More and more relevant research results show that anatomical segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early-stage non-small cell lung cancer (diameter<2.0 cm). Segmentectomy is more difficult than lobotomy. Nowadays, with the promotion of personalization medicine and precision medicine, three-dimensional technique has been widely applied in the medical field. It has advantages such as preoperative simulation, intraoperative positioning, intraoperative navigation, clinical teaching and so on. It plays a key role in the discovery of local anatomical variation of pulmonary segment. This paper reviewed the clinical application of three-dimensional technique and briefly described the clinical application value of this technique in segmentectomy.
目的 評價手衛生健康教育對重癥監護病房（ICU）患者家屬手衛生依從性的影響。 方法 選取2012年3月－5月ICU患者家屬558人，對其進行手衛生健康教育。將健康教育前的1個月定義為第1階段(基線調查階段），健康教育當月定義為第2階段，健康教育結束后的第1個月定義為第3階段。對ICU患者家屬開展手衛生健康教育，第1和第3階段均采用張貼展板和宣教圖片，床旁準備速干手消毒液；第2階段在此基礎上，每周示范六步洗手法3次，由責任護士督促并指導家屬使用速干手消毒液進行手衛生。觀察3個階段患者家屬手衛生依從性變化情況。 結果 在對“接觸患者前”、“接觸患者后”和“接觸患者周圍環境后”3個手衛生時機的依從率比較中，第2階段明顯高于第1階段（P＜0.01）；第3階段較第2階段有明顯下降（P＜0.01）；在3個階段中，使用速干手消毒液進行手衛生的人數均高于使用洗手液的人數。 結論 手衛生健康教育普及了手衛生相關知識，提高了ICU患者家屬對手衛生的依從性。
Objective To evaluate the cl inical results of the femoral reconstruction technique in patients with proximal femoral deformity in total hip arthroplasty. Methods Between March 2004 and June 2009, total hip arthroplasty procedures were performed on 25 patients (26 hips) with hip joint disease and proximal femoral deformity, including primary osteoarthritis of the hip joint (2 hips), developmental dysplasia of the hip (8 hips), traumatic arthritis of the hip (14 hips), and tuberculosus arthritis of the hip (2 hips). There were 10 males (10 hips) and 15 females (16 hips), with an average age of 64 years (range, 42-82 years). The disease duration was 10 months to 25 years (mean, 10.6 years). The Harris score was 44.2 ± 5.1, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 45.0 ± 2.7 before operation. According to Berry’s classification system of primary disease, 8 hips were classified as developmental dysplasia of hip, 7 hips as malunion of fracture, 2 hips as chronic tuberculosis, 2 hips as sl ipped femoral epiphysis, 1 hip as previous subtrochanteric osteotomy, 1 hip as previous shelf operation of the acetabulum, and 5 hips as previous internal fixation; according to the anatomic site of the deformity, there were 5 hips of greater trochanter, 10 hips of femoral neck level, 10 hips of metaphyseal level, and 1 hip of diaphysis. Results All wounds healed by first intention. Deep venous thrombosis occurred in 3 patients within 1 week, and were cured with braking and anticoagulant therapy. Bursal synovitis of great trochanter occurred in 1 patient after 6 weeks, and was eased after taking drugs for pain rel ief. All patients were followed up 1 year and 6 months to 6 years, with an average of 3 years and 3 months. The Harris score and WOMAC score at last follow-up were 88.4 ± 3.6 and 82.0 ± 5.2 respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). The X-ray films at last follow-up showed good location of prosthesis and no loosening expect 1 patient who had aseptic loosening and was given revision at 8 months postopera tively. Conclusion Proximal femoral deformity classification will contribute to the choice of prosthesis and surgical strategy,thus the good results of femoral reconstruction and cl inical results would be obtained.
Objective To assess the effectiveness of increasing water intake for the prevention of urinary calculi and its recurrence. Methods We defined the searching area, which included Medline, Embase, Cochrane CCTR and CBMA, and found the relevant materials by computer search and document search. At least two reviewers assessed trials quality and extracted data independently. Results A total of 4 studies met the inclusion criteria (I RCT, I CCT and 2 prospective cohort studies). Meta-analysis’ results showed that the aggregate OR and 95%CI of the effect of increasing water intake for the prevention of urinary calculi were 0.64 and 0.53-0.77; the aggregate OR and 95%CI of the effect of increasing water intake for the prevention of recurrence were 0.56 and 0.37-0.84; increasing water intake can prolong the recurrence interval (P=0.016). Each result had statistical significance. Conclusion Increasing water intake can prevent urinary calculi and its recurrence. Increasing water intake can prolong the recurrence interval.
