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.

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 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.

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.

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.

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.

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 evaluate the therapeutic efficacy and safety of micro-invasive craniopuncture scavenging technique (MPST) for treatment of intracranial hematoma in patients with hypertensive cerebral hemorrhage (HICH).Methods All the clinical randomized controlled trial (RCT) studies published on MPST and internal medicine conservative treatment of HICH were searched via computer screening of databases including Cochrane clinical trials database, the Chinese biomedical literature database (CBM), Chinese periodical network full-text special topic database, Chinese science and technology periodical database and electronic periodicals database of Wanfang from January 2006 to January 2017. The study group was given the MPST plus basic treatment, and the control group was given conservative treatment. The studies collected meeting the eligible criteria were sorted and analyzed by the software RevMan 5.0, the differences in therapeutic effect and mortality were compared between the two groups, and a funnel chart was plotted to analyze the potential publication bias.Results A total of 13 RCTs published studies consistent with the eligible criteria were found, including1556 patients. The Meta-analysis showed that the effective rate in the study group was significantly higher than that in the control group [odds ratio (OR) = 4.29, 95% confidence interval (95%CI) 3.33 - 5.53,P < 0.01]; the fatality rate was markedly lower than that of the control group (OR = 0.25, 95%CI 0.19 - 0.35,P < 0.01). The funnel graph showed that each study had asymmetrical scatter plot of the variable quantity of research results, indicating a publication bias being present, which might be related to the subjectivity of the researchers in publishing their results.Conclusions Using MPST to treat HICH can significantly improve the therapeutic efficiency and reduce deterioration rate. However, due to the low quality of clinical research, it is necessary to carry out rigorous andmulti-center randomized controlled studies to further confirm the results.

Objective To explore the efficacy of breast-conserving therapy of ductal carcinoma in situ (DCIS),and to evaluate its safety.Methods 54 patients with DCIS receiving breast-conserving therapy(the experimental group) and 49 patients with DCIS treated with mastectomy(the control group) in the First Affiliated Hospital of Wenzhou Medical College from Mar.2010 to Mar.2013 were retrospectively analyzed.The follow-up results of the 2 groups were analyzed in terms of the local recurrence,distant metastasis and the 3-year diseasefree survival(DFS).The efficacy and safety of breast-conserving treatment were evaluated.Results All patients were followed up for 5 months to 39 months,with the average of(22.3 ± 8.5) months.No local recurrence happened in the experimental group.There was 1 case of chest wall recurrence in the control group.One case in the experimental group and 2 cases in the control group had distant metastasis.DFS rate in the 2 groups was 100％ and 95.9％ relatively.No statistically significant difference was found between the 2 group in terms of the above items (P ＞ 0.05).Conclusion For DCIS patients,the difference between breast-conserving therapy and mastectomy surgery in the rate of local recurrence and distant metastasis was not significant.Breast-conserving therapy is safe for DCIS patients and should be further promoted.

Objective To summarize the experience in pediatric nursing of children with congenital insensitivity to pain and anhidrosis (CIPA) combined with proximal femoral fracture.Methods Two CIPA children with proximal femoral fracture received good treatment of security,plaster casts/braces,body temperature and skin as well as guidance of function exercise and health care education.The nursing experience was summarized.Result After intensive nursing,all patients successfully tided over their perioperative period and discharged.Conclusions The security management,careful observation of skin and body temperature after plaster casts/braces fixation,are of great significance for the decreased complication.Function exercises are equally effective in CIPA children with proximal femoral fracture.