目的 对比分析电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效。方法 将我院2018年11月—2020年11月间收治的92例胸腺瘤患者作为本次实验案例,根据随机双盲原则进行分组,其中对照组46例患者采用传统开胸手术治疗,观察组46例患者采用电视胸腔镜手术治疗,对于2组患者治疗中的临床疗效进行对比分析。结果 观察组术后的肺功能指标下降幅度小于对照组,且观察组的手术时间、胸管引流时间、下床活动时间、住院时间均短于对照组,出血量、引流量低于对照组,切口长度小于对照组,组间指标数据存在统计学差异(P＜0.05)。结论 电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效相比,前者创伤小、恢复快、对于患者肺功能的影响更小,具有明显的优势。

目的 本文旨在对全流程的生物安全管理问题进行梳理,为未来出现的大规模核酸筛查提供参考。方法 我们参考技术规范及其他医疗机构的实践总结,结合自身实际经验,梳理了核酸采集场所、个人防护、标本采集转运检测流程共3个方面的生物安全管理需注意的问题及解决措施。严格要求采样队伍按标准要求执行,以达到保质保量完成筛查任务的目的。结果 新冠核酸筛查期间我院共外派采集标本361 841人次。标本零污染零丢失,未发生一例生物安全事件,圆满完成采样任务。结论 大规模新冠核酸筛查是查清疫情源头、抑制疫情蔓延的重要手段。为了保证全流程的生物安全,应做好充足准备,严格落实各项生物安全措施。

Objective This article aims to sort out the problems in the whole process of biosafety management and provide reference for large-scale nucleic acid screening in the future. Methods We refer to the technical guidelines and the practice of other medical institutions, combined with our practical experience, summarized the problems and solutions needing attention in biosafety management in three aspects: nucleic acid sampling place, personal protection and the process from sample collection to detection. The sampling team was strictly required to implement the standard requirements, so as to complete the screening task with quality and quantity. Results A total of 361 841 samples were collected during SARS-CoV-2 nucleic acid screening. No samples were contaminated or lost, and no biosafety accident occurred. The sampling task were successfully completed. Conclusion Large-scale SARS-CoV-2 nucleic acid screening is an important method to find out the source of the epidemic and curb the spread of the SARS-CoV-2 pandemic. In order to ensure the biosafety of the whole process, sufficient preparations should be made and biosafety measures should be strictly implemented.

目的 探索老龄化形势下广州市白云区西部卒中防治工作的新模式。方法 通过完善组织结构、管理架构、建立稳定高效运行的(1+1+N)紧密型医联体模式,创建优质高效的卒中救治区域联盟,实现高质量的基层首诊,双向转诊,快速响应的卒中绿道急救和全程管理。结果 初步完成构建广州市白云区西部区域性卒中救治中心,区域内卒中患者及时救治,溶栓效率,血管再通等均有显著提升,整体提升白云区西部医疗机构的卒中救治水平。结论 区域性的协同救治是提高卒中救治水平的重要举措。(1+1+N)紧密型医联体模式能提高卒中患者救治率,具有可行性和必要性。

Objective To explore the effectiveness of a new stroke prevention and treatment pattern in the western part of Baiyun District, Guangzhou city, under an aging situation. Method We aim to build a high-quality and efficient stroke treatment regional alliance based on a (1+1+N) compact medical consortium, expecting to improve the overall abilities of stroke treatment in the western part of Baiyun District through high-quality primary care, two-way referrals, rapid response to stroke greenway emergency and full-process management. Results We have initially established a regional stroke treatment center in the western part of Baiyun District, Guangzhou. Stroke patients in that region can be treated in time, and the efficiency of thrombolysis and vascular recanalization have been significantly improved. Conclusion Regional coordinated treatment is an effective measure to reduce the disability and fatality rate of stroke. The (1+1+N) compact medical consortium model can improve the treatment effect in stroke patients, which is feasible and necessary.

