目的 探讨常规二维超声、超声弹性成像技术和经皮超声造影(CEUS)对乳腺癌患者同侧腋窝前哨淋巴结的诊断价值.方法 对158例乳腺癌患者进行回顾性分析,术前均行常规二维超声、超声弹性成像、CEUS及粗针穿刺,以病理穿刺结果为金标准,与病理结果一致性进行Kappa检验,以病理诊断前哨淋巴结转移为因变量,以常规二维超声、超声弹性成像和CEUS为自变量,建立Logistic回归模型,并用ROC曲线评价常规二维超声、超声弹性成像和CEUS对乳腺癌前哨淋巴结的诊断价值.结果 经病理诊断共检出206个淋巴结,其中转移性76个,非转移性130个.常规二维超声检查对乳腺癌前哨淋巴结转移的敏感度为69.7％,特异性为94.6％,准确度为85.4％;应用超声弹性成像技术检查的敏感度为84.0％,特异性为96.9％,准确度为92.2％;CEUS检查的敏感度为88.3％,特异性为98.4％,准确度为94.7％;三者联合检查的敏感度为93.4％,特异性为99.2％,准确度为97.1％;与病理结果一致性进行比较,弹性成像、CEUS的一致性均高于常规二维超声,三者联合诊断的一致性最好(Kappa=0.683、0.828、0.884、0.937,P<0.05).ROC曲线显示:常规二维超声、超声弹性成像、CEUS和三者联合诊断乳腺癌前哨淋巴结转移的曲线下面积为0.668、0.712、0.738、0.756.结论 超声弹性成像技术、CEUS对乳腺癌前哨淋巴结的诊断价值均高于常规二维超声,且三者联合诊断的敏感度、特异性、准确性更高,对术前乳腺癌患者同侧转移性前哨淋巴结的诊断具有重要价值.

Objective:To compare the milligant-morgant hemorrhoidectomy (MMH), procedure for prolapse and hemorrhoids (PPH), tissue selecting therapy (TST) and Doppler-guided hemorrhoidal artery ligation (DG-HAL) in the treatment of hemorrhoids, and to provide evidence-based reference in clinic.Methods:The full-text database of CNKI, Wanfang Database, CBMdisc, Pubmed, Cochrane Library and Embase were retrieved from the date of their establishment to December 2020. Randomized controlled trials (RCTs) about MMH, PPH, TST and DG-HAL in the treatmnet of hemorrhoids were collected. Meta-analysis was conducted by using GeMTC 0.14.3 statistical software.Results:A total of 45 RCTs were included, involving 5 847 patients. Compared with MMH, DG-HAL (MD=-4.16, 95% CI: -6.49, -1.82; P<0.05) and PPH (MD=2.28, 95% CI: 0.64, 3.89; P<0.05) could significantly reduce the degree of postoperative pain, the incidence of urinary retention after TST was significantly lower (OR=2.08, 95% CI: 1.23, 4.09; P<0.05). Compared with MMH (OR=0.01, 95% CI: 0, 0.15; P<0.05) and PPH (OR=0.08, 95% CI: 0, 0.78; P<0.05), the incidence of anal stenosis after DG-HAL was lower. PPH (OR=6.56, 95% CI: 1.20, 57.74; P<0.05) and TST (OR=58.25, 95% CI: 4.37, 2 605.94; P<0.05) had lower anal stenosis rates than MMH, TST was better than PPH (OR=8.50, 95% CI: 1.23, 150.91; P<0.05), with statistical significance. The order of probability were as follows: DA-HAL>TST>PPH>MMH in pain scores 24 hours after operation, MMH>PPH>TST>DA-HAL in postoperative bleeding, MMH>PPH>DA-HAL>TST in urinary retention, MMH>PPH>TST>DA-HAL in anal stenosis, DA-HAL>PPH>MMH>TST in recurrence rate.Conclusions:The four surgical methods show their own advantages in the treatment of hemorrhoids. DG-HAL and TST have low incidence of postoperative complications such as pain, bleeding, urinary retention, anal stenosis and obvious advantages in postoperative comfort and safety. However, in terms of recurrence rate, TST is the best and DG-HAL is the worst.

