下颈椎骨折脱位的治疗术式选择

目的:探讨下颈椎骨折脱位的手术方式选择及其疗效.方法:我院2007年1月至2012年10月收治下颈椎骨折脱位患者32例,男23例,女9例;年龄28～78岁,平均56.4岁.术前伴脊髓损伤22例,Frankel分级A级5例,B级9例,C级6例,D级2例.根据患者骨折类型、椎间盘突出及压迫脊髓程度、小关节交锁情况、颈椎损伤程度等因素选择手术方案,其中21例椎体骨折但不伴有椎间小关节绞锁的病例采用单纯前路于术治疗(单间隙或椎体次全切除减压、椎间植骨钢板内固定);4例颈椎脱位伴有小关节绞锁但不伴有明显的椎体骨折、MRI示脊髓前方无明显受压,或屈曲牵张型双侧关节突骨折/绞锁者行后路减压、复位、内固定;7例有椎体骨折和椎间盘损伤,并存在椎体脱位、椎间小关节绞锁,或椎板骨折、骨块脱入椎管者采用前后联合入路手术.随访患者神经功能改善情况,影像学评价骨折愈合、植骨融合及颈椎稳定性情况:结果:32例均顺利完成手术,术中无神经、气管和食管损伤等并发症.4例术中发现硬脊髓破损,术后发生脑脊液漏,经对症处理后愈合.术后佩戴颈托3个月.均获随访,随访时间6～24个月,平均18.5个月,术后6个月22例有脊髓神经功能损伤患者除1例B级无恢复外,其余患者Frankel分级提高1～2级.术后复查X线片示颈椎序列恢复良好,骨折愈合,植骨均在6个月内获骨性融合(平均4.5个月),无假关节、骨不连发生,椎体间高度、生理曲度及颈椎稳定性维持良好,随访期间无钢板螺钉脱出、断裂.结论:术前对下颈椎骨折脱位患者的损伤类型、损伤节段、颈椎间盘突出压迫脊髓位置及受伤程度等因素进行综合分析,采取合理的手术方式,能够使损伤节段获得早期稳定,有利于提高患者神经功能的恢复.     

Where is the optimal plane to mobilize the anterior rectal wall in female patients undergoing total mesorectal excision?

BACKGROUND Since Heald proposed the total mesorectal excision(TME) procedure,the prognosis of patients with rectal cancer has been significantly improved. But Heald did not specifically describe the anterior surgical plane in female patients.And the surgical plane for mobilizing the anterior rectal wall during TME surgery in female patients remains controversial.AIM To investigate the anatomy of the female pelvis and identify the optimal plane for mobilizing the anterior rectal wall.METHODS We r...     

湿润烧伤膏治疗宫颈环形电切术后创面疗效观察

目的观察湿润烧伤膏（MEBO）治疗宫颈环形电切术后创面的疗效。方法将200例宫颈疾病患者行宫颈环形电切术后随机分为治疗组（100例）,对照组（100例）。治疗组术后创面外涂MEBO治疗,对照组术后创面用明胶海绵填塞治疗,观察两组患者术后创面愈合情况。结果治疗组术后阴道出血持续时间、阴道流液时间、术后创面愈合时间均比对照组明显缩短（P〈0．005）,治疗组术后宫颈黏膜外翻及宫颈息肉样增生程度明显低于对照组（P〈0．叭）。结论宫颈环形电切术后创面应用MEBO治疗,能减轻宫颈环形电切术后的不良反应,缩短创面愈合时间,且无瘢痕形成,效果满意,值得临床推广运用。     

国产吻合器行痔上黏膜环切术的并发症及应用价值

目的：探讨国产吻合器痔上黏膜环切术（PPH）的并发症及应用价值。方法：总结吻合器痔上黏膜环切术治疗严重Ⅱ度、Ⅲ度、Ⅳ度痔病63例的临床资料。结果：手术时间10-20min，术后平均住院2～5d，无肛门狭窄、无肛门失禁、无复发等并发症。结论：国产痔吻合器是治疗重度痔的一种安全有效方法，创伤少，并发症少，价格低廉，有望替代传统的痔切除术。     