目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果。方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌Kegel运动,并在产后42天开始行盆底康复治疗仪治疗6周,统计临床疗效,2组均在产后42天、3个月、6个月统计2组盆底功能检测、盆底器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incorrtinence,SUI)发生情况。结果 观察组和对照组一般资料,2组在年龄、分娩孕周、新生儿平均体重无统计学差异(P＞0.05),2组盆底功能进行检测比较,产后42天观察组阴道收缩持续时间、Ⅱ类肌纤维强度(85.24±22.19 cmH₂O)高于对照组(74.14±19.94 cmH₂O),差异具有统计学意义(P＜0.05),产后3月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(76.41±16.42 cmH₂O;4.35±1.78 s;94.15±18.25 cmH₂O)高于对照组(62.45±17.55 cmH₂O;3.89±1.52 s;88.55±18.36 cmH₂O),差异具有统计学意义(P＜0.05),产后6月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(79.56±15.78 cmH₂O;5.46±2.01 s;99.78±23.47 cmH₂O)明显高于对照组(67.63±14.45 cmH₂O;4.13±1.45 s;90.16±18.75 cmH₂O),差异具有统计学意义(P＜0.05)。对比2组POP和SUI发生率情况,产后42天观察组SUI发生率(28.24%)低于对照组(35.14%),差异具有统计学意义(P＜0.05);产后3月观察组POP和SUI发生率(18.32%;13.74%)低于对照组(22.70%;17.83%),差异具有统计学意义(P＜0.05),产后6月观察组POP和SUI发生率(0.00%;0.07%)明显低于对照组(8.10%;11.89%),差异具有统计学意义(P＜0.05)。 结论 孕期行盆底肌锻炼联合产后盆底功能康复治疗能明显改善产后盆底功能状态,显著降低产后盆底功能障碍性疾病的发生率。

Objective To explore the prevention and treatment effect of pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy on postpartum pelvic floor dysfunction in women. Methods From January 2019 to June 2020, women in our hospital's obstetrics outpatient department for regular obstetric checkups were selected, which ultrasound confirmed it was a singleton full-term delivery. The cases of stillbirth, fetal malformation and placenta previa were excluded. A total of 316 cases met the inclusion criteria and were randomly divided into the observation group and the control group, with 131 cases in the observation group and 185 cases in the control group. Observation group started regular pelvic floor muscle Kegel exercises from 12 weeks of gestation,and accepted pelvic floor rehabilitation therapeutic treatment from 42 days to six weeks postpartum. We summerized the pelvic floor function tests results, pelvic organ prolapse (POP) and stress urinary incontinence (SUI) situation of both groups in 42 days, 3 months and 6 months postpartum. Results The general information of the observation group and the control group showed that there were no statistical differences in age, gestational age of delivery and average weight of newborn (P>0.05). The pelvic floor function 42 days after delivery of the two groups was tested and compared, duration of vaginal contraction and class Ⅱ muscle fiber strength of the observation group [(85.24±22.19) cmH₂O] was significantly higher than that of the control group [(74.14±19.94) cmH₂O], and the difference was statistically significant (P＜0.05). Class I muscle fiber strength, duration of vaginal contraction and class Ⅱ muscle fiber strength were observed at 3 months postpartum, those of observation group[(76.41±16.42) cmH₂O; (4.35±1.78) s; (94.15±18.25) cmH₂O] were significantly higher than that in the control group [(62.45± 17.55) cmH₂O; (3.89±1.52) s; (88.55±18.36) cmH₂O], and the difference were statistically significant (P<0.05). At 6 months postpartum, class I muscle fiber strength, vaginal contraction duration and class Ⅱ muscle fiber strength in observation group [(79.56±15.78) cmH₂O; (5.46±2.01) s; (99.78±23.47) cmH₂O] were significantly higher than that of the control group [(67.63±14.45) cmH₂O; (4.13± 1.45) s; (90.16±18.75) cmH₂O], and the difference were statistically significant (P<0.05). Comparison of the incidence of POP and SUI between the two groups showed that the incidence of SUI in the observation group at 42 days postpartum (28.24%) was significantly lower than that in the control group (35.14%), the difference was statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 3 months postpartum (18.32%; 13.74%) were significantly lower than that of the control group (22.70%; 17.83%), the difference were statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 6 months postpartum (0.00%; 0.07%) were significantly lower than that of the control group (8.10%; 11.89%), the difference were statistically significant (P＜0.05). Conclusion Pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy can significantly improve postpartum pelvic floor function and significantly reduce the incidence of postpartum pelvic floor dysfunction diseases.

