目的 分析比较经皮穿刺胃造瘘术与食管支架置入术在晚期食管癌营养支持治疗中的临床效果.方法 回顾性分析2019年6月至2022年6月因晚期食管癌于北京市普仁医院行介入治疗且资料完整的48例患者临床资料,根据其采取治疗方案,分为经皮穿刺胃造瘘组25例和食管支架置入组23例.比较术前及术后3个月时的营养风险筛查评分及血清白蛋白、血红蛋白水平.比较两组患者术后早期并发症(术后14d),如血肿或出血、堵塞或移位、胸痛及异物感、肺部感染等;随访期术后3个月并发症,如肺部感染、食管支架堵塞及移位、胃造瘘管堵塞及脱落等;比较术后3个月内再入院率.结果 食管支架置入组的术后早期并发症(术后14d)中胸痛及异物感发生率高于经皮穿刺胃造瘘组,差异有显著性(P＜0.05);术后3个月并发症发生率差异无显著性(P＞0.05);术后3个月,两组患者营养状态较术前均明显改善,两组术后营养风险筛查评分、血清白蛋白和血红蛋白水平及再入院率差异均无显著性(P＞0.05).结论 经皮穿刺胃造瘘术及食管支架置入术对于伴有进食梗阻的食管癌晚期患者均为安全、有效改善营养的手术操作,但经皮穿刺胃造瘘术并发症发生率更低.

Objective:To explore a novel technique for stone extraction of bile duct stones after choledochoenterostomy.Methods:Using PTCD to control the biliary infection. The site of percutaneous jejunum puncture was determined by CT. The jejunum was punctured in the dilated state, and 8.5F catheter was placed and fixed. After 1 month, take out the bile duct stones with the stone basket through this sinus under fluoroscopy. After removing the bile duct stones, give 14F drainage tube to support the choledochojejunostomy for 1 year.Results:Removal of bile duct stones were performed in 18 cases by the way of percutaneous jejunal puncture. 17 cases were removed completely by one or more fluoroscopy, and 1 case was transferred to the jejunal sinus choledochoscopy after three times of incomplete stone extraction, without obvious complications such as hemorrhage, intestinal fistula, biliary fistula and abdominal infection. During the follow-up period, no stone was found, and the biliary and intestinal anastomosis was unobstructed..Conclusions:Percutaneous jejunal puncture for removal of bile duct stones is a feasible,safe and effective method for the treatment of bile duct stones after choledochoenterostomy.

目的 评价老年结直肠癌术后应用口服营养支持治疗(oral nutritional supplements,ONS)对营养状态及生活质量的影响.方法 选择2018年1月至2022年1月于北京市普仁医院行结直肠癌根治性手术患者77例,根据随机数字表法分为ONS组37例和对照组40例.比较两组患者出院后30、60d人体测量指标(体重、体重指数、三头肌皮褶厚度)、营养相关实验室指标(血红蛋白、白蛋白、前白蛋白)、营养风险筛查表(nutrition risk screening 2002,NRS 2002)及EQ-5D量表评分变化值等.结果 ONS组出院后30 d体重、体重指数及三头肌皮褶厚度变化值(治疗后减去出院时基线值)均增加,但与对照组相比,差异无显著性(P＞0.05);ONS组出院后60 d体重、体重指数及三头肌皮褶厚度变化值均较对照组显著改善,差异有显著性(P＜0.05).ONS组在出院后30d及60d前白蛋白、白蛋白增加值较对照组差异有显著性(P＜0.05),在血红蛋白增加值差异无显著性(P＞0.05).ONS组在出院后30d和60dNRS评分均下降,NRS评分＜3分无需再予营养支持的患者较对照组增多,但两组评分差异无显著性(P＞0.05);ONS组出院后60d时 EQ-5D量表评分变化值优于对照组,差异有显著性(P＜0.05).结论 对于存在营养风险的结直肠癌术后老年患者,出院后予以口服营养补充疗法可有效改善营养状况,提高患者生活质量,利于患者术后康复.

