目的 探究生活空间扩展联合增能视角叙事心理干预对老年慢性阻塞性肺疾病(COPD)患者自我感受负担及认知情绪调节的影响.方法 选取2020年1月至2021年9月于该院就诊的104例老年COPD患者为研究对象,采用随机数字表法分为观察组和对照组,每组各52例.对照组采用生活空间扩展联合常规护理模式干预,观察组在对照组的基础上联合增能视角叙事心理护理干预模式进行干预,两组干预时间均为3个月.比较两组自我感受负担[自我感受负担量表(SPBS)]及生活自理能力[日常生活能力量表(ADL)]、生活质量评分[生存质量测定量表简表(WHOQOL-BREF)]、心理状态[情绪调节 自我效能感量表(RES)]、认知情绪调节能力[认知情绪调节问卷(CERQ)].结果 干预后,两组SPBS、ADL评分均较干预前明显下降,且观察组明显低于对照组,差异有统计学意义(P＜0.05).干预后,两组 WHOQOL-BREF 5项评分、RES评分均明显高于干预前,且观察组明显高于对照组,差异有统计学意义(P＜0.05).干预后,两组CERQ积极调节评分较干预前明显升高,且观察组明显高于对照组,差异有统计学意义(P＜0.05);CERQ消极评分较干预前明显降低,且观察组明显低于对照组,差异有统计学意义(P＜0.05).结论 生活空间扩展联合增能视角叙事心理干预可明显降低患者自我感受负担,提升患者日常生活质量,改善患者情绪调节自我效能感,并且可提高患者积极情绪,值得临床推广应用.

目的 探讨术前预后营养指数(prognostic nutritional index,PNI)对远端胰腺切除术(distal pancreatectomy,DP)后患者临床相关胰瘘(clinically related postoperative pancreatic fistula,CR-POPF)发生的影响及CR-POPF发生的影响因素,为临床预测CR-POPF提供依据.方法 回顾性收集2017年1月1日至2021年1月31日期间在徐州医科大学附属医院顺利完成DP且符合本研究纳入和排除标准患者的临床病理资料.计算患者术前PNI值并根据受试者操作特征曲线(ROC)获得最佳截取值,以最佳截取值为界分为低和高PNI,比较低和高PNI以及是否发生CR-POPF患者间的临床病理特征,同时采用多因素logistic回归分析患者CR-POPF发生的影响因素.结果 本研究共纳入符合纳入和排除标准患者143例,术后发生CR-POPF 33例(23.08％),术前PNI平均值为52.26 (39.20～ 65.10).根据术前PNI预测CR-POPF的发生情况绘制ROC曲线得到PNI的最佳截取值为50.55,低PNI (＜50.55) 49例、高PNI (≥50.55) 94例.年龄≥65岁者和发生CR-POPF者在低PNI患者中占比高于高PNI患者(P＜0.05);胰腺质地较软者和低PNI者在术后发生CR-POPF患者中占比较术后未发生CR-POPF者高(P＜0.05).进一步将术前PNI和胰腺质地结合其他研究认为与CR-POPF发生相关的因素(手术方式、术中出血量、脾脏处理)带入二分类logistic回归进行多因素分析,结果发现,术前低PNI (OR=5.417,P＜0.001)和较软的胰腺质地(OR=4.126,P=0.002)增加CR-POPF发生的风险.结论 术前低PNI和胰腺质地软增加DP后CR-POPF发生的风险,术前有必要对患者PNI状况进行评估.

目的:探究复发肾上腺肿瘤患者行经腹腹腔镜手术治疗的疗效,总结手术技巧.方法:回顾性分析2017年3月～2019年3月收治的行经腹腹腔镜手术的复发肾上腺肿瘤患者13例的临床资料、手术过程以及治疗效果.结果:(1)2例左侧开放11肋间切口入路,11例为后腹腔镜手术入路.9例为普通腹腔镜肾上腺切除术,4例为机器人辅助腹腔镜肾上腺切除术(RALA).(2)13例手术全部成功,无中转开放治疗.手术时间为24～92min,平均51m i n.出血量28～201m L,平均116m L.患者住院时间4～9d,平均5.8d.1例复发.结论:复发肾上腺肿瘤具有解剖异常、原手术区域粘连的特点,术中需尽量与原粘连部位避开,可选择与原入路方式不同的径路.复发肾上腺肿瘤体积较大时,可考虑行RALA这种安全可靠、疗效确切、创伤较小的术式.

