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。     

外科手术在ⅢA期非小细胞肺癌治疗中的作用

ⅢA期非小细胞肺癌治疗方式存在争议,对于N1期患者,外科手术被广泛接受,对于N2期患者,国内外存在一定的分歧。对于N2期患者,外科手术治疗的效果主要取决于纵隔淋巴结转移情况,微灶转移和单站淋巴结转移患者,外科手术治疗效果比较满意,多站淋巴结转移患者外科手术治疗效果较差,而是需要做行根治性的放化疗。     

外科手术在ⅢA期非小细胞肺癌治疗中的作用

ⅢA期非小细胞肺癌治疗方式存在争议,对于N1期患者,外科手术被广泛接受,对于N2期患者,国内外存在一定的分歧。对于N2期患者,外科手术治疗的效果主要取决于纵隔淋巴结转移情况,微灶转移和单站淋巴结转移患者,外科手术治疗效果比较满意,多站淋巴结转移患者外科手术治疗效果较差,而是需要做行根治性的放化疗。     

脾脏外科手术治疗的思考

目前国内外医学界倾向于对具有手术指征的脾脏疾病行全脾脏切除术,甚至进行一些脾脏周围疾病的手术时,也连脾脏一同切除.这种做法违背了医疗的"个体化"原则.本文以哲学角度对脾脏全切除术治疗脾脏相关疾病的合理性进行思考,辩证分析"全切"与"不全切"的利弊,为临床脾脏外科学制定正确的手术方式提供科学的参考依据.由此我们认为脾脏手术应依据具体情况,因不同患者的疾病类别和危重程度来决定脾脏的切除范围,不能一概全切.     

导言：外科手术在晚期乳腺癌治疗中的共识与争论

众所周知,在早期乳腺癌与可手术乳腺癌的综合治疗方面,仍是以外科手术为主。时至今日,早期乳腺癌的治疗目标是治愈,而手术是治愈早期乳腺癌必不可少的手段,这一总体原则一致获得国际医学界的公认,并指导着当代乳腺癌治疗的临床实践。对于晚期乳腺癌而言,公认其无法治愈,其治疗目标是延年益寿、改善生活质量。手术是一种有创伤的局部治疗方法,而乳腺癌是一种全身疾病,既然晚期乳腺癌无法治愈,那么手术是否必要,是不是多余的呢？由此产生了外科手术在晚期乳腺癌治疗领域有无必要的争论。     

外科手术在晚期乳腺癌中的作用与地位

首诊Ⅳ期乳腺癌的外科治疗是否获益,是当前热议的问题,目前争议很大。本文就外科手术在晚期乳腺癌中的作用与地位问题,进行了探讨,认为需要更多的实践才能得出结论;提出晚期乳腺癌外科手术治疗的辩证观点,即处理好局部与整体的关系,抓住主要矛盾,根据不同的分子分型进行个体化的治疗选择。     

原发性肝细胞肝癌的TACE联合外科治疗及单纯外科手术治疗对照研究

对比单纯外科治疗以及外科手术联合TACE治疗原发性肝癌的疗效以及生存时间.回顾性分析我院2006年至2009年的260例原发性肝癌的治疗情况,分为单纯外科组(对照组)以及TACE联合外科手术组进行对照研究,比较术后3月的疾病控制率;并比较其1,2,3年生存率,以kaplan-Meier生存曲线进行生存分析.结果3个月时疾病控制率单纯手术组为75.70％,TACE联合手术组为85.62％,P=0.043有统计学差异.单纯手术组第1、2、3年生存率为55.14％,15.89％,9.35％;TACE联合手术组为66.01％,27.45％,18.95％,第1年生存率两者没有统计学差异,P=0.076;第2、3年生存率联合组明显高于单纯手术组,P=0.029,P＝0.033.因此,TACE联合外科手术治疗原发性肝细胞肝癌的远期疗效比单纯手术有明显优势.     

外科手术患者的血糖管理

随着糖尿病患患者数的迅速增加,需要接受外科手术治疗的糖尿病患者也越来越多。糖尿病患者的血糖控制与外科手术相互影响,一方面,手术应激可进一步加重糖尿病患者的糖代谢紊乱;另一方面,合并糖尿病使患者发生围手术期并发症甚至死亡的风险大大增加。因此,对糖尿病患者进行完整的术前评估,良好的术前、术中、术后血糖管理是糖尿病患者手术顺利进行、平稳渡过围手术期、改善预后的重要保证。     

胰腺癌分型在规范胰腺外科手术治疗中的重要意义

胰腺癌在美国是肿瘤导致死亡的第四大疾病。尽管国际上有多种以 T NM 为基础的关于胰腺癌的分期方式，比如U ICC分型和JPS分型，但这些分期对如何手术没有指导作用。目前，国内外仍然缺乏一个对规范外科手术方式的胰腺癌分型。我们根据胰腺肿瘤和血管的关系提出一种新的胰腺分型方式。这种分型将胰腺癌分为八种不同的类型，结合文献...     

