手术治疗单一局部复发或远处转移病灶乳腺癌的临床观察

探索手术治疗单一局部复发或唯一远处转移病灶乳腺癌的临床价值。收集2006年6月至2013年6月湖南省人民医院乳甲外科收治的64例局部复发或术后远处转移乳腺癌患者,其中28例为单发病灶病例。根据是否采取了包含手术的综合治疗,将其分为手术组与非手术组。回顾性分析两组的临床资料和随访数据,分析手术治疗局部复发或远处转移乳腺癌有无临床意义。结果28例都采取了含化疗的综合治疗,8例局部单发病灶与9例远处单一脏器转移病例进行了手术治疗。手术组的局部缓解率与控制率明显优于非手术组,均为100％。两组无进展生存时间（PFS）和总生存时间（（）S）比较,手术组明显长于非手术组;但在单一远处脏器转移手术组中0S没有优势。2年生存率方面手术组与非手术组比较有统计学意义。对于术后单一局部复发病灶或唯一远处脏器转移的乳腺癌患者,采取含手术的综合治疗方案能带来明显的PFS优势,若有手术机会和条件成熟,手术仍是不应放弃的有效治疗方法。     

食管裂孔疝的外科治疗进展

食管裂孔疝即腹腔内脏器经食管裂孔疝入胸腔,并引发烧心、反酸等消化道及其他非消化道症状。按其解剖及临床表现可分为四型。通过病史采集、体格检查及一系列客观检查可以明确食管裂孔疝的诊断、分型及疾病进展程度。食管裂孔滑动疝并发反流、食管裂孔旁疝合并明显症状、混合型及多器官型食管裂孔疝或内科治疗效果不佳的通常应优先考虑手术治疗,以消除疝形成的因素,控制胃食管反流。食管裂孔疝手术目前通常采取腹腔镜下疝修补、补片加强及胃底折叠术,同时也存在食管延长、胃固定等其他替代术式。围手术期通过积极地控制风险因素,有助于降低各类术中、术后并发症风险及复发率。对复发、儿童及肥胖等特殊患者,也应视患者条件积极实施手术治疗。随着研究的进一步深入,食管裂孔疝手术在手术入路、补片材料、复发及并发症控制、日间手术模式应用等方面将取得更大的进展。     

Cognitive,behavioral and psychological functioning in children with metopic synostosis: a meta-analysis examining the impact of surgical status

Neurodevelopmental delays are known to occur in children with metopic synostosis, but it is presently unclear whether the cognitive, behavioral and psychological outcomes of children with metopic synostosis differ to those of their healthy peers. This meta-analysis consolidated data from 17 studies (published prior to August 2017) that examined the cognitive, behavioral and psychological outcomes of children (n = 666; aged ≤19 yrs) with metopic synostosis. Hedges’g (g_w) effect sizes compared the outcomes of samples with metopic synostosis (unoperated, operated) to healthy controls or normative data and, where available, the prevalence of problems/disorders was calculated. Children with unoperated metopic synostosis performed significantly worse than their healthy peers on measures of: general cognition (g_w = ?.38), motor functioning, (g_w = ?.81), and verbal (g_w = ?.82) and visuospatial (g_w = ?.92) abilities. Children with operated metopic synostosis performed significantly worse on measures of motor functioning (g_w = ?.45), visuospatial skills (g_w = ?.32), attention (g_w = ?.50), executive functioning (g_w = ?.36), arithmetic ability (g_w = ?.37), and behavior (g_w = ?.34). Cognitive, behavioral, and psychological problems were prevalent, but variable. Overall, the cognitive, behavioral, and psychological outcomes of children with metopic synostosis are generally worse than their healthy peers, regardless of surgical status. However, research is sparse, samples small, controls are rarely recruited, and the severity of metopic synostosis often not stated. Nevertheless, the findings suggest that children with metopic synostosis are likely to experience a variety of negative outcomes and should therefore receive ongoing monitoring and support.     

外科手术抗生素的预防性应用探讨

手术野感染(surgical site infection,SSI)是外科手术的并发症之一,预防性抗生素使用可减少SSI发生率,但使用的目的与作用仅仅是在手术过程中,一旦手术结束这一作用也就结束。对于创伤较小清洁手术可以不用预防性抗生素;轻度污染手术创伤不大,也可以不使用预防性抗生素;只有患者存在高危因素时才考虑应用。麻醉诱导期使用最为合理的。对不同的手术部位和不同的创伤程度,应选择不同的抗生素即个体化给药原则。     

达芬奇手术机器人系统在普通外科的应用

20世纪80年代腹腔镜的出现使微创技术的发展取得了长足的进步,在此基础上,手术机器人的研发和应用开启了微创外科新纪元。本文通过达芬奇手术机器人系统在普通外科各类手术中的具体运用,分析了手术机器人对比传统腔镜技术的技术优势,及当前临床应用的瓶颈,并对高新技术的发展进行了点滴思考。     

胃癌前哨淋巴结研究路在何方

淋巴结转移程度和清除范围是影响胃癌预后的重要因素,根据胃癌前哨淋巴结研究的现状、存在的问题,探索胃癌前哨淋巴结的研究方向,对于揭示胃癌淋巴结转移规律、指导外科手术具有重要意义。     

Using goal setting, task clarification, and feedback to increase the use of the hands-free technique by hospital operating room staff

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.     

骨盆测量在直肠癌手术中的应用进展

回顾当前各种骨盆测量手段,分析骨盆径线与直肠癌手术难度的关系。CT和MRI是目前直肠癌骨盆测量的较好选择,坐骨棘间径、坐骨结节间径、上耻骶尾骨最短径、骶尾骨长度和骶尾骨弯曲度等径线对直肠癌手术难度的影响已经得到了证实。未来的研究需要建立骨盆测量评价标准以指导临床医师制定手术方案。     

脊柱侧弯手术治疗进展

随着医学技术的发展,脊柱侧弯的治疗方法也在不断的进步。针对其治疗方法的改变,提出以下思考和分析：（1）脊柱侧弯的治疗方法遵循着螺旋式上升,曲折式前进的发展过程;（2）运用适度原则和最优化原则,为患者制定个体化治疗方案;（3）运用运动发展的眼光即动态性原则来观察和解决脊柱侧弯手术治疗中存在的问题。