探讨腹腔镜下胆总管切开取石术在复方性胆总管结石患者中的临床应用价值

胆总管结石(Common Bile Duct Stones,CBDS)是一种常见病,在亚洲地区为高发地,是肝胆外科的常见疾病之一,其形成原因考虑与年龄、性别、职业、肥胖、生活习惯、饮食搭配、妊娠、肝硬化、胆道蛔虫病史、糖尿病、高脂血症和胃肠外营养等有相关[1-3],CBDS形成的原因不明,影响因素多.

Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

Appendiceal mass:Is interval appendicectomy “something of the past” ?

The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.

What is the optimal treatment for appendiceal mass formed after acute perforated appendicitis?

We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011.The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass.The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass,and might prove to be more cost-effective than conservative treatment,with no need for interval appendectomy.However,we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass,with no need for appendectomy,too.

Clinical observation of treatment with Yiqi Jianpi decoction combined with FOLFOX4 for the postoperation patients of colorectal cancer

Objective: The aim of the study was to observe the clinical efficacy with Yiqi Jianpi decoction combination with FOLFOX4 for the postoperative patients of colorectal cancer (CRC). Methods: Eighty-five patients were randomly divided into two groups. The treated group (n = 41) received Yiqi Jianpi decoction combined with FOLFOX4 chemotherapy and the control group (n = 44) received FLOFOX4 chemotherapy alone. A treatment course of 6 months was applied to both groups. Results: The life quality, symptomatic improvement and adverse side effects reducing in the treated group were better than those of the control group. Conclusion: Yiqi Jianpi decoction combination with FOLFOX4 chemotherapy is effective in the treatment of the postoperative patients with colorectal cancer.

Minimally invasive aortic valve surgery

Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.

Cost of two different therapies for end-stage renal disease in northwest China

Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.

浅谈儿科护理观念中的“以人为本”

在现代的医疗服务观念中,'以人为本'占据着主要地位,随着科学技术的发展和医学应用模式的改变,儿科护理这一医疗领域更亟待改善,在当代健康需求和护理观念的指导下,我们需要做到护理手段多样化。在药物治疗的同时,辅以必要的心理,饮食,音乐疗法,达到治疗的最大效益。作为赤峰市预防保健中心的一名医疗人员,要把服务患者铭记心间,让患者焦急而来,满意而归。本文主要讨论'以人为本'的儿科护理观念的重要性,并提供切实可行的真实医疗案例,让小儿护士及基层护理人员在护理过程中做到有章可循。

Observations on After-Effect Duration of Kidney-Nourishing and Marrow-Replenishing Therapy on 58 Cases of Mediterranean Anemia

To observe the after-effect duration of kidney-nourishing and marrow-replenishing therapy on Mediterranean anemia. Methods： To observe the kidney-nourishing and marrow-replenishing therapy on 58 cases of Mediterranean anemia and the influence of various relative factors on the after-effect duration. Results： The after-effect duration on 58 cases varied from 3-6 months, about 4 months on average, and was not influenced by sex, clinical types, genetic types, types of Mediterranean anemia and other factors. Conclusion： Kidney-nourishing and marrow-replenishing therapy used to treat Mediterranean anemia can not only produce good therapeutic effect during treatment but also keep after effect lasting for about 4 months, indicating that the therapy used to treat Mediterranean anemia has good clinical after effect.

三台县2001-2009年结核病防治效果评价

目的评价三台县2001-2009年结核病防治效果。方法根据2001-2009年三台县结核病防治工作月、季、年报表及相关文件资料按《四川省结核病防治规划终期评估实施方案》进行分析和评价。结果以镇(乡)为单位现代结核病控制策略覆盖率达到100%;共发现、登记、治疗肺结核患者7 360例,总登记率为55.86/10万,初治涂阳病人治愈率达92.54%,复治涂阳病人治愈率达78.53%。结论在全球基金结核病防治项目和中央、省、市、县财政经费的支持下,三台县结核病防治效果显著。