目的 上消化道出血发作急、变化快,具有较高的危险性,本研究目的在于分析急性上消化道出血患者的临床特征及危险因素,为临床诊治提供参考。方法 将2019年1月—2021年2月年我院的242例疑似急性上消化道出血患者作为研究对象,收集患者的年龄、性别、是否有长期抽烟史、饮酒史,是否有合并症以及并发症等一般资料,运用单因素分析其临床特征,运用多因素Logistic回归分析其独立危险因素。结果 患者年龄、长期饮酒史、消化性溃疡、门脉高压、急性胃黏膜病变、服用阿司匹林(ASA药物)、Hp感染等临床特征与急性上消化道出血具有相关性,与患者的性别、长期抽烟史不具有相关性;年龄、消化性溃疡、门脉高压、服用ASA药物、Hp感染是急性上消化道出血的危险性因素。结论 急性上消化道出血病势程度较重,死亡率高,出血需及时针对性治疗;对于急性上消化道出血高危患者,严密监测病情变化,评估其风险系数。

Objective Upper gastrointestinal bleeding has a high risk because of its rapid change. The purpose of this study is to analyze the clinical characteristics and risk factors of patients with acute upper gastrointestinal bleeding, so as to provide reference for clinical diagnosis and treatment. Methods A total of 242 patients with suspected acute upper gastrointestinal bleeding in our hospital from January 2019 to February 2021 were selected as the research objects. The general data such as patients' age, gender, whether they had a long-term history of smoking or drinking, whether they had complications and data of complications were collected. The clinical characteristics were analyzed by univariate analysis, and the independent risk factors were analyzed by multivariate Logistic regression analysis. Results Age, long-term drinking history, peptic ulcer, portal hypertension, acute gastric mucosal lesions, taking aspirin (ASA drugs), Hp infection and other clinical characteristics were correlated with acute upper gastrointestinal bleeding, but gender and long-term smoking history were not. Age, peptic ulcer, portal hypertension, taking ASA drugs and Hp infection were the risk factors of acute upper gastrointestinal bleeding. Conclusion The acute upper gastrointestinal bleeding is a serious disease, with high mortality, and the bleeding needs timely targeted treatment. For patients with high-risk acute upper gastrointestinal bleeding, closely monitor the changes of the disease and evaluate the risk coefficient are needed.

目的 统计分析Ⅲ型食管闭锁与食管气管瘘(esophageal atresia and tracheoesophageal fistula,EA-TEF)术后气管食管瘘复发(recurrent tracheoesophageal fistula,RTEF)的高危因素,并计算高危因素预测RTEF的能力。方法 回顾分析2015年9月—2021年1 月我院EA-TEF患儿的临床资料,并根据术后是否气管食管瘘复发分成复发组(recurrent组,R组)及无复发组(not recurrent组,NR组),比较两组患儿的基本情况、开放手术或胸腔镜手术、手术时间、气管食管瘘结扎方式等术中情况,统计分析RTEF的高危因素,分析其预测RTEF的能力。结果 研究期间共纳入Ⅲ型食管闭锁患儿154例,男98例,女56 例,R组11例,NR组143例,单因素对比分析R组与NR组患儿除吻合口瘘外其余均无统计学差异,其中R组吻合口瘘6人,占该组54.55%;NR组13人,占该组9.10%,P<0.001;Logistic回归模型调整后可见有吻合口瘘相对于无吻合口瘘发生RTEF的风险增加12倍(OR=12.000,95%CI:3.216~44.771)。结论 RTEF与患儿基本情况、术中情况无关,与吻合口瘘显著相关,且有吻合口瘘的患儿出现RTEF风险是无吻合口瘘患儿的12倍。

