【摘要】目的探討子宮內膜異位癥患者子宮內膜組織中巨噬細胞移動抑制因子(macrophage migration inhibitory factor,MMIF)表達的臨床意義。方法2007年10月2008年10月應用免疫組化法檢測MMIF在82例子宮內膜異位癥患者的異位內膜組織、正常位置內膜組織和58例非子宮內膜異位癥患者(對照組)正常位置子宮內膜組織的表達。結果①子宮內膜異位癥患者在4個不同分期的異位內膜組織中MMIF的表達均明顯高于其正常位置內膜組織(Plt;005);②子宮內膜異位癥患者不同內膜組織中MMIF的表達較對照組明顯增高;③隨著分期的增加,MMIF在異位內膜組織中及其正常位置內膜組織中表達均逐漸上調,但只有Ⅳ期與Ⅰ期內膜組織的MMIF表達差異具有統計學意義(Plt;005)。結論MMIF與子宮內膜異位癥的發生、發展密切相關。
目的:探討保留肛門外括約肌低位直腸癌保肛手術的應用。方法: 在全直腸系膜切除的基礎上,應用國產一次性管狀吻合器,對32例低位直腸癌行保留肛門外括約肌超低位結肛吻合,隨訪12～36個月。回顧性分析其根治性、術后排便功能、手術并發癥、局部復發率。結果: 全組病例術后病理檢查無切端癌殘留,無大便失禁,無吻合口漏;全組無手術死亡;腫瘤局部復發率9.4%(3/32)。結論: 低位直腸癌保留肛門外括約肌保肛手術,遵循腫瘤根治的原則下,能保留患者正常的肛門排便功能,明顯改善該類患者的生活質量。
ObjectiveTo compare the clinical effect of day surgery mode and inpatient operation mode for intertrochanteric fracture in elderly patients.MethodsThirty-seven elderly patients with intertrochanteric fracture treated in day surgery mode in the Second Hospital of Shanxi Medical University from July 2018 to July 2019 were retrospectively included. At the same time, another 37 elderly patients with intertrochanteric fracture treated in general inpatient operation mode in the same period were randomly selected. The preoperative waiting time, operation time, length of hospital stay, hospital expenses, postoperative complications, and clinical effect were compared between the two groups.ResultsThere was no significant difference in operation time [(56.21±10.75) vs. (58.81±12.56) min] or postoperative Harris hip scores (1 month after surgery: 61.03±7.74 vs. 59.47±7.42; 3 months after surgery: 85.40±4.22 vs. 85.03±4.33) between the two groups (P>0.05). In terms of the preoperative waiting time [(23.17±3.18) vs. (52.64±10.12) h], length of hospital stay [(2.01±0.97) vs. (8.34±4.22) d], hospital expenses [(4.012±0.771)×104 vs. (4.679±1.117)×104 yuan], and the incidence of deep venous thrombosis during perioperative period (10.8% vs.37.8%), the day surgery mode group had more obvious advantages than general inpatient operation mode group (P<0.05).ConclusionsDay surgery mode is safe and effective for intertrochanteric fracture in elderly patients. It is worthy of great application for clinical work in the future.
ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
Objective To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction (AMI). Methods Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis. Results Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02). Conclusion Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.