Objective:The effect of laparoscopic sleeve gastrectomy (LSG) on the prevalence of gastroesophageal reflux disease (GERD) is unclear. Our aim is to analyze the impact of LSG on GERD.Methods:Make the retrieval strategy, search the Wanfang, Zhiwang, PubMed, EMbase, The Cochrane Library and Web of Science databases, screen the literature according to the inclusion criteria and exclusion criteria, extract the relevant data of the included literature, and carry on the methodological quality evaluation and Meta analysis.Results:A total of 11 articles and 1034 patients were included. The results of Meta analysis showed that the difference of new GERD symptoms after LSG operation was statistically significant (OR=0.39,95% CI:0.26~0.60), LSG P<0.0001). The number of new GERD symptoms after operation was significantly higher than that before operation. In addition, there was significant difference in GERD-Q score before and after LSG (MD=-0.59, 95% CI:-1.07~-0.11). The rhombus representing the combined effect was located on the left side from the forest map, indicating that the symptoms of GERD were significantly aggravated after LSG. There was significant difference in DeMeester score in 24-hr pH before and after LSG (MD=-11.82,95% CI:-16.27~-7.37, P<0.000 01). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the symptoms of GERD after LSG are significantly more severe than before. There was a significant difference in the average number of acid reflux before and after LSG (MD=-15.71,95% CI:-23.97~-7.44). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the average number of acid reflux after LSG is significantly higher than that before operation. The time of acid reflux detected by 24-hr pH before and after LSG was significantly different (SMD=-1.00,95% CI:-1.38~-0.61 P<0.000 01). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the acid reflux time after LSG is significantly longer than that before operation. The difference of daily PPI intake before and after LSG was statistically significant (RR=0.41,95% CI:0.23~0.73). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the daily PPI intake after LSG is significantly higher than that before operation. However, there was no significant difference in the changes of GERD symptoms before and after LSG operation (OR=0.97,95% CI:0.46~2.04), LSG 0.093>0.05). There was no significant change in GERD symptoms before and after), LSG operation.Conclusion:Due to the contradictory results of existing studies, the exact effect of LSG on the prevalence of GERD has not been answered. When choosing the appropriate weight loss technique, surgeons should carefully evaluate the preoperative symptoms of GERD in order to more clearly determine the effect of SG on GERD in patients with weight loss.

Objective:To explore the effect of cluster nursing strategy in preventing pressure injury during Da Vinci robot assisted gastric volume reduction combined with esophageal hiatal hernia repair.Methods:a retrospective analysis was made on the nursing data of 100 patients who underwent Da Vinci robot assisted gastric volume reduction and esophageal hiatus hernia repair in the operating room of our hospital from April 2021 to April 2022. Among them, 50 patients who underwent surgery from April to October 2021 were treated with routine nursing methods as the control group; From December, 2021 to April, 2022, 50 surgical patients were treated with cluster nursing strategy, which was the experimental group. The incidence of surgical stress injury and patient satisfaction were compared between the two groups.Results:the incidence of pressure injury in the observation group was significantly lower than that in the control group (P＜0.05); The nursing satisfaction of the observation group was significantly higher than that of the control group (P＜0.05).Conclusion:the implementation of cluster nursing strategy for the prevention of pressure injury in patients with gastric volume reduction and esophageal hiatus hernia repair assisted by Da Vinci robot can effectively reduce the incidence of pressure injury and improve the satisfaction of surgical patients.

目的分析快速康复理念在全腹腔镜下食管裂孔疝修补术患者围术期护理中的具体影响。方法选取2017年7月至2018年10月于新疆维吾尔自治区人民医院收治的食管裂孔疝患者90例。所有患者均行腹腔镜食管裂孔疝修补及护理,随机分为实验组和对照组各45例。实验组给予快速康复概念护理,对照组给予正常护理模式。对比各护理模式下,护理效果的差异,如住院时间、肛门疲劳时间、胃管拔出时间、首次进食时间、护理满意度及并发症发生率等。结果观察组在住院时间、肛门疲劳时间、胃管拔除时间、首餐时间、护理满意度、并发症等方面均优于对照组,且两组比较的差异有统计学意义（P＜0.05）。结论对于全腹腔镜下食管裂孔疝修补术患者在手术期间给与快速康复护理,可以有效地加快患者术后的康复速度,提高患者护理满意度,并降低术后并发症发生率,值得临床推广应用。

目的 探讨进一步提高对人工跖趾关节置换术的手术配合过程及特点.方法 回顾性分析我院10例患者跖趾关节置换术的手术方式、术前准备、术中配合要点和过程.结论 充分的术前准备、密切的术中配合、掌握手术步骤是手术成功不可缺少的环节.

Objective Investigate the video -assisted thoracoscopic lung volume reduction surgery in the treatment of chronic obstructive pulmonary emphysema with preoperative preparation and surgical care.Methods January 2007 to 20l2 December,21 cases in our hospital thoracoscopic lung volume reduction surgery in pa-tients with chronic obstructive pulmonary emphysema,get preoperative preparation,intra-operative medical staff with the implementation of surgery .Results 21 surgeries were successfully completed,without conversion to thoracotomy,intraoperative blood transfusion,postoperative wound infection,mean operative time was 109.1 ±10. 4min;postoperative chest drainage remain indwelling average 6.0 ±1.1d;postoperative hospitalization time of 10.7 ±6.3d.2 patients postoperative complications oc-curred in 2 cases(9.5%),in which the lung persistent air leak >7d,1 cases,pulmonary infection in 1 case,postoperative 1 second forced expiratory volume(FEV1),to-tal lung capacity(TLC),residual volume(RV),arterial oxygen pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2),the difference was statistically signifi-cant(P<0.05)6MWT compared with the preoperative.Follow-up of 18 patients(85.7%),the follow-up period of 6 months to 2 years,review of blood gas analysis, the 6MWT and pulmonary function improved significantly compared with preoperative difference was statistically significant (P<0.05).Conclusion Video-assisted tho-racoscopic implementation of lung volume reduction surgery has little damage,quick recovery,high-quality care with the patients can get the best results of operations, improve the success rate of surgery,postoperative rehabilitation is essential to promote the patient.

目的:探讨应用能量平台进行胰十二指肠切除术的观察与手术配合。方法:将96例行胰十二指肠切除术的患者随机分为观察组和对照组各48例,观察组术中采用常规止血方式加能量平台止血,对照组采用常规止血方法,比较不同止血方式在不同部位的止血时间。结果:在相同部位使用不同止血方式的止血时间不同,其中结扎束止血时间最短,差异有统计学意义(P<0.01)。观察组的手术时间小于对照组,差异有统计学意义(P<0.05)。结论:能量平台具有集单极电切电凝、双极电凝、血管结扎闭合系统多种功能于一体,减少占用手术室空间,尤其是血管结扎闭合系统闭合速度比使用缝线快,无需对组织束进行分离,闭合后无残留、无焦痂,比缝合器节省费用,关键是缩短了手术时间,减少了手术出血量。同时对结扎束手柄等精密仪器、器械的正确使用,术中默契的配合,术后精心的保养,是手术顺利进行、延长仪器器械使用寿命的重要保证。