食管癌外科治疗近期疗效的影响因素分析

目的探讨食管癌患者年龄、吻合位置与术后并发症发生率和死亡率的关系,以及新辅助化疗对食管癌手术切除率的影响。方法回顾性分析西安交通大学医学院第一医院肿瘤外科自1997年~2003年首诊收治、资料完整587例食管癌患者资料。结果不同年龄组手术切除率分别为91.2%、95.9%和97.7%(P>0.05);>70岁年龄组术后吻合口瘘发生率和术后死亡率均较其它组高(P<0.05)。胸膜顶部吻合口瘘发生率为16.67%,较其它位置吻合口瘘发生率明显高(颈部2.17%、弓上1.09%、弓后2.60%、弓下0),具有显著性差异(P=0.019)。III期食管癌患者行术前新辅助化疗组与未化疗组的手术切除率分别为96.92%和78.85%,具有显著差异(P<0.05),而术后吻合口瘘发生率和术后死亡率无明显差异(P=1.000)。结论术前新辅助化疗可提高食管癌手术的切除率并不增加术后并发症。年龄大并不完全是手术禁忌,高龄患者的手术应充分考虑患者的生理年龄。     

微课在外科教学中的发展与探索

外科作为临床医学核心课程之一,基本以课堂理论教学—实践课操作练习—毕业实习的模式展开,教学周期长达一年及以上。学科涵盖知识量大,教师在有限的理论课上呈现的往往是提炼、概括、浓缩后的知识点。而实践课及毕业实习一般采用传统"传帮带"的方式进行,一过性的演示不利于学生真正掌握技能。2011年微课概念被引入国内,作为一种新型信息教育形式,微课以其"主题突出、情境真实、短小精悍、交互性好"等特点被广泛认可。微课包括微课结合其他新型教育形式在逐渐应用于外科教学中,其效果得到越来越明确验证的同时,也暴露出了一些问题。     

Video-assisted thoracoscopic surgery （VATS） for bilateral primary spontaneous pneumothorax

Objective:To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS). Materials and methods: Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results: Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6±18.3) min (range 25-96 min) and (120.6±28.7) min (range 84-166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions: VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.     

pre-operative serum potassium levels and peri-operative outcomes in patients undergoing cardiac surgery

Although potassium is critical for normal electro physiology, the associations between pre-operative serum potassium level and peri-operative adverse events such as arrhythmias in cardiac surgery have not been examined in detail. The objective of this study was to determine the prevalence of abnormal pre-operative serum potassium levels and whether such levels were associated with adverse peri-operative events in 50 patients undergoing coronary artery bypass grafting. Intra-operative and post-operative arrhythmias, the need for cardio-pulmonary resuscitation, cardiac death and death due to any cause prior to discharge from the post-operative intensive care unit were studied. The incidence for adverse outcome was 0.5% for death, 0.5% for cardiac death and 2% for cardio pulmonary resuscitation in patients with hypokalemia (serum potassium level <3.5 meq. L⁻¹). Hypokalemia was found to be a predictor of serious peri-operative (OR:2.2; 95% Cl: 1.2–4.1) and post-operative arrhythmias (OR: 1.7;95%Cl: 1.0–2.7). Pre-operative potassium repletion is low cost and low risk treatment measure and the data from this study suggests that screening and repletion be considered in patients scheduled for cardiac surgery.     

浅谈高等院校音乐专业视唱练耳课程教学

视唱练耳是音乐专业的必修课,视唱练耳也是音乐学习和工作的基础。通过视唱练耳训练,会对学生在音乐表现上以及在今后的音乐学习等方面给予帮助、奠定基础。文章论述了视唱练耳的形成及主要教学内容,重点论述了音准、节奏、听觉惰性等问题。并提出了解决教学重点中的问题及视唱练耳教学的新方法——增强学生与教师的互动、运用多媒体、多音色的听觉训练、首调与固定调并用训练。     

论钢琴听觉素质及培养

音乐是听觉的艺术,是诉诸感情的艺术,而领悟音乐艺术的美都离不开听觉。音乐通过声音而实现的全部实际的音响效果,只有通过耳朵的倾听来鉴别来协调才能弹奏出更美妙的音乐,可见听觉训练在钢琴学习和练习中非常重要。我们要培养内心听觉,要培养钢琴学习者的听觉素质,使其具有高标准的音乐欣赏能力和鉴别能力以达到高水平的演奏效果。     

636例鼻内镜术后鼻腔填塞硅胶管的护理体会

目的：探索鼻内镜术后鼻腔硅胶管填塞患者的最佳护理措施。方法：正确评估吸引时机,采取有效的吸引方法,配合使用促进鼻腔分泌物排出的措施,确保鼻腔通畅。结果：减轻了对鼻黏膜的刺激,改善了患者术后的呼吸、进食和睡眠,缩短了术后恢复时间。结论：做好鼻腔内放置硅胶管期间的护理,可明显减轻患者的痛苦,促进康复。     

整形外科学书刊中图片的重要性及其审选

针对整形外科学书刊的特点--具有大量的图片,论述图片的重要性及其基本要求和审选方法.     

通经草总黄酮含量及抗炎作用研究

以70%乙醇为提取溶剂,超声提取温度为60℃,料液比为1:30,采用先浸泡再水浴加热后超声的方法提取通经草不同部位的总黄酮,然后通过小鼠耳肿胀实验,比较通经草不同部位的抗炎作用。结果表明,通经草根中总黄酮的含量为2.37%,茎中总黄酮的含量为3.05%,叶中总黄酮的含量为5.10%。通经草不同部位高、中剂量提取液均能显著抑制二甲苯致小鼠耳廓肿胀,与阴性对照组比较有显著性差异(P<0.01)。表明通经草有显著的抗炎作用,抗炎作用强弱依次为叶>茎>根。