目的:分析不同品牌疝补片的微观结构及拉伸、顶破强度进而评估不同疝补片的力学性能。方法:分别使用天平、显微镜对常见的15种疝补片进行质量和微观结构测试，并分别使用拉伸试验机与顶破试验机来检测疝补片的拉伸性能与顶破性能，并对疝补片进行力学性能分析。结果:疝补片的编织结构为菱形、多边形和圆形。腹股沟补片的平均质量为0.08 mg/mm 2，腹壁疝补片的平均质量为0.18 mg/mm 2。G3~G6疝补片的丝径较大，G12的网孔率较低。在拉伸性能测试中，G15的拉伸强度最大，重量型补片中G12、G14的拉伸强度较小，轻量型补片中G1、G2、G7的拉伸强度较小。在顶破性能测试中，G3、G9、G15疝补片的顶破强度最大，重量型补片中G12、G13、G14的顶破强度较小，轻量型补片中G1、G2、G4的顶破强度较小。 结论:多边形网孔且大网孔率的疝补片具有更好的力学性能，为优化疝补片提供了实验依据，有望为相关的研究和应用提供更好的支持。

目的 探讨玻璃体腔内注射康柏西普联合玻璃体切除术(PPV)治疗增殖性糖尿病视网膜病变(PDR)的临床效果.方法 选择2016年6月至2018年9月肇庆市高要区人民医院收治的PDR患者56例(56只眼)为研究对象,以随机数表法将患者分为观察组与对照组各28例(28只眼),对照组给予常规PPV术,观察组给予玻璃体腔内注射康柏西普联合PPV手术治疗,比较两组患者术中出血发生率、手术时间、术中电凝止血率、术中医源性视网膜裂孔率、视力改变情况、再次手术率、激光补充治疗率及并发症情况.结果 观察组患者的手术时间为(72.11±9.81)min,明显少于对照组的(99.21±8.11)min,术中出血发生率为10.7％,明显低于对照组的50.0％、电凝止血发生率为7.1％,明显低于对照组的57.1％,医源性视网膜裂孔发生率为10.7％,明显低于对照组的46.4％,以上各项指标比较差异均有统计学意义(P<0.05);观察组与对照组患者术后最佳矫正视力(BCVA)分别为(3.99±0.56)D、(4.01±0.32)D,均明显高于术前的(2.56±0.32)D、(2.59±0.21)D,差异均有统计学意义(P<0.05),但术后两组患者的BCVA比较差异无统计学意义(P>0.05);观察组患者术后激光补充治疗(1.51±0.90)次,明显少于对照组的(2.54±0.82)次,并发症发生率为10.7％,明显低于对照组46.4％,差异均有统计学意义(P<0.05).结论 玻璃体腔内注射康柏西普联合PPV能够有效降低PDR手术治疗难度,同时能够减少术中出血,缩短手术时间,更好的改善患者术后视力,降低术后激光补充治疗率,且并发症少,手术安全性高.

