目的:比较超声引导下胸横肌平面-胸神经阻滞(TTP-PECS)和胸椎旁神经阻滞(TPVB)用于乳腺癌改良根治术的效果。方法:将80例择期行单侧乳腺癌改良根治术的女性患者,ASAⅠ-Ⅱ级,年龄28~74岁,身高151~172 cm,体重47~72 kg,采用随机数字表法分...目的:比较超声引导下胸横肌平面-胸神经阻滞(TTP-PECS)和胸椎旁神经阻滞(TPVB)用于乳腺癌改良根治术的效果。方法:将80例择期行单侧乳腺癌改良根治术的女性患者,ASAⅠ-Ⅱ级,年龄28~74岁,身高151~172 cm,体重47~72 kg,采用随机数字表法分为2组(n=40):TTP-PECS组(TP组)和TPVB组(T组)。TP组行超声引导下患侧TTP-PECS,T组行超声引导下患侧TPVB。比较两组患者术中、PACU和术后24 h PCIA芬太尼消耗量,PCIA有效按压次数,补救镇痛率,阻滞镇痛维持时间;比较两组患者不同时间点血清IL-6、MCP-1和TNF-α水平,及NPY、PGE2和β-内啡肽水平;比较两组患者术后恢复各相关指标。结果:与T组比,TP组患者术后24 h PCIA芬太尼消耗量,PCIA有效按压次数和补救镇痛率明显降低,阻滞镇痛时间明显延长;术后12 h的IL-6、MCP-1和TNF-α水平及PGE2、NPY和β-内啡肽水平均明显降低;术后低血压和心动过缓发生率,12 h DSIS睡眠干扰评分和首次下床活动时间明显降低(P<0.05)。结论:超声引导下胸横肌平面-胸神经阻滞用于乳腺癌改良根治术,较胸椎旁神经阻滞的术后镇痛效果更持久,更有利于抑制术后炎性反应,促进患者术后早期转归。展开更多
目的：研究吸烟及戒烟对冠状动脉旁路移植术（CABG）后早期结果的影响。方法：回顾性分析我院2004—01至2005—12行CABG2570例患者资料，其中有吸烟情况记录者共2486例，按照术前吸烟情况分为吸烟组（1457例）和不吸烟组（1029例），其...目的：研究吸烟及戒烟对冠状动脉旁路移植术（CABG）后早期结果的影响。方法：回顾性分析我院2004—01至2005—12行CABG2570例患者资料，其中有吸烟情况记录者共2486例，按照术前吸烟情况分为吸烟组（1457例）和不吸烟组（1029例），其中吸烟组根据术前1个月是否戒烟分为戒烟者（409例）及未戒烟者（1048例），采用Logistic多因素回归分析吸烟及戒烟与住院期间术后早期并发症及死亡率的关系。结果：与不吸烟组相比，吸烟组接受CABG时年龄较小，男性患者占比例更高，体重指数较高，心肌梗死史高，合并慢性阻塞性肺病史高，较少合并高血压病及高脂血症，合并二尖瓣反流史低，射血分数低，较少应用体外循环，差异均有统计学意义（P〈0．001～0．05）。吸烟组与不吸烟组比较术后肺部并发症发生率高（3．2％VS1．6％），呼吸机辅助时间增加（8h vs 6h），差异均有统计学意义（P均〈0．05）。多因素回归分析表明吸烟组（包括术前戒烟和未戒烟患者）发生肺部并发症的风险为不吸烟组的1．91倍（95％可信区间1．03—3．56）；未戒烟者发生肺部并发症的风险为不吸烟组的2．30倍（95％可信区间1．19～4．46），差异均有统计学意义（P均〈0．05）；其他术后早期并发症的发生吸烟组与不吸烟组间比较差异均无统计学意义（P均〉0．05）。结论：吸烟组患者术后肺部并发症明显增加，呼吸机辅助时间延长，术前未戒烟患者术后并发症显著增加。应鼓励患者及早戒烟，戒烟有助于减少CABG后并发症的发生。展开更多
AIM:To evaluate the safety and effectiveness of our new cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemoperfusion(HIPEC)program.METHODS:Retrospective review of patients with gastrointestinal malignanc... AIM:To evaluate the safety and effectiveness of our new cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemoperfusion(HIPEC)program.METHODS:Retrospective review of patients with gastrointestinal malignancies who were suitable candidates for CRS and HIPEC between 12/1/2009 and 10/1/2010.All clinicopathologic data were reviewed with a special focus on the surgical outcome and the postoperative morbidity and mortality.RESULTS:Fourteen patients were identified.Median age was 64 years;seven were female.The primary tumors were:colonic(29%),appendiceal(36%),peritoneal mesothelioma(14%),gastric(7%),adenocarcinoma of unknown primary(7%),and