目的:构建术前滤泡状甲状腺癌(FTC)预测模型,并验证预测效果.方法:回顾性分析2015年1月—2020年12月模型队列(北京大学第一医院患者)和验证队列(北京市普仁医院患者)接受手术治疗的甲状腺结节患者的术前资料.根据术后病理分别将两队列患者分为FTC组和非FTC组.在模型队列使用Logistic回归分析,探索FTC发生的危险因素,根据危险因素构建术前FTC预测模型.使用受试者工作特征(ROC)曲线确定最佳诊断切点.分别在模型队列和验证队列中验证预测模型预测FTC的准确度.结果:模型队列患者术前血清甲状腺球蛋白(Tg)水平升高(P＜0.001)、结节直径大(P＜0.001)、无钙化(P=0.003)、结节呈实性(P＜0.001)、结节边缘平滑(P=0.035)和结节可见血供(P＜0.001)是甲状腺结节患者最终被诊断为FTC的危险因素.模型队列中根据Logistic回归因素和系数构建预测FTC模型:Y=0.013×Tg(ng/mL)+0.7×结节直径(cm)+0.919×(钙化状态)+2.355×(结节性质)+1.073×(结节边缘)+1.424 ×(结节血供)-10.681.使用ROC曲线分析得出最佳诊断切点为Y=-3.96,此时诊断FTC的准确度为91.53％,敏感度为87.16％.在验证队列中,预测模型Y的诊断敏感度为90.91％、特异度为90.99％.模型队列和验证队列中,预测模型判断FTC准确率均高于术中冷冻切片(P＜0.001).结论:利用术前血清Tg水平和甲状腺结节超声特征,所构建的FTC术前预测模型预测效果可靠.

目的 探讨新型冠状病毒肺炎二级防护下和常规无菌操作下急诊经皮肝穿刺胆管引流术的成功率、病人在室时间和术后2周医患感染新型冠状病毒肺炎发生率.方法 回顾性分析2019年1月1日至2020年4月30日完成急诊经皮肝穿刺胆管引流术43例.其中在新型冠状病毒肺炎二级防护下完成了7例患者,男3例,女4例,年龄范围在42～79岁,平均年龄为76.3岁.常规无菌操作下完成了36例患者,男23例,女13例,年龄范围在40～92岁,平均年龄为73.7岁.比较两组患者手术成功率、病人在室时间和术后2周医患感染新型冠状病毒肺炎发生率.结果 对照组36例患者中,35例顺利完成穿刺,观察组7例患者均穿刺成功;对照组平均在室时间64.2 min,观察组平均在室时间为60.0 min.术后2周7例患者及参与的医务人员均未感染新型冠状病毒肺炎.结论 新型冠状病毒肺炎疫情期间,急诊经皮肝穿刺胆管引流是一种安全有效的治疗方式,科学防护下不增加医患感染发生率和患者手术风险,可使病人获得最大收益.

目的:分析腹腔镜胆囊切除术治疗急性胆囊炎并发胆结石的安全性及预后情况.方法:选择2016年9月-2019年9月于本院接受治疗的80例急性胆囊炎并发胆结石患者为研究对象.按照就诊顺序,将其随机分为对照组和观察组,每组40例.对照组应用开腹胆囊切除手术,观察组应用腹腔镜胆囊切除术.比较两组住院时长、术中出血量以及手术时长、术后情况以及并发症发生情况.结果:观察组手术时长、住院时长均短于对照组,术中出血量低于对照组,差异均有统计学意义(P<0.05).观察组并发症发生率为10.00％,明显低于对照组的40.00％,差异有统计学意义(P<0.05).观察组排气时长、疼痛持续时长及引流管留置时长均短于对照组,差异均有统计学意义(P<0.05).结论:对于急性胆囊炎合并胆结石患者来讲,利用腹腔镜下胆囊切除术能够取得满意效果.此法安全性强、有效性高.可以降低术中出血发生率,缩短引流管留置时间、肛门排气时间及疼痛持续时长,因此值得进一步推广.但开展此类手术之前,必须确定患者的手术适应证.且要以保证手术安全为基础,同时也要依靠临床医生的精湛技术水平以及临床经验.只有这样,才能够更好地突显出来腹腔镜手术的优势.

