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中国医师进修杂志
中国医师进修杂志

姒健敏

旬刊

1673-4904

yishi@zgysjxzz.com

0411-82482314

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国医师进修杂志/Journal Chinese Journal of Postgraduates of Medicine北大核心CSTPCD
查看更多>>1978年创刊，中华人民共和国卫生部主管，中华医学会主办。本刊是综合性临床医学期刊，其主要读者对象为临床中、高级内、外、妇、儿、五官科医务人员。从创刊至今始终坚持以继续医学教育、岗位进修培训为办刊宗旨。现开设的主要栏目：专题辅导、专家论坛、临床论著、进展概述、综述与讲座、教学查房、临床病例讨论、病例报告、探讨与评价、药物与临床、影像与临床、新技术介绍、教训纵横等。其中专题辅导、教学查房等栏目深受读者欢迎。
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    结肠癌患者术后感染的影响因素分析及列线图模型构建

    张艳华张湛张琳琳张莉...
    48-53页
    查看更多>>摘要：目的 分析影响结肠癌患者术后感染的危险因素并构建列线图模型。 方法 回顾性分析安徽省肿瘤医院2019年5月至2022年6月220例结肠癌患者的临床资料。其中，发生术后感染55例（感染组），未发生术后感染165例（非感染组）。采用受试者工作特征（ROC）曲线分析各指标预测结肠癌患者发生术后感染的效能；采用多因素Logistic回归分析影响结肠癌患者发生术后感染的独立危险因素。采用R语言3.5.2软件构建预测结肠癌患者发生术后感染的列线图模型并验证和评估。 结果 两组性别构成、体质量指数、肿瘤分期、术中输血、高血压、吸烟史、饮酒史、肿瘤直径和血红蛋白比较差异无统计学意义（P>0.05）；感染组年龄、糖尿病比例、手术时间和排气时间明显大于非感染组[（49.60 ± 4.40）岁比（47.20 ± 4.12）岁、63.64%（35/55）比30.30%　（50/165）、（197.80 ± 12.55）min比（192.23 ± 12.05）min和（3.42 ± 1.18）d比（2.60 ± 0.80）d]，白蛋白明显低于非感染组[（28.29 ± 3.02）g/L比（32.80 ± 3.21）g/L]，差异有统计学意义（P<0.01）。ROC曲线分析结果显示，年龄、手术时间、排气时间和白蛋白预测结肠癌患者发生术后感染的曲线下面积分别为0.672、0.610、0.706和0.846，最佳截断值分别为49岁、184 min、3 d和30 g/L。多因素Logistic回归分析结果显示，年龄（>49岁）、糖尿病、手术时间（>184 min）、排气时间（>3 d）、白蛋白（≤30 g/L）是影响结肠癌患者发生术后感染的独立危险因素（OR = 2.131、1.758、1.449、1.841和2.325，95% CI 1.269～2.696、1.354～3.059、1.201～1.965、1.018～2.365和1.582～3.051，P<0.01）。以年龄、糖尿病、手术时间、排气时间、白蛋白作为预测因子构建了列线图模型。此列线图模型预测结肠癌患者发生术后感染的校正曲线趋近于理想曲线（C-index为0.764，95%CI 0.657～0.834）；决策曲线分析结果显示，风险阈值>0.07时，此列线图模型提供临床净收益；且模型的临床净收益高于年龄、糖尿病、手术时间、排气时间和白蛋白。 结论 年龄（>49岁）、糖尿病、手术时间（>184 min）、排气时间（>3 d）和白蛋白（≤30 g/L）是影响结肠癌患者发生术后感染的独立危险因素，且基于以上变量构建的列线图模型可以对患者术后感染进行较好的预测。 Objective To analyze the risk factors of postoperative infection in patients with colon cancer, and construct a nomogram model. Methods The clinical data of 220 patients with colon cancer in Anhui Cancer Hospital from May 2019 to June 2022 were retrospectively analyzed. Among them, 55 patients developed postoperative infection (infection group), and 165 patients did not develop postoperative infection (non-infection group). The receiver operating characteristic (ROC) curve was used to analyze the efficacy of each index in predicting postoperative infection in patients with colon cancer. Multivariate Logistic regression analysis was used to analyze the independent risk factors of postoperative infection in patients with colon cancer. R language 3.5.2 software was used to construct a nomogram