RÉSUMÉ
Objective To investigate the clinical effect of No ha la hu(Mongolian medicine abdominal massage)combined with Ni ru ha(Mongolian medicine enema)in the treatment of incomplete intestinal obstruction.Methods A total of 80 patients with incomplete intestinal obstruction admitted to the department of emergency and critical care medicine of Inner Mongolia International Mongolian Hospital from April 2020 to April 2022 were selected as the study objects,they were randomly divided into control group and observation group,40 cases in each group.The control group was treated with routine modern medicine,and the observation group was treated with mongolian medicine No ha la hu combined with Ni ru ha on the basis of routine treatment.Specific methods:the patient supine position,both lower limbs flexion,natural calm breathing,the doctor stands on the patient's right side,applies a little butter to the palm of his hand,rub hands,massages the abdomen with the middle finger and ring finger at acupoints such as ileocecal point,small intestine point,small intestine point,small intestine point and lower clockwise direction point.Massage the abdomen with the palm for about 20 minutes,once a day for 3 days.No ha la hu was given after the treatment of Ni ru ha(Rhubarb 250 g,Cold water stone 150 g,Sanai 100 g,Facial alkali 100 g,Hyacinth 50 g,Terminalia chebula 50 g),the patients should lie on the left side,raise the buttocks about 10 cm,insert the enema into the rectum 15-20 cm,take the Mongolian medicine Liuweian powder 12 g and warm water 50-100 mL for enema,once a day for 3 days.The difference of relieving time of abdominal pain and distension,time of exhaustion,time of fasting,and time of hospital stay between the two groups were compared,and the clinical effect was observed.Results Relieving time of abdominal pain,abdominal distension,time of exhaust and time of hospital stay in the observation group were significantly shorter than those in the control group[abdominal pain relief time(hours):5.3±1.8 vs.8.1±1.6,abdominal distension relief time(hours):3.2±1.5 vs.6.5±1.9,time of exhaust(days):2.6±1.7 vs.4.1±2.1,hospital stay(days):8.3±2.9 vs.10.1±2.1,all P<0.05],time of fasting in the observation group were shorter than those in the control group(days:2.9±0.5 vs.3.1±0.6,the difference was not statistically significant(all P>0.05).The effective rate of the observation group was significantly higher than that of the control group[92.5％(37/40)vs.75.0％(30/40),P<0.05].Conclusion On the basis of routine treatment of western medicine,the treatment of incomplete intestinal obstruction by Mongolian medicine No ha la hu combined with Ni ru ha is more effective,which can effectively restore gastrointestinal function,relieve abdominal pain and other symptoms,and shorten the time of exhaust.
RÉSUMÉ
Objective:To investigate the value of machine learning-based computed tomography (CT) images radiomics analysis in preoperative evaluation of surgical portal vein-superior mesenteric vein (PV-SMV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).Methods:The retrospective study was conducted with 156 consecutive PDAC patients who were underwent surgery at the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2010 and July 2021. There were 95 males and 61 females, with the age of (65.7±8.2) years. Patients were randomly split into training set and validation set by a ratio of 3∶2. Minimum redundancy maximum relevance was used to select radiomic features, which were extracted from contrast-enhanced CT images. Five machine learning classifiers were developed, and those models' area under the curve (AUC) values were compared with the conventional radiologic-feature-based evaluation.Results:Ninety-four and 52 patients were included into the training set and validation set, respectively. Their PV-SMV invasion rates were confirmed by intraoperative exploration with 31.9%(30/94) and 40.3%(25/61), respectively. Five models: LASSO regression, random forest, support vector machine, k-nearest neighbor and Naive Bayesian, were established based on ten features from CT images radiomics, and LASSO regression model achieved the highest AUC value compared with the other four models (all P<0.05). Compared with the conventional radiologic evaluation, the LASSO regression model had higher AUC (0.920 vs. 0.752) and sensitivity (92.0% vs. 86.5%)(both P<0.05). Conclusion:Machine learning-based CT images radiomics analysis can be used to evaluate PV-SMV invasion status preoperatively in PDAC. The LASSO regression model showed better performance than the conventional radiologic evaluation.
RÉSUMÉ
@#（正）结肠代食管术（esophageal replacement with colon，ERC）被称作食管外科“皇冠上的明珠”，也是食管重建的最后一种选择。ERC 手术操作复杂，吻合口瘘等并发症发生率较高，一直没有得到广泛开展[1]。传统 ERC 手术常选择经右侧胸腹联合切口，手术创伤较大、术后恢复慢、术后肋间神经损伤等并发症较多，但随着胸腔镜微创技术的日益发展，我们使用胸腔镜微创技术游离胸腔食管并清扫纵隔淋巴结，开腹横结肠代食管行消化道重建，该技术可减少手术创伤、减轻术后疼痛，加速康复。本视频在于展示胸腔镜辅助食管癌根治横结肠代食管术手术入路、操作技巧。
RÉSUMÉ
Objective To investigate the efficacy and the indication and the management of perioperative complications in treatment of infra- kidney abdominal aortic aneurysm (AAA) by using endovascular graft exclusion (EVGE). Methods From April 2006 to September 2008, 24 patients with infra- kidney abdominal aortic aneurysms were diagnosed by contrast-enhanced CT or MRI scan. Vascular access was obtained through the bilateral femoral artery after arteriotomy and stent-graft was deployed into AAA of below the renal artery to occlude the left over cavity of AAA. The stent- graft was extended and anchored to the both side wall of AAA, the blood flow enter into the arteria iliaca communis through the sten't.Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 20 patients and the type Ⅰ minor leakage in 4 patients. No stent movement or organ and both lower extremities ischemia was found at the early post operative stage in all the patients. Six months after the operation, in all the 24 patients, contrast-enhanced CT scan showed the disappearance of the aneurysm and thrombosis at the level of the stent. Conclusions EVGE is simple,minimally invasive,less complication and quick recovery after operation. Thus it becomes first choice for the treatment of AAA for the elder patients.
RÉSUMÉ
Objective To review the experience of surgical management for caustic esophageal stricture and discuss the surgical techniques of transverse colon interposition for esophageal replacement. Methods 106 patients with caustic esophageal stricture were treated surgically. 32 patients underwent colon interposition with colonphargageal anastomosis and others received colon interposition with a cerrical anastomosis. The ascending branch of the left artery of the transverse colon was preserved as the supporting vessel of the interpositioned colon. Results There was no postoperative death. The leakage of cervical anastomosis was observed in 12 patients, anastomosis stenosis in 8 patients, and tracheotomy was performed in 3 patients. All patients were perfectly recovered by the treatment. Conclusion Transverse colon interposition for esophageal reconstruction is an optimal approach in the treatment of caustic esophageal stricture.