目的 探讨脊柱外科围术期康复指导方案的临床疗效。方法 选取毕节市第三人民医院脊柱外科184例行择期手术治疗的患者,对照组继续脊柱外科原康复方案行术前及术后管理,观察组使用新的康复行为规范方案,即系统行术前预康复指导和术后规范管理。对患者的术后起床活动、在院时间、住院费用、疼痛恢复情况、满意调查情况进行对比。结果 术前,患者的性别、年龄、病种分布对比差异无统计学意义（P>0.05）。术后,观察组的术后下床活动时间（3.09±1.02）d、住院时间（10.73±3.96）d、住院费用（17 388±5 217）元、术后2天VAS评分（3.04±1.19）分、出院时VAS评分（2.36±1.25）分、住院患者满意度（89.80±8.20）分,均优于对照组的术后起床活动时间（4.44±1.58）d、住院时间（13.38±2.73）d、住院费用（23 242±7 971）元、术后2天VAS评分（4.01±1.44）分、出院时VAS评分（3.39±1.38）分、住院满意度（80.27±11.45）分。新的康复指导方案在脊柱外科患者中较对照组减轻术后疼痛、减少患者卧床时间及缩短住院时间（P<0.05）。结论 围手术期加快患者术后康复及提高术后恢复优良率,提高患者就医满意度,使医患关系更加融洽。

Objective To investigate the clinical effect of the rehabilitation guidance protocol of spinal surgery in perioperative period．Methods A total of 184 patients undergoing selective surgery in the spine surgery department of the Third People's Hospital of Bijie City were selected．The conventional rehabilitation group was the control group,which preoperative and postoperative management was continued with the original rehabilitation program of spine surgery;the rehabilitation guidance group was the observation group：the new rehabilitation behavior code program was used to provide systematic preoperative pre-rehabilitation guidance and postoperative standardized management．The patients' activities of getting up after surgery,days in hospital,economic use,pain recovery and satisfaction survey were compared．Results Before surgical treatment,the gender,age and disease distribution of patients were compared（P>0.05）．After surgical treatment,observation group：Postoperative time of getting out of bed（3.09±1.02）d,length of hospitalization（10.73±3.96）d,hospitalization expenses（17 388±5 217）yuan,VAS score of 2 days after surgery（3.04±1.19）,VAS score of discharge（2.36±1.25）,inpatient satisfaction（89.80±8.12）,were significantly better than the control group：Postoperative activity time（4.44±1.58）d,length of hospitalization（13.38±2.73）d,hospitalization expenses（23 242±7 971）yuan,VAS score（4.01±1.44）,VAS score at discharge（3.39±1.38）,hospitalization satisfaction（80.27±11.45）．Compared with the control group,the new rehabilitation guidelines significantly reduced postoperative pain,bed time and hospital days in spinal surgery patients（P<0.05）．Conclusions Speeding up the postoperative rehabilitation of patients and improving the rate of postoperative recovery,improving patients' sense of access to medical treatment,can make the doctor-patient relationship more harmonious．

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.