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Pancreatic necrosis: Complications and changing trend of treatment 预览
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作者 Mamoon Ur Rashid Ishtiaq Hussain +5 位作者 Sundas Jehanzeb Waqas Ullah Saeed Ali Akriti Gupta Jain Neelam Khetpal Sarfraz Ahmad 《世界胃肠外科杂志:英文版(电子版)》 2019年第4期198-217,共20页
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution;som... Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution;some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered. 展开更多
关键词 Pancreatic NECROSIS NECROSECTOMY Open SURGERY MINIMALLY invasive SURGERY COMPLICATIONS TREATMENT Review article
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Reducing anastomotic leak in colorectal surgery:The old dogmas and the new challenges 预览
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作者 Jeremy Meyer Surennaidoo Naiken +4 位作者 Niki Christou Emilie Liot Christian Toso Nicolas Christian Buchs Frédéric Ris 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第34期5017-5025,共9页
Anastomotic leak(AL)constitutes a significant issue in colorectal surgery,and its incidence has remained stable over the last years.The use of intra-abdominal drain or the use of mechanical bowel preparation alone hav... Anastomotic leak(AL)constitutes a significant issue in colorectal surgery,and its incidence has remained stable over the last years.The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned.The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration,such as the intravenous route or enema.In parallel,preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens,as identified by the microbiome analysis.AL can be further reduced by fluorescence angiography,which leads to significant intraoperative changes in surgical strategies.Implementation of fluorescence angiography should be encouraged.Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications. 展开更多
关键词 Anastomotic LEAKAGE RECTAL SURGERY COLIC SURGERY Prevention Surgical site infection ANASTOMOSIS COMPLICATION
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外科腹腔镜手术患者的护理干预进展
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作者 黄辉 《中国城乡企业卫生》 2019年第4期79-81,共3页
现阶段腹腔镜手术是外科疾病治疗的首选手术方案,其相比传统的开腹手术具有明显的优越性,主要体现在手术时间短、对患者的创伤较小、术中出血少、有助于患者早日康复等。近年来随着外科腹腔镜手术应用的不断深入,相应的围术期护理措施... 现阶段腹腔镜手术是外科疾病治疗的首选手术方案,其相比传统的开腹手术具有明显的优越性,主要体现在手术时间短、对患者的创伤较小、术中出血少、有助于患者早日康复等。近年来随着外科腹腔镜手术应用的不断深入,相应的围术期护理措施也备受关注。如何通过有效的护理干预,提高患者在腹腔镜手术过程中的耐受性,降低术后并发症的发生率,促进患者早日康复,是众多专家学者研究的热点问题之一。很多专家学者开展了大量的理论和实践研究工作,并取得了不错的效果。基于此,本文对近些年关于外科腹腔镜手术患者的护理干预进展进行综述,以期为外科腹腔镜手术患者的临床护理提供参考。 展开更多
关键词 外科 腹腔镜手术 护理干预
重视手术并发症的发生及预防 预览
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作者 王维斌 何小东 《协和医学杂志》 CSCD 2019年第4期313-316,共4页
外科手术学的发展史在一定程度上是外科医生与手术并发症博弈的历史,从最初的无菌术、麻醉学到抗生素的发明,显著降低了手术并发症的发生率,使现代医学的外科手术实现了从"高死亡率"向"高成功率"的蜕变。医疗层面,... 外科手术学的发展史在一定程度上是外科医生与手术并发症博弈的历史,从最初的无菌术、麻醉学到抗生素的发明,显著降低了手术并发症的发生率,使现代医学的外科手术实现了从"高死亡率"向"高成功率"的蜕变。医疗层面,医学技术的进步、手术治疗策略和治疗理念的更新在降低手术并发症方面起到了关键作用;教育层面,"三基三严"的住院医师规范化培训制度不仅是成为优秀外科医生的重要基石,也是手术质量和患者安全的重要保证;管理层面,借助综合交叉学科优势形成的"多学科诊疗模式"、医疗安全制度的建立以及手术流程的优化等有效降低了手术并发症的发生率。外科医生要始终高度重视手术并发症的发生和预防,将关口前移,以预防为主,努力将外科手术并发症的发生率降至更低水平。 展开更多
关键词 外科 手术学 并发症
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Precision surgical approach with lymph-node dissection in early gastric cancer 预览
