多学科协作手术治疗颈静脉孔区颅内外沟通型肿瘤的临床分析

目的总结分析多学科协作手术切除颈静脉孔区哑铃型肿瘤的临床疗效。方法回顾性分析2011年4月—2023年7月重庆医科大学附属第一医院神经外科后颅底脑干组收治的5例多学科协作手术治疗的颈静脉孔区颅内外沟通型肿瘤患者的临床资料。采集信息包括一般情况、临床表现、专科检查、辅助检查、手术方法、术后并发症、病理及随访结果。结果所有病例均由神经外科、耳鼻咽喉科、颌面外科行MDT讨论并采用MDT手术治疗方案,其中2例行颞下窝Fisch A型联合颈部入路,3例行颅颈联合入路。5例患者中次全切除4例,部分切除1例。术后病理结果提示脑膜瘤2例,神经鞘瘤1例,副神经节瘤1例,脊索瘤1例。术后后组颅神经损伤3例,面瘫3例,听力下降2例,脑脊液漏2例,颅内感染3例。平均随访时间51.8个月(8~150个月);平均随访卡氏功能状态评分(KPS)90分(80~100分)。结论多学科协作手术不仅增加了颈静脉孔区哑铃型肿瘤的切除程度,而且提高了颈静脉孔区哑铃型肿瘤的手术安全性。当全切除较为困难或可能导致较为严重的并发症时,次全切除后辅助放疗也是一种较好的治疗方案。

多学科协作手术室护理在高血压脑出血手术中的价值及对并发症的影响

目的探讨多学科协作手术室护理在高血压脑出血手术中的价值及对并发症的影响。方法本研究选取2021年1月至2022年8月该院62例高血压脑出血患者按随机数字表法分组,常规组开展常规围术期护理(31例),协作组开展多学科协作手术室护理(31例),比较两组术前应激指标及血压控制情况、并发症以及术后恢复情况。结果协作组干预后皮质醇(Cor)、去甲肾上腺素(NE)含量及收缩压(SBP)、舒张压(DBP)水平均低于常规组;协作组并发症发生率低于常规组;协作组干预后运动功能评定量表(FMA)及格拉斯哥预后评分(GOS)评分均高于常规组,其美国国立卫生研究院卒中量表(NIHSS)得分低于常规组,差异有统计学意义(P<0.05)。结论多学科协作手术室护理用于临床高血压脑出血手术期间,可获得满意效果,术后并发症较少。

1例罕见的肝癌患者癌栓转移到右心房的多学科手术配合

总结多学科手术配合切除肝癌合并右心房癌栓的手术配合经验。方法:对一例罕见的肝癌癌栓转移到右心房的多学科参与的手术,采取各专科手术由专科护士分别配合的方式,并且介绍了器械护士与巡回护士的配合过程以及整个手术过程中需要额外关注的问题。结果:多学科参与的手术采用专科护士配合能提高手术效率与护理安全。结论:专科化的手术配合是手术顺利完成的关键。

国内手术相关医学学科应用PBL教学效果的Meta分析

为探讨国内手术相关医学学科应用PBL教学效果,用循证医学方法对手术相关学科以往关于PBL与传统教学法进行比较的相关研究进行Meta分析和系统评价。检索并最终纳入11篇文献,累计学生1 155人,其中PBL组561人,传统组594人。结果表明,PBL教学模式在手术相关学科培养医学生的理论成绩、技能成绩、问卷调查肯定回答人数、综合能力考试成绩、阶段考试成绩、期末考试成绩、附加题考试成绩等方面明显优于传统教学模式。

多学科协作快速康复外科手术室护理在高血压脑出血手术中的作用

目的研究高血压脑出血(HICH)患者行多学科协作快速康复外科手术室护理的效果。方法数据取自福建医科大学附一闽南医院2020年4月至2021年4月收治的84例HICH患者,“双盲法”分为参照组(42例,传统护理)、协作组(42例,多学科协作快速康复外科手术室护理),比较两组的疗效。结果护理前比较心理应激性、血压水平,无差异(P>0.05);护理后与参照组比较,协作组SAS、SDS值更低;SBP、DBP指标更低;协作组满意率(97.62%)高于参照组(80.95%)(P<0.05)。结论多学科协作快速康复外科手术室护理可有效改善HICH患者的心理应激性、稳定血压,改善护患关系、避免纠纷出现,值得推崇。

