开颅术后早期连续性肾脏替代治疗患者的护理

目的 总结5例开颅术后早期因急性肾功能损害而行连续性肾脏替代治疗患者的护理.方法 组建多学科团队,拟定患者的监测参数和治疗 目标,采取多模态监测下的重要参数的目标化管理,密切观察出凝血功能,做好感染防控、镇静及镇痛护理,早期进行肠内营养.结果 5例患者顺利完成治疗,未因颅内出血或难以控制的颅内高压行再次手术.2例完全康...     

肺移植营养不良患者多学科营养管理方案的构建与应用

目的 构建肺移植营养不良患者多学科营养管理方案,探讨该方案对术前营养不良患者肺移植术后营养状态及康复效果的影响.方法 按照住院时间将肺移植前营养不良患者分为对照组49例和干预组50例.对照组采用常规营养管理方案,干预组构建并实施包括运动处方、营养处方、药物治疗、心理管理等方面的多学科营养管理方案.结果 移植后1个月,干预组患者总白蛋白、白蛋白、竖脊肌横截面积、6分钟步行距离、呼吸困难评分显著优于对照组,术后住院时间显著短于对照组(P＜0.05,P＜0.01).结论 多学科营养管理有利于改善术前营养不良肺移植患者的术后营养状态,促进康复.     

多学科融合精准治疗模式下垂体瘤患者的综合护理

目的 总结多学科融合精准治疗的垂体瘤患者综合护理经验。方法 对713例垂体瘤患者，配合多学科融合精准治疗完成患者各项内分泌功能试验及评估、术前专科准备、心理护理、术后病情观察、并发症护理以及延续护理。结果 所有患者手术顺利，平均手术时间1.35 h，无手术死亡和严重并发症发生，平均住院日8.50 d，术后随访患者内分泌功能均恢复良好。结论 实施多学科融合精准治疗模式下的综合护理，可提高垂体瘤患者围术期护理质量，促进患者康复。     

数字化辅助多学科联合诊疗模式在复杂面中部骨折修复重建中的应用研究

目的总结归纳复杂面中部骨折数字化辅助多学科联合诊疗的流程,并评价其治疗效果。方法2018年10月至2019年12月,我院数字化辅助多学科联合诊疗团队共收治复杂面中部骨折患者32例。所有患者术前均经过多学科联合讨论以及个性化的虚拟手术设计,并在导航系统辅助下接受切开复位手术。术后进行颌面部CT检查,并将其与术前设计进行拟合对比,从而评价治疗效果。结果经由数字化辅助多学科诊疗团队治疗,患者术后功能和外形都取得了较好的恢复,且未见明显并发症。结论数字化辅助多学科联合诊疗模式在复杂面中部骨折后的功能及外形修复重建中具有较高的应用价值。     

MTM正畸技术在成人前牙美容中的应用

目的:探讨MTM正畸技术在成人前牙美容中的作用.方法:从近年已完成正畸治疗的患者中整理出因前牙美容问题而运用MTM正畸技术治疗的成人患者42名.对其就诊情况和治疗效果进行回顾性分析.结果:42例患者(男性11名,女性31名),活动矫治6人,固定矫治36人,平均疗程10.35个月.有32人仅通过MTM正畸治疗就达到了效果,有10人在完成正畸后进行了修复治疗,所有患者均取得了满意的临床治疗效果.结论:MTM正畸技术是一种能有助于减少牙体组织的损伤,维护牙周组织的健康,帮助提高前牙美容效果的技术,值得在-临床推广应用.运用多学科的知识,制订适合于不同个体的、明确的、详细的治疗目标,是治疗成功的关键.     

从并发症角度浅谈直肠癌保肛手术中应重视的若干问题

直肠癌手术理念和外科器械的飞速发展,肿瘤多学科协作（multi-disciplinary team,MDT）治疗模式的提出,在低位直肠癌手术治疗目标逐渐转向兼顾根治性与生活质量的前提下,近几年,低位直肠癌患者手术整体保肛率从原来的45%提升至76%左右.     

多学科诊疗模式治疗“梗阻性黄疸伴肝门胆管占位”1例病例报道

目的以多学科诊疗模式讨论1例"梗阻性黄疸伴肝门胆管占位"患者的个体化治疗。方法采用多学科诊疗模式对四川省肿瘤医院于2017年5月收治的1例"梗阻性黄疸伴肝门胆管占位"患者进行诊断、围手术期处理以及手术治疗方案的制定,实现肝癌患者的个体化治疗。结果患者因"梗阻性黄疸伴肝门胆管占位"就诊,门诊误诊为"肝门胆管癌"并收治入院,通过多学科诊疗模式修正诊断为"肝细胞癌伴胆总管癌栓"。多学科诊疗模式讨论认为,肝癌伴胆管癌栓虽是肝癌的晚期表现,但结合目前的研究进展建议积极采取手术切除治疗。治疗计划及方案包括:首先对患者进行经皮肝穿刺右侧胆道引流;待胆道引流1个月、肝功能恢复后进行肝癌切除联合胆总管及癌栓切除。该患者成功实施胆道引流以及手术切除,手术顺利,术后恢复可,随访半年后复查未见肿瘤复发。结论多学科诊疗模式不但可减少"梗阻性黄疸伴肝门胆管占位"的误诊,同时可使患者获得最佳治疗和个体化治疗方案。     