Objective To statistical analyze the high-risk factors of recurrent tracheoesophageal fistula (RTEF) after the repair of type Ⅲ esophageal atresia and tracheoesophageal fistula (EA-TEF),and evaluate the ability of these high-risk factors predicting RTEF. Methods Retrospectively analyzed the clinical data of children with type Ⅲ EA-TEF in our hospital from September 2015 to January 2021. Patients were divided into two groups (recurrent and non-recurrent group,R and NR group) according to whether there was RTEF. The general situation of those patients, situation during surgery like open or thoracoscopic surgery,operation time,method of tracheoesophageal fistula ligation were compared. Those factors of two groups were analyzed, the high-risk factors of RTEF were summarized, and Logistic regression analysis on the high-risk factors was performed to analyze the ability of predicting RTEF. Results A total of 154 infants with type Ⅲ EA-TEF were included in the study, 98 males, 56 females. There were 11 cases in R group, 143 cases in NR group. Univariate comparative analysis was carried out on R group and NR group, and no statistical differences were found except in anastomotic fistula. There were 6 patients in R group with anastomotic fistula, accounting for 54.55%, and 13 patients in NR group, accounting for 9.10%,P< 0.001. After adjusting the Logistic regression model with the high-risk factors, there was 12-fold increase in the risk of RTEF with anastomotic fistula (OR=12.000, 95%CI: 3.216~44.771) compared with no anastomotic fistula. Conclusion RTEF was not related to patients' general situation or surgery situation, but significantly related to anastomotic fistula. Patients who with anastomotic fistula had a 12-fold increase in the risk of RTEF compared with no anastomotic fistula.

目的 探讨透明帽辅助下套扎切除小胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的临床应用价值。方法 回顾性分析2017年2月—2020年2月在我院行透明帽辅助下小GIST套扎切除术151例患者的临床资料,分析其完整切除率、复发率、并发症发生率、手术时间、住院天数等指标。结果 151例小GIST患者中,瘤体位于胃底91例,胃体53例,胃窦7例,均采用透明帽辅助下完整切除病变。150例病变部位切除后肉眼及病理所见包膜完整无残留,1例分2次套扎后才完全切除肉眼无残留。术中活动性出血3例,无术后迟发性出血,术中主动穿孔105例,穿孔直径最大约1 cm。发生气胸及纵隔气肿3例,局限性腹膜炎3例,发热4例。所有病例经内镜下止血、修补及对症处理后均好转,无1例术中及术后转外科治疗;平均手术时间(28.3±7.6)min,平均住院时间为(4.3 ±1.9)天。病理结果显示极低危险度胃肠道间质瘤132例,低危险度胃肠道间质瘤19例。术后随访复查胃镜均无复发征象。结论 透明帽辅助下套扎切除术胃小GIST操作简单,安全、有效,具有临床推广的价值。

Objective To explore the clinical value of resection of small gastrointestinal stromal tumor(GIST) with transparent cap assisted band ligation. Methods The clinical data of 151 patients who underwent ligation of small GIST assisted with transparent cap in our hospital from February 2017 to February 2020 were retrospectively analyzed, and the complete resection rate, recurrence rate, and complication rate, operation time, hospitalization days and other indicators were analyzed. Results Among the 151 patients with small GIST, 91 cases were located in the fundus of the stomach, 53 cases were in the stomach body, and 7 cases were in the antrum of the stomach. All the lesions were completely resected with the aid of transparent cap. Among lesions of 150 cases, the envelopes were intact and no residue was seen by naked eyes and pathology examination, and 1 case was completely resected after 2 ligations. There were 3 cases of active bleeding, no delayed bleeding, and 105 cases of iatrogenic perforation during the operation. The maximum diameter of the perforation was about 1 cm. There were 3 cases of pneumothorax and mediastinal emphysema, 3 cases of localized peritonitis, and 4 cases of fever. After hemostasis, repair and symptomatic treatment under endoscopy, no case was transferred to surgical departmat during or after operation; the average operation time was (28.3±7.6) minutes, and the average hospital stay was (4.3±1.9) days. Pathological results showed there were 132 cases of very low-risk gastrointestinal stromal tumors and 19 cases of low-risk gastrointestinal stromal tumors. There was no sign of recurrence in the gastroscope during the follow-up. Conclusion The transparent cap assisted ligation resection of small GIST was simple, safe and effective, and had the value of clinical promotion.

