大面积脑梗死患者血管内低温技术的可操作性分析

目的探讨大面积脑梗死患者血管内低温技术的可操作性。方法前瞻性纳入大面积脑梗死接受血管内低温治疗的患者22例。按发病6个月生存与否或改良Rankin评分（mRS）,分为生存组（14例）和死亡组（8例）,预后良好组（mRS0～4分,11例）和预后不良组（mRS5～6分,11例）。分析血管内低温技术的可操作性及其与预后的关系。结果①22例患者诱导低温时间为（7．4±3．1）h,降温速度（0．66±0．40）℃/h;维持低温中位数时间24．0（20．5～72．0）h,最大温度偏差中位数0．2（0．1～2．0）℃,最大温度偏差≤0．3℃时长占维持低温时长的比率平均〉90％,15例患者低温过程中最大温度偏差≤0．3℃;恢复常温时间（36．0±13．9）h,复温速度（0．09±0．05）℃/h。生存组与死亡组比较以及预后良好组与预后不良组比较,各项温度相关变量的差异无统计学意义（P〉0．05）。②1例发生低温操作技术实施意外（盐水腔破裂）;4例患者发生低温仪器运转意外（6例次）,其中3次电源松动和1次机器停止运转的持续时间长,并引起体温波动,幅度为0．4～0．7℃。生存组与死亡组比较以及预后良好组与预后不良组比较,低温操作意外事件差异无统计学意义（P=1．000）。结论血管内低温技术的可操作性较好,但仍需提前做好低温治疗方案和各种意外事件处理预案,以保证低温治疗顺利实施。     

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: How can patients be better selected?

Chronic thromboembolic pulmonary hypertension (CTEPH) comprises organizing thrombotic obstructions in the pulmonary arteries by nonresolving thromboemboli, formation of fibrosis and remodeling of pulmonary blood vessels. Surgical pulmonary endarterectomy (PEA) is the therapy of choice for patients with surgically accessible CTEPH, which leads to a profound improvement in hemodynamics, functional class and survival. Select- ing the candidates that will benefit from surgery is still a challenging task. Criteria for surgical suitability have been described but the decision-making for or against surgical intervention remains still subjective. The optimal characterization of the reciprocal contribution of large vessel and small vessel disease in the elevation of pulmonary vascular resistance is crucial for the indication and outcome of PEA. Recently, Toshner et al intended to validate the partition resistance into small and large vessels compartments (upstream resistance:Rup) by the occlusion technique in the preoperative assessment of PEA. We discuss the advantages and disadvantages of Rup and compare it with other hemodynamic predictor to evaluate operative risk in CTEPH patients.     

加速康复外科从理论到实践——我们还需要做什么?

加速康复外科(enhanced recovery after surgery,ERAS)的临床实践已有充分的证据改变了外科手术的结果,缩短住院日并节约费用.但是目前ERAS无论是被应用的广度还是深度却远远不够,原因何在呢？我们分析可能主要原因是缺少”可操作、可评估、可重复”的临床方案.可操作主要是指临床方案简单易行,团队和患者依从性均好;可评估是指方案应用前、中、后均有客观评估标准及处理方案;可重复是临床方案在本单位及推广过程中重复性好.     

Operability score: An innovative tool for quantitative assessment of operability in comparative studies on surgical anatomy

ObjectivesComparative anatomical studies have proved to be invaluable in the evaluation of advantages and drawbacks of single approaches to access established target areas. Approach-related exposed areas do not necessarily represent useful areas when performing surgical manoeuvres. Accordingly the concept of “operability” has recently been introduced as a qualitative assessment of the ability to execute surgical manoeuvres. The authors propose an innovative model for the quantitative assessment of the operability, defined as “operability score” (OS), which can be effectively and easily applied to comparative studies on surgical anatomy.MethodsA microanatomical study was conducted on six cadaveric heads.ResultsMorphometric measurements were collected and operability scores in selected target points of the surgical field were calculated. As illustrative example, the operability score was applied to the extradural subtemporal transzygomatic approach (ESTZ).ConclusionThe operability score is effective in grading system of surgical operability, and instruments manipulation capability. It is a useful tool to evaluate, in a single approach, areas that can be exposed, and to quantify how those areas are suitable for surgical manoeuvres.     

