ObjectiveTo analyze the increased risks of nursing due to expansion of ophthalmic day surgery indications, and the countermeasures. MethodsWe collected the information in the last three years from January 2012 to December 2014 in the Department of Ophthalmology, including the number of operations, the proportion of cataract patients, patients aged over 70 and under 12 years old, patients with high-risk fall, the number of general anesthesia operations, adverse events, and the data from the satisfaction survey of the patients. All the data were analyzed by statistical method. ResultsDuring the last three years, the relaxation of ophthalmic day surgery indications led to an increased admission rate of high-risk patients, and caused more nursing risk factors. Through the efforts of prevention and care, during the last three years, there were no adverse events, and patients had a satisfaction rate over 90%. ConclusionAlthough the ophthalmic day surgery indication has been relaxed, through the establishment of nursing risk response system by pre-hospital guidance, admission assessment, peri-operative education and follow-up visit, with the continuous improvement of nursing management system and convenient workflow, we can not only improve the work efficiency, but also ensure nursing safety.
Objective To approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.
目的总结针对局部进展期非小细胞肺癌（LA-NSCLC）施行肺癌扩大指征手术的临床经验。 方法回顾性分析2008年1月至2012年12月同济大学附属东方医院胸心外科非计划性实施肺癌扩大指征手术治疗的14例LA-NSCLC患者的临床资料，其中男9例、女5例，年龄30～67（59.5±6.1）岁。行胸壁切除与重建术2例，主动脉切除及重建术1例，肺癌上腔静脉切除重建术3例，椎体部分切除术1例，左心房部分切除术1例，肺上沟瘤外科治疗2例，袖形全肺切除或肺叶切除隆突成形术3例，支气管肺动脉成形术1例。 结果本组患者无围手术期死亡病例。术后病理诊断鳞癌7例，腺癌4例，鳞腺癌1例，腺样囊性癌2例。随访18.5（7～48）个月。全组患者中术后生存时间最长者超过4年；3例分别于术后7个月、11个月和17个月死于肿瘤远处转移；1例存活26个月，1例存活20个月，另1例术后3个月并发肺部感染死亡；4例已存活3年以上；另有3例术后随访至2013年9月，随访时间未满1年仍存活。 结论肺癌扩大指征手术能使LA-NSCLC患者获得肺癌的完全性切除，其中相当部分患者术后可获良好的近远期效果，因此外科治疗依旧是肺癌治疗的基石，对有条件手术者应力争手术治疗。
【摘要】目的 探讨重症急性胰腺炎(SAP)的手术时机和疗效。方法 回顾性分析我院1997年5月至2004年7月期间收治的152例SAP患者的治疗效果。结果 总治愈率为94.74%(144/152)，其中非手术综合治疗组为 97.73%(86/88)，手术组为90.63%(58/64); 并发症发生率非手术综合治疗组为7.95%(7/88)，手术组为25.00%(16/64); 总死亡率为5.26%(8/152), 其中非手术综合治疗组为2.27%(2/88)，手术组为9.38%(6/64)。结论 当SAP继发明显感染、胆道梗阻或出现暴发性胰腺炎时应及时手术治疗。
To standardize the treatment of secondary hyperparathyroidism and effectively meet the needs of practical clinical work, we gathered experts and nursing experts from Departments of Thyroid Surgery, Nephrology, Endocrinology and Metabolism, Nuclear Medicine, Ultrasound, Anesthesiology, Cardiology, and other departments at West China Hospital of Sichuan University to solicit opinions. This consensus was finally established based on published guidelines and the best evidence in Chinese and English combined with clinical practice. This consensus is intended to summarize and conclude, to the greatest extent possible, the practical issues encountered in diagnosing and treating secondary hyperparathyroidism in perioperative settings and to provide recommendations for clinical practice.
ObjectiveTo compare the ascending aortic diameter and postoperative outcomes of patients with simple ascending aortic dissection or simple ascending aortic dilatation and to study the reliability of the surgical indication in present guideline for Chinese patients with ascending aortic dilatation.MethodsThe clinical data of patients with aortic aneurysm and aortic dissection who underwent surgery at Beijing Anzhen Hospital, Capital Medical University from 2010 to 2017 were retrospectively reviewed. After exclusion of patients with Marfan syndrome, heart valve and other diseases, 139 patients were divided into two groups: a simple ascending aorta dilatation group (56 patients) and a simple ascending aortic dissection group (83 patients). The ascending aortic diameter and postoperative outcomes of two groups were compared. ResultsThe inner ascending aortic diameter (57.30±9.41 mm vs. 50.72±9.53 mm, P <0.001) and the inner ascending aortic diameter index (31.12±5.38 vs. 27.22±6.40, P<0.001) in the simple ascending aorta dilatation group were significantly greater than those in the simple ascending aortic dissection group. For male patients, the results were similar (60.28±10.80 mm vs. 47.40±6.53 mm; 30.00±6.33 vs. 23.60±3.72, both P<0.001). But for the female patients, there was no significant difference between the two groups (54.90±7.47 mm vs. 53.81±10.84 mm; 32.03±4.37 vs. 30.58±6.56, both P>0.05). The mortality, the incidence of tracheotomy and postoperative reopen rate in the simple ascending aortic dissection group were higher.ConclusionIn this study, the inner diameter of the ascending aorta in the group of ascending aorta is mostly < 5.5 cm. In our opinion, the present surgical indication for Chinese patients with ascending aortic dilatation is not enough. In the future clinical studies, we also need to find more reasonable surgical indications.
ObjectiveTo review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP). MethodsThe incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. ResultsThe incidence of OBPP is not declining in recent years. Birth weight of ≥4 kg, forceps delivery, and prepregnancy body mass index of ≥21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used:C5, 6 injury as type I, C5-7 injury as type Ⅱ, C5-T1 injury as type Ⅲ, C5-T1 injury with Horner's syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. ConclusionBrachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma (even neuroma-in-continuity) resection followed by microsurgical reconstruction of the brachial plexus is favored.