目的 探讨加强医学影像学的教育在肝胆外科本科实习教育中的应用效果。方法 选择了2021年3月—2023年12月，在广州市花都区人民医院肝胆胰疝外科实习的80名本科实习生为研究对象，依据随机数字表法将全部实习生随机分为两组，每组各40例，研究组接受强化影像教育，参照组接受传统教学，并对教学效果进行统计分析。结果 两组实习生经过两种不同教学方法后，研究组的总体成绩优于参照组，满意度比例高于参照组，组间差异具有统计学意义。结论 在肝胆外科临床实习教学中，加强影像学教育，可显著提高实习生的总体成绩，获得更高的教学满意度。

      Objective To explore the application effect of strengthening medical imaging education in the undergraduate internship education of hepatobiliary surgery．Methods Eighty undergraduate interns who interned in the Department of Hepatobiliary，Pancreatic and Hernia Surgery of our hospital from March 2021 to December 2023 were selected as research subjects．Using a random number table method，the interns were evenly divided into two groups，with 40 interns in each group．The experimental group received enhanced imaging education，while the control group received traditional teaching．The teaching effects were statistically analyzed．Results After undergoing two different teaching methods，the experimental group had better overall scores than the control group，and a higher satisfaction rate than the control group ，with statistically significant differences between the groups．Conclusions Strengthening imaging education in clinical internship teaching of hepatobiliary surgery can significantly improve interns’ overall scores and achieve higher teaching satisfaction，indicating its value for promotion．

目的 研究和分析外科Ⅲ类手术切口术后感染的危险因素,达到进一步预防外科Ⅲ类手术切口术后感染的目的。方法 研究对象为我科2014年1月—2016年12月普外科的1 816例Ⅲ类手术切口患者,以术后是否发生切口感染为因变量,以性别、年龄、是否切口贴用医用薄膜、切口是否碘伏冲洗等相关因素为自变量,进行Logistic回归分析,统计分析外科Ⅲ类手术切口术后发生感染的危险因素。结果 1 816例外科Ⅲ类手术切口中,术后发生切口感染有218例,切口感染率为12%。单因素分析显示,8项影响因素与Ⅲ类手术切口术后感染具有相关性(P﹤0.01),对具有统计学意义的8影响因素进行多因素Logistic回归分析,结果显示手术切皮前应用薄膜保护切口、术后切口碘伏冲洗及合理应用抗生素为切口感染保护因素(P﹤0.01),而患者年龄、全麻、急诊手术、输血及住院时间为切口感染独立危险因素(P﹤0.01)。结论 手术皮肤切开前应用医用薄膜、关腹后碘伏冲洗伤口对降低Ⅲ类手术切口术后感染发生率有一定效果,值得临床推广。

Objective: To research and analyze the risk factor which lead to type Ⅲ operation incision infection,and prevent the incision infection.Methods: The clinical data of 1816 typeⅢoperation incision patients from the general surgery department during 2001-2016,With incision infection serving as a dependent variable, gender, age, using medical films, rinsing the incision with iodophor after the abdomen closing and other factors as independent variables, single factor analysis and logistic regression analysis were used to identify risk factor for typeⅢoperation incisions.Results: From 1816 typeⅢoperation incision patients,218 patients suffered from incision infection with a infection rate of 12%,Single factor analysis showed that 8 factors had significant effects on infection of type Ⅲ operation incision(P<0.01). Logistic regression analysis showed that there were 8 related factors out of 9 factors,and age,anesthesia,blood transfusion,the days of hospitalization and emergency surgery were possible independent risk factors of incision infection(P<0.01), and the critical pathway,using medical films,rinsing the incision with iodophor after the abdomen closing,reasonable use of antibiotics were protective factors against incision infection(P<0.01),while age,anesthesia,blood transfusion,the days of hospitalization and emergency surgery were possible independent risk factors of incision infection(P<0.01).Conclusion: Using medical films before the skin incising, rinsing the incision with iodophor after the abdomen closing can reduce the rate of incision infection postoperation, it is worthy of clinical promotion.

