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Objective:To compare the clinical efficacy of splenorenal shunt and traditional devascularization in the treatment of portal hypertension.Method:The clinical data of 109 patients with portal hypertension due to hepatitis B cirrhosis undergoing splenorenal shunt and traditional devascularization at Affiliated Hospital of Nantong University from Jan 2012 to Nov 2021 were retrospectively analyzed.Results:The operation time (208±43) min in shunt group was longer than that of (172±53) min in devascularization group ( t=-3.677, P<0.05). The intraoperative blood loss of (131±89) ml and postoperative hospital stay (21±6) d in shunt group were not significantly different from those of (164±109) ml and (21±8) d in devascularization group ( t=1.621, P>0.05; t=-0.403, P>0.05). There was no significant difference in the incidence of moderate to severe ascites, intraabdominal hemorrhage and hepatic encephalopathy between the two groups ( χ2=0.973, 0.830, 0.095, all P>0.05). The rebleeding rate in shunt group (5%) was lower than that in devascularization group (28%) ( χ2=5.280, P<0.05). The operation method was an independent predictor of rebleeding. The 1-, 2-, 3-, and 5-year cumulative survival rates in the shunt group were 95%, 94%, 91% and 88%, and in devascularization group were 95%, 88%, 85% and 73%. Rebleeding was an independent risk factor affecting the survival rate, and the risk of death in patients with postoperative rebleeding. Conclusion:Compared with devascularization, splenorenal shunt has obvious advantages in reducing postoperative rebleeding rate and prolonging survival time.
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Objective:To explore how to carry out endoscopic skill training in undergraduate medical education and evaluate the teaching effect of modular skill training using endoscopic simulator.Methods:After completing the basic teaching content of the surgical practice course, we added the learning course of the basic theory and basic operation of endoscopy to the students of Clinical Medicine Department from Nantong University. In the experimental group, 292 students were trained by the modular training using the endoscopic simulator. The control group consisted of 114 students, who were treated with ordinary video teaching and instrument operation exercises. After the same class hours of training, the two groups of students were evaluated with intermittent suture and knotting under endoscope as the skill assessment criteria. The chi-square test was performed using SPSS 19.0.Results:The excellent rate and qualified rate of the medical students after the modular training of the endoscopic simulator were 7.5% and 42.8% respectively, which were significantly higher than 0% and 11.4% of the control group, while the unqualified rate of the experimental group was 49.7%, which was also lower than 88.6% of the control group, with significant differences ( P<0.01). Conclusion:Modular training using endoscopic simulator helps the medical undergraduates to quickly increase the ability of endoscopic operation. And in the stage of undergraduate, medical education implementation of the training can shorten the learning curve of endoscopic skills for medical students after they enter clinical practice.