目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
Objective To investigate the prognostic differences and decision-making role in postoperative radiotherapy of four molecular subtypes in pT1-2N1M0 stage breast cancer. Methods The clinicopathological data of 1526 patients with pT1-2N1M0 breast cancer treated at West China Hospital of Sichuan University between 2008 and 2018 were retrospectively analyzed. χ2 test was used to compare the clinicopathological features among patients with different molecular subtypes. Kaplan-Meier survival analysis and log-rank test were used to draw the survival curves and compare the overall survival (OS) and breast cancer-specific survival (BCSS) among patients with different molecular subtypes. Cox regression model was used to determine the influencing factors of OS of patients after radical mastectomy. Results Among the 1526 patients with pT1-2N1M0 breast cancer, there were 674 cases (44.2%) of Luminal A subtype, 530 cases (34.7%) of Luminal B subtype, 174 cases (11.4%) of human epidermal growth factor receptor 2 (Her-2) overexpression subtype, and 148 cases (9.7%) of triple-negative subtype. The 5-year OS rates of Luminal A, Luminal B, Her-2 overexpression and triple negative patients were 98.6%, 94.3%, 95.5% and 91.2%, respectively (χ2=11.712, P=0.001), and the 5-year BCSS rates were 99.3%, 94.6%, 95.5% and 92.5%, respectively (χ2=18.547, P<0.001). Multiple Cox regression analysis showed that menstrual status [hazard ratio (HR)=0.483, 95% confidence interval (CI) (0.253, 0.923), P=0.028] and whether endocrine therapy [HR=2.021, 95%CI (1.012, 4.034), P=0.046] were prognostic factors for the 5-year OS rate of breast cancer patients after radical mastectomy (P<0.05). However, it failed to reveal that Luminal subtypes and postoperative radiotherapy were prognostic factors for the 5-year OS rate (P>0.05). Conclusions In pT1-2N1M0 breast cancer patients, the 5-year OS rate and 5-year BCSS rate in triple-negative patients are the lowest. The relationship between Luminal classification, postoperative radiotherapy and survival in patients after radical mastectomy needs further study in the future.
Objective To investigate the clinical effect of polylactic acid membrane in prevention of epidural scar and adhesion. Methods From July 1998 to April 2000, 62 patients with lumbar disc herniation were randomly assigned into two groups. All were treated surgically with discectomy by fenestration or laminectomy.One group were placed with a thin of polylactic acid membrane covering the interlaminar space(n=32). The thickness of the film was 0.1mm. The other group was blank control(n=30). After 2 weeks of operation, we observed the local and systemic reactions. After 6 months clinical symptoms were revaluated and the degrees of epidural scar and adhesion were determined by CT scans. Results After 2 weeks, we found no adverse systemic reactions in all patients. Wound healing was excellent. No abnormalities of hepatic and renal functions as well as blood for routine were found. Temperature after operation was normal. After 6 months, the curative effects were as follows in experimental group and in control group: excellent in 27 patients and in 24 patients, good in 4 patients and in 4 patients, fair in 1 patient and in 1 patient, and poor in 0 patient and in 1 patient, respectively. There are no significant difference between two groups. The CT scans showed no adhesion between the epidural scar and the dural sac in all patients of experimental group. There existed various extents of adhesion in control group. Conclusion The results demonstrate that the polylactic acidmembrane can effectively prevent the epidural scar adhesion with a good biocompatibility and no toxity. Its clinical application was promising.
Objective To elucidate the protective effect of leukocyte depletion on the myocardium during the settings of myocardial reperfusion injury. Methods Twenty patients undergoing cardiopulmonary bypass with continuous infusion of blood cardioplegia were randomized into two groups:the control group (n=10) with no leukocyte depletion filter used, and the experimental group (n=10) with the use of leukocyte depletion filter on the bypass circuit. The blood cells count before and after the filtration were measure...
目的 观察和评估一期手术治疗肛门直肠周围脓肿的临床疗效。方法 回顾性分析我院2001年1月至2006年10月期间107例实施一期手术的肛门直肠周围脓肿患者的临床资料。结果 所有患者均行一次性根治手术，术后切口换药。住院时间9～28 d，平均18.5 d。术后随访3～36个月，平均19.5个月，1例术后形成瘘管，2例术后脓肿复发，此3例经再次手术治愈，无复发； 术后一次性治愈率达97.2%（104/107）。结论 一期手术治疗肛门直肠周围脓肿较单纯切开引流手术能明显地缩短术后感染控制时间，降低术后脓肿的复发率和肛瘘的发生率，减轻患者的痛苦。
目的探讨钢丝缝合固定胸骨骨折的治疗效果。 方法回顾性分析2010年1月至2014年12月我院使用钢丝缝合固定胸骨骨折患者16例的临床资料，其中男15例、女1例，年龄30～74（46.3±7.1）岁，采用胸部正中切口达骨折处，上下骨折端适当游离后，用成人型带针钢丝从下骨折端缝入2针，翻转上下骨折端后从上骨折端对应部位出针，骨折复位后扭紧钢丝，14例单处骨折均用此法固定，2例2处骨折用8字缝合固定。 结果16例患者均治愈，术后骨折部疼痛明显减轻，切口愈合良好。单纯性胸骨骨折手术时间50～90（68.46±12.31）min，手术费4 414～6 765（5 495.77±786.36）元。骨折复查发现1例对位稍差，其余患者对位对线均良好，无钢丝断裂及钢丝割裂胸骨病例。 结论钢丝缝合固定能快速恢复胸廓的稳定性，方法简单、安全、费用低、效果好，值得在基层医院推广应用。
As an advanced mode of diagnosis and treatment, day surgery is widely carried out in foreign countries. Although it started late in China, it has been gradually valued and vigorously promoted in medical and health field in recent years. The effective implementation of day surgery in hospital cannot be separated from the strong support of performance management system. Through introducing the performance management experiences in promoting day surgery mode in West China Hospital of Sichuan University, this article discusses how to construct an effective whole-course performance management system for day surgery combined with operation management through three mechanisms: the management committee mechanism, the operation management mechanism and the performance assessment mechanism, which are based on the structure-process-outcome dimensions of quality management system, at the three levels of hospital, department and position, so as to provide a reference for developing day surgery in China.