目的 探究青鹏软膏联合地奈德软膏治疗儿童特应性皮炎的临床疗效及对血清炎性因子影响.方法 选取2016年1月～2017年1月在我院治疗的特应性皮炎患儿74例,数字表随机分配法分为实验组和对照组,各37例.实验组采取青鹏软膏联合地奈德软膏治疗,对照组采用地奈德软膏治疗.观察两组患儿临床疗效,治疗前后SCORAD评分,检测患儿血清嗜酸性粒细胞含量,记录副反应发生情况.结果 实验组有效率97.30％,高于对照组72.97％,差异有统计学意义(P<0.05);治疗后两组各项SCORAD评分低于治疗前,差异有统计学意义(P<0.05);实验组皮疹、瘙痒和总积分低于对照组,差异有统计学意义(P<0.05);实验组血清嗜酸性粒细胞含量少于对照组,差异有统计学意义(P<0.05);两组副反应发生率对比,差异无统计学意义(P>0.05).结论 青鹏软膏联合地奈德软膏治疗儿童特应性皮炎可有效提高临床疗效,清除炎性因子,且未增加不良反应发生率.

目的:分析评价手术治疗混合痔的临床疗效.方法:选取我院在2015年2月 —2017年2月收治的80例混合痔患者作为研究的对象,按随机盲选法分成两组,观察组40例给予吻合器痔上粘膜环切术加外痔切除治疗,对照组40例则给予外剥内扎术治疗,进一步对两组临床治疗效果进行比较评价.结果:观察组在治疗总有效率上为97.50％,和对照组的72.50％ 比较明显更高,两组数据差异具备统计学意义(P<0.05).在手术时间 、创面愈合时间上,观察组均明显短于对照组,两组数据差异具备统计学意义(P<0.05).结论:吻合器痔上粘膜环切术加外痔切除治疗混合痔的疗效显著,值得采纳及应用.

Objective To explore the use of antimicrobial agents and the influence factors of incision infection in patients with breast surgery.Methods A total of 126 cases in January 2013 to March 2015 received breast surgery in our hospital were selected as the research objects. The types of antimicrobial agents,using rate,timing and treatment course,surgical incision infection rate and pathogen species and related factors were analysis.Results The using rates of cephalosporins, penicillins,nitroimidazoles,lynk amine,and aminoglycosides were 78.57%,15.08%,8.73%,2.40%,and 1.59%, respectively. The rate of preoperative administration was 1.58%lower than that of 7.94%,and the difference was statistically significant(P<0.05).Incision infection was detected in 16 patients,with the infection rate of 12.70%;5 kinds of pathogenic bacteria were detected ,and the gram positive bacteria was accounted for 43.75%,and the Gram negative bacteria was accounted for 56.25%;the infection rate of breast cancer patients was higher than that of breast lump biopsy ,breast tumor resection and breast quadrant resection,and the difference was significant(P<0.05). Conclusion Hospital should strengthen the management and rational use of antibiotics ,postoperative incision infection rate and the type of operation , operation time and incision type,treatment,combined with the actual situation to prevent,reduce the incidence of infection.

