Table of Content

01 July 2023, Volume 11 Issue 3

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Expression of programmed death-ligand 1 of triple negative breast cancer tissues and their correlations with the clinicopathological characteristics and prognosis of patients

GAO Yue, LI Xiaoqian, XU Feng, JANG Hongchuan

2023, 11(3):  2. 

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Objective The purpose of this study was to detect the expression of programmed death-ligand 1(PD-L1) in triple negative breast cancer, and to explore the relationship between the expression of PD-L1 and the clinicopathological features and prognosis of triple negative breast cancer. Method From May 2010 to October 2020, 269 paraffin sections of triple negative breast cancer tissue collected by Beijing Chaoyang Hospital Affiliated to Capital Medical University, were used for immunohistochemical staining to detect the expression of PD-L1 in breast cancer tissue. Analyze the relationship between PD-L1 positive expression and clinical pathological characteristics and prognosis of patients. Result The expression rate of PD-L1 in tumor cells and infiltrating

lymphocytes around tumor was 7.8%（21/269） and 17.84%（48/269）. The total expression rate of PD-L1 in tumor cells and infiltrating lymphocytes around tumor was 21.19%（57/269）.The total expression of PD-L1 in tumor and peritumor infiltrating lymphocytes was correlated with histological grade, nerve invasion, vascular tumor emboli, lymph node metastasis, and Ki-67 high proliferation index. Multivariate regression analysis showed that lymph node metastasis was risk factor for the expression of PD-L1. The expression of PD-L1 was associated with RFS in the prognosis of triple negative breast cancer. Conclusion The high expression of PD-L1 in the tumor cells of triple negative breast cancer and the infiltrating lymphocytes around the tumor is related to the tumor progression and poor prognosis, which can be used as the target of triple negative breast cancer immunotherapy.

Risk factors and management strategies of central lymph node metastasis in patients with papillary thyroid carcinoma

QI Yingcai, QU Kaiqiang

2023, 11(3):  8. 

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Objective This study retrospectively analyzed the clinical data of patients with papillary thyroid carcinoma (PTC) to explore the risk factors for central lymph node metastasis (CLNM) in the neck of PTC. Method The clinical data of 161 hospitalized patients who underwent thyroid surgery for the first time and were pathologically confirmed as PTC in Yingcheng People's Hospital from July 2020 to July 2021 were collected. The patients were divided into metastasis group and non metastasis group according to whether they had CLNM. Compare general information such as gender, age, and preoperative ultrasound imaging data between two groups to analyze the risk factors for CLNM in PTC patients. Result Univariate analysis showed that CLNM was associated with age, gender, ultrasound examination of tumor diameter, microcalcification, and presence of blood flow signals (P＜ 0.05), but not with factors such as tumor palpation results and tumor number (P ＞ 0.05). Multivariate analysis showed that age<45 years old, male, tumor diameter ＞ 1.0cm, ultrasound display of tumor microcalcification, and detection of blood flow signals within the tumor are risk factors for CLNM in PTC patients. Conclusion Men, age ＜ 45 years old, tumor size ＞ 1cm, microcalcifications, and internal blood flow signals within the lesion have a higher risk of developing CLNM. It is recommended that such PTC patients undergo preventive central lymph node dissection.

Potential profile analysis and influencing factors for benefit discovery in colorectal cancer patients with enterostomy

JI Yanyan, WANG Kaixuan, LI Chang, XU Xiaoqing, ZHANG Dianliang, LIU Zhimei

2023, 11(3):  13. 

