Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy:A 2-year follow-up study in Bogotá,Colombia

BACKGROUND The global prevalence of obesity has increased over the past 40 years,and bariatric surgery has proven to be the most effective therapy for long-term weight loss.Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones,thereby modifying satiety signals.Single anastomosis duodeno-ileal bypass with sleeve gastrectomy(SADI-S)combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients.AIM To describe the outcomes and complications of SADI-S.METHODS We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá,Colombia.This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics,postoperative complications,comorbidities,nutritional deficiencies,and intraoperative complications during a 2-year follow-up.RESULTS Sixty-one patients with a mean body mass index(BMI)of 50±7.1 kg/m2 underwent laparoscopic SADI-S.The mean operative time and hospital stays were 143.8±42 min and 2.3±0.8 d,respectively.The mean follow-up period was 18 mo,and the mean BMI decreased to 28.5±12.2 kg/m2.The excess BMI loss was 41.8%±13.5%,and the weight loss percentage was 81.1%±17.0%.Resolution of obesity-related comorbidities,including type 2 diabetes mellitus,hypertension,dyslipidemia,and obstructive sleep apnea,was achieved and defined as complete or partial remission.No intraoperative complications were observed.Short-term complications were observed in four(6.8%)patients.However,larger studies with longer follow-up periods are required to draw definitive conclusions.CONCLUSION SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities,including hypertension,type 2 diabetes mellitus,dyslipidemia,and sleep apnea syndrome.

Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer

AIM: To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.

Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

AIM： To investigate the correlation between the nutri- tional risk index （NRI） and postoperative wound com- plications.

Impact of body mass index on complications following pancreatectomy:Ten-year experience at National Cancer Center in China

AIM: To examine the impact of body mass index(BMI)on outcomes following pancreatic resection in the Chinese population.METHODS: A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Individuals who underwent pancreatic resection between January2004 and December 2013 were identified and included in the study. Persons were classified as having a normal weight if their BMI was < 24 kg/m2 and overweight/obese if their BMI was ≥ 24 kg/m2 as defined by the International Life Sciences Institute Focal Point in China. A χ 2 test(for categorical variables) or a t test(for continuous variables) was used to examine the differences in patients' characteristics between normal weight and overweight/obese groups. Multiple logistic regression models were used to assess the associationsof postoperative complications, operative difficulty,length of hospital stay, and cost with BMI, adjusting for age, sex, and type of surgery procedures.RESULTS: A total of 362 consecutive patients with data available for BMI calculation underwent pancreatic resection for benign or malignant disease from January1, 2004 to December 31, 2013. Of the 362 patients,156 were overweight or obese and 206 were of normal weight. One or more postoperative complications occurred in 35.4% of the patients following pancreatic resection. Among patients who were overweight or obese, 42.9% experienced one or more complications,significantly higher than normal weight(29.6%)individuals(P = 0.0086). Compared with individuals who had normal weight, those with a BMI ≥ 24.0kg/m2 had higher delayed gastric emptying(19.9% vs5.8%, P < 0.0001) and bile leak(7.7% vs 1.9%, P =0.0068). There were no significant differences seen in pancreatic fistula, gastrointestinal hemorrhage, reoperation,readmission, or other complications. BMI did not show a significant association with intraoperative blood loss, operative time, length of hospital stay, or cost.CONCLUSION: Higher BMI increases the risk for postoperative complications after pancreatectomy in the Chinese population. The findings require replication in future studies with larger sample sizes.

Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction

BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.

