目的 探讨布加综合征肠房转流术后顽固性腹水的治疗。方法 对2008年收治的1例经多次治疗(包括肠房转流术)后均于短期内复发的布加综合征患者进行回顾性分析。结果 临床表现为重度腹水致呼吸困难，CT静脉造影检查示肠房人工血管通畅但血流量低，考虑吻合口狭窄所致。术中探查发现吻合口极度狭窄，用带外支撑环的补片重建吻合口，疗效满意。结论 复杂或经多次手术或介入治疗的布加综合征患者，要遵循个体化治疗原则，强调术前明确诊断及选择正确治疗方案和手术方式。
ObjectiveTo acquaint the development process and item composition of the appraisal tools and reporting standards of clinical pathways worldwide, in order to improve the development and evaluation of clinical pathways. MethodsWe searched databases including PubMed, EMbase, Web of Science, CBM, CNKI and WanFang Data for articles about the appraisal tools and reporting standards of clinical pathways from inception to Jan, 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and compared the difference in development process and item composition among included appraisal tools and reporting standards of clinical pathways. ResultsA total of 7 appraisal tools and reporting standards were included. Among them, 3 were from UK, 1 from China, 1 from Australia, 1 from Belgium, and 1 from Saudi Arabia. All included appraisal tools contained 4 to 15 domains and 14 to 99 items. Based on the comparison of different domains and items of included appraisal tools, "Clinical Pathway Management Guidelines" published by the National Health and Family Planning Commission of the People's Republic of China and the research of Vannhaecht, we identified 17 key elements of clinical pathway as follows:organizational commitment, pathway project management, format of doc, content of pathway, multidisciplinary involvement, variance management, EBM/guidelines, maintenance of pathway, accountability, patient involvement, development of pathway, additional support systems & documents, operational arrangement, implementation, outcome management, safety and organization of the care process. ConclusionCurrently, the appraisal tools and reporting standards of clinical pathways are rudimentary, so we desperately needs to establish mature appraisal tool and reporting standard of clinical pathways to guide the development and implementation of clinical pathway, so as to improve their application effects in clinical practice and medical quality.
目的 探讨对侧颈动脉已被切除的颈动脉体瘤的手术方法。方法 左颈动脉体瘤患者1例，女，54岁。右侧颈动脉31年前因右颈动脉体瘤手术已经切除，本次手术以成对的蚊式钳逐步直接分离至瘤体与颈内动脉的Gordon-Tayler白线，在保证颈内动脉完整的情况下，完整切除瘤体及包裹其内的颈外动脉。结果 患者术后无声音嘶哑、呛咳、头晕等并发症，顺利出院。结论 充分的术前准备及正确的分离平面是保证手术顺利的关键。
ObjectiveTo analyze the earthquake emergency plans in 31 provinces (including autonomous regions, municipalities directly under the Central Government) of China, in order to summarize the relevant characteristics and discuss the existing problems to provide references for the revision and improvement of the earthquake emergency plan for the government and relevant departments. MethodsComprehensive literature search was conducted in the following websites:The Central People's Government of the People's Republic of China, China Earthquake Information Network, China Earthquake Administration, Government Websites and Earthquake Information Networks in 31 provinces (including autonomous regions, municipalities directly under the Central Government) of China. The literature which met the inclusion criteria was collected for descriptive analysis. ResultsEarthquake emergency plans in 31 provinces (including autonomous regions, municipalities directly under the Central Government) played a guiding role in the earthquake emergency and rescue work. However, some existing problems needed to be solved, which included:poor manoeuvrability of earthquake emergency plan, inadequate mechanisms of early warning and prevention, lower security on command platform and emergency shelter, and unclearly defined updating and revising time. ConclusionDifferent provinces (including autonomous regions, municipalities directly under the Central Government) of China should establish sound laws and regulations, improve the mechanisms of early warning and prevention, strengthen security measures of command platform and emergency shelter, and update and revise plans timely combined with its own characteristics, so that earthquake emergency plans could play a greater role in earthquake emergency in the future.
Objective To retrospectively analyze data of 4 377 victims during 2 weeks after Min-Zhang earthquake (Richter scale: 6.6), to provide references for decision-making of earthquake medical rescue. Methods We collected data of the wounded during two weeks after the earthquake, analyzed injuries and general rescue in hospital, input the data into Excel, and analyzed the data using SPSS 11.0. Descriptive analysis was conducted. Results As of 14 days after the earthquake, a total of 4 377 victims had been treated, including 858 hospitalized and 194 seriously-injured. The victims were from Min county, Zhang county, Dangchang county, and Li county. 145 injured people had been transferred to 10 municipal hospitals in Gansu province. Mental health centre of Gansu province had conducted psychological intervention among more than thousands of person-times. Disease control and prevention institutions in Dingxi city started severe natural disaster contingency planning 2 hours after earthquake, stipulated and improved the post-quake disease control technology plan, and dispatched quickly anti-epidemic emergency teams to complete tasks that included disposal of carcasses, monitoring water quality and epidemics, disinfecting environmental ruins, epidemic control in resettled areas, and large-scale health education. Conclusion The headquarter, in charge of medical relief and anti-epidemic work in the stricken areas of Min county and Zhang county, integrated resources, made overall command and quick response, and accomplished the phased tasks including anti-quake work, medical relief and anti-epidemic work, which replenished valuable data and experience.
目的 探讨Abernethy畸形致下消化道出血的诊断及治疗方法。方法 回顾1例Abernethy畸形患者的诊治情况，并结合相关文献进行分析。结果 血管造影确诊后经积极术前准备，行剖腹探查、乙状结肠造瘘术，术后3周开始给予中药保留灌肠至术后7周，6个月关闭造瘘,3周后继续辅以中药保留灌肠4周。患者顺利恢复出院，随访9个月未再次出血。结论 正确的诊断及合理的治疗方案是救治的关键。
Objective To retrospectively analyze medical rescue during Min-Zhang earthquake. Methods Medical rescue data reported from cities and counties in Gansu province were summarized in the earthquake relief and medical rescue headquarter of Gansu province. They were input into a database using Excel software. Descriptive analysis was conducted using SPSS 17.0. Results After the earthquake, Gansu Heath System quickly responded to the situations and started the contingency plan for earthquake, while patches of medical rescue teams were sent to the stricken areas. As of 14 days after the earthquake, 4 377 victims were treated in medical institutions of each levels. Hospital infection was comprehensively in control and psychological intervention was conducted among the target population. Conclusion The emergency response of Gansu Heath System was quick, effective, and well organized. Facing extraordinary disaster, Gansu province smoothly accomplished the tasks of earthquake relief and medical rescue at the initial stage.