目的 探讨肠道菌群多样性及丰度在抗结核治疗强化期的变化。方法 收集广州市胸科医院20例初治菌阳肺结核患者使用强化方案治疗1周及强化期结束的粪便标本,所有标本进行16S rDNA测序,进行生物信息学分析。结果 强化期结束治疗组的Alpha多样性指标Chao1和observed_otus指数分别为(97.8±28.3)和(97.6±28.2),高于治疗1周组的(81±34.7)和(81±34.7),差异有统计学意义(P=0.04;P=0.038)。基于加权和未加权Unifrac距离的PCoA分析显示两组整体菌群结构无明显差异。在相对丰度较高的菌科中,强化期结束治疗组的拟杆菌科、肠球菌科、肠杆菌科、丹毒菌科、卟啉单胞菌科、双歧杆菌科等相对丰度下降,毛螺菌科、梭杆菌科、普氏菌科、瘤胃球菌科、韦氏菌科等相对丰度增加。通过线性判别分析效应量LEfse分析两组数据,发现在属水平上,厚壁菌门的瘤胃球菌、乳杆菌及放线菌门的柯林氏菌为组间显著差异菌种。结论 强化期治疗结束与治疗1周相比,肠道菌群多样性增加,但肠道菌群结构无明显差异。肠道拟杆菌科丰度减少,毛螺菌科丰度增加。

Objective To investigate the changes in the diversity and abundance of intestinal flora during the intensive period of anti-tuberculosis treatment. Methods Stool specimens from 20 patients with newly treated bacteria-positive pulmonary tuberculosis in Guangzhou Chest Hospital, which were treated with the intensive treatment for 1 week and whole intensive treatment, were collected. All the specimens were subjected to 16S rDNA sequencing and bioinformatics analysis. Results The Alpha diversity index Chao1 and observed_otus index of the treatment group with whole process were (97.8±28.3) and (97.6±28.2) respectively, which were higher than (81±34.7) and (81±34.7) of the 1-week treatment group, which had statistical differences (P=0.04;P=0.038). PCoA analysis based on weighted and unweighted Unifrac distance showed that there was no significant difference in the overall flora community structure between the two groups. Among the bacteria families with higher relative abundance, the relative abundance of Bacteroidaceae,Enterococcaceae,Enterobacteriaceae,Erysipelotrichaceae,Porphyromonadaceae and Bifidobacteriaceae in the treatment group with whole process decreased, the relative abundance content of Lachnodoiraceae,Fusobacteriaceae,Prevotellaceae, Rumincoccaceae, and Veillonellaceae increased. By using linear discriminant analysis effect size (LEfse) to analyze the two sets of data, it was found that at the genus level,Rumincoccaceae of Firmicutes and Lactobacillus;Collinsella of Actinobacteria were significantly different species between the groups. Conclusion Compared with 1 week of treatment, the diversity of intestinal flora increased at the end of intensive treatment, but there was no significant difference in the community structure of intestinal flora. The abundance of intestinal Bacteroidaceae decreased, and the abundance of Lachnodoiraceae increased.

目的 评估基于NRS2002系统的多学科营养支持对直肠癌放化疗患者的作用。方法 选取2017年2月—2020年2月我院收治的96例直肠癌放化疗患者作为研究对象,根据入院建档顺序不同分2组,每组48例,对照组接受常规护理,观察组接受基于NRS2002系统的多学科营养支持。比较2组干预前后主观全面评定法(PG-SGA)评分、营养指标[前白蛋白(prealbumin, PA)、血清白蛋白(serum albumin, SA)、转铁蛋白(transferrin, TF)]、癌因性疲乏、生存质量(FLIC评分)。结果 干预后观察组营养状况优于对照组(P＜0.05);干预后观察组SA、PA、TF高于对照组(P＜0.05);干预后观察组癌因性疲乏低于对照组(P＜0.05);干预后观察组生存质量FLIC各维度评分高于对照组(P＜0.05)。结论 基于NRS2002系统的多学科营养支持有助于改善直肠癌放化疗患者营养状态,减轻癌因性疲乏,提升生存质量水平。