目的 比较胆总管切开探查术后留置T管和胆总管切开探查并一期缝合术后胆管内支架引流这两种模式治疗胆管疾病的手术疗效。方法 对2012年—2014年期间收治的90例需择期行胆总管探查的患者进行前瞻性随机对照研究。按照实验方式分为T管组40例和单管内支架组50例。对比分析两组胆总管置管缝合手术时间、住院时间、治疗总费用、生活质量指数值以及并发症发生率,包括引流失败率(T管滑脱、内支架管滑脱、移位)、胆漏、胆道感染、胰腺炎和残石率。结果 开腹胆总管探查术术后内支架引流患者的出院前生存质量评价高于T管引流患者,住院时间少于T管引流患者,置管及胆管缝合时间长于T管引流患者(均为P＜0.05);术后两组患者间的治疗总费用和非计划脱管、胆漏、胆道感染、胰腺炎、残石率和不能拔/脱管等术后并发症发生率的差异无统计学意义(P＞0.05)。结论 内镜下胆道支架内引流术(Endoscopic retrograde biliary drainage,ERBD)移植于胆总管切开探查并一期缝合术具有可行性、安全性及治疗效果确切,显著缩短患者住院时间、加快患者康复提高患者出院前的生存质量,并放宽胆总管一期缝合指征。

Objective To compare the clinic research between biliary stent insertion drainage and T-tube drainage after choledochotomy. Methods The clinical data of 90 cases from 2012 to 2014 were analyzed in a prospectively randomized trial, and they were divided into two groups by T-tube drainage and biliary stent insertion drainage. Cathetering and suture time, length of stay, hospital costs, life quality and incidence of complications were compared, respectively. Results After open common bile duct exploration (OCBDE), the life quality of stent group was significantly higher than that of T-tube group, the length of stay in stent group was shorter, and cathetering and suture time of bile duct in stent group was longer than that of T-tube group (P＜0.05); There were no significant differences between the two groups in the hospital costs and incidences of postoperative complications including bile leakage, early stent dislodgement, biliary infection, pancreatitis and residual stone (P＞0.05). Conclusion Endoscopic retrograde biliary drainage (ERBD) with primary closure after choledochotomy is a safe, effective and feasible procedure for the management of choledocholithiasis, it can significantly reduce the postoperative hospital stay and improve the life quality of patients and expand the indications for primary closure of CBD incision.

目的 观察氟伐他汀联合环磷腺苷葡胺治疗慢性肺心病急性加重期的临床疗效。方法 将我院收治的74例慢性肺心病急性加重期病人,使用随机数字表法分为联合用药组与对照组,每组各37例。对照组单独使用环磷腺苷葡胺,联合用药组在对照组的基础上加服氟伐他汀。两组疗程均为7周。观察比较两组患者治疗前后的NO,ET-1,CRP,PaO₂水平以及治疗效果。结果 经7周疗程治疗后,对照组有效率为64.86%,联合用药组94.59%。两组间比较,差异有统计学意义(P<0.05)。两组NO,ET-1,CRP,PaO₂水平比较,联合用药组均优于对照组,差异有统计学意义(P<0.05)。结论 氟伐他汀联合环磷腺苷葡胺治疗慢性肺心病急性加重期的临床疗效更为显著,值得临床推广。

Objective To observe the clinical efficacy of combined treatment of Fluvastatin combined with Meglumine Adenosine Cyclophosphate on acute exacerbation of chronic pulmonary heart disease. Methods 74 patients with acute exacerbation of chronic pulmonary heart disease were randomly divided into combined treatment group and control group. The control group was treated by Meglumine Adenosine Cyclophosphate for 7 weeks.The combined treatment group was treated by Meglumine Adenosine Cyclophosphate and Fluvastatin for 7 weeks. The clinical efficacy and the score of NO,CRP,ET-1,PaO₂ were assessed before and after the treatment. Results After 7 weeks treatment, the total clinical efficacy rate was 64.86% in the control group and 94.59% in the combined treatment group. The differences between them has statistically significant(P<0.05). The score of NO,ET-1,CRP,PaO₂ in combined treatment group were significantly improved compared to control group (P<0.05). Conclusion The clinical efficacy of Fluvastatin combined with Meglumine Adenosine Cyclophosphate on acute exacerbation of chronic pulmonary heart disease is more efficient. It is worth to develop clinically.