研究目的:探讨院前急救护理工作的应用与安全防范对策.研究方法:选取我院2020年9月到2020年12月所收治的136例较严重的患者作为研究对象,将其分为常规管理组(观察实验组)68例以及采用安全隐患防范组(对照组)68例对两组患者院前急救护理工作中急救护理的应用效果进行探究.研究结果:通过和实验组数据对比观察实验组的抢救率高于对照组,由此得出结论在院前急救护理工作开展过程中,采取安全隐患防范工作,能够有效提升院前急救工作效率和提升工作质量.

目的 比较腹腔镜Heller肌切开术(LHM) +Dor胃底折叠术和经口内镜下食管肌切开术(POEM)治疗贲门失弛缓症的临床疗效.方法 回顾性分析徐州医科大学附属医院2014年1月至2018年12月期间收治的67例确诊为贲门失弛缓症患者的临床资料,其中19例采用LHM+Dor胃底折叠术治疗(LHM组),48例采用POEM治疗(POEM组),比较两种手术的临床疗效及安全性.结果 2组患者的基线资料如性别、年龄、病程、体质量指数、术前Eckardt评分、术前食管最大直径及既往治疗史比较差异均无统计学意义(P＞0.05).2组患者的手术时间、术中出血量、术后3和12个月时的Eckardt评分、食管最大直径下降幅度、术后并发症(除胃食管反流外,P=0.029)及复发率比较差异均无统计学意义(P＞0.05),但与LHM组比较,POEM组的总住院时间和术后住院时间更短(P＜0.05)且住院总费用更少(P＜0.05).结论 LHM与POEM均能有效缓解患者的临床症状,二者近期疗效与安全性相近,POEM术后恢复更快且具有良好的经济效益,但其术后胃食管反流发生率较高.

研究目的:危重患者院前急救工作开展中护理安全管理应用在相关实践时形成的护理效果.方法:搜集2020年8月至2020年10月急诊科所收治者院前急救危重患者84例,按照随机数字表法将其分为实验组和对照组,其中实验组开展的是护理安全管理,而对照组开展的是常规护理管理,对比两组患者医疗抢救成功率和护理满意率.结果:观察组患者的成功率要高于对照组患者,且观察组并没有发生一定的医疗纠纷,对照组存在部分为医疗纠纷问题,数据具有显著的差异.由此可以得出在危重患者院前急救工作开展过程中护理安全管理工作的落实,能够有效提升院前急救的效果.

目的 探讨钬激光腔内治疗已放置输尿管支架的上尿路结石的结石清除率和并发症.方法 选取2016年1月至2018年9月本院收治的已放置输尿管支架的上尿路结石患者110例,随机分为两组,各55例.对照组行常规微创经皮肾镜取石术治疗,观察组行钬激光腔内治疗,对比两组患者的结石清除率和并发症.结果 观察组患者手术耗时与对照组对比差异无统计学意义;观察组患者留置导尿管时间短于对照组(P<0.01),差异具有统计学意义;观察组患者术后住院时间短于对照组,差异具有统计学意义(P<0.01);观察组患者结石清除率为87.27％,高于对照组的67.27％,差异具有统计学意义(P<0.05);观察组患者并发症发生率为7.27％,与对照组的10.91％对比差异无统计学意义;Logistic多元回归分析显示,结石最大直径大和结石数多的已放置输尿管支架的上尿路结石患者行钬激光腔内治疗的结石清除率低.结论 钬激光腔内治疗已放置输尿管支架的上尿路结石的结石清除率高,并发症少,对于结石数少和体积较小的患者具有良好的安全性与有效性.

