Objective To explore the operative methods and indications of duodenoscopic papillotomy during the course of operation(IEPT)for cholelithiasis.Methods Cholecystectomy was firstly conducted under the condition of laparoscopy or open laparotomy.For the gross choledochus,the common bile duct was cut open to clear the stones.The ureteric catheter and zebra guidewire were inserted into the common bile duct and duodenum.Then they were inserted via duodenoscopy into thepapillum of duodenum.The papillary stenosis was removed with electro-knife by pin-head-like and arch-like to track along the ureteric catheter and zebra guidewire.For the tiny choledochus,the ureterie catheter and zebra guidewire were inserted via the cholecystic duct remnant into the common bile duct and duodenum.Then they were inserted via duodenoscopy to perform papillotomy to clear the stones of the common bile duct with the reticulation and the balloon of duodenoscopy.Results Forthe gross choledochus,IEPT in laparoscopy was successful in 45 cases and the other 2 received other operation.IEPT in open laparotomy was successful in 5 cases.For the tiny choledochus,IEPT in laparoscopy was successful in 73 cases and the other 1 underwent other operation.IEPT in open laparotomy was successfulin 2 cases.Conclusion If patients are suitable,IEPT is safe and effective in the hands of skilled endoscopiests for laparoscopy and open laparotomy.

Objective To evaluate combination of cholcdochoscopy or duodenoscopy with therapeutic laparoscopy (LCDCS) in treatment of detail choledochus stones. Methods Laparoscopic cholecystectomy was firstly performed and followed by choledochoscopy or duodenoscopy. Procedures of therapeutic choledochoscopy were as follows: choledochoscopic exploration via cystic duct remnant, choledochotomy, electrohydralic lithothipsy, drainage of bile duct with ureteral catheter via cystic duct remnant, T-tube drainage, or the suture of duct incision. Procedures of therapeutic duodenoscopy were as follows: access to the common bile duct and duodenum through ureteric catheter and zebra guidewire via cholecystic duct remnant, duodenoscopy via oral cavity into the duodenum papilla, papillotomy with needle-knife or arch-like electro-knife along the ureteric catheter or zebra guidewire, and stone clearance in the common bile duct with the reticulation and balloon of duodenescopy. Results Combination therapy were given to 191 cholelithiasis patients with detail choledochus stones. Combined choledochoscopy were performed in 117 patients. Stones were completely removed and average operation time was 114 min. Bile leakage occurred in 7 cases, but was cured with drainage. Postoperative imaging showed 2 cases of bile duct stenosis at primary closure of duct incision. Combined duodenescopic procedures were performed in 74 patients. Papillotomy and stone clearance were successfully performed in 68 patients, 5 others of whom underwent successful papillotomy only, and another underwent other operations. Average operation time was 97 min. Post-operation mild acut pancreatitis developed in 6 patients. No perforation of intestine or bile duct, bleeding, severe pancreatitis, or death was observed in each group. Conclusion LCDCS was safe and effective with appropriate indications.

Objective To investigate the prevalence of nutritional risk and undernutrition of geriatric patients with hip fracture in the department of orthopaedics and analyze the relationship between nutritional risk scores and clinical outcomes.Methods In this prospective cohort study,the baseline demographic data of 235 elderly patients with hip fracture in the department of orthopaedics of Ningbo First Hospital were consecutively recorded from November 2013 to December 2015.The prevalence of nutritional risk and undernutrition,infectious complications,and length of hospital stay were also recorded.The infectious complications and length of hospital stay in patients in different age groups(60-69 years,70-79 years,and ≥80 years)and those with different nutritional risks(<3 points,3-4 points,and ≥5 points)were analyzed.Results All patients without PN EN support during hospitalized durations.The incidence of nutritional risk was 62.98％in 235 elderly patients with hip fracture,twenty patients were undernutritioned by multi-item standard based on Nutritional Risk Screening 2002 nutrition disorder score,and 15 patients were undernutritioned by one-item standard with body mass index.Hip arthroplasty patients had significantly higher nutritional risk than those who had undergone internal fixation(74.04％vs.54.20％,P=0.002).Patients with comorbidities had significantly higher nutritional risk than patients without comorbidities(71.56％vs.55.56％,P=0.011).There were significant differences in infectious complications(2.30％vs.3.91％vs.50.00％)and length of hospital stay[(6.35±0.87)d vs.(8.12±1.13)d vs.(10.85±1.52)d,(8.66±2.06)d vs.(10.45±2.43)d vs.(13.25 ±3.65)d] among patients with different nutritional risks(<3 points,3-4 points,and ≥5 points)(P=0.000).Conclusions Elderly patients with hip fracture has relatatively high nutritional risk.These patients tend to have more complications and longer hospital stay.

