ABSTRACT
Objective:To analyze the law of distant metastasis in patients with small lung adenocarcinoma with different CT findings, and to explore the feasibility of different preoperative examination methods for small lung adenocarcinoma with different imaging characteristics.Methods:Clinicopathological data of cT1a-cN0 lung adenocarcinoma patients admitted to the respiratory center of China-Japan Hospital from January 2017 to December 2018 were retrospectively collected. A total number of 785 patients were included, including 289 males and 496 females. SPSS 22.0 was used for statistical analysis.Results:A total number of 785 patients were included in this study, including 287 pure ground-glass nodule (GGN) patients, 111 GGN predominant patients, 221 solid predominant patients and 166 solid nodule patients. Among the included patients, 8 had distant metastasis, including 6 with bone metastasis, 1 with brain metastasis and 1 with brain and adrenal metastasis. No distant metastasis was observed in the patients with pure GGN and GGN predominant nodule, while 1 solid predominant patients had distant metastasis, and 7 patients with solid nodules had distant metastasis. The probability of distant metastasis was 0.5% for the solid predominant patients and 4.2% for the solid nodule patients. Univariate analysis results showed that CEA level ( P=0.030), the largest diameter of the lung window tumor ( P=0.003), the largest diameter of the solid component of the lung window tumor ( P<0.001), the largest area of the lung window tumor ( P=0.002), mediastinal window tumor maximum area ( P<0.001), CTR ( P<0.001), TDR ( P<0.001), and pleural indentation sign ( P=0.037) were risk factors for distant metastases. Multivariate analysis showed that CEA ( OR=1.019, 95% CI: 1.002-1.037, P=0.028) and TDR ( OR=0.000, 95% CI: 0.000-0.310, P=0.001) were independent risk factors of distant metastasis. Conclusion:For patients with pure GGN and GGN predominant nodule, preoperative examination could not be required, but for pure solid nodules, it is necessary to perform relevant preoperative examination including skull MRI before surgery to exclude distant metastasis.
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Objective To investigate the effect of implementation of QCC (quality control circle) in management of preoperative examination.Methods Through analysis of the common factors of patients' preoperative examination,the QCC was used to manage every parts of preoperative examination,and the nursing process of preoperative examination for resident patients was formulated.The effect of nursing management of preoperative examination before and after the implementation of QCC was investigated and compared.Results The result showed that the degree of satisfaction was significantly higher than before,and the risk incident was significantly lower than before.Conclusions To carry out QCC could improve the efficiency of preoperative examination and the patients' safety,as well as enhance the awareness of the nursing management.
ABSTRACT
BACKGROUND: Unexpected difficult intubation is probably the result of inadequate preoperative examinations of the airway. The purpose of this study is to indicate that the oropharyngeal classification (OPC) and several tests may be predict difficult intubation in Korean. METHODS: In each of 462 adults the OPC was determined in sitting position. In supine position, hyomental distance (HD) and sternomental distance (SMD) with head in neutral, and thyromenal distance (TD), SMD and inter-incisors distance (DI) on mouth opening with the head fully extended were measured. The laryngoscopic grades were determined at the time of induction. We defined the cases of intubation trials > or = 3 times in patients with laryngoscopic grade 3 and 4 as difficult intubation. The datas were analyzed with Mann-Whitney and Kruskal-Wallis test. RESULTS: 14 patients had difficulty in intubating (3.03%) and 1 of 14 was failed to intubate (0.22 %). Assignment to either OPC > or = 3 and DI or = 3 and HD < or = 5.5 cm had high sensitivity, specificity, and NPV. When DI and HD < or = 4 cm were employed, combination of OPC and HD/DI resulted in increasing sensitivity and positive predictive value (PPV). CONCLUSIONS: Based on the results and performance indexes of patients in this study, we concluded that assignment to OPC, DI and HD, consider either alone or combinations, be valuable tests to predict difficult intubation before anesthesia in Korean.