Chen, Biao, Shuai Li, Kun He, Dunzhu Basang, Yuzhen Suolang, Fang Li, Jiangcun Silang, Hongyuan Yi, Langjie Jinmei, La Dan, Deqing Ciren, Haifeng Xu, and Dong Wu. Mitigating Intraoperative Fatigue in Surgeons at High Altitude: A Stepped-Wedge Cluster Randomized Trial. High Alt Med Biol. 00:00-00, 2026. BACKGROUND:Both genetically adapted Tibetan surgeons and less-acclimatized Han surgeons deployed through the Aid-Tibet medical aid program face significant challenges from hypobaric hypoxia in the Qinghai-Xizang Plateau. Hypoxia is known to impair cognitive functions and induce fatigue, threatening surgical performance and patient safety. Traditionally, surgeons in Tibet consume Coca-Cola to combat fatigue, a potentially harmful practice lacking in scientific basis. Supplemental oxygen, recommended for better cerebral oxygen delivery, is underutilized. This study compares supplemental oxygen versus Coca-Cola in mitigating intraoperative fatigue among surgeons in Tibet, considering the influence of long-term high-altitude adaptations. METHODS:We conducted a stepped-wedge cluster randomized controlled trial at the People's Hospital of Xizang Autonomous Region in Lhasa (3,650 m altitude). Twenty-two surgeons (11 Han, 11 Tibetan) performed 24 surgeries each, receiving either 100 ml of Coca-Cola every 30 minutes or continuous 2 l/min supplemental oxygen via nasal cannula. Cognitive fatigue was assessed using the d2 Test of Attention, and physical fatigue was measured using a dynamometer, before and after surgeries. The primary outcome was change in concentration performance (ΔCP). The secondary outcome was the change in maximum voluntary contraction force (ΔMVC). Data were analyzed using a linear generalized estimating equations model. RESULTS:All 22 surgeons completed 528 surgeries. Generally, supplemental oxygen significantly reduced cognitive fatigue compared to Coca-Cola (ΔCP: 6.08, 95% confidence interval [CI]: 1.37-10.80, p = 0.012). In subgroup analysis, oxygen significantly lowered cognitive fatigue in Han surgeons (ΔCP: 7.06, 95% CI: 0.72-13.40, p = 0.029), while the effect in Tibetan surgeons did not reach statistical significance (ΔCP: 4.82, 95% CI: -0.51-10.16, p = 0.076). No significant difference was observed in physical fatigue (ΔMVC: -0.18, 95% CI: -1.77-1.40, p = 0.822). CONCLUSIONS:Supplemental oxygen outperforms Coca-Cola in reducing cognitive fatigue during high-altitude surgery, especially for less-acclimatized Han surgeons, supporting its adoption to enhance surgeons' performance and well-being.

目的 探究腹腔镜手术治疗高原地区肝囊型棘球蚴病(hepatic cystic echinococcosis,HCE)的临床效果.方法 选取2021年4月至2022年3月西藏自治区人民医院普通外科收治的124例HCE患者进行前瞻性研究,根据手术方案的不同分为观察组(68例,采用腹腔镜手术治疗)和对照组(56例,采用开腹手术治疗).比较两组的手术相关指标、创伤应激指标(皮质醇、C反应蛋白)、术后疼痛程度、肝病生存质量量表1.0(Liver Disease Quality of Life Questionnaire 1.0,LDQOL1.0)评分及并发症发生情况.结果 观察组术中出血量少于对照组,术后进食时间、下床活动时间、排气时间、拔管时间、术后住院时间短于对照组,差异均有显著性(P＜0.05).术前两组血清皮质醇、C反应蛋白水平比较差异无显著性(P＞0.05);术后3d和7d两组血清皮质醇、C反应蛋白水平均明显高于术前,但观察组明显低于对照组,差异有显著性(P＜0.05);术后7d两组皮质醇、CRP水平均明显低于术后3d,差异有显著性(P＜0.05).两组术后疼痛程度均随时间延长而逐渐降低,且术后1d、3d和7d时观察组的疼痛程度均明显低于对照组,差异有显著性(P＜0.05).术前两组LDQOL1.0评分比较差异无显著性(P＞0.05);术后1个月和3个月两组LDQOL1.0评分均明显高于术前,且观察组明显高于对照组,差异有显著性(P＜0.05);术后3个月两组LDQOL1.0评分均明显高于术后1个月,差异有显著性(P＜0.05).观察组并发症发生率(2.94%)与对照组(1.79%)比较差异无显著性(P＞0.05).结论 腹腔镜手术治疗高原地区HCE创伤小、术后恢复快、疼痛程度轻,可有效提高患者生活质量,在严格把握适应证的前提下值得临床应用.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To explore the risk factors of primary acute mesenteric venous thrombosis (AMVT) in plateau area.Methods:Data of 54 primary AMVT cases admitted to the People's Hospital of Tibet Autonomous Region between Jan 2015 and Jul 2021 were retrospectively analyzed. There were 42 males and 12 females, aged from 29-79 years. One hundred and ninty matched volunteers severed as control. Logistic multivariate regression analysis was used to screen out independent risk factors. The receiver operating characteristic (ROC) curve and the area under the curve are used to evaluate the value of each indicator and model prediction.Results:Univariate analysis showed that the two groups were significantly different in gender, smoking history, drinking history, and hemoglobin concentration ( P<0.05); there was no significant difference in age, altitude of residence, uric acid and BMI ( P>0.05). Logistic multivariate regression analysis showed that male ( OR=2.466, 95% CI: 1.166-5.212, P=0.018), elevated hemoglobin levels ( OR=2.761, 95% CI: 1.411-5.403, P=0.003) were independent risk factors for primary AMVT. The area under the ROC curve of the two predictors and prediction model are 0.639 (95% CI: 0.559-0.719), 0.650 (95% CI: 0.563-0.737), 0.697 (95% CI: 0.618-0.776). Conclusion:Male and elevated hemoglobin levels are independent risk factors for primary AMVT in plateau areas.

