Perioperative high-dose-rate brachytherapy in locally advanced and recurrent gynecological cancer: Final results of a Phase II trial

PurposeTo determine the long-term results of a Phase II trial of perioperative high-dose-rate brachytherapy (PHDRB) in primary advanced or recurrent gynecological cancer.Methods and MaterialsFifty patients with locally advanced and recurrent gynecological cancer suitable for salvage surgery were included. Unirradiated patients (n = 25) received preoperative chemoradiation followed by surgery and PHDRB (16–24 Gy). Previously irradiated patients (n = 25) received surgery and PHDRB alone (32–40 Gy).ResultsMedian followup was 11.5 years. Eight unirradiated patients (32%) developed Grade ≥3 toxic events including two fatal events. Local and locoregional control rates at 16 years were 87.3% and 78.9%, respectively. Sixteen-year disease-free and overall survival rates were 42.9% and 46.4%, respectively. Ten previously irradiated patients (40.0%) developed Grade ≥3 adverse events, including four fatal events. Local and locoregional control rates at 14 years were 59.6% and 42.6%, respectively. Fourteen-year disease-free and overall survival rates were 16.0% and 19.2%, respectively.ConclusionsPHDRB allows effective salvage of a subset of unfavorable gynecological tumors with high-risk surgical margins. Toxicity was unacceptable at the initial dose levels but deescalation resulted in the absence of severe toxicity without a negative impact on locoregional control. A substantial percentage of patients remain alive and controlled at >10 years including a few previously irradiated cases with positive margins.     

Consenso sobre Ecocardiografia Transesofágica Perioperatória da Sociedade Brasileira de Anestesiologia e do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia

Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.     

多学科协作模式在高龄胆道结石患者围术期全程管理中的应用

目的 探讨多学科协作模式在高龄胆道结石患者围术期全程管理中的应用。方法 采用回顾性队列研究,选取2018年1月至2019年12月在我科行手术治疗的80岁以上胆总管结石患者92例为研究对象,按诊疗模式分为传统组(n=41)和MDT组(n=51),分别以传统及MDT模式诊疗,比较两组住院、围术期各项指标和围术期并发症等情况。结果 (1)住院相关指标:传统组与MDT组术后ICU住院时间分别为(3.48±0.89)d、(1.26±0.25)d;术后总住院时间分别为(8.36±1.23)d、(5.48±1.32)d;住院费用分别为(3.87±0.45)万元、(3.34±0.56)万元,差异均有统计学意义(P0.05)。(2)术前、术中相关指标:传统组与MDT组术前等待时间分别为(5.54±1.26)d、(4.04±0.92)d;手术时间分别为(136.33±25.67)min、(118.24±23.34)min,差异均有统计学意义(P0.05)。(3)术后恢复指标:传统组与MDT组肛门排气时间分别为(2.26±0.25)d、(1.17±0.23)d;下床活动时间分别为(2.84±0.34)d、(2.38±0.27)d;差异均有统计学意义(P0.05)。(4)围术期并发症及相关情况:传统组与MDT组术后并发症(局部、全身)、院内感染、围术期死亡、医患纠纷例数比较,差异均有统计学意义(P0.05)。结论 与传统模式相比,多学科协作模式在高龄胆道结石患者围术期全程管理,有明显优势,值得推广。     

经闭孔无张力阴道吊带术治疗女性压力性尿失禁的护理

目的 探讨经闭孔无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的护理方法.方法 对138例女性SUI接受TVT-O治疗患者的临床资料及围手术期护理行回顾性分析.结果 138例患者手术均获成功,术后症状消失.随访1月～4年,均未复发.1例术后3个月网片外露,未发现其他并发症.结论 TVT-O治疗女性SUI,操作简单,创伤小,并发症少,配合细致周到的围手术期护理,手术成功率高.     

120例输卵管阻塞不孕围手术期护理

目的探讨腹腔镜治疗输卵管阻塞配合护理程序的临床效果。方法120例腹腔镜下对输卵管伞端粘连、积水部分进行切开、分离并使之翻卷以防粘连并实施整体护理。结果与结论腹腔镜手术配合护理程序治疗输卵管阻塞具有安全、微创、出血少、恢复快等优点，再通率及受孕率均增高。     

髋关节镜下治疗髋关节撞击综合征的围手术期护理干预

目的探讨髋关节镜下治疗髋关节撞击综合征患者的围手术期护理干预效果。方法选取2014年3月~2016年12月期间我院收治的髋关节镜下治疗髋关节撞击综合征的患者117例,将其按照随机数字表法分为对照组和观察组,对照组应用常规护理干预,观察组应用围手术期护理干预,观察两组的Harris髋关节评分、α角度、并发症和护理满意度。结果对照组的Harris评分为(77.72±8.31)分,α角度为(49.31±5.38)°,并发症发生率为48.27%,护理总满意率为63.79%;观察组的Harris评分为(91.65±8.64)分,α角度为(33.82±5.83)°,并发症发生率为22.03%,护理总满意率为86.44%,观察组的Harris评分和护理总满意率较对照组高,α角度和并发症发生率较对照组小,两组差异有统计学意义(P0.05)。结论对髋关节镜下治疗髋关节撞击综合征的患者应用围手术期护理干预,能够有效减少患者疼痛,加快患者的恢复,缩小髋关节的α角度,减少并发症的发生率,患者满意度高,值得广泛临床推广。     

探讨围手术期护理对腹腔镜子宫肌瘤切除患者的干预效果

目的：研究围手术期护理对腹腔镜子宫肌瘤切除患者的影响。方法将该院92例行腹腔镜治疗的子宫肌瘤切除患者以随机数表法分为观察组与对照组,两组均为46例,对照组采取常规护理,观察组采取术前、术中、术后围术期全程护理,比较两组临床指标变化情况、止痛剂使用及伤口愈合情况。结果观察组肛门排气时间、住院时间、手术时间、术中出血量分别为(7.67±1.85)h、(3.03±1.46)d、(66.64±12.03)min、(101.35±22.03)mL与对照组(11.03±2.48)h、(5.82±1.61)d、(72.38±11.98)min、(121.85±25.69)mL比较显著较低,对比差异有统计学意义(P<0.05);两组止痛剂使用率比较差异无统计学意义(P>0.05),不良反应发生率21.74%与对照组47.83%比较显著较低(P<0.05)。结论术前、术中、术后全程护理措施可缩短患者康复时间,促进伤口愈合,减少止痛剂使用率,具有较高的临床应用价值。     

优质护理在脑肿瘤患者围术期中的应用分析

目的：探讨优质护理在脑肿瘤患者围术期中的应用效果。方法选取我院收治的120例脑肿瘤手术患者作为研究对象,根据入院先后顺序分为干预组和对照者,各60例,对照组实施常规护理,干预组实施优质护理,观察两组患者的护理效果。结果干预后,两组患者的ADL评分均较干预前显著提高,且干预组干预后的ADL评分显著高于对照组(P<0.05);干预后,干预组的独立、轻度依赖者所占比例均显著高于对照组,中度依赖、重度依赖者所占比例均显著低于对照组(P<0.05);干预组术后并发症发生率为5.00%,显著低于对照组的31.67%,组间比较差异具有统计学意义(P<0.05)。结论对脑肿瘤手术患者实施优质护理,能有效提高围术期护理质量,改善患者的心理状态,提高患者的身心舒适度及生活质量,值得推广。