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作者 Shinichi Kinami Naohiko Nakamura +4 位作者 Yasuto Tomita Takashi Miyata Hideto Fujita Nobuhiko Ueda Takeo Kosaka 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第14期1640-1652,共13页
The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to trea... The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition. 展开更多
关键词 Stomach neoplasms SURGERY GASTRECTOMY methods Recovery of function SENTINEL LYMPH NODE SURGERY Gastric cancer
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循证护理用于外科腹腔镜手术的护理效果评价 预览
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作者 王丽丽 《系统医学》 2019年第15期181-183,共3页
目的对外科腹腔镜手术患者中应用循证护理的效果进行探讨。方法选择收治的外科腹腔镜手术患者90例,所有患者均于2018年1-12月在该院接受治疗,按照随机数字表法分为实验组(n=45)和常规组(n=45)。常规组接受常规护理,实验组接受循证护理,... 目的对外科腹腔镜手术患者中应用循证护理的效果进行探讨。方法选择收治的外科腹腔镜手术患者90例,所有患者均于2018年1-12月在该院接受治疗,按照随机数字表法分为实验组(n=45)和常规组(n=45)。常规组接受常规护理,实验组接受循证护理,观察两组手术时间、术中出血量、并发症发生率、护理满意度。结果实验组手术时间(98.53±13.53)min、术中出血量(36.57±6.73)mL均显著低于常规组,差异有统计学意义(t=11.03、13.81,P<0.05)。两组麻醉时间对比差异无统计学意义(P>0.05)。实验组腹胀、肩痛、恶心呕吐、尿潴留、血压下降发生率分别为6.67%、4.44%、6.67%、0.00%、0.00%,均显著低于常规组,差异有统计学意义(χ2=5.41、7.28、6.48、5.20、4.19,P<0.05)。实验组护理满意度显著高于常规组,差异有统计学意义(P<0.05)。结论针对外科腹腔镜手术患者开展循证护理,能够显著降低术中出血,缩短手术时间,减少术后并发症,患者认可程度更高。 展开更多
关键词 外科 腹腔镜手术 循证护理
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Learning curve of enhanced recovery after surgery program in open colorectal surgery 预览
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作者 Varut Lohsiriwat 《世界胃肠外科杂志:英文版(电子版)》 2019年第3期169-178,共10页
BACKGROUND Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients’ outcomes is unknown. AI... BACKGROUND Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients’ outcomes is unknown. AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery. METHODS This was a review of prospectively collected database of 380 “unselected” patients undergoing elective “open” colectomy and/or proctectomy under ERAS protocol from 2011 (commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups (76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery: defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission. RESULTS Hospitalization more than 5 d occurred in 22.6%(n = 86), major complication was present in 2.9%(n = 11) and 30-d readmission rate was 2.4%(n = 9) accounting for unsuccessful recovery of 25%(n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1st quintile to 72.4%-85.5% in the following quintiles (P < 0.001). Average compliance with ERAS protocol gradually increased over the time - from 68.6% in 1st quintile to 75.5% in 5th quintile (P < 0.001). The application of preoperative counseling, nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period.CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery. 展开更多
关键词 Enhanced recovery after SURGERY ERAS COLON RECTUM SURGERY Learning curve OUTCOME COMPLIANCE
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59例骶尾部脊索瘤术后放疗后的生存分析
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作者 路顺 邹炳文 +2 位作者 彭新皓 张菡奕 郎锦义 《肿瘤预防与治疗》 2019年第1期38-42,共5页