儿童胆石症是罕见的,患病率在不同国家之间存在差异;例如,意大利报道为0.13％～0.2％,日本约为0.13％,荷兰的患病率最高为1.9％,我国学者报道为0.53％-1.16％[1-4];但随着医学水平的发展和超声医学的发展,小儿胆石症的患病率一直在上升.本文就我院普通外科手术治疗的儿童胆石症31例临床资料进行回顾性分析,以明确本地区儿童胆石症的临床特点,为儿童胆石症的治疗及预防提供信息,现将诊治情况汇报如下.

目的:观察藏医阿如色泄治疗慢性胆囊炎的临床疗效.方法:选取2019年3月-2020年6月山南市藏医医院脾胃科门诊或住院治疗的100例慢性胆囊炎患者作为研究对象,采用随机数表法分为治疗组和对照组,各50例.治疗组给予藏药基础药加阿如色泄疗法,对照组单纯给予藏药基础药治疗,对比两组临床疗效、证候疗效及胆囊彩超疗效.结果:治疗组临床疗效(92.00％,46/50)、证候疗效(96.00％,48/50)及胆囊彩超疗效(88.00％,44/50)均优于对照组(P＜0.05).结论:藏医阿如色泄治疗慢性胆囊炎临床疗效确切,能有效改善临床症状、藏医证候及影像学征象,值得临床推广.

目的 探讨腔内激光闭合术联合硬化剂在高原地区下肢静脉曲张患者中的治疗情况.方法 收集2019年4月至2021年10月在西藏自治区人民医院治疗的99例原发性下肢静脉曲张患者临床资料,所有患者均行单侧大隐静脉闭合术+泡沫硬化剂注射微创治疗,观察患者的围手术期指标、切口情况、大隐静脉闭合情况、复发情况及并发症发生情况.结果 术前合并溃疡者20例,比例为20.2％;术中出血量为10(10,20)ml;17例患者术中做了切口,切口比例为17.2％,切口长度为1(1,2)cm;平均住院时间(3.28±0.57)d;术后第7天、第1个月、第3个月、第6个月,均未出现伤口延迟愈合,其中术后第6个月随访时复发2例(2.02％).结论 腔内激光闭合术联合硬化剂是治疗高原地区下肢静脉曲张患者的安全、彻底、有效的微创方式.

