PURPOSE: Laparoscopic surgery is accepted as a standard alternative to open procedures in the management of both benign and malignant colorectal disease. However, the safety and efficacy of the laparoscopic approach for emergency colorectal surgery has not been established. Hand-assisted laparoscopic (HAL) surgery might be a suitable option for colectomy in an emergency setting. The aim of this study was to report our experience of emergency HAL colectomy. METHODS: This was a retrospective review of consecutive colorectal emergency cases that were treated using HAL colectomy. Patient demographics, indications for surgery, operative details, and postoperative complications were examined. RESULTS: From March 2015 to April 2016, 18 patients underwent emergency HAL colectomy for complicated colorectal disease. Eight patients (44%) had an obstruction that required intraoperative decompression procedure. Sixteen patients (89%) had a perforation (five of which were sealed perforations involving large abscesses and inflammatory changes). Eight patients underwent sigmoidectomy, four underwent anterior resection, one underwent low anterior resection, two underwent left hemicolectomy, and three underwent Hartmann's procedure. There were two instances of open conversion (11%). The median duration of surgery was 178 minutes. The median time to bowel function recovery and median postoperative stay were 3 days and 10 days, respectively. The postoperative complication rate associated with the operation was 33% (6/18). There was one postoperative mortality. CONCLUSION: For the experienced surgeon, HAL can be a reasonable option for emergency colorectal surgery.
Abscess ; Colectomy ; Colorectal Surgery ; Decompression ; Demography ; Emergencies* ; Hand-Assisted Laparoscopy* ; Humans ; Laparoscopy ; Mortality ; Postoperative Complications ; Recovery of Function ; Retrospective Studies

Objective: To research the change of PR interval shortening in ECG examination in different periods of pregnancy. Methods: From March 2016 to August 2016, 616 pregnant women who underwent maternity examinations in the Women and Children's Hospital of Ningbo were selected in this study.According to the different gestational periods, they were divided into the early pregnancy group (198 cases), the mid-pregnancy group (232 cases) and the late pregnancy group (186 cases). And another 241 non-pregnant women who underwent health examination in our hospital during the same period were selected as controls.All pregnant and non-pregnant women were examined by electrocardiogram, and the results of electrocardiogram were analyzed.The average heart rate, the average PR interval and the shortened ratio of PR interval were compared between the two groups of women and women with different pregnancy periods, and the short PR interval distribution of women in different pregnancy periods was observed. Results: The average heart rate level, PR interval and PR interval shortening ratio of pregnant women and non-pregnant women were (76.55±7.81)times/min, (0.096±0.008)s, 12.66% and (72.56±6.49)times/min, (0.138±0.014)s, 4.98%, respectively.The average heart rate and the shortening ratio of PR interval in pregnant women were significantly higher than those in non-pregnant women, while the average PR interval in pregnant women was significantly lower than that in non-pregnant women, the differences were statistically significant (t=7.565, χ²=10.879, t=52.672, all P<0.05). With the increase of pregnancy cycle, the shorter the average heart rate and PR interval of pregnant women, the shorter the average PR interval.The average heart rate, PR interval and PR interval shortening ratio in the early pregnancy group, the mid-pregnancy group and the late pregnancy group were (75.41±6.65)times/min, (0.103±0.010)s, 8.59% and (77.03±7.12)times/min, (0.095±0.009)s, 11.21% and (79.74±8.43)times/min, (0.088±0.008)s, 18.82%, respectively.There were statistically significant differences among the three groups(t=16.720, 116.440, χ²=9.791, all P<0.05). Conclusion Pregnancy women are prone to have shorten PR interval, and its incidence increases with the increase of pregnancy cycle, but in most cases belongs to benign electrophysiological changes, and the prognosis is good without special treatment.It is of great significance for clinical diagnosis and treatment to reduce the outcome of bad pregnancy by observing the shortening of the PR interval of electrocardiogram during the pregnancy.

Objective To develop a self-care scale for patients with lymphedema after breast cancer surgery and verify its reliability and validity.Methods Based on the model of knowledge,belief and practice,a questionnaire item pool was constructed after literature reviews and qualitative interviews.A questionnaire-based scale was drafted based on the established item pool by carrying out two rounds of consultation with 15 clinical nursing specialists,nursing administrators and nursing educators from 8 provinces or cities in China.Reliability and validity of the scale were tested using convenience sampling,involving 444 patients with breast cancer surgery related lymphedema from 7 general hospitals in Hubei and Henan provinces,China,between May and July 2023.Results The response rates for the two rounds of expert consultation were 93.75%and 93.33%,respectively.The authority coefficients of the two rounds were 0.86 and 0.89,respectively,and the coordination coefficients for the 2 rounds were 0.130 and 0.379,respectively.In the first round,the average importance rating was from 4.33 to 4.93 with the coefficient of variation from 0.05 to 0.19,and the full score ratio from 53.33%to 93.33%.In the second round,the average importance rating ranged from 2.86 to 4.93 with the coefficient of variation from 0.05 to 0.36,and the full score ratios from 7.14%to 92.86%.A total of 421 patients completed the survey.The overall Cronbach's α coefficient of the scale was 0.943,the overall split-half reliability was 0.824,the scale-level content validity index(S-CVI)was 0.912,and the item-level content validity index(I-CVI)of the total scale ranged from 0.857 to 1.000.The KMO value of exploratory factor analysis was 0.919,the Bartrett spherical test value was 4671.724(P<0.001),and the cumulative variance contribution rate was 64.155%.Confirmatory factor analysis showed a good model fit.After the reliability and validity tests,the scale was finalised and determined to consist of three dimensions with 33 items:knowledge(9 items),attitude(6 items)and behaviour(18 items).Conclusion The self-care scale for the patients with lymphedema after breast cancer surgery has demonstrated good reliability and validity,and makes it an effective assessment tool for the patients with lymphedema after breast cancer surgery.