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Objective To explore the potential categories of benefit findings in colorectal cancer enterostomy patients, and to analyze the influencing factors of different benefit findings in colorectal cancer enterostomy patients. Method A total of 216 patients with colorectal cancer enterostomy who were hospitalized or outpatients in Qingdao Municipal Hospital from January 2022 to September 2022 were selected as subjects by convenience sampling method. The survey was conducted using the General Information Questionnaire, the Benefit Finding Rating Scale, the Medical Coping Style Questionnaire, the Perceptive Social Support Inventory, the Revised Life Orientation Test Scale, and the Rumination Rumination Questionnaire. The potential profile analysis method was used to analyze the characteristics of benefit discovery of the research object, and the factors influencing the

potential categories of benefit discovery were discussed by univariate analysis, variance analysis and ordered multiple Logistic regression analysis. Result The benefit findings in colorectal cancer enterostomy patients could be divided into three potential categories: low benefit findings-coping fatigue group (16.7%), moderate benefit findings-lack of exercise group (52.3%) and high benefit findings - healthy and loved group (31.0%). Facing and yielding, family support and other support, optimistic tendency, retirement, and never or almost no communication with health care workers were factors influencing the potential categories of beneficial findings. Conclusion There is significant group heterogeneity in the benefit finding of colorectal cancer enterostomy patients. Medical staff should identify the characteristics and influencing factors of different potential categories of benefits and formulate targeted intervention strategies to improve the level of benefit finding in patients.

Research progress in quality assessment tools for intestinal preparation in colonoscopy patients

WANG Guangning, GAO Kunfan, YANG Suzhen, WANG Yajing, LIU Huisong

2023, 11(3):  22. 

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This study reviewed the intestinal preparation quality assessment tools for colonoscopy patients developed at home and abroad, summarized the application status and characteristics of the intestinal preparation quality assessment tools for colonoscopy patients, and analysed the advantages and disadvantages of the existing assessment tools, so as to provide reference for the correct assessment of the bowel preparation quality in patients.

Influencing factors and treatment progress of seroma after laparoscopic inguinal hernia repair

XIONG Bing, GAO Lan, YAN Hongrui

2023, 11(3):  27. 

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Seroma is a sterile inflammatory reaction occurring in tissue spaces, potential cavities, and surgical cavities. Exudate in the cavities gather to form liquid lumps, causing pain, cellulitis, infection, and other complications. Almost all patients with laparoscopic Inguinal hernia repair will have seroma after operation. This article summarizes and analyzes the literature on the influencing factors of seroma after laparoscopic Inguinal hernia repair for reference.

Clinical comparison of endoscopic and open thyroidectomy via areola approach in the treatment of benign thyroid lesions

WANG Xiangzhong, ZHAO Ke

2023, 11(3):  30. 

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Objective To compare and analyze the clinical effects of endoscopic thyroidectomy via areola approach and open thyroidectomy in patients with benign thyroid diseases. Method A total of 82 patients with benign thyroid lesions admitted to our hospital from February 2020 to January 2022 were selected and divided into two groups according to the willingness of patients to operate, 42 patients were in the control group and 40 patients were in the test group. The patients in the control group were treated with open thyroidectomy, and the patients in the test group were treated with endoscopic resection through the areola approach. The perioperative indicators, pain degree, postoperative complications, and cosmetic effects of the two groups were statistically compared. Result The operation time, extubation time and hospitalization time in the test group were significantly shorter than those in the control group, and the intraoperative bleeding volume and postoperative drainage volume were significantly

less than those in the control group (P ＜ 0.05). The pain scores of the test group at 6h, 1d and 2d after operation were significantly lower than those of the control group (P ＜ 0.05). The incidence of postoperative complications in the test group was significantly lower than that in the control group (P ＜ 0.05). The score of beauty satisfaction in the test group was significantly higher than that in the control group (P ＜ 0.05). Conclusion The advantages of endoscopic thyroidectomy via areola approach in patients with benign thyroid diseases are obvious, such as short operation time, quick recovery after operation, less pain and low complication rate, which is worthy of clinical application.

Clinical efficacy of laparoscopic cholecystectomy via different anatomical approaches of gallbladder triangle in the treatment of cholelithiasis with chronic cholecystitis

HUANG Xingyang, CHEN Yong, GE Yong

2023, 11(3):  34. 

