目的探讨达芬奇机器人甲状腺癌根治术后拔除引流管时机对并发症的影响。方法选取笔者所在医院科室2014年7月至2018年12月期间收治的315例达芬奇机器人甲状腺癌根治术患者,根据术后伤口引流液的量决定是否拔管将患者分为观察组和对照组,...目的探讨达芬奇机器人甲状腺癌根治术后拔除引流管时机对并发症的影响。方法选取笔者所在医院科室2014年7月至2018年12月期间收治的315例达芬奇机器人甲状腺癌根治术患者,根据术后伤口引流液的量决定是否拔管将患者分为观察组和对照组,观察组99例,对照组216例。观察组拔管指征是连续2 d 24 h伤口引流液量<20 mL;对照组按照临床上大多数观念倾向于连续2 d 24 h伤口引流液量<10 mL。分别观察2组患者术后引流管拔除后伤口及隧道的感染率、血肿发生率、伤口愈合情况及术后引流管的拔除时间及术后住院时间。结果观察组和对照组在引流管拔除后伤口感染率、血肿发生率及伤口愈合率方面的差异均无统计学意义(P>0.05),观察组患者的术后拔管时间和住院时间均明显短于对照组(P<0.05)。结论在达芬奇机器人甲状腺癌根治术后,将连续2 d 24 h伤口引流液量<20 mL作为拔管时机并不增加并发症的发生率,但可显著缩短患者术后拔管时间和住院时间,可在临床推广应用。展开更多
背景与目的:近年来,腔镜保留乳头乳晕乳腺癌根治切除(NSM)加假体植入乳房重建术的开展逐渐增多。腔镜手术的入路多种多样,目前主要是腋窝入路与侧方入路,然而目前对两种入路手术效果的比较研究仍少有报道,因此,本研究对腋窝入路与侧方...背景与目的:近年来,腔镜保留乳头乳晕乳腺癌根治切除(NSM)加假体植入乳房重建术的开展逐渐增多。腔镜手术的入路多种多样,目前主要是腋窝入路与侧方入路,然而目前对两种入路手术效果的比较研究仍少有报道,因此,本研究对腋窝入路与侧方入路行腔镜NSM加假体重建手术的疗效进行比较,以期为临床选择合适的腔镜手术入路提供参考。方法:回顾性收集中国人民解放军陆军军医大学第一附属医院乳腺甲状腺外科2016年1月—2022年10月152例行腔镜NSM加假体植入乳房重建术乳腺癌患者临床资料。按手术入路分为腋窝入路组(78例)与侧方入路组(74例),比较两组患者的相关临床指标。结果:两组患者的基线资料差异无统计学意义(均P>0.05)。侧方入路组手术时间短于腋窝入路组(211.50 min vs.250.00 min,P<0.001),引流量少于腋窝入路组(300.50 mL vs.504.50 mL,P<0.001),腋窝入路组行胸肌前假体植入比例明显高于侧方入路组(24.4%vs.6.8%,P=0.003),两组术中出血量、术后引流时间差异无统计学意义(均P>0.05)。两组患者术后血肿、感染、积液、乳头乳晕或皮瓣坏死、包膜挛缩发生率差异均无统计学意义(均P>0.05)。术后随访6个月结果显示,两组患者乳房外形、生活质量情况及术后满意度(腋窝入路:91.0%vs.侧方入路:91.9%)差异均无统计学意义(均P>0.05)。两组在远处转移、局部复发、总生存率差异均无统计学意义(均P>0.05)。结论:经腋窝入路和侧方入路NSM加假体植入乳房重建的两种入路方式均安全有效,美学效果无差异。腋窝入路适合进行胸肌前假体植入,侧方入路操作简便,手术时间短,利于保留胸肌筋膜,可进行免补片的胸肌后假体植入。展开更多
The diesel soot was collected from diesel engine exhaust pipe. The morphology and structure of the collected diesel soot was characterized by HRTEM, XRD and XPS and its tribological behavior was investigated by a SRV ...The diesel soot was collected from diesel engine exhaust pipe. The morphology and structure of the collected diesel soot was characterized by HRTEM, XRD and XPS and its tribological behavior was investigated by a SRV IV oscillating reciprocating friction and wear tester. Test results showed that the tribological behavior of diesel soot was largely influenced by the test load. Under a low load, the diesel soot could reduce the wear volume of the disc. While under a high load, the diesel soot could reduce the friction coefficient of base oil. Based on the characterization of the worn scars by the SEM technique, the 3D surface profiler and the Raman spectroscopy, it was assumed that the core-shell structure of diesel soot with several graphitic layers played important roles. On one hand, its spherical and special structure could make it roll between friction pairs to reduce wear under a low load. On the other hand, its outer-shell graphite layers could be peeled off to form lubrication film to reduce friction under a high load and shear force.展开更多
