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Segmenting Jugged Ligation Combined with Skin Bridge Plastic Operation In Treatment for Circumferential Mixed Hemorrhoids

目的总结分段齿形结扎加皮桥整形术治疗环状混合痔的优、缺点。方法将我院2007年1月至2009年12月期间收治的80例环状混合痔患者按入院顺序简单随机分成2组，治疗组采用分段齿形结扎加皮桥整形术治疗，对照组采用传统的外剥内扎术，比较2组的疗效。结果治疗组治愈率为95%(38/40),对照组为90%(36/40)，2组比较差异无统计学意义(Pgt;0.05); 治疗组较对照组的治愈时间明显缩短(Plt;0.05)，术后疼痛、水肿、皮赘残留及肛管狭窄并发症方面更轻(Plt;0.05)。结论分段齿形结扎加皮桥整形术治疗环状混合痔比传统的外剥内扎术有更好的临床实用价值。

采用自制双层涤纶垫带行三尖瓣瓣环成形术

冠状动脉旁路移植同期行二尖瓣成形术治疗缺血性二尖瓣关闭不全

目的 总结缺血性二尖瓣关闭不全（ＩＭＲ）患者同期行冠状动脉旁路移植术（CABG）和二尖瓣成形术的临床经验，以提高手术疗效。 方法 对36例ＩＭＲ行ＣＡＢＧ加同期二尖瓣成形术患者的临床资料进行回顾性分析。共移植血管93支，平均每例2.58支。二尖瓣成形采用Carpentier环6例，Duran环14例，交界褥式环缩16例；edge to edge技术6例，后叶楔形切除2例。 结果 住院死亡5例（13.89%）,死亡原因：低心排血量、循环功能衰竭、肾功能衰竭和脑梗死。术后随访21例，失访10例，随访时间26.4±5.6个月，远期死亡3例。生存患者心功能分级（NYHA）Ⅰ级14例，Ⅱ级3例，Ⅲ级1例。随访期间复查超声心动图提示：二尖瓣无反流或微量反流4例，轻度反流13例，中度反流4例；心功能明显改善。 结论 对冠状动脉多支病变合并中度IMR患者应慎重选择二尖瓣成形手术，单纯CABG可能是首选的治疗方案。CABG同期行二尖瓣成形术治疗IMR早期效果较好，远期复发率高，但多数患者不需再次手术治疗。

静脉/动脉血液管理保护管路与经外周静脉置入中心静脉导管的联合应用

目的　总结静脉/动脉血液管理保护管路（VAMP）与经外周静脉置入中心静脉导管（PICC）联合应用于重症患者的血液标本采集的方法及护理。 方法　对2011年8月－11月79例留置PICC的患者应用VAMP采集血标本的方法进行回顾总结。 结果　79例患者所取血液标本合格率达100%，未发生针刺伤，且采血时未断开输液接头。 结论　PICC导管与VAMP配合应用可有效避免反复抽血给患者带来的痛苦，同时减少血样采集时的感染、针刺伤和血液废弃物，值得临床推广。

呼吸机使用的安全护理

目的：探讨呼吸机使用过程中的安全护理方法。方法：制定严密的呼吸机护理措施，包括人员培训、统一呼吸机机型、建立标准操作程序、常见报警处理、呼吸机维护和消毒管理。结果：通过8个月的实践，患者未发生由于呼吸机使用不当导致的不良事件，护士对呼吸机安全护理意识加强，能熟练使用呼吸机，能及时应对紧急情况。结论：呼吸机使用过程中的安全护理可减少安全问题的发生，值得监护病区借鉴。

重症胸部创伤并发急性呼吸窘迫综合征62例

神经重症监护病房导管相关感染目标性监测与干预

目的了解神经重症监护病房导管相关感染情况，采取有效的综合干预措施，以期降低导管相关感染率，为专科重症监护病房感控的实施和防控重点提供参考。 方法采用目标性监测方法对2011年3月－12月神经重症监护病房患者进行导管相关感染的目标监测，包括使用呼吸机、中心静脉插管和泌尿道插管的使用情况及呼吸机相关性肺炎、导管相关血流感染及导尿管相关尿路感染的感染率进行监测，并将监测分成2个阶段，2011年3月－7月为干预前阶段，2011年8月逐步实施综合干预措施，对存在的问题采取综合控制措施并进行持续质量改进，比较干预前后的导管相关感染率。 结果932例患者中，发生医院感染253例次，发生率为27.15%。排在医院感染部位前3位的分别为下呼吸道（56.52%）、泌尿道（18.19%）、血流相关感染（11.46%）。在干预手段介入后，有创呼吸机相关性肺炎感染率由55.73‰降至27.96‰，差异有统计学意义（P＜0.05）；尿管相关感染率由8.88‰降至3.69‰，差异有统计学意义（P＜0.05）；中心静脉导管相关血流感染率由7.30‰降至0.89‰，差异无统计学意义（P＞0.05）。 结论神经重症监护病房由于患者疾病特点，导管易发生相关感染，在实践过程中采取多种预防措施可以显著降低导管相关感染率。

