目的 探讨快速康复外科护理在老年腹腔镜阑尾切除术围术期中的临床效果.方法 将144例急性阑尾炎行腹腔镜阑尾切除手术的老年患者,随机分为研究组(n=72):实施快速康复外科护理,与对照组(n=72):实施常规护理.记录2组患者住院时间、住院费用、进食时间、肛门排气时间、排便时间、术后并发症及手术前后的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分并进行对比分析.结果 研究组住院时间、住院费用、进食时间、肛门排气时间、排便时间、并发症、手术后1 d、2d的SAS评分和SDS评分均少于对照组,差异有统计学意义(P＜0.05).结论 快速康复外科护理能缩短老年腹腔镜阑尾切除术的住院时间,减少住院费用,改善心理状态,加快胃肠功能恢复,且能减少患者并发症,可以推广应用.

目的:探讨甲状腺乳头状癌双侧腺叶病灶患者,接受甲状腺切除术联合双侧中央区淋巴清扫术的临床效果和价值.方法:选取医院2017年6月-2020年6月收治的58例甲状腺乳头状癌双侧腺叶病灶患者,将其随机分为两组.对照组采用甲状腺切除术治疗;观察组采用甲状腺切除术联合双侧中央区淋巴结清扫术治疗.对比两组患者的术后复发率发生情况,和术后1年患者的疾病复发率情况.结果:对照组患者经手术治疗后,并发症发生率为13.79％,术后1年患者的疾病复发率为10.34％.观察组患者经手术治疗后,并发症发生率为13.79％,术后1年患者的疾病复发率为0.两组患者术后并发症发生率差异无统计学意义.两组患者术后1年疾病复发率差异具有统计学意义.此外,观察组患者经手术后,清扫淋巴结数目为2～7枚,平均(4.4±0.9)枚,共清除135枚,中央区淋巴结阳性患者比率为41.38％.结论:甲状腺乳头状癌双侧腺叶病灶患者,在接受甲状腺切除术治疗的基础上,联合双侧中央区淋巴结清扫术,患者并发症发生率没有增加,同时,患者术后1年复发率较低.

目的:探讨腹腔镜完全腹膜外疝修补术与开放Lichtenstein疝修补术治疗腹股沟疝的临床效果.方法:将206例单侧腹股沟疝成年患者,随机分为开放Lichtenstein疝修补术组(Lichtenstein组)与腹腔镜完全腹膜外疝修补术组(TEP组),记录2组术后4小时、12小时、24小时、1周、4周的VAS评分、手术时间、术后住院天数、住院费用、并发症发生率和复发率进行统计学对比分析.结果:TEP组与Lichtenstein组在术后4小时、12小时、24小时、1周VAS评分、术后住院天数及切口感染相比,差异有统计学意义(P<0.05);而2组在术后4周VAS评分、手术时间、住院费用、血清肿、复发率方面则无统计学意义(P>0.05).结论:2组手术方式均安全可靠,但随着腹腔镜技术的进步,TEP较Lichtenstein能减轻腹股沟疝患者的术后疼痛不适,缩短住院时间,促进患者早日康复.

目的:探讨腹腔镜手术对高龄胆石症患者炎症反应及疼痛程度的影响.方法:纳入2016年6月—2019年10月我院收治的78例高龄胆石症患者,按分层随机法分组,各39例.对照组采用传统开腹手术治疗,观察组以腹腔镜手术治疗,对比两组手术效果.结果:观察组手术时间长于对照组,但术中失血量、术后排气时间、下床时间和住院时间短于对照组(P<0.05);术后两组CRP、IL-6和IL-10水平较术前明显升高但观察组各指标水平低于对照组(P<0.05);术后观察组VAS评分低于对照组(P<0.05);观察组术后并发症发生率低于对照组(P<0.05).结论:对高龄胆石症患者实施腹腔镜手术治疗可减轻患者术后疼痛,降低炎症应激反应影响且安全性较高.

目的 探讨腹腔镜阑尾切除术后腹腔内注射布比卡因的术后镇痛效果及安全性评价.方法 197例急性阑尾炎患者采用双盲法、安慰剂对照的方式,随机分为观察组和对照组,在腹腔镜阑尾切除术后回盲部及右横膈区域:观察组使用布比卡因喷洒;对照组使用生理盐水喷洒.记录两组术后各时段VAS评分、使用阿片类药物例数、手术时间和住院日、及手术前后心率、血压、心肌酶谱、心肌钙蛋白的变化.结果 观察组术后1h、4h VAS评分明显减低,住院日缩短,使用阿片类药物例数明显减少,与对照组比较差异有统计学意义(P<0.01).而两组间在术后12h、24h及48h的VAS评分、手术时间、穿孔病例数、术后并发症、腹腔留置引流管病例,手术前后心率、血压、心肌酶谱(天门冬氨酸氨基转移酶、肌酸激酶、肌酸激酶的同工酶、乳酸脱氢酶及α-羟丁酸脱氢酶)、心肌钙蛋白比较,差异无统计学意义(P>0.05).观察组和对照组盐酸哌替啶用药总量分别为335mg、1240mg.结论 腹腔镜阑尾切除术术后腹腔喷洒布比卡因镇痛效果安全、有效,能缩短住院日,且能减少阿片类药物的使用.