Development of a Multi-Disciplinary Intervention for the Treatment of Childhood Obesity Based on Cognitive Behavioral Therapy

Along the lines of the evidence-based recommendations, we developed a multi-disciplinary intervention for overweight children 7- to 12-years-old, primarily aiming at helping children to adopt healthier eating habits and a physically active lifestyle. The program combined nutrition intervention, based on a non-dieting approach, with physical activity intervention, implemented through the basic principles of Cognitive Behavioral Therapy (CBT), along with parental support. The program was conducted by dieticians with the collaboration of child psychiatrists and pediatricians. Training and regular supervision upon CBT priniciples application was intended to enhance dieticians' efficiency. The intervention is currently being evaluated to determine its effectiveness in treating childhood obesity.     

Occupational Therapy in the Treatment of Schizophrenia

A review of Occupational Therapy literature on the treatment of schizophrenia identified four loosely defined treatment categories: (1) sensory integration, (2) activity groups, (3) social skills training, and (4) living skills training. From available data is appears that sensory integration therapy has been able to improve the motivation and affect of schizophrenic patients and structured activity programs can contribute to a reduction in positive symptomatology. Social and living skills training show promise as treatment methods to promote the community functioning of this population. A future need to establish which schizophrenic patients and what schizophrenic symptomatology respond to different types of treatment is identified.     

门静脉高压症外科治疗观的转变

纵观门静脉高压症 (PHT)的外科治疗史 ,如果说本世纪中叶以前是以技术创新为主 ,那么后半世纪在手术技术方面已渐趋成熟 ,而且自 2 0世纪 80年代开始 ,西方国家已进入了肝移植时代 ,特别是非手术治疗领域的不断拓宽 ,PHT的治疗已不仅仅是手术方式多样化和积累病例 ,而是观念和策略的更新和转变。1　从分断之争到个体化选择的转变国外自Whipple等 194 5年在总结前人经验的基础上倡导门腔静脉分流手术治疗PHT以来 ,其观念和方法被普遍认同和接受 ,一度认为PHT问题似乎已经基本得到解决。追溯历史 ,我国PHT的外科治疗 ,不少是借鉴国外的…     

Occupational Therapy Intervention in the Treatment of Alcoholics

The first section of this article will provide the rationale for all occupational therapists to learn extensively about the isease of alcoholism regardless of area of practice or type of agency where employed. It will offer su estions on how this learning can take place. The second section will take an historic look at occupational therapy literature documenting the use of occupational therapy in alcoholism rehabilitation from 1941 to the present. It will describe modalities currently being used by occupational therapists in alcoholism rehabilitation and discuss expansion of occupational therapy in this practice area.     

A Healthy Lifestyle Program for the Treatment of Obesity in Minority Men

Historically, minority males have had limited success in programs designed to reduce weight. Twenty-five obese minority males participated in a healthy lifestyle program designed to treat essential hypertension, hyperlipidemia, type II diabetes, obesity, and hypothyroidism. Coined the LE ³ AN Lifestyle Program (emphasizing healthy lifestyles, realistic exercise, reasonable expectations and emotions, attitudes, and nutrition), the program offered a treatment model that involved reasonable low-intensity short exercise regimens, instruction, and extensive practice in making healthy food choices, behavior modification, and self-monitoring techniques coupled with guidance on realistic weight loss and exercise expectations. The participants were able to lose 13 Ib during the inpatient plus day treatment phases of the program and continued to maintain a 19-lb weight loss at 12 months. A program overview, case examples, and suggestions to improve outcome efficacy with difficult to manage obese, minority, male patients are provided.     

Dialectical Behavior Therapy in the Treatment of Abusive Behavior

Summary

Research suggests that a subset of men who abuse their partners have characteristics associated with borderline personality disorder (BPD). Dialectical Behavior Therapy (DBT) has shown promise as a treatment for BPD, and thus may be useful for these men. This paper describes how DBT principles might be applied to address the problem of partner abuse, including discussion of why one might expect DBT to be a helpful treatment model for this population, and how implementation of the model might be designed.