Search

单孔胸腔镜下常规手术器械替代一次性手术器械对肺癌肺叶切除术的临床分析

目的探讨单孔胸腔镜下常规手术器械替代一次性手术器械对肺癌肺叶切除术近期临床疗效及治疗费用差异。方法前瞻性纳入 2017 年 10 月至 2018 年 6 月云南省肿瘤医院胸外一科Ⅰa～Ⅲa 期非小细胞肺癌患者 44 例。患者按手术方式不同分为一次性器械组 24 例［A 组，对照组，男 10 例、女 14 例，平均年龄 53.8（30～77）岁］和常规器械替代组 20 例［B 组，试验组，男 9 例、女 11 例，平均年龄 53.6（35～70）岁］。比较两组临床效果。结果两组手术均顺利完成，两组术中出血量、术后引流管引流量、术后胸腔引流管留置时间、术后住院时间、并发症发生情况差异无统计学意义（P>0.05）。A 组手术时间和住院总费用分别为（57.29±7.52）min 和（52 830.79±6 621.71）元，B 组手术时间和住院总费用分别为（79.00±9.81）min 和（29 565.90±2 734.25）元，两组差异有统计学意义（P<0.05）。结论单孔胸腔镜下常规手术器械替代一次性器械在肺癌肺叶切除术中安全可行，且大大降低了患者住院总费用。

Comparison between One-off Anesthesia Paracentesis Kit and Ordinary Peritoneal Paracentesis Kit Used in Intra-peritoneal Chemotherapy

【摘要】　目的　探讨一次性麻醉穿刺包与普通腹腔穿刺包在腹腔化疗中应用效果。　方法　将2008年6月-2009年4月住院的胃癌和卵巢癌行腹腔化疗的患者53例，随机分为两组。实验组29例，用一次性麻醉穿刺包行腹腔穿刺化疗；对照组24例，用普通腹腔穿刺包行腹腔穿刺化疗；比较两组患者应用不同穿刺包行腹腔穿刺化疗的并发症比较。　结果　实验组并发症发生率明显低于对照组(Plt;0.05)。　结论　一次性麻醉穿刺包应用于腹腔化疗中操作简便、创伤小、并发症少，患者乐于接受等优点，值得在临床上推广使用。【Abstract】　Objective　To explore the effects of one-off anesthesia paracentesis kit and ordinary peritoneal paracentesis kit in intraperitoneal chemotherapy.　Methods　A total of 53 patients with gastric cancer or ovarian cancer from June 2008 to April 2009 were randomly divided into two groups: 29 patients in trial group underwent intra-peritoneal chemotherapy with one-off anesthesia paracentesis kit, and 24 patients in the control group underwent intra-peritoneal chemotherapy with ordinary peritoneal paracentesis kit. The complications in two groups were compared.　Results　The incidence of complications in trial group was much lower than that in the control group (Plt;0.05).　Conclusion　One-off anesthesia paracentesis kit in intra-peritoneal chemotherapy has several advantages including simple manipulation, small injuries, and few complications, which is well accepted by the patients.

Modified Bacon surgery for one-time operation in treatment of ultra-low rectal cancer

ObjectiveTo evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection for ultra-low rectal cancer.MethodsThe medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated by Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively. According to the different methods during the operation, the patients were divided into a modified Bacon one-time operation group (modified Bacon group, n=26) and a Bacon secondary operation group (traditional Bacon group, n=33). The perioperative period data and follow-up results were observed and compared.ResultsA total of 59 ptients were collected, including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group. There were no significant differences in gender composition, age, etc. baseline data between the two groups (P>0.05). All surgery were successfully completed. There were no conversion to laparotomy, intraoperative or postoperative massive bleeding, severe infection and other serious complications and perioperative period death. The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group [0.0% (0/26) versus 18.2% (6/33), P=0.030]. There were no significant differences in the incidences of postoperative anastomotic bleeding, anastomotic stricture, rectal irritation, and external intestinal necrosis between the two groups (P>0.05). And the number of dissected lymph nodes, operation time, intraoperative blood loss, the first exhaust time, and postoperative hospital stay had no significant differences between the two groups (P>0.05). There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome (LARS) between the two groups at 3 and 6 months after operation (P>0.05). However, the total LARS score at 6 months after operation was lower than that at 3 months in the same group (P<0.001). By the end of the last follow-up (January 2021), there was no obvious difference in the anal shape between the two kinds of surgery. There was no recurrence or death during the follow-up period.ConclusionModified Bacon one-time operation for ultra-low rectal cancer is safe and feasible, which could achieve natural orififice specimen extraction surgery and ultra-low limit sphincter preservation, reduce occurrence of postoperative anastomotic leakage and external intestinal necrosis, times of operation, and shorten total length of stay and reduce total cost of hospitalization.

