Objective To investigate the effect of hemostatic drug on coagulation status after operation of bladder tumor.Methods Eighty-two bladder tumor patients in hospital for treatment were selected,and were randomly divided into observation group and control group with 41 patients in each.The patients in observation group were treated with hemostatic drug after operation,and the patients in control group were treated without hemostatic drug.The coagulation status between two groups were compared after operation.Results The index of preoperative coagulation status between two groups had no significant difference (P＞ 0.05).Compared with the preoperative,the activated partial thromboplastin time(APTT) and prothrombin time (PT) in two groups were prolonged on postoperative 1,2 d,plasminogen activator inhibitor (PAI)-1,tissue plasminogen activator (t-PA),D-Dimer (D-D) were increased,platelet (PLT) was decreased,thrombin time(TT) was shortened,there were significant differences (P ＜ 0.05).On postoperative 1,2 d,Tr in observation group was shorter than that in control group[(14.36 ± 0.17) s vs.(15.42 ± 0.18) s,(14.36 ± 0.28) s vs.(15.29 ± 0.27) s],PAI-1,t-PA,D-D were significantly higher than those in control group [(98.19±2.32) μg/Lvs.(82.19±2.38) μg/L,(84.52±2.25) μg/Lvs.(72.94±2.26) μg/L,(27.06 ± 1.69) μg/L vs.(21.63 ± 1.16) μg/L,(27.28 ± 1.37) μg/L vs.(21.69 ± 1.19) μg/L,(7.06 ±0.08) μg/L vs.(1.89 ± 0.28) μg/L,(12.83 ± 1.05) μg/L vs.(1.96 ± 0.18) μg/L],there were significant differences (P＜0.05).No significant difference was found in PLT,APTT,PT between two groups (P＞0.05).The incidence of deep vein thrombosis (DVT) in observation group and control group was 7.32％(3/41),2.44％ (1/41),which had no significant difference (P ＞ 0.05).Conclusions The application of hemostatic drug can aggravate hypercoagulability of patients with bladder tumor after operation.Therefore,it should be carefully applied preventive hemostatic drug.

Objective To investigate the risk factors for complications after tension-free repair in patients with inguinal hernia.Methods A retrospective analysis was made on clinical data of 503 patients with inguinal hernia after tension-free repair.The gender,adhesion,BMI index,the size of hernia sac,hernia type,patch type,degree of adhesion of the hernia ring and the mode of anesthesia were analyzed,and the risk factors were summarized.Results 47 cases occurred complications in 503 patients,the incidence rate was 9.34%.Chi square test showed that the degree of adhesion of the hernia ring and BMI index might be the influence factors of complications after operation,the differences were statistically significant(x2=11.495,8.944,all P<0.05).The degree of adhesion of the hernia ring and BMI index were taken into logistic regression analysis,and found that the degree of adhesion of the hernia ring and BMI index were the independent risk factors,the differences were statistically significant(OR=2.034,2.439,all P<0.05).Conclusion The incidence rate of complications after tension-free repair in patients with inguinal hernia is high,and the degree of adhesion of the hernia ring,BMI index are the independent risk factors of complications,target measures should be taken before operation.

The metastases status of internal mammary lymph node(IMLN) is an independent prognostic factor for breast cancer and it also is an important reference for neoplasm staging.The patients with IMLN metastases consistently have worse outcomes.The overall risk of IMLN metastases is 18 ％-33 ％.Metastases exclusively situated in the IMLN,without concurrent axillary metastases,occur in 2 ％-11％ of patients.Factors related to IMLN metastases include the status of axillary node,the age of patients,the localization and characteristics of primary tumor.Recently,with the development of sentinel lymph node biopsy(SLNB), internal mammary-SLNB may access the status of IMLN with a minimal risk. Internal mammary-SLNB procedure can improve the system for nodal staging of breast cancer,and it will contribute to the individualized treatment for breast cancer patients.

Medicine is a practical science which needs comprehensive analysis.The old fashion of disease treatment model divided by different professions or departments was gradually unable to meet the needs of the clinical diagnosis and treatment,and the corresponding medical education pattern was very limited.As the development of multi disciplinary treatment (MDT) focused on a certain disease or organ,medical teaching mode also changed.Since our hospital used MDT as the treatment of severe acute pancreatitis (SAP),teaching model has been reformed by launching the joint multidisciplinary teaching.After that,the graduate students and advanced students from relevant departments have greatly improved their diagnosis and treatment skills.