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Objective To investigate the effect of laparoscopic cholecystectomy through different anatomical approaches of gallbladder triangle in the treatment of cholecystolithiasis with chronic cholecystitis. Method From June 2020 to December 2021, 150 in-patients with gallstones and chronic cholecystitis admitted to Xinghua Hospital of Traditional Chinese Medicine were selected. They were randomly divided into the control group (n=75) and the observation group (n=75). The patients in the control group used the triangular approach to the gallbladder, and the patients in the observation group used the posterior triangular approach to the gallbladder. Compare the levels of C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin-6 (IL-6) before and after treatment between two groups of surgical related indicators, as well as the incidence of complications and conversion to

open surgery. Result The surgery time, gastrointestinal function recovery time, and hospitalization time of the observation group patients were shorter than those of the control group, and the bleeding volume was smaller than that of the control group, with significant differences (P ＜ 0.05). After surgery, the average levels of CRP, TNF-α, and IL-6 in the observation group were lower than those in the control group, and the incidence of complications and conversion to laparotomy were also lower than those in the control group, with significant differences (P＜0.05). Conclusion Laparoscopic cholecystectomy for the treatment of gallstones with chronic cholecystitis can reduce the injury of patients, help patients recover, reduce the inflammatory reaction of the body, and reduce the risk of complications and conversion to laparotomy.

Clinical efficacy analysis of laparoscopic inguinal hernia repair procedures

WANG Yaopeng, ZHANG Lifeng, HUANG Leirun, HUANG Mingjin, YUAN Guanglin

2023, 11(3):  38. 

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Objective To analyze the clinical efficacy of laparoscopic inguinal hernia repair. Method 58 patients with laparoscopic hernia repair admitted to the 926th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2020 to January 2021 were selected as the laparoscopic group, and 58 patients treated with traditional hernia repair during the same period were selected as the traditional group. Compare the surgical conditions, postoperative complications, and recurrence rates between the two groups of patients. Result Surgery time, bedtime, and hospitalization time of the laparoscopic group were shorter than those of the traditional group, with less intraoperative bleeding and lower pain scores at different postoperative periods

compared to the traditional group (P ＜ 0.05). There was no significant difference in surgical efficacy between the two groups of patients, and the total incidence of complications in the laparoscopic group was lower than that in the traditional group, with a significant difference (P＜0.05). However, there was no significant difference in the 2-year postoperative recurrence rate between the two groups of patients (P ＞ 0.05). Conclusion Laparoscopic hernia repair surgery has fewer complications compared to traditional hernia repair surgery, and can shorten the surgical time and promote patient recovery.

Comparison of transabdominal preperitoneal prosthesis and flat plate tension-free hernia repair operation in the repair of bilateral inguinal hernia

LI Dongfang, CAI Dejun, CHEN Yonghan, JIANG Xiaosong

2023, 11(3):  42. 

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Objective To investigate the efficacy of transabdominal preperitoneal prosthesis(TAPP) versus flat plate tension-free hernia repair(Lichtenstein) surgery in bilateral inguinal hernia repair. Method A retrospective analysis of 75 patients with bilateral inguinal hernia admitted to the hospital from January 2019 to April 2022, of which 40 were treated with Lichtenstein surgery and 35 were treated with TAPP. The perioperative condition, shortterm treatment effect, recurrence rate and complication rate of the two groups were compared. Result The surgical time in the TAPP group was higher than that in the Lichtenstein group, The postoperative 24-hour pain score, postoperative bedtime, postoperative exhaust time, and hospital stay in the TAPP group were significantly lower than those in the Lichtenstein group, The hospitalization expenses of the TAPP group were higher than those of the Lichtenstein group, the differences are significant (P ＜ 0.05). On the 1st postoperative day, white blood cell count in the TAPP group was (4.98±1.02)×109/L, tumor necrosis factor-α lever was(35.13±4.52)pg/L, and C-reactive protein lever was (3.78±0.62) mg/L, which were all lower than those in the Lichtenstein group [(5.63±1.38)×109/L, (42.17±4.31)pg/L, and (4.83±0.70)mg/L, respectively], the differences are significant (P ＜ 0.05). The recognition rate of patients in the TAPP group was 91.43%, higher than that in the Lichtenstein group (85.00%), but there was no statistically significant difference between the groups (P ＞ 0.05). 3 patients in the TAPP group experienced complications, with a total incidence rate of 8.5%;6patients in the Lichtenstein group experienced complications, with a total incidence rate of 15.0%. There was no statistically significant difference between the two groups(P ＞ 0.05). All cases were followed up for 19 months after surgery, In the TAPP group, 2 cases (5.71%) recurred at 7 and

