在临床诊疗工作中,放置各类引流管目的是防止术后并发症或治疗部分外科疾患,如腹部外科术后放置的腹、盆腔引流管,胸外科术后放置的胸腔闭式引流管,以及软组织术后放置的负压吸引管等.放置引流管的目的均是将腹腔或胸腔内及皮下积液(包括血液、脓液、炎性渗液、胆汁等)引流到体外.在临床工作中,常遇到引流管口敷贴黏性不足、吸水性差等原因,导致引流管滑脱、引流管口渗液等,特别是渗液,使得引流管口周围皮肤受到引流液持续刺激,从而导致周围皮肤损伤、伤口愈合延迟、伤口感染风险增加等问题.为此,特设计了一种吸水性和黏性均良好的新型引流管口换药贴.该引流管口换药贴主要由黏贴层、防水层、竹炭纤维层和撕脱贴组成.与传统的引流管换药方式比较,应用新型引流管口换药贴的优势在于可稳妥黏贴于皮肤,避免滑落,且吸水性良好,从而避免渗液对皮肤产生长时间的刺激,降低伤口感染风险.为临床解决引流管渗液处理提供了一种很好的方案,值得推广.

调查新冠肺炎疫情防控背景下医学生线上教学状态及存在问题,助力医学院校线上教学模式改进.

病人,男,28岁.因发现右颈部肿物1 个月于2019 年9 月20 日入院.病人无意中发现右颈部肿物,约硬币大小,无疼痛,无吞咽困难及呼吸困难.体格检查:右颌下,胸锁乳突肌前方触及1 类圆形肿物,大小约2.5 cm ×1.5 cm,无压痛,质软,边界清.颈部B超检查见右颈动脉外侧混合回声,大小2.3 cm ×1.1 cm,边界清,实性成分内可见粗大钙化,可见血流信号,同时双叶甲状腺未见异常.颈部增强CT见颈部肿物为囊性,增强扫描囊性部分无强化,边缘可见结节样强化(图1).进一步行细针穿刺检查提示乳头状癌,怀疑淋巴结转移癌,结合影像学检查未见原发病灶.

The proportion of boardline resectable pancreatic cancer (BRPC) is relatively high in patients with pancreatic cancer. At present, the main therapeutic treatment of BRPC is surgical resection after neoadjuvant therapy. Therefore, the neoadjuvant therapy of BRPC has drawn more and more attention in recent years. Once making a breakthroug in the treatment plan, it can greatly improve the overall prognosis of patients with pancreatic cancer. In this study, the development process, specific programs, advantages and disadvantages of each plan and the current research progress of BRPC neoadjuvant therapy are discussed.

The scalpel is the most practical tool for surgeons. The traditional scalpel is a blade with a split handle, but the length of the blade cannot be adjusted, and it is easy to scratch medical staff. In order to solve the above problems, a retractable scalpel handle was designed by the medical staffs of department of general surgery, Affiliated Hospital of Yangzhou University (Clinical Teaching Hospital of Dalian Medical University), and obtained the National Utility Model Patent of China (ZL 2019 2 0203154.9). The telescopic scalpel adopted the design of rotary telescopic sleeve and threaded column handle to achieve the purpose of built-in blade. By rotating the handle at one end of the handle, the length of the surgical blade extending out of the sleeve could be adjusted according to the actual needs. The structure of the device is simple and easy to operate. The adjustable blade length could also achieve the purpose of accurate operation while effectively avoiding the injury of medical personnel during the operation.

目的:全内脏转位在临床罕见，多因腹部疾病就诊时偶然发现。全内脏转位合并外科疾病需行手术治疗时，手术难度会因解剖变异而增加。本研究回顾性分析2012—2018年苏北人民医院普外科收治的12例全内脏转位患者的临床资料，总结全内脏转位合并腹部疾病的诊治经验。

