【摘要】 目的 比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）的费用，并进行卫生经济学评价。 方法 对2009年5-7月行胆囊择期手术的124例患者，随机分为LC组72例、OC组52例。比较两组的手术住院情况、直接和间接医疗成本、总成本。 结果 LC组的直接医疗成本、间接医疗成本、总成本分别为（4891±231）元、（338±76）元、（5229±387）元，均低于OC组的（5505±389）元、（540±82）元、（5945±412）元，两组间各项成本比较有统计学意义（Plt;0.001）。 结论 LC能缩短手术时间、住院时间，降低医疗费用，加快床位周转，提高卫生资源的利用效率。【Abstract】 Objective To compare the cost of the laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) and make the health economic evaluation. Methods From May to July 2009, 124 patients who underwent selective cholecystectomy were divided into LC group (72 cases), and OC group (52 cases). The hospitalizations, direct and indirect medical costs and the total costs were analyzed and evaluated. Results The direct, indirect health care costs and the total costs of the LC group were (4891±231), (338±76),(5229±387) yuan; and were lower than those of the OC group [(5505±389), (540±82), (5945±412) yuan]. The cost comparison between the two groups were significant different (Plt;0.001). Conclusion LC could shorten the operative time, hospitalization time, lower the medical cost, speed up the bed turnover and increase the efficiency in the use of health resource.
目的 了解医院外科患者手术部位感染的危险因素，以采取预防与控制干预措施，降低手术部位感染率。 方法 以回顾性调查方法对2011年1月－6月外科手术患者统计手术部位感染率；以前瞻性调查的方法对2012年1月－6月外科手术部位患者进行目标性监测。 结果 2011年1月－6月手术部位感染率为1.01%，2012年1月－6月手术部位感染率为0.63%，两者比较，差异有统计学意义（P＜0.05）。患者年龄、手术类型、手术时间、手术性质是手术部位感染的高危因素。 结论 实施目标性监测，加强危险因素管理，采取干预措施，能有效降低外科手术部位感染率。
ObjectiveTo review the definition, incidence, risk factors, potential pathogenesis, biomarkers, and choice of follow-up treatment strategies of hyperprogressive disease (HPD).MethodDomestic and international literatures were collected to summarize the research progress of HPD in patients with malignant tumors who treated with immune checkpoint inhibitors (ICIs).ResultsThe research types of HPD were scattered, the sample size was limited, the definition standard was different, and there was lack of prospective validation studies. Therefore, the early warning assessment and molecular mechanism of HPD would become the next focus of the study of immunotherapy.ConclusionICIs can greatly improve the survival time of some patients with advanced malignant tumor, although some patients have HPD during treatment, but the incidence is relatively low.
Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. The existing treatment of postoperative AF mainly focuses on preoperative prevention, intraoperative protection and postoperative treatment for factors prone to AF before, during and after surgery, but the postoperative treatment in various areas and hospitals is different. This article combines the latest literature published in Europace about the practice guidance of cardioversion of AF and atrial flutter, and summarizes the treatment of electrical cardioversion, in order to provide clinical guidance for electrical cardioversion of AF after cardiac surgery.
Objective To summarize the preoperative CT three-dimensional reconstruction, and administration and visualization of indocyanine green (ICG) during ICG-assisted laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods A 56-year-old female patient admitted to the Department of Biliary Surgery in West China Hospital in April 2022 was retrospectively analyzed. The patient was considered the possibility of benign tumor of pancreatic head, and underwent LDPPHR. Three-dimensional CT reconstruction was performed before operation, and ICG (5 mg) was injected intravenously preoperative and intraoperative to complete LDPPHR. Results Preoperative three-dimensional CT reconstruction can assist in judging the course and relationship of anterior and posterior pancreaticoduodenal arterial arch and surrounding main blood vessels. After intravenous injection of 5 mg ICG 24 hours before operation, the common bile duct at the upper edge of pancreas was clearly visualized, and the cystic mass was judged not to communicate with bile duct and pancreatic duct. But it was difficult to identify the pancreatic segment of the common bile duct in fluorescence mode, ICG 5 mg was injected intravenously during the resection stage, and then the common bile duct was obviously visualized. After the resection stage, injected ICG (5 mg) intravenously again. Within 1 min, the fluorescence of the duodenum was enhanced, which suggested that the blood perfusion of duodenum was well. The operative time was 280 min, the blood loss was about 200 mL. On the 10th day after operation, the patient developed transient gastrointestinal bleeding with bile leakage, which improved after symptomatic treatment and was discharged on the 19th day. Postoperative pathological examination diagnosed pancreatic serous cystadenoma. Conclusions Three-dimensional reconstruction and ICG assisted LPDDHR can successfully visualize and identify the blood vessels and bile ducts, and check the duodenal blood perfusion. Which can making the operation more accurate and visual is a powerful guarantee for LDPPHR to be carried out safely and effectively.
