目的 深入了解T管带管患者对居家护理平台服务的体验及效果评价,明确居家护理平台进一步改善的方向,为各医疗机构居家护理相关制度的制定提供参考依据.方法 根据目的抽样法和信息饱和原则选取居家护理平台T管带管患者,对其进行半结构式访谈,对访谈过程进行录音,使用NVivo 11.0软件将访谈资料转录为文字,经双人核对后,按顺序进行编码、归纳,最终形成主题并进行验证,得出结论.结果 共提炼出2个主题:①T管带管患者对居家护理平台服务满意;②T管带管患者对居家护理平台服务改进的具体期待.结论 居家护理平台的优势明显,专业的团队和科学的流程规范满足了社会需要和患者的多元化、多层次需求,未来健康、有序的居家护理环境还需广大医护人员共同建设.

目的 探讨CICARE沟通模式对留置T管患者的影响.方法 采用方便抽样法选取2020 年 9 月—2021 年2 月本科室收治的 100 例留置T管的患者作为研究对象,本研究采用历史对照研究的方法,其中将2020 年9 月—11 月收治的50 例患者作为对照组,将2020 年 12 月—2021 年2 月收治的50 例患者作为观察组.对照组实施常规护理措施,并采用单向沟通的常规模式进行术后护患沟通及出院后的电话回访;观察组在术后当天、术后第3 天、术后第7～9 天、出院前、出院后 1 个月5 个阶段采用CICARE沟通模式.对比两组患者对T管相关知识的认知度、出院后对正确T管护理措施的应用情况以及术后并发症的发生情况.结果 观察组 T管认知度评分高于对照组(P＜0.05),观察组出院后对T管护理措施的正确应用率高于对照组(P＜0.05),观察组的术后并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论 实施CICARE沟通模式能提高留置T管患者对T管相关知识的认知度,并能使患者在生活中采取正确的T管护理措施,进一步降低了术后并发症发生率,值得推广.

良好的术野暴露和操作空间是完成腹腔镜肝切除手术的基础，对于肝Ⅶ段肿瘤的切除，腹腔镜手术存在较大困难和风险。本研究回顾性分析7例完全腹腔镜下肝蒂优先背侧入路解剖性肝Ⅶ段切除患者的临床资料。术后病理结果提示肝细胞癌3例、肝局灶性结节增生2例、肝血管平滑肌脂肪瘤1例、神经内分泌癌1例，7例患者术后均未出现Clavien-Dindo Ⅲa级以上并发症。术后住院5~14（8.5±2.4）d。至随访截止日期，所有患者均存活，4例恶性肿瘤患者术后未见明显复发征象。本研究表明由熟练的手术团队施行肝蒂优先背侧入路腹腔镜解剖性肝Ⅶ段切除安全可行，近期疗效优良。

卡波西样血管内皮瘤是一种内皮来源的具有局部侵袭性的肿瘤。其好发于皮肤、四肢等浅表部位，发生于肝、脾者临床较为罕见。本文报道2例分别原发于肝与脾的卡波西样血管内皮瘤患者的临床资料，并结合相关文献，复习总结诊治经验。

患儿男性,5岁,8个月早产儿.因尿色深黄1周,皮肤巩膜重度黄疸1天于2019年4月外院就诊.腹部体检:腹部稍膨隆,上腹部可见腹壁静脉显露,余项无明显异常.白细胞计数10.23×109/L,谷丙转氨酶142?U/L,谷草转氨酶317?U/L,总胆红素151.4?μmol/L,糖基抗原19-9?162.97?U/mL.MRI示:胰头区占位性病变并肝内外胆管扩张.于2019年4月转入湖南师范大学附属第一医院后,复查血常规:白细胞计数13.46×109/L,总胆红素 142.1 ?μmol/L,谷草转氨酶372.16?U/L,谷丙转氨酶100?U/L.

总结新型冠状病毒肺炎防疫期间长沙市某三级甲等医院肝胆外科实施的护理应急管理策略,主要包括强化护士突发传染病知识培训、制订科学规范的病房护理管理制度、利用"护+"平台开展科普和咨询等措施,以切实保证科室住院患者的健康安全,通过科学规范的病房护理管理策略,有效地提高了护理工作质量,实现住院患者"零死亡",院内感染"零发生".