目的:明确骶尾部脊索瘤患者是否能从术后的辅助放疗中获益,并且探索恰当的术后放疗模式。方法:回顾性纳入59例无远处转移且病理诊断明确为骶尾部脊索瘤的患者,分析其术后辅助放疗的生存情况。患者分为3组:22例为单纯手术切除组,24例为... 目的:明确骶尾部脊索瘤患者是否能从术后的辅助放疗中获益,并且探索恰当的术后放疗模式。方法:回顾性纳入59例无远处转移且病理诊断明确为骶尾部脊索瘤的患者,分析其术后辅助放疗的生存情况。患者分为3组:22例为单纯手术切除组,24例为手术联合术后图像引导下调强放疗(IG-IMRT)治疗组,13例为手术联合伽马刀(GKS)治疗组。结果:所有患者的5年生存率及5年无复发生存率分别为80.1%和44.5%;单纯手术组、IG-IMRT组及GKS组5年生存率分别为90.9%、87.5%及59.3%,5年无复发生存率分别为29.8%、70.9%和35%;术后辅助放疗组对比单纯手术组的5年无复发生存率差异具有统计学意义(P=0.029),IG-IMRT组的5年无复发生存率优于GKS组(P=0.023)。结论:术后辅助放疗有助于提升脊索瘤术后患者的5年无复发生存率,且术后辅助IG-IMRT可能是更为恰当的术后放疗模式。 展开更多
关键词 骶尾部脊索瘤 外科手术 辅助放疗 IG-IMRT GKS
颞下颌关节外科与正颌外科的共性思考
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作者 祝颂松 《中华口腔医学杂志》 CAS CSCD 北大核心 2019年第8期510-514,共5页
颞下颌关节外科与正颌外科是口腔颌面外科中的两个亚专业。临床上同时涉及牙颌面畸形与颞下颌关节的疾病并不少见,这些疾病在诊断与治疗上具有一定的复杂性与特殊性,尤其需要对颞下颌关节外科与正颌外科这两个学科交叉与重叠的领域进行... 颞下颌关节外科与正颌外科是口腔颌面外科中的两个亚专业。临床上同时涉及牙颌面畸形与颞下颌关节的疾病并不少见,这些疾病在诊断与治疗上具有一定的复杂性与特殊性,尤其需要对颞下颌关节外科与正颌外科这两个学科交叉与重叠的领域进行认真思考,同时也对口腔颌面外科医师提出更高的要求。本文通过对此类疾病诊治经验的介绍,分享对颞下颌关节外科与正颌外科的共性思考。 展开更多
关键词 外科 口腔 正颌外科学 颞下颌关节 颌面畸形
Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer 预览
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作者 Xian-Qiang Chen Chao-Rong Xue +2 位作者 Ping Hou Bing-Qiang Lin Jun-Rong Zhang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第33期4970-4984,共15页
BACKGROUND Obstructive colorectal cancer(OCC)is always accompanied by severe complications,and the optimal strategy for patients with OCC remains undetermined.Different from emergency surgery(ES),self-expandable metal... BACKGROUND Obstructive colorectal cancer(OCC)is always accompanied by severe complications,and the optimal strategy for patients with OCC remains undetermined.Different from emergency surgery(ES),self-expandable metal stents(SEMS)as a bridge to surgery(BTS),could increase the likelihood of primary anastomosis.However,the stent failure and related complications might give rise to a high recurrence rate.Few studies have focused on the indications for either method,and the relationship between preoperative inflammation indexes and the prognosis of OCC is still underestimated.AIM To explore the indications for ES and BTS in OCCs based on preoperative inflammation indexes.METHODS One hundred and twenty-eight patients who underwent ES or BTS from 2008 to 2015 were enrolled.Receiver operating characteristic(ROC)curve analysis was used to define the optimal preoperative inflammation index and its cutoff point.Kaplan–Meier analyses and Cox proportional hazards models were applied to assess the association between the preoperative inflammation indexes and the survival outcomes[overall survival(OS)and disease-free survival(DFS)].Stratification analysis was performed to identify the subgroups that would benefit from ES or BTS.RESULTS OS and DFS were comparable between the ES and BTS groups(P>0.05).ROC curve analysis showed derived neutrophil-to-lymphocyte ratio(dNLR)as the optimal biomarker for the prediction of DFS in ES(P<0.05).Lymphocyte-tomonocyte ratio(LMR)was recommended for BTS with regard to OS and DFS(P<0.05).dNLR was related to stoma construction(P=0.001),pneumonia(P=0.054),and DFS(P=0.009)in ES.LMR was closely related to lymph node invasion(LVI)(P=0.009),OS(P=0.020),and DFS(P=0.046)in the BTS group.dNLR was an independent risk factor for ES in both OS(P=0.032)and DFS(P=0.016).LMR affected OS(P=0.053)and DFS(P=0.052)in the BTS group.LMR could differentiate the OS between the ES and BTS groups(P<0.05).CONCLUSION Preoperative dNLR and LMR could predict OS and DFS in patients undergoing ES and BTS,respectively.For O 展开更多