多学科团队协作的手术室流程优化在腹腔镜胆囊切除术中的应用效果

目的:探讨多学科团队协作的手术室流程优化在腹腔镜胆囊切除术中的应用效果。方法:回顾性分析本院2022年1月至5月行腹腔镜胆囊切除术的70例患者的临床资料,将受试者根据不同手术室流程分为对照组和研究组,各35例,对照组与研究组患者分别行常规手术室流程与多学科团队协作的手术室流程优化,对比两组患者心理应激指标评分变化、手术相关指标、术后并发症发生率与患者及医护人员满意度。结果:干预后两组患者的SAS与SDS评分较干预前明显降低,且研究组降低幅度较对照组更为显著(P<0.05);研究组患者手术时间较对照组更短,术中出血量较对照组更少,P<0.05,有统计学差异;研究组患者术后发生并发症3例(占8.57%),对照组患者术后发生并发症9例(占25.71%),P<0.05,有统计学差异;研究组患者与医护人员满意度评分相较于对照组更高,P<0.05,有统计学差异。结论:多学科团队协作的手术室流程优化有助于缓解患者心理应激反应,缩短术前准备、麻醉以及术后恢复时间,减少术后并发症发生风险,患者及医护人员满意度高,对确保腹腔镜胆囊切除术顺利进行、促进术后康复具有积极意义。

我院多学科联合手术室的构建

目的探讨多学科联合手术室设计及功能特点。方法浅析我院新建多学科联合手术室的设计过程,并在工程完成后进行各项技术测试。结果联合手术室的构建联合了11个合作科室的综合技术力量,设计合理,各项测试达标,能在满足一个(DSA)造影室需要的同时达到一个洁净手术室的标准。结论跨学科的联合手术室可以综合利用优势资源、提高疗效、拓宽治疗指征、降低医疗风险、减少患者费用。

瑞芬太尼+丙泊酚多学科手术麻醉效果评价

目的:观察探索瑞芬太尼+丙泊酚在多学科手术麻醉中的应用效果。为短小手术提供最佳麻醉方法、麻醉药物和剂量。方法:将瑞芬太尼+丙泊酚静脉复合麻醉用于人工流产术、开胸引流术、开颅减压术、扁桃体切除术、骨科小手术等,观察术中血流动力学变化、麻醉诱导、手术、苏醒时间和定向力恢复、镇痛效果及术后不良反应发生情况。结果:瑞芬太尼+丙泊酚在多学科应用血流动力学、作用时间、镇痛效果、副作用发生率各组间无显著性差异,P>0.05。瑞芬太尼+丙泊酚三种剂量副作用对照A、B组与C组比较,P<0.05;A、C组与B组比较,P<0.05;镇痛效果B、C组与A组比较P<0.05。瑞芬太尼+丙泊酚组合,安全保障的最佳用药量分别为0.9～1.4μg/mg、1.9～2.2mg/kg。结论:瑞芬太尼+丙泊酚组合在多学科应用血流动力学干扰轻,作用时间理想,镇痛效果显著,副作用发生率低,不受体质、性别、年龄影响,适用于多学科手术麻醉。

多学科协作手术室护理在高血压脑出血手术中的价值及对并发症的影响

目的研究多学科协作手术室护理在高血压脑出血手术中的价值及对并发症的影响。方法本文选取2020年8月至2021年12月在本院接受手术治疗的高血压脑出血患者60例进行研究,应用简单随机分组法将其分为两组,即对照组(实施常规护理)和观察组(应用多学科协作手术室护理)。对比两组患者的并发症发生率、生活能力和神经功能缺损情况、血压水平。结果观察组患者的并发症发生率同对照组相比,明显更低(P<0.05);观察组患者的美国国立卫生院神经功能缺损(NIHSS)评分明显低于对照组,日常生活能力量表(ADL)评分明显高于对照组,血压水平低于对照组(P<0.05)。结论在高血压脑出血手术中应用多学科协作手术室护理的效果理想,在降低相关并发症发生率方面有显著价值。

