老年胆总管结石与中青年患者经腹腔镜胆总管探查取石并一期缝合治疗的比较研究

目的比较老年胆总管结石患者与中青年患者行腹腔镜胆总管探查(LCBDE)并一期缝合的有效性与安全性。 方法回顾性分析2012年5月至2017年2月期间81例行LCBDE并一期缝合患者的临床与随访资料,根据年龄分为两组,≥65岁的老年组(n＝39)和<65岁的中青年组(n＝42)。采用SPSS22.0软件对两组临床资料进行统计学分析。围手术期相关指标等计量资料以( ±s)表示,采用独立t检验;术后并发症发生率及随访情况等计数资料以例(%)表示,组间比较采用fisher精确概率法检验,以P<0.05为差异有统计学意义。 结果81例患者均顺利完成手术,无中转开腹。两组患者手术时间、术中出血量等差异均无统计学意义(P>0.05),与中青年组比较,老年组术后腹腔引流时间、下床时间、胃肠功能恢复时间、住院时间明显延长(P<0.05)。老年组手术并发症总发生率12.8%高于中青年组7.1%,但差异无统计学意义(P>0.05)。老年组术后出现1例结石残留,两组均无结石复发。 结论腹腔镜胆总管探查取石并一期缝合治疗老年胆总管结石疗效确切,安全可行,术后并发症及结石复发与中青年者相当,在严格把握手术指征前提下,适合作为老年胆总管结石患者选择的术式。     

程序化腹腔镜肝左外叶切除术的疗效评价

目的评价程序化腹腔镜肝左外叶切除术与传统腹腔镜和开腹肝左外叶切除术的临床疗效。 方法回顾性分析2014年1月至2017年8月接受肝左外叶切除术患者62例资料,其中开腹组19例(A组),传统腹腔镜组20例(B组),程序化腹腔镜组23例(C组)。采用SPSS 20.0统计学软件进行统计学分析,术中与术后恢复相关指标及肝功能指标等用均数±标准差表示,采用t检验;一般资料和术后并发症采用χ²检验比较,以P<0.05为差异有统计学意义。 结果三组数据比较,C组切口总长度最短,手术时间、术中出血量、术后拔管时间、胃肠功能恢复时间、术后住院时间最少(P<0.05),术后第1天、第3天白蛋白(ALB)相对最高、丙氨酸氨基转移酶(ALT)冬氨酸氨基转移酶(AST)相对最低(P<0.05);术后并发症发生率三组相当(P>0.05)。 结论程序化腹腔镜肝左外叶切除术疗效确切优良,较传统腹腔镜和开腹肝左外叶切除术创伤小、出血少、恢复快、且不增加术后并发症,值得在临床中应用推广。     

胃癌D2根治术采用腹腔镜与传统开腹术治疗进展期胃癌的疗效对比

目的探究腹腔镜胃癌D2根治术与传统开腹胃癌D2根治术治疗进展期胃癌的手术疗效。 方法回顾性分析2015年6月～2017年6月60例进展期胃癌患者资料,根据手术方法不同对患者实施分组,开腹组27例,给予传统开腹胃癌D2根治术治疗;腹腔镜组33例,给予腹腔镜胃癌D2根治术治疗。采用统计学软件SPPSS18.0进行处理。两组手术相关指标、VAS评分以及总体健康评分选择标准差( ±s)表示,采取独立t检验;两组并发症率用%表示,进行χ²检验,P<0.05差异有统计学意义。 结果腹腔镜组患者术中出血量、胃肠功能恢复时间及住院时间等均优于开腹组(P<0.05);腹腔镜组患者术后VAS评分、总体健康评分均显著优于开腹组(P<0.05);腹腔镜组患者术后总并发症发生率占6.1%,显著低于开腹组的25.9%,两组差异均有统计学意义(P<0.05)。 结论腹腔镜胃癌D2根治术治疗进展期胃癌,创伤小、安全性高,有利于缓解疼痛,提升患者生活质量,并发症少,值得推广应用。     

