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食管癌患者術后一年非腫瘤原因死亡分析

摘要： 目的 分析食管癌患者術后1年內非腫瘤原因死亡的原因，以提高外科治療效果。 方法 回顧性分析1997年10月至2002年10月甘肅省腫瘤醫院收治的40例食管癌手術后1年內因非腫瘤原因死亡患者的臨床資料，其中男35例，女5例；年齡53~76歲（65±13歲）。對40例食管癌手術后死亡患者進行隨訪，并分析其死亡的原因。 結果 40例非腫瘤復發轉移死亡中有27例（67.50％）行食管癌根治手術，22例（55.00％）無淋巴結轉移，38例（95.00％）切緣癌陰性。術后因放化療并發癥死亡11例，主要原因是化療引起肝、腎功能衰竭、 消化道和呼吸道大出血、全身衰竭； 放療致食管主動脈瘺、食管氣管瘺、食管胸膜瘺等。因手術相關并發癥死亡18例，主要原因是膿胸胸腔感染、切口感染、壞疽性腸梗阻 、胃功能障、胸胃擴張無法進食致全身衰竭、反流性食管潰瘍致上消化道出血和誤吸致肺部感染等。因老年合并疾病死亡11例，主要原因是心肌梗死、肺栓塞和腦出血等。 結論 對食管癌患者應重視食管癌術后放化療并發癥的預防，重視出院后遠期并發癥、老年病的預防和治療，加強多科的康復治療。

護患糾紛的原因及防范措施

護患糾紛是目前導致醫護人員與患者關系緊張的重要因素之一,護患糾紛的產生有多種原因,本文從多個方面分析糾紛產生的原因,并提出避免護患糾紛的建議,以期為防范護患糾紛提供參考

Conversion to thoracotomy during minimally invasive esophagectomy: Retrospective analysis in a single center

Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors, extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.

Clinical Evidence of Unexplained Infertility

Researches of doctor-patient conflicts in China: a systematic review

ObjectiveTo systematically review the current status of doctor-patient conflicts in China.MethodsWe searched CNKI and CSSCI databases to collect literatures about the doctor-patient conflicts from inception to April 23rd, 2017. The literatures were categorized by the published time, the high-frequency vocabulary, the citation frequency, the researching discipline, the researching facility, the quality of literature, the theme of literature and so on. The current research status of the doctor-patient conflicts was analyzed.ResultsA total of 226 literatures were included, in which 72 defined and classified the doctor-patient conflicts, 122 analyzed the causing reasons of doctor-patient conflicts, and 160 analyzed the governance paths of doctor-patient conflicts. The research disciplinary vision was limited to the policies, regulations and the medical education and so on, and the researches in psychology or economics disciplinary vision were insufficient. The medical and comprehensive universities were the main research units of the studies of the doctor-patient conflicts. The frequency and quality of the researches about doctor-patient conflicts were low.ConclusionThe classified studies of doctor-patient conflicts are insufficient, so the scientific and manageable classified criterions are needed in the further studies. Systematic studies in influential factors of doctor-patient conflicts are insufficient, so the occurring mechanisms of conflicts are needed to be done by systematical researches on patient-centered way. The studies of governance paths of doctor-patient conflicts are insufficient, so the strategies of classified and systematical management which according to the different conflicting forms and entire process of the conflict occurrence should be put forward.

Retrospective Analysis of Death Causes in Wenchuan Earthquake Victims

Objective　To retrospectively analyze the characteristics and death causes among the Wenchuan earthquake victims in The Third People’s Hospital of Chengdu so as to provide information for reducing mortality in future earthquake disasters. Methods　The analysis was based on the data provided by the Department of Information, the Medical Record Library, and the Emergency Room of the hospital through July 12. Microsoft EXCEL was used for data input and SPSS 13.0 was used for statistical analyses. Results　Through July 12, 9 (1.57%) out of the 575 wounded patients died, comprising 3 males and 6 females. Of those, 5 died in the outpatient department. The death causes were all related to severe cerebral injuries. The other 4 died in the inpatient department and the death causes were related to severe underlying illnesses and infection. Conclusion　Screening and early treatment for cerebral injuries is very important in the period directly following the earthquake. Later, more attention should be paid to the treatment of underlying illnesses as well as the prevention and control of infection.

Revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of hip after total hip arthroplasty

ObjectiveTo investigate revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). MethodsA clinical data of 14 patients (15 hips) with Crowe Ⅳ DDH, who underwent a revision hip arthroplasty between January 2008 and May 2018, was retrospectively reviewed. There were 1 male (1 hip) and 13 females (14 hips). The age ranged from 27 to 63 years (mean, 45.0 years). There were 7 cases of left hip, 6 cases of right hip, and 1 case of bilateral hips. The prosthetic interfaces of primary THA were metal-on-polyethylene (MOP) in 9 hips, ceramic-on-ceramic (COC) in 4 hips, ceramic-on-polyethylene (COP) in 1 hip, and ceramic-on-metal in 1 hip. The time from primary THA to revision was 3-204 months (mean, 65.0 months). The causes of revision included aseptic loosening in 7 hips, dislocation in 3 hips, periprosthetic joint infection in 2 hips, osteolysis in 1 hip, nonunion of osteotomy in 1 hip, and a small-angle of femoral anteversion in 1 hip. Preoperative Harris score was 54.1±17.8 and the range of motion (ROM) of flexion was (92.7±20.2)°. Preoperative X-ray films showed the acetabular bone defect in 11 hips and osteolysis of femoral side in 4 hips. During the revision, the prostheses with COP and COC interfaces were used in 5 hips and 10 hips, respectively. Both acetabular and femoral revisions were performed in 11 hips and only femoral revision was performed in 4 hips.ResultsThe mean operation time was 3.7 hours (range, 1.5-6.0 hours). The mean intraoperative blood loss was 940.0 mL (range, 200-2 000 mL). All patients were followed up 16-142 months (mean, 73.9 months). Postoperative X-ray films showed no difference in inclination and anteversion between primary THA and revision (P>0.05). The height of rotation center and offset after revision were higher than those after primary THA, and the difference in offset was significant (P<0.05). At last follow-up, the Harris score and ROM of flexion were 85.0±7.3 and (115.0±17.0)°, respectively, which were significantly higher when compared with those before revision (t=8.909, P=0.000; t=4.911, P=0.000). Three hips underwent a re-revision operation. All protheses were fixed well and no radiolucent line, loosening, or subsidence was observed at last follow-up.ConclusionThe most common reason for revision in patients with Crowe Ⅳ DDH after THA was aseptic loosening. Due to high activity demand of this population, the prosthesis with MOP interface should be prevented and the prosthesis with COC interface could be alternative. Metal block, cup-cage, and reinforcement ring were reasonable solutions for reconstruction of acetabulum with severe bone defects and have satisfactory effectiveness. S-ROM prosthesis should be the preferred stem for neither primary THA or revision.

The Causes of Reoperation of Cholelithiasis and Prevention

目的:探討膽石癥再次手術的原因及預防措施。方法:對我院過去5年收治的134例膽石癥再次手術病例的臨床資料進行回顧性分析。結果:膽石癥再次手術主要原因為結石殘留或復發(86.57%),醫源性膽管損傷(4.48%),拔除T管后膽汁性腹膜炎(4.48%),殘留膽囊炎伴結石(2.99%),膽腸吻合口狹窄伴結石(1.49%)等。再次手術方式以膽總管切開取石膽道鏡檢查取石“T”形管引流術、膽總管十二指腸側側吻合術,肝膽管空腸Roux-en-Y吻合術,肝葉段切除,殘留膽囊切除術為主。本組患者痊愈131例,死亡3例,死亡率2.29%,術后殘石率5.17%.結論:對于膽石癥,無論是首次手術還是多次手術,均應做好術前檢查,制定周密的手術計劃,利用膽道外科和肝臟外科技術,努力貫徹去除病灶,解除梗阻,通暢引流三原則,力爭將殘石率、復發率、再手術率降低到最低限度。

Forensic Pathologic Analysis of Traumatic Brain Injury

【摘要】 目的 探討顱腦損傷(BI)死亡的法醫病理學特點,以及繼發性腦干損傷、并發癥的發生與死亡之間的因果關系。方法 從性別、年齡、致傷方式、損傷類型、生存時間、死亡原因等方面,對四川大學華西法醫學鑒定中心1998年1月-2008年12月127例BI死亡尸檢案例進行回顧性統計研究分析。結果 127例法醫病理學檢案中,原發性BI死亡51例(402%),繼發性腦干損傷死亡61例(480%),并發癥死亡15例(118%),其中傷后12 h內死亡者直接死因均為嚴重原發性腦損傷,存活12 h～1周者直接死因以繼發性腦干損傷居多,生存時間超過1周者約半數死于并發癥。結論 在BI案例的死亡原因確定時,應在全面系統的病理學檢驗基礎上,結合案情及臨床資料進行綜合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.

The Investigation and Analysis of Laparoscopic Puncture-Related Hemorrhage

目的探討腹腔鏡手術中穿刺相關出血的常見原因及相應的對策。 方法對2000年5月至2010年10月期間我院腹腔鏡手術中發生與穿刺相關出血的16例患者的資料進行回顧性分析。 結果16例患者中腹壁穿刺孔腹膜層出血7例，肌層出血5例，誤傷大網膜血管3例，誤傷后腹膜血管1例，均在術中及時發現。誤傷大網膜血管病例予鏡下止血，誤傷后腹膜血管病例及時中轉開腹手術，腹膜層及肌層出血病例分別給予電灼或縫扎止血。 患者均康復出院。 結論直視進腹、規范操作和抽吸滴水試驗是避免腹腔鏡手術穿刺時血管誤傷及出血遺漏的有效方法。