加速康复外科的临床意义不仅仅是缩短住院日

加速康复外科(ERAS)已在我国开展近10年,其包含的围术期镇痛方案和目标导向性液体治疗等干预措施不断得到优化.ERAS理念在外科领域得到了广泛应用和推广,它不仅缩短患者的住院时间、还能减少患者术后并发症、提高器官功能、减轻手术应激反应、改善肿瘤患者预后及延长患者的生存时间.ERAS是一门方兴未艾的学科,推动ERAS的多学科培训及教育计划,补充高质量的研究证据,以及进一步转化临床实践应用将是其未来发展的方向.因此,加深对ERAS本质的研究及理解具有重要意义.     

炎症性肠病外科治疗的策略和技术

外科治疗是炎症性肠病（IBD）出现肠道并发症或内科治疗失败时的重要手段,而选择合适的手术时机能减少术后并发症,是决定治疗成功与否的关键.过度强调药物治疗、在无效的情况下仍一味延长其疗程,将使患者失去最佳手术时机.同时外科医师需要掌握好IBD急诊手术与择期手术的不同技巧.在多学科合作治疗模式下,各专科医师明确手术的必要性后,应积极调整术前药物治疗、改善患者营养状态,为IBD患者外科治疗争取最佳的生理功能储备,做好围手术期处理.     

高龄早期乳腺癌的治疗经验(病例报道及文献复习)

总结我科最近一例高龄早期乳腺癌患者的临床资料,通过多学科治疗团队分析高龄早期乳腺癌的麻醉方式、手术、辅助放疗、辅助化疗及内分泌治疗对患者影响制定治疗方案,最终在在利多卡因局部浸润麻醉下顺利接受左乳癌保乳术,术后10天愈合。术后病理:左乳浸润性乳头状癌,直径约4 cm,前哨淋巴结阴性,ER(95%+),PR(95%+),HER-2(0),Ki-67(20%+)。术后未接受辅助放疗及全身系统辅助治疗。多学科治疗团队治疗前评估高龄乳腺癌治疗获益及风险,可为高龄乳腺癌患者制定明确安全且可靠的治疗方案。     

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??Algorithm of diagnosis and multidisciplinary treatment for hepatocellular carcinoma DAI Chao-liu??JIA Chang-jun. Department of Hepatobiliary & Splenic Surgery??Shengjing Hospital??China Medical University??Shenyang110004??China
Corresponding author??DAI Chao-liu??E-mail??daicl@sj-hospital.org
Abstract The treatment choice for hepatocellular carcinoma??HCC??depends on the cancer stage??patient performance status and liver function. A multidisciplinary approach and close cooperation among specialists are required for the best patients’ outcomes. Future clinical studies on HCC should center on multidisciplinary treatment to improve the treatment efficacy??which is depended on the basis of scientific and standardized HCC diagnosis and treatment algorithm.     

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??Enhanced recovery after surgery: current controversies and concerns YANG Yin-mo. Department of Surgery??Beijing University First Hospital??Beijing 100034??China
Abstract The enhanced recovery after surgery??ERAS?? protocol is an evidence based??perioperative care pathway??which is to reduce the physiological neuroendocrine stress response to surgery??with the ultimate goal of improving patient recovery and outcomes. In clinical practice, the multidisciplinary team??multimodal approach??and individualized program are necessary to get the ERAS protocol implemented. It is the most important approach for patient recovery to improve the quality of surgery so as to reduce the surgical stress. The goals of ERAS should be realistic and the related program should be implemented under national conditions by adhering to the principle of safety first??and efficiency second.     