一次性灌肠器在行盆底组织重建术女性患者术前阴道冲洗中的应用

目的探讨一次性灌肠器在行盆底组织重建术女性患者术前阴道冲洗中的应用及效果。 方法对2012年2月－2013年8月收治的88例拟行盆底组织重建术女性患者，术前采用一次性灌肠器进行阴道冲洗的方法及效果进行回顾分析。 结果本组患者采用一次性灌肠器进行阴道冲洗，均无不良反应或意外情况发生，经冲洗各例患者外阴均能保持良好清洁度，符合手术清洁要求。 结论一次性灌肠器用于阴道冲洗，操作简便、省力、省时，患者舒适度高，值得临床推广使用。

Innovative practice of auditing qualification documents of disinfectant, disinfection devices and disposable medical devices

The quality of disinfectant, disinfection devices and disposable medical devices is closely related to the patients' safety. Hospital infection management department must carry out the audit responsibilities for qualification documents of disinfectant, disinfection devices and disposable medical devices, to guarantee legality, safety and effectiveness of products used in hospital. This paper mainly introduces the implementation of qualification documents audit in West China Hospital, Sichuan University, including system construction, process reengineering, documents audit scope and key points, and document management.

新型医用储痰杯的研制

Effectiveness analysis of disposable skin stretch closure in treatment of difficult to close skin and soft tissue defects

Objective To observe the effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close. Methods The clinical data of 13 patients with skin and soft tissue defects that were difficult to close treated with disposable skin stretch closure and met the selection criteria between July 2021 and February 2022 were retrospectively reviewed. There were 9 males and 4 females, the age ranged from 15 to 71 years with a mean of 39.8 years. The causes of injury included falling injury in 5 patients, traffic accident injury in 5 patients, and falling from height injury in 3 patients. The causes of skin soft tissue defects included open fractures in 4 patients, wound infection in 4 patients, osteomyelitis in 3 patients, degloving injury in 1 patient, and necrosis of skin graft in 1 patient. The injury was located at calf in 8 patients, calcaneus in 3 patients, pelvis in 1 patient, and plantar in 1 patient. The skin and soft tissue defects ranged from 5.0 cm×2.0 cm to 10.5 cm×6.5 cm. Wound conditions (wound closure and wound healing) and the presence or absence of complications were recorded. Results All 13 patients were followed up 32-225 days with a median of 164 days. The wound closure time ranged from 5 to 14 days, with a mean of 8.8 days. The wound closure speed ranged from 0.7 to 13.7 cm2/day, with a mean of 3.6 cm2/day. All wounds healed at grade A, and no complication such as skin edge injury, wound necrosis, infection, dehiscence, and edema occurred. No patient complained of pain or discomfort, and no obvious scarring was found during follow-up. The wound healing time ranged from 17 to 28 days, with a mean of 21.7 days. One of them was transferred to other department due to lung cancer condition changes after using disposable skin stretch closure, and the wound had directly healed without suturing at 17 days after operation. Conclusion The effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close was exact, with short wound closure time, few complications, and easy operation.

