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Objective:To explore the risk factors for overall complications after laparoscopic pancreaticoduodenectomy(LPD) and to establish postoperative pancreatic fistula prediction model for LPD.Methods:The clinical data of 176 patients undergoing LPD from Jan 2014 to Mar 2018 were retrospectively analyzed.Results:One died within 30 days. Five patients underwent reoperation. Seventy-three patients (41%) had complications including pancreatic fistula in 30 cases(17.0%), postoperative hemorrhage in 16 (9.1%); bile leakage in 10 (5.7%); abdominal infection in 6 (3.4%); wound infection in 4 (2.2%); pulmonary infection in 4 (2.2%); gastric emptying disorder in 3 (1.7%). Age, intraoperative blood loss, diabetes mellitus were risk factors for overall postoperative complications of LPD(all P<0.05); Age, male gender, pancreatic duct diameter, pancreas texture, lesion size were risk factors for pancreatic fistula after LPD(all P<0.05). Conclusions:Age, intraoperative blood loss, diabetes mellitus were risk factors for overall postoperative complications of LPD; Age, male gender, pancreatic duct diameter, pancreas texture, and lesion size were risk factors for pancreatic fistula after LPD.
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Objective@#To understand the current situation of sedentary behaviors among middle school students and its relationship with physical health.@*Methods@#Data came from the Taizhou City and Township Health Survey in 2018. Sedentary behaviors and physical fitness of 2 374 middle school students in Taizhou were analyzed.@*Results@#The total time spent in sedentary behaviors of middle school students in Taizhou was (8.75±1.56) h/d on weekday and (7.34±1.55) h/d on weekend; Compared with students whose screen time <2 h/d in weekday or weekend, weekend homework time <2 h/d and private tutoring class <2 h/d, students whose screen time ≥2 h/d in weekday or weekend, weekend homework ≥2 h/d and private tutoring class ≥2 h/d showed higher rate of low physical fitness(OR was 1.43, 1.37, 1.12, 1.43, respectively, P<0.05).@*Conclusion@#Long duration of weekend homework and private tutoring class, as well as high screen time in weekday and weekend is associated with decline of physical fitness among middle school students.
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Objective To study the coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy (LPD).Methods A retrospective analysis was conducted on 101 patients who underwent LPD at the Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,from January 2014 to March 2017.The study aimed to study the coordination and function of a laparoscopic assistant.Results LPD was successfully completed in all the 101 patients.There was no conversion to open surgery.The operation time was (326.0 ± 55.6) min,and the resection time was (174.4 ± 42.5) min.The digestive tract reconstruction time was (101.0 ± 21.4) min.The time of pancreaticojejunostomy was (40.5 ± 8.7) min.The time of gastrointestinal anastomosis was:(26.3 ± 5.5) min.The time of biliary anastomosis was (24.4 ± 6.5) min.The intraoperative bleeding was (175.6 ± 41.1) ml.Postoperative pathological data showed that 27 patients (26.7％) had distal common bile duct cancer,23 patients (22.8％)ampullary carcinoma,39 patients (38.6％) duodenal papillary carcinoma,and 12 patients (11.9％) pancreatic ductal adenocarcinoma.The tumor diameter was (2.3 ± 1.3) cm,and the number of resected lymph nodes was (16.7 ±4.2).The number of positive lymph nodes was 1.3 ± 1.1.The length of postoperative hospital stay was 14.8 (8 ～ 29) d.Twenty-three patients developed postoperative pancreatic fistula,including 17 patients (16.8％) with a biochemical fistula,5 patients (5.0％) with a grade B pancreatic fistula,and 1 patient (1.0％) with a grade C pancreatic fistula.There were 2 patients (3.0％) with bile leakage,7 patients (6.9％) with intra-abdominal bleeding,4 patients (4.0％) with delayed gastric emptying,6 patients (5.9％) with abdominal infection,3 patients (3.0％) with pulmonary infection,2 patients (2.0％)with intestinal obstruction,3 patients (3.0％) required a repeated operation,and 1 patient (1.0％) with death in hospital within 30 days after surgery.Conclusions The laparoscopic assistant should have the perspective of "one axis,two sides and four regions" in LPD,and warn the operator to ensure the safety and fluency of the operation by clearly exposing important blood vessels and organs when performing the Kocher incision and when dissecting the key parts such as the dangerous triangle of the uncinate process.During anastomosis,the laparoscopic assistant should appropriately adjust the distance of vision,clearly reveal the surgical field of the anastomotic area,and help the surgeon in improving the precision of the suture and the quality of the anastomosis.