目的 探讨肝脏血管肉瘤临床症状、病理特点及诊治要点.方法 回顾性分析本院2014年5月到2020年5月收治的11例肝脏血管肉瘤患者的临床资料,包括临床症状及特征、病理特点及诊治方法.结果 发现肝血管肉瘤存在腹胀、腹痛表现,存在轻度贫血、D-二聚体水平增高的实验室检查特点,而甲胎蛋白(alpha fetoprotein,AFP)值在正常范围,B超及CT影像学结果均显示为血供丰富的肿瘤.结论 肝脏血管肉瘤缺乏临床特异性症状与体征,病理检查可明确诊断,穿刺诊断较为安全,预后差而且目前没有成熟的治疗方案.

目的 探讨不同冲洗液温度对纤维胆道镜取石术后患者生命体征和并发症的影响.方法 选取2016年5月至2018年2月我院进行术后纤维胆道镜检查的600例患者作为研究对象,将患者随机等分为A,B,C 3组,其中A组患者给予温度为20～25℃的冲洗液,B组给予温度26～30℃的冲洗液,C组给予温度为31～35℃恒温冲洗液.比较3组患者冲洗前后生命体征变化以及术后并发症发生情况.结果 A,B组患者冲洗后体温、心率、呼吸频率均明显高于冲洗前(P<0.05),但冲洗前后收缩压、舒张压比较差异无统计学意义(P>0.05);C组患者冲洗前后生命体征变化比较差异无统计学意义(P>0.05).C组患者冲洗后发热、寒颤、胃肠道反应等并发症发生率明显低于A,B组(P<0.05),但3组患者胆道出血、胆瘘发生率比较差异无统计学意义(P>0.05).结论 术后纤维胆道镜检查,采用恒温冲洗液(31～35℃)能够有效维持患者生命体征,降低术后并发症的发生率,减轻患者不适,有效地促进患者恢复,其操作简单方便,值得推广应用.

目的 研究对中晚期肝细胞肝癌患者实施肝动脉化疗栓塞术(TACE)与索拉非尼联合治疗的临床治疗效果.方法 选取2015年4月～2017年4月在我院进行治疗中晚期肝细胞肝癌的患者,共100例,根据入院时间分为Z组和C组,C组患者实施肝动脉化疗栓塞术(TACE)进行常规治疗及护理,Z组患者实施肝动脉化疗栓塞术(TACE)与索拉非尼联合治疗及综合护理,对比两组患者在治疗过程中出现不良反应的概率以及护理满意度.结果 Z组患者实施联合治疗后产生不良反应的概率明显低于C组患者(P<0.05);Z组患者的护理总有效率明显好于C组患者(P<0.05).结论 肝动脉化疗栓塞术(TACE)与索拉非尼联合治疗,不仅可以促进患者的治疗效果,还可以提高患者的护理满意度,值得临床推广应用.

目的 探讨PDCA循环管理模式在肝胆外科管道护理中的应用效果.方法 选择2018年7月～9月我院肝胆外科行胆囊切除和胆道探查术的胆总管结石患者64例作为对照组,另选择2018年10月～12月我院肝胆外科行胆囊切除和胆道探查术的胆总管结石患者71例作为实验组.对照组采取常规留置管道护理措施,实验组采用PDCA循环管理模式对进行护理安全管理,对比两组管道安全事故发生率及护理满意度评分.结果 实验组护理安全事故总发生率为5.63％,低于对照组的20.31％,差异有统计学意义(<0.05).实验组管道护理规范性、护理态度、护理质量、护理专业性及总分高于对照组,差异有统计学差异(<0.05).结论 PDCA循环管理模式可有效降低肝胆外科术后患者管道护理安全事故发生率,提升护理质量,提高患者满意度.

