民医院收治的150例腹股沟疝患者作为研究对象,随机将其分为3组,每组50例。A组行传统腹股沟疝修补术,B组行疝环充填式无张力疝修补术,C组行腹腔镜下经腹腹膜前疝修补术。比较3组患者的临床总有效率,手术时间,出院时间,术中出血量,术后24 h、1周及1个月的疼痛视觉模拟评分（VAS）,复发率以及并发症情况。 结果B组和C组患者在临床总有效率,手术时间、出院时间、术中出血量、术后各时段的VAS评分、复发率及并发症均优于A组,差异有统计学意义（P<0.05）。B组和C组相比,C组在手术时间、住院时间、各时段VAS评分优于B组,差异有统计学意义（P<0.05）。 结论三种手术方式比较发现,腹腔镜下经腹腹膜前疝修补术与疝环填充式无张力疝修补术具有良好的临床效果,恢复迅速,可缩短住院时间,缓解术后疼痛,降低复发率和并发症发生风险,缓解了患者的疼痛,就术后疼痛、术后恢复和手术时间而言,腹腔镜下经腹腹膜前疝修补术更优越。     

预测胰十二指肠切除术后切口疝发病风险列线图模型的建立

目的建立预测胰十二指肠切除（PD）术后发生切口疝的风险列线图模型,为切口疝的早期干预提供依据。 方法回顾性分析2009年1月至2017年1月于邯郸市中心医院行PD术的926患者的临床资料,随访发生切口疝的患者24例（切口疝组）,未发生切口疝的按照1∶5的比例随机抽取120例为非切口疝组。分别使用单因素和Logistic回归多因素分析术后切口疝的独立危险因素,并建立相关列线图预测模型。 结果年龄≥60岁（OR=5.800,95% CI 1.530~21.984）、BMI≥24 kg/m²（OR=4.165,95% CI 1.187~14.613）、糖尿病（OR=5.321,95% CI 1.548~18.285）、呼吸系统疾病（OR=4.565,95% CI 1.225~17.007）、切口感染（OR=6.803,95% CI 1.573~29.419）及手术时间≥6 h（OR=6.934,95% CI 1.938~24.813）是PD术后发生切口疝的独立危险因素（P<0.05）。基于以上6项独立危险因素建立列线图模型,并对该模型进行验证,预测值同实测值基本一致,C-index 0.890（95% CI 0.854~0.926）,说明本研究列线图模型具有良好的精准度和区分度。 结论年龄≥60岁、BMI≥24 kg/m²、糖尿病、呼吸系统疾病、切口感染及手术时间≥6 h是PD术后发生切口疝的独立危险因素,本研究建立的列线图预测模型具有良好的精准性和区分度,有利于临床筛查PD术后发生切口疝的高风险人群和制定针对性规避措施。     

葡萄胎的声像图诊断

临床资料胡×× 27岁停经3~-月,孕40~+天时阴道出血已一月余,疑为葡萄胎。声像图特征子宫增大如孕4~+月,(宫体纵径16.0厘米,前后径10.0厘米,横径14.0厘米)宫腔内无妊娠囊及胎体显示。布满密集的强光点及大、小不等液性暗区,双侧附件均可见黄素囊肿液暗区。声像图诊断葡萄胎。双侧卵巢黄素囊肿(图1)。手术及病理吸出小葡萄样物及陈旧性血液共8,000毫升,病理为葡萄胎。以后继续用B超复查三次,仍见子宫增大,宫腔光点强弱不等,黄素囊肿存在,化疗一个月后,第四次B超复查,子宫恢复正常大小,黄素囊肿消失。     

Bone Mass and Strength in School‐Age Children Exhibit Sexual Dimorphism Related to Differences in Lean Mass: The Generation R Study

Bone strength, a key determinant of fracture risk, has been shown to display clear sexual dimorphism after puberty. We sought to determine whether sex differences in bone mass and hip bone geometry as an index of strength exist in school‐age prepubertal children and the degree to which the differences are independent of body size and lean mass. We studied 3514 children whose whole‐body and hip scans were measured using the same densitometer (GE‐Lunar iDXA) at a mean age of 6.2 years. Hip dual‐energy X‐ray absorptiometry (DXA) scans underwent hip structural analyses (HSA) with derivation of bone strength indices. Sex differences in these parameters were assessed by regression models adjusted for age, height, ethnicity, weight, and lean mass fraction (LMF). Whole‐body bone mineral density (BMD) and bone mineral content (BMC) levels were 1.3% and 4.3% higher in girls after adjustment by LMF. Independent of LMF, boys had 1.5% shorter femurs, 1.9% and 2.2% narrower shaft and femoral neck with 1.6% to 3.4% thicker cortices than girls. Consequent with this geometry configuration, girls observed 6.6% higher stresses in the medial femoral neck than boys. When considering LMF, the sexual differences on the derived bone strength indices were attenuated, suggesting that differences in muscle loads may reflect an innate disadvantage in bone strength in girls, as consequence of their lower muscular acquisition. In summary, we show that bone sexual dimorphism is already present at 6 years of age, with boys having stronger bones than girls, the relation of which is influenced by body composition and likely attributable to differential adaptation to mechanical loading. Our results support the view that early life interventions (ie, increased physical activity) targeted during the pre‐ and peripubertal stages may be of high importance, particularly in girls, because before puberty onset, muscle mass is strongly associated with bone density and geometry in children. © 2015 American Society for Bone and Mineral Research.     

The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency

The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1?g 3/day?×?3 days and slow intravenous input sodium chloride 1000 ～1500 mL 3–12?h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4?h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251?umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.