目的 回顾性分析吻合器痔上黏膜环切钉合术(PPH)术后吻合口狭窄与同期手术无狭窄者的临床资料,探讨吻合口狭窄相关的危险因素.方法 回顾性收集2015年1月至2020年6月期间在新疆医科大学第一附属医院和昌吉分院行PPH手术术后发生吻合口狭窄的112例作为病例组,根据1:1配对原则筛选同期住院行PPH术后未发生肛门狭窄的112例作为对照组,回顾性分析比较两组相关临床表现,进而通过logistics回归分析PPH术后吻合口狭窄的危险因素.结果 本研究结果显示瘢痕体质(χ2=62.910,P<0.001)、术后大便不成形(χ2=76.522,P<0.001)、既往手术史(χ2=5.448,P=0.032)与PPH术后吻合口狭窄有关,差异有统计学意义.Logistic多因素回归分析结果显示瘢痕体质(OR=5.238,95％CI:0.038～0.953;P<0.05)和术后大便不成形(OR=8.547,95％CI:0.036～0.3761;P<0.05)是PPH术后吻合口狭窄的独立危险因素.结论 PPH术后吻合口狭窄是由多种危险因素共同作用的结果.严格掌握手术适应证,对长期大便不成形、腹泻患者术前术后积极内科辅助治疗,建立良好的饮食排便机制,对于临床上降低PPH术后吻合口狭窄发生率意义重大.

Objective:To evaluate the effectiveness and safety of procedure for prolapse and hemorrhoids (PPH) and Doppler-guided hemorrhoidal artery ligation (DGHAL) in the treatment of hemorrhoids by systematically analyzing the data of operation time, hospital stay, pain score, postoperative recurrence rate and related complication rates.Methods:The full-text database of CNKI, Wanfang database, CBMdisc, Pubmed, Cochrane Library and Embase were retrieved from the date of their establishment to December 2020. All clinical studies of PPH and DGHAL in the treatment of hemorrhoids were collected. Two reviewers independently screened the literature and extracted the data, and analyzed the heterogeneity of the included studies.Results:A total of 1 316 patients were included in 14 studies, including 646 in PPH group and 670 in DGHAL group. Meta analysis showed that there were no significant differences between the two groups in terms of operative time (WMD=1.58, 95% CI: -2.40-5.55; P=0.44), bleeding (OR=1.75, 95% CI: 0.96-3.19; P=0.07) and urinary retention (OR=1.47, 95% CI: 0.91-2.38; P=0.11). There were significant differences in the length of hospital stay (WMD=1.39, 95% CI: 0.59-2.20; P=0.000 7), and 24-hour pain score (WMD=2.34, 95% CI: 1.10-3.58, P=0.000 2). The recurrence rate of DGHAL group was significantly higher (OR=0.62, 95% CI:0.43-0.88, P=0.007). The incidence of anal stenosis in PPH group was 13.68% (26/190), which was higher than that in DGHAL group (5.79%, 11/190) (OR=2.79, 95% CI: 1.31-5.98, P=0.008).Conclusions:DGHAL therapy is associated with significantly less rectal stenosis rate, postoperative recovery and pain. However, PPH is better than DGHAL in the long-term efficacy.

目的 探讨快速康复护理对全膝关节置换病人术后膝关节功能恢复的效果.方法 2018年12月-2019年4月选取新疆某三甲医院72例全膝关节置换术(TKA)患者,随机分为对照组和干预组,各36例,对照组给予常规护理,干预组给予快速康复护理.比较两组患者疼痛评分、美国特种外科医院膝关节(HSS)评分、关节活动度(ROM),术后首次下床时间、直腿抬高时间、导尿管留置时间、住院时间、并发症的差异.结果 干预组在术后2h、6h、1d、2d静息状态疼痛评分明显低于对照组(P＜0.05);干预组患者出院时及术后1个月膝关节HSS评分均明显高于对照组,同时术后3d、出院时及术后1个月ROM均大于对照组,差异具有统计学意义(P＜0.05);干预组首次下床时间、直腿抬高时间、导尿管留置时间、住院时间、并发症的发生率明显低于对照组(P＜0.05).结论 快速康复护理模式可以促进患者术后早期康复、缩短住院时间、提高患者术后膝关节功能恢复效果,具有临床推广价值.

Objective:To investigate the current status of frailty in elderly patients with fragile hip fractures and analyze its influencing factors.Methods:The clinical data of 196 elderly patients with fragile hip fractures who underwent surgical treatment in 4 Class Ⅲ Grade A hospitals from April to November 2019 were collected. Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess nutritional status, Montreal Cognitive Assessment (MOCA) was used to assess cognitive function, 5-Item Geriatric Depression Scale (GDS-5) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess mental state, Fried Frailty Phenotype (FP) was used to assess the occurrence of frailty of patients and multivariate binary logistic regression analysis was used to explore the influencing factors of frailty in patients.Results:Among the 196 elderly patients with fragile hip fractures, the incidence of frailty and non-frailty were 50.5% (99/196) and 49.5% (97/196) , respectively. There were statistically significant differences in incidence of frailty among elderly patients with fragile hip fractures with different ages, exercise frequency, self-perceived health status, sleep quality, activity of daily living, Charlson comorbidity index (CCI) , nutritional status, depression status assessment, cognitive status assessment and anxiety self-assessment ( P<0.05) . Logistic regression analysis showed that age, self-perceived health status, sleep quality, CCI and nutritional status were the main risk factors affecting the occurrence of fragility in elderly patients with fragile hip fractures ( P<0.05) . Conclusions:In elderly patients with fragile hip fractures, the incidence of frailty is higher, and the main risk factors for frailty are age, self-perceived health, sleep quality, CCI and nutritional status. It is necessary for medical staff to identify frailty patients before surgery and timely adopt interdisciplinary frailty management to reduce and delay the occurrence of frailty and promote the recovery of elderly patients with fragile hip fractures.