gastrointestinal stromal tumor(7%).Eleven patients(79%)received CRS/HIPEC,three for palliation.Three patients that did not undergo CRS/HIPEC had an average peritoneal cancer index(PCI)of 25.The eight patients that underwent curative CRS/HIPEC had an average PCI of 10 and a completeness of cytoreduction score of 0(87.5%) or 1(12.5%).Postoperative morbidity was 36%;the worst adverse event was Grade 3 ileus.Mortality rate was 0%.CONCLUSION:CRS with HIPEC is safe and feasible at tertiary institutions with fledgling programs.PCI is an accurate predictor of surgical outcomes.展开更多
Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd<展开更多
背景:手术入路是影响髋关节置换快速康复的重要因素,不同入路患者术后康复时间存在差异。目的:比较直接上方入路(direct superior approach,DSA)和后外侧入路(posterolateral approach,PLA)全髋关节置换(total hip arthroplasty,THA)的...背景:手术入路是影响髋关节置换快速康复的重要因素,不同入路患者术后康复时间存在差异。目的:比较直接上方入路(direct superior approach,DSA)和后外侧入路(posterolateral approach,PLA)全髋关节置换(total hip arthroplasty,THA)的早期临床疗效。方法:前瞻性连续纳入2020年1月至2020年6月行THA的患者60例(60髋),随机分为DSA组(30例)与PLA组(30例)。比较两组手术时间、切口长度、总失血量、起始下地时间、疼痛视觉模拟评分(VAS)、髋关节Harris评分、术后双下肢不等长(LLD)和并发症等。结果:DSA组平均随访9.3个月,PLA组平均随访8.9个月。与PLA组相比,DSA组的手术时间更长[(99±11)min比(78±21)min]、总出血量更少[(482±236)ml比(680±299)ml]、切口更短[(8.8±0.6)cm比(13.9±1.1)cm]、下地时间更早[(15.8±4.0)h比(20.5±3.5)h],差异均具有统计学意义(P<0.05)。DSA组术后3 d局部疼痛VAS评分低于PLA组。两组除术后第3天白细胞计数有统计学差异(P=0.039),C反应蛋白、D-二聚体、白细胞计数等术后实验室检查指标无统计学差异(P>0.05)。两组术后LLD以及随访时的Harris评分均无统计学差异(P>0.05)。结论:DSA入路THA的总出血量、术后3天疼痛评分、切口长度、起始下地时间均优于PLA入路,在THA早期快速康复的应用中有一定的优势。但两种入路术后半年随访临床疗效无明显差异。展开更多
文摘目的:比较超声引导下胸横肌平面-胸神经阻滞(TTP-PECS)和胸椎旁神经阻滞(TPVB)用于乳腺癌改良根治术的效果。方法:将80例择期行单侧乳腺癌改良根治术的女性患者,ASAⅠ-Ⅱ级,年龄28~74岁,身高151~172 cm,体重47~72 kg,采用随机数字表法分为2组(n=40):TTP-PECS组(TP组)和TPVB组(T组)。TP组行超声引导下患侧TTP-PECS,T组行超声引导下患侧TPVB。比较两组患者术中、PACU和术后24 h PCIA芬太尼消耗量,PCIA有效按压次数,补救镇痛率,阻滞镇痛维持时间;比较两组患者不同时间点血清IL-6、MCP-1和TNF-α水平,及NPY、PGE2和β-内啡肽水平;比较两组患者术后恢复各相关指标。结果:与T组比,TP组患者术后24 h PCIA芬太尼消耗量,PCIA有效按压次数和补救镇痛率明显降低,阻滞镇痛时间明显延长;术后12 h的IL-6、MCP-1和TNF-α水平及PGE2、NPY和β-内啡肽水平均明显降低;术后低血压和心动过缓发生率,12 h DSIS睡眠干扰评分和首次下床活动时间明显降低(P<0.05)。结论:超声引导下胸横肌平面-胸神经阻滞用于乳腺癌改良根治术,较胸椎旁神经阻滞的术后镇痛效果更持久,更有利于抑制术后炎性反应,促进患者术后早期转归。
