目的 回顾性分析吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)与外剥内扎术联合消痔灵注射术治疗混合痔的10年随访结果.方法 选择2010年1月至2012年1月在北京中医药大学东直门医院肛肠科住院的201例混合痔患者,按照既往手术方式分为PPH术组123例和外剥内扎术组78例,回顾性分析比较患者临床病历资料,观察并分析患者主要并发症、术后取钉情况、术后总复发率、再手术率以及术后满意度.结果 两组患者肛门狭窄、肛门坠胀、肛门疼痛、肛门出血的发生率比较,差异无显著性(P>0.05),PPH术组痔核脱出的发生率高于外剥内扎术组,差异有显著性(P<0.05);PPH术组总复发率、再手术率均明显高于外剥内扎术组,差异有显著性(P<0.05);两组术后满意程度比较,差异无显著性(P>0.05).PPH术组患者术后有26例于门诊取钉,其中门诊行1次、2次、3次及以上取钉者分别有17、6、3例,占该组随访人数的13.82％、4.88％、2.44％.结论 PPH术的复发率、再手术率较外剥内扎术更高,同时部分患者存在吻合钉残留现象,术后的附加支出更多,其长期获益与外剥内扎术相比无明显优势.

蔓状血管瘤即脉管畸形之动静脉畸形,临床发病率低,会阴部发病者更少见,容易误诊,治疗棘手,文献鲜有报道,临床医生对此认识有限.本文通过复习相关文献,并结合1例会阴部巨大(瘤体约7.0 cm×5.0 cm)蔓状血管瘤经消痔灵注射液硬化栓塞术治疗后痊愈的验案,为临床医生认识及治疗本病提供参考与借鉴.

目的:研究影响公立医院医务人员工作满意度的条件变量组合,验证公立医院医务人员工作满意度的影响机制,为医疗卫生体制改革的方向提供一定启示.方法:选取某市22家市属公立医院,对其员工进行现场和电话随访,共收集1738份调查问卷,利用fsQCA 3.0软件进行定性比较分析.结果:公立医院医务人员高工作满意度的条件组合可以概括为工作情境主导、内外配合主导和内在动机主导3种路径.在影响公立医院医务人员工作满意度的7种条件构型中,条件构型1-3覆盖10％的案例,条件构型4-7覆盖90％的案例.结论:影响公立医院医务人员工作满意度的因素多样,需减轻医务人员工作负担,增加医务人员收入,营造好的工作氛围,促进职业发展和认同.

新型冠状病毒肺炎(简称新冠肺炎)疫情的暴发及常态化形式的持续,对研究生学业、毕业和就业等有不同程度影响,已经引起学生们极大的焦虑和烦躁,通过梳理、总结、分析在新冠肺炎疫情期间传染病专业研究生存在的院感防控管理难度大和学生存在焦虑情绪等问题,并结合研究生管理实际建立了行之有效的四级三维网格化联动培养模式,切实解决了研究生管理工作中存在的问题,同时也为重大疫情期间培养核心竞争力强、综合素质高的传染病专业研究生提供借鉴.

运用数据包络分析(Data Envelopment Analysis,DEA)法中的松散依据模型进行综合指数构建,按照二级指标和一级指标的维度,在每个维度下分别计算效率值,得出公益性水平的具体值,据此对北京市属三级公立医院的公益性水平进行测度及评价.结果显示,2013—2018年北京市属三级公立医院整体公益性水平较高,2018年市属医院公益性水平较高的占比31.8％,处于中等水平的占比63.6％,仅1家医院公益性水平较低.基于此提出针对性政策建议:一是贯彻落实中央精神,提高运营效率促进公益性;二是理顺医疗服务三方关系,实现可持续发展提高公益性;三是把握信任品的供需机制,激发系统收益提升公益性.