目的 探讨基于“护+”APP的上门护理服务在肝胆外科T管出院患者中的应用效果.方法 于2017年11月～2018年10月在我院肝胆外科手术治疗后带管出院并接受“护+”APP上门护理服务的长沙市区患者中随机选取62例纳入实验组,同时从带管出院未接受“护+”APP的上门护理服务的长沙市区患者中随机选取62例纳入对照组.对照组接受常规的出院指导,实验组在对照组基础上接受“护+”APP的上门延续护理服务.比较两组患者并发症发生情况(发热、管道堵塞、管道脱落、胆道出血)、感染发生率、护理知识掌握程度、焦虑评分及生活质量.结果 实验组并发症发生率为3.23％,感染发生率为1.61％,低于对照组的19.35％、12.90％,差异有统计学意义(P＜0.05);实验组焦虑评分低于对照组,差异有统计学意义(P＜0.05);实验组生理功能、症状学、社会活动与日常生活能力、精神状态以及治疗评价得分均高于对照组,差异有统计学意义(P＜0.05);实验组患者护理知识掌握程度高于对照组(96.77％ vs 75.81％),差异有统计学意义(P＜0.05).结论 “护+”APP的上门护理服务的建立对于促进肝胆外科术后带管出院患者的康复有着明显的效果,能够降低患者并发症及感染发生率,改善患者焦虑等不良情绪,提高患者生活质量,提高患者对护理知识的掌握程度,进而改善患者预后.

Objective: To investigate the efficacy and safety of primary closure of the common bile duct plus nasobiliary drainage via antegrade transabdominal approach in treatment of common bile duct stones. Methods: One hundred and thirty-eight patients with gallstones and concomitant choledocholithiasis admitted in the Department of Hepatobiliary Surgery of Hunan Provincial People's Hospital from August 2015 to February 2017 were enrolled. Of the patients, 45 cases underwent laparoscopic cholecystectomy, common bile duct exploration and endoscopic nasobiliary drainage with primary choledochal closure (nasobiliary drainage group), and 93 cases underwent laparoscopic cholecystectomy and common bile duct exploration plus T-tube drainage (T-tube drainage group). The main clinical variables between the two groups of patients were compared. Results: Operations were successfully completed in all the 138 patients, and no serious surgical complication occurred. In nasobiliary drainage group compared with T-tube drainage group, the operative time, intraoperative blood loss and volume of bile drainage on the first postoperative day showed no significant difference (all P>0.05), but the time to postoperative bowel function recovery, retention of the bile drainage tube, length of hospital stay and hospitalization cost as well as the amount of postoperative fluid infusion, and the volume of bile drainage on the second and third postoperative day were all significantly reduced (all P<0.05). There was no significant difference in overall incidence of postoperative complications between the two groups (P>0.05), but the incidence of symptoms of electrolyte imbalance such as nausea and vomiting in nasobiliary drainage group was significantly lower than that in the T-tube drainage group (P<0.05). Conclusion: Nasobiliary drainage extends the indications for primary closure of the common bile duct, and can shorten the tube retention time and length of hospital stay, and reduce the fluid and electrolyte disorders, with no increase of complications such as bile leakage and biliary stricture. It has certain superiority to T-tube drainage, but its indications should be followed.

[目的]探讨全程健康教育模式在肝胆结石病区的应用效果.[方法]选取2015年11月至2016年10月于本院接受手术治疗的76例肝胆管结石患者,随机分为观察组和对照组各38例.观察组采用全程健康教育模式实施护理,对照组采用肝胆外科常规护理模式实施护理.比较两组患者的离床活动时间、肛门排气时间、住院天数、患者对健康知识的掌握程度、不良事件发生率、患者满意度.[结果]观察组患者离床活动时间、肛门排气时间、住院天数及不良事件发生率明显低于对照组,而患者对健康知识的掌握程度及满意度明显高于对照组(均 P <0.05).[结论]全程健康教育模式可明显改善肝胆管结石患者的健康教育效果,可作为一种制度化、常规化的护理措施在临床推广应用.