近年来胰腺疾病的发病率不断上升,胰腺切除主要涉及胰腺十二指肠切除术(pancreaticoduo-denectomy,PD)和胰体尾切除术(distal pancreatectomy,DP)两种标准术式.术后胰瘘(postoperative pan-creatic fistula,POPF)是最常见和最严重的胰腺切除术后并发症,发现或处理不及时甚至会导致患者死亡.最近,随着对POPF的共识定义的发展,已经有大量的报告研究了各种风险因素、预测模型以及针对这一系列复杂问题的缓解策略.尽管采取了这些策略,但POPF的发生率并没有显著下降.我们回顾了大量关于POPF的危险因素、预测、预防及管理方面的文献资料并作一综述.

Objective To investigate the risk factors associated with the formation of parastomal hernia after Miles operation, and to provide scientific evidence for the prevention of parastomal hernia. Methods The clinical data of 218 patients with rectal cancer who undergoing Miles operation in the Affiliated Hospital of Xuzhou Medical University between May 2011 and May 2015 were analyzed retrospectively. Fifteen possible factors affecting the occurrence of parastomal hernia were selected. The fifteen related factors were analyzed by single factor analysis and two elements logistic regression analysis. Results A total of 55 patients with parostomy hernia occurred in 218 patients during follow-up period, and the incidence of parastomal hernia was 25.23％. Univariate analysis showed that age, thickness of subcutaneous fat in abdomen, BMI, stoma pathway, and hypertension were related to the formation of parastomal hernia after Miles operation (P＜0.05). Further two elements logistic regression analysis showed that, advanced age, thickness of subcutaneous fat in abdomen, BMI＞25 kg/m2, and transperitoneal were independent risk factors for the formation of parastomal hernia after Miles operation (P＜0.05). Conclusion For patients with risk factors, it is very important to choose optimum stoma pathway during Miles operation to avoid the occurrence of formation of parastomal hernia after Miles operation.

Objective To investigate the clinical efficacy and prognosis of conventional laparotomy , 2D laparoscopic and 3D laparoscopic, in the treatment of primary liver cancer. Methods From February 2013 to January 2015, clinical data of 80 patients with liver cancer who received hepatectomy were analyzed retrospectively.According to the operation mode, they were divided into traditional laparotomy group (30 cases), 2D laparoscopic group (25 cases), and 3D laparoscopic group (25 cases).Statistical analysis was performed by using SPSS 24.0 software, Sex, tumor location and other unordered two categories of data were compared by chi square test , Child-Pugh classification, AFP classification and other ordered two categorical data, the rank sum test was used.Age, tumor size, time, amount of blood, et al were presented as ( -x ±s), and t test was applied.The postoperative survival data was analyzed by Kaplan -meier.P value of<0.05 was considered as significant difference . Results Compared with traditional laparotomy group , anal exhaust time, postoperative hospitalization time of 2D laparoscopic group and 3D laparoscopic group was significantly lower.Compared with traditional laparotomy group and 2D laparoscopic group, ALT of patients in 3D laparoscopic group at 1d after operation was not only significantly lower , but also at 3 days and 5 days after operation (P <0.05).The TBIL of three measurements of 3D laparoscopic surgery group were lower than those in traditional laparotomy group (P <0.05).There was no significant difference among three groups in terms of incidence of complications and survival time within two years after operation . Conclusion 3D laparoscopic hepatectomy could shorten anal exhaust time and postoperative hospital stay , and could accelerate the recovery of postoperative liver function , with good clinical value.

