基于“T-tube”模型的中心动脉脉搏波双通道盲辨识

提出了由两路人体外周动脉脉搏波(peripheral artery pulse wave,PAP)来估计中心动脉脉搏波(central aortic pulse wave,CAP)的多通道盲辨识(multi-channel blind system identification,MBSI)方法,旨在实现心血管系统中心动脉脉搏波的实时无创连续监测.首先简单介绍了多通路盲辨识算法,并证明了心血管系统IIR模型特性可由FIR模型逼近,从而简化了MBSI算法.然后介绍了心血管"T-tube"模型,并结合两路外周动脉实测(肱动脉、股动脉)脉搏波来重建中心动脉脉搏波和辨识模型.结果表明,MBSI算法稳定性较好,估计出的CAP波形畸变率百分比小于6%、形态整体能量误差百分比小于3%.

T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation:An updated systematic review and metaanalysis

BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.

Pediatric T-tube in adult liver transplantation:Technical refinements of insertion and removal

BACKGROUND With the increasing use of extended-criteria donor organs,the interest around Ttubes in liver transplantation(LT)was restored whilst concerns regarding T-tuberelated complications persist.AIM To describe insertion and removal protocols implemented at our institution to safely use pediatric rubber 5-French T-tubes and subsequent outcomes in a consecutive series of adult patients.METHODS Data of consecutive adult LT patients from brain-dead donors,treated from March 2017 to December 2019,were collected(i.e.,biliary complications,adverse events,treatment after T-Tube removal).Patients with upfront hepaticojejunostomy,endoscopically removed T-tubes,those who died or received retransplantation before T-tube removal were excluded.RESULTS Seventy-two patients were included in this study;T-tubes were removed 158 d(median;IQR 128-206 d)after LT.In four(5.6%)patients accidental T-tube removal occurred requiring monitoring only;in 68(94.4%)patients Nelaton drain insertion was performed according to our protocol,resulting in 18(25%)patients with a biliary output,subsequently removed after 2 d(median;IQR 1-4 d).Three(4%)patients required endoscopic retrograde cholangiopancreatography(ERCP)due to persistent Nelaton drain output.Three(4%)patients developed suspected biliary peritonitis,requiring ERCP with sphincterotomy and nasobiliary drain insertion(only one revealing contrast extravasation);no patient required percutaneous drainage or emergency surgery.CONCLUSION The use of pediatric rubber 5-French T-tubes in LT proved safe in our series after insertion and removal procedure refinements.

Results of Montgomery T-Tube in Primary Treatment of Laryngotracheal Stenosis

Introduction: For tracheal stenosis, tracheal resection and anastomosis is widely considered the treatment of choice. However, this surgical approach is not feasible when the glottis and subglottis are involved or in patients with a poor general condition and tracheal stents are a plausible means of providing a permanent or temporary airway opening. Objectives: Evaluate the features and the results of patients with Montgomery T-tube in tracheal stenosis. Methods: Fifteen patients with Myer-Cotton grades 2-3 circular cicatricial tracheal stenosis who received a Montgomery T-tube between 2002-2011 were analyzed in terms of age, gender, etiology, duration of intubation, location and size of the stenotic segment on computed tomography(CT), follow-up time with the T-tube, the complications that occurred after T-tube removed and additional tracheal surgery. Conclusion: A T-tube can be applied in tracheal stenosis at the first treatment before attempting surgery. The patients should be closely followed-up due to the possibility of re-stenosis and other complications.

LCBDE术中一期缝合与T管引流的术后胆漏发生率比较

目的比较腹腔镜胆总管探查术中(LCBDE)行一期缝合和T管引流的术后胆漏发生率,并分析术后胆漏的危险因素。方法回顾性分析2015年1月至2022年11月于温州医科大学附属第一医院行LCBDE的患者资料,分为一期缝合组和T管引流组,采用Logistic多因素回归分别分析两组发生胆漏的危险因素。对两组中有肝内结石、上段胆总管结石、最大结石直径、体温最高值和中性粒细胞百分比5项指标进行倾向性评分匹配(PSM)后,比较两组胆漏发生率。结果共纳入患者1052例,其中143例患者发生术后胆漏,发生率为13.5%。Logistic多因素回归分析显示年龄>60岁为一期缝合组(n=506)胆漏的危险因素(OR=2.242,95%CI 1.300-4.038,P=0.005),主刀医师实施LCBDE少于10例为T管引流组(n=546)胆漏的危险因素(OR=3.525,95%CI 1.469-7.996,P=0.003)。经PSM成功匹配383对患者,一期缝合组胆漏发生率较T管引流组高[15.1%(58/383)vs 9.9%(38/383),P=0.029]。结论患者年龄>60岁是行LCBDE术中一期缝合后发生胆漏的独立危险因素,医师经验不足(主刀医师实施LCBDE少于10例)是行留置T管后发生胆漏的独立危险因素。相较于一期缝合,留置T管引流可以降低LCBDE术后胆漏的发生率。

LCBDE术并一期缝合与并T形管引流治疗老年胆总管结石的临床研究

目的 分析老年胆总管结石患者应用经腹腔镜胆总管切开探查并取石术(Laparoscopic Common Bile Duct Ex-ploration,LCBDE)并一期缝合与并T形管引流治疗取得的疗效。方法 采用目的抽样法选取2020年2月—2023年12月安徽省池州市人民医院78例老年胆总管结石患者为研究对象(均行LCBDE术治疗),按照治疗方法不同分为两组,每组39例,分别提供一期缝合治疗(观察组)和T形管引流治疗(对照组),比较两组手术时间、引流时间、住院时间、出血量、并发症发生率。结果 两组引流时间比较,差异无统计学意义(P>0.05)。观察组手术时间、住院时间短于对照组,出血量少于对照组,差异有统计学意义(P均<0.05)。观察组水电解质紊乱率(2.56%)、胆道出血率为(0)、残余结石率(2.56%)、胆道感染率为(0)低于对照组,差异有统计学意义(χ^(2)=3.924、5.343、3.924、5.343,P均<0.05)。结论 老年胆总管结石应用LCBDE术并一期缝合的效果更佳,相比于T形管引流治疗,可以更好地改善患者预后,应用价值高。

T/R双模微波功率模块技术及其应用

微波功率模块(MPM)是真空电子器件和固态电子器件组合而成的一种新型微波功率器件,具有频率高、频带宽、功率大、体积重量小等特点,它使常规行波管的应用变得更加便利和广泛。现代战争向雷达、电子战综合一体化方向发展,这就要求功放既能工作在高峰值功率、低占空比的高模工作方式,也能工作在低峰值功率、准连续波的低模工作方式,针对这一需求,结合电子系统收发共孔径的要求,提出了T/R双模MPM技术。T/R双模MPM技术的核心是T/R双模行波管,基于三端口双向T/R行波管,通过在慢波系统的衰减器附近设置一个耦合口,实现行波管的信号反向接收功能;通过T/R双模行波管设计、双模放大均衡组件、双调制栅极电源等技术实现MPM的双模双向功能。T/R双模MPM应用前景广阔,特别是在基于无人机平台的作战应用中的具有明显优势。

T型管油水分离效率的正交数值试验研究

T型管广泛应用于油田的油水分离,影响其分离效率的因素较多。运用正交试验方法对T型管的管径、垂直管间距、垂直管数等三个几何参数和含油率、进口速度和分流比等三个操作参数共计6因素3水平设计了18组试验方案,并运用计算流体力学数值模拟方法对其进行了数值试验研究,结果表明:各因素对T型管分离效率的影响大小为垂直管数>垂直管间距>分流比>含油率>入口流速>管径。管径60 mm、垂直管数3、垂直管间距1000 mm、含油率40%、入口流速0.35 m/s、分流比0.4为T型管的最优结构组合,此时T型管的分离效率达到99.99%。分离效率随垂直管数、垂直管间距的增加先降低再升高,随分流比、含油率的增加先升高再降低。管径和入口速度对分离效率的影响较小,其大小可视需要而定。

基于TRNSYS的扁平热管PV/T系统性能优化

基于太阳能技术现状分析,将太阳能光伏组件与扁平式热管高效结合,提出新型扁平热管PV/T系统.为实现该系统综合效率最大化,结合TRNSYS仿真,开展试验并进行优化分析.结果表明,安装扁平热管后夏季热水温度从原来的51.1℃升高到57.3℃,提高了12.1%,冬季热水温度从47.6℃升高到55.2℃,提高了15.9%.夏季系统的综合效率提高了4.7%、冬季系统的综合效率提高了4.8%.可以得出结论扁平热管对PV/T空调系统性能的优化效果明显,也为该技术在建筑领域的应用提供了依据.

腹腔镜胆总管切开取石术一期缝合在老年肝外胆管结石治疗中的效果及安全性评价

目的 探讨腹腔镜胆总管切开取石术一期缝合在老年肝外胆管结石治疗中的效果及安全性。方法 选取老年肝外胆管结石患者148例为研究对象。所有患者均行腹腔镜胆总管切开取石术,其中88例行一期缝合(一期缝合组),60例做常规T管引流(常规组)。比较2组的手术相关指标、炎症因子水平变化、术后胃肠功能恢复情况以及并发症发生率。结果 一期缝合组的手术时间、术后引流时间、住院时间以及首次排气时间和肠鸣音恢复时间短于常规组,差异有统计学意义(P<0.05)。2组术中出血量、治疗总有效率比较,差异无统计学意义(P>0.05)。与术前相比,2组术后的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和总胆红素(TBIL)水平均呈先升后降低的变化趋势,不同时点差异均有统计学意义(P<0.05)。一期缝合组术后1、2 d的血清CRP、TNF-α、IL-1β水平低于常规组,差异有统计学意义(P<0.05)。一期缝合组的术后并发症总发生率为3.41%,低于常规组的11.67%,差异有统计学意义(P<0.05)。2组术后3个月内的胆总管狭窄发生率比较,差异无统计学意义(P>0.05)。结论 腹腔镜胆总管切开取石术一期缝合在老年肝外胆管结石患者治疗中的应用效果较好,有助于缩短手术时间,减轻炎症反应,降低术后并发症发生率,且安全性较高。

三镜联合免T管保留Oddi括约肌功能在胆总管结石治疗中的应用

目的研究腹腔镜、胆道镜和十二指肠镜三镜联合免T管保留Oddi括约肌功能治疗胆总管结石的临床效果,探讨其临床应用价值。方法回顾性分析2021年9月至2023年9月曲靖市第一人民医院分别采用腹腔镜下胆总管探查取石+鼻胆管引流+胆总管一期缝合术(LCBDE+ENBD+PC组,n=38)和腹腔镜下胆总管探查取石+T管引流术(LCBDE+T管引流组,n=49)治疗的胆总管结石患者的临床资料。比较两组的手术时间、术中出血量、术后并发症、住院时间和治疗费用等指标。结果LCBDE+ENBD+PC组与LCBDE+T管引流组在术中出血量[(46±10)mL vs(50±11)mL,t=-1.750,P=0.084]、一次性结石取净率[94.74%(36/38)vs 93.88%(46/49),χ^(2)=0.029,P=0.864]、腹腔引流管拔除时间[(4.3±1.0)d vs(4.4±1.0)d,t=-0.879,P=0.382]方面差异均无统计学意义。LCBDE+ENBD+PC组住院时间[(9±1)d vs(12±2)d,t=-8.456,P<0.001]、总治疗费用[(21750±966)元vs(22862±2026)元,t=-3.177,P=0.002]及并发症发生率[10.53%(4/38)vs 36.73%(18/49),χ^(2)=7.781,P=0.005]均低于LCBDE+T管引流术组。结论LCBDE+ENBD+PC治疗胆总管结石治不仅降低了术后并发症发生率,还能缩短住院时间、减少总治疗费用,避免患者长期带T管的痛苦;该方法同时保护了Oddi括约肌功能,为胆总管结石的治疗提供了新的选择。

耳穴压豆对腹腔镜胆总管切开取石+T管引流术患者术后胆汁成分的影响

目的分析耳穴压豆对腹腔镜胆总管切开取石+T管引流术患者术后胆汁成分的影响。方法66例胆管结石患者,随机分为对照组和观察组,每组33例。两组均予以腹腔镜胆总管切开取石+T管引流术治疗,对照组术后给予常规对症治疗,观察组在对照组基础上术后给予耳穴压豆治疗。比较两组患者术后不同时间点的胆汁成分、肝功能及术后胆汁总引流量。结果观察组术后第4天胆汁中总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆汁酸(TBA)、钙离子(Ca^(2+))、胆固醇(CHO)分别为(520.46±110.15)μmol/L、(350.36±80.07)μmol/L、(270.45±40.06)μmol/L、(1042.34±130.05)μmol/L、(1.56±0.15)mmol/L、(4.01±0.92)mmol/L,术后第8天分别为(359.47±71.35)μmol/L、(242.24±50.34)μmol/L、(222.16±40.31)μmol/L、(1232.10±150.43)μmol/L、(1.38±0.15)mmol/L、(3.59±0.47)mmol/L;对照组术后第4天胆汁中TBIL、DBIL、IBIL、TBA、Ca^(2+)、CHO分别为(572.93±97.27)μmol/L、(390.52±69.17)μmol/L、(294.78±56.22)μmol/L、(929.48±135.27)μmol/L、(1.76±0.19)mmol/L、(4.47±0.89)mmol/L,术后第8天分别为(495.53±83.86)μmol/L、(344.41±62.06)μmol/L、(264.47±43.36)μmol/L、(1003.87±152.18)μmol/L、(1.57±0.17)mmol/L、(3.99±0.43)mmol/L。术后第4、8天,两组患者胆汁中TBIL、DBIL、IBIL、Ca^(2+)、CHO较术后第1天显著降低,且观察组低于对照组;两组患者胆汁中TBA较术后第1天显著升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。术后第4、8天,两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)较术后第1天降低,且观察组低于对照组,差异有统计学意义(P<0.05);观察组术后胆汁总引流量为(2684.65±252.45)ml,多于对照组的(2135.89±295.42)ml,差异有统计学意义(P<0.05)。结论对腹腔镜胆总管切开取石+T管引流术患者术后予以耳穴压豆治疗,可改变胆汁成分及肝功能,能增加TBA及胆汁排空能力,降低胆红素和Ca^(2+)含量,效果理想。

1例气管重度狭窄病人全身麻醉下经硬质气管镜置入Montgomery T管术后的护理

总结1例气管切开术后气道重度狭窄病人在全身麻醉下行经硬质气管镜气管上段置入Montgomery T管治疗术的护理经验。护理要点包括制定出术后风险预警评估方案及预警阳性事件的紧急处理规范;气道湿化管理及非零负压浅层探索式吸痰的方法;术后康复功能锻炼;心理支持干预。经过多学科专业的规范化治疗和精心护理,病人于术后第9天复查支气管镜效果良好,术后第10天顺利出院,出院后连续随访3个月,情况良好。

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation:a meta-analysis

Objective:To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation.Methods:Randomized control trials(RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library,MEDLINE(1966/1-2010/4),Scopus(1980/1-2010/4),ClinicalTrials.gov(2010/4),the Cochrane Hepato-Biliary Group Controlled Trials Register,and the Cochrane Central Register of Controlled Trials.Studies and data were extracted and assessed independently.Dichotomous outcomes were reported as odds ratios(ORs) and weighted mean difference with 95% confidence intervals(CI).Results:Five RCTs and eight comparative studies with a total of 1 608 subjects were identified.The data showed that the operation with T-tube had better outcomes for duct stenosis(P=0.01,OR=0.45,95% CI 0.24-0.85).The operations with or without T-tube had equivalent outcomes as follows:overall biliary complications(P=0.85,OR=1.15,95% CI 0.28-4.72),bile leaks(P=0.38,OR=0.75,95% CI 0.39-1.42),and cholangitis(P=0.24,OR=4.64,95% CI 0.36-60.62).These results were strengthened by the analysis of all thirteen non-randomized and randomized studies.Conclusions:Our systematic review and meta-analysis suggest that the insertion of a T-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.

Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration:a meta-analysis

Background and aims:Laparoscopic common bile duct exploration(LCBDE)is considered a safe and effective method for the removal of bile duct stones.However,the choice of primary duct closure(PDC)or T-tube drainage(TTD)technique after LCBDE is still controversial.This study aimed to compare the safety and effectiveness of PDC and TTD after LCBDE.Methods:Studies published before May 1,2021 in Pub Med,Web of Science,and Cochrane Library databases were searched to screen out randomized controlled trials(RCTs)and cohort studies to compare PDC with TTD.Meta-analyses of fixed effect and random effect models were performed using Rev Man 5.3.Results:A total of 1865 patients were enrolled in six RCTs and ten cohort studies.Regarding RCTs,the PDC group was significantly better than the TTD group in terms of operation time,total postoperative complications,postoperative hospital stay,and hospitalization expenses(all P<0.05).Based on cohort studies of the subgroup,the PDC group had shorter operation time,shorter postoperative hospital stay,less intraoperative blood loss,and limited total postoperative complications.Statistically,there were no significant differences in bile leakage,retained stones,stone recurrence,bile duct stricture,postoperative pancreatitis,other complications,or postoperative exhaust time between the TTD and PDC groups.Conclusions:Based on the available evidence,compared with TTD,PDC is safe and effective,and can be used as the first choice after transductal LCBDE in patients with choledocholithiasis.

胆总管一期缝合与T管引流两种术式在腹腔镜下胆总管切开胆道镜探查取石术后的效果比较

目的 探索胆总管一期缝合与T管引流两种术式在腹腔镜下胆总管切开胆道镜探查取石术后应用的效果。方法 2019年1月~2023年5月期间收治行腹腔镜下胆总管切开胆道镜探查取石术的胆总管结石病人90例,采用随机数字表法分为两组,对照组45例,术后采用T管引流治疗;观察组45例,术后采用胆总管一期缝合治疗。比较两组治疗后手术相关指标、肝功能水平、术后并发症发生率,随访3个月,比较结石残留率。结果 两组术中出血量、术后排气时间、引流管拔除时间、术后并发症发生率、结石残留率比较,差异均无统计学意义(P>0.05),观察组取石时间、住院时间短于对照组,住院总费用元少于对照组,差异有统计学意义(P<0.05),术后1天,7天的TBil、ALT均低于对照组,差异有统计学意义(P<0.05)。结论 腹腔镜下胆总管切开胆道镜探查取石术后进行胆总管一期缝合,更能够缩短取石时间,减轻对肝损害,提高生存质量,加速病情康复。

腹腔镜胆总管切开取石一期缝合术治疗胆总管结石的效果分析

目的研究腹腔镜胆总管切开一期缝合术的临床疗效。方法方便选取2020年1月—2022年12月高邮市中医医院收治的符合入院标准的81例胆总管结石患者为研究对象,依据胆总管缝合方式不同分为对照组和观察组,其中45例对照组患者采取T管引流术,36例观察组患者采取一期缝合术。比较两组术中出血量、手术时间、术后住院时间、术后肛门排气时间、住院总费用、术后并发症发生率等。结果两组术中出血量对比,差异无统计学意义(P>0.05)。观察组手术时间、术后肛门排气时间、术后住院时间、住院总费用均少于对照组,差异有统计学意义(P均<0.05)。观察组并发症发生率为13.89%,低于对照组的28.89%,差异有统计学意义(χ^(2)=9.592,P<0.05)。随访时间内两组患者均未出现结石复发。结论腹腔镜胆总管切开一期缝合术可以减少患者痛苦、缩短手术时间、降低术后并发症发生率,从而加快术后机体的恢复,节约了部分社会资源。

基于流-热-固耦合分析的数值模拟及结构优化

为解决等径T型管路应力过大问题,提出一种基于流-热-固耦合分析方法的优化方法对等径T型管结构进行优化。首先,基于流、固力学理论建立T型管多场耦合的数学模型和物理模型,对T型管内流体的速度温度变化情况和管路的等效应力的分布情况进行仿真模拟,在仿真结果的基础上对管路进行结构优化。仿真结果表明:冷热流体的压力差会导致流体产生逆流现象,从而导致管路的上游区等效应力值增大。等径T型管的最大等效应力值出现在主支管交汇的下游内壁面处。优化后管路内壁面最大等效应力值下降约14%,可以有效地延长管路的使用寿命。该方法对提高气体管路设计的可靠性具有一定的实践意义。

黏膜瓣缝合技术联合耳用T管置入在复杂鼻腔泪囊造口术中的应用

目的探讨黏膜瓣缝合技术联合耳用T管置入在复杂鼻腔泪囊造口术中的应用方法与临床效果。方法回顾性分析2016年11月-2022年3月在复杂鼻腔泪囊造口术中采用鼻内镜下黏膜瓣缝合技术联合耳用T管置入治疗鼻泪管阻塞患者26例(31眼)的临床资料,总结手术方法,观察临床疗效。结果26例(31眼)患者术后随访6~48个月,痊愈率为61.3%(19/31),显效率12.9%(4/31),有效率9.7%(3/31),无效率16.1%(5/31),总有效率83.9%(26/31)。结论在复杂鼻腔泪囊造口术中,采用鼻内镜下黏膜瓣缝合技术联合耳用T管置入,创伤小,疗效确切。术后应定期随访处理,以提高手术疗效。