目的 了解老年髋部脆性骨折患者衰弱现状,分析其影响因素.方法 采用便利抽样法,选取2019年4—9月乌鲁木齐市4所三级甲等综合医院的老年髋部脆性骨折患者作为研究对象.采用基本资料、衰弱评估问卷、简易微型营养评估量表、简易认知状态量表、简明老年抑郁量表对其进行调查,采用二分类Logistic回归分析老年髋部脆性骨折患者衰弱发生的影响因素.结果 158例老年髋部脆性骨折患者衰弱评分(2.83±0.89)分,其中衰弱评分≥3分(即衰弱组)87例(55.1％),衰弱评分<3分(即非衰弱组)71例(44.9％).二分类Logistic回归分析结果显示:自我感觉健康状态、抑郁、共病状况是老年髋部脆性骨折患者衰弱的危险因素(P<0.05),手握力是老年髋部脆性骨折患者衰弱的保护性因素(P<0.05).结论 老年髋部脆性骨折患者的衰弱检出率较高,自我感觉健康状态较差、抑郁、共病状况、手握力低的老年患者衰弱发生率较高,医护人员尽早识别衰弱患者,加强衰弱管理,减少和延缓老年患者衰弱的发生.

目的 探讨加速康复外科护理在肝囊型包虫病患者围术期护理的实践效果.方法 选择2017年10月～2019年2月新疆医科大学第一附属医院肝胆包虫科患者106例,采用类实验研究方法,将符合纳入标准的肝囊型包虫病患者为研究对象,选择2017年10月～2018年5月的53例患者为对照组;选择2018年6月～2019年2月的53例患者为干预组,比较两组患者术后活动时疼痛评分、生活自理能力评分及术后恢复情况.结果 两组术后不同时点活动时疼痛评分、生活自理能力评分均高于术前,且干预组低于对照组,差异有统计学意义(P＜0.05);两组肛门排气、排便时间、术后首次下床活动时间、住院时间及费用比较,差异有统计学意义(P＜0.05).结论 加速康复外科护理在肝囊型包虫病患者中实践是安全有效的.

目的:探究信息-动机-行为(IMB)护理模式对老年高血压患者疾病认知优良率、并发症及生活质量的影响.方法:选取2016年1月～2017年12月收入我院的120例老年高血压患者为研究对象,按随机数字表法分为对照组和观察组,每组各60例,对照组采用传统护理模式,观察组在对照组基础上采用IMB护理模式,比较两组患者血压控制情况、疾病认知情况、治疗依从性、生活质量及并发症发生情况.结果:护理干预3个月后,对照组患者血压与护理前无明显差异(P＞0.05);观察组收缩压和舒张压均显著低于对照组(P＜0.05).观察组患者护理后对疾病的认识优良率为88.33％,显著高于对照组(60.00％),P＜0.05.护理干预后,对照组生活质量总分及各项项目评分与护理干预前无明显差异(P＞0.05);观察组生活质量总分、生理、心理、环境、社会关系及生活信念等项目评分明显高于对照组,(P均＜0.05),独立性评分与对照组无明显差异(P＞0.05).观察组各项不良事件发生率显著低于对照组,依从性为88.33％,明显高于对照组(48.33％)(P＜0.05).结论:IMB护理模式能够显著改善老年高血压患者血压水平,提高患者的生活质量和疾病认知情况,降低并发症的发生率.

目的:分析老年病区患者护理中人文关怀的应用价值.方法:将本院2017年1月—2018年1月老年病区患者74例纳入至本次研究中,根据患者不同入院时间将其平均分为两组,分别是37例,给予对照组患者常规护理,研究组则接受人文关怀,对两组护理满意程度进行比较.结果:在护理满意程度方面,对照组是72.97％,研究组是94.59％,研究组较对照组更高,差异具有统计学意义(P<0.05).结论:老年病区患者护理期间,应用人文关怀有助于改善老年患者心理状况,促进护理满意度的提高.