Objective:To investigate the impacts on urinary and sexual function after laparoscopic versus open radical resection for low rectal cancer in young and middlea-ged male patients .Methods:A total of 118 young and middle-aged male patients with low rectal cancer receiving operation from Jan .2015 to Mar.2016 were enrolled into laparoscopic group (experimental group,n=56) and open group ( control group ,n=62 ) .The incidence of erectile and ejaculatory dysfunction at 6 months and 12 months after operation ,the incidence rate of short-term and long-term urination dysfunction were compared between two groups respectively .Results:The incidence of erectile dysfunction at 6 months after operation and ejaculatory dysfunction at 12 months after operation in laparoscopic group were lower than those in open group (21.43%vs.38.71%;5.36%vs.19.35%);the incidence of short-term urination dysfunction in lapa-roscopic group was lower than that in open group (12.50% vs.27.42%),the differences were statistically significant (P<0.05). While the incidence of erectile dysfunction at 12 months after operation and long-term urination dysfunction was similar between the two groups (P>0.05).Conclusions:Compared with laparotomy,laparoscopic radical resection of low rectal cancer can better protect the urinary and sexual function in young and middle-aged male patients,it can improve patients' life quality,and is worthy of clinical popu-larization.

目的:探讨普外科临床教学中,PBL(problem-based learning,PBL)与CBL(case-based learning,CBL)联合教学法的可行性及应用效果.方法:选取2015年7月至2016年3月在徐州医科大学附属医院普外科实习的临床医学专业本科生92例进行分析,采取随机分组设计,将其分为观察组(46例)和对照组(46例),其中,观察组采取PBL-CBI联合教学法,对照组采取传统的LBL(lecture-based learning,LBL)教学法.实习结束前进行理论及操作考核成绩、教学满意度调查.结果:观察组的理论及操作考核成绩均优于对照组,P<0.05;观察组的教学满意度评分高于对照组,P<0.05,差异均具有统计学意义.可见,在普外科临床教学中,采取PBL-CBL联合教学法,能取得更好的教学效果,值得推广.

OBJECTIVE To explore the influence of the ABCG2 inhibitor verapamil on the capability of cell invasion and metastasis of human pancreatic cancer cell line SW1990 in vitro and vivo.METHODS SW1990 cells were cultured in vitro and treated with verapamil (0,12.5,25,50,100 and 200 μmol/L) for 24,48 and 72 hours and then the proliferation inhibitory rates were detected by CCK-8 assay.The mRNA and protein expression level of ABCG2 in SW1990 cell in vitro and vivo were measured and analyzed by RT-PCR and Western blotting respectively.Transwell assay and cell wound healing assay were used to investigate the invasion and motility abilities of SW1990 cell in vitro.The cells were injected into nude mice,and the tumor forming condition was observed.The expression of ABCG2 in tumor tissues was examined by immunohistochemistry.RESULTS CCK-8 assay showed that the inhibition was positively correlated to drug concentration and time when the SW1990 cells were exposed to 25,50 and 100 μmol/L verapamil.The cell scratch assay showed that migration rate in experimental group were lower than that in control group at 24 h[(19.2±2.04)％ vs (36.8±2.25) ％,P＜0.001] and 48 h [(43.7±3.14) ％ vs (78.4±2.67) ％,P＜0.001].The result of transwell demonstrated that the cell numbers of invasive and migration between verapamil and control group were[(46.6 ±3.3) vs 90.2±2.7),t=-47.2,P＜0.001] and [(61.4±2.8) vs (110.3±3.5),t=-39.5,P＜0.001].TheABCG2 mRNA and protein expression in verapamil group were significantly decreased compared with control group in vitro and vivo.Tumor was observed 10 days after injecting the SW1990 cells into nude mice.The tumor volume in the verapamil group was significantly smaller than that in the control group [(521.6±48.5) mm3 vs (1 496.6±73.1) mm3,t=-38.6,P＜0.001].The tumor was significantly lighter in the verapamil group than that in control group[(0.53±0.18) g vs (1.61±0.45) g,t=-22.4,P＜0.001].Verapamil significantly inhibited the expression of ABCG2 in tumor tissues by immunohistochemistry.CONCLUSION Verapamil can significantly depress the invasion and metastasis of pancreatic cell line SW1990 by down-regulation the expression of ABCG2 in vitro and vivo.

