Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
【Abstract】ObjectiveTo investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. MethodsThe parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginateBaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5，15，25，35，45，55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. ResultsThe calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. ConclusionMicroencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.
The islet transplantation site can be divided into two categories: orthotopic islet transplantation and ectopic islet transplantation. Orthotopic islet transplantation refers to that the insulin secreted and released from the transplanted islet will be metabolized into the liver through the hepatic portal vein system, which does not change the original insulin metabolic pathway, including the portal vein of the liver, the greater omentum. The insulin secreted by the ectopic islet transplantation changes the original metabolic pathway of insulin. The ideal islet transplantation site generally has the following characteristics: high success rate transplantation, high long-term survival rate of graft, simple operation, less trauma, less complications, low risk, easy to repeat detection and so on. This article provides a review of the current research status of each islet transplantation site, in order to provide reference for future related research.
It has been certificated that hip and knee arthroplasty can improve quality of life and relieving pain and discomfort for ageing population and patients with muscloskeletal disorders. However, the outcomes of prosthetic joint infections (PJI) after arthroplasty usually are disastrous. The incidence of PJI is lower, but the number of this population is huge, which makes the strong impacts on quality of life for patients and healthcare economics. This review discusses the prevention strategies of PJI based on clinical epidemiology, diagnostic definition, pathogenesis, microbiology and risk factors, combined with some guidelines for prevention surgical site infections published recently.
Objective To explore the application methods and values of using health failure mode and effect analysis (HFMEA) to prevent surgical site infection (SSI) in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. Methods Patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected. Based on whether receiving HFMEA-based risk management or not, the patients were divided into conventional group and intervention group. The compliance rates with infection control measures, changes in risk priority numbers (RPN) at various stages (1 month and 10 months after intervention) of HFMEA implementation, and the incidence of SSI between the conventional group and the intervention group were compared. Results A total of 884 surgeries were included. Among them, there were 399 cases in the conventional group and 485 cases in the intervention group; 16 cases SSI occurred. A total of 7 SSI prevention and control measures had been formulated. Except for proper surgical attire (P＞0.05), there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients (P＜0.05). In the intervention group, the RPN values of pre-operative, intra-operative, and post-operative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention (P<0.05). Except for the incidence of SSI during craniotomy surgery (6.1% vs. 1.8%, P=0.375), there were statistically significant differences in the total SSI incidence (3.3% vs. 0.6%) and bone fracture surgery SSI incidence (2.7% vs. 0.5%) between the conventional group and the intervention group (P>0.05). Conclusion Applying HFMEA-based risk management techniques to prospectively identify, assess, analyze, manage and track the risk of SSI in bone fracture and craniotomy surgery with class Ⅰ incision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.
目的 通过对1例原发于宫颈的胎盘部位滋养细胞肿瘤（PSTT）的资料及相关文献的复习，全面介绍胎盘部位滋养细胞肿瘤的临床特征、病理特点、治疗方式及预后。 方法 对收治1例罕见原发于宫颈部位的PSTT的临床病理资料进行分析，并以“胎盘部位滋养细胞肿瘤”为主题词查阅中国知网（CNKI）及PubMed等文献数据库进行文献复习。 结果 该例原发于宫颈部位的PSTT患者术后化学疗法后，目前情况良好，已随访3年，无复发及转移征象。2011年9月1日前，CNKI数据库共报道300余例PSTT病例，PubMed数据库共160余例，其中有2例原发于宫颈部位的PSTT。原发于宫颈部位的PSTT罕见，易误诊，往往需要宫颈活组织检查或宫颈搔刮才能确诊。 结论 原发于宫颈部位的PSTT的预后是否遵循PSTT尚需收集更多的病例证实。PSTT因其发病率低，临床表现多无特异性，通常需要通过诊断性刮宫、活组织检查甚至术后病理检查才能确诊。PSTT首选的治疗方式为手术，多数患者病灶清除后可治愈，对有高危因素的患者术后宜选择依托泊苷+甲氨蝶呤+放线菌素D+环磷酰胺+长春新碱（EMA-CO）方案或依托泊苷+甲氨蝶呤+放线菌素D+依托泊苷+顺铂（EMA-EP）方案进行化学治疗，以期改善预后。
每位外科医师均会遭遇到外科感染，这是手术技术自身所决定了的，外科手术必然破坏人体宿主抵抗力的第一道防线皮肤和粘膜屏障，使得细菌得以进入体内。从外科发展历史看，因外科感染而死亡是很常见的，特别是在19世纪末叶以前，当时截肢术死亡率在25%~90%之间，美国内战时期则为50%左右，这主要是外源性感染所致。但从现代外科学观点看，外科感染的内涵已发生了许多重要变化，如医院内获得性感染超过了患者原有的感染； 体内的内源性正常菌群感染多于外源性致病细菌感染； 外科手术后的手术部位感染（surgical site infection，SSI）多于需要外科处理的一般化脓性感染。其中SSI已成为值得关注的临床课题。
目的探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染（SSI）的疗效。 方法回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料，比较以碘伏原液浸泡切口（浸泡组）和冲洗切口（常规组）处理后患者的切口愈合情况。 结果术后常规组57例患者中，有43例切口愈合等级为甲级，5例为乙级，9例为丙级，SSI发生率为24.56%（14/57）。浸泡组35例患者的切口愈合均良好，均为甲级愈合，SSI发生率为0，低于常规组（P<0.05）。 结论采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生，值得临床推广应用。
Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.