The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery

BackgroundCorticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Studies have shown that patients on long-term corticosteroids have higher infection rates. However, the rates of infection and other complications following lumbar decompression surgery remains under-investigated. The aim of our study was to determine the impact of preoperative long-term corticosteroid usage on acute, 30-day postoperative complications in a subset of patients undergoing lumbar spine decompression surgery, without fusion or instrumentation. We hypothesize that patients on long-term corticosteroids will have higher rates of infection and other postoperative complications after undergoing lumbar decompression surgery of the spine.MethodsA retrospective cohort study was conducted using data collected from the National Surgical Quality Improvement Program database data from 2005 to 2016. Lumbar decompression surgeries, including discectomies, laminectomies, and others were identified using CPT codes. Chi-square analysis was used to evaluate differences among the corticosteroid and non-corticosteroid groups for demographics, preoperative comorbidities, and postoperative complications. Logistic regression analysis was done to determine if long-term corticosteroid use predicts incidence of postoperative infections following adjustment.Results26,734 subjects met inclusion criteria. A total of 1044 patients (3.9%) were on long-term corticosteroids prior to surgical intervention, and 25,690 patients (96.1%) were not on long-term corticosteroids. Patients on long-term corticosteroids were more likely to be older (p < 0.001), female (p < 0.001), nonsmokers (p < 0.001), and have a higher American Society of Anesthesiologist class (p < 0.001). Multivariate analysis demonstrated that long-term corticosteroid usage was associated with increased overall complications (odds ratio [OR]: 1.543; p < 0.001), and an independent risk factor for the development of minor complications (OR: 1.808; p < 0.001), urinary tract infection (OR: 2.033; p = 0.002), extended length of stay (OR: 1.244; p = 0.039), thromboembolic complications (OR: 1.919; p = 0.023), and sepsis complications (OR: 2.032; p = 0.024).ConclusionLong-term corticosteroid usage is associated with a significant increased risk of acute postoperative complication development, including urinary tract infection, sepsis and septic shock, thromboembolic complications, and extended length of hospital stay, but not with superficial or deep infection in patients undergoing lumbar decompression procedures. Spine surgeons should remain vigilant regarding postoperative complications in patients on long-term corticosteroids, especially as it relates to UTI and propensity to decompensate into sepsis or septic shock. Thromboembolic risk attenuation is also imperative in this patient group during the postoperative period and the surgeon should weigh the risks and benefits of more intensive anticoagulation measures.     

腹腔镜手术治疗溃疡性结直肠炎

目的探讨腹腔镜手术治疗溃疡性结直肠炎的可行性和安全性。方法对腹腔镜手术治疗溃疡性结直肠炎5例患者的临床资料进行回顾性分析。结果5例均在腹腔镜下完成手术,其中4例行全结-直肠切除,回肠储袋-肛管吻合术(total proctocolectomy and ileal pouch-anal anastomosis,IPAA),1例行结肠次全-全直肠切除,盲肠-肛管吻合术。中位手术时间7.5(6.5～9)h,中位出血量250(150～400)mL,中位术后进半流食时间62(60～86)h,中位术后住院时间12(10～14)d。术后发生盆腔感染1例,粘连性肠梗阻1例。随访中位时间22(10～34)个月,大便平均每天6.5(4～10)次。日常生活自理,工作正常,无复发。结论腹腔镜下溃疡性结直肠炎手术,创伤小,恢复快,安全可靠,但尚需进一步积累临床资料。     

齿线十方黏膜环切术治疗中重度痔的临床疗效观察

目的探讨齿线上方黏膜环切术的吻合口距齿线的距离对手术疗效的影响。方法运用痔上黏膜环形切除吻合器治疗脱垂性中重度痔280例。其中Ⅱ度内痔35例，Ⅲ-Ⅳ度痔245例。吻合口在齿线上0．3～1．0cm内150例，1．0～2．0cm间83例，2．0～3．0cm中47例。测量手术吻合口与齿线间距离，并将数据与手术治疗的效果进行分析。结果吻合口距齿线上0．3～1．0cm内者（简称A组），术后发生脱垂率为2％（3／150）；吻合口距齿线上1．0～2．0cm间者（简称B组），术后发生脱垂率为12．1％（10／83）；吻合口距齿线上2．0～3．0cm中者（简称C组），术后发生脱垂率为17．0％（8／47）。结论吻合口的位置与手术效果（脱垂性方面）有明显直接的关系，越靠近齿线疗效越好；而术后疼痛程度也相应增加（P〈0．05）。     

Estimating nurses' workload using the Diagnosis Procedure Combination in Japan

Aim:  To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC).
Methods:  For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub-arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3-year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self-report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource-based relative value scale.
Results:  Twenty-five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC.
Conclusion:  The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload.     

膀胱镜盲区膀胱肿瘤腔内钬激光治疗

目的：探讨膀胱镜盲区膀胱颈部肿瘤的腔内治疗方法。方法：对32例膀胱镜盲区肿瘤经皮膀胱穿刺引入膀胱镜或输尿管镜及钬激光光纤切除肿瘤。结果：肿瘤显露满意，切除顺利，术后恢复时间与经尿道膀胱肿瘤钬激素切除无明显差异。结论：经皮腔内钬激光治疗膀胱颈部肿瘤，可减小手术创伤，操作简便，效果好。