A new technique of esophagogastrostomy above the aortic arch— covering and suspending of the anastomotic area with mediastinal pleural flap

The postoperative anastomotic leakage is the most severe complication and the principal cause of death after resection of esophageal carcinoma. Especially, anastomosis above the aorta arch is accompanied by high incidence of anastomotic leakage usually with fatal prognosis. The authors improved the conventional method of anastomosis by using a mediational pleural flap to cover and suspend the anastomotic area with excellent result. From January 1990 to April 1995, total 210 patients with esophageal carcinoma underwent surgery resection with this procedure. No anastomotic leakage or stricture developed. Only one patient died of extensive myocardial infarction with an overall mortality of 0.47%. The major merit of this procedure was that the mediastinal pleural flap could cover the area of anastomosis and sustain dragging force acting on this area, providing a better condition for the anastomosis to heal and thus reducing the possibility of anastomotic leakage.     

医用电气设备的漏电流测试（2）

国标GB9706.1——1995《医用电气设备第一部分：安全通用要求》是目前医用电气设备认证的安全基础标准。本文就该标准中有关漏电流和患者辅助电流的要求进行论述，从电介质的特性开始，用直观易懂的图表，结合实际工作情况，对医用电气设备的漏电流的产生原因、种类、测量要求及测量方法等进行分析和整理，并用高压电位治疗仪为例，说明如何正确理解标准的测试方法。希望本文对医用电气设备制造商和医院等医用电气设备使用单位的工作能提供一些帮助，同时也期待得到检测同行的指正。     

Three-dimensional optical coherence tomographic findings in central serous chorioretinopathy

Purpose The purpose of this study was to evaluate three-dimensional optical coherence tomographic findings at the leakage point on fluorescein angiography in central serous chorioretinopathy (CSC) with OCT-ophthalmoscope. Methods Twenty-seven eyes of 26 patients (23 men, three women; mean age, 50 years; range, 30–72) diagnosed with CSC were examined with OCT-ophthalmoscope, and transverse and longitudinal images were compared with fundus and fluorescein angiography findings. Results Transverse images (C-scan) clearly showed serous retinal detachment in all eyes and irregular lesions in retinal pigment epithelium (RPE) in 26 of 27 eyes (96%). These results agreed with the location of lesions in areas of fluorescein dye leakage on fluorescein angiography. Longitudinal images (B-scan) of irregular RPE lesions in transverse images showed RPE detachment (PED) in 17 eyes (63%), small protrusion of the RPE layer in five eyes (19%), and rough RPE layer in four eyes (15%). Conclusions OCT-ophthalmoscope detects morphologic changes easily and noninvasively at the point of dye leakage in eyes with CSC.     

医用电气设备的漏电流测试

国标GB9706．1——1995《医用电气设备第一部分：安全通用要求》是目前医用电气设备认证的安全基础标准。本文就该标准中有关漏电流和患者辅助电流的要求进行论述，从电介质的特性开始，用直观易懂的图表，结合实际工作情况．对医用电气设备的漏电流的产生原因、种类、测量要求及测量方法等进行分析和整理，并用高压电位治疗仪为例，说明如何正确理解标准的测试方法。希望本文对医用电气设备制造商和医院等医用电气设备使用单位的工作能提供一些帮助．同时也期待得到检测同行的指正。     

透明质酸酶制剂治疗外周输液渗漏研究

目的探讨透明质酸酶制剂治疗外周输液渗漏的疗效。方法分动物实验及临床实验 ,临床随机选择住院病人中因静脉注射发生药物外渗的病人 ,分为两组 ,对照组 2 3例用 10 %硫酸镁湿敷 ,观察组用透明质酸酶乳膏剂涂擦。结果透明质酸酶制剂对注射外渗所致的肿胀具有较好的治疗作用 ,消肿时间明显少于临床常用的硫酸镁湿敷法 ,P <0 .0 1差异有显著意义。结论透明质酸酶制剂治疗药物静脉外渗所致肿胀具有良好效果 ,明显优于临床常用的 10 %硫酸镁湿敷法 ,可广泛应用于临床。     

HFMEA模式干预对儿科门诊留观输液室儿童静脉输液渗漏发生率的影响研究

目的 探讨医疗失效模式与效应分析（healthcare failure mode and effect analysis, HFMEA）模式在儿科门诊留观输液室患儿静脉输液治疗中的应用及其对预防静脉输液渗漏的价值。方法 选取2021年1月至2021年12月于温州市中西医结合医院儿科门诊留观输液室进行静脉输液治疗的3680例患儿开展回顾性分析,按照就诊时间,2021年1月至6月HFMEA干预前的患儿为对照组（n=1835）,2021年7月至12月HFMEA干预后的患儿为研究组(n=1845)。对比开展HFMEA前后的患儿失效模式风险优先指数（risk priority number,RPN）评分、统计开展HFMEA前后的患儿静脉输液渗漏发生率和家属投诉率,并对患儿家属进行护理满意度调查。结果 开展HFMEA模式后,儿童静脉输液渗漏主要影响因素RPN评分均低于开展前,差异均有统计学意义（P<0.05）;开展HFMEA模式后,患儿静脉输液渗漏率（1.68%）、家属投诉率（0）分别低于开展前（2.67%、0.33%）,而家属护理满意度（89.27%）则高于开展前（86.54%）,差异均有统计学意义（P<0.05）。结论 HFMEA模式干预在儿科门诊留观输液室护理管理中,能够有效降低儿童静脉输液渗漏发生风险,继而减少患者家属投诉情况,家属认可度更高。     

