刍议现代普通外科的进展和展望

随着科学技术的进步,现代普通外科学科取得了突飞猛进的发展,其学科范畴不断扩大;微创外科和器官移植成为发展方向;高新材料和高新技术在临床逐渐应用;传统的外科处理方式不断改进和创新;通过基因水平诊断和治疗疾病成为可能;各种辅助治疗则增加了外科治疗的效果.     

血管外科治疗进展与科技发展的关系

血管外科在近几十年日益发展成熟,并逐渐从普外科分离出来成为单独发展的学科.在科技发展日新月异的新世纪,新技术新材料的应用也推动着血管外科诊疗手段的突飞猛进.这就要求从事血管外科的医务工作者在临床工作中要树立科技发展观的意识,及时了解科技前沿的发展动态,用新技术新方法改善治疗效果,最大程度地减少患者的痛苦和提高患者的生活质量,促进人类健康生存和发展.     

血管外科治疗进展与科技发展的关系

血管外科在近几十年日益发展成熟,并逐渐从普外科分离出来成为单独发展的学科。在科技发展日新月异的新世纪,新技术新材料的应用也推动着血管外科诊疗手段的突飞猛进。这就要求从事血管外科的医务工作者在临床工作中要树立科技发展观的意识,及时了解科技前沿的发展动态,用新技术新方法改善治疗效果,最大程度地减少患者的痛苦和提高患者的生活质量,促进人类健康生存和发展。     

功能性内窥镜鼻窦外科应用的情况及问题

20世纪70年代,以慢性鼻窦炎/鼻息肉为主要治疗对象的功能性内窥镜鼻窦外科的创立和发展,开辟了鼻窦外科的新领域.功能性内窥镜鼻窦外科技术把鼻窦外科推向了新的阶段,使鼻窦炎临床治愈率提高到80%～90%,已成为国内外鼻窦炎外科治疗的主要方式.回顾功能性内窥镜鼻窦外科的发展历史,分析了鼻腔-鼻窦病变中应用的情况,并提出了应用中应处理好的两个问题,对准确把握功能性内窥镜鼻窦外科发展的趋势和特点具有重要的作用.     

功能性内窥镜鼻窦外科应用的情况及问题

20世纪70年代,以慢性鼻窦炎/鼻息肉为主要治疗对象的功能性内窥镜鼻窦外科的创立和发展,开辟了鼻窦外科的新领域。功能性内窥镜鼻窦外科技术把鼻窦外科推向了新的阶段,使鼻窦炎临床治愈率提高到80%~90%,已成为国内外鼻窦炎外科治疗的主要方式。回顾功能性内窥镜鼻窦外科的发展历史,分析了鼻腔-鼻窦病变中应用的情况,并提出了应用中应处理好的两个问题,对准确把握功能性内窥镜鼻窦外科发展的趋势和特点具有重要的作用。     

教学基地建设与外科医生的培养

随着外科疾病诊疗技术的迅速发展,外科学已成为一门更加系统的学科.因此,如何培养优秀的外科医生已成为当前提高医疗卫生水平的重要课题.我院积极研究并率先实施了以教学基地建设促进外科医师培养的新模式,在建立良好培训制度以及利用丰富的临床、教学资源的基础上,通过成立专门的临床教学小组、加强培训医生的临床实践的强度、建立和完善临床教学资源平台系统以及充分利用现代网络技术等手段,在外科医师培养工作中取得了显著成效.     

麻醉医生是外科的内科医生——浅谈21世纪麻醉医生的责任与义务

在科学技术高速发展的21世纪,西医外科学取得了相当大的成绩。心脏直视手术,器官移植的巨大成功标志着外科学已经进入了一个崭新的时代。但这些成绩的取得离不开麻醉学科的发展。麻醉医生是外科的内科医生,这句话里有两层含义,一是表明了麻醉医生在外科领域里所要承担的责任;二是在今后的医学发展中麻醉学研究的方向及自身的义务。本文将从麻醉学科的历史定位、现代定位和责任与义务三个层面展开讨论,为中国麻醉事业美好的明天而努力。     

麻醉医生是外科的内科医生——浅谈21世纪麻醉医生的责任与义务

在科学技术高速发展的21世纪,西医外科学取得了相当大的成绩.心脏直视手术,器官移植的巨大成功标志着外科学已经进入了一个崭新的时代.但这些成绩的取得离不开麻醉学科的发展.麻醉医生是外科的内科医生,这句话里有两层含义,一是表明了麻醉医生在外科领域里所要承担的责任;二是在今后的医学发展中麻醉学研究的方向及自身的义务.本文将从麻醉学科的历史定位、现代定位和责任与义务三个层面展开讨论,为中国麻醉事业美好的明天而努力.     