加速康复外科临床实践中应重视的几个问题

加速康复外科（ERAS）基于循证医学基础,通过优化围手术期诊疗路径,达到促进术后康复的目的。ERAS的理论基础是减少围手术期应激及其导致的代谢改变。临床实践中应坚持以多学科合作为基础,针对病人的具体情况多模式、个体化地开展ERAS。提高手术质量、减少创伤应激是促进病人术后康复的重要途径。ERAS应与我国国情及临床的实际情况相结合,秉承安全第一、效率第二的基本原则。     

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??Renewal of ideas and focus of gastroenteropancreatic neuroendocrine neoplasm LOU Wen-hui. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai200032??China
Abstract The incidence of gastroenteropancreatic neuroendocrine neoplasm (GEP-NENs) is increasing. More emphasis should be paid to the multidisciplinary cooperation and construction of regional center of excellence. The goals of treatment for GEP-NENs are improving quality of life, prolonging survival and control of symptom related to excessive hormone secretion. There are still lots of problems need to be solved in this field, such as accurate pathological grade and stage, molecular target for diagnosis and treatment, proper treatment sequence and evaluation criteria, and whether all neuroendocrine tumor need to be treated. The answers to these questions will improve the outcome of GEP-NENs.     

外科概念的转变-学科交叉的发展

许多疾病的治愈已经不能由单一专业的科学家来完成,需要多种方法综合治疗从而确定最佳治疗方案,为病人提供优质高效的治疗服务.学科交叉是外科学发展的必然规律和强大动力.     

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??Pay more attention to and standardize multidisciplinary comprehensive treatment for soft tissue tumors SHI Ying- qiang. Department of Gastric and Soft Tissue Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Abstract Soft tissue tumors are a relatively rare, heterogeneous group of tumors arising from mesenchymal tissues and occurring almost anywhere in the body. They have many kinds and many of them can easily have local recurrence or have hematogenous dissemination after operations. We should pay more attention to and make multidisciplinary comprehensive treatment for them. In order to standardize the multidisciplinary comprehensive treatment, we should establish a comprehensive treatment team and be quite familiar with the main contents of the treatments. A uniform guideline, a view of overall situation and an effective individual treatment program can make help to standardize the comprehensive treatment.     

Optimal timing of cleft palate closure. Speech, facial growth, and hearing considerations

We have presented an updated overview of the controversy surrounding the timing of cleft palate closure based upon the goals of cleft palate surgery: attainment of normal speech, maxillofacial growth, and hearing. From a critical analysis of the conflicting literature in these areas, we have developed our own philosophy of the cleft palate closure over the past decade that incorporates these three primary goals in the multidisciplinary care of the cleft palate patient. We feel that only through an objective, long-term, goal-oriented, prospective study of our patients will we be able to obtain realistic data in this controversial area. To date, there are no long-term, prospective, double-blind studies available in the area of cleft palate surgery. In the interim, we must objectively assess our results and, above all, adhere to the primary principle of medicine of doing no harm in the multidisciplinary management of the cleft palate patient.     

Planning surgical treatment

The following should be regarded as prerequisites for successful surgical treatment: careful assessment of the local problem and of the patient as a complete individual; a thorough understanding of the biomechanical implications of the disease and of the operations used in its management; a clear definition of the goals of surgery in both the patient's and the surgeon's minds; and very careful planning with regard to the timing and sequence of operations. Other factors of major importance, especially in multijoint reconstructive programmes, are careful patient selection, the early establishment of good doctor/patient rapport, the support of a highly skilled multidisciplinary team of health professionals, and impeccable supervision of the convalescence, especially at the particularly difficult period for the patient following discharge from hospital. Finally, the hospital team must be prepared to offer a permanent service as a readily available advice bureau for family doctors, patients, and their relatives.     

Education in Vascular Access

The successful creation and use of an arteriovenous vascular access (VA) requires a coordinated, educated multidisciplinary team to ensure an optimal VA for each patient. Patient education programs on VA are associated with increased arteriovenous VA use at dialysis initiation. Education should be tailored to patient goals and preferences with the understanding that experiential education from patient to patient is far more influential than that provided by the healthcare professional. VA education for the nephrologist should focus on addressing the systematic and patient‐level barriers in achieving a functional VA, with specific components relating to VA creation, maturation, and cannulation that consider patient goals and preferences. A deficit in nursing skills in the area of assessment and cannulation can have devastating consequences for hemodialysis patients. Delivery of an integrated education program increases nurses’ knowledge of VA and development of simulation programs or constructs to assist in cannulation of the VA will greatly facilitate the much needed skill transfer. Adequate VA surgical training and experience are critical to the creation and outcomes of VA. Simulations can benefit nephrologists, dialysis nurses surgeons, and interventionalists though aiding in surgical creation, understanding of the physiology and anatomy of a dysfunctional VA, and practicing cannulation techniques. All future educational initiatives must emphasize the importance of multidisciplinary care to attain successful VA outcomes.     

The pregnant trauma patient

Trauma is the leading non-obstetric cause of maternal death. Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anaesthetist and critical care physician play a pivotal role in the entire continuum of fetomaternal care, from initial assessment, resuscitation and intraoperative management, to postoperative care that often involves critical care support and patient transfer. Primary goals are aggressive resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanisms of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality. A framework for the acute care of the pregnant trauma patient is presented.