Objective To evaluate the efficacy and safety of meperizumab for patients with refractory asthma by means of meta-analysis. Methods PubMed, Web of Science, China National Knowledge Infrastructure and other databases were searched for literatures on randomized controlled trials of meperizumab for patients with refractory asthma published before October 30, 2021. The Endnote X9.2 software was used to summarize and eliminate duplicate studies. The literature was screened according to the pre-specified inclusion and exclusion criteria, and data extraction and quality evaluation were performed on the selected literature. Stata 16.0 was used for meta-analysis. Results A total of 632 related articles were detected, and 8 articles were included after screening, including 2438 subjects. Meta-analysis results showed that the patients with refractory asthma treated with meperizumab had a 22% reduction in the risk of exacerbation [relative risk (RR)=0.78, 95% confidence interval (CI) 0.70 to 0.88], forced expiratory volume in one second [weighted mean difference (WMD)=0.10, 95%CI 0.06 to 0.13] and asthma control questionnaire score (WMD=–0.32, 95%CI –0.47 to –0.17) were improved, blood eosinophil count (WMD=–0.23, 95%CI –0.37 to –0.09) and sputum eosinophil count (WMD=–6.37, 95%CI –9.68 to –3.06) were significantly decreased. The probability of serious adverse reactions was significantly reduced (RR=0.65, 95%CI 0.47 to 0.90). Conclusion Meperizumab can effectively reduce the risk of exacerbation for asthma, improve lung function and asthma control level, reduce blood eosinophil count and sputum eosinophil count, and reduce the incidence of serious adverse reactions in patients with refractory asthma.
Objective To evaluate the effect of endoscopic surgery combined with intraoperative color Doppler ultrasound on removing the injected breast augmentation agents and share our experiences. Methods Sixteen female who accepted the bilateral removal of injected breast augmentation agents through endoscopic surgery combined with intraoperative color Doppler ultrasound between 2008 and 2010 were enrolled in this study. The results, techniques, and advantages of management were analyzed retrospectively. Results One incision was made in 18 breasts, 2 in 4 breasts, 3 in 10 breasts. The length of incision was 0.5 to 1 cm. The mean operative time was 128.70 min per person. The average amount of bleeding was 52.67 ml per person. Complications such as postoperative bleeding, infection, poor drainage, or breast augmentation agents remain did not happened in all cases. No case was turned into normal operation. Female who accepted this operation were all satisfied with the appearance of incisions. During 1-3 months follow up, neither clinically palpable mass nor sensory disturbance in nipple or areola of breast was observed. Color Doppler ultrasound or magnetic resonance showed 16 cases had been cleared free of breast augmentation agents. Conclusion With the advantages of beauty, safe, minimal invasion, and partial resection of lesions at the same time, endoscopic surgery combined with intraoperative color Doppler ultrasound was an effective approach in the removal of injected breast augmentation agents.
【摘要】 目的 探讨乳腺癌保乳切除加经乳腔镜清扫腋窝淋巴结的可行性和手术难点。 方法 将2007年2月－2011年2月行乳腺癌保乳切除手术的27例患者，分成乳腔镜腋窝清扫组（乳腔镜组）11例和常规腋窝清扫组（常规组）16例，比较两组患者手术时间、术中出血量、术中清扫淋巴结数、术后引流时间及引流量等。 结果 手术时间:乳腔镜组（186.36±11.20） min，常规组（158.13±25.29） min，两组差异有统计学意义（P=0.002）；术中出血量:乳腔镜组（61.82±51.54） mL，常规组（103.75±42.56） mL，两组差异有统计学意义（P=0.030）；两组术中清扫淋巴结个数、术后引流时间、引流量比较，差异均无统计学意义（Pgt;0.05）；随访1个月~4年，无一例发生肿瘤局部复发或戳孔转移。 结论 乳腺保乳切除加经乳腔镜清扫腋窝淋巴结可以安全应用于早期乳癌的保乳治疗，操作者需学习一定的手术技巧。【Abstract】 Objective To investigate the feasibility and surgical difficulty of breast-conserving resection and endoscopy-assisted axillary lymph node dissection for breast cancer patients. Methods Twenty-seven patients treated by breast-conserving surgery from February 2007 to February 2011 in our hospital were divided into endoscopy-assisted axillary lymph node dissection group (the EALND group, n=11) and conventional axillary lymph node dissection group (the CALND group, n=16). Then, we compared the operation time, intra-operative bleeding volume, number of lymph nodes dissected, postoperative drainage time and amount between the two groups. Results The operation time was significantly longer in the EALND group than that in the CALND group [(186.36±11.20) vs. (158.13±25.29) minutes, P=0.002]. The intra-operative bleeding volume of the EALND group was significantly less than that of the CALND group [(61.82±51.54) vs. (103.75±42.56) mL, P=0.030]. There were no significant differences between the two groups in the number of lymph nodes dissected, postoperative drainage time and amount. Follow-up was done for one month to four years, during which no local recurrence or trocar displacing occurred. Conclusion The breast-conserving resection and endoscopy-assisted axillary lymph node dissection can be safely used in early breast cancer patients, and surgical skills should be mastered in the study.
