泡沫敷料在预防呼吸科无创辅助通气患者鼻部压疮中的应用

目的探讨泡沫敷料在预防呼吸科无创辅助通气患者鼻部压疮中的应用价值。方法选取2017年1～6月我院呼吸科收治的使用无创呼吸机治疗的62例患者作为研究对象,根据护理方案的不同将其分为对照组(n=31)和观察组(n=31)。对照组患者采取鼻部常规护理,观察组患者在对照组的基础上采取泡沫敷料。比较两组患者的鼻部压疮发生率、舒适度、生活质量评分。结果观察组患者的鼻部压疮总发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组患者的护理总舒适度为93.55%,显著高于对照组的70.97%,差异有统计学意义(P<0.05)。两组患者干预后的生活质量评分均高于干预前,观察组患者干预后的生活质量评分高于对照组,差异有统计学意义(P<0.05)。结论对于采取无创呼吸机辅助通气的患者,采取泡沫敷料可明显降低鼻部压疮发生率,且明显可提高患者舒适度,改善患者的生活质量,值得在临床进一步探讨和推广。

引导性路径护理在妇产科腹腔镜术后患者中的应用效果

目的探讨引导性路径护理在妇产科腹腔镜术后患者中的应用效果。方法选取2016年7月~2018年7月瑞金市人民医院收治的60例腹腔镜手术患者作为研究对象,按照随机数字表法将其分为对照组和研究组,每组各30例。对照组采取常规护理模式,研究组采取引导性路径护理模式。比较两组患者的手术指标、腹胀发生率。结果研究组患者的术中出血量少于对照组,胃肠功能恢复时间、肛门排气时间、住院时间短于对照组,差异有统计学意义(P<0.05)。研究组患者的腹胀总发生率为6.67%(2/30),低于对照组的26.67%(8/30),差异有统计学意义(P<0.05)。结论将引导性路径护理模式应用于腹腔镜手术患者中,有利于患者胃肠功能恢复,减少术后腹胀发生率,值得在临床进一步探讨和推广。

Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis

Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.

Long-term outcomes of surgical treatment for pulmonary carcinoid tumors： 20 years＇ experience with 131 patients

Background Bronchial carcinoids are rare malignant neuroendocrine neoplasms. Some issues regarding surgical treatment of bronchial carcinoids remain controversial, including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy. Methods This retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010. Results Eighty-nine （67.9%） of the patients were male, and the mean age was 46 years, ranging from 17 to 81 years. Preoperative fiberoptic bronchoscopy was performed in all patients. Endoscopic biopsy was performed in 100 patients with central tumors, and 70 （70%） patients were diagnosed as bronchial carcinoid. The resections performed consisted of 31 pneumonectomie, 32 Iobectomies, 26 bilobectomies, 34 sleeve Iobectomies, six bronchoplastic procedures without lung resection, and two segmentectomies. During a median of 87 months follow-up, there were nine recurrences including three local recurrences and 6 distant recurrences. No bronchial recurrences were observed. The 3-, 5- and 10-year overall survival rates of pneumonectom and bronchoplastic surgery （including sleeve Iobectomy and bronchoplastic procedure without lung resection） were 93.2%, 81.0% and 69.4%, 97.5%, 91.9% and 70.0%, respectively. Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors. Conclusions Bronchoplastic surgery should be considered whenever possible for central carcinoids. Systematic lymphadenectomy is recommended for bronchial carcinoid patients. Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid.

Eighty-six cases of laparoscopic vaginoplasty using an ileal segment

Background The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies, we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively. Methods Totally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study. Of the 86 patients, 70 （81.4%） underwent primary operations and 16 （18.6%） secondary operations. Nineteen （22.1%） patients underwent total laparoscopic vaginoplasty and 67 （77.9%） patients underwent laparoscope-assisted vaginoplasty. The operation time, cost of hospitalization, and hospital duration were compared between the two laparoscopic groups. The Student＇s t test and the Mann-Whitney test were used to examine the differences. Results All the surgeries were successfully completed with no any intraoperative complication. There were three major surgical complications in the postoperative period： one case of intra-abdominal hemorrhage, one case of meatal stenosis and one case of intestinal obstruction. The mean follow-up period of this series was 18 months. Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up. Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups, such as the operation time, cost of hospitalization, and hospital duration （P 〈0.01）. There were no significant differences in sexual function between the two groups. Conclusions The laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic, functional, and anatomic results. Vaginoplasty with an ileal segment, performed by either total laparoscopic or laparoscope-assisted techniques, has a high success rate for a functional vagina.