Objective To analyze the relationship between serum preoperative C-reactive protein (CPR) level and the prognosis of retroperitoneal malignant fibrous histiocytoma (MFH).Methods Clinical pathological and prognostic data about 50 patients with retroperitoneal MFH in Chinese PLA General Hospital from March 2000 to March 2015 were collected.According to the CRP level,patients were divided into high CRP group (n=19) and normal CRP group (n=31).The differences in clinicopathological features and prognosis between the two groups were analyzed.Results Univariate analysis showed that CRP level (x 2=5.911,P=0.015),operation method (x 2=16.811,P=0.000) and tumor stage (x 2=4.741,P=0.037) were related to prognosis.The multivariate analysis showed that CRP level (HR=4.865,P=0.003),operation method (HR=4.546,P=0.002) and tumor stage (HR=2.4,P=0.031) were independent prognostic factors for prognosis of MFH.Conclusion Retroperitoneal MFH patients with high serum CRP level have poor prognosis.

Abstact: ObjectiveTo investigate the influence of preoperative enriched supplementary enteral nutrition on elderly patients with gastrointestinal cancer.Method Patients with nutritional risk were selected from preliminary diagnosed elderly gastrointestinal cancer. These patients were randomly divided into the control group given traditional nutritional support method and the test group given enriched supplementary enteral nutrition. The levels of albumin (ALB), pre-albumin (PA), transferring (TF) and lymphocyte count (LY) were observed and compared between the two groups on admission, preoperative day 1, postoperative day 3.Postoperative complications and the hospitalization cost, length of stay was recorded.Result The PA, TF were significant different in Different groups of nutritional preparations after 1 days before and 3 days after operation (P<0.05), the detection level of the test group was higher than control group (P<0.05). The LY, ALB levels in 3 days postoperatively were significant higher than control group (P<0.05). There was a significant difference of anal exsufflation time and out of bed activity time in test group and control group (P<0.05). The incidence rate of postoperative total infection and total complications postoperative were significant difference between the two groups (P<0.05). The average hospitalization time in test group was (16.5±6.8)days, the control group was (23.0±6.6) days, there were significant differences between them (P<0.05).Conclusion Preoperative enriched supplementary enteral nutrition is safe and effective, which is an appropriate choice to improve the nutrition and decrease infectious complication and promote rehabilitation of the patients with gastrointestinal cancer during the perioperative period.

ObjectiveTo evaluate the effects, sequential therapy and prognostic analysis of percutaneous cholecystostomy(PCT) for the treatment of acute cholecystitis in the older or poor-risk patients.MethodA retrospective clinical analysis was undertaken in the older or poor-risk patients receiving PCT from January 2010 to December 2015. Further therapy was included of cholecystectomy, perpetual PCT drainage and remove of PCT drainage. The morbidity and morbidity rate was analyzed.ResultThe study included 118 patients accepting PCT. Hospital discharge was 102 cases after persistent PCT drainage. The patterns of sequential therapy was 83 cases of Cholecystectomy, 12 cases of perpetual PCT drainage and 7 cases of remove of PCT drainage with acalculous cholecystitis.16 cases was died after PCT drainage and 75% was over 80 years of ages.ConclusionPCT is considered relatively safe and cost effective for the management of acute cholecystitis in the older or poor-risk patients, but in some patients over 80 years of ages the prognostic is poor because of significant comorbidities. The patterns of sequential therapy was decided after evaluating the aetiologic agent of acute cholecystitis and systemic disease of the patients.

目的探讨老年急性胆源性胰腺炎(ABP)的临床特点和诊治。方法回顾分析88例老年人急性胆源性胰腺炎的临床资料。结果轻症非梗阻型34例非手术治疗后好转;轻症梗阻型28例中,除1例急诊行经皮肝穿胆道外引流术(PTCD),均非手术治疗后好转;重症非梗阻型20例,其中3例死亡,其余以非手术治疗后好转;重症梗阻型6例,均先行急诊PTCD,其中4例痊愈,2例死亡。结论老年急性胆源性胰腺炎早期一般均可保守治疗,梗阻明显者可先行急诊PTCD治疗,胰腺炎症水肿消退,病情稳定后应及时手术治疗。