目的:分析多排螺旋CT对纵膈肿瘤病变的诊断价值.方法:选取2014-04/2016-11第二军医大学附属长海医院收治的48例纵膈占位性病变患者作为研究对象,按照随机数表法将其分为观察组(n=24)和对照组(n=24).对照组患者采用核磁共振成像进行诊断,观察组患者采用多排螺旋CT进行诊断,比较两组患者的临床诊断价值和诊断结果.结果:两组患者的基线情况比较,差异无统计学意义(P>0.05);以手术病理诊断为金标准,观察组患者的临床症状诊断准确率为91.67％,对照组患者的临床症状诊断准确率为62.50％,两组患者的临床诊断准确率比较,差异有统计学意义(P<0.05).结论:采用多排螺旋CT对纵膈肿瘤病变患者进行诊断可以比较直接地观察患者纵膈病变的内部结构,具有较高的临床诊断价值,值得在临床治疗中推广使用.

目的 :探讨动物外科教学中基于翻转课堂的"问题式教学法"(problem-based learning,PBL)教学法的应用体会.方法 :将我校2014级五年制本科学员327人随机分为4个班级,均进行动物外科教学,随机抽取2个班级作为教改班,教改班采用基于翻转课堂的PBL教学模式;另2个班级作为普通班,普通班采用传统的大班课授课方式及观看手术录像.学员课堂结束后,教员通过改良DOPS评分表对学员操作过程进行教学评估,学员通过视觉类比量表(VAS)对两种授课模式进行评价.结果 :教改班即采用基于翻转课堂的PBL教学模式的班级在基础理论知识、技能实践、临床学习的兴趣和热情、学习的主动性和自信心、发现并解决问题的能力等方面均优于普通班.结论 :基于翻转课堂的PBL 教学法在动物外科的教学效果上明显优于传统教学法,值得医学院校推广.

目的 探讨病例分析法在动物外科清创术教学中的应用体会.方法 将我校2014级5年制本科学员327人随机分为4个班次,均进行动物外科教学,随机抽取2个班级作为教改组,教改组采用病例分析法教学模式;另2个班级作为对照组,对照组采用传统的大班课授课方式及观看手术录像.学员课堂结束后,教员通过改良DOPS评分表对学员操作过程进行教学评估,学员通过视觉类比量表对两种授课模式进行评价.结果 教改组在自学能力的提高、知识点的掌握程度、临床学习的兴趣和热情、学习的主动性和自信心、发现并解决问题的能力等方面均优于对照组,差异具有统计学意义(P<0.05).结论 病例分析教学法在动物外科清创术中的教学效果优于传统教学法.

动物外科是引导医学生由医学基础课跨入临床外科学大门的重要桥梁课程,传统课程设置重视对腹部外科操作能力的培养,涉及创伤急救处理内容较少,无法满足当前医学发展的需求.本文在分析动物外科课程设置的基础上,探讨犬跟腱缝合在动物外科教学中的可行性,以期构建学生创伤外科知识体系,提高动物外科教学质量.

犬盲肠切除术是动物外科的一节操作课,用以模拟人体阑尾切除术.通过对该节课教学中存在的问题进行分析,提出采用3D打印教具结合微视频技术进行教学,以提高动物外科教学效果.

Objective To discuss the design and application effects of flipped classroom teaching method combined with WeChat public platform in surgical probation.Methods From March to May 2017,90 medical undergraduates of the grade 2014 five-year clinical medicine undergraduate professional on probation in the Department of General Surgery of Changhai Hospital were enrolled as teaching objects and divided into the traditional group and the educational reform group by random number table,with 45 cases in each group.The traditional group was given traditional teaching methods and the educational reform group was given flipped classroom combined with WeChat teaching methods.The scores of theories and skills test were compared between the two groups.The standardized questionnaire designed by experts of the medical department was used to evaluate the teaching effect,learner's ability,learning attitude and learning methods and the medical humanistic consciousness.Results There was no statistically significant difference in the scores of theoretical examination between the two groups (P ＞ 0.05).In the skill test,there were no statistically significant differences in the scores of love concept,strain capacity during operation,operation steps,overall quality of operation,aseptic concept,aseptic operation skill and record writing between the two groups(P ＞ 0.05),the scores of learning attitude,operation readiness and coordination aspects in the educational reform group were higher than those of the traditional group,with statistically significant differences (P ＜ 0.05).The questionnaire survey showed that understanding and memorying the theoretical knowledge,learning initiative and enthusiasm,clinical thinking judgment,theory combined with practical application,learning efficiency and learning atmosphere in the educational reform group were all better than those of the traditional group,with statistically significant differences(P ＜ 0.05).Conclusion The teaching mode of flipped classroom combined with WeChat platform in surgical probation is feasible and more effective than the traditional teaching mode in improving teaching effectiveness.