新冠肺炎疫情的爆发引起党和国家及专家学者对应急管理体系和应急管理能力的广泛关注.依靠坚强有力的组织体系,充分发挥党组织战斗堡垒和党员先锋模范作用,是我们党应对每一次重大风险挑战的制胜武器.重点分析重大疫情防控工作中定点医院党委的角色与定位,应急能力的显著优势和不足,并在此基础上提出思考和建议.

新医改环境下,临床医学人才的医德培养愈发重要,也越来越引起管理层重视.而医院文化环境对研究生医德培养可以起着潜移默化的引领作用,优秀的医院文化,能塑造并铸就研究生良好信念,强化研究生医德养成.结合传染病专科医院自身文化环境特点,探索传染病学研究生医德培养方式,对于传染病专科医院研究生医德培养具有一定理论指导意义.

应用系统工程霍尔三维结构理论,从文化主体维度、文化形态维度、文化功能维度构建传染病医院应急文化体系.传染病医院应急文化体系建设是多维度、多层级、多要素的系统,需从文化主体维度注重培训教育、提升职工应急素质,从文化形态维度加强顶层设计、丰富医院应急文化内涵,从文化功能维度坚持“平战结合”差异化功能定位,形成与医院发展相适应的物质文化、制度文化、行为文化、观念文化,提升传染病医院卫生应急处置能力.

借鉴双循环新发展格局的思路,尝试性地构建了传染病医院高质量发展的体系,阐述了高质量发展体系构建的背景、提出了传染病医院高质量发展体系的构建内涵,并运用SWOT分析法对医院所面临的优势、劣势、机遇与挑战进行了思考和分析,进而提出了构建院内大循环体系和院内院外双循环高质量发展体系的构建思路.

目的:观察祛风胜湿方治疗大肠湿热型溃疡性结肠炎(UC)的疗效.方法:共纳入104例大肠湿热型UC患者,随机分成观察组(54例)和对照组(50例).观察组给予祛风胜湿方免煎颗粒,治疗组给予美沙拉嗪缓释颗粒(艾迪莎).治疗4周后评价疗效.结果:治疗后两组主要症状评分、Geboes指数和Mayo活动指数均较本组治疗前显著改善(P＜0.01,P＜0.05),且治疗后观察组改善程度优于对照组(P＜0.05).结论:祛风胜湿方与美沙拉嗪缓释颗粒均可有效改善大肠湿热型UC患者临床症状、促进黏膜愈合、降低疾病活动指数,且祛风胜湿方疗效较佳.

目的:探索溃疡性结肠炎(UC)经络表现的规律,为从经络角度认识疾病和治疗的辨经选穴提供新的参考.方法:疾病组纳入81例UC患者,对照组纳入30例健康志愿者.在腹部、四肢肘膝关节至腕踝关节范围内行经络诊察,测量诊察阳性腧穴及对称部位的压痛阈值.比较疾病组和对照组的经络诊察差异.疾病组诊察结果进行聚类分析,并分别比较疾病组左右侧经络之间、上下肢及腹部之间的差异.结果:①UC影响双侧经络,在腹部则以左侧经络明显,疼痛敏感区主要位于下肢部,其次为腹部.②脾经、大肠经、肝经、肾经、肺经与UC关系密切.③足三里、上巨虚、大横、腹结、天枢、三阴交与UC关系较密切.结论:经络诊察法研究UC是一个可行的方向,今后研究重点应在探索基础性规律及在此基础上构建标准的评判体系.

肾细胞癌(RCC)占所有恶性肿瘤的2％～3％.25％～30％的患者在肾细胞癌诊断时即有转移,还有20％～30％在原发病灶治疗后的随访过程中出现转移,仅4％的肾细胞癌转移到小肠.在既往的文献中,肾细胞癌转移到小肠多以个案形式报道,本文报道了1例85岁的老年男性,左肾癌根治性切除后8年出现小肠转移的病例.本文于PubMed、Embased数据库和中文数据库中进行检索,对肾细胞癌原发病灶治疗后小肠转移的病案报道进行回顾.