1例Ⅳ期子宫静脉平滑肌瘤累及右心的术前、术后护理

血管内平滑肌瘤病是一种少见的子宫中胚叶良性肿瘤,早在1896年就有对该病例的描述,但直到1975年,血管内平滑肌瘤的诊断名词才被正式提出。该病的主要临床特征是平滑肌瘤细胞超出子宫范围,沿血管内呈蔓延性生长,可以从小静脉延及下腔静脉,甚至右心房[1]。该病的组织学特征为良性病变,但其生长方式与子宫肌瘤完全不同,类似恶性肿瘤,肿瘤引起循环系统严重梗阻者可危及生命。因为该病临床症状缺乏特异性,且发病较少,多为检查时无意中发现静脉系统瘤栓,常常在诊断与处理上造成困惑。本科于2018年1月12日收治了1名子宫静脉平滑肌瘤并累及右心的患者,并成功进行手术治疗,通过术前、术后对患者进行了严密的观察与护理,3 w后患者康复出院,现将护理体会报告如下。

颈侧后联合入路在颈椎管沟通性肿瘤一期切除手术中的应用

目的探讨经颈侧后联合入路手术一期切除颈椎管沟通性肿瘤的临床疗效。方法病例系列报告。纳入2015年7月—2022年8月南通大学附属医院12例颈椎管沟通性肿瘤患者,其中男3例、女9例,年龄33~74(51.2±11.9)岁;ToyamaⅡb型2例、Ⅱc型7例、Ⅲb型3例;肿瘤位于C2节段以上4例、C2~4节段3例、C4~7节段5例。患者均采用颈侧后联合入路一期切除手术治疗:神经外科采用经典后正中入路,磨除病变节段半椎板,切除位于椎管内和椎间孔处的肿瘤;头颈外科对于肿瘤完全位于下颌骨平面以上者采用颈腮腺入路,其余采用单纯颈侧入路切除向椎旁颈部间隙延伸的肿瘤组织,并与后正中入路会师,切除顺序为先椎管内、后椎管外。观察肿瘤一次性全切率、手术时间、术中出血量、手术并发症及术后神经症状改善情况,术后6个月颈椎X线摄片评估脊柱稳定性。结果本组患者肿瘤均一期彻底切除,肿瘤一次性全切率为12/12。术后病理诊断:神经鞘瘤10例,软骨瘤和神经纤维瘤各1例。手术时间215(183,315)min,术中出血120(85,188)mL。术后并发脑脊液漏1例、局部感染1例,均经对症处理痊愈后出院。5例患者因切除2个节段半椎板术后佩戴颈托6~12周。术后随访6~90个月,12例患者均恢复正常生活,无一例肿瘤复发;12例中,有1例患者术后手部麻木缓解不明显、运动功能正常,其余患者原神经受累症状改善。所有患者术后复查颈椎X线片,随访期内未见脊柱畸形,脊柱稳定性良好。结论对于累及颈椎管内外的沟通性肿瘤,采用耳鼻咽喉头颈外科和神经外科协作颈侧后联合入路手术,不仅可以一期彻底切除肿瘤,还能最大限度地减少对头颈部重要血管神经的损伤以及术后颈椎不稳,体现了多学科合作的优势。

Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis

This article is to offer a concise review on the use of cytoreductive surgery （CRS） plus intraperitoneal hyperthermic chemotherapy （IPHC） for the treatment of peritoneal carcinomatosis （PC）. Traditionally, PC was treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 too. With the establishment of several phase Ⅱ studies, a new trend has been developed toward the use of CRS plus IPHC as a standard method for treating selected patients with PC, in whom sufficient cytoreduction could be achieved. In spite of the need for more high quality phase Ⅲ studies, there is now a consensus among many surgical oncology experts throughout the world about the use of this new treatment strategy as standard care for colorectal cancer patients with PC. This review summarizes the current status and possible progress in future.

Iris recognition:a biometric method after refractive surgery

Iris recognition,as a biometric method,outperforms others because of its high accuracy. Iris is the visible internal organ of human,so it is stable and very difficult to be altered. But if an eye surgery must be made to some individuals,it may be rejected by iris recognition system as imposters after the surgery,because the iris pattern was altered or damaged somewhat during surgery and cannot match the iris template stored before the surgery. In this paper,we originally discuss whether refractive surgery for vision correction(LASIK surgery) would influence the performance of iris recognition. And experiments are designed and tested on iris images captured especially for this research from patients before and after refractive surgery. Experiments showed that refractive surgery has little influence on iris recognition.

Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

AIM:To evaluate the effects of preoperative immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention.In addition,effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups.The immunonutrition group received a combination of arginine,fatty acids and nucleotides.The second and third group received normal nutrition and standard enteral nutrition,respectively.Nutrition protocols were administered for 7 d prior to the operation.Nutritional parameters,in particular prealbumin levels and lymphocyte subpopulations(CD4+,CD8+,CD16+/56+,and CD69 cells)were evaluated before and after the nutrition protocols.Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed thestudy,16 received immunonutrition,13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group,but this parameter was improved after the nutritional protocol only in the immunonutrition group(13.64±8.83 vs 15.98±8.66,P=0.037).Groups were similar in terms of CD4+,CD16+/56,and CD69+prior to the nutritional protocol;whereas CD8+was higher in the standard nutrition group compared to the immunonutrition group.After nutritional protocols,none of the groups had an increase in their lymphocyte subpopulations.Also,groups did not differ in terms of postoperative complications and postoperative durations of hospital stay. CONCLUSION:Preoperative immunonutrition provided a significant increase in prealbumin levels,while it did not significantly alter T lymphocyte subpopulation counts,the rate of postoperative complications and the duration of hospital stay.

Multi-disciplinary treatment for cholangiocellular carcinoma

Cholangiocarcinoma(CC)is rare malignant tumors composed of cells that resemble those of the biliary tract.It is notoriously difficult to diagnose,and is associated with a high mortality.Traditionally,CC is divided into intrahepatic and extraheaptic disease according to its location within the biliary tree.Intrahepatic cholangiocellular carcinoma(IH-CCC)or peripheral cholangiocellular carcinoma(CCC)appears within the second bifurcation of hepatic bile duct,and is the second most common primary liver cancer following hepatocellular carcinoma(HCC),IH-CCC or peripheral CCC often presents with advanced clinical features,and the cause for this cancer rise is still unclear.MRI,CT and PET provide useful diagnostic information in those patients.Surgical resection is the only chance for cure,with results depending on selected patients and careful surgical technique.Liver transplantation could offer long-term survival in selected patients when combined with chemotherapy.Chemotherapy,radiation therapy or combination therapies remain as the only treatment for inoperable patients.However,these are uniformly ineffective in patients' survival.

Surgical management of gastric stump cancer:a report of 37 cases

Objective:To observe the clinicopathological characteristics of gastric stump cancer(GSC)and evaluate the benefitsof radical surgery of GSC.Methods:The clinicopathological characteristics and postoperative survival time of 37 GSC patientswho underwent surgery were investigated retrospectively.The survival time was compared according to the type of surgicaloperation(radical resection vs palliative operation).Twenty-one cases that received radical resection were analyzed based on thepTMN stage.Survival curves were traced by using Kaplan-Meier methods.Results:Most GSC(32/37)was detected in patientswho had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease.The lesser curvature side and thesuture line of anastomosis were the most frequent sites where GSC occurred(27/37).Differentiated adenocarcinoma was thedominant histopathological type(24/37).The postoperative 5-year survival rate of early stage GSC patients(n=9)was significantlyhigher than advanced stage GSC(n=12)(55.6% vs 16.5%,x_L^2=11.48,P<0.01).Five-year survival rate of 21 GSC patients withradical resection were 75%(3/4)for stage Ⅰ,60%(3/5)for stage Ⅱ,14.2%(1/7)for stage Ⅲ,and 0%(0/5)for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative op-eration(43.0 m vs 13.0 m,X_L^2=36.31,P<0.01),the median survival time of stage Ⅳ patients with radical resection was 23.8months.Conclusions:Without remote metastasis,radical resection for GSC is possible,and is an effective way to improve theprognosis of GSC.Even in stage Ⅳ GSC,radical resection can still prolong the survival time.It is necessary for the patients withbenign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up,especially in patients with BillrothⅡ reconstruction procedure at 15-20 years.

Factors Influencing Pleural Effusion after Fontan Operation:an Analysis with 95 Patients