Experience with outcomes research into the real-world effectiveness of novel therapies in Dutch daily practice from the context of conditional reimbursement

Policymakers more often request outcomes research for expensive therapies to help resolve uncertainty of their health benefits and budget impact at reimbursement. Given the limitations of observational data, we assessed its usefulness in evaluating clinical outcomes for bortezomib in advanced multiple myeloma patients. Data were retrospectively collected from patients included in the pivotal Assessment of Proteasome Inhibition for Extending Remissions trial (APEX; n = 333) and two groups of daily practice patients treated with bortezomib following progression from upfront therapy (n = 201): real-world patients treated as of May 2009 (RW-1; n = 72) and June 2012 (RW-2; n = 129). Prognosis, treatment, and effectiveness were compared. Outcomes research was useful for policymakers for addressing to whom and how bortezomib was administered in daily practice. It was limited however in generating robust evidence on real-world safety and effectiveness. The quality of real-world evidence on effectiveness was low due to missing data in patient charts, existing treatment variation and the dynamics in care during the novel drug's initial market uptake period. Policymakers requesting real-world evidence on clinical outcomes for reimbursement decisions should be aware of these limitations and advised to carefully consider beforehand the type of evidence that best addresses their needs for the re-assessment phase.     

大型C臂机实时引导下经超细支气管镜肺大疱减容术有效性及其影响因素的初探

目的 初步探讨大型C臂机实时引导下经超细支气管镜肺大疱减容术的有效性及其影响因素.方法 6例肺大疱患者均在大型C臂机实时引导下经超细支气管镜工作通道先后通过微导管向目标细支气管注入利多卡因、自身血、纤维蛋白原、凝血酶.通过患者客观症状、肺功能FEV1、胸部HRCT、血气分析、6分钟步行距离等指标评价术式的有效性及其影响因素.结果 6例患者中,术后完全有效2例,明显有效1例,基本有效2例,完全无效1例(有效率83.3％).有效性影响因素可能包括肺大疱周围肺组织对所注入的减容药物反应程度、H RCT扫描肺大疱大小时呼吸动度、肺大疱周围组织内源性弹性回缩作用力大小及其各个作用力的方向、患者特异质等.结论 应用大型C臂机实时引导下经超细支气管镜肺大疱减容术,可以避免手术治疗并发症的发生,缩短住院时间,改善肺功能,提高患者生活状态,值得进一步推广.     

Transcutaneous Tibial Nerve Stimulation in the Management of Overactive Bladder: A Scoping Review

ObjectiveOveractive bladder (OAB) is a condition that has physical, social, psychosocial, and financial impacts. Transcutaneous tibial nerve stimulation (TTNS) is a modality that stimulates the nerve root fibers of L5-S3, the same spinal segments of the parasympathetic nervous system as the bladder. This scoping review aims to identify current literature available on the feasibility and outcomes of TTNS as a first-line treatment option for OAB.Materials and MethodsA scoping review of six electronic data bases was performed to identify full-text articles from 2015 that explored the impact of TTNS on OAB and bladder dysfunction in people aged >18 years.ResultsA total of 15 articles met the inclusion criteria. TTNS was compared with sham treatment, parasacral stimulation, pelvic floor muscle training (PFMT), anticholinergic medication, and percutaneous tibial nerve stimulation (PTNS). Heterogeneity in treatment application and parameters existed, with variations in treatment duration, frequency of use, and treatment settings such as pulse width (μs) and frequency (Hz). Results indicated that TTNS has efficacy equal to PFMT and PTNS in the management of OAB; however, it is not as efficacious as anticholinergic medication.ConclusionsTTNS is a promising first-line management option for people with OAB, particularly in the older population and for those with neurogenic bladder. It can provide symptomatic relief from urinary incontinence, frequency, urgency, and nocturia, while avoiding the bothersome side effects of more invasive or pharmaceutical therapies. Heterogeneity in treatment parameters limits generalizability and translation of the most appropriate clinical application and should be considered in future trials.