Objective To evaluate the effectiveness of membrane induction technique in the treatment of Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect. Methods The clinical data of 20 patients with Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defects admitted between January 2019 and December 2020 were retrospectively analyzed, including 15 males and 5 females, with an average age of 35 years (range, 19-70 years). Causes of injuries included 15 cases of traffic accidents and 5 cases of falling from height. Bone defect located at metaphyseal in 11 cases and at proximal metaphyseal in 9 cases. The time from injury to primary first-stage surgery was 4-28 hours, with an average of 11 hours. After primary radical debridement, the length of bone defect was 3-12 cm, with an average of 6 cm. Antibiotic-containing bone cement was implanted in the bone defect site to induce membrane formation. At 34-56 days (mean, 45 days) after the first-stage surgery, bone grafting was performed in the induced membrane for the repair and reconstruction of bone defects; 16 patients received a combination of autogenous cancellous and allogeneic bone grafts and 4 patients received cancellous bone grafts. The bone graft healing time after the second-stage surgery was recorded; the visual analogue scale (VAS) score and Lysholm score were compared before the second-stage bone graft and at last follow-up to evaluate the pain and functional improvement of the affected limb; and the knee joint range of motion at last follow-up was recorded. Results None of the patients had a second revision after the first-stage surgery, 1 patient recieved flap transfer and the flap survived well after operation. All patients were followed up 12-36 months after the second-stage surgery, with an average of 23 months. All patients achieved bone union, and the bone union time was 7-10 months (mean, 8.4 months). No bone nonunion or donor site related complications occurred. The Lysholm score and VAS score at last follow-up were 85.6±4.1 and 1.7±0.8, respectively, and they were significantly improved when compared with those before the second-stage bone defect repair (42.7±4.6 and 7.1±0.8, respectively) (t=37.410, P<0.001; t=21.962, P<0.001). Knee flexion range of motion was 60°-120°, with an average of 95°; the limit of elongation was 0°-10°, with an average of 5°. ConclusionFor Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect, induction membrane technique can effectively control infection, promote bone healing of the defect site, and effectively restore the function of lower limbs with satisfactory effectiveness.
ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastrointestinal stromal tumor (GIST) with liver metastasis.MethodThe experiences of MDT model in treating huge (>10 cm) GIST with liver metastasis in the Affiliated Hospital of North Sichuan Medical College on August 2018 were summarized.ResultsThe 46 years old female patient diagnosed with intestinal stromal tumor with liver metastasis at the initial visit. There was no chance of surgery. After the neoadjuvant therapy, the tumor was shrunk. After 2 MDT discussions, the R0 resection of the primary tumor or metastases was successfully performed. And then the patient continued to receive the oral imatinib 600 mg/d. The current overall survival was 31 months till now. No recurrence of the tumor was observed and the follow-up was still continued.ConclusionsTyrosine kinase inhibitors combined metastasectomy may be the most appropriate treatment for patient diagnosed with GIST with liver metastasis, which can improve the survival. In clinical work, MDT model could be used reasonably and carried out during the whole treatment process to provide the best treatment option for patient with GIST with liver metastasis.
ObjectiveTo investigate the effectiveness of flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Methods A clinical data of 33 patients with post-traumatic tibial osteomyelitis with soft tissue defect who met the selection criteria between August 2015 and October 2018 was retrospectively analyzed. There were 21 males and 12 females. The age ranged from 19 to 70 years, with an average of 39 years. The osteomyelitis located in the upper 1/3 of tibia in 8 cases, in the middle 1/3 of tibia in 14 cases, and in the lower 1/3 of tibia in 11 cases. According to Cierny-Mader classification standard, 19 cases of osteomyelitis were type Ⅲ and 14 cases were type Ⅳ. The duration of osteomyelitis ranged from 2 months to 20 years (median, 3 months). In the first-stage operation, after radical debridement, the length of bone defect was 1.5-12.5 cm (mean, 5.0 cm) and the size of soft tissue defects ranged from 5 cm×4 cm to 15 cm×12 cm. Bone cement containing antibiotics was implanted into the bone defect and the personalized flap was used to repair the wound. After the wound healed at 6-8 weeks and the infection was controlled, bone grafting was performed to repair bone defects in the second-stage operation. Results The flaps survived completely after the first-stage operation in 29 cases. Partial necrosis of the flap occurred in 4 cases and healed after surgical dressing change. All the incisions healed by first intention after the second-stage operation. All patients were followed up 24-32 months (mean, 28 months). All the bone grafts healed after operation, and the radiographic healing time was 3-9 months (mean, 5 months). The clinical healing time was 4-14 months (mean, 8 months). There was no recurrence of osteomyelitis during follow-up. At last follow-up, according to Johner-Wruhs evaluation criteria, the limb function was excellent in 27 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 93.9%. Conclusion For the post-traumatic tibial osteomyelitis with soft tissue defect, the flap combined with induced membrane technique is a reliable and effective method and can effectively restore the function of lower limbs with satisfactory effectiveness.