Anastomotic leak in colorectal cancer patients: New insights and perspectives

Anastomotic leak (AL) remains a potentially life-threatening sequela of colorectal surgery impacting on mortality, short- and long-term morbidity, quality of life, local recurrence (LR) and disease-free survival. Despite technical improvements and the identification of several surgery- and patient-related factors associated to the risk of AL, its incidence has not significantly changed over time. In this context, the clarification of the mechanisms underlying anastomotic healing remains an important unmet need, crucial for improving patients’ outcomes.This review concentrates on novel key findings in the etiopathogenesis of AL, how they can contribute in determining LR, and measures which may contribute to reducing its incidence.AL results from a complex, dynamic interplay of several factors and biological processes, including host genetics, gut microbiome, inflammation and the immune system. Many of these factors seem to act in concert to drive both AL and LR, even if the exact mechanisms remain to be elucidated. The next generation sequencing technology, including the microbial metagenomics, could lead to tailored bowel preparations targeting only those pathogens that can cause AL.Significant progress is being made in each of the reviewed areas, moving toward translational and targeted therapeutic strategies to prevent the difficult complication of AL.     

引流管管周渗液收集袋的设计与应用

目的 设计腹部外科术后患者引流管管周渗液收集袋并评价其应用效果。方法 设计的引流管管周渗液收集袋由袋体和底座2个部分组成。将2020年9月—2021年7月在湖州市某三级甲等医院接受治疗的200例腹部外科术后发生大量渗液的患者,按照其自愿原则分为试验组112例和对照组88例。试验组在管周发生大量渗液时应用引流管管周渗液收集袋,对照组在管周发生大量渗液时采用传统的敷料换药,比较两组每日换药次数、每日换药产生的费用、管周皮肤损伤情况以及满意度。结果 试验组每日换药次数、每日换药产生的费用、管周皮肤损伤发生率均低于对照组（P<0.001）;同时试验组满意度高于对照组（P<0.001）。结论 引流管管周渗液收集袋能有效减少换药频率,减轻患者的经济负担,降低患者管周皮肤损伤的发生率,增加患者的满意度,有利于患者早期康复。     

Maternal-neonatal transfusion compatibility irrespective of ABO mismatch – a prospective observational study

Abstract

Objective: To determine transfusion compatibility of maternal RBCs for her neonate up to 4 weeks of age, irrespective of maternal-neonatal ABO mismatch.

Methods: This was a prospective observational study involving eligible mothers with their neonates delivered in participating site from 1 July 2012 till 31 December 2012. Mother’s blood was collected before child birth. Neonatal blood sample was collected from placental end, shortly after birth. Blood Groups of mother–baby pair were individually tested for ABO and Rh-D groups. Pairs with negative Rh-D antigen/s or with same ABO blood groups were excluded. Thus, 28 pairs with both maternal and neonatal samples positive for Rh-D antigen and with different maternal neonatal ABO blood groups were included in the study. Blood samples were collected at birth and at 4 weeks. Cross matching was done at birth and at 4 weeks for each pair with standard blood bank protocols.

Results: All 28 pairs showed positive compatibility with standard blood bank cross-matching protocols at birth and at 4 weeks.

Conclusions: Maternal blood irrespective of ABO compatibility might be a viable and potentially acceptable option for her new born baby in neonatal period. This may be especially important in developing world with limited blood bank resources.     

脊柱手术致脑脊液漏的处理方法探讨

目的：探讨脊柱手术中发生脑脊液漏的处理方法,对比分析两种处理方法的临床效果。方法：选择2010～2015年间我科室120例脊柱手术致脑脊液漏患者,将其随机分为观察组与对照组,每组各有60例,其中观察组给予 EC 耳脑胶结合阔筋膜术中进行封堵,再放置明胶海绵保护硬脊膜;对照组给予直接丝线连续缝合,再用筋膜、明胶海绵覆盖保护硬脊膜。两组术后均放置伤口引流管经椎旁肌由切口旁引出,再接无菌负压引流袋低位引流。观察比较两组患者术后引流量、拔管时间以及脑脊液漏、伤口脑脊液渗、皮下积液、头痛、伤口感染、颅内感染的发生情况。结果：观察组术后引流（257.3±46.2）mL,拔管时间（2.75±1.13）d,均少于对照组的（524.6±83.3）mL 和（7.05±1.68） d,差异具有统计学意义。观察组术后发生脑脊液漏、头痛、伤口脑脊液渗、皮下积液、伤口感染、颅内感染的例数分别是2例、2例、3例、1例、1例、0例,对照组术后发生脑脊液漏、头痛、伤口脑脊液渗、皮下积液、伤口感染、颅内感染的例数分别是9例、8例、10例、3例、2例、0例,观察组术后并发症发生率低于对照组。结论：EC 耳脑胶结合阔筋膜、明胶海绵术中封堵处理脊柱手术致脑脊液漏的效果优于直接丝线连续缝合+筋膜、明胶海绵覆盖。