目的 比较肝细胞癌解剖性肝切除(anatomic resection,AR)与非解剖性肝切除(non-ana-tomic resection,NAR)的临床疗效,并分析影响患者生存率的因素,为制定手术方案提供临床依据.方法 回顾性分析2014年3月1日至2017年1月31日就诊于大连医科大学附属第二医院肝胆外科行根治性肝切除术的肝细胞癌患者资料89例,其中AR组42例,NAR组47例,比较两组临床疗效.结果 AR组的平均手术时间长于NAR组,但其术中出血量及术后第3 d血清谷丙转氨酶(alanine amin-otransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、白蛋白(albumin,ALB)明显低于NAR组(P<0.05).在并发症方面,总并发症发生率无统计学差异(P>0.05).AR组术后2年无瘤生存率明显高于NAR组(P<0.05).2年总体生存率与NAR组相仿(P>0.05).AFP(甲胎蛋白)、微血管侵犯、手术术式为影响患者的无瘤生存率的独立危险因素.甲胎蛋白(alpha-fetoprotein,AFP)和ALT为影响患者的总体生存率的独立危险因素.结论 与非解剖性肝切除术相比,解剖性肝切除技术要求复杂,手术耗时较多,但操作精细,术中出血较少,能够减少肝功能损害,提高术后早期无瘤生存率.

人体寄生虫有原虫、蠕虫和节肢动物三大种类,其感染可见于全身大部分组织器官,亦可与眼部组织相互作用.寄生虫可寄生在眼球、眼眶软组织及睫毛根部等部位,致盲率较高.眼睛可与外界直接接触感染病原体,且随着获得性免疫缺陷综合征(AIDS)患者增多和角膜接触镜(隐形眼镜)佩戴人数增加,眼部寄生虫感染病例数量呈上升趋势,引起人们的广泛关注.本文选取原虫、蠕虫和节肢动物中能寄生于人眼,并导致眼部病变的几种典型寄生虫(棘阿米巴、刚地弓形虫、猪囊尾蚴、曼氏裂头蚴、结膜吸吮线虫、蠕形螨、蝇蛆、阴虱)进行介绍,并针对其最新病例及研究进展进行综述.

The aim of this study is to evaluate carotid atherosclerosis in patients of type 2 diabetes mellitus with microalbuminuria (MA) by high-frequency ultrasonography. Two hundred and fifty patients of type 2 diabetes mellitus were divided into two groups according to urinary albumin excretion rate (UAER): normoalbuminuria group (130 cases) and microalbuminuria group (120 cases). The intimal-medial thickness (IMT) and the atherosclerotic plaques of carotid artery were observed in both groups by high-frequency ultrasound. Fasting blood glucose (FBG), hemoglobin A1c, and lipid profiles were measured. The values of IMT of microalbuminuria group were significantly higher than those of normoalbuminuria group (P < 0.05). In univariate analysis, IMT was positively and significantly associated with age (r = 0.265, P < 0.05), waist circumference (r = 0.263, P < 0.05), body mass index (r = 0.285, P < 0.05), systolic blood pressure (r = 0.276, P < 0.05), UAER (r = 0.359, P < 0.05), HbA1c (r = 0.462, P < 0.05) and, duration of diabetes (r = 0.370, P < 0.05). In multivariate linear regression analysis, UAER and HbA1c were independent predictors of IMT (P < 0.05 for all). In the two groups, the rate of soft plaques was higher than that of dense plaques and calcified plaques. In conclusion, there is a significant association between microalbuminuria and IMT which is regarded as the early sign of carotid atherosclerosis in type 2 diabetic patients.

Objective To evaluate carotid artery wall elasticity and clinical significance in the patients with type 2 diabetes mellitus (T2DM) complicated with microalbuminuria (MA) by ultrasonographic elastography. Methods Ninety-one patients with T2DM were divided into two groups according to urinary albumin excretion rate (UAER): T2DM without MA (T2DM1 group, 49 cases) and T2DM with MA (T2DM2 group, 42 cases). The ratio B/A (the ratio of elastic stiffness coefficient) of the right common carotid artery were calculated by ultrasonographic elastography. The correlation between B/A and general data was analyzed. Results Compared with the value in the T2DM1 group, the B/A of T2DM2 group was significantly higher (P0.05). The B/A was correlated with CREA,UAER and HbA1c (r= 0.266,P 0.05; r=0.426, P 0.05; r=0.405, P0.05). The 2 h PG, BMI, TC, CREA, UAER and HbA1c of T2DM2 group were significantly higher than those of T2DM1 group (P0.05). Conclusion The carotid artery wall elasticity in T2DM with MA decreased. Ultrasonographic elastography can accurately and rapidly evaluate carotid artery wall elasticity in T2DM with MA, which can guide clinical physician with aggressive treatment and prognosis of improvement.