model for predicting postoperative infection in patients with colon cancer, and it was verified and evaluated. Results There were no significant differences in gender composition, body mass index, tumor stage, intraoperative blood transfusion, hypertension, smoking history, alcohol consumption history, tumor diameter and hemoglobin between the two groups (P>0.05) the age, diabetes mellitus ratio, operation time and exhaust time in the infection group were significantly higher than those in the non-infection group: (49.60 ± 4.40) years old vs. (47.20 ± 4.12) years old, 63.64% (35/55) vs. 30.30% (50/165), (197.80 ± 12.55) min vs. (192.23 ± 12.05) min and (3.42 ± 1.18) d vs. (2.60 ± 0.80) d, the albumin was significantly lower than that in the non-infected group: (28.29 ± 3.02) g/L vs. (32.80 ± 3.21) g/L, and there were statistical differences (P<0.01). ROC curve analysis result showed that the area under the curve of age, operation time, exhaust time and albumin for predicting postoperative infection in patients with colon cancer were 0.672, 0.610, 0.706 and 0.846, and the optimal cut-off values were 49 years old, 184 min, 3 d and 30 g/L, respectively. Multivariate Logistic regression analysis result showed that age (>49 years old), diabetes mellitus, operation time (>184 min), exhaust time (>3 d) and albumin (≤30 g/L) were independent risk factors of postoperative infection in patients with colon cancer (OR = 2.131, 1.758, 1.449, 1.841 and 2.325 95% CI 1.269 to 2.696, 1.354 to 3.059, 1.201 to 1.965, 1.018 to 2.365 and 1.582 to 3.051 P<0.01). A nomogram model was constructed with age, diabetes mellitus, operation time, exhaust time, and albumin as predictors for predicting postoperative infection in patients with colon cancer. The correction curve of the nomogram model for predicting postoperative infection in patients with colon cancer was close to the ideal curve (C-index = 0.764, 95%CI 0.657 to 0.834) decision curve analysis result showed that the nomogram model provided clinical net benefit when the risk threshold was > 0.07 and the clinical net benefit of the model was higher than that of age, diabetes mellitus, operation time, exhaust time and albumin. Conclusions The age (>49 years old), diabetes mellitus, operation time (>184 min), exhaust time (>3 d) and albumin (≤30 g/L) are the independent risk factors of postoperative infection in patients with colon cancer, and the nomogram model based on the above variables could predict postoperative infection.