Systemic inflammatory response index is a predictor of prognosis in gastric cancer patients: Retrospective cohort and meta-analysis

BACKGROUND The systemic inflammatory response index(SIRI)has been demonstrated to make a significant difference in assessing the prognosis of patients with different solid neoplasms.However,research is needed to ascertain the accuracy and reliability of applying the SIRI to patients who undergo robotic radical gastric cancer sur-gery.AIM To validate the applicability of the SIRI in assessing the survival of gastric cancer patients and evaluate the clinical contribution of preoperative SIRI levels to predicting long-term tumor outcomes in patients,who received robotic radical gastric cancer surgery.METHODS Initially,an exhaustive retrieval was performed in the PubMed,the Cochrane Library,EMBASE,Web of Science,and Scopus databases to identify relevant studies.Subsequently,a meta-analysis was executed on 6 cohort studies iden-tifying the value of the SIRI in assessing the survival of gastric cancer patients.Additionally,the clinical data of 161 patients undergoing robotic radical gastric cancer surgery were retrospectively analyzed to evaluate their clinicopathological characteristics and relevant laboratory indicators.The association between preoperative SIRI levels and 5-year overall survival(OS)and disease-free survival(DFS)was assessed.RESULTS The findings demonstrated an extensive connection between SIRI values and the outcome of patients with gastric cancer.Preoperative SIRI levels were identified as an independent hazard feature for both OS and DFS among those who received robotic surgery for gastric cancer.SIRI levels in gastric cancer patients were observed to be associated with the presence of comorbidities,T-stage,carcinoembryonic antigen levels,the development of early serious postoperative complications,and the rate of lymph node metastasis.CONCLUSION SIRI values are correlated with adverse in the gastric cancer population and have the potential to be utilized in predicting long-term oncological survival in patients who undergo robotic radical gastric cancer surgery.

A novel use of the comprehensive complication index in perihilar cholangiocarcinoma surgery

It is well known that radical intent surgery is,as of today,the only curative treatment available for perihilar cholangiocarcinoma(pCCA);the standard surgical procedure includes major hepatectomy with caudate lobe resection and extrahepatic bile duct resection(1).A recent paper set the benchmark values for pCCA surgery:in this paper,acceptable benchmark values for morbidity.

Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications.However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently,two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0(no complications) to 100(patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.

Prospective study of the effect of ERAS on postoperative recovery and complications in patients with gastric cancer

Objective:To study the efficacy of the enhanced recovery after surgery(ERAS)program on postoperative recovery and complications in patients with gastric cancer.Methods:Eighty patients in the perioperative period with radical gastrectomy were enrolled and randomly divided into 2 groups,the ERAS group and the non-ERAS group.The differences between the 2 groups in terms of postoperative recoveries and complications rate were determined.According to the body mass index(BMI)level,the ERAS group was divided into 2 subgroups,namely group A(BMI<28 kg/m2,n=16)and group B(BMI≥28 kg/m2,n=24).The non-ERAS group was also divided into group C(BMI<28 kg/m2,n=18)and group D(BMI≥28 kg/m2,n=22).The recovery and complications of each group were then determined.Results:The postoperative length of stay and visual analogue scale pain score were less in the ERAS group than the non-ERAS group(P<0.05).Time to first postoperative exhaustion,first postoperative defecation,returning leukocyte count to normal,and stopping intravenous nutrition were significantly shorter in the ERAS group(n=40),compared to the non-ERAS group(n=40,all P<0.05).The incidence of postoperative lower extremity intramuscular venous thrombosis was significantly higher in group D than in group B(χ2=4.800,P=0.028).In addition,the incidence of lower extremity intermuscular venous thrombosis and lung infection in group D was higher than those in other groups.Conclusions:The perioperative ERAS program was associated with faster recovery in patients undergoing radical gastrectomy.For patients with higher BMI(BMI≥28 kg/m2),the use of the perioperative ERAS program was more advantageous.

Cost of postoperative complications:How to avoid calculation errors

Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.