良性声门下气管狭窄(subglottic tracheal benign stenosis,STBS)是非常棘手的临床难题.此区域处于喉外科、介入呼吸内科、胸外科的学科交叉领域,治疗方法尚没有一致的共识.支气管镜下介入治疗STBS需谨慎,过度能量治疗或金属支架容易使病变上移,造成患者不可逆的呼吸、发声功能障碍.外科切除重建可以治愈部分患者.Montgomery T管是一种硅酮材质的人工气道支架,对气道黏膜刺激小,不会移位,在恢复正常通气同时,可以保证患者正常发声功能,而对于不适合外科切除的患者,T管是又一治疗选择.下面我们介绍一种硬质气管镜下放置T管治疗STBS的介入治疗方法.

Objective To assess the safety and early oncologic results of minimally invasive esophagectomy(MIE)combined with super-extended two-field lymph node dissection for treating esophageal squamous cell carcinoma.Methods A total of 49patients who underwent MIE through McKeown approach(right chest,left neck,and abdomen)between May 2012and Dec.2013were enrolled in this study.Lymph node dissection fields included whole mediastinum,lower para-esophagus viathoracoscope route,and abdomen.Results The patients included 44males and 5females,with an age range of 45-78years old and a median of 58years old.Sixteen(32.7%)patients were at StageⅠ.Forty-eight(98.0%)patients received complete resection,and 18(36.7%)patients had post-operation complications,including 9(18.4%)with neck leakage and 7(14.3%)with vocal cord paralysis.Post-operative early death occurred in one case.The mean number of removed lymph nodes was 18and the lymph node metastasis rate was 42.9%(21/49);28.6%(6/21)of the positive nodes were found in the upper mediastinum and lower para-esophagus areas.Seven of the 18patients who were followed up had recurrence,with a recurrent rate of 38.9%.The 7cases included 5in the locoregional areas and 2in distant organs.Conclusion MIE combined with super two-field dissection can achieve the lymphadenectomy effect recommended by National Comprehensive Cancer Network(NCCN),with satisfactory safety.Short-term follow-up indicates that the locoregional recurrence is more frequent than distant metastases,demanding more thorough mediastinal lymph node dissection.

Objective:To study the risk factors and treatment methods of the re-valve surgery after mitral valve operation.Methods:From January 2006 to December 2009,a total of 28 patients underwent the second mitral valve replacement after their first mitral valve repair or replacement surgery.Among the patients who received mitral valve replacement for the first time,7 patients had perivalvular leakage,6 patients happened the degeneration of the artificial biovalves,5 patients were valve stenosis.Among these patients,4 were complicate with artificial valve endocarditis,with 3 positive of the blood culture,and 1 negative.One patient have infravalve stenosis of the artificial valve was because of thrombogenesis.Ten patients received the mitral valve replacement operation because of the degeneration of mitra valve after valve repair surgery.Results:Two patients were dead after operation,and the fatality rate was 7.14%,both were complicated with artificial valve endocarditis.The follow up was 5 months to 5 years.Two patient had severe atrioventricular block,and both received permanent pacemaker implantation in our hospital.All patients received cardioultrasonogragh,and the results showed the artificial valves worked well,and their cardiac function had been from I to II degree of the New York Heart Association(NYHA) functional cbassification.Conclusions:The degeneration of mitra valve after valve repair surgery has been gradually become the major cause of reoperation of the mitral valve,to restrict the indication of repair surgery can decrease the risk of reoperation.Prosthetic valve endocarditis is a severe complication with high mortality,we should discover it earlier,treat it earlier,to save enough time for the operation.