Vacuum Sampling versus Disposable Needle Sampling via Femoral Vein in Infants of China: A Systematic Review

Objective　To evaluate the effect and safety of infantile femoral vein blood sampling with vacuum versus disposable needle. Methods　Such databases as VIP, CNKI, CBM, Google Academic and Wanfang data were searched to collect the randomized controlled trials (RCTs) about infantile femoral vein blood sampling with vacuum versus disposable needle published from January 2000 to July 2010. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the methodology quality was assessed, and meta-analysis was conducted by using RevMan 5.0 software. Results　A total of 15 RCTs were included. Of 3 490 patients in all, 1 770 were in the treatment group and 1 726 were in the control group. The baseline conditions were reported in 14 studies, and the random methods were mentioned in 11 RCTs. All studies didn’t report the allocation concealment and blind method. Only 2 RCTs reported separately that, the degree of neonatal pain was lower in the treatment group (Plt;0.01), and the satisfaction of parents was higher in the treatment group (Plt;0.01). Four RCTs compared the sampling time between the two groups without meta-analysis mentioned due to the disunity of standard, only the descriptive outcomes showed a shorter time in the treatment group. The meta-analysis showed that, compared with the control group, the reject rate of sample quality was lower (RR=0.20, 95%CI 0.15 to 0.26), the success rate of one time sampling was higher (RR=1.20, 95%CI 1.16 to 1.24), the injury of local tissue was slighter (RR=0.62, 95%CI 0.45 to 0.86), and the iatrogenic contamination was lower (RR=0.62, 95%CI 0.45 to 0.86) in the treatment group. Conclusion　This review shows that the vacuum sampling is superior to the disposable needle sampling for domestic infantile femoral vein blood collection. Due to the low quality of the included studies with high possibility of bias, this conclusion needs to be further verified by performing more high-quality studies.

一次性胃管应用于肺叶切除术后胸腔闭式引流的临床研究

目的探讨采用一次性胃管作为肺癌肺叶切除术后引流管的疗效及护理。 方法将2014年1月－7月行肺癌肺叶切除术的60例患者随机均分为试验组和对照组，试验组应用一次性胃管作为胸腔引流管治疗，对照组应用常规硅胶管作为胸腔引流管治疗，对比分析两组患者的胸腔引流管堵塞情况、伤口疼痛程度、胸腔引流管拔管时间、胸腔引流管拔管后引流口渗液情况及术后平均住院时间。 结果两组患者的胸腔引流管均无堵塞。试验组患者伤口疼痛评分低于对照组；试验组平均拔管时间（2.43±1.36）d，对照组平均拔管时间（3.77±1.87）d；试验组4例（13.3%）拔引流管后引流口有渗液，对照组13例（43.3%）；试验组术后平均住院日为（3.50±1.38）d，对照组为（4.93±1.86）d；两组比较差异有统计学意义（P＜0.05）。 结论一次性胃管应用于肺癌肺叶切除术后胸腔闭式引流，材质柔软，患者疼痛减轻，方便离床活动，进一步促进伤口愈合和肺功能恢复，缩短拔管时间及术后平均住院时间，减轻患者经济负担。

三种胃管固定方法在急诊洗胃中的应用

目的 比较临床上常见的3种急诊洗胃胃管固定方法优劣。 方法 将2010年1月－2014年8月收治的300例急诊洗胃患者随机抽签分为A组（100例）注射器固定胃管，B组（100例）一次性口垫固定胃管，C组（100例）气管导管固定器固定。3组患者一般资料差异无统计学意义（P＞0.05），具有可比性。观察3组洗胃过程中出现的不良反应以及置管时间、洗胃时间。 结果 3组患者在口腔内相关损伤和胃管脱落、咬闭方面，差异有统计学意义（P＜0.05）；在误吸方面，A组与B、C组之间差异有统计学意义（P＜0.05），B、C组之间差异无统计学意义（P＞0.05）。3组患者在留置胃管时间上差异无统计学意义（P＞0.05）。在洗胃时间上，3组两两比较差异均有统计学意义（P＜0.05）。 结论 气管导管固定器固定胃管的方法在洗胃不良反应方面优于一次性口垫固定法及注射器固定法，并可以缩短洗胃时间。