Objective To investigate the association between preoperative,operative,and postoperative factors and persistent pleural effusion after the extracardiac Fontan procedure. Methods Ninety-five consecutive patients diagnosed with univentricular heart underwent extracardiac connection using Gore-Tax conduits at the Department of Children’s Heart Centre,Justus-Liebig-University Giessen in Germany from June 1996 to July 2007. The outcome measures were duration and volume of chest tube drainage after surgical intervention. The investigated factors included age and weight at the time of operation,anatomical diagnosis,preoperative oxygen saturation,mean pulmonary artery pressure,ventricular end-diastolic pressure,fenestration,cardiopulmonary bypass time,conduit size,postoperative pulmonary artery pressure,administration of angiotensin-converting enzyme inhibitors,and postoperative infection. Associations between these factors and persistent pleural effusion after the extracardiac Fontan procedure were analyzed. Results Every patient suffered postoperative effusion. The median duration of postoperative chest tube drainage was 9 days (range,3-69 days),and the median volume was 12 mL·kg-1·d-1 (range,2.0-37.5 mL·kg-1·d-1). Thirty-seven (38.9%) patients had pleural drainage for more than 15 days,and the volume in 35 (36.8%) patients exceeded 25 mL·kg-1·d-1. Nineteen (20%) patients required placement of additional chest tubes for re-accumulation of pleural effusion after removal of previous chest tubes. Fifteen (17.8%) patients were hospitalized again due to pleural effusion after discharge. The median length of hospital stay after the operation was 14 days (range,4-78 days). Multivariate analysis results showed that non-fenestration,low preoperative oxygen saturation,and postoperative infections were independent risk factors for prolonged duration of pleural drainage (P<0.05). Long cardiopulmonary bypass time,non-fenestration,small conduit size,and low preoperative oxygen saturation were independent risk factors for excessive volume of pleural drainage (P<0.05).Conclusions For reduing postoperative duration and volume of pleural drainage following Fontan procedure,it seems to be important to improve the preoperative oxygen saturation,use large size of conduit,shorten cardiopulmonary bypass time,and make fenestration during the operation,as well as avoid postoperative infections.

Hepatic non-parenchymal cells and extracellular matrix participate in oval cell-mediated liver regeneration

AIM： To elucidate the interaction between non- parenchymal cells, extracellular matrix and oval cells during the restituting process of liver injury induced by partial hepatectomy （PH）. METHODS： We examined the localization of oval cells, non-parenchymal cells, and the extracellular matrix components using immunohistochemical and double immunofluorescent analysis during the proliferation and differentiation of oval cells in N-2- acetylaminofluorene （2-AAF）/PH rat model. RESULTS： By day 2 after PH, small oval cells began to proliferate around the portal area. Most of stellate cells and laminin were present along the hepatic sinusoids in the periportal area. Kupffer cells and fibronectin markedly increased in the whole hepatic Iobule. From day 4 to 9, oval cells spread further into hepatic parenchyma, closely associated with stellate cells, fibronectin and laminin. Kupffer cells admixed with oval cells by day 6 and then decreased in the periportal zone. From day 12 to 15, most of hepatic stellate cells （HSCs）, laminin and fibronectin located around the small hepatocyte nodus, and minority of them appeared in the nodus. Kupffer cells were mainly limited in the pericentral sinusoids. After day 18, the normal liver Iobule structures began to recover.CONCLUSION： Local hepatic microenvironment may participate in the oval cell-mediated liver regeneration through the cell-cell and cell-matrix interactions.

Continuous wound infusion of local anaesthetic agents following colorectal surgery:Systematic review and meta-analysis

AIM:To provide a specifi c review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparoto-my for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a sig- nificant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a signifi cant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local an- aesthetic wound infusion was associated with a signifi - cant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no signifi cant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic re- view and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major color- ectal surgery is a promising technique but do not pro- vide conclusive evidence of benefi t. Further research is required including cost-effectiveness analysis.

Amniotic membrane transplantation for porous sphere orbital implant exposure

Objective: This study is aimed at describing the clinical outcome of amniotic membrane transplantation for exposure of porous sphere implants. Methods: A retrospective review of consecutive cases of porous sphere orbital implant exposure was carried out. Eight cases were presented between May 2004 and Oct. 2006 (5 males, 3 females; mean age 44.5 years). Six had enucleation and two had evisceration. Exposure occurred in two primary and six secondary. Orbital implant diameter was 22 mm in seven cases and 20 mm in one case. Six patients are with hydroxyapatite and two with high-density porous polyethylene (Medpor) orbital implants. The mean time from implantation to exposure was 1.1 months (range 0.8~2 months). All patients required surgical intervention. Results: The time of follow-up ranged from 3.0 to 28.0 months (mean 16.5 months). Amniotic membrane grafting successfully closed the defect without re-exposure in all of these patients. The grafts were left bare with a mean time to conjunctiva of about 1 month (range 0.8~1.5 months). Conclusion: Exposed porous sphere implants were treated suc-cessfully with amniotic membrane graft in all of patients. The graft is easy to harvest. This technique is useful, dose not lead to prolonged socket inflammation and infection, and it is valuable application extensively.