COMPARISON OF TRAUMATIC RELATED INDEX IN SERUM BETWEEN MINIMALLY INVASIVE AND OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR TISSUE INJURY

Objective To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF. Methods Sixty patients were enrolled by the entry criteria between May and November 2012, and were divided into MIS-TLIF group (n=30) and open TLIF group (n=30). There was no significant difference in gender, age, type of lesions, disease segment, and disease duration between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, and postoperative hospitalization time were recorded, and the pain severity of incision was evaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) and creatine kinase (CK) were measured at preoperation and at 24 hours postoperatively. The levels of interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) in serum were measured at preoperation and at 2, 4, 8, and 24 hours after operation. Results The operation time, intraoperative blood loss, and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group (P lt; 0.05), and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1, 2, and 3 days after operation (P lt; 0.05). The levels of CRP, CK, IL-6, and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation (P lt; 0.05), but there was no significant difference between 2 groups before operation (P gt; 0.05). No significant difference was found in TNF-α level between 2 groups at pre- and post-operation (P gt; 0.05). Conclusion Compared with the open-TLIF, MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.

Three-field versus Two-field lymphoadenectomy for Upper or Middle Thoracic Esophageal Cancer

目的探讨胸中上段食管癌淋巴结清扫的合理范围。 方法回顾性分析2010年1月至2013年10月我院134例胸中上段食管癌淋巴结清扫患者的临床资料。将患者分为两组：三野组，56例，男50例、女6例，年龄（55.4±9.6）岁，行三野淋巴结清扫根治术；二野组，78例，男69例、女9例，年龄（56.3±7.3）岁，行完全二野淋巴结清扫根治术。比较两组临床效果。 结果三野组患者淋巴结转移率明显高于二野组（60.7%vs.42.3%，P < 0.05），主要差别在于三野组有较高的颈部淋巴结转移率（21.4%）。三野组与二野组患者上纵隔淋巴结转移率分别为33.9%和30.8%，差异无统计学意义（P>0.05）。三野组及二野组患者术后并发症发生率差异无统计学意义（P>0.05）。三野组及二野组患者术后１年生存率分别为96.3%和85.5%，差异有统计学意义（P < 0.05）；三野组及二野组患者术后1年内颈部淋巴结复发率分别为1.9%和11.8%，差异有统计学意义（P < 0.05）。 结论三野淋巴结清扫根治术有助于提高胸中上段食管癌手术根治性，能减少术后局部复发和转移，提高患者术后生存率，相对于完全二野淋巴结清扫术并不显著增加手术并发症。

EFFECT OF INTRAVENOUS MANNITOL OR DEXAMETHASONE ON LOW BACK AND LEG PAIN AFTER LUMBAR FUSION SURGERY

ObjectiveTo compare the effect of intravenous 20% mannitol or dexamethasone (DM) on low back and leg pain after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). MethodsBetween October 2012 and September 2013, 100 patients with degenerative lumbar diseases underwent MI-TLIF and percutaneous pedicle screw fixation. All patients were randomly divided into 3 groups:34 patients received intravenous 20% mannitol after operation (mannitol group); 32 patients received intravenous DM after operation (DM group); and 34 patients received neither dehydrating agent nor steroid after operation (control group). There was no significant difference in gender, age, disease duration, clinical symptoms, lesion types, and lesion segments between groups (P>0.05). The serum levels of inflammatory factors[tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6] were measured by ELISA at pre-operation and 3, 24, 48, 72, and 96 hours after operation. Low back and leg pain was determined by using visual analogue scale (VAS) score after operation. ResultsAll procedures were smoothly performed without major complications of nerve root injury, hematoma, or infection. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). The VAS score of low back pain showed no significant difference between groups at all time points after operation (P>0.05); the VAS score of leg pain in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than those in the mannitol group at 3, 24, 48, and 96 hours after operation (P<0.05). The serum level of TNF-α in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than that in the mannitol group at 3, 48, 72, and 96 hours after operation (P<0.05). The serum level of IL-1β in the DM group was significantly lower than that in the control group at 3, 24, 48, and 72 hours after operation (P<0.05), and than that in the mannitol group at all time points after operation (P<0.05). The serum level of IL-6 in the DM group was significantly lower than that in the control group at 3 and 24 hours after operation (P<0.05), and than that in the mannitol group at 3, 24, and 48 hours after operation (P<0.05). ConclusionIntravenous 20% mannitol may has no effect on postoperative low back and leg pain, while DM can markedly relieve leg pain after MI-TLIF.