目的:探讨腹腔镜辅助胃癌D2根治术治疗进展期胃癌的根治效果与临床应用价值.方法:回顾分析2013年4月至2014年4月成功施行的120例胃癌根治术的临床资料,由患者选择手术方式,其中腹腔镜组52例,开腹组68例.对比两组手术的安全性、肿瘤根治性、术后恢复情况、并发症发生率等.结果:腹腔镜组均顺利完成D2淋巴结清扫,无一例中转开腹.腹腔镜组手术时间[(242.7±50.8) minvs.(213.4±40.6) min]长于开腹组(P =0.003),切口长度[(6.2±1.1) cm vs.(18.7±4.7) cm]、术中出血量[(180.4±120.8) ml vs.(276.6±138.7) ml]、术后肛门排气时间[(2.8±1.6)d vs.(5.2±2.6)d]、首次下床活动时间[(3.8±0.6)d vs.(5.2±1.8)d]、首次进食流质时间[(4.3±0.8) dvs.(6.7±0.9)d]、术后住院时间[(12.3±3.2) dvs.(15.1±4.2)d]均优于开腹组,差异有统计学意义.两组近端切缘距肿瘤距离[(5.3±0.8) cmvs.(5.0±0.7) cm]、远端切缘距肿瘤距离[(5.2±0.7)cmvs.(5.3±0.7)cm]、清扫淋巴结数量[(17.6±6.5)枚vs.(19.3±6.9)枚]差异无统计学意义.腹腔镜组术后并发症发生率为11.5％ (6/52),开腹组为23.5％ (16/68),两组差异无统计学意义(x2=1.285,P=0.225).结论:与开腹胃癌D2根治术相比,腹腔镜进展期胃癌手术可达到相同的根治效果,且具有患者创伤小、出血少、术后康复快等临床优势.

Objective To investigate the curative effect of laparoscopic cholecystectomy ( LC) in the treatment of gallstones combined with liver cirrhosis so as to provide reference for clinical treatment options.Methods A total of 82 cases of gallstones combined with liver cirrhosis received laparoscopic cholecystectomy.The management during the perio-perative period and the effect were summarized.Results All the 82 patients were cured.The operation time was (55.3 ±17.6) min.Laparoscopic subtotal cholecystectomy (LSC) was performed in 18 cases.Only 5 cases were transferred to laparotomy.No postoperative complications such as abdominal cavity bleeding and abdominal cavity infection were ob-served.Length of hospital stay was (7.5 ±3.2) days.Conclusion Laparoscopic cholecystectomy is safe and reliable for the treatment of gallstones combined with liver cirrhosis.It is important to improve liver function before surgery, per-form careful dysjunction during surgery, and take preventive measures after surgery.

目的:探讨吉西他滨诱导胰腺癌细胞ABCG2的表达及与其化疗耐药的关系.方法:吉西他滨不同浓度、不同时间作用胰腺癌SW1990细胞后,用CCK-8法检测细胞的增殖抑制率,并计算吉西他滨不同作用时间的半数抑制浓度(IC50);根据IC50值选择合适浓度的吉西他滨,作用SW1990细胞24、48、72 h后,用流式细胞仪检测细胞凋亡率,并用Western blot和RT-PCR法检测ABCG2蛋白与mRNA的表达.结果:吉西他滨作用后,SW1990细胞增殖明显抑制,并呈浓度与时间依赖性,但IC50值呈时间依赖性增加(均P＜0.05);3.9 mg/mL吉西他滨作用24、48、72 h后,SW1990细胞总凋亡率逐渐增加,但晚期凋亡率呈降低趋势,ABCG2蛋白与mRNA的表达明显升高,并呈时间依赖性(均P＜0.05).结论:吉西他滨能抑制胰腺癌细胞SW1990的增殖,但作用呈时间依赖性减弱,这可能与其诱导ABCG2上调表达有关.