目的 分析西藏地区藏族人群胆囊结石发生的相关因素.方法 以2020年8月至2021年7月在西藏自治区人民医院普通外科收治的胆囊结石患者为胆石组,以同期在体检中心体检的健康人群为对照组;对全部对象进行饮食行为问卷调查、体格及血液指标检查;个人饮食行为采用频数法调查,对象评估近两年来的饮食习惯平均周频次;计量资料两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用x2检验;使用logistic回归分析筛查独立相关因素.结果 共有612例对象纳入研究,其中胆石组317例、对照组295例.两组间在性别、女性产史、BMI水平、患脂肪肝及每周食用糌粑、牛奶、酒精次数等10个指标上比较有统计学差异(P＜0.05);进一步logistic单因素及多因素分析显示女性(OR=4.115,95％CI:2.693～6.288)、BMI(≥24 kg/m2)(OR=1.777,95％CI:1.208～2.614)、患脂肪肝(OR=9.380,95％CI:3.800～23.154)、夜宵(≥1 次/周)(OR=1.542,95％CI:1.031～2.306)、酒精(≥4 次/周)(OR=5.267,95％CI:2.382～11.648)是西藏地区藏族人群发生胆囊结石的独立危险因素;牛奶(≥4次/周)(OR=0.427,95％CI:0.225～0.810)、糌粑(≥4 次/周)(OR=0.565,95％CI:0.354～0.902)、每天吃早餐(OR=0.143,95％CI:0.080～0.256)是保护性因素;P值均＜0.05.结论 女性、肥胖或超重、患有脂肪肝、酒精摄入过多是西藏地区藏族人群胆囊结石发生的独立危险因素,而多食用牛奶及糌粑、规律早餐是保护性因素.

Objective: The present study aims to explore the application value of three-dimensional (3D) reconstruction technology in the preoperative evaluation of patients with complicated hepatic echinococcosis in Tibet.Methods: A total of 200 patients with complicated hepatic echinococcosis, admitted to our hospital between May 2019 and December 2020, who underwent radical hepatectomy, were enrolled in the present study. The patients were randomly divided into a preoperative computer tomography group and a preoperative 3D reconstruction group. According to the imaging results, a surgical plan was formulated. A comparison was made between the two groups of the coincidence rate of the surgical plan and intraoperative and postoperative complications.Results: The patients with hepatic echinococcosis who underwent 3D visualization reconstruction before surgery had a high compliance rate with the surgical plans and the operating time, the number of cases with blood flow blockage, the blood flow blockage time, intraoperative hemorrhage, and postoperative biliary fistulas were significantly lower.Conclusion: The application of preoperative 3D visualization reconstruction in patients with complicated hepatic echinococcosis in Tibet could effectively improve surgical safety.

目的 比较腹腔镜与传统开腹手术对肝囊型包虫病的临床疗效.方法 随机选取2015年1月-2020年1月间该院行手术治疗的50例肝囊型包虫病患者,根据手术方式不同分为腹腔镜组和开腹组,比较两组手术用时、术中出血、术后恢复及并发症等指标.结果 腹腔镜组手术时间(157.9±38.7)min,明显长于开腹组的(120.6±24.8)min,差异有统计学意义(t=4.057,P<0.05);腹腔镜组术中出血、术后住院时间、消化道功能恢复时间明显少于开腹组[分别为(120.7±36.3)mL vs(189.4±80.5)mL、(6.7±2.2)d vs(12.9±5.8)d、(34.9±17.5)h vs(47.3±18.2)h],差异有统计学意义(t=3.890、4.997、2.456,P<0.05);腹腔镜组胆漏、感染、腹腔积液等发生率少于开腹组(分别为12.0％vs 20.0％、4.0％vs 8.0％、8.0％vs 12.0％),两组差异无统计学意义(χ2=0.595、0.355、0.222,P>0.05);两组复发率差异无统计学意义(χ2=0.355,P>0.05).结论 腹腔镜手术治疗肝囊型包虫病相比传统开腹手术,具有患者住院时间短、恢复快等特点,但实施时需要严格把握手术适应证.

目的 观察三维可视化技术用于肝占位性病变精准手术中的效果.方法 选择2018年10月-2019年11月收治的35例肝占位性病变患者(10例肿瘤,25例肝包虫),所有患者术前均接受64排CT扫描,提取毫米扫描数据,将其整合至三维可视化软件MI-3DVS内,分别予以切割图像、三维重建、肝脏分段、体积测算、规划虚拟摘除平面、拟定手术方案.结果 所有患者经三维可视化技术处理后,均能清晰的呈现出肝脏中各血管形态、分段及病变部位、规格大小及具体数目.术中所观察到的肿瘤情况和术前规划相符率达到100％(10/10).依照三维重建结果拟定术前计划,现实手术操作和术前规划相符率为100％(10/10),手术切除工作顺利进行,围手术期未出现死亡病例,2例患者术后出现胸腔积液,经引流处理后符合临床治愈标准.对于25例肝包虫病患者,虚拟手术设计欲切除的肝脏体积为(762.12±504.17)mL,在全肝体积中所占比例为(39.22±18.74)％,术中实际切除肝脏体积为(755.84±501.86)mL.在全肝体积中占(38.97±16.97)％,经统计学软件分析,虚拟手术欲切除肝脏体积和术中实际切除体积差异无统计学意义(t=0.044,0.039,P均＞0.05).结论 针对肝占位性病变患者,采用三维可视化技术能提升术前诊断的精确性,术前对手术方案作出规划,以进一步提升术中操作准确度,优化临床治疗效果.