目的 评估使用丝线结扎+Hem-o-lok结扎锁夹闭阑尾残端在腹腔镜阑尾切除术(LA)中的可行性及有效性.方法 使用单盲法将汕头市潮阳区人民医院2017年5月至2019年5月186例急性阑尾炎患者以随机数表法分为参照组和研究组,各93例.研究组阑尾残端采用丝线结扎+Hem-o-lok结扎锁夹闭,参照组阑尾残端丝线结扎后,予盲肠浆肌层荷包包埋,统计两组的临床指标,进行对比分析.结果 研究组手术时间短于参照组,手术总费用少于参照组,差异有统计学意义(均P<0.05).研究组住院时间、术后并发症发生率、术后24 h腹痛视觉模拟评分(VAS)、48 h腹痛VAS评分及电话随访2周腹痛VAS评分与参照组比较,差异无统计学意义(均P>0.05).结论 LA中采用丝线结扎+Hem-o-lok结扎锁处理阑尾残端是一种可行且有效的选择.

目的 对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜胆总管探查术(lapa-roscopic common bile duct exploration,LCBDE)与内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)+内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+LC治疗胆囊结石合并胆总管结石的临床效果.方法 将100例胆囊结石合并胆总管结石患者随机分为观察组(n=52)和对照组(n=48).观察组行LC+LCBDE;对照组行ERCP+EST,1～3 d后再行ERCP+EST+LC.比较两组患者的临床指标.结果 观察组住院费用、手术时间、住院天数比对照组减少,差异有统计学意义(P<0.05).两组患者胆结石清除成功率、并发症发生率、复发率比较,差异无统计学意义(P>0.05).结论 LC+LCBDE与ERCP+EST+LC治疗胆囊结石合并胆总管结石同样安全有效,但是LC+LCBDE住院时间较短,住院费用较少,可作为EST失败后的有效补救手术方式.

Objective To investigate the fracture limb swelling the clinical effect of treatment of tcm. Method The total of 66 cases of fracture of limb swelling in patients with late stage as the research object, are in our hospital from June 2012 to June 2013 were selected, using digital table method of random grouping, mannitol intravenous therapy(control group, n=30) and Chinese medicine treatment(observation group, n=36)compared the effectiveness of. Results The observation group cases clinical total effective rate was 97.2%, signiifcantly higher than that of the control group 80%, the difference was statistically signiifcant(P<0.05). Conclusion The traditional Chinese medicine treatment of fracture of limb swelling, can signiifcantly improve the clinical effect, guarantee the quality of life of patients.

目的:观察分析中西医结合疗法用于神经根性颈椎病临床治疗中的效果.方法:选取我院2008年～2012年收治的90例神经根性颈椎病患者(观察组),予以西药内服联合中药口服、推拿按摩、微波照射治疗;对照前期单纯西药口服+牵引治疗的60例神经根性颈椎病患者(对照组)临床疗效.结果:对照组患者治愈”例、治疗有效36例、无效7例,总有效率88.3％;观察组患者治愈54例、有效36例、无效0例,总有效率100.0％,治疗组有效率明显高于对照组(P＜0.05).两组均未见明显不良反应(P＞0.05).结论:中西医结合疗法的规范运用可有效提升神经根型颈椎病临床疗效,值得推广应用.

Objective To discuss the issue of post-operative early portal vein chemotherapy in prevention of colorectal cancer liver metastases results and methods.Methods The patients were randomly divided into 34 cases of treatment group and control group 32 cases,giving patients treated with radical resection and portal vein infusion chemotherapy,simple radical resection of the control group patients.Results Patients of all intubated successful implementation of the 4 years of follow-up,treatment group,liver metastases was 14.7%;the control group,liver metastases was 46.9%.Two liver metastasis rate were significantly different(P<0.01).After 3 years and 5 years in patients treated with the survival rate was significantly higher(P<0.05).Conclusion Early portal vein chemotherapy can significantly prevent cancer liver metastases,and effectively improve the survival rate of acceptance of colorectal cancer patients with radical surgery.

Objective To compare the effects of early enteral nutrition(EEN) supportand total parenteral nutrition(TPN) support for the patiens with severe acute pancreatitis(SAP).Methods 42 cases of SAP were studied restrospectively and the patiens were divided into two groups randomly:early enteral nutrition group(EEN group,n=21),total parenteral nutrition group(TPN group,n=21).Pepti-2000 was transfused through nasojejunal tube in the 3rd to the 6 th day after admission in EEN group.The calory and nitrogen in both groups were 30 kcal/kg·d and 0.17 g/kg·d.Results ① The death rate in the EEN group was lower than that in the TPN group,but there were no differences between two groups(P0.05);the hospitalized days in EEN group were less than that in the TPN group(P0.05).② In the two weeks after admission :hemoglobin and body weight in EEN group were measured more than that in TPN group,but no significant difference was found;plasma total protein and albumin in EEN group were measured more than that in TPN group(P0.05);and more prealbumin was found in EEN group.Conclusions Compared to TPN support,early EEN support is more efficient to improve body nutrition condition and shortens hospitalized days.

Objective To study the current management strategy for colorectal trauma. Methods Clinical data of 40 patients in recent 15 years with colorectal trauma were collected and analyzed retrospectively. Results Operations were performed on 38 patients,including simply repear ,sigmoid colostomy plus drainge. 2 cases died 5h after admition. Conclusions It is important to understand the characteristics of colorectal trauma, graspindications for one-stage operation, and specificity of management of rectal trauma and istmgenic colorectal traumafor decreasing the complication and improving the effect of surgical treatment.

目的探讨急性胃十二指肠溃疡穿孔的诊断和治疗方法.方法对1980年至2002年期间,我院外科收治的1226例急性胃十二指肠穿孔病人的临床资料进行了回顾性的分析.结果 122例保守治疗成功.1104例行手术治疗,其中行单纯穿孔修补术393例,围手术死亡率6.9%.行胃大部切除术和溃疡病局部切除术711例,围手术死亡率0.72%.结论胃大部切除术是胃十二指肠溃疡急性穿孔的主要治疗方法.在保守治疗过程中,应该掌握外科的手术适应证,以便提高治愈率,降低手术死亡率.