17 months respectively; 1 case (2.50%) in the Lichtenstein group relapsed 13 months after surgery. There was no statistically significant difference in the recurrence rate between the two types of surgery (P ＞ 0.05). Conclusion TAPP and Lichtenstein surgery have a definite clinical effect on bilateral inguinal hernia, and the complication rate is equivalent, but patients treated with TAPP recover faster after surgery.

Observation on the effect of daytime operation for inguinal hernia combined with cyst of round ligament of uterus

FENG Gangxiang, ZHOU Xi, CHEN Dan

2023, 11(3):  49. 

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Objective To analyze the therapeutic effect of daytime operation on patients with inguinal hernia and cyst of round ligament of uterus. Method 68 patients with inguinal hernia combined with uterine round ligament cyst admitted to Huangshi Industrial and Mining Hospital from August 2018 to August 2019 were selected and divided into a control group and an observation group using the envelope method, with 34 cases in each group. The control group underwent non day surgery, while the observation group underwent day surgery. The treatment effect and hospitalization status of the two groups of patients were compared. Result On the 1st and 3rd day after surgery, there was no significant difference in pain scores between the observation group and the control group at two times. There was no significant difference in intraoperative bleeding volume, surgical time, and incidence of

complications between the two groups of patients (P ＞ 0.05). The hospitalization time of the observation group patients was shorter than that of the control group, and the hospitalization cost was significantly lower than that of the control group (P ＜ 0.05). After a 3-year follow-up, there was no significant difference in the recurrence rate between the two groups (P ＞ 0.05). Conclusion The safety of daytime operation for inguinal hernia combined with round ligament cyst of uterus is equivalent to that of non-daytime operation, and the cost of daytime operation is low, and the patient's hospitalization time is short.

Effect of prophylactic terminal ileostomy on clinical efficacy and anal function in elderly patients with rectal cancer

GU Xuezhou, LIN Weihua, CHEN Hang

2023, 11(3):  53. 

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Objective Explore the effectiveness of preventive ileostomy in the treatment of elderly rectal cancer patients and its impact on anal function. Method 40 rectal cancer patients admitted to Sheyang County People's Hospital from July 2018 to July 2022 were randomly divided into control group (n=20) and observation group (n=20). The control group was treated with laparoscopic radical resection of rectal cancer, and the observation group was treated with laparoscopic radical resection of rectal cancer plus a prophylactic terminal ileostomy protocol. The operation time, bleeding volume, length of resection lesion and number of lymph node dissection were compared between the two groups, and the anal tube resting pressure, rectal threshold sensory volume and maximum rectal tolerance volume before and after treatment were detected to evaluate anal function, and the complication rate and surgical safety were counted. Result Operation time, blood loss, tissue length and lymph node dissection between the two groups (P ＞ 0.05). Postoperative anal resting pressure, rectal threshold sensory capacity, and maximum rectal tolerance capacity were all less than those of the control group, the complication rate was lower in the observation group than in the control group (P ＜ 0.05). Conclusion Prophylactic terminal ileum stoma intervention is effective and can improve anal function and reduce complication rate.

Effect of one-time radical operation on inflammatory factors and complications in patients with perianal abscess

TANG Kun

2023, 11(3):  57. 