Objective To evaluate the efficacy of multidisciplinary nutritional support through NRS2002 system on patients undergoing radiotherapy and chemotherapy with rectal cancer. Methods From February 2017 to February 2020, 96 cases of rectal cancer patients undergoing radiotherapy and chemotherapy in our hospital were selected as the research objects, which were divided into two groups according to the order of filing, 48 cases in each group. The control group received routine nursing, and the observation group received multidisciplinary nutritional support through NRS2002 system. The PG-SGA score, nutritional indexes [prealbumin (PA), serum albumin (SA), transferrin (TF)], cancer-related fatigue and quality of life (FLIC score) were compared between two groups before and after intervention. Results After the intervention, the nutritional status of the observation group was better than that of the control group (P<0.05). The SA, PA, TF of the observation group were higher than those of the control group (P<0.05). The cancer-related fatigue of the observation group was lower than that of the control group (P<0.05), and the FLIC score of the observation group was higher than that of the control group (P<0.05). Conclusion Multidisciplinary nutritional support through NRS2002 system was helpful to improve nutritional status of patients, reduce cancer-related fatigue and improve quality of life of patients with rectal cancer undergoing radiotherapy and chemotherapy.

目的 研究煤工尘肺(coal worker's pneumoconiosis, CWP)患者电子计算机断层扫描(computed tomograghy, CT)的影像学表现。方法 选取2017年10月—2020年10月我院CWP患者102例,均行CT检查、X线胸片检查,比较CT检查、X线胸片检查影像学征象、小阴影形态、大阴影影像学表现,并对比CT检查、X线胸片检查并发症情况(灶周气肿、胸膜改变、淋巴结肿大、钙化)。结果 CT检查、X线胸片检查大阴影、肺内钙化影、肺大疱、空洞检出率比较,差异无统计学意义(P＞0.05);CT检查小阴影检出率82.03%高于X线胸片检查73.20%(P＜0.05);CWP患者小阴影主要形态为q/q,且CT检查q/q比例82.67%高于X线胸片检查72.77%(P＜0.05);CT检查灶周气肿31.37%、胸膜改变21.57%、淋巴结肿大15.69%、钙化18.63%, 高于X线胸片检查18.63%、10.78%、6.86%、8.82%(P＜0.05)。结论 CT检查CWP患者影像学征象、并发症检出率均高于X线胸片检查,且小阴影以q/q为主,对大阴影表现明显,有助于病情早期诊断及治疗方案的制定。

Objective To study the imaging features of computed tomograghy (CT) scanning in coal worker's pneumoconiosis (CWP). Methods A total of 102 CWP patients in our hospital from October 2017 to October 2020 were selected. CT examination and X-ray chest examination were performed to compare the imaging features, small shadow shape and large shadow imaging manifestations, and compared the complications of CT examination and X-ray chest examination (focal emphysema, pleura change, lymph node enlargement and calcification). Results There was no statistical difference in the detection rates of large shadow, calcification shadow, pulmonary bulla and cavity in CT and X-ray chest examination (P>0.05); the detection rate of small shadow in CT was 82.03%, which was higher than that of X-ray chest examination (73.20%, P<0.05); the main shape of small shadow in CWP patients was q/q, and the q/q ratio of CT examination was 82.67%, higher than that of X-ray chest examination (72.77%, P<0.05); the detection rates of the focal emphysema by CT examination was 31.37%, the changes of pleura were 21.57%, lymph node enlargement was 15.69%, calcification was 18.63%, which were higher than those of X-ray chest examination (18.63%, 10.78%, 6.86%, 8.82%, P<0.05). Conclusion The detection rate of imaging signs and complications in CWP patients by CT was higher than that of X-ray, and the small shadow was mainly q/q, and CT examination was obvious for detecting large shadow, which was helpful for the early diagnosis and treatment of the disease.