Influence of postoperative complications on long-term survival in liver transplant patients

BACKGROUND Liver transplant(LT)is a complex procedure with frequent postoperative complications.In other surgical procedures such as gastrectomy,esophagectomy or resection of liver metastases,these complications are associated with poorer long-term survival.It is possible this happens in LT but there are not enough data to establish this relationship.AIM To analyze the possible influence of postoperative complications on long-term survival and the ability of the comprehensive complication index(CCI)to predict this.METHODS Retrospective study in a tertiary-level university hospital.The 164 participants were all patients who received a LT from January 2012 to July 2019.The follow-up was done in the hospital until the end of the study or death.Comorbidity and risk after transplantation were calculated using the Charlson and balance of risk(BAR)scores,respectively.Postoperative complications were graded according to the Clavien-Dindo classification and the CCI.To assess the CCI cut-off value with greater prognostic accuracy a receiver operating characteristic(ROC)curve was built,with calculation of the area under the curve(AUC).Overall survival was estimated according to the Kaplan-Meier test and log-rank test.Groups were compared by the Mann-Whitney test.For the multivariable analysis the Cox regression was used.RESULTS The mean follow-up time of the cohort was 37.76(SD=24.5)mo.A ROC curve of CCI with 5-year survival was built.The AUC was 0.826(0.730-0.922),P<0.001.The cut-off was calculated by means of the Youden index with a result of 35.95.The sensitivity was 84.6%and the specificity 61.3%.Survival curves for comparison of patients with CCI score<36 vs≥36 were calculated.The estimated 5-year survival was 57.65 and 43.95 months,respectively(log-rank<0.001).This suggests that patients with more severe complications exhibit worse long-term survival.Other cut-off values were analysed.Comparison between patients with CCI<33.5 vs>33.5(33.5=median CCI value)showed estimated 5-year survival was 57.4 and 45.71 months,respectively(log-rank<0.0001).Dividing patients according to the mode CCI value(20.9)showed an estimated 5-year survival of 60 mo for a CCI below 20.9 vs 57 mo for a CCI above 20.9(log-rank=0.147).The univariate analysis did not show any association between individual complications and long-term survival.A multivariate analysis was carried out to analyse the possible influence of CCI,Charlson comorbidity index,BAR and hepatocellular carcinoma on survival.Only the CCI score showed significant influence on long-term survival.CONCLUSION A complicated postoperative period–well-defined by means of the CCI score–can influence not only short-term survival,but also long-term survival.

罗斯曼指数对老年髋膝关节置换后非计划再入院和并发症的影响

背景:人工髋膝关节置换术在老年群体中有广泛应用,但临床中缺乏对患者非计划再次入院和术后并发症的准确预测方法。目的:探讨罗斯曼(Rothman)指数对老年髋膝关节置换患者术后非计划再入院和并发症的影响。方法:选择遵义市第一人民医院骨科一病区2020年12月至2022年12月接受择期髋、膝关节手术患者153例为研究对象,根据出院后90 d内是否非计划再次入院分为再入院组(n=21)和非再入院组(n=132)。通过电子病历系统统计所有患者一般性资料,包括性别、年龄、体质量指数、合并糖尿病、合并高血压、手术关节类型等,参照文献评估Rothman指数,统计患者术后并发症。结果与结论:①再入院组和非再入院组患者性别、体质量指数、手术关节类型、住院时长比较差异无显著性意义(P>0.05),两组共病数量、年龄、Rothman得分比较差异有显著性意义(P<0.05);②多因素Logistics回归分析结果显示,共病数量、年龄和Rothman得分均是老年髋、膝关节疾病患者术后90 d再入院的独立影响因素(P<0.05);③受试者工作特征曲线分析结果表明,Rothman指数预测人工髋膝关节置换术后90 d再入院曲线下面积为0.824,敏感度为80.85%,特异度为78.85%,最大youden指数为0.597,最佳截断值为46分;④Rothman<46分的老年患者总并发症发生率高于Rothman≥46分的老年患者(P<0.05);⑤提示Rothman指数可较为准确地预测老年髋、膝关节疾病患者术后非计划再入院,同时Rothman指数低于46分者发生并发症总体风险较高,关节恢复较差,可用于临床中改善患者术后管理。