关键词 Inflammation indexes Emergency SURGERY Self-expanding metal stent INSERTION as a bridge to SURGERY OBSTRUCTIVE colorectal CANCERS
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Mandated health insurance increases rates of elective knee surgery 预览
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作者 Daniel Kim Woo Do +3 位作者 Shahein Tajmir Brandon Mahal Joe DeAngelis Arun Ramappa 《世界骨科杂志(英文版)》 2019年第2期81-89,共9页
BACKGROUND The recent federal ruling to against Affordable Care Act(ACA),specifically the mandate requiring people to buy insurance,has once again brought the healthcare reform debate to the spotlight.The ACA increase... BACKGROUND The recent federal ruling to against Affordable Care Act(ACA),specifically the mandate requiring people to buy insurance,has once again brought the healthcare reform debate to the spotlight.The ACA increased the number of insured Americans through the development of subsidized healthcare plans and health insurance exchanges.Insurance-based differences in the rate of upper extremity elective orthopaedic surgery have been described before and after healthcare reform in Massachusetts,where a similar mandate was put into place years before the ACA was passed.However,no comprehensive study has evaluated insurance-based differences of knee elective surgery before and after reform.AIM To investigate how an individual mandate to purchase health insurance affects rates of knee surgery.METHODS A retrospective review was performed within an orthopaedic surgery department at a tertiary-care,academic medical center in Massachusetts.The rate of elective knee surgery performed before and after the healthcare reform(2005-2006 and 2007-2010,respectively)was calculated.The patients were categorized by insurance type(Commonwealth Care,Medicare,Medicaid,private insurance,Workers’Compensation,TriCare,and Uninsured).Usingχ^2 testing,differences in rates of surgery between the pre-reform and post-reform period and among insurance subgroups were calculated.RESULTS Rate of surgery increased in the post-reform period(pre-reform 8.07%(95%CI:7.03%-9.11%),post-reform 9.38%(95%CI:8.74%-10.03%)(P=0.04)and was statistically significant.When the insurance groups and insurance types were compared,the rates of surgery are not significantly different before or after reform.CONCLUSION The increase in the rate of elective knee surgery in the post-reform period suggests that health care reform in Massachusetts has been successful in decreasing the uninsured population and may increase health care expenditures.This is a hypothesis generating study that suggests further avenues of study on how mandated coverage may change healthcare utiliz 展开更多
关键词 Healthcare reform ELECTIVE SURGERY LOWER EXTREMITY Affordable Care Act ORTHOPAEDIC SURGERY
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腹股沟疝日间手术觃范化流程专家共识(2019版) 预览
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作者 陈杰 +1 位作者 申英末 孙立 《中华疝和腹壁外科杂志(电子版)》 2019年第3期193-197,共5页
一、前言日间手术(day surgery或ambulatory surgery)在全世界有多种定义,国际日间手术协会(International Association for Ambulatory Surgery,IAAS)推荐的日间手术定义是:"患者在同一个工作日完成手术或操作并出院的,不包括那... 一、前言日间手术(day surgery或ambulatory surgery)在全世界有多种定义,国际日间手术协会(International Association for Ambulatory Surgery,IAAS)推荐的日间手术定义是:"患者在同一个工作日完成手术或操作并出院的,不包括那些在诊所或门诊进行的手术或操作。"另外一组重要的人群是那些需要过夜观察的患者,我们建议将其称之为"日间手术—延期恢复患者",其定义是"在日间手术中心/单元(独立或在医院内)治疗的患者,需要延期恢复(在医院过夜),次日出院"。 展开更多
