BACKGROUND:Surgical site infection is one of the most common complications of conventional laparoscopic surgery. Preventing infection of the incision is particularly important.OBJECTIVE:To discuss how to prevent the occurrence of surgical site infection after contaminated abdominal surgery.METHODS:Five hundred and fifty-one surgery patients with ``contaminated abdominal incisions'' from January 2011 to May 2013 were analyzed in terms of the preventative treatment, and summarized for surgical site infection. Subcutaneous tissue flushed with normal saline + hydrogen peroxide before suturing in the intervention 1 group; subcutaneous tissue flushed with normal saline + 0.5% povidone-iodine before suturing in the intervention 2 group.RESULTS:When subcutaneous fat was contaminated to a depth of ≤ 2.5 cm, the rates of surgical site infection in the control group and the intervention groups showed no significant difference (P > 0.05). When subcutaneous fat was contaminated to a depth of ≥ 3.0 cm, the rate of surgical site infection in the control group compared with the intervention one group was not statistically different (P > 0.05). The rate of surgical site infection in the control group compared with the intervention two group was statistical significant (P < 0.05). The rate of surgical site infection in the intervention one group compared with the intervention two group was statistical significant (P < 0.05).CONCLUSIONS:Preoperative control of the blood sugar; correction of anemia and the hypoalbuminemia; use of intraoperative the high-frequency electrotome; irrigation of the incision with plenty of physiological saline +$ iodophor before suturing the subcutaneous fat layer were key to effectively preventing infection in contaminated abdominal incisions.

目的：观察丹参对急性胰腺炎大鼠血液流变学的影响。方法将60只大鼠随机分为两组，胰腺炎组按1 mL/kg胰腺被膜下注入5％牛磺胆酸钠，关腹前腹腔内注射0．9％氯化钠（10 mL/kg）。丹参组在关腹前腹腔内注入丹参注射液（10 mL/kg）。两组分别在造模6、12、24 h后腹主动脉采血，采用利普生LBY-N6血液流变仪测定血液流变学指标（全血黏度、全血还原黏度、血浆黏度及红细胞比容）。结果丹参组在6、12、24 h时点血液流变学指标水平均低于胰腺炎组（P均＜0．05）。结论丹参可以明显改善急性胰腺炎血液流变学指标。

目的 探讨闭合式全囊切除在治疗囊性肝包虫的临床意义.方法 对我院2010年01月～2013年04月期间34例囊性肝包虫均行闭合式全囊切除术治疗,并与51例同期间行传统手术患者比较住院及手术指标.结果 闭合式全囊切除手术组的手术时间及术中出血量高于传统手术组(P＜0.05).闭合式全囊切除手术组的带引流管时间、术后残腔积液、术后感染,术后胆汁瘘及复发例数均低于传统手术组(P＜0.05).结论 闭合式全囊切除治疗囊性肝包虫病时安全、可靠,可明显、有效的降低术后复发.

OBJECTIVE:To explore the blood oxygen saturation and heart rate changes of the Antarctic explorers.METHODS:During August 2010 to April 2011, the changes in blood oxygen saturation, heart rate and plateau reaction of 16 Antarctic expedition team in different plateau environments (Tibetan plateau versus Antarctic plateau) were monitored with the noninvasive pulse oximeter MD300-C. The extent of acute mountain sickness was determined according to the Lake Louise Consensus acute mountain reaction symptom scores and judgment method.RESULTS:The changes of blood oxygen saturation, heart rate at different altitudes of 110, 3650, 4300 m (96.8% ± 1.2%,89.1% ± 1.2%, 86.1% ± 2.0%, (75.0 ± 5.4) times/min, (104.0 ± 4.3) times/min, (113.0 ± 5.2) times/min,F = 214.155, 240.088,both P < 0.05). With rising latitude and elevation gradient in Antarctic plateau, the changes of blood oxygen saturation, heart rate at different altitudes of 2000, 2500, 3000, 3500 and 4087 m(91.9% ± 1.3%,90.5% ± 1.3%,87.6% ± 1.4%,85.0% ± 1.8%,81.5% ± 2.2%, (85.9 ± 3.2) times/min, (90.6 ± 2.8) times/min, (97.8 ± 4.1) times/min, (102.0 ± 3.4) times/min, (106.3 ± 3.9) times/min, F = 105.418, 90.174, both P < 0.05). Levels of blood oxygen saturation and heart rate were both correlated with the risk of altitude sickness (r = -0.446 and 0.565, both P < 0.05).CONCLUSIONS:As the increases of altitude, there are significant changes in oxygen saturation, heart rate of the Antarctic explorers. And with the increases of altitude, the risk of altitude sickness gradually increases.