利拉鲁肽联合达格列净治疗糖尿病肾病患者的疗效及超声心动图参数变化分析

目的分析利拉鲁肽联合达格列净治疗糖尿病肾病(DN)患者的疗效及超声心动图参数变化。方法前瞻性选取2020年10月至2021年11月中南大学湘雅医学院附属海口医院内分泌科就诊的120例DN患者,依据信封法将其分为对照组(n=59)和观察组(n=61)。对照组采用胰岛素联合利拉鲁肽治疗,观察组在对照组基础上联合达格列净治疗。比较两组治疗效果,治疗前、治疗8周后的血糖指标[糖化血红蛋白(HbA1c)、空腹血糖、餐后2 h血糖(2 h PG)]、胰岛素抵抗指数(HOMA-IR)、肾功能[肾小球滤过率(eGFR)、尿白蛋白排泄率(UAER)、尿白蛋白与肌酐比值(UACR)及24 h尿蛋白定量]、超声心动图参数[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)]及并发症发生情况。结果观察组治疗总有效率为95.08%,高于对照组(83.05%),差异有统计学意义(P<0.05)。观察组治疗8周后的HbA1c、FPG、2 h PG及HOMA-IR分别为(6.80±1.13)%、(6.12±0.43)mmol/L、(7.58±1.25)mmol/L、2.64±0.41,均低于对照组[(7.34±1.26)%、(6.39±0.54)mmol/L、(8.11±1.32)mmol/L、2.96±0.38],差异均有统计学意义(P<0.05)。观察组治疗8周后的eGFR为(100.54±10.19)min·1.73 m^(2),高于对照组[(96.36±8.54)min·1.73 m^(2)],UAER、UACR及24 h尿蛋白定量分别为(86.95±6.57)μg/min、(87.69±7.32)mg/g、(153.64±10.18)mg/24 h,均低于对照组[(89.63±6.49)μg/min、(90.54±6.87)mg/g、(158.34±11.85)mg/24 h],差异均有统计学意义(P<0.05)。观察组治疗8周后的LVEDD及LVESD分别为(46.13±3.22)、(30.15±1.85)mm,均低于对照组[(47.42±3.34)、(30.95±1.95)mm],LVEF为(65.94±2.12)%,高于对照组[(65.05±2.36)%],差异均有统计学意义(P<0.05)。两组总并发症发生率比较,差异无统计学意义(P>0.05)。结论利拉鲁肽联合达格列净治疗DN患者,治疗效果更好,能明显改善患者血糖、肾功能及心功能,且安全性高。

老年人营养风险指数预测高龄髋关节置换术后并发症的价值

目的探讨老年人营养风险指数(GNRI)预测高龄髋关节置换术后并发症的价值。方法前瞻性选取2020年1月至2022年2月在唐山市第二医院行髋关节置换术的高龄患者271例,根据术后1个月内并发症发生情况分为发生组(n=28)和未发生组(n=243)。采用多因素logistic回归分析导致术后并发症发生的危险因素;绘制受试者工作特征曲线(ROC)分析GNRI对术后并发症的预测价值。结果发生组年龄、术中输血例数占比、术中出血量、手术时间及白细胞、肌酐、中性粒细胞、单核细胞均高于未发生组,GNRI、淋巴细胞、血红蛋白水平低于未发生组(P<0.05);多因素logistic回归分析显示,术中输血、术中出血量高、GNRI低、手术时间长及血红蛋白水平低是导致术后并发症发生的危险因素(P<0.05);ROC曲线显示,GNRI预测术后发生并发症的曲线下面积为0.892。结论GNRI是影响高龄患者髋关节置换术后发生并发症的独立危险因素,并具有较高的预测价值。

急性压力性损伤风险防控护理在行肺癌根治术患者中的应用效果

目的探究急性压力性损伤风险防控护理在行肺癌根治术患者中的应用效果。方法选取2022年1月至2023年1月南京医科大学附属淮安第一医院120例行肺癌根治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观察组,各60例。对照组采取常规手术护理措施,观察组应用术中急性压力性损伤风险防控护理。比较两组手术相关指标变化及并发症。结果术毕时,两组气道压、平均脉压、心率、体温、乳酸、血氧饱和度高于术前即刻,且观察组高于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论在行肺癌根治术患者中采用急性压力性损伤风险防控护理,可有效改善患者手术相关指标,降低并发症发生率,提高预后效果,值得临床推广采纳。