目的:研究宫腔镜代输卵管镜对输卵管远端黏膜状况评价的应用价值,指导临床治疗方案的选择.方法:收集2015年1月-2018年2月首都医科大学附属复兴医院宫腔镜中心拟行输卵管切除术的174条输卵管,切除前行宫腔镜代输卵管镜评估输卵管黏膜状况.应用Puttemans分类方法,将grade Ⅰ输卵管黏膜评为佳;gradeⅡ、Ⅲ输卵管黏膜评为欠佳;gradeⅣ、Ⅴ输卵管黏膜评为差.切除标本在光学显微镜下观察,以病理学为金标准,根据输卵管黏膜层炎细胞浸润情况以及黏膜病变程度,将输卵管分为正常输卵管,轻度、中度以及重度炎性改变,通过统计学分析宫腔镜代输卵管镜与病理学检测诊断远端输卵管黏膜病变的一致性.结果:宫腔镜诊断远端输卵管黏膜病变敏感度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、总的符合率和Kappa值分别为98.2％、91.5％、84.6％、99.1％、8.5％、1.8％、93.7％、0.861.结论:宫腔镜代输卵管镜判断远端输卵管黏膜病变敏感度和特异度均较高,有较好的诊断价值,可以为临床选择提供依据.

Falloposcope,a microendoscopy for the inspection of inner side of fallopian tube,can enter into fallopian tube with the guide of hysteroscopy,laparoscopy and fertiloscopy,or without the guide.Not only can falloposcope be used for the examination of tubal patency,including stenosis,obstruction,adhesions,hyperemia,hydrops,polyps,diverticulum,endometriotic lesions and so on,but also used for the biopsy of lesion and the dredge of fallopian tube.Falloposcope can be used to evaluate the function of fallopian tube,correcting the false positive and false negative results of the traditional test.It means that falloposcope can be employed for both diagnosis and treatment.Moreover,the causes of some tubal infertility can be clarified by falloposcope.The in vitro fertilization and embryo transfer (IVF-ET) is preferred for those patients with serious tubal lesions,while surgical treatment can increase the natural pregnancy chance for patients with mild tubal lesions.With the development of reproductive medicine technology and the deep study on fallopian tube,the advantages of falloposcopy have been showed,especially its irreplaceable role in the diagnosis and treatment of tubal disease.This review focuses on the progress of diagnosis and treatment of falloposcopy at home and abroad in recent years,and summarizes the clinical application value of it.

Objective To investigate happiness index of medical personnel and its influencing factors,and provide countermeasures for improving happiness index.Methods Taking Beijing Ditan Hospital of Capital Medical University as an example,a questionnaire survey was performed among 852 medical staff through cluster sampling method.The descriptive statistical analysis and multiple regression analysis were used to analyze the influencing factors on happiness index of medical personnel.Results The current happiness index of medical personnel was in the medium level and the major influencing factors included salary and benefits,work pressure,and work environment.Measures should be taken to improve the happiness index of medical staff from aspects of promotion of salary and benefits,reducing stress,strengthening humanistic care and psychological counseling,etc.

Objective To observe the clinical efficacy of guangtongxiao volatile oil in the treatment of anal fissure pain, Methods One hundred and twelve cases of anal fissure pain were randomized into A group(nitroglycerin ointment group,26 cases),B group(guangtongxiao volatile oil group,28 cases),C group (guangtongxiao devolatization oil group,28 cases)and D group(guangtongxiao decoction group,30 cases), In each guangtongxiao group,corresponding guangtongxiao agents were used and also infused in rectal cavity,5 to 8 cm distant to the anal edge,10 ml/ time, In the D group,0, 2% nitroglycerin ointment was used topically on the affected area, All the medicines were applied once a day,in 5 min of a hip bathing with warm saline after defecation, VAS score,alleviation of pain and pain duration were observed before and 1 week after treat-ment in each group, Results One week after treatment,VAS score and pain duration in guangtongxiao vola-tile oil group were different significantly as compared with the other groups(P < 0, 05), Conclusion Guang-tongxiao volatile oil has the essential and unique effect on anal fissure pain and it is the important and indis-pensible component of guangtongxi.