关键词 日间手术 腹股沟疝 SURGERY SURGERY 专家 IAAS 医院内 患者
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A novel technique for sacropelvic fixation using image-guided sacroiliac screws:a case series and biomechanical study 预览
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作者 Kee D.Kim Huy Duong +3 位作者 Aditya Muzumdar Mir Hussain Mark Moldavsky Bandon Bucklen 《生物医学研究杂志:英文版》 CAS CSCD 2019年第3期208-216,共9页
In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were ... In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting. 展开更多
关键词 LUMBOSACRAL FIXATION sacropelvic FIXATION SACROILIAC screw COMPUTER-ASSISTED SURGERY IMAGE-GUIDED SURGERY
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Microsurgical efficacy in 326 children with tethered cord syndrome: a retrospective analysis 预览
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作者 Ai-Jia Shang Chang-Hao Yang +4 位作者 Cheng Cheng Ben-Zhang Tao Yuan-Zheng Zhang Hai-Hao Gao Shao-Cong Bai 《中国神经再生研究:英文版》 SCIE CAS CSCD 2019年第1期149-155,共7页
关键词 症候群 绳索 孩子 功效 神经病 调查结果 回归分析 持续时间
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Effect of laparoscopic hepatectomy on growth factor, immunoglobulin and related factors in patients with hepatocellular carcinoma
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作者 Gang Wang Gen-Hai Shen +2 位作者 Quan-Gen Gao Jian-Mao Yuan Li-Qiang Qian 《海南医科大学学报(英文版)》 2019年第12期53-56,共4页
Objective:To compare the effects of laparoscopic surgery and traditional open surgery on serum growth factor, immunoglobulin and related factors in patients with hepatocellular carcinoma after operation.Methods: 60 pa... Objective:To compare the effects of laparoscopic surgery and traditional open surgery on serum growth factor, immunoglobulin and related factors in patients with hepatocellular carcinoma after operation.Methods: 60 patients with hepatocellular carcinoma admitted to our hospital from 2014 to 2018 were randomly divided into the control group and the observation group, with 30 cases in each group. Patients in the control group underwent traditional open radical hepatectomy, while patients in the observation group underwent laparoscopic radical hepatectomy. Before and after the operation, the levels of Alpha-alanine aminotransferase (ALT), aspartate aminotransferase (AST), vascular endothelial growth factor (VEGF), acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin G (IgG), matrix metalloproteinase-13 (MMP-13), Procalcitonin (PCT) and C-reactive protein (CRP) were compared between the patients in the two groups.Results:The levels of ALT, AST, VEGF, aFGF, bFGF, IgA, IgM, and IgG of patients in the control group were significantly decreased after the operation, but the levels of MMP-13, PCT and CRP increased significantly. The serum levels of ALT, AST, VEGF, aFGF, bFGF, IgA, IgM, and IgG of patients in the observation group were significantly decreased after operation, but the levels of MMP-13, PCT and CRP increased significantly. The above indexes of patients in the observation group were better than those in the control group (P<0.05).Conclusion: Laparoscopic hepatectomy has a good clinical effect. It can significantly reduce the level of growth factor in serum of patients. It has less damage to immune function than open surgery and can reduce the level of inflammatory stress caused by operation. 展开更多