Objective:To investigate the expressions of annexin A2 and the epithelial-mesenchymal transition (EMT) markers E-cadherin and vimentin in hepatolithiasis-associated intrahepatic cholangiocarcinoma and their significance.Methods:The expressions of annexin A2,E-cadherin and vimentin in tumor tissues from 46 patients with hepatolithiasis-associated intrahepatic cholangiocarcinoma (tumor group),bile duct tissues with chronic inflammation from 50 patients with simple hepatolithiasis (inflammation group) and normal bile duct tissues form 35 patients undergoing surgical resection for hepatic hemangioma or liver injury (normal group) were determined by immunohistochemical staining.The expressions of the three proteins among the groups were compared and their relations with clinicopathologic factors and prognosis of the patients with hepatolithiasis-associated intrahepatic cholangiocarcinoma were analyzed.Results:The positive expression rates of both annexin A2 and vimentin were presented in descending order as tumor group＞inflammation group＞normal group (69.6％ vs.36.0％ vs.11.4％;54.3％ vs.28.0％ vs.8.6％,all P＜0.05),while the opposite pattern was seen in that of E-cadherin (21.7％ vs.48.0％ vs.71.4％,all P＜0.05).In cholangiocarcinoma tissues,there was a positive correlation between the annexin A2 and vimentin expression (r=0.627,P＜0.05),and negative correlation between the E-cadherin expression and either the annexin A2 or vimentin expression (r=-0.682;r=-0.575,both P＜0.05).The expressions of annexin A2 and vimentin were significantly associated with the degree of tumor differentiation,lymph node metastasis and TNM stage,and E-cadherin expression was significantly associated with the degree of tumor differentiation and lymph node metastasis (all P＜0.05).Among the patients with hepatolithiasis-associated intrahepatic cholangiocarcinoma,the survival rate in cases with positive annexin A2 or vimentin expression was significantly lower than that in their corresponding negative ones,and the survival rate in cases with negative E-cadherin expression was significantly lower than that in those with its positive expression (all P＜0.05).Conclusion:The annexin A2/EMT pathway may probably play an important role in the development and progression of hepatolithiasis-associated intrahepatic cholangiocarcinoma.The expressions of annexin A2,E-cadherin and vimentin are closely related to the degree of malignancy of the tumor and prognosis of the patients.

Objective:To investigate the alteration of serum microRNAlet-7a (let-7a) level in patients with hepatocellular carcinoma (HCC) and its diagnostic value for HCC.Methods:The let-7a expressions in 60 HCC patients and 46 healthy subjects undergoing health maintenance examination were measured by qRT-PCR.And then the relations of serum let-7a level with clinicopathologic factors of HCC patients were analyzed and the diagnostic efficacy of let-7a for HCC was determined by using a receiver operating characteristic curve (ROC).Results:The relative expression level of serum let-7a in HCC patients was significantly lower than that in healthy population (0.538 vs.1.571,P＜0.05).The serum let-7a level was significantly associated with the formation of tumor emboli (P＜0.05),but was irrelevant to all other studied factors that included sex,age,HBV infection,cirrhosis,tumor diameter,tumor number,lymph node metastasis,TNM stage,pathological grade and AFP level (all P＞0.05).At an optimal cut-off value of 0.529 of let-7a for diagnosis of HCC,the sensitivity was 79％,the specificity was 71％ and the area under the curve (AUC) was 0.77 (95％ CI=0.624-0.839) respectively;in combined detection of serum let-7a and AFP for diagnosis of HCC,the sensitivity was 83％,the specificity was 97％ and the AUC was 0.92 (95％ CI=0.866-0.987),respectively.Conclusion:The serum let-7a level is decreased in HCC patients,which may be potentially used as a newmolecular marker for diagnosis of HCC,and its diagnostic efficacy for HCC can be enhanced by combinationdetection of AFP.

Objective To formulate a comprehensive and reasonable admission nursing assessment sheet with specialty features, so as to improve quality of nursing assessment for patients at admission to Department of Hepatobiliary Surgery. Methods According to characteristics of patients newly admitted to Department of Hepatobiliary Surgery and need of medical service,a nursing assessment sheet suitable for inpatients to Department of Hepatobiliary Surgery was designed,with main contents including basic information, physical examinations for nursing,conditions of daily life,social and psychological conditions,specialty examinations,risk of falling down from bed,and risk of pressure sores. Incidence rate of adverse nursing events like patients' falling down from bed or pressure sores,and the patients' satisfaction were compared before (June 2014 to May 2015) and after (June 2015 to May 2016) application of this sheet. Results After application of this new version of admission nursing assessment sheet,incidence of adverse nursing events happened to inpatients dropped from 2.95% to 0.91% (χ2=4.386,P< 0.05);patients' satisfaction increased from (83.16±10.62) to (90.41±8.66) (t=14.103,P<0.05). Conclusions By using this new version of admission nursing assessment sheet,status of the patients can be assessed in a diversified and multi-dimensional way,so that incidence of falling down from the bed can be lowered,medical risks be decreases,patients' satisfaction be increased,and nursing efficiency be improved,which make it worth promoting in Department of Hepatobiliary Surgery.