    结肠肿瘤列线图危险因素术后感染

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    比较切开挂线对口引流术与切开挂线旷置引流术治疗肛周脓肿的疗效观察

    贺磊邵帅江波吕彤...
    53-57页
    查看更多>>摘要：目的 分析切开挂线对口引流术与切开挂线旷置引流术治疗肛周脓肿的临床疗效。 方法 采用前瞻性研究的方法，选取2019年11月至2022年11月安庆市立医院收治的肛周脓肿患者82例，按照随机数字表法分为A组和B组各41例。A组实施切开挂线对口引流术治疗，B组实施切开挂线旷置引流术治疗。比较A组和B组肛周脓肿患者临床疗效、手术时间、创面愈合时间、术后恢复时间和住院时间。采用视觉模拟评分（VAS）和大便失禁严重程度评分（Wexner评分）分别评估患者术前、术后1 d和术后7 d疼痛感和肛门功能。统计患者术后1个月内并发症发生情况。 结果 两组患者临床总有效率、手术时间比较差异无统计学意义（P>0.05）。A组患者创面愈合时间、术后恢复时间和住院时间均明显短于B组[（21.34 ± 2.21）d比（27.86 ± 2.84） d、（23.12 ± 2.42） d比（28.36 ± 2.91） d、（8.12 ± 0.83） d比（13.25 ± 1.47） d]，差异有统计学意义（P<0.05）。术后1和7 d，A组VAS和Wexner评分低于B组[（6.11 ± 0.62）分比（6.54 ± 0.67）分、（2.39 ± 0.25）分比（3.21 ± 0.33）分、（7.54 ± 0.77）分比（8.96 ± 0.91）分、（4.22 ± 0.43）分比（5.68 ± 0.58）分]，差异有统计学意义（P<0.05）。两组患者术后1个月总并发症发生率比较差异无统计学意义（P>0.05）。 讨论 与切开挂线旷置引流术相比，切开挂线对口引流术治疗肛周脓肿患者可促进创面愈合，缩短住院时间，降低术后疼痛感，改善术后肛门功能，具有一定安全性。 Objective To analyze the clinical curative effects of wire-to-port drainage and put-aside drainage after incision and hanging on perianal abscess. Methods Eighty-two patients with perianal abscess admitted to Anqing Municipal Hospital between November 2019 and November 2022 were enrolled. The patients were divided into group A (41 cases, incision and hanging wire-to-port drainage) and group B (41 cases, incision and hanging put-aside drainage) by random digits table method. The clinical curative effect, operation time, wound healing time, postoperative recovery time and hospitalization time in the two groups were compared. The pain and anal function were evaluated by visual analogue score (VAS) and Wexner continence grading score (Wexner score) before surgery and 1, 7 d after surgery. The occurrence of complications within 1 month after surgery was statistically analyzed. Results There was no significant difference in total clinical response rate between group A and group B (P>0.05). There was no significant difference in operation time between the two groups (P>0.05). The wound healing time, postoperative recovery time and hospitalization time in group A were significantly shorter than those in group B: (21.34 ± 2.21) d vs. (27.86 ± 2.84) d, (23.12 ± 2.42) d vs. (28.36 ± 2.91) d, (8.12 ± 0.83) d vs. (13.25 ± 1.47),P<0.05. At 1 and 7 d after surgery, the VAS and Wexner score in group A were lower than those in group B: (6.11 ± 0.62) points vs. (6.54 ± 0.67) points, (2.39 ± 0.25) points vs. (3.21 ± 0.33) points, (7.54 ± 0.77) points vs. (8.96 ± 0.91) points, (4.22 ± 0.43) points vs. (5.68 ± 0.58) points,P<0.05. There was no significant difference in total incidence of complications between the two groups within 1 month after surgery (P>0.05). Conclusions Compared with incision and hanging put-aside drainage, incision and hanging wire-to-port drainage can promote wound healing, shorten hospitalization time, relieve postoperative pain and improve anal function in patients with perianal abscess, with certain safety.

    脓肿肛周切开挂线对口引流术切开挂线旷置引流术临床疗效

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    双歧杆菌三联活菌胶囊辅助三联疗法治疗儿童幽门螺杆菌阳性慢性胃炎的临床研究