目的 探讨吉西他滨诱导胰腺癌细胞SW1990中ABCG2的表达及其与化疗耐药的关系.方法 胰腺癌细胞SW1990用DMEM培养液常规培养,用0.82 mg/ml吉西他滨作用SW 1990细胞24、48和72 h后,使用流式细胞仪测其细胞凋亡率,Western blot检测ABCG2蛋白的表达,RT-PCR检测ABCG2 mRNA的表达,并且分析ABCG2表达水平与化疗耐药的关系.结果 0.82 mg/ml吉西他滨作用SW1990细胞24、48和72 h后,细胞凋亡率分别为(21.1±0.61)％、(13.4±2.17)％、(6.4土1.34)％,不同时间点两两相比P均＜0.05.0.82 mg/ml吉西他滨作用SW1990细胞24、48、72 h后与对照组相比,ABCG2 mRNA分别上升了(2.21士0.11)倍、(3.30士0.08)倍和(4.72±0.12)倍,蛋白上升了(2.17±0.14)倍、(3.61士0.09)倍和(4.98士0.13)倍,且组间比较P均＜0.05,有统计学意义.结论 吉西他滨能抑制胰腺癌细胞SW1990的增殖,但随着时间延长,药物抵抗逐渐增强,这可能与吉西他滨作用细胞后上调ABCG2的表达有关.

Objective: To explore the impact of laparoscopic versus open cholecystectomy( OC) for the aged on liver and renal function. Methods: A consecutive series of 118 patients over 70 years old underwent elective open or laparoscopic cholecystectomy( LC) between Jun. 2009 and Jun. 2013,including 65 patients in LC group and 53 patients in OC group,and their clinical data including operation time,intraoperative bleeding,postoperative hospital stay,complications,and change of their liver and renal function between pre- and postoperation were analyzed in a retrospective manner. Results: All procedures were successfully accomplished,without conversion to open operation. There were no significant difference in operative time or intraoperative blood loss between the two groups. Compared with OC group,postoperative stay [( 9. 1 ± 1. 6) d vs.( 7. 2 ± 1. 4) d],time to start of diet [( 25. 3 ± 4. 2) h vs.( 22. 9 ± 4. 1) h] and complications after operation was less in LC group( P 0. 05). Compared with pre-operation,the indices of AST,ALT, ALP,TBIL,BUN,SCr significantly rised on the first day after operation in both groups( P 0. 05),but decreased to normal in LC group on the fifth day after operation,whereas the levels were still high in OC group. The levels of AST,ALT,ALP,TBIL,BUN,SCr were lower in LC group than those in OC group on the first day and the fifth day after operation( P 0. 05). Conclusions: LC is a safe and feasible surgical approach which has the advantages of minimal invasion,quick recovery,little impact on liver and renal function,and is worthy to be generalized especially for the aged. The keys of the operation are strictly selected indication and individual treatment.

现有大量文献报道乳腺癌耐药蛋白(ABCG2)参与多种肿瘤细胞多药耐药机制[1],但对于ABCG2与胰腺癌耐药方面报道较少.本实验旨在探讨胰腺癌中ABCG2与化疗耐药的关系. 一、材料与方法 1.材料:胰腺癌细胞株SW1990由江苏省人民医院苗毅教授馈赠.吉西他滨(江苏豪森药业),兔抗人ABCG2抗体(Abcam公司),ABCG2引物由上海生工生物公司合成. 2.细胞培养与传代:用含10％胎牛血清的DMEM高糖培养基,在37℃、5％CO2,饱和湿度的培养箱中培养,细胞每2～3d按1∶3传代1次.

目的 分析替吉奥与5-氟尿嘧啶联合奥沙利铂治疗晚期胃癌的临床疗效及安全性.方法 选取2011年1月至2014年7月间收治的90例晚期胃癌患者,采取随机数字表法分为对照组和试验组,每组45例.对照组给予5-氟尿嘧啶、奥沙利铂及亚叶酸钙治疗,试验组给予替吉奥联合奥沙利铂治疗,比较两组患者的临床疗效及不良反应.结果 试验组患者的有效率和临床获益率分别为44.4％和91.1％,对照组分别为31.1％和75.6％,差异均有统计学意义(均P＜0.05).试验组与对照组在血细胞减少、血小板减少、恶心呕吐、贫血、外周神经毒性、腹泻及口腔黏膜炎方面差异均有统计学意义(均P＜0.05).结论 采用替吉奥联合奥沙利铂治疗晚期胃癌的临床疗效较为确切,不良反应较少,安全性较高,值得推广.