胸腔镜外科的发展、现状与思考

胸腔镜手术已经有近100年的历史,经历了传统胸腔镜外科,电视胸腔镜外科,机器人辅助胸腔镜外科,远程机器人手术等阶段,目前已成为许多胸部疾病的首选治疗手段.但胸腔镜外科的发展并不一帆风顺,经历了兴起、衰落、振兴的过程.我国现处于电视胸腔镜阶段.胸腔镜外科的发展历程是生产力水平和社会需求两个要素综合作用的典型范例,随着21世纪的到来,胸腔镜外科的明天更辉煌.     

胸腔镜外科的发展、现状与思考

胸腔镜手术已经有近100年的历史,经历了传统胸腔镜外科,电视胸腔镜外科,机器人辅助胸腔镜外科,远程机器人手术等阶段,目前已成为许多胸部疾病的首选治疗手段。但胸腔镜外科的发展并不一帆风顺,经历了兴起、衰落、振兴的过程。我国现处于电视胸腔镜阶段。胸腔镜外科的发展历程是生产力水平和社会需求两个要素综合作用的典型范例,随着21世纪的到来,胸腔镜外科的明天更辉煌。     

Cognitive changes following subthalamic nucleus stimulation in two patients with Parkinson disease

The limits of a drug therapy in severe forms of Parkinson disease have led to refining neurosurgery on the basal ganglia. Deep brain stimulation of the subthalamic nucleus has been recognized as one of the most promising techniques to decrease "off" motor symptoms and motor fluctuations, allowing a reduction of drug therapy and limiting side effects of the drugs. There is still open debate on the possible consequences of chronic subthalamic stimulation in other ways, apart from motor symptoms, of general cognitive performance. We examined and followed two patients with Parkinson disease for 9 mo. after surgery for deep stimulation, studying their cognitive performances. There is a general amelioration of cognitive performances, in particular as far as linguistic capabilities is concerned. We discuss the possible significance of these results, reminding strenuously that only two patients were involved, so the potential for generalization is seriously limited.     

Effectiveness and safety of epilepsy surgery: what is the evidence?

Evidence from a recent randomized controlled trial of surgical versus medical therapy of temporal lobe epilepsy proves that antero-mesial resection is safe and more effective than medical therapy. The number of patients needed to treat for one patient to become free of disabling seizures is two, which is superior to most interventions in neurology. A meta-analysis of non-randomized trials gives almost identical results; about two-thirds of patients become seizure-free, compared with only 8% with medical therapy. The results are remarkably similar among studies from different parts of the world. Quality of life improves early after epilepsy surgery, the improvements are both statistically and clinically significant, and they are sustained. Surgical morbidity with clinically important permanent sequelae is 2%. Epilepsy surgery remains underutilized in developed countries and it does not exist in all but a few developing countries. Current randomized trials are underway to explore the effect of early surgery versus optimum medical therapy on the prevention of disability in patients with mesial temporal lobe epilepsy, and to examine the effectiveness of novel interventions, such as minimally invasive surgery and brain stimulation.     

机器人辅助手术在普通外科的应用及进展

机器人在过去的20多年里为普通外科做出了突出的贡献,且在不断的实践和改进之下机器人正逐步得到越来越多的应用。本文就机器人技术的发展和在普通外科的手术领域包括胆囊切除术、食管及胃部手术、减肥手术、结直肠癌手术和内分泌手术的应用以及进展综述如下。     

从搭建大消化系平台谈医学整合思想

消化病系是医学整合思想指导下的一个范例,沈阳军区总医院内窥镜科和肝胆外科、普通外科、麻醉科、中医科等共同协作,打造了消化病系这一平台,在临床工作中创造了很多成绩,作用突出,意义重大,值得推广。     