    顾岚徐惠张莉
    58-63页
    查看更多>>摘要：目的 研究双歧杆菌三联活菌胶囊辅助三联疗法治疗儿童幽门螺杆菌（Hp）阳性慢性胃炎的临床效果。 方法 回顾性分析无锡市儿童医院2019年1月至2022年3月80例Hp阳性慢性胃炎患儿的临床资料。其中，采用双歧杆菌三联活菌胶囊联合三联疗法（奥美拉唑、阿莫西林和克拉霉素）治疗40例（联合组），三联疗法治疗40例（对照组），均治疗4周。比较两组疗效、Hp根除情况（停药4周后行13C呼气试验）和症状改善情况（评估上腹痛、纳差和反酸的评分）。治疗前后采集患儿粪便，检测肠道菌群双歧杆菌、乳酸杆菌、双歧杆菌/肠杆菌；治疗前和治疗14 d检测血清炎性因子C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白细胞介素10（IL-10）和核转录因子κB（NF-κB）水平；记录不良反应（呕吐、腹泻、头晕和皮疹）发生情况。 结果 联合组总有效率和Hp清除率明显高于对照组[95.00%（38/40）比80.00%（32/40）和92.50%（37/40）比75.00% （30/40）]，差异有统计学意义（P<0.05）。联合组治疗后上腹痛、纳差和反酸评分明显低于对照组[（0.56 ± 0.14）分比（1.12 ± 0.35）分、（1.20 ± 0.37）分比（1.50 ± 0.42）分和（1.02 ± 0.28）分比（1.39 ± 0.43）分]，差异有统计学意义（P<0.01）。联合组治疗后双歧杆菌、乳酸杆菌和双歧杆菌/肠杆菌明显高于对照组[（8.56 ± 1.35）lgcfu/g比（7.94 ± 1.32）lgcfu/g、（9.27 ± 1.63）lgcfu/g比（8.35 ± 1.58）lgcfu/g和1.85 ± 0.40比1.25 ± 0.34]，差异有统计学意义（P<0.01）。联合组治疗后CRP、TNF-α和NF-κB明显低于对照组[（12.06 ± 3.14）ng/L比（17.36 ± 3.08）ng/L、（10.74 ± 3.25）μg/L比（15.30 ± 4.18）μg/L和（1.17 ± 0.34）μg/L比（2.21 ± 0.82）μg/L]，IL-10明显高于对照组[（43.14 ± 6.38）μg/L比（35.29 ± 5.03）μg/L]，差异有统计学意义（P<0.01）。两组不良反应发生率比较差异无统计学意义（P>0.05）。 结论 双歧杆菌三联活菌胶囊辅助三联疗法治疗Hp阳性慢性胃炎患儿疗效明确，不良反应少，能明显改善临床症状，机制可能与其调控肠道菌群-血清炎性反应有关。 Objective To study the clinical effect of combined capsules of live Bifidobacterium, Lactobacillus and Enterococcus assisted triple therapy in chronic gastritis children with Helicobacter pylori (Hp) positive. Methods The clinical data of 80 chronic gastritis children with Hp positive from January 2019 to March 2022 in Wuxi Children′s Hospital were retrospectively analyzed. Among them, 40 children (combination group) were treated with combined capsules of live Bifidobacterium, Lactobacillus and Enterococcus combined with triple therapy (omeprazole, amoxicillin and clarithromycin), 40 children (control group) were treated with triple therapy, and all children were treated for 4 weeks. The efficacy, Hp clearance rate (performed 13C breath test after 4 weeks of discontinuation) and symptom improvement (the scores of upper abdomen pain, anorexia and sour regurgitation) were compared between two groups. The feces before treatment and after treatment were collected, and the intestinal flora was detected, including Bifidobacterium, Lactobacillus, Bifidobacterium/Enterobacteria the levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α), interleukin 10 (IL-10) and nuclear transcription factor κB (NF-κB) before treatment and 14 d after treatment were detected the adverse reactions (vomiting, diarrhea, dizziness and erythra) were detected. Results The total effective rate and Hp clearance rate in combination group were significantly higher than those in control group: 95.00% (38/40) vs. 80.00% (32/40) and 92.50% (37/40) vs. 75.00% (30/40), and there were statistical differences (P<0.05). The scores of upper abdomen pain, anorexia and sour regurgitation after treatment in combination group were significantly lower than those in control group: (0.56 ± 0.14) scores vs. (1.12 ± 0.35) scores, (1.20 ± 0.37) scores vs. (1.50 ± 0.42) scores and (1.02 ± 0.28) scores vs. (1.39 ± 0.43) scores, and there were statistical differences (P<0.01). TheBifidobacterium, Lactobacillus, Bifidobacterium/Enterobacteria after treatment in combination group were significantly higher than those in control group: (8.56 ± 1.35) lgcfu/g vs. (7.94 ± 1.32) lgcfu/g, (9.27 ± 1.63) lgcfu/g vs. (8.35 ± 1.58) lgcfu/g and 1.85 ± 0.40 vs. 1.25 ± 0.34, and there were statistical differences (P<0.01). The CRP, TNF-α and NF-κB after treatment in combination group were significantly lower than those in control group: (12.06 ± 3.14) ng/L vs. (17.36 ± 3.08) ng/L, (10.74 ± 3.25) μg/L vs. (15.30 ± 4.18) μg/L and (1.17 ± 0.34) μg/L vs. (2.21 ± 0.82) μg/L, the IL-10 after treatment was significantly higher than that in control group: (43.14 ± 6.38) μg/L vs. (35.29 ± 5.03) μg/L, and there were statistical differences (P<0.01). There was no statistical difference in the incidence of adverse reactions between two group (P>0.05). Conclusions The combined capsules of live Bifidobacterium, Lactobacillus and Enterococcus assisted triple therapy has clear efficacy in chronic gastritis children with Hp positive, with few adverse reactions. It can significantly improve clinical symptoms, and its mechanism may be related to the regulation of intestinal microbiota and serum inflammation.