目的 探讨以案例为基础(CBL)结合以问题为基础(PBL)的教学方法在高校临床医学专业本科生教学中的应用.方法选择新疆医科大学2014级临床医学专业本科生共118人,分为观察组和对照组,观察组采用CBL联合PBL教学法,对照组采用填鸭式传统教学法,比较两组学生岗位胜任能力综合评价、国家执业医师考试外科学成绩、临床综合能力专家评价,手术操作能力专家评价,基本知识掌握能力、知识全面程度、主动动手学习能力、临床思考能力、团队协作能力、课堂气氛以及课程喜欢程度等.结果观察组在岗位胜任能力综合评价,国家执业医师资格考试外科学成绩,手术操作能力专家评价等方面均显示出优越性.在基本知识掌握能力[(87.4±8.9)分比(83.9±8.8)分]、知识全面程度[(83.0±6.9)分比(80.0±5.9)分]、主动动手学习能力[(84.6±7.1)分比(78.8±6.9)分]、临床思考能力[(83.9±7.4)分比(79.7±5.8)分]、团队协作能力[(84.8±6.8)分比(65.1±7.9)分]、课堂气氛[(85.3±7.7)分比(81.3±4.6)分]以及课程喜欢程度[(91.3±6.9)分比(88.5±7.6)分]等方面,观察组优于对照组.结论CBL联合PBL教学法与传统的填鸭式教学方法相比,有较为明显的优越性,岗位胜任能力综合评价、国家执业医师考试外科学成绩等均有不同程度的提高,其中岗位胜任能力综合评价效果最为显著,因此该教学方法在实际教学工作中值得推广与应用.

目的:观察参苓白术散联合针刺在老年脾虚湿盛型肠内营养相关性腹泻患者治疗中的应用效果.方法:选取2014年1月～2017年10月我院收治的86例老年肠内营养相关腹泻患者为研究对象,随机分为观察组与对照组各43例.对照组予以蒙脱石散治疗,观察组在对照组基础上予以参苓白术散联合针刺治疗.比较两组临床疗效、腹泻控制时间及肠内营养热量达标情况.结果:观察组治疗总有效率及肠内营养摄入量达标率明显高于对照组,腹泻控制时间明显低于对照组(P＜0.05).结论:老年脾虚湿盛型肠内营养相关腹泻患者采用参苓白术散联合针刺治疗,可有效提高临床疗效,缩短腹泻时间,增加营养摄入量,值得临床推广应用.

Objective The purpose of this study was to investigate the clinical curative effect of the timing of anti-tuberculosis treatment and surgical treatment in the treatment of tuberculous anal fistula in pulmonary tuberculosis patients.Methods Clinical data of 52 pul-monary tuberculosis patients with tuberculous anal fistula were evaluated according to the choice of operation time.Patients were divided into two groups undergoing surgery before anti-tuberculous treatment (group A)and surgery after anti-tuberculous treatment(group B). Clinic alanalysis was performed using correlation index.Results There were no statistical significances(P>0.05)between the two groups in gender,age,ethnic,duration,follow-up time.Total effective rate of anal fistula in group B was 100.00%,it was significantly higher than group A of 76.92%.There were statistical significances(P<0.05)between the two groups in the aspects of postoperative pain score,postoperative pain time,postoperative healing time and recurrence rate.However,there were no statistical significances(P>0.05)between the two groups in anal sphincter function score and life quality score.Conclusions Anti-tuberculous treatment before surgery may improve the prognosis of tuberculous accompanied with anorectal fistula.

目的 观察连蒲消肿熏洗液对Ⅱ、Ⅲ度混合痔术后的临床疗效.方法 将160例本病患者随机分为3组.治疗组选用连蒲消肿熏洗液熏洗治疗,阳性对照组选用高锰酸钾溶液熏洗治疗,阴性对照组选用70℃热水熏洗治疗.所有患者于术后第1天开始,2次/d,先熏后洗,共治疗7d.比较各组术后疼痛、创面水肿情况、临床总有效率以及创面完全愈合天数.结果 治疗组术后疼痛积分、创面水肿积分、临床总有效率与阳性对照组比较,P ＞0.05,无统计学意义;与阴性对照组相比,P＜0.05,差异具有统计学意义.且创面完全愈合天数比较,治疗组完全愈合天数(12.54±1.38)d,阳性对照组完全愈合天数(14.32±2.15)d,阴性对照组完全愈合天数(15.16±1.76)d,创面愈合时间明显少于对照组.结论 外用连蒲消肿熏洗液对Ⅱ、Ⅲ度混合痔术后患者具有明显的止痛、消肿、促愈合作用.

目的:探讨中医挂线拖线引流法治疗高位肛瘘的研究 方法:采用中医挂线拖线引流法治疗78例高位复杂性肛瘘患者.结果:78例一次性治愈,痊愈后生理功能正常,肛门无移位,无明显缺损口,黏液泄漏、肛门失禁、形成肛瘘等后遗症.结论:虚线挂线法治疗马蹄形肛瘘易操作、较安全,疗效确切,并能有效预防肛瘘的发生.