目的 总结840例小切口胆囊切除术的经验体会。方法 我院应用新器械行小切口胆囊切除术840例,男302例,女538例,年龄16~64岁; 胆囊结石832例,胆囊息肉8例。其手术指征与大切口胆囊切除术相同。术中应用小切口自动伸开架、深部送结器、小切口带灯拉钩、缝合胆囊肝床之外科扣锁钳、肝脏直角灯钩以及为防止在小切口内手术时遗失纱布而特制的气囊纱布; 同时,确保手术能在小切口内完成,术前进行了周密检查以排除肝、胆、胃之肿瘤,并于术前行动态胆囊底B超定位检查,以确定小切口之位置和了解手术难易。结果 840例中行择期手术737例,急诊手术103例; 手术历时平均30分钟; 住院时间3~4天。术后全部患者均获随访,其满意度为98.5%(827/840)。因照明障碍误伤右肝管1例,因胆囊颈结石嵌顿误伤胆总管1例。结论 应用小切口及自制手术器械行胆囊切除术,避免了LC及传统开腹术的一些弊端,效果确切,便于患者接受。
目的 探讨自制封闭式负压引流冲洗治疗四肢难愈性创面的护理要点。 方法 对2011年8月-2012年9月收治的38例使用自制封闭式负压引流冲洗+Ⅰ期植皮修复四肢难愈性创面的患者进行护理观察。 结果 34例四肢难愈性创面Ⅰ期成功修复创面,减轻了患者住院期间痛苦,缩短患者治疗时间,住院费用明显下降,4例创面因感染植皮大部分融解,经2次冲洗引流,培养肉芽后再植皮痊愈,无护理并发症发生。 结论 术后患者维持在适应的体位、间歇式冲洗,持续恒定的负压吸引、密切的护理观察和引流管的管理是护理的关键环节。
目的探讨自制双套管持续负压吸引对低位直肠癌经腹前切除术后吻合口漏的防治效果。 方法2006年1月至2012年12月期间笔者所在医院施行了106例低位直肠癌经腹前切除术,均采用自制双套管持续负压吸引,回顾性分析其预防和治疗吻合口漏的效果。 结果本组106例患者术后发生吻合口漏6例(5.66%),给予双套管持续滴注冲洗结合持续低负压吸引,同时给予全身抗感染、禁食、肠外营养或后期肠内营养处理。12~16 d(平均14 d)后患者的大便成型、冲洗液清亮,遂拔除引流管。其中1例为直肠阴道瘘,经保守治疗失败后行横结肠双腔造瘘术,于术后6周恢复,3个月后行造瘘口关闭术。 结论低位直肠癌保肛手术应用自制双套管持续负压吸引技术后,吻合口漏的发生率较低;其还能有效控制盆腔感染,从而促进漏口愈合。
In this study, we propose an automatic contour outlining method to measure the spatial resolution of homemade automatic tube current modulation (ATCM) phantom by outlining the edge contour of the phantom image, selecting the region of interest (ROI), and measuring the spatial resolution characteristics of computer tomography (CT) phantom image. Specifically, the method obtains a binarized image of the phantom outlined by an automated fast region convolutional neural network (AFRCNN) model, measures the edge spread function (ESF) of the CT phantom with different tube currents and layer thicknesses, and differentiates the ESF to obtain the line spread function (LSF). Finally, the values passing through the zeros are normalized by the Fourier transform to obtain the CT spatial resolution index (RI) for the automatic measurement of the modulation transfer function (MTF). In this study, this algorithm is compared with the algorithm that uses polymethylmethacrylate (PMMA) to measure the MTF of the phantom edges to verify the feasibility of this method, and the results show that the AFRCNN model not only improves the efficiency and accuracy of the phantom contour outlining, but also is able to obtain a more accurate spatial resolution value through automated segmentation. In summary, the algorithm proposed in this study is accurate in spatial resolution measurement of phantom images and has the potential to be widely used in real clinical CT images.