1型糖尿病患儿血清分泌型卷曲相关蛋白5水平与糖脂代谢和微血管并发症的关系

目的研究1型糖尿病患儿血清分泌型卷曲相关蛋白5(Secreted frizzled-related protein 5,SFRP5)的水平与糖脂代谢指标及和微血管并发症的关系。方法以2022年1月-2023年12月于山西省儿童医院就诊的96例1型糖尿病患儿为糖尿病组,选择同时期在本院接受健康体检的100名正常儿童作为健康组。分别测定两组血清SFRP5水平、空腹血糖(Fasting blood glucose,FBG)、总胆固醇(Total cholesterol,TC)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterin,LDL-C)、三酰甘油(Triacylglycerol,TG)水平以及糖化血红蛋白(Glycosylated hemoglobin,HbA1c),对糖尿病组患儿是否患有微血管并发症进行评估。采用Pearson相关性分析评估血清SFRP5水平与糖脂代谢指标间的相关性。采用受试者工作特征(Receiver operating characteristic,ROC)曲线评估血清SFRP5水平对1型糖尿病合并微血管并发症的诊断效能。结果与健康组比较,糖尿病组FBG、HbA1c、LDL-C和TG水平升高,HDL-C水平降低,差异有统计学意义(P<0.05)。糖尿病组血清SFRP5水平为(352.53±53.69)pg/mL,低于健康组[(424.49±63.54)pg/mL],差异有统计学意义(t=5.453,P<0.05)。糖尿病组血清SFRP5水平与FBG、HbA1c和TG水平呈负相关关系(P<0.05)。1型糖尿病合并微血管并发症儿童的HbA1c和LDL-C水平高于未合并微血管并发症儿童,差异有统计学意义(P<0.05)。与未合并微血管并发症患儿血清SFRP5水平[(363.43±57.24)pg/mL]比较,1型糖尿病合并微血管并发症患儿血清SFRP5水平(315.87±42.35)pg/mL降低,差异有统计学意义(t=4.042,P<0.001)。血清SFRP5水平对1型糖尿病合并微血管并发症诊断效能的曲线下面积为0.838(0.755~0.921),灵敏度为86.4%,特异度为73.0%。结论1型糖尿病患儿血清SFRP5水平低于健康儿童,血清SFRP5水平与血清FBG、HbA1c和TG含量呈负相关,合并微血管并发症的糖尿病患儿血清SFRP5水平低于未合并者。

腹腔镜术前口服高糖溶液对结直肠癌患者的影响

目的探讨结直肠癌患者腹腔镜术前口服高糖溶液对术后胃肠功能、炎症水平及胰岛素抵抗的影响。方法选择2020年5月至2022年7月南京中医药大学附属连云港市中医院收治的78例结直肠癌患者为研究对象,利用随机数字表法将其分为两组,观察组39例,对照组39例。观察组男20例、女19例,年龄38~75(56.65±8.43)岁,Dukes分期:Ⅰ期21例,Ⅱ期18例;对照组男19例、女20例,年龄39~74(55.79±8.39)岁,Dukes分期:Ⅰ期22例,Ⅱ期17例。对照组采用常规治疗,观察组术前采用高糖溶液口服。比较两组患者的术后胃肠功能、炎症水平、胰岛素抵抗指数及并发症情况。采用独立样本t检验、配对t检验和χ^(2)检验。结果治疗后,观察组术后肛门排气时间、术后首次排便时间、住院时间分别为(23.97±2.85)h、(14.35±5.43)h、(5.69±0.87)d,均短于对照组(34.68±3.94)h、(21.06±7.47)h、(9.52±1.14)d,差异均有统计学意义(均P<0.05);治疗后,观察组患者肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平分别是(141.85±30.29)ng/L、(8.69±2.05)mg/L、(7.34±0.93)ng/L,均低于对照组(182.46±33.37)ng/L、(15.33±2.78)mg/L、(9.97±1.54)ng/L,差异均有统计学意义(均P<0.05);治疗后,观察组胰岛素抵抗指数(5.14±0.31),低于对照组(7.75±0.96),差异有统计学意义(P<0.05);治疗后,观察组并发症总发生率为10.25%(4/39),低于对照组的28.21%(11/39),差异有统计学意义(P<0.05)。结论腹腔镜术前口服高糖溶液能有效改善结直肠癌患者术后的胃肠功能,降低患者炎症水平,改善患者胰岛素抵抗,降低并发症发生率,值得推广。

早期康复护理对股骨颈骨折术后患者恢复及并发症的影响评价

目的研究早期康复护理对股骨颈骨折术后患者恢复情况及并发症情况的影响。方法随机选取2020年10月—2023年9月寿光市人民医院创伤骨科收治的90例股骨颈骨折患者为研究对象,均实施手术治疗,依据不同护理方法分为对照组、研究组,每组45例。对照组采用常规护理,研究组采用早期康复护理,比较两组患者Harris髋关节评分、Barthel指数、疼痛评分、生活质量、并发症、满意度。结果护理后,两组患者Bar-thel指数、Harris髋关节评均得到改善,且研究组改善效果优于对照组,差异有统计学意义(P均<0.05)。研究组护理后1周、2周、4周疼痛评分均低于对照组,生活质量评分均高于对照组,差异有统计学意义(P均<0.05)。研究组并发症总发生率[2.22%(1/45)]低于对照组[15.56%(7/45)],差异有统计学意义(χ^(2)=4.939,P<0.05)。研究组总满意率高于对照组,差异有统计学意义(P<0.05)。结论早期康复护理的实施可以帮助患者有效抑制并发症及疼痛情况,对改善生活质量及关节功能有积极意义,满足患者合理护理需求。

65例胃早癌脉管侵犯的相关因素分析

目的探讨胃早癌脉管侵犯的相关因素。方法回顾性分析江苏省扬州市江都人民医院2018年1月—2023年6月收治的65例胃早癌内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)患者资料。根据术后病理结果将患者分为脉管侵犯组与非侵犯组,分别为31例和34例。分析各组病例的临床特征、胃镜表现及病理特点,通过logistic回归分析探讨胃癌发生脉管浸润的独立危险因素。结果病灶>2 cm(OR=4.959,95%CI1.490~16.500)、合并溃疡(OR=3.667,95%CI 1.429~21.950)、Kit-67指数>30%(OR=9.601,95%CI2.530~36.373)、病理分化差(OR=6.440,95%CI1.822~22.760)及浸润深度T1b(tumour infiltration depth 1b,T1b)(OR=6.301,95%CI1.913~20.802)对胃早癌脉管侵犯有影响(P<0.05)。Kit-67指数>30%是脉管转移独立高危因素(P<0.05)。结论脉管侵犯与多种因素有关,Kit-67指数对评估是否合并脉管侵犯有重要临床意义。

腹腔镜下完全腹膜外疝修补术对腹股沟疝患者术后血气分析指标及并发症的影响

目的:探究腹腔镜下完全腹膜外疝修补术(TEP)治疗腹股沟疝对血气分析指标及并发症发生情况的影响。方法:回顾性分析2021年12月—2024年1月仁怀市人民医院收治的86例腹股沟疝患者资料,按照手术方法的不同将其分为TEP组与改良Kugel无张力疝修补术(MK)组,各43例。MK组采用MK治疗,TEP组采用TEP治疗,比较两组的血气分析指标和并发症发生情况。结果:术后,两组pH、动脉血氧分压水平均高于术前,但TEP组均低于MK组,动脉血二氧化碳分压水平均低于术前,但TEP组高于MK组,差异均有统计学意义(P<0.05)。TEP术组并发症发生率4.65%低于MK术组的18.60%,差异有统计学意义(P<0.05)。结论:TEP术治疗腹股沟疝患者,有助于改善患者血气分析指标,减少并发症。