关键词 LAPAROSCOPIC SURGERY Open SURGERY Liver cancer Growth FACTOR IMMUNOGLOBULIN Inflammatory FACTOR
Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery
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作者 San-Bao Hu Yong Hai +3 位作者 Jie-Fu Tang Tao Liu Bing-Xin Liang Bo-Qiong Xue 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第8期943-947,共5页
Background:To prevent risk of life-threatening stent thrombosis,all patients need to undergo dual antiplatelet therapy(DAPT)for at least 6 weeks to 12 months after stent implantation.If DAPT is continued during noncar... Background:To prevent risk of life-threatening stent thrombosis,all patients need to undergo dual antiplatelet therapy(DAPT)for at least 6 weeks to 12 months after stent implantation.If DAPT is continued during noncardiac surgery,there is a risk of severe bleeding at the surgical site.Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery.Methods:The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed.Prior to orthopedic surgery,DAPT was continued in 16 patients(groupⅠ),24 patients were treated with single antiplatelet therapy(groupⅡ),and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation ofall antiplatelet therapies(groupⅢ).Twelve patients were excluded,as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty.The perioperative blood loss of each patient was calculated using Nadler's formula and Gross5 formula.The intraoperative bleeding volume,total volume of intraoperative bleeding in addition to postoperative drainage,and total blood loss were compared between groups.The level of significance was set at P<0.05.Results:There were no significant differences between the three groups in age,intraoperative bleeding volume,total volume of intraoperative bleeding in addition to postoperative drainage,and total perioperative blood loss calculated by Nadler's formula and Gross,formula(all P>0.05).Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy;one of these patients in group III died from myocardial infarction.Conclusions:Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin.However,the discontinuation of antiplatelet therapy increase 展开更多
关键词 Dual ANTIPLATELET THERAPY NON-CARDIAC SURGERY ORTHOPEDIC SURGERY BLEEDING
Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation 预览
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作者 Tomohide Hori 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第13期1531-1549,共19页
Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic appr... Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes;however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation;using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons. 展开更多
关键词 LAPAROSCOPIC SURGERY Choledocholithotomy BILE DUCT LAPAROSCOPY General SURGERY
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Up-to-date intraoperative computer assisted solutions for liver surgery 预览
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作者 Apollon Zygomalas Ioannis Kehagias 《世界胃肠外科杂志:英文版(电子版)》 2019年第1期1-10,共10页
Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy,appropriate volumetric measurements,identification of anatomical risks,definition of tumour resection mar... Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy,appropriate volumetric measurements,identification of anatomical risks,definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations.Although preoperative computer surgical analysis has been widely used in daily clinical practice,intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation.Computer science technology can efficiently assist modern surgeons during complex liver operations,mainly by providing image guidance with individualized 2D images and 3D models of the various anatomical and pathological structures of interest.Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies,for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple.In laparoscopic liver surgery,intraoperative computer aid is definitively more important as,apart from a restricted field of view,there is also loss of the fine haptic feedback.Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice.There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions.An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed. 展开更多
关键词 Computer assisted SURGERY Liver INTRAOPERATIVE 3D models Navigation Image guidance AUGMENTED REALITY Hepatic SURGERY HEPATECTOMY
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非遗传性双侧同时性肾癌的诊治经验
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作者 王杭 许培榕 +5 位作者 张思弘 朱延军 姜帅 胡骁轶 何敏坷 郭剑明 《中华泌尿外科杂志》 CAS CSCD 北大核心 2019年第5期361-364,共4页
目的探讨非遗传性双侧同时性肾癌的诊治原则。方法回顾性分析2009年1月至2016年12月收治的36例非遗传性双侧同时性肾癌患者的临床资料,男30例,女6例。年龄26~77岁,平均55岁。36例共74个肾占位,其中34例双侧均为单发占位,2例为一侧肾脏有... 目的探讨非遗传性双侧同时性肾癌的诊治原则。方法回顾性分析2009年1月至2016年12月收治的36例非遗传性双侧同时性肾癌患者的临床资料,男30例,女6例。年龄26~77岁,平均55岁。36例共74个肾占位,其中34例双侧均为单发占位,2例为一侧肾脏有2个占位。占位直径1~11 cm,平均(6.8±4.1)cm。行保留肾单位手术(NSS)者的R.E.N.A.L.评分为4~12分,平均(6.1±3.4)分;中山评分为3~13分,平均(6.9±3.7)分。按手术方式分为4组:A组16例,术前肌酐63~103μmol/L,平均(80.9±11.4)μmol/L,行双侧NSS;B组7例,术前肌酐59~87 μmol/L,平均(75.7±8.9)μmol/L,先行一侧NSS再行对侧根治性肾切除术(RN);C组7例,术前肌酐57~107μmol/L,平均(77.6±19.2)μmol/L,先行一侧RN再行对侧NSS;D组6例,仅一侧行NSS或RN,对侧未行手术,其中2例为术前拟行NSS,术中发现肿瘤累及肾盂及输尿管上段,改行RN。16例行双侧NSS患者中,4例先行高评分侧肿瘤手术,二期行低评分侧肿瘤手术;11例先行低评分侧肿瘤手术,二期行高评分侧肿瘤手术;1例同期行双侧手术。对A、B、C组术后指标进行分析。结果 A、B、C组30例手术均顺利完成。NSS手术时间60~110 min,平均(88.6±23.6)min;RN手术时间40~90 min,平均(72.3±21.4)min。NSS热缺血时间12~40 min,平均(29.5±9.7)min。A组一期术后1个月肌酐62~117μmol/L,平均(89.4±15.8)μmol/L;二期术后1个月肌酐57~392μmol/L,平均(129.6±74.9)μmol/L;均无复发转移。B组一期术后1个月肌酐64~115 μmol/L,平均(94.0±14.4)μmol/L;二期术后1个月肌酐93~453μmol/L,平均(190.4±117.2)μmol/L;1例发生肺转移。C组一期术后1个月肌酐84~113 μmol/L,平均(90.1±12.1)μmol/L;二期术后1个月肌酐88~156μmol/L,平均(121.4±24.8)μmol/L;1例发生肺转移。B组1例二期术后出现少尿,行血液透析治疗1周后好转。3组一、二期术后肌酐与术前比较差异均无统计学意义(P>0.05)。30例一期术后住院时间3~16 d,平均(6.7±3.4)d;二期� 展开更多
关键词 肾癌 手术 保留肾单位手术
加速康复外科理念在胰腺外科中的应用与思考 预览
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作者 田孝东 杨尹默 《临床肝胆病杂志》 CAS 北大核心 2019年第5期964-967,共4页
近年来,加速康复外科(ERAS)理念及路径在我国临床实践被广泛认同与开展,在胰腺外科领域中也逐步开展。由于胰腺外科手术具有疾病复杂、手术难度大、术后并发症发生率高等客观因素,导致ERAS理念在胰腺外科的临床应用在不同胰腺中心差异较... 近年来,加速康复外科(ERAS)理念及路径在我国临床实践被广泛认同与开展,在胰腺外科领域中也逐步开展。由于胰腺外科手术具有疾病复杂、手术难度大、术后并发症发生率高等客观因素,导致ERAS理念在胰腺外科的临床应用在不同胰腺中心差异较大,其相关路径的开展与应用显著滞后于其他学科。目前,ERAS理念在胰腺外科中应用效果的的高级别循证医学证据仍较为缺乏,需要开展高质量临床研究证实其安全性和有效性。评述了目前胰腺外科开展ERAS的可行性及相关热点问题,供同道参考。 展开更多
关键词 胰腺疾病 外科学 加速康复外科 胰十二指肠切除术
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