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Objective To investigate the construction and application in practice of information process management system in the treatment of acute ischemic stroke (AIS).Methods From August 2017 to November 2017,the clinical data of the 597 patients with suspected stroke received green channel treatment for stroke and incorporated into the information process management system at the Cerebrovascular Disease Center,Changhai Hospital,the Second Military Mcdical University were analyzed retrospectively.The operation status and operational efficiency of each link in the AIS treatment process were evaluated.The performance assessment indicators for stroke nurses and visiting doctors were developed.The accuracy and missed diagnosis of stroke determined by the stroke nurses were calculated.The operation ability of stroke nurses was evaluated by the doctor's arrival at triage desk to establishment of intravenous access time and signing of informed consent to rt-PA bolus time,with less than 10 min as the standard.The emergency response capability of consultation physicians was evaluated by calling consultation physician to arriving at the triage desk and establishing venous channel to transport to the CT room time,with less than 5 min as the standard.The standard-reaching rate was calculated.Results A total of 597 patients were prechecked as suspected stroke.Among them,549 patients with stroke were judged by doctors,430 established venous access,443 were transported to CT room,441 completed CT scan,and 52 were treated with venous thrombolysis.In the process,the median time of patients to hospital to doctor to triage desk,doctor to triage desk to establishment of venous channel,establishment of venous channel to transportion to CT room to completion of CT scan,completion of CT scan to rt-PA bolus,patients to hospital to completion of CT scan and patients to hospital to rt-PA bolus was 3 (1,5),8 (3,16),3 (2,5),3 (2,9),9 (3,22),20(10,30) and 27 (19,55) min,respectively.The stroke nurses determined the accuracy and misdiagnosis rate of stroke were 92.0％ (549/597) and 8.4％ (50/597) respectively.The standard-reaching rate of doctor to triage desk to establishment of venous channel,signing informed consent to rt-PA bolus time were 82.1％ (353/430) and 80.8％ (42/52) respectively.The standard-reaching rates of calling consultation doctor to doctor to triage desk,establishment of venous channel to transportion to CT room time were 94.5％ (564/597) and 91.4％ (405/443) respectively.Conclusion A process management system centered on "time management" may help analyze the efficiency of various links and personnel in the AIS treatment process,and optimize the process continuously.
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Objective:To determine the prevalence, disease burden, and possible causes of lung cancer. Population-based lung cancer registration data collected from 1993 to 2012 were used to analyze the lung cancer epidemic status in Qidong City. Methods:Joinpoint regression was used to calculate the trend of incidence and mortality for lung cancer. Age-period-cohort model was used to assess the effects of age and exposure on the incidence and mortality rates. Results:Upward trends were observed both for the incidence and mortality rates of lung cancer. The risk of incidence and mortality increased with age. According to the cohort effect, the risk of lung cancer increased with recent birth dates. Women had higher risk than men. Conclusion:The incidence and mortality rates of pulmo-nary neoplasms have annually increased, and the exposure to risk factors for lung cancer gradually increases. Among the community population in Qidong City, people over 70 years belong to the high-risk groups.
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@#Objective To discuss the treatment of acromioclavicular joint dislocation associated with clavicular distal end fracture and remedial means.Methods 28 cases of acromioclavicular joint dislocation associated with clavicular distal end fracture were treated with clavicular hook plate.28 patients included 4 cases of Allman's type Ⅰ,14 cases of type Ⅱ,10 cases of type Ⅲ.Classification of fracture included 9 traverse cases,14 oblique cases,3 comminuted cases,and 2 avulsion cases.There were 24 acute injury cases,4 obsolete injury cases.3 cases were open fractures.1 case was not successful by conservative management.After operation,early rehabilitation was emphasized and following-up was performed.The therapeutic effect was assessed with Karlsson standard.Results 28 patients were followed up for an average of 14.6 months(6～26 months).According to Karlsson standard:17 cases got A level,8 cases got B level,3 cases got C level.The rate of excellence was 89.3%.Conclusion Acromioclavicular joint dislocation associated with clavicular distal end fracture is not steady fracture and complicated with many ligaments avulsion often.Effective internal fixation on time and ligament repaired is necessary.