良性前列腺增生手术适应证探讨与方法的选择

良性前列腺增生（benign prostatic hyperplasia,BPH）是中老年患者的常见疾病,生活水平提高和寿命延长使得患者数量在逐年增加。电切镜的应用使下尿路疾病尤其是前列腺增生症的治疗发生了根本性的改变,新的治疗方法近年发展较快,并在BPH治疗过程中得到了广泛运用。前列腺增生症患者症状和程度各不相同,并且高龄高危患者居多,其手术适应证需要进一步探讨。开放前列腺切除术、经尿道前列腺电切术、经尿道前列腺汽化电切术、经尿道等离子前列腺电切术是目前常用的治疗方法,经尿道激光治疗、腹腔镜手术近几年开始尝试,初步应用证实其应用得当是有效、微创、并发症少的治疗方法,因此发展迅速。微波、超声消融、支架植入治疗目前较少应用,但有其适应证,尚不能替代经尿道前列腺电切术,可作为对症辅助治疗或适用于无法耐受手术者。结合国内外BPH诊治指南提出的手术适应证,查阅近年国内外发表相关文献,对于指南在实际应用和执行中遇到的问题与解决办法进行探讨。对各种外科手术的临床疗效予以对比和总结,探讨良性前列腺增生症外科治疗的临床决策问题。     

Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder

Cognitive-behavioral therapy can be effective for many clients who have obsessive-compulsive disorder. Despite its effectiveness, many treatment guidelines fail to describe cognitive-behavioral therapy procedures in adequate detail. The present paper will review the literature on cognitive-behavioral therapy for OCD in an attempt to provide concise, meaningful guidelines for the psychological treatment of this disorder. Cognitive-behavioral therapy includes four general components: initial preparation for therapy, development of applied coping skills, exposure with ritual prevention, and relapse prevention. The four general treatment components are described, and clinical examples are provided.     

浅谈现代普通外科观念的变更

随着自然科学和社会科学的发展,特别是现代医学模式的转变,普通外科的观念与传统观念有了很大不同。人本主义观念是普通外科的所有医疗活动的指导原则,循证观念成为解决临床问题的有效手段,微创观念将引导现代普通外科的发展方向,置换观念是社会和自然科学发展的必然,整体观念体现着现代医学对立统一的思想,而新的健康观念更符合人类文明进步的要求,协作观念则是提高医疗质量的保障。     

浅谈外科手术在重度肥胖治疗中的作用

目前在重度肥胖治疗中存在着孤立地,片面地看待疾病,对主要矛盾注意不够的问题,且过度依赖内科治疗。而外科手术对病态肥胖有着良好的效果,是去除代谢综合征(MS)主要致病因素的有效手段。但由于人们观念陈旧,临床上很少有人接受手术治疗。因此转变人们的观念是提高重度肥胖治疗效果的关键和必需的一步。     

Non-directive counselling in a general practice

Many patients in general medical practice are not ill in the physical sense, but bring their unhappiness to the surgery. An experiment is described in which a counsellor was attached to a general practice in north London, to help to deal with problems of this kind.     

MATERIALISM, SOCIOCULTURAL APPEARANCE MESSAGES, AND PATERNAL ATTITUDES PREDICT COLLEGE WOMEN'S ATTITUDES ABOUT COSMETIC SURGERY

Rates of cosmetic surgery procedures have increased dramatically over the past several decades, but only recently have studies of cosmetic surgery attitudes among the general population begun to appear in the literature. The vast majority of those who undergo cosmetic surgery are women. We examined cosmetic surgery attitudes among 218 undergraduate women, most of whom were White. Specifically, we examined their acceptance of cosmetic surgery and expressed desire to undergo cosmetic surgery procedures, and several potential predictors: appearance attitudes of mothers, fathers, and friends; awareness and internalization of sociocultural appearance messages; and materialism. Multiple regression analyses indicated that materialism and internalization of sociocultural messages consistently emerged as significant predictors of acceptance of cosmetic surgery and desire for cosmetic surgery procedures. Paternal attitudes positively predicted acceptance of cosmetic surgery for social reasons and desire for cosmetic surgery; nonmaterialism negatively predicted considering cosmetic surgery and the desire for cosmetic surgery procedures.