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Objective:To explore the application effect of case-based learning (CBL) teaching model on the clinical teaching of standardized residency training of hepatobiliary surgery.Methods:The study selected 46 residents as the research objects who attended the standardized residency training program from January 2015 to December 2016. All the residents were randomly divided into control group ( n=22) using the traditional teaching method and experimental group ( n=24) using CBL teaching method. After the training, the teaching effect was evaluated by the assessment of theoretical knowledge and clinical skills and questionnaire survey between the two groups. Results:The theoretical knowledge and clinical skills of the residents in the experimental group were significantly better than those in the control group after training [ (85.2±5.9) vs. (81.2±5.6) , (85.0±5.8) vs. (81.4±3.9) ]. The questionnaire survey showed that the total satisfaction of the experimental group with CBL teaching method combined with 3D visualization technology was significantly higher than that of the teaching method of the control group (95.8% vs. 72.7%) .Conclusion:The CBL teaching method with 3D visualization technology is worth popularizing and applying in the education of standardized residency training.
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Objective To explore the value of medical three-dimensional visualization technology in preoperative precise assessment for hepatocellular carcinoma (HCC).Methods The clinical data of 24 HCC patients were analyzed retrospectively from Jan 2015 to Dec 2016 in our department.Thin-layer 320-slice CT scaning was performed and data stored in the form of DICOM.Three dimensional reconstruction and simulated hepatectomy were conducted,and correlation test analysis was performed.Results The volume of simulated resected liver was (565 ± 296)ml,while the actual liver resection volume was(523 ± 252)ml.There was no significant difference between the predicted and the actual values (t =1.734,P ＞ 0.05).The actual liver resection volume was positively correlated with the predicted liver resection volume (r =0.920,P ＜ 0.05).The stimulated resection margin was (1.2 ± 0.6)cm,while the actual resected tumor margin was (1.0 ± 0.5) cm.There was no significant difference between the predicted and the actual values (t =1.853,P ＞0.05).The actual margin was positively correlated with the predicted one (r =0.956,P ＜ 0.05).Conclusion The three-dimensional visualization technology has a certain degree of clinical value in the preoperative evaluation of HCC.
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Objective To evaluate catheter-directed thrombolysis via the popliteal vein in the treatment of the lower limb acute deep venous thrombosis.Methods From July 2009 to October 2010,32patients of the lower limb acute deep venous thrombosis including 3 patients with concurrent pulmonary embolism underwent uhrasound-guided catheter-directed thrombolysis via the popliteal vein.The thrombolytic catheter was inserted into thrombus,through which urokinase was infused at a dosage of 100 × 104U/d.The venous patency score and the rate of patency improvement were observed by venograms before and after therapy.Results In every patient,the lower limb swell and pulomonary symptoms relieved.The circumferences between affected and normal thigh before and after the thrombolysis were(5.4 ± 1.4)cm and (1.7 ± 1.3)cm(t =9.92,P ＜0.01).The circumferences between affected and normal leg before and after the thrombolysis were(4.1 ± 1.5)cm and(1.5 ±0.7)cm(t =7.65,P ＜0.01).The venous patency score before and after the thrombolysis were(15 ± 4)and(4 ± 3)(t =7.12,P ＜ 0.01).The mean rate of venous patency was 88.21％.In the 3 patients with pulmonary embolism,thrombus was complete dissolved in 1 case and partial dissolved in 2 cases.No major complications occurred in all these patients.29 patients were followed up for 3-12 months.There were no thrombosis relapsed.Conclusions Catheter-directed thrombolysis via the popliteal vein with urokinase for acute lower limb deep venous thrombosis is safe and effective.
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Objective To investigate the cause, prevention and treatment of biliary fistula after biliary tract operation.Methods Biliary fistula developed postoperatively in 27 out of 3*!786 patients undergoing bile duct surgery from 1991 to 2000. Results Injury of liver bed cholangiole or tiny accessory hepatict duct occured in 8 cases, 1 developed after incision and exploration of CBD in biliary duct cancer, stump leakage of cystic duct in 7, early T tube inadvertent sliding off or after T tube removement in 10. 21 patients underwent conservative therapy (78%), 6 reoperation (22%). Fistula was cured in 26 cases, the remaining one who suffering from late staged bile duct cancer died. Conclusions Biliary fistula often occurs after cholecystectomy, and after the removal of a T tube. Conservative therapy is often successful unless there is a frank peritonitis, biliary tract obstruction, or improper peritoneal drainage.
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Objective To investigate the protective effect of the first window(FW)of liver ischemic preconditioning(IPC),the second window(SW) of remote(leg) ischemic preconditioning(RPC) and conbined applications of liver and lges IPC to against liver ischemia/reperfusion(I/R) injury in the rat,and to investigate the mechanism of the protection.Methods Rats were randomly divided into five groups(n=8 each):(1) Sham group(S group),rats without IPC,(2) Rats with 5 min IPC(IPC group);(3) Rat wiht both liver and lower limbs IPC and repeated three times(RPC group);(4) IPC 24 h after RPC group;(5) IR without IP(I/R group);except S group,the rats were subjected to 60 min sustained liver ischemia followed by 180 min reperfusion.All ischemia rats were only subjected to 70% liver ischemia.Finally,blood and liver samples were obtained to determine the activity of ALT and AST,the expressions of TNF-? and HSP70 protein,and liver wet/dry weight(W/D) and pathology.Results All IPC group and RPC group and IPC+RPC group had obviously lower levels of ALT,AST,W/D,TNF-? than that of the I/R group(P0.05).Conclusions The FW of the IPC,the SW of the RPC and combined applications can lessen hepatic I/R injury.There is no significant difference in the protective intensity of the 3 motheds.The protective effects possibly are due to suppression of TNF-? production,induction of protein HSP70 expression and improvement of liver microcirculation.