目的 探究快速康复外科理念应用于肝囊型包虫病内囊摘除手术治疗的效果,为快速康复外科理念在临床上的推广提供参考.方法 将60例患者分别分成A组(传统组)和B组(快速康复组),观察比较两组手术时间、术中出血量、术后下床活动时间、首次进食时间、首次肛门排气时间、术后住院天数、住院费用情况.结果 两组的一般资料(性别、年龄和体质指数)比较差异无统计学意义(P＞0.05),手术时间(min)、术中出血量(ml)方面的比较差异无统计学意义(P＞0.05),而在术后下床活动时间(h)、术后首次进食时间(h)、术后首次肛门排气时间(h)、术后住院时间(天)、住院费用(元)方面的比较,两组比较(p＜0.05)差异有统计学意义.结论 将快速康复外科理念应用于肝囊型包虫病内囊摘除手术治疗中,可加快患者术后的康复,缩短住院时间,降低住院费用,值得在临床上的推广.

The capacitor placement based on rational reactive power partition can reduce the power loss and increase benefits in middle distribution systems. So this paper proposes a new capacitor placement method based on reactive power partition. First the distribution is partitioned by Depth First Search algorithm and the principle that the reactive power of each partition load is the most similar. Then the number of node is also more similar in each partition. This is helpful for the selection of locations. Secondly the locations and capacity are simultaneously optimized after partition and obtain more benefits. Finally the 94 node distribution system proves the advantage and practicality of the proposed algorithm.

This paper proposes a heuristic method for optimization of reactive power compensation. Firstly, two fuzzy sets of node voltage and cost savings are formed. The compensation location with the greatest compensation suitability is obtained by fuzzy reasoning. Considering the operation modes of several different loads, the mathematical model of reactive power compensation optimization is established, and fuzzy multi-objective optimization is adopted. The method solves the fixed and variable compensation capacity, and calculates the compensation capacity for each existing compensation position cycle until the change does not occur. The above process is repeated until the new compensation position is no longer saved, and finally all the compensation positions, capacity and total savings can be obtained. The example analysis shows the effectiveness and practicability of the method.

目的 对比传统开腹胆总管切开取石+胆囊切除术与经十二指肠镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)+内镜乳头括约肌切开取石术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石临床疗效.方法 回顾性分析2016-09 ～ 2017-09在该院接受治疗的88例胆囊结石合并胆总管结石患者的基本资料.将上述患者分为开腹组(开腹胆总管切开取石+胆囊切除术,44例)和ERCP+ EST+ LC组(44例).比较两组患者的一般临床资料、手术时间、住院时间、住院费用、术前术后肝功能及术后并发症情况.结果 两组术前谷丙转氨酶(ALT)、谷草转氨酶(AST)方面比较差异无统计学意义(P＞0.05),而在手术时间、住院时间、住院费用、术后ALT、术后AST、术后总并发症发生率方面比较差异有统计学意义(P＜0.05).结论 ERCP+ EST+ LC组治疗胆囊结石合并胆总管结石总体优于传统开腹胆总管切开取石+胆囊切除术,且手术时间及住院时间短,住院费用少,术后肝功能损伤小,安全性较高,值得推广.

目的 探讨在高原地区进行腹腔镜胆囊切除术(LC),不同CO2气腹压对呼吸及术后不良影响.方法 选取西藏自治区人民医院外一科胆囊结石并慢性胆囊炎病例82例,择期在全身麻醉下行胆囊切除术.分为低压组(L)10mmHg、高压组(H)14mmHg.观察患者气腹前20min、气腹中20min、放气后20min呼吸循环及术后不良影响.结果 两组在手术前平均动脉压(MAP)mmHg、手术时间(min)无明显差异(P>0.05);气腹前、气腹后及放气后20min,心率HR(min)和平均动脉压MAP(mmHg)均无明显差异(P>0.05);气腹前及放气后20min呼吸末二氧化碳分压(PETCO2)均无明显差异(P>0.05),但气腹后20min呼吸末二氧化碳分压(PETCO2)有差异(P<0.05);术后两组出现肩胛区疼痛、呕吐、心律失常不良影响的总发生率有差异(P<0.05).结论 在高原地区进行腹腔镜胆囊切除术,CO2气腹压越高对呼吸及术后不良影响越明显.