手术频率对腹腔镜胃癌根治术学习曲线的影响

目的:探讨手术频率对于腹腔镜胃癌根治术学习曲线的影响。方法:回顾性分析由同一组甲医师(n=100例,月平均手术3.33例)、乙医师(n=90例,月平均手术2.50例)分别在2008年1月～2010年6月和2008年1月～2011年1月完成的腹腔镜胃癌根治手术。按照手术先后顺序,将甲医师组分为4阶段(A、B、C、D),每阶段25例,乙医师组分为6阶段(E、F、G、H、I、J),每阶段15例。分别比较甲、乙医师组内各阶段及甲乙医师两组的手术时间、术中出血量、术后住院天数、并发症、中转开腹数、淋巴结清扫数。结果:所有分组比较的手术患者年龄、性别、病理分期、手术方式上均具有可比性。甲医师组C、D阶段手术时间及出血量显著少于A、B阶段,乙医师组I、J阶段手术时间及出血量显著少于E、F、G、H阶段,各阶段间淋巴结清扫数、并发症、术后住院天数及中转开腹率差异无统计学意义。甲医师组手术时间显著少于乙医师组手术时间,甲医师组术中出血量显著少于乙医师组术中出血量,两者差异具有统计学意义,两医师组间淋巴结清扫数、中转开腹率、手术并发症差异无统计学意义。结论:当适当增加手术频率时,可以在较短的学习曲线下,更好地掌握腹腔镜胃癌根治术。

手术频率对腹腔镜下宫颈癌根治术学习曲线的影响

目的探讨手术频率对腹腔镜下宫颈癌根治术学习曲线的影响。方法回顾性分析2008年3月—2010年9月同科室甲、乙两组分别完成的120例和84例腹腔镜下宫颈癌根治术(月平均手术分别为4.0例和2.8例)。按手术完成先后,将甲组分为A、B、C、D 4阶段(每阶段平均30例),乙组分为E、F、G、H 4阶段(每阶段平均21例)。比较两组内各阶段及组间的手术时间、术中出血量、盆腔淋巴结清扫数目、并发症及术后生存时间。结果所有患者在年龄、FIGO临床分期、病理类型方面,差异均无统计学意义(P>0.05)。甲组A阶段手术时间及术中出血量明显高于其他三阶段,乙组E、F阶段手术时间及术中出血量高于G、H阶段,各个阶段在盆腔淋巴结清扫数目、并发症及术后生存时间方面,差异无统计学意义。甲组手术频率高于乙组,达到学习曲线的时间短于乙组,手术时间、术中出血量也比乙组短。结论腹腔镜手术经过约30~40例能达到平稳的状态,且适当地提高手术频率能有效缩短到达学习曲线的时间。

手术矫正联合自律空间频率刺激法治疗小儿远视内斜合并弱视的临床疗效观察

目的探讨手术矫正联合自律空间频率刺激法治疗小儿远视内斜合并弱视的临床疗效。方法将我院收治的远视内斜合并弱视患儿124例(158只眼)随机分为研究组62例(78只眼)和对照组62例(80只眼)。研究组给予常规药物治疗同时采用手术联合自律空间频率刺激法进行治疗,对照组给予常规药物治疗同时采用自律空间频率刺激法进行治疗。对比2组临床疗效和治疗前后患儿视力改善情况。结果研究组总有效率高于对照组明,差异有统计学意义(P<0.01)。治疗前2组视力比较差异无统计学意义(P>0.05)。治疗后,2组患儿视力均较治疗前好转,但研究组视力好转程度优于对照组,差异有统计学意义(P<0.01或P<0.05)。结论常规治疗的基础上采用手术矫正联合自律空间频率刺激法对小儿远视内斜合并弱视进行治疗,疗效好,具有个性化、趣味性,患儿易坚持,费用较低,具有临床应用价值。

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope

AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3MTH Littmann Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, soundto-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patientshad acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudoobstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. CONCLUSION: Auscultation of bowel sounds is nonspecific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.

Observation on effect of electroacupuncture of different frequencies on patients after thyroid surgery:a randomized controlled trial

Objective To observe postoperative effect of electroacupuncture（EA） of different frequencies in acupuncture anesthesia combined with drugs on patients undergoing thyroid surgery.Methods One hundred and twenty patients undergoing thyroid surgery were randomly divided into a 2Hz electroacupuncture anesthesia group（group A）,a 100 Hz electroacupuncture anesthesia group（group B）,a 2Hz/100 Hz electroacupuncture anesthesia group（group C） and a cervical plexus block group（group D） in accordance with the random number table method,with 30 patients in each group.In group A,group B and group C,electroacupuncture was applied at bilateral Futu（扶突 LI 18）,Hegu（合谷 LI 4） and Neiguan（内关 PC 6） at frequencies of 2 Hz,100 Hz and 2 Hz/100 Hz respectively for 30 min.The needles were retained till the end of the surgery.Dolantin and atropine were intramuscularly injected In group D,bilateral cervical plexus block was produced with a mixture of1%lidocaine and 0.375%bupivicaine.Before surgery,pain threshold and threshold of pain tolerance were determined;during surgery,the duration of surgery was recorded;and after surgery,QOLS（Quality Of Life Score） and PHS（Prince-Henry Score） were assessed.Results PHS in group A,group B and group C were lower than that in group D,respectively（0.20±0.41,0.17±0.38,0.10±0.31 vs 0.40±0.50,P〈0.01）,and PHS in group C was lower than those in group A and group B,respectively（both P〈0.01）.QOLS in group A,group B and group C were higher than that in group D,respectively（9.97±1.07,9.97±2.27,10.40±1.45 vs 9.73±1.41,P〈0.05,P〈0.01）,and QOLS in group C was higher than those in group A and group B,respectively（both P〈0.05）.Conclusion Acupuncture anesthesia combined with drugs has better postoperative effect than drug anesthesia.Electroacupuncture of different frequencies can significantly improve general quality of life of patients,so patients recover well after thyroid surgery.As patients in group C suffered from the slightest pain with the highest quality of life,they recovered best within the shortest time.Electroacupuncture at frequency of 2 Hz/100 Hz can better play postoperative analgesic effect.