文摘目的探讨达芬奇机器人甲状腺癌根治术后拔除引流管时机对并发症的影响。方法选取笔者所在医院科室2014年7月至2018年12月期间收治的315例达芬奇机器人甲状腺癌根治术患者,根据术后伤口引流液的量决定是否拔管将患者分为观察组和对照组,观察组99例,对照组216例。观察组拔管指征是连续2 d 24 h伤口引流液量<20 mL;对照组按照临床上大多数观念倾向于连续2 d 24 h伤口引流液量<10 mL。分别观察2组患者术后引流管拔除后伤口及隧道的感染率、血肿发生率、伤口愈合情况及术后引流管的拔除时间及术后住院时间。结果观察组和对照组在引流管拔除后伤口感染率、血肿发生率及伤口愈合率方面的差异均无统计学意义(P>0.05),观察组患者的术后拔管时间和住院时间均明显短于对照组(P<0.05)。结论在达芬奇机器人甲状腺癌根治术后,将连续2 d 24 h伤口引流液量<20 mL作为拔管时机并不增加并发症的发生率,但可显著缩短患者术后拔管时间和住院时间,可在临床推广应用。
文摘背景与目的:近年来,腔镜保留乳头乳晕乳腺癌根治切除(NSM)加假体植入乳房重建术的开展逐渐增多。腔镜手术的入路多种多样,目前主要是腋窝入路与侧方入路,然而目前对两种入路手术效果的比较研究仍少有报道,因此,本研究对腋窝入路与侧方入路行腔镜NSM加假体重建手术的疗效进行比较,以期为临床选择合适的腔镜手术入路提供参考。方法:回顾性收集中国人民解放军陆军军医大学第一附属医院乳腺甲状腺外科2016年1月—2022年10月152例行腔镜NSM加假体植入乳房重建术乳腺癌患者临床资料。按手术入路分为腋窝入路组(78例)与侧方入路组(74例),比较两组患者的相关临床指标。结果:两组患者的基线资料差异无统计学意义(均P>0.05)。侧方入路组手术时间短于腋窝入路组(211.50 min vs.250.00 min,P<0.001),引流量少于腋窝入路组(300.50 mL vs.504.50 mL,P<0.001),腋窝入路组行胸肌前假体植入比例明显高于侧方入路组(24.4%vs.6.8%,P=0.003),两组术中出血量、术后引流时间差异无统计学意义(均P>0.05)。两组患者术后血肿、感染、积液、乳头乳晕或皮瓣坏死、包膜挛缩发生率差异均无统计学意义(均P>0.05)。术后随访6个月结果显示,两组患者乳房外形、生活质量情况及术后满意度(腋窝入路:91.0%vs.侧方入路:91.9%)差异均无统计学意义(均P>0.05)。两组在远处转移、局部复发、总生存率差异均无统计学意义(均P>0.05)。结论:经腋窝入路和侧方入路NSM加假体植入乳房重建的两种入路方式均安全有效,美学效果无差异。腋窝入路适合进行胸肌前假体植入,侧方入路操作简便,手术时间短,利于保留胸肌筋膜,可进行免补片的胸肌后假体植入。
基金the financial support of the Logistics Key Basic Research Program of PLA (BX214C006)the Chongqing Science and Technology Achievement Transformation Fund (KJZH17139)
文摘The diesel soot was collected from diesel engine exhaust pipe. The morphology and structure of the collected diesel soot was characterized by HRTEM, XRD and XPS and its tribological behavior was investigated by a SRV IV oscillating reciprocating friction and wear tester. Test results showed that the tribological behavior of diesel soot was largely influenced by the test load. Under a low load, the diesel soot could reduce the wear volume of the disc. While under a high load, the diesel soot could reduce the friction coefficient of base oil. Based on the characterization of the worn scars by the SEM technique, the 3D surface profiler and the Raman spectroscopy, it was assumed that the core-shell structure of diesel soot with several graphitic layers played important roles. On one hand, its spherical and special structure could make it roll between friction pairs to reduce wear under a low load. On the other hand, its outer-shell graphite layers could be peeled off to form lubrication film to reduce friction under a high load and shear force.