Objective To investigate the alterations of blood coagulation and fibrinolysis system in murine experimental severe acute pancreatitis (SAP) at different altitudes.Methods 72 Wistar male rats were divided into three groups randomly (n =24 in each group):4300 metres' altitude(group H),3300metres' altitude group(group M) and 1500 metres' altitude group(group L).Each group was further divided into four subgroups (n =6 in each subgroup):normal group (group N),6 hour after SAP model establishment group(group p6 h),12 hour after SAP model group(group p12 h),24 hour after SAP model group(group p24 h).Retrograde pancreatic duct injection of 5％ sodium taurocholate (NaTc) method was used to establish SAP animal model.The levels of amylase (AMY),D-dimer,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB) and the contents of antithrombin Ⅲ (AT-Ⅲ) in serum were measured.Pancreatic tissues were sampled and studied by hematoxylin-eosin(HE) staining.Results (1)Compared to group N,the pancreas pathology score,AMY,Fib and D-dimer in serum increased significantly (P ＜ 0.05) and PT,APTT and AT-Ⅲ lowered significantly (P ＜ 0.05) at each time point in group P in the same altitude.In group P,the contents of Fib and D-dimer and pathological score gradually increased with time (P ＜ 0.05),AT-Ⅲ activitise gradually decreased with time (P ＜ 0.05) ; there was a significant difference (P ＜ 0.05) when Fib,D-dimer,AT-Ⅲ was compared among three altitude's group P.(2) There was a significant difference (P ＜ 0.05) between histological scores,PT and APTT in group Hp and group Lp,and the same result (P ＜ 0.05) between group Mp and group Lp.There was no significant difference between group Hp and group Mp (P ＞ 0.05).(3) There was a positive correlation between histological scores and Fib,D-dimer (P ＜ 0.05) in group P in the same altitude ; AT-Ⅲ and histological scores,Fib,D-dimer (P ＜ 0.05) have a negative correlation in group P in the same altitude.Conclusions More severe damage of pancreatic tissues and disorders of coagulation and fibrinolysis system were observed in rats with severe acute pancmatitis at high altitudes.Changes in blood coagulation and fibrinolysis system may be involved in the severity of acute pancreatitis.

目的探讨外科治疗克罗恩病的手术时机及手术方式。方法回顾性分析了1998～2012年期间笔者所在医院收治的13例克罗恩病手术患者的临床资料。结果 13例患者中行急诊手术6例,择期手术7例;行左半结肠切除术2例,回盲部并小肠切除术4例,部分小肠切除术4例,右半结肠切除术2例,全结肠切除回肠造口术1例。本组仅7例获随访,随访时间12～48个月,平均38个月,有2例患者分别于术后16个月和31个月死亡,死亡原因为营养不良,消化道出血,多脏器功能衰竭;另外5例预后良好。结论对克罗恩病正确把握手术时机及选择手术方式,围手术期结合激素及免疫抑制剂治疗是取得满意治疗效果的关键。

探讨肝癌自发性破裂的发病机制和外科治疗方法。采用文献回顾的方法对肝癌自发性破裂患者的临床资料加以综合比较、综述。结果表明,肝癌自发性破裂可能与门脉高压、肝癌组织坏死、凝血功能障碍、血管病变及抗原抗体复合物的血管壁沉积有关。急诊治疗首选肝动脉插管栓塞,待患者一般情况好转后采用二期手术治疗可取得良好的效果。肝癌破裂大出血者,如果符合手术指征,在辅以其他治疗的同时,应尽可能的及时手术治疗。

目的探讨HIF-1和COX-2在高原重症急性胰腺炎（SAP）中的作用以及二者之间的关系,初步探讨高原SAP的发病机制,为更好的诊治SAP提供理论基础。方法将72只SPF级健康雄性Wistar大鼠随机根据海拔不同分为3个大组（每组24只）,再将每个大组随机分成4个小组（每组6只）。采用向胰胆管逆行注射5%牛磺胆酸钠的方法建立SAP动物模型。SAP组（p组）在造模后的第6、12、24 h分批处死大鼠,假手术组（n组）在造模后6 h处死大鼠,分别测定血清淀粉酶（AMY）、胰腺组织缺氧诱导因子（HIF-1）和环加氧酶-2（COX-2）含量,观察胰腺组织病理变化并评分。结果p组各时点的胰腺病理评分及AMY、COX-2、HIF-1均较n组显著增高（P＜0.05）。三个海拔的p组相比,胰腺病理评分及HIF-1、COX-2的表达具有显著性差异（P＜0.05）。HIF-1、COX-2、HE评分呈正相关（P＜0.05）。结论①HIF-1、COX-2在SAP的早期即被激活,被激活因子可能在SAP的始发阶段起重要作用;②HIF-1与COX-2密切关联;③HIF-1、COX-2在高原SAP的发生发展中起重要作用。