中耳乳突内镜手术与开放术腔的鼓室乳突根治术治疗中耳胆脂瘤疗效对比

目的 研究中耳乳突内镜手术与开放术腔的鼓室乳突根治术对中耳胆脂瘤的治疗效果,为临床提供参考。方法 选取2016年11月至2021年11月新疆生产建设兵团第二师库尔勒医院收治的82例中耳胆脂瘤患者为研究对象,按照随机数字表法分为观察组和参照组,各41例。观察组患者采取中耳乳突内镜的鼓室乳突根治术治疗,参照组患者采取开放术腔的鼓室乳突根治术治疗,比较两组患者治疗总有效率、不良反应发生情况及术后两组患者的气导听阈、骨导听阈、气骨导差及干耳时间。结果 观察组患者治疗有效率高于参照组(P<0.05);观察组患者不良反应发生率低于对照组(P<0.05);术后观察组患者的气导听阈、骨导听阈及气骨导差低于参照组(均P<0.05);观察组患者的术后干耳率显著高于参照组,干耳时间短于参照组(P<0.05)。经过1年随访,两组患者均未见复发。结论 中耳乳突内镜手术的鼓室乳突根治术治疗中耳胆脂瘤效果显著,可以显著提升治疗有效率,降低不良反应发生率,具有应用价值。

Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma

AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.

Reynolds number dependence of flow past a shallow open cavity

Measurements were carried out in a shallow open cavity with particle image velocimetry technique.The cavity has a lengthto-depth ratio of 4:1,and the upstream inflow conditions include laminar,transient,and turbulent regimes at seven different Reynolds numbers.The measured instantaneous velocities were analyzed through ensemble average,vortex extraction,and proper orthogonal decomposition(POD)to investigate overall flow circulations,Reynolds stress distribution,spanwise vortex population,and the characteristics of the POD modes.The results reveal distinctive Reynolds number dependence of the cavity flow,e.g.an increase in Reynolds number results in constant migration of the overall circulation,enhancement of Reynolds stress,reduction of correlation between vortex and Reynolds stress,and decrease of fractional energy of the characteristic POD modes.Finally,a phenomenological model was proposed to describe various features of cavity flow.