The purpose of the drug and medical service separation reform is to eliminate the subsidization of medical services with excessive drug sales from the system,standard medical behaviors from interest mechanism,improve rational use of drugs,relieve patients' burden,and embody the medical staffs' labor value. The impact on both doctors and patients of drug and medical service separation reform in Beijing is analyzed,in order to explore new approach of optimizing management model of public hospitals. Meanwhile,through the validation of the effectiveness of reform implementation to mining policy problems,useful suggestions are provided for the further improvement of the policy perfection and improvement.

Objective To observe the clinical efficacy on headache and dizziness treated with qingxuan zhitong decoction after anorectal surgery under lumbar anesthesia.Methods 60 cases of headache and dizziness induced by lumbar anesthesia in anorectal surgery were randomized into a treatment group(30 cases)and a control group(30 cases).In the treatment group,qingxuan zhitong decoction was prescribed for oral administration.In the control group,paracetamol tablets were prescribed.VAS scores,the alleviation degree of headache and dizziness and curative rate were observed after treatment in 3 days.Results The clinical research showed that the comparison of VAS scores on the 1st,2nd and 3rd days were different significantly in statistics between two groups(P0.05).In the treatment group,the curative rate was 66.67% and the total effective rate was 93.33%.In the control group,the curative rate was 40.00% and the total effective rate was 76.67%.The differences in the curative rate and the total effective rate were significant in comparison between two groups(P0.05).In the treatment group,the alleviation degree of headache in the treatment of 3 days was superior to that in the control group.Conclusion Qingxuan zhitong decoction achieves the definite efficacy on the post-surgical headache and dizziness.The efficacy of qingxuan zhitong decoction is superior on headache and dizziness induced by lumbar anesthesia in anorectal surgery as compared with paracetamol tablets.Hence,this medicine deserves to be promoted in clinic.

Based on the current public health sy stem in Beijing's flawed and the people of the difficulties for medical treatmenton the three-tier hospitals in the city build new community health service system, howtoco-ordinate the local government officesin the community health service institutions play their role in resolving the masses "medical care and your doctor." Throug hresearch and work to clear the three hospitals in improving community health service agencies medical standards, the establishmentof community health files, strengthening community health propag anda and education to improve the people's quality of life andimprove disease prevention capacity to meet community health service agencies initially realized " two-way referral "processes andhospitals green channel, the establishment of communities to respond to public health emergencies effective emergency treatmentand prevention and control sy stem and the community minimal needs SH Ccrowd can get care, and other aspects of the governmentto play a full and tertiary hospital community health care services is currently in Beijing to resolve the development of communityhealth services in the best imperfect model.

目的探讨肺减容手术(LVRS)改善慢性阻塞性肺疾病(COPD)患者肺功能等的机制.方法对20例LVRS手术(切除范围为20%～30%)患者,于手术前及手术后3个月进行肺功能(FEV1、RV、TLC)、动脉血气分析(PO2、PCO2)、心脏超声多普勒(CO、Cl、EF、PAP)等指标的比较分析.结果 LVRS手术后患者的FEV1、RV、TLC等都有明显提高(P<0.01).PO2术后比术前有提高(P<0.05),PCO2显著减小(P<0.01).心功能指标:Cl、CO、EF及肺动脉压力(PAP)术后3个月较术前无明显变化(P>0.05).20例患者术后6min走(6MWT)为(286±85)m,比术前(182±102)m显著增加(P<0.01).结论切除范围在20%～30%的LVRS可明显改善COPD患者的肺功能,提高PO2,降低PCO2,而对心功能、肺动脉压力影响不明显.其机制可能在于余肺血管及肺单位的代偿及功能的重新恢复.