文摘目的：研究吸烟及戒烟对冠状动脉旁路移植术（CABG）后早期结果的影响。方法：回顾性分析我院2004—01至2005—12行CABG2570例患者资料，其中有吸烟情况记录者共2486例，按照术前吸烟情况分为吸烟组（1457例）和不吸烟组（1029例），其中吸烟组根据术前1个月是否戒烟分为戒烟者（409例）及未戒烟者（1048例），采用Logistic多因素回归分析吸烟及戒烟与住院期间术后早期并发症及死亡率的关系。结果：与不吸烟组相比，吸烟组接受CABG时年龄较小，男性患者占比例更高，体重指数较高，心肌梗死史高，合并慢性阻塞性肺病史高，较少合并高血压病及高脂血症，合并二尖瓣反流史低，射血分数低，较少应用体外循环，差异均有统计学意义（P〈0．001～0．05）。吸烟组与不吸烟组比较术后肺部并发症发生率高（3．2％VS1．6％），呼吸机辅助时间增加（8h vs 6h），差异均有统计学意义（P均〈0．05）。多因素回归分析表明吸烟组（包括术前戒烟和未戒烟患者）发生肺部并发症的风险为不吸烟组的1．91倍（95％可信区间1．03—3．56）；未戒烟者发生肺部并发症的风险为不吸烟组的2．30倍（95％可信区间1．19～4．46），差异均有统计学意义（P均〈0．05）；其他术后早期并发症的发生吸烟组与不吸烟组间比较差异均无统计学意义（P均〉0．05）。结论：吸烟组患者术后肺部并发症明显增加，呼吸机辅助时间延长，术前未戒烟患者术后并发症显著增加。应鼓励患者及早戒烟，戒烟有助于减少CABG后并发症的发生。
文摘 AIM:To evaluate the safety and effectiveness of our new cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemoperfusion(HIPEC)program.METHODS:Retrospective review of patients with gastrointestinal malignancies who were suitable candidates for CRS and HIPEC between 12/1/2009 and 10/1/2010.All clinicopathologic data were reviewed with a special focus on the surgical outcome and the postoperative morbidity and mortality.RESULTS:Fourteen patients were identified.Median age was 64 years;seven were female.The primary tumors were:colonic(29%),appendiceal(36%),peritoneal mesothelioma(14%),gastric(7%),adenocarcinoma of unknown primary(7%),and gastrointestinal stromal tumor(7%).Eleven patients(79%)received CRS/HIPEC,three for palliation.Three patients that did not undergo CRS/HIPEC had an average peritoneal cancer index(PCI)of 25.The eight patients that underwent curative CRS/HIPEC had an average PCI of 10 and a completeness of cytoreduction score of 0(87.5%) or 1(12.5%).Postoperative morbidity was 36%;the worst adverse event was Grade 3 ileus.Mortality rate was 0%.CONCLUSION:CRS with HIPEC is safe and feasible at tertiary institutions with fledgling programs.PCI is an accurate predictor of surgical outcomes.
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd<
文摘背景:手术入路是影响髋关节置换快速康复的重要因素,不同入路患者术后康复时间存在差异。目的:比较直接上方入路(direct superior approach,DSA)和后外侧入路(posterolateral approach,PLA)全髋关节置换(total hip arthroplasty,THA)的早期临床疗效。方法:前瞻性连续纳入2020年1月至2020年6月行THA的患者60例(60髋),随机分为DSA组(30例)与PLA组(30例)。比较两组手术时间、切口长度、总失血量、起始下地时间、疼痛视觉模拟评分(VAS)、髋关节Harris评分、术后双下肢不等长(LLD)和并发症等。结果:DSA组平均随访9.3个月,PLA组平均随访8.9个月。与PLA组相比,DSA组的手术时间更长[(99±11)min比(78±21)min]、总出血量更少[(482±236)ml比(680±299)ml]、切口更短[(8.8±0.6)cm比(13.9±1.1)cm]、下地时间更早[(15.8±4.0)h比(20.5±3.5)h],差异均具有统计学意义(P<0.05)。DSA组术后3 d局部疼痛VAS评分低于PLA组。两组除术后第3天白细胞计数有统计学差异(P=0.039),C反应蛋白、D-二聚体、白细胞计数等术后实验室检查指标无统计学差异(P>0.05)。两组术后LLD以及随访时的Harris评分均无统计学差异(P>0.05)。结论:DSA入路THA的总出血量、术后3天疼痛评分、切口长度、起始下地时间均优于PLA入路,在THA早期快速康复的应用中有一定的优势。但两种入路术后半年随访临床疗效无明显差异。