Objective To evaluate the short?term efficacy and cosmetic effect of dual?port laparoscopic distal gastrectomy (DPLDG) for gastric cancer. Methods Thirty consecutive patients underwent DPLDG at the Department of General Surgery,Nanfang Hospital from November 2016 to August 2018. Inclusion criteria:(1)age of 18 to 75 years;(2)primary gastric adenocarcinoma confirmed pathologically by endoscopic biopsy;(3)tumor located at middle?low stomach and planned for distal gastrectomy;(4)cT1b?2N0?1M0 at preoperative staging;(5)tumor diameter ≤3 cm;(6)US Eastern Cancer Cooperative Group(ECOG)score 0 to 1 points;(7)American Society of Anesthesiologists grade I to II;(8) perioperative management based on enhanced recovery after surgery (ERAS) principle. Exclusion criteria:previous upper abdominal surgery(except laparoscopic cholecystectomy),history of other malignant disease,and body mass index ≥30 kg/m2. A self?developed single?incision,multiport, laparoscopic surgery Trocar(Surgaid Medical,Xiamen,China,comprising 3 channels for observation, main surgeon and assistant surgeon)was placed through a 3?4 cm incision under or at the left side of the umbilicus. An additional 5 mm Trocar was inserted under the rib margin of the right clavicle to serve as the secondary operating hole and the position of the drainage tube. The liver was suspended to expose the surgical field clearly. Surgical procedure was as follows:conventional laparoscopic instruments were used. After entering the omental sac,dissection was performed along the transverse colon to the spleen flexure. Left gastroepiploic vessels were identified and then ligated at the root. No.4sb lymph nodes were dissected. The No.4d lymph nodes were dissected along the greater curvature of the stomach. Then the dissection was continued rightward to the hepatic flexure to separate mesogastrium and mesocolon. The right gastroepiploic artery was ligated at the root to allow the removal of No. 6 lymph nodes. The duodenal bulb was transacted by liner stapler,the right gastric artery was ligated at the root and the No. 5 lymph nodes were removed. Peritoneal trunk,common hepatic artery,splenic artery and left gastric artery and vein in posterior pancreatic space at upper pancreas were separated,then left gastric vessels were ligated,and No.9,No.8a,No.11p and No.7 lymph nodes were dissected. The left side wall of portal vein was exposed and No. 12a lymph nodes were removed. No. 1 and No. 3 lymph nodes were dissected along the lesser curvature. The stomach corpus was transacted by liner stapler at 4?5 cm proximal end of the tumor. Roux?en?Y anastomosis or Billroth II anastomosis was performed in the cavity. A drainage tube was placed near the gastrojejunal anastomosis through the right upper abdomen secondary operating hole. Postoperative short?term efficacy(operation time,blood loss,5?port conversion rate,open conversion rate,number of retrieved lymph nodes,time to postoperative first flatus,time to first soft diet intake, time to removal of drainage tube, postoperative hospital stay, postoperative analgesics use, and postoperative 30?day complication rate)and cosmetic scale(questionnaire:degree of satisfaction with scar,description of scar,grade of scar;total score ranged from the lowest 3 to the highest 24;the higher the better) were evaluated in all 30 patients. Results No serious complication and death were observed intraoperatively. The mean operative time was(197.8±46.9)minutes. The median blood loss was 30 ml(quartile 31.25 ml). The mean number of retrieved lymph node was 38.7±14.1. Five?port conversion rate was 3.3%(1/30),and no open conversion occurred. Mean time to postoperative first flatus,time to first soft diet intake,time to removal of drainage tube and postoperative hospital stay were(45.3±18.9) hours,(87.6±35.6)hours,(101.8±58.0)hours and(6.1±2.1)days,respectively. Twenty?four(80%) of patients had no additional analgesics use. The postoperative complication rate within 30 days was 16.7%(5/30). Postoperative overall cosmetic score was 22.1±1.3,and cosmetic score of 96.7%(29/30) of patients was 18 to 24. Conclusion DPLDG is safe and feasible with advantages of faster postoperative recovery,reducing pain and better cosmetic outcomes.

目的 探讨雷珠单抗辅助玻璃体切割对增殖性糖尿病视网膜病变(PDR)患者眼功能的影响.方法 将慈溪市人民医院2016年1月-2018年6月间收治的200例(271眼)PDR患者随机数字法分为对照组(100例,126眼)和观察组(100例,145眼).对照组给予玻璃体切割,观察组在玻璃体切割前1周给予注射雷珠单抗.比较2组手术情况、视力、眼压、视网膜厚度、并发症等.通过统计学软件对数据进行分析,进而探讨雷珠单抗辅助玻璃体切割对增殖性糖尿病视网膜病变(PDR)患者眼功能的影响.结果 观察组手术时间(71.8±11.4) min、电凝止血次数(1.14±0.53)次、视网膜裂孔率(5.51％)均明显低于对照组的手术时间(82.7±10.8)min、电凝止血次数(1.78 ±0.52)次、视网膜裂孔率(14.29％).治疗后,2组眼压、视力明显改善,观察组优于对照组(均P＜0.05).观察组术后并发症发生率明显低于对照组(P＜0.05).患者并发症均经对症治疗后恢复.结论 雷珠单抗辅助玻璃体切割可有效降低增殖性糖尿病视网膜病变患者手术时间、电凝止血次数、视网膜裂孔率,有效改善患者眼压及视力,并能减少术后并发症.

目的 探讨光学相干断层成像(OCT)技术在糖尿病黄斑水肿患者中的应用价值.方法 将2017年10月至2018年11月中国人民解放军联勤保障部队第九八九医院收治的51例糖尿病黄斑水肿患者纳入研究组,另将同期收治的51例无黄斑水肿与视功能改变的糖尿病患者纳入对照组.入院后所有患者均接受OCT检查及最佳矫正视力测试.比较两组患者OCT检查结果 (中心凹厚度、黄斑裂孔情况、视网膜出血情况、黄斑囊性水肿情况)和最佳矫正视力.结果 研究组患者黄斑中心凹厚度大于对照组,黄斑裂孔率、视网膜出血率、黄斑囊性水肿率均高于对照组,差异有统计学意义(均P<0.05).对照组和研究组最佳矫正视力分别为1.09±0.19、0.41±0.08,研究组最佳矫正视力低于对照组,差异有统计学意义(P<0.05).结论 糖尿病黄斑水肿患者黄斑形态和视功能与未发生黄斑水肿的糖尿病患者存在显著差异,通过OCT检查可明确患者黄斑形态改变情况,为临床制定、调整治疗方案提供客观参考依据.