    儿童幽门螺杆菌胃炎双歧杆菌三联活菌胶囊三联疗法

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    机器人辅助腹腔镜手术治疗马蹄肾合并肾肿瘤1例报告并文献复习

    张玥柯盈卢鹏予温立洁...
    63-68页
    查看更多>>摘要：目的 探讨机器人辅助腹腔镜手术治疗马蹄肾合并肾肿瘤的技术重点。 方法 回顾性分析2021年9月大连医科大学附属第二医院1例机器人辅助腹腔镜肾部分切除术治疗马蹄肾合并肾肿瘤患者的临床资料。检索PubMed、中国知网、万方和维普数据库自建库至2022年12月所有采用机器人辅助腹腔镜肾切除术或肾部分切除术治疗马蹄肾合并肾肿瘤的文献。 结果 检索到10篇文献11例患者，加上本例共计12例患者。12例患者中，采用腹膜后入路4例，经腹腔入路8例。2例先行传统腹腔镜下操作，寻及动脉并控制后再置入机器人机械臂行肾部分切除及缝合；10例全程采用机器人辅助腹腔镜下操作。行一侧肾切除术5例，肾部分切除术7例。术后病理诊断为透明细胞癌8例，嫌色细胞癌1例，嗜酸细胞癌1例，肾细胞癌1例，肾脓肿1例。大连医科大学附属第二医院的1例患者，女，38岁，因发热入院，术前完善CT动脉造影和三维重建后，行机器人辅助腹腔镜右肾部分切除+峡部离断术治疗，术中肿瘤滋养血管以一次性使用组织闭合夹逐一结扎并离断，贴肿瘤左侧采用内镜下切割吻合器离断峡部，环肿瘤边缘锐性完整切除肿瘤。手术历时240 min，无热缺血时间，出血量约300 ml，患者术后恢复良好，术后病理诊断为肾脓肿。 结论 机器人辅助腹腔镜手术治疗马蹄肾合并肾肿瘤安全有效，较传统腹腔镜手术更具优势。术前应完善CT动脉造影或三维血管重建检查，充分评估变异血管，根据肿瘤大小和位置决定手术入路和手术方案，术中妥善处理变异血管，采用内镜下切割吻合器处理峡部会更利于手术操作。 Objective To explore the technical focus of robotic-assisted laparoscopic surgery for the treatment of horseshoe kidney combined with renal tumor. Methods The clinical data of a patient with horseshoe kidney combined with renal tumor treated by robot-assisted laparoscopic partial nephrectomy in the Second Hospital of Dalian Medical University in September 2021 were retrospectively analyzed. PubMed, CNKI, Wanfang and VIP databases were searched for all the literature on the use of robot-assisted laparoscopic nephrectomy or partial nephrectomy for the treatment of horseshoe kidney combined with renal tumor from the time of establishment to December 2022. Results A total of 11 patients from 10 articles were retrieved and 12 patients were enrolled. Among the 12 patients, 4 cases used the retroperitoneal approach and 8 cases used the transperitoneal approach. Two cases were operated by traditional laparoscope, and the arteries were searched for and controlled before the robotic arm was placed to perform the partial nephrectomy and suture and 10 cases were operated with the robotic-assisted laparoscopic approach throughout the whole procedure. Five cases of nephrectomy were performed on one side, and 7 cases were performed in the partial nephrectomy. Postoperative pathological diagnosis was clear cell carcinoma in 8 cases, chromophobe cell carcinoma in 1 case, eosinophilic cell carcinoma in 1 case, renal cell carcinoma in 1 case, and renal abscess in 1 case. The patient in the Second Hospital of Dalian Medical University was 38 years old female who was admitted to the hospital with a fever. After CT arteriography and three-dimensional reconstruction, robotic-assisted laparoscopic partial nephrectomy of right kidney and isthmus dissecting was performed. During the operation, tumor trophoblast vessels were ligated and dissected one by one by using single-use tissue closure clips, and the isthmus was dissected using endoscopic cutting anastomosis on the left side of the tumor, with the tumor edges sharply resected and completely dissected. The operation time was 240 min, without thermal ischemia time, and the bleeding volume was about 300 ml. The patient recovered well after the operation, and the postoperative pathological diagnosis was renal abscess. Conclusions Robot-assisted laparoscopic treatment of horseshoe kidney combined with renal tumor is safe and effective, and has more advantages than traditional laparoscopic surgery. Preoperative CT arteriography or three-dimensional reconstruction examination should be applied to fully evaluate the variant vessels. The surgical access and plan should be decided according to the size and location of the tumor. The variant vessels should be properly handled during operation. The use of endoscopic cutting anastomosis to deal with the isthmus can be more conducive to the surgical operation.

