Objective:The effects of longitudinal “U” suture，“Double R” and traditional pancreatic duct jejunal mucosa anastomosis in laparoscopic pancreaticoduodenectomy（LPD）were compared and analyzed.Methods:A total of 108 patients with LPD from January 2018 to April 2021 were selected and divided into U-shaped group，Double R group and traditional group by random number table method，36 patients in each group，U-shaped group underwent pancreaticojejunostomy by longitudinal “U” suture，Double R group underwent “Double R” pancreaticojejunostomy，and traditional group underwent traditional pancreaticojejunostomy. SPSS 22.0 was used for statistical analysis. Perioperative indicators and postoperative quality of life were expressed by（xˉ±s），one-wayANOVA was performed for comparison between multiple groups，and LSD-t test was performed for pairwise comparison between groups. Postoperative complications were analyzed by χ2 test. P<0.05 indicated statistically significant difference.Results:The operation time and pancreaticoenterostomy time of U-shaped group were shorter than those of Double R group and traditional group，and Double R group was shorter than traditional group（P<0.05）；The length of postoperative hospital stay in U-shaped group and Double R group was shorter than that in traditional group（P<0.05）；There was statistically significant difference in the total incidence of postoperative complications among the three groups（P<0.05），and the Double R group was significantly lower than the traditional group（χ2=5.791，P=0.016）；Three months after surgery，scores of physical function，psychological function，social function and material life status in Double R group were significantly higher than those in U-shaped group and traditional group，and U-shaped group was higher than traditional group（P<0.05）.Conclusion:Compared with longitudinal U-shaped suture，“Double R” pancreaticojejunostomy in LPD has advantages in reducing postoperative complications and improving postoperative quality of life of patients，although it can prolong the operation time and pancreaticojejunostomy time. Therefore，it is worthy of clinical application.

背景与目的:胰瘘是胰体尾切除(DP)术后最常见并发症,其与患者的预后及转归有着密切的关系.因此,本研究在探讨DP术后胰瘘发生情况及其影响因素,为制订防治措施提供依据.方法:回顾性分析2015年1月—2021年2月中国人民解放军空军军医大学第二附属医院收治的99例因胰腺肿瘤行DP术患者的临床资料,统计患者术后胰瘘的发生率,对可能导致术后胰瘘发生的相关因素行单因素及多因素Logistic回归分析.结果:99例患者DP术后生化漏发生率为34.3％ (34/99),B级胰瘘发生率18.2％ (18/99),C级胰瘘发生率1.0％ (1/99).单因素分析结果示,年龄、手术时间、胰管直径及是否联合脾切与胰瘘发生明显有关(均P＜0.05),多因素Logistic回归分析结果示,年龄＜42岁(OR=0.955,95％CI=0.914～0.998)、手术时间≥253 min (OR=1.013,95％ CI=1.005～1.021)及联合脾切术(OR=4.152,95％ CI=1.043～16.535)为DP术后胰瘘的独立危险因素(均P＜0.05).结论:DP术后有一定的胰瘘发生率,年龄、手术时间、联合脾切是DP术后胰瘘的独立危险因素.这些危险因素评估对术后胰瘘的风险预测及防范措施的制定提供了一定的依据.

With the development of science and technology and the progress of society, the application of a se-ries of new theories, new technologies and new materials makes surgeons' skills improve. But due to the limitations of technological development, public cognition and regulations construction, current surgeons have a variety of helplessness and still face many problems that need to be solved urgently. The solution of these problems needs not only the perfection and progress of the surgeons, but also the understanding and inclusion of the society as well as the perfection and implementation of the policies and regulations. Only with the cooperation of all sides, it can give full play to surgeon' s ability, reduce the surgeon' s helplessness, make the doctor-patient relationship more har-monious, and promote the healthy development of medical and health services.

Objective:This study aims to compare the effect of laparoscopic and open splenectomy plus cardiac peripheral vascular disconnection in the treatment of liver cirrhosis with portal hypertension.Methods:A total of 120 patients with cirrhosis and portal hypertension were selected from January 2012 to December 2013 in Tangdu Hospital of the Fourth Military Medical University.All of them were randomly divided into the observation group (n=60) and control group (n=60).The observation group was treated by spleneetomy plus cardiac peripheral vascular disconnection which used laparoscopy,and the control group was treated by traditional open surgery.The intraoperative blood loss,operation time,postoperative hospital stay,recovery time of gastrointestinal tract and occurrence of complications were compared betwccn two groups.Results:The average operation time of observation group showed no significant difference fiom the control group (P＞ 0.05).However,the intraoperative blood loss,postoperative hospital stay time,recovery time of gastrointestinal tract and occurrence of complications of observation group were all better than those of the control group (P ＜0.05).The postoperative complications included postoperative fever,wound infection,abdominal bleeding and portal venous system thrombosis effusion,the incidence of which was obviously lower in the observation group than those of in the control group (P＜0.05).Conclusions:Splenectomy plus cardiac peripheral vascular disconnection which used laparoscopy had significant clinical efficacy and high safety in the treatment of liver cirrhosis with portal hypertension.

OBJECTIVE:To evaluate the effect of high altitude on uterine and umbilical artery blood flow dynamics during normal pregnancy.METHOD:Uterine artery blood flow parameters of the pregnant (34) and nonpregnant (37) subjects and umbilical artery blood flow parameters of 119 subjects living at high altitude or at low altitude were measured with color Doppler flow imaging system.RESULTS:Uterine artery diameter, blood flow volume increased during pregnancy at both altitude, and uterine artery blood flow volume and diameter were smaller at high altitude than at low altitude [(0.35 +/- 0.04) cm vs (0.45 +/- 0.04) cm, (280 +/- 48) ml/min vs (425 +/- 55) ml/min, P < 0.01]. Umbilical artery blood flow velocity systolic to diastolic (S/D) value, resistant index of different pregnant period were greater at high altitude than at low altitude (P < 0.01).CONCLUSION:High altitude has effect on placental and infant blood flow that causes the decrease of placental blood infusion and the increase of uterine and umbilical artery flow velocity S/D and reactive index.

在正确治疗的同时实施全而的护理及配合功能训练,使糖尿病性神经性膀胱功能恢复,能自行排尿.首先做好留置导尿的护理,留置导尿是糖尿病性神经性膀胱的重要治疗措施,是帮助膀胱功能恢复和减轻泌尿系感染症状的主要途径,注意严格执行无菌操作,根据病情选择适宜的膀胱冲洗液;密切观察病情变化,采取切实有效的护理措施;适时地给患者和家属讲解糖尿病性神经性膀胱功能恢复的可能性,及膀胱功能训练的配合与注意事项;膀胱功能训练应在膀胱明显缩小后进行,按摩膀胱时手法不宜过重,以免损伤膀胱.能自行排尿后,要注意巩固和强化训练.