【摘要】 目的 探讨腔镜技术通过不同切口方式取出聚丙烯酰胺水凝胶（polyacrylamide hydrogel，PAHG）注射隆乳剂手术的临床效果，以取得最大隆乳剂清除率。 方法 2008年1月－2011年3月双侧乳房PAHG注射隆乳术后并发症患者35例，将腔镜技术分别应用于经乳房外侧切口和经乳晕切口PAHG注射隆乳剂取出手术。经乳房外侧切口治疗21例，于乳房外侧缘隐匿部位分别选做长约0.5～1.0 cm的切口1～3个，穿刺吸刮PAHG后在腔镜结合彩色多普勒超声彻底清除PAHG；经乳晕切口14例，沿乳晕下缘做2～3 cm弧形切口，吸刮PAHG后，以长头拉钩挑起囊腔，在内镜辅助下通过刮除或吸刮交替清除残留PAHG，彩色多普勒超声扫查确认未见PAHG回声团块。总结比较两种切口中应用腔镜技术的临床经验。 结果 所有患者均顺利完成手术，达到最大限度取出隆乳剂的目的。无中转改变手术方式，无术后出血、感染、引流不畅、隆乳剂残留等并发症；患者均对切口感到满意。经乳晕切口组中6例取出隆乳剂后同期置入硅胶囊假体，该组有1例出现乳头乳晕的感觉敏感度降低。 结论 腔镜辅助下经乳腺外侧切口和经乳晕切口都能够安全、有效并最大限度地取出PAHG注射隆乳剂，具有美容、微创和可以同期切除病变组织的优势，经乳晕切口手术方便同期硅胶囊假体的置入。腔镜技术值得在PAHG注射隆乳剂取出术中进一步推广应用。【Abstract】 Objective To explore the clinical outcome of endoscopic techniques in the removal of injected breast-augmentation polyacrylamide hydrogel (PAHG) through different incision methods in order to achieve a maximal PAHG removal rate. Methods From January 2008 to March 2011, 35 patients with postoperative complications after bilateral breasts PAHG injection were diagnosed and treated in our hospital. Endoscopic techniques were applied to remove PAHG through the lateral incision of breast or the mammary areolar incision. Twenty-one patients were treated with lateral incision in which 1-3 incisions with a length of 0.5-1.0 cm were selected at hidden lateral sites of breasts, and PAHG was removed by vacuum sucking followed by endoscopic technique with Doppler color ultrasound to achieve a complete removal. Fourteen patients were treated with mammary areolar incision where an arc-shaped 2-3 cm incision was made under the lower margin of mammary areola. After vacuum sucking of PAHG, long head hook was used to lift the cyst and endoscopic technique was used along or alternate with sucking to remove the remaining PAHG. Doppler color ultrasound scanned to confirm the absence of PAHG mass. The clinical experiences of these two endoscopic techniques were compared and summarized. Results All patients successfully underwent the surgery and achieved a goal of maximal removal of PAHG. None of the patients had to switch surgery approach, and no such complications as post-surgery bleeding, infection, obstructed drainage or PAHG remaining occurred. Patients were all satisfied with the appearance of incisions. Six patients were given silicone prosthesis implantation after removing PANG through the areola incision, among whom one patient showed a decreasing sensitivity in mammary nipple and areola. Conclusions Both endoscopic techniques through the lateral incision of breast and the mammary areolar incision are safe, and can achieve maximal removal of PAHG. They both have the advantages of beautifying, minimal invasiveness and simultaneous removal of pathologic tissues. The mammary areolar incision facilitates implantation of silicone prosthesis simultaneously. The endoscopic techniques are worthy to be further applied into removal of PAHG
Objective To discuss the effect of monitoring-training-planning (MTP) intervention model on the prevention and control of catheter–associated urinary tract infection (CAUTI) in Intensive Care Unit (ICU). Methods Patients with indwelling catheter from departments with ICU (ICU, ICU of the Department of Neurosurgery, ICU of the Department of Neurologic Medicine) between 2014 and 2015 were included in this study. Based on the inclusion criteria, target monitoring indicators were set in accordance with Hospital Infection Monitoring Norms. A total of 493 patients with indwelling catheters from January to December 2014 were subjected to target surveillance, and were used as baseline for the study. A total of 529 patients with indwelling catheters from January to December 2015 were treated with MTP intervention. The occurrence of indwelling catheter–associated urinary tract infections in the intensive care unit was compared before and after intervention. Results The incidence of indwelling catheter-associated urinary tract infections before and after MTP intervention were different, and the difference was statistically significant (P<0.05). Conclusion MTP intervention model can effectively prevent and reduce indwelling catheter-associated urinary tract infections in ICU.