    马蹄肾肾部分切除术腹腔镜手术机器人辅助腹腔镜

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    腹腔镜超声造影在肝细胞癌伴肝硬化患者腹腔镜手术中的应用

    朱沭罗鸿昌陈经远杨淑君...
    68-73页
    查看更多>>摘要：目的 探讨腹腔镜超声造影在肝细胞癌（HCC）伴肝硬化患者腹腔镜手术中的应用价值。 方法 回顾性分析2018年2月至2020年2月华中科技大学同济医学院附属同济医院71例肝细胞癌伴肝硬化患者的临床资料。患者术前行增强CT和多参数MRI检查，行腹腔镜下肝部分切除术治疗，术中行腹腔镜超声造影检查。根据组织学检查和随访结果，比较术前影像与术前影像联合术中腹腔镜超声造影对肝细胞癌伴肝硬化患者肝脏恶性病灶的诊断效能。 结果 71例患者中，完成腹腔镜手术69例，中转开腹手术2例。术前影像学检查诊断HCC病灶110个，其中术中超声检出105个，术中腹腔镜超声造影诊断HCC病灶98个；术前影像与术前影像联合术中超声造影诊断肝脏恶性病灶的灵敏度、特异度、准确率、阳性预测值和阴性预测值比较差异无统计学意义[94.4%（102/108）比99.1%（107/108）、81.0%（34/42）比66.7%（28/42）、90.6%（136/150）比90.0%（135/150）、92.7%（102/110）比88.4%（107/121）和85.0%（34/40）比96.6%（28/29），P>0.05]。术中腹腔镜超声造影新发现的11个可疑恶性病灶中5个组织学证实为HCC。改变手术策略7例。 结论 HCC伴肝硬化患者在腹腔镜手术中行腹腔镜超声造影可对病灶全面检出、鉴别定性、精准定位、修正手术方案。 Objective To explore the application value of laparoscopic contrast enhanced ultrasound in laparoscopic surgery for patients with hepatocellular carcinoma combined with cirrhosis. Methods The clinical data of 71 patients with hepatocellular carcinoma combined cirrhosis from February 2018 to February 2020 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. The patients underwent preoperative enhanced CT and multi-parameter MRI examination, followed by laparoscopic partial hepatectomy, and intraoperative laparoscopic contrast enhanced ultrasound examination. Based on histological examination and follow-up results, the diagnostic efficacy of preoperative imaging and preoperative imaging combined with intraoperative laparoscopic contrast enhanced ultrasound in patients with hepatocellular carcinoma combined with cirrhosis was compared. Results Among the 71 patients, 69 completed laparoscopic surgery and 2 converted to open surgery. One hundred and ten HCC lesions were diagnosed by preoperative imaging examination, 105 lesions were detected by intraoperative ultrasound among them, of which 98 lesions were diagnosed as HCC by intraoperative laparoscopic contrast enhanced ultrasound. There were no statistically significant difference in sensitivity, specificity, accuracy, positive predictive value and negative predictive value between preoperative imaging and preoperative imaging combined with intraoperative laparoscopic contrast enhanced ultrasound in the diagnosis of malignant liver lesions: 94.4% (102/108) vs. 99.1% (107/108), 81.0% (34/42) vs. 66.7% (28/42), 90.6% (136/150) vs. 90.0% (135/150), 92.7% (102/110) vs. 88.4% (107/121) and 85.0% (34/40) vs. 96.6% (28/29), P>0.05. Laparoscopic contrast enhanced ultrasound revealed an additional 11 suspected malignant lesions, of which 5 lesions were histologically confirmed as HCC. Seven patients underwent surgical strategy changes. Conclusions Laparoscopic contrast enhanced ultrasound in patients with HCC combined with cirrhosis during laparoscopic surgery can be used to detect, identify, accurately locate of the lesions and modify the surgical plan.

