Ⅰ期手术治疗结肠穿孔的疗效研究

目的研究Ⅰ期手术治疗结肠穿孔的有效性及安全性。方法将綦江区人民医院胃肠外科2011年9月至2014年4月收治的37例结肠穿孔患者分为观察组与对照组。观察组行Ⅰ期穿孔修补术或肠切除吻合术;对照组行分期手术,Ⅰ期行穿孔修补术或肠管切除术,Ⅱ期行近端肠管造瘘术。比较两组患者的疗效及安全性。结果两组患者术中出血量、切口感染发生率、心肺并发症发生率及住院时间比较,差异无统计学意义(P0.05);观察组患者术后肛门排气、排便时间大于对照组,住院费用高于对照组,组间比较差异均有统计学意义(P0.05)。所有患者均安全度过围术期,无严重并发症发生,观察组19例患者中发生术后吻合口瘘1例、切口感染3例、无腹腔感染发生。结论对部分结肠穿孔患者行Ⅰ期手术治疗安全有效,值得临床推广。     

快速康复外科护理在结直肠癌手术病人中的应用效果研究

目的:探讨快速康复外科护理在结直肠癌手术病人中的应用效果。方法:将2013年1月~2014年3月在我院行结直肠癌手术病人116例随机等分成观察组与对照组,对照组给予常规护理,观察组实施快速康复外科护理,比较两组病人术后首次排气时间、开始进食时间、术后住院时间、住院总费用、术后并发症发生情况及对护理工作满意度。结果:观察组病人术后首次排气时间、开始进食时间、术后住院时间、住院总费用、术后并发症发生率明显低于对照组(P0.05);满意度明显高于对照(P0.05)。结论:快速康复外科护理有助于缩短住院时间,减少住院费用,提高病人满意度,值得临床推广应用。     

手术大量输血后患者电解质及凝血功能的变化

目的探讨手术大量输血后对患者机体血清电解质和凝血功能的变化。方法对25例大量输血患者输血中,输血后血清电解质和凝血功能进行检测分析。结果术中输入小于1 000mL血液制品后,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和K+、Na+、Cl-、Ca2+均无明显改变(P0.05),但术后输入3 000mL以上血液制品,PT、APTT、TT时间明显延长(P0.01),同时纤维蛋白原(FIB)水平明显下降,K+、Ca2+下降明显(P0.01)。结论患者大量输血后极易出现低钾和低钙血症及凝血功能紊乱,手术时应动态监测各项指标,以防严重并发症的发生。     

舒适护理在直肠癌 Miles 术患者中的应用

目的：探讨舒适护理干预对直肠癌Miles术患者的影响。方法选择2010年4月至2012年2月在本科接受治疗的直肠癌miles术患者46例,按照随机数字表法将患者随机分为观察组和对照组各23例,对照组接受常规护理,观察组采用舒适护理模式。对两组的疼痛情况、心理舒适度和护理满意度进行比较。结果观察组患者的术后疼痛程度轻于对照组（ P＜0．05）,而对护理工作的满意度、心理舒适度高于对照组（P＜0．05）。结论舒适护理是一种以患者为中心、人性化的护理模式,在减轻直肠癌miles术患者术后疼痛和提高患者对护理工作的满意度、心理舒适度方面有着重要的临床意义。     

Bacteriostasis evaluation of the different soaking solutions in perineal skin preparation before the male urethral open operation: a randomized controlled trial

Perineal soaking is of crucial importance for skin preparation before the male urethral open operation; however, soaking solutions vary across the world. The aim of this research was to explore the bacteriostasis efficacy of the different soaking solutions in perineal skin preparation before the operation. Thirty‐six patients were randomly divided into three groups. In Group A, 0·1% povidone iodine was used to soak the 12 patients' perineum to reduce the bacterial load of the skin preparation before the operation. Similarly, combination of 0·1% povidone iodine and 1·6% saline for Group B and 1·6% saline for Group C was used. Bacteria samples were collected in four sites of the patients' perineum, before soaking, 1 d after soaking and 2 d after soaking, respectively. No serious adverse reactions were observed. There was a significant lower bacteria load in Group C after soaking (P = 0·032). For penoscrotal junction, there were significant lower bacteria loads after soaking in both Group A and Group B compared with Group C (P = 0·009), and there was significant lower bacteria load after soaking in Group A (P = 0·001) and Group B (P = 0·017). Similar with penoscrotal junction, bacteria load at the bottom of the scrotum decreased significantly in Group A (P = 0·001) and Group B (P = 0·002) and there were significant lower bacteria loads after soaking in both Group A and Group B compared with Group C (P = 0·041). In the middle of the penis, still, there were significant lower bacteria loads after soaking in both Group A and Group B compared with Group C (P = 0·019), and there was significant lower bacteria load after soaking in Group A (P = 0·012) and Group B (P = 0·006). In conclusion, combination of 0·1% povidone iodine and 1·6% saline solution for the preoperative skin preparation of male open urethral operation is safe and efficient.     

门静脉高压症复发性上消化道出血的精准外科治疗

目的探讨应用精准外科的理念,个体化选择最适合的手术方式,改善门静脉高压症复发性上消化道出血的治疗效果。方法回顾性分析2008年4月至2013年7月采用精准外科技术个体化治疗66例门静脉高压症复发性上消化道出血患者的临床资料。结果术后胃镜检查40例静脉曲张完全消失,19例基本消失,7例为轻度曲张。伴有门脉高压性胃病(PHG)的41例术后胃黏膜病变均明显改善。术后1年内再出血率6.1%(4/66)。术后肝性脑病发生率7.6%,1年、3年及5年生存率分别为97.0%(64/66)、93.3%(42/45)、85.7%(18/21)。结论应用精准外科技术采用个体化的术式治疗门静脉高压症复发性上消化道出血,可减少术后并发症的发生率,改善近远期疗效。     

Feasibility and Safety of Outpatient Total Laparoscopic Hysterectomy

Methods:We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center.Results:Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes.Conclusion:Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis.     

Postoperative Acute Pulmonary Embolism Following Pulmonary Resections

Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism.Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections.