【Abstract】ObjectiveTo introduce the clinical appliance of liver transplantation (LT) in the therapy of alveolar hydatid disease (AHD).MethodsThe related literatures were collected and reviewed.ResultsThe 5year survival rate of AHD was 71% after LT. Removing the liver and preventing the recurrence are the two major difficulties in the treatment.ConclusionAs the only feasible and effective therapy for advanced AHD, LT should be studied further.
Eight patients treated with modified radical mastectomy and fenestration of pectoralis muscle to preserve pectoral, nerves are reported and the practical procedure is introduced. The results indicate that this method can overcome the disadvantage of mastectomy (Auchincloss) in that only dissection of fatty tissue and lymph nodes in the lateral part of axilla is carried out. With fenestration of pectoralis major muscle, not only the pectoral nerves can be perserved but also the fatty tissue and lymph nodes, including of those medial to the pectoralis minor, subclavicular and interpectoral nodes can be dissected. This method almost reached Halsted’s demand and it can be used for stage Ⅰ-Ⅱ, and even stage Ⅲ breast cancer if no infiltration to pectoralis major muscle is found.
Objective To explore the short term and long term effectiveness of the problem-based learning (PBL) in clinical skill training. Methods A total of 162 clinical medicine undergraduates in Grade 2003 (7-years study) and 2004 (5-year study) who were supposed to intern in the internal medicine departments were randomly divided into the PBL group (n=75) and the control group with traditional training (n=87) for having their clinical skills training. Then t test was applied to compare the two groups about the scores of intern rotation examination and graduate OSCE as well. Results About the baseline: the students in the two groups got similar scores in their internal medicine exam before clinical intern rotation (84.04±7.40 vs. 82.63±8.77, P=0.287). About the short term effectiveness: compared to the control group, the students in the PBL group got higher subjective evaluation from their supervised clinicians (P=0.006). In writing examination, the students of those two group got similar scores in knowledge part (54.17±9.26 vs. 51.67±9.56, P=0.92), while the PBL group won in case reasoning question (20.39±5.27 vs. 16.51±4.90, Plt;0.001). About the long term effectiveness: in the graduate OSCE, the two groups got similar scores in skills operation such as punctures and lab results analyses (P=0.567 and P=0.741), while the students in the PBL group had better performance at the case reasoning and standard patients treating (75.59±9.85 vs. 71.11±12.01, P=0.027). Conclusion With the great short term and long term effectiveness, the PBL applied in the clinical skill training improves the students’ ability of both synthesized analyses and the integrated clinical skills such as clinical thinking and interpersonal communication, but doesn’t aim at the basic knowledge and operation skills.
目的 探討β —七葉皂甙鈉對乳腺癌術后患側上肢水腫的預防作用。方法 84例乳腺癌患者配對后分為實驗組和對照組。對照組給予手術等常規治療，實驗組術后另給予β —七葉皂甙鈉10～20 mg靜脈推注，每12小時1次，連用7～10天，觀察兩組患者術后患側上肢水腫的發病率。結果 對照組術后患側上肢水腫發生率為20.93%(9/43)，實驗組為4.88%(2/41)，兩組之間差異有顯著性意義。結論 β —七葉皂甙鈉對乳腺癌術后患側上肢水腫的發生有預防作用。
目的 減少肝內膽管結石術后的殘留。方法 回顧性分析近5年我科收治的50例肝內膽管結石病例行病灶肝切除并結合術中、術后膽道鏡應用的近期療效及術后殘石率。結果 術后近期并發癥發生率為8%，無膽漏、肝衰及手術死亡發生，術后B超、逆行T管造影及術后膽道鏡檢查證實的即期殘石率僅4%（2例）。結論 減少肝內膽管結石術后結石殘留的關鍵是術中術后膽道鏡的使用，肝內及肝門膽管狹窄的徹底處理； 依據狹窄膽管所引流區域行“根治性”的肝組織切除是取盡結石，清除病灶的合理方法。
ObjectiveTo analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B1+2) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B1+2c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS1+2 resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS1+2 resection (3 patients), LS1+2c resection (4 patients) and LS1+2(a+b) resection (2 patients). Conclusion This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.