During the process of teaching in clinical practice, there objectively exist the contradiction between the obligation of teaching and the invasion of the right to informed consent, and the contradiction between the growth of medical students and the invasion of patients' right to privacy. Health reforms, such as the regulation of "patient selecting doctor", bring some side effects to the teaching in clinical practice. In order to maintain the right to informed consent and privacy, to benefit the teaching in clinical practice, to develop the doctor-patient relationship, and to decrease medical disputes, the art to deal with the doctor-patient relationship must be explored. The laws and regulations of the teaching in clinical practice and of the right of doctors and patients must be developed too.

ObjectiveTo evaluate the efficacy of preemptive analgesia with parecoxib for acute postoperative pain after pulmenary lobectomy.MethodsSixty ASA Ⅱ or Ⅲ patients of both sexes aged 20-64 yr weighing 50-80 kg undergoing elective pulmonary lobectomy were randomly divided into 3 groups ( n =20 each): control group (group C); group A (parecoxib 40 mg was injected iv at 20 min before surgery) and group B (parecoxib 40 mg was injected iv when skin was sutured).Patient controlled intravenous analgesia (PCIA) with sufentanil and ramosetron (continuous background dose 2 ml/h,bolus dose 0.5 ml,lockout time 15 min) was used after surgery.When VAS score ＞ 3,iv bolus of tramadol 1-2 mg/kg was injected as rescue medicine.Agitation condition was observed after operation.The number of successfully delivered doses and the number of attempt were recorded.The consumption sufentanil and the number of rescue medicine were recorded during 24 h after surgery.ResultsThe incidence of postoperation agitation,number of successfully delivered doses and number of attempt,consumption sufentanil and number of rescue medicine were significantly lower in groups A and B than in group C.The consumption sufentanil and number of rescue medicine were significantly lower in group A than in group B ( P ＜0.05).ConclusionParecoxib can use for preemptive analgesia in patients after thoracic surgery,reduce the complication during anesthesia recovery and the opioid analgesics consupmtion.

Objective To explore the treatment of children with hernia,and the advantage of transabdominal extraperitoneal hernia sac exclusion was analyzed.Methods A total of 102 patients in our hospital from January 2005 to January 2015 were randomly divided into 2 groups,55 cases who treated by the surgery of transabdominal extraperitoneal hernia sac exclusion were treatment group,47 cases who treated by the surgery of high ligation of the hernia sac throug the inguinal incision were control group.The operative time,length of hospital stay, length of incision,postoperative pain and hospitalization costs between two groups were compared.Results The effect of the treatment group was superior to the control group on operative time,length of incision and postoperative pain,the difference was significant(P <0.05).Con-clusion There are some advantages of more simplified operation,shorter time of the surgery,less complication,lower recurrence rate and more reliable curative effect in the treatment of transabdominal extraperitoneal hernia sac exclusion for children with hernia,which is worthy of clinical promotion.

Objective To analyze the therapy and prognosis of palindromic ovarian carcinoma. Methods The clinical data of 40 cases of palindromic ovarian carcinoma were reviewed retrospectively. Results After the first surgery, the mean recurrent time of the patients with remained tumors smaller than 2 0 cm was (37 26?11 79) months, and that of the patients with remained tumors larger than 2 0 cm was (7 88?1 49) months. There was a significnat difference in the mean recurrent time between the two groups of the patients with different size of remained tumors(P0 05). Conclusion The recurrence of ovarian cancer was related to the size of remained tumor. Secondary operation plus chemotherapy could improve the short-term survival rate of the patients with palindromic ovarian carcinoma.

Objective To study the clinical characteristics of elderly sleep apnea syndrome (ASA). Methods 329 SAS patients diagnosed by 7-hour polysomnography(PSG) were classified into the aged and the middle aged groups. Results Both the body mass index(BMI) and neck circumference were significantly lower in the aged group than those in the middle aged group(P

0.05), but BIS was markedly lower in group Ⅲ than that in group Ⅰ (P

Objective To report the diagnostic and therapeutic effects of arthroscopic surgery on elbow sports injuries. Methods Nineteen patients with elbow diseases were treated by arthroscopic methods from January 1996 to February 2000. The modified HSS elbow rating scale was used as criteria of the efficacy. All patients were followed up for 4.5 months to 4.5 years (an average 8.6 months). Results Among nineteen patients, eleven had an excellent results, seven good, one poor, and satisfactory rate was 94.7 percent. Ten patients were satisfied greatly with the results,eight patients satisfied, one unsatisfied, the satisfactory rate was up to 94.7 percent according to the responses of questionnaire from the patients. The time resuming daily was in a medium of 7 days, and that for sports was in an average of 2.5 months. All the 11 cases of athletes and actors(actresses) resumed their previous seats. Complications occurred in 3 earlier cases, one had radial nerve temporary paralysis, the other two had residue loose bodies. Conclusion Elbow arthroscopic treatment is a reliable method with the advantages of minor trauma, quicker recovery and less traumatic manipulation. Careful pre-operative examination, selection of a safer portal of entry, and standard manipulation are very important points for the attainment of better results and less complications.

Objective To introduce a better and quicker technique of transperitoneal laparoscopic ureterolithotomy. Methods 42 cases of ureterolithiasis (23 males and 19 females;mean age of 42.4 years,range from 16 to 63 years) were included.Of them 26 cases had calculi on the left side and 16 cases,on the right side.All the cases underwent laparoscopy through 3-port technique. Results The operations were successful in all of 42 cases.The mean operative time was 43 min (range,33 to 56 min).Blood loss was 20 to 50 ml.The postoperative hospital stay was 3 to 5 days.None experienced urinary leakage.During the follow-up of 12～18 months no ureteral stricture was found.The renal functions were improved. Conclusions Our experience indicates that appropriate trocar location,exactly checking of calculi,good D-J tube drainage and skillful intra-abdomenal suturing are the keys to perform laparoscopic ureterolithotomy quickly.

Objective To describe the new technique of transperitoneal laparoscopic dismembered pyeloplasty and to evaluate its clinical effect. Methods Of the 18 cases of ureteropelvic junction (UPJ) obstruction who underwent transperitoneal laparoscopic dismembered pyeloplasty,8 cases had severe hydronephrosis;7,intermediate;3,mild. Results Operations were all successful in 18 cases with the operating time being 100 to 210 min (mean,142 min) and the blood loss,40 to 200 ml.All the pores of puncture healed at phase 1;mean hospitalization was 7.4 d.Only 1 case had postoperative urine leakage.Follow-up of 3 to 12 months showed there was no stricture at UPJ and hydronephrosis was remitted (intermediate hydrops in 4 cases,mild in 7 and resolution in 7).The renal functions were improved. Conclusions Laparoscopic dismembered pyeloplasty is an effective and minimally invasive approach and can be used as an alternative to open surgery for UPJ obstruction.