    肝硬化癌,肝细胞腹腔镜超声检查

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    菌群-肠-脑轴靶向治疗假性肠梗阻1例报告

    高丽陈蝶祁红艳姜亚...
    74-77页
    查看更多>>摘要：假性肠梗阻（IPO）是一种少见但难治的肠动力异常疾病，通常病情严重、可出现多种并发症，临床治疗手段有限。脑肠互动异常、肠道菌群紊乱可能是胃肠动力障碍/功能疾病的重要发病机制；另外，患者在应激事件下的精神心理异常（如抑郁状态），也可能是发病的机制。所以，IPO患者结合心理评估结果，给予抗抑郁、神经调节、补充益生菌等针对菌群-肠-脑轴协同调节的综合性治疗可能更有效。

    假性肠梗阻抑郁菌群-肠-脑轴神经调节菌群调节

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    低钾血症导致房室传导阻滞1例报告

    邱恒霞强佳琪乔洁张姝兰...
    78-79页
    查看更多>>摘要：低钾血症是临床常见的一种电解质代谢紊乱，可引起各种心律失常，但引起房室传导阻滞少见。现介绍1例因低钾血症导致二度房室传导阻滞的病例，以提高临床医生对低钾血症导致传导阻滞的认识。

    房室传导阻滞低钾血症病例报告

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    体表神经调控治疗胃肠动力/功能障碍的研究进展

    李飞俞汀汤玉蓉姜柳琴...
    80-85页
    查看更多>>摘要：体表神经调控（TN）是近年新兴的一种补充治疗方法，具有无创无痛、便携、经济、操作方便、可重复和持续应用、患者依从性高等优点，已广泛用于临床多种疾病的治疗和研究，尤其在调节胃肠动力和功能方面表现出巨大潜力。现就近年TN治疗胃肠动力/功能障碍的临床应用及机制进行综述，以期更好地推动TN的临床应用。

    胃肠动力/功能障碍体表神经调控临床应用综述

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    抑酸强度和抑酸速度在食管炎黏膜愈合中的作用

    王艳陈奇林琳张莉...
    85-89页
    查看更多>>摘要：抑酸强度和抑酸速度的提高可能有助于食管炎的治疗。H2受体拮抗剂、质子泵抑制剂和新药钾离子竞争性酸阻滞剂（P-CAB）在作用机制上各有不同，故在食管炎黏膜愈合的起效速度、疗效维持方面有一定的差异。P-CAB在一定程度上可以缩短抑酸起效时间，维持抑酸时间，尤其有望用于质子泵抑制剂无效的食管炎患者。

    胃食管反流质子泵抑制剂H2受体拮抗剂钾离子竞争性酸阻滞剂

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    肺动脉分支狭窄的支架治疗现状及进展

    陈晓会杨明刘佳辰王智慧...
    89-92页
    查看更多>>摘要：肺动脉分支狭窄（PAS）是肺血管系统的异常狭窄，可以发生在肺动脉分支的任何地方，狭窄的类型包括局限性狭窄、弥漫性狭窄以及阶段性狭窄。目前PAS的治疗包括简单的球囊血管成形术、切割球囊血管成形术和支架植入。经皮球囊血管成形术因再狭窄率高而难以达到理想治疗效果。支架植入能有效解决上述难题，成为大多数治疗PAS的有效选择。

    狭窄,肺动脉支架植入介入治疗

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