Objective? To explore the effects of enhanced recovery after surgery based on nutritional support in perioperative nursing of elderly patients with hip fracture and joint replacement. Methods? From January 2015 to June 2017, we selected 278 elderly hip fracture patients with nutritional risk (NRS 2002≥3) by convenience sampling. All of the patients were divided into observation group (n=132) and control group (n=146) with the method of envelope. Observation group accepted nutritional support and brought it into enhanced recovery nursing process. Control group applied routine perioperative nursing without standardized nutritional support. We compared the albumin and loss of hemoglobin at the second day after surgery, the score of activity of daily living (ADL), time of getting out from bed for the first time, hospital stay as well as complications of patients between two groups. Results? The albumin at the second day after surgery and score of ADL of patients in observation group were (29.16±1.33) g/dl and (63.90±5.47) respectively higher than those in control group;the loss of hemoglobin after surgery, time of getting out from bed for the first time, hospital stay in observation group were (1.34±0.30) g/dl, (1.56±0.20)d, (7.08±2.23)d respectively lower than those in control group;the differences were all statistical (t=-3.089, -14.881, -13.640, -15.279, -8.480;P＜0.05). The incidence of complications of observation group was 9.09% lower than that of control group (19.18%) with statistical difference (χ2=3.877, P＜0.05). Conclusions? Enhanced recovery nursing based on nutritional support can shorten the hospital stay in elderly patients with hip fracture, promote postoperative rehabilitation after hip joint replacement and improve clinical outcomes of patients.

Objective To investigate the current status of perioperative nutritional risk and nutritional intake in aged patients with hip fracture, so as to provide references for standard nutritional support. Methods A prospective cohort study was designed. 235 patients with hip fracture admitted in the Orthopedics Department of Ningbo First Hospital from November 2013 to December 2015 were selected and investigated by nutritional risk screening 2002 ( NRS-2002 ) , to assess the nutritional risk of patients with hip fracture and collect their nutritional intake situation. Results The nutritional risk of 235 patients with hip fracture was 63. 40%, which was higher than that of patients without hip fracture (χ2=37.445,P<0.05), and it was also higher than that of patients with other kinds of fracture ( P<0. 05 ) . Single factor analysis showed that, the perioperative nutritional risk of aged patients with hip fracture was influenced by surgical procedures (χ2 =9. 093,P<0.05) . 235 aged patients with hip fracture were given daily foods in the perioperative period, and the intake of protein and calories were lower than the standard recommended in guideline. Conclusions The nutritional risk in aged patients with hip fracture is high, and the nutritional support was not enough, which should be paid attention by clinical medical workers.

ObjectiveTo evaluate the clinical effectiveness of doctor-nursing integration mode on the prevention of venous thromboembolism(VTE) in geriatric patients with hip fracture. MethodsFrom January to June of 2018, a total of 120 elderly patients with hip fracture admitted to the orthopaedic department of Ningbo First Hospital were selected in this study. According to the time of admission, they were divided into the control group (n=58)and the observation group (n=62). The conventional nursing mode was adopted in the control group and doctor-nursing integration nursing mode was adopted in the observation group. The two groups were compared in terms of the scores of VTE related knowledge, swelling degree of the affected limbs, the plasma D-Dimer level and the incidence of DVT on the lower limbs as well as the pulmonary thrombus. ResultsOne week after surgery, the patients in the observation group achieved higher score in the VTE related knowledge than the control group with statistical significance (P＜ 0.05); one day and one week after surgery, the observation group was lower than the control group in the swelling degree of the 10cm above the hip of the affected limb; one week and two weeks after surgery, the observation group was lower than the control group in the plasma D-Dimer level, both with statistical significance (P＜0.05); the control group's incidence of perioperative DVT on the lower limbs was 11.4% , lower than the 25.8% in the observation group with statistical significance (P＜ 0.05). ConclusionsDoctor-nursing integration nursing model can help to improve the compliance with the thrombosis prevention of the elderly patients with hip fracture, relieve the symptoms related to perioperative VTE and reduce the incidence of DVT on the lower limbs.

Objective? To establish, implement and evaluate the pain control quality system for patients with total knee arthroplasty(TKA). Methods? Through literature search and interviews with medical staff and retrospective reviews of TKA cases in orthopedic wards, the problems in pain control of TKA patients during perioperative period were analyzed. According to the evidence-based practice guideline and the existing problems in pain nursing practice, the pain control quality system was constructed. From January to November 2018, 75 TKA patients in Orthopedic Department, Ningbo First Hospital were selected as the research objects and randomly divided into the control group (n=35) and the intervention group (n=40). The control group received the routine pain nursing mode, and the intervention group was managed by the pain control quality system. The static and dynamic VAS scores on the 1st, 3rd and 7th day after TKA, the incidence of analgesia-related complications and the quality of pain nursing were compared between the two groups. Results? There were significant statistical differences in static and dynamic VAS scores of knee joint between the two groups on the 1st, 3rd and 7th day after operation (P＜0.05). There was no statistical difference in the incidence of analgesia-related complications between the two groups (P＞ 0.05). The total score of TKA perioperative pain nursing quality in the intervention group was 84 (80, 85), while that of the control group was 56 (53, 58). The difference between the two groups was statistically significant (P＜0.01). Conclusions? The construction of pain control quality system can effectively improve the level of perioperative pain management of TKA, the quality of pain nursing care, and improve the perioperative pain of TKA patients.