Objective To analyze and discuss the clinical effect of the four-hands technique mode of doctor-nurse collaboration in endoscopic sinus surgery. Methods Convenient sampling method was used to select 50 cases of patients with nasal endoscopic surgery who met the inclusion criteria and agreed to participate in this study in the period between January to May in 2016. Designing one side of the nasal cavity of patients with traditional surgery mode, the other side of the nasal cavity to carry out the four-hands operation mode. The operation time and amount of bleeding were recorded. Results The operation time, amount of bleeding of traditionalsingle hand operationside and the other side of four-hands operation respectively were (39.30 ± 21.96) min, (143.86 ± 15.01) ml and (31.60 ± 19.27) min, (102.98 ± 12.85) ml, with significant differences between the two groups (t=2.096, 14.625, P<0.01). Conclusions The four-hands technique of doctor-nurse collaboration can significantly reduce the operation time, reduce the amount of bleeding and get a better surgical field, clinical nurse and doctor′s cooperation is more closely and also improve the quality of patient care.

Anatomic segmental hepatectomy,as an important part ofprecision surgery,has been accepted and widely applied as the promotion of precision hepatectomy.Anatomic segmental hepatectomy is superior to non-anatomical hepatectomy in clinical efficacy,application scope and operation techniques.There are many operation techniques developed by surgeons to accomplish segmental hepatectomy,and it is worthy for spreading in clinical practice.

Objective:To explore scientific and effective methods of management regarding the features of Da Vinci Surgical Robotic System and clinical applications.Methods: Enhance operation room management of Da Vinci Surgical Robotic System; Establish surgical robotic system management system to carry out inter-provincial communication and cooperation, thereby building novel forms of treatment by teamwork and multidisciplinary integration; Regular maintenance and reparation of the equipment by engineers to avoid or reduce the possibility of equipment failure during the operation of equipment.Results: Proposing scientific and effective suggestions for clinical application and management of Da Vinci Surgical Robotic System to provide references for using of such equipment.Conclusion: Via surgical management of Da Vinci Surgical Robotic System and its operation room as well as quality control and preventive maintenance during the operation of equipment, the methods play an important role in reducing the usage risk of equipment, improving usage efficiency of equipment, extending life span of equipment and improving surgical precision and security.

Objective To explore the clinical value of 3-dimensional digital subtraction angiography(3D-DSA)in the diagnosis and therapy of intracranial aneurysms.Methods 2-dimensional digital subtraction angiography (2D-DSA)and 3D-DSA was performed respectively on 1 53 patients,including 1 5 1 cases with spontaneous subarachnoid hemorrhage (SAH),1 case with headache and 1 case with cerebral infarction;Meanwhile,to compare the difference in diagnosis of intracranial aneurysms between 2D-DSA and 3D-DSA.Results 1 12 patients(125 pieces)with intracranial aneurysms were detected on 2D-DSA,its detecting rate was 73.2%(1 12/1 53 );136 patients(1 52 pieces)with intracranial aneurysms were detected on 3D-DSA,its detecting rate was 88.9%(136/1 53)(χ2 =12.254,P <0.05).The displaying rate of 3D-DSA for the relationship between carrying tumor artery and aneurysms and the necks of aneurysms was 100%(1 52/1 52),however,the displaying rate of 2D-DSA for that was 61.6%(77/125)(χ2 =63.993,P <0.05). Conclusion 3D-DSA can improved the diagnostic accurate rate of intracranial aneurysms,it is important in chosing the therapeutic regimen.

Objective To evaluate the feasibility and safety of stent implantation in treating patients with symptomatic vertebral artery kinking. Methods Forty-two patients with vertebral artery kinking confirmed by digital subtraction angiography and accorded with the stent implantation indications were chosen in our study; these patients were performed stent implantation. The stenosis and haemodynamics changes, and recent and postoperative complications were observed; Malek scale was adopted to evaluate the clinical efficacy during the 1-year follow-up. Results The success rate of stent implantation for patients with symptomatic vertebral artery kinking was 100%(42/42). The percentage of stenosis was significantly reduced from (75.6 ± 13.5)%to (8.3 ± 3.1)%after stenting, and the mean flow velocity of kinking lesion was obviously decreased from (49.5 ± 12.4) cm/s to (31.7 ± 15.0) cm/s, and there were statistical differences (P<0.01). The cerebellum hematoma was noted in 1 patient , subcutaneous hematoma of puncture point appeared in 2 and femoral artery pseudoaneurysm after the stenting in 1;all these complications did not cause serious consequences. Malek scale indicated that 36 cases got 1 point,4 cases got 2 points, 1 case got 3 points, 1 case got 4 points and no one got 5 points;36 patients (85.7%, 36/42) were asymptomatic during the 1-year follow-up;no significant in-stent restenosis was found. Conclusions Symptomatic vertebral artery kinking can be treated safely and effectively with stent implantation.

The triad of trauma including hypothermia,acidosis,and coagulopathy during initial operative and resuscitation efforts has been recognized as a significant cause of death in patients with severe abdominal traumatic injuries.Damage control surgical approach with a brief fast surgery,subsequent intensive care unit resuscitation,and a planned reoperation is an emerging technique to control bleeding and contamination and undertake temporary abdominal wall closure that can shorten the operating time,lessen the traumatic stress,fast correct the triad of trauma and lower the incidence rate of postoperative complications.Damage control surgery places a important role in dealing severe traumatic injuries currently.