目的 研究需要行頸動脈外膜剝脫術腦癱患兒全身麻醉（全麻）誘導時給予鹽酸戊乙奎醚預防術后口腔分泌物過多的效果。 方法 2009年12月－2011年12月選擇60例美國麻醉醫師協會分級Ⅰ～Ⅱ級的需要在全麻下行頸動脈外膜剝脫術的腦癱患兒，隨機分為兩組，每組30例。A組于麻醉誘導時靜脈注射阿托品10 μg/kg，B組于麻醉誘導時靜脈注射戊乙奎醚10 μg/kg。分別記錄兩組的麻醉持續時間、入室心率、氣管插管后10 min的心率差、停藥后的拔管時間及拔管時口腔分泌物評分[采用視覺模擬評分法（VAS）]。 結果 兩組相比，患兒麻醉持續時間、入室心率和停藥后拔管時間差異均無統計學意義（P＞0.05），而拔管時口腔分泌物的VAS評分差異有統計學意義（P＜0.05），其中口腔分泌物過多（VAS＞2分），A組為46.67%，B組為16.67%，B組比A組口腔分泌物更少，氣管插管后10 min心率A組為（28.30 ± 9.73）次/min，B組為（9.93 ± 10.25）次/min，兩組差異有統計學意義（P＜0.05）。 結論 鹽酸戊乙奎醚能夠有效減少需要行頸動脈外膜剝脫術的腦癱患兒術后口腔分泌物過多的情況，且比常規應用阿托品的效果更好。
ObjectiveTo summarize the clinical manifestations, pathogenesis, diagnosis and treatment of multiple endocrine neoplasia type 1 (MEN-1) so as to improve the understanding of MEN-1.MethodThe clinical data of 1 case of MEN-1 with new mutated gene in the Yantai Yuhuangding Hospital of Medical College of Qingdao University (our hospital) were analyzed retrospectively.ResultsThe patient was a 73-year-old woman, who was admitted to our hospital because of “abdominal pain, diarrhea” for 4 d. After discussion by a multidisciplinary team, MRI of pancreatic, adrenal and pituitary, and endoscopy examinations were performed to further identify the cause of diarrhea. Meanwhile, MEN-1 gene was detected in the peripheral blood of the patient and her relatives, and the result showed that the proband and his daughter had a cytosine deletion at c.1401 in exon 10 of MEN-1 gene, which resulted in frame shift mutation of p.e468r fs, it was confirmed as MEN-1. After 5 d of conservative treatment of the disease, the patient’s family requested discharge and the patient died half a month after discharge.ConclusionsMEN-1 is a rare autosomal dominant inheritable disease, with diverse clinical manifestations and easy misdiagnosis. Therefore, it is necessary to be alert to abnormal indicators in the glands associated with MEN-1, so as to achieve early diagnosis and treatment.
目的 研究七氟醚誘導氣管插管減輕短期內行兩次手術的腦性癱瘓患兒術前焦慮的效果。 方法 2009年12月－2011年7月選擇需要短期內行兩次全身麻醉（全麻）手術的痙攣性腦性癱瘓患兒60例，美國麻醉醫師協會（ASA）Ⅰ～Ⅱ級。隨機分為A組常規麻醉誘導氣管插管（30例）和B組七氟醚誘導氣管插管（30例）；分別在一期及二期手術術前訪視時（M1、M3）、入手術室時（M2、M4）對兩組患兒進行改良耶魯圍術期焦慮量表評估；并分別在一期及二期手術麻醉誘導期（N1、N2）對兩組患兒進行誘導期合作度量表的標準評定。 結果 同組一期、二期手術比較，A組患兒二期手術術前焦慮更明顯（P＜0.05），二期入手術室時焦慮更明顯（P＜0.05），二期手術合作度更差（P＜0.05）；B組患兒兩次手術術前焦慮無明顯變化（P＞0.05），一期入手術室時焦慮明顯（P＜0.05），一期手術合作度較差（P＜0.05）。兩組之間，一期手術兩組患兒焦慮情況無明顯區別（P＞0.05），二期手術A組比B組的患兒焦慮更明顯（P＜0.05），兩次手術B組都比A組的患兒合作度更好（P＜0.05）。 結論 七氟醚麻醉誘導氣管插管能夠有效減輕短期內需要進行兩次手術的痙攣性腦性癱瘓患兒的術前焦慮，提高患兒二期手術的合作度，提供良好的手術麻醉條件，保證患兒的圍術期安全。