Objective:To discuss the effect of pipeline standard management implementation on reducing the pipeline adverse events of inpatients. Methods:Selected 2853 patients in our hospital before the implementation of pipeline standard management from January to December in 2013 as before-implementa-tion group;selected 2985 patients in Januaryto December in 2014 as after-implementation group;established pipeline standard management group,defined members'responsibilities; improved pipeline standard management by training,formulating pipeline marks,quality inspection and constant quality improve-ment;compared the incidence rate of adverse events and patients'satisfaction before and after the implementation. Results:The implementation of pipeline standard management could reduce the incidence rate of adverse events and improve patients'satisfaction;the differences had statistical significance ( P<0. 05). All nurses improved their theoretical knowledge of pipeline nursing and average scores of operating skill after the implementation (P<0. 05). Con-clusion:Pipeline standard management could reduce the incidence of adverse events of pipeline nursing and improve inpatients'satisfaction.

目的:探讨延续护理对提高带T管出院患者自我护理能力的效果.方法:将2014年4～8月出院的45例胆总管切开探查或取石术后带T管患者作为对照组,采取常规出院宣教;将2014年9～12月出院的50例胆总管切开探查或取石术后带T管患者作为观察组,实施延续护理服务.比较两组患者出院时、出院后1个月和出院后2个月的各项自我护理能力评分,以及带管期间的护理不良事件发生率.结果:出院后l,2个月观察组患者自我护理能力评分高于对照组患者(P＜0.05),带管期间护理不良事件发生率低于对照组患者(P＜0.05).结论:延续护理能明显提高带T管患者的自我护理能力,减少护理不良事件的发生率,对临床护理工作有一定的延伸意义.

目的:探讨梗阻型轻症急性胆源性胰腺炎(MABP)的最佳治疗方案.方法:回顾性分析2008-2014年收治的132例梗阻型MABP患者的临床资料.其中35例行以内镜逆行胆胰管造影为基础的微创治疗(内镜组),43例行腹腔镜下胆囊切除、胆总管探查术(腹腔镜组),54例行开腹手术(开腹组).比较各组的相关临床指标.结果:内镜组、腹腔镜组、开腹组间的腹痛缓解时间(3.31 d vs.3.84 d vs.7.65 d)、白细胞恢复正常时间(4.20 d vs.5.35 d vs.8.72 d)差异均有统计学意义(均P＜0.05);内镜组与腹腔镜组的血淀粉酶恢复正常时间(3.26 d vs.3.53 d)、住院时间(9.49 d vs.9.30 d)差异无统计学意义(均P＞0.05),但均短于开腹组(4.35 d、9.30 d)(均P＜0.05).3组的治愈率均为100％,均无死亡病例,并发症发生率差异无统计学意义(P＞0.05);内镜组术后1年内胰腺炎复发率(42.86％)明显高于腹腔镜组(0.00％)和开腹组(1.85％)(均P＜0.05),但后两组间差异无统计学意义(P＞0.05).结论:对于梗阻型MABP,在大多数情况下,腹腔镜途径是解除胆道梗阻的首选方法.

目的:探讨品管圈活动在提高带T管患者自我照护能力中的应用效果.方法:2014年4～10月,通过成立品管圈小组、确定主题、拟定活动计划、分析现状、设定目标、实施整改措施、效果评价等流程开展为期6个月的品管圈活动.结果:品管圈活动实施后,带T管患者的自我照护能力高于实施前(P＜0.05),圈员对手法的运用及其自信心较实施前均有明显提升.结论:品管圈活动能有效提高带T管患者的自我照护能力,提升护理人员的素质.