Ergebnisse der Behandlung des operierten Bronchuscarcinoms und des nicht operierten kleinzellig anaplastischen Carcinoms

Zusammenfassung Von 1732 Patienten konnte bei 95 % das weitere Schicksal geklärt werden. Verhältnis Männer: Frauen war 7:1, der Altersgipfel lag im 7. Lebensjahrzehnt. 80% waren Raucher, 64% primär und 4 % nach Probethorakotomie inoperabel. Die postoperative Letalität betrug 8,2 %, 3 Bronchusfisteln und 17 Pleuraempyeme komplizierten den Verlauf. 45,5 % der Operierten ohne LK.-Metastasen und 14,7 % mit LK.-Metastasen überlebten 5 Jahre. 86% von 242 nicht operierten Patienten mit einem kleinzelligen Carcinom starben im ersten Jahr nach Entlassung. Nur 1,2 % überlebten 5 Jahre.

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Results of surgical treatment of bronchiogenic carcinoma and nonsurgical treatment of oat cell carcinoma

Summary Of 1732 patients, 95 % were followed up. The proportion of men to women was 7:1, most patients being about 70 years old. Eighty percent of the patients smoked, 64 % were considered inoperable when first seen, and 4 % were found to be incurable at the time of surgery. Postoperative deaths were 8.2 %; 3 bronchopleural fistulass and 17 pleural empyemas complicated recovery. Of those patients operated on without lymph node involvement, the 5-year survival rate was 45.4 %, with lymph node metastasis 14.7 %. Of 242 patients with oat cell carcinoma who were not operated on, 86 % died within the first year after hospital discharge. Only 1.2 % survived 5 years.

Vortrag gehalten auf der 96. Tagung der Deutschen Gesellschaft für Chirurgie     

关于GB／T14233．1存在问题的探讨

对国标GB/T14233．1中所描述的试剂级别、标准方法的可操作性以及环氧乙烷检测的平衡时间等问题提出了不同看法。标准贮备液的配制要使用基准级试剂；环氧乙烷残留量检测60℃20分钟不能使系统达到气-液相平衡。     

卫生监督统计指标评价

目的构建实用性及操作性强的卫生监督统计指标体系。方法 2011年9月-11月采用德尔菲专家咨询法对指标的实用性、代表性进行评价,利用问卷调查法对指标的操作性进行评价,利用制定的评价原则对指标进行实用性与操作性评价。结果评价出实用性及操作性较强的卫生监督统计指标57个,两轮专家咨询的积极系数均为100.00%,操作性指标的积极系数也为100.00%;专家权威程度两轮分别为0.75和0.79;协调系数第一轮专家咨询实用性为0.27、代表性为0.24,第二轮实用性为0.23、代表性为0.22(P<0.05)。结论评价出的实用性卫生监督统计指标体系较为实用、可靠,可用于评价卫生监督工作。     

PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer

Objective

To prospectively assess the value of PET/CT for staging, diagnosis and operability of ovarian cancer, with special attention to the peritoneal spread.

Methods

From June 2009 to March 2011, 69 patients with suspicion of having an ovarian cancer underwent an ¹⁸ F-FDG PET/CT. To identify the diagnostic value of PET/CT, the results were compared with the findings at diagnostic laparoscopy and/or debulking surgery.

Results

There were 56 patients with malignant tumors and 13 with benign tumors. We observed a sensitivity and specificity of 93% and 77%, respectively for malignant tumors with PET/CT. CT alone had a sensitivity and specificity of 96% and 38%, respectively. The overall FIGO classification evaluation for PET/CT and CT were the same. For the evaluation of metastases, the sensitivity of PET/CT was worse, while the specificity was better than CT. Retroperitoneal lymph node metastases were diagnosed better with PET/CT, while there was no difference for peritoneal spread and for the intestines. PET/CT detected another unknown primary tumor in 3 (4.3%) cases.

Conclusion

PET/CT is better than CT in detecting retroperitoneal lymph node metastases, but not for peritoneal metastases.