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Objective To investigate the effect of one-time radical operation on inflammatory factors and complications in patients with perianal abscess. Method A retrospective analysis was conducted on 94 patients with perianal abscess admitted to Xing'an County People's Hospital in Guilin City from June 2021 to June 2022. They were divided into an observation group and a control group, with 47 patients in each group, based on different surgical methods. The observation group patients were treated with one-time radical surgery, while the control group patients were treated with three gap drainage. Compare the clinical treatment efficacy, inflammatory factor levels, surgical indicators, and incidence of complications between the two groups of patients. Result The short-term efficacy of the observation group patients was significantly better than that of the control group, and the incidence of

complications and secondary surgery rates were lower than those of the control group, with significant differences (P ＜ 0.05). Although the incidence of anal fistula was lower than that of the control group, there was no significant difference (P ＞ 0.05). The surgery time of the observation group patients was longer than that of the control group, and the postoperative wound healing time was shorter than that of the control group. The intraoperative bleeding was less than that of the control group, and the average levels of C-reactive protein and interleukin-6 water were lower than those of the control group, with significant differences (P ＜ 0.05). Conclusion The one-time radical operation for the treatment of perianal abscess has good clinical effect and low complications.

Efficacy and safety analysis of AcoStream thrombus clearance device in the treatment of lower limb deep vein thrombosis

ZENG Jinfu, HUANG Yonghao, HUANG Wei, WANG Weiping, HE Dongmei

2023, 11(3):  61. 

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目的 探讨AcoStream 血栓抽吸装置用于下肢深静脉血栓治疗的血栓清除率、显效消肿率以及安全性的影响。方法 选取2019 年1 月至2022 年9 月在化州市人民医院住院治疗的30 例下肢深静脉血栓患者，依据治疗方式的不同分为观察组与对照组，各15 例。观察组患者接受AcoStream 机械血栓抽吸治疗，对照组患者接受单纯导管接触溶栓治疗，比较两组患者术前及术后生活质量、手术相关指标，以及术后相关并发症。结果 观察组患者的术中尿激酶用量少于对照组，患者的小腿和大腿消肿率均高于对照组，且术中溶栓时间、患者住院时间均短于对照组，差异均有显著性（P ＜ 0.05）。但观察组的住院费用显著高于对照组，差异有显著性（P ＜ 0.05）。观察组患者的溶栓有效率以及Ⅱ级和Ⅲ级占比均高于对照组，差异有显著性（P ＜ 0.05）；同时，观察组并发症总发生率[6.67%（1/15）] 显著低于对照组[40.00%（6/15）]，差异有显著性（χ2=4.658，P=0.031）。结论 AcoStream 机械血栓清除装置用于下肢深静脉血栓治疗，安全有效，能提高患者术后生活质量。

Application of quality management based on specialist nursing-sensitive indexes in nursing of patients with enterostomy

PAN Ting, FANG Fang, LI Qin, TONG Bo

2023, 11(3):  68. 

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Objective To explore the construction of sensitive indexes of enterostomy nursing，and discuss the application of quality management based on indexes in the nursing of enterostomy patients. Method 287 patients with enterostomy who underwent outpatient and inpatient procedures at Subei People's Hospital from January 2020 to December 2021 were selected and divided into two groups based on the time period. 149 patients with enterostomy who did not undergo indicator monitoring from January to December 2020 were selected as the control group, and 138 patients with enterostomy who underwent indicator monitoring from January to December 2021 were selected as the study group. Compare the accuracy of preoperative positioning, incidence of skin complications around the stoma, and changes in nursing satisfaction of stoma patients between two groups of patients. Result The preoperative positioning accuracy (92.75%) and nursing satisfaction (97.83%) of patients in the study group were higher than those in the control group (81.21% and 88.59%, respectively). The incidence of skin complications around the stoma (4.35%) was lower than that in the control group (10.74%), with significant differences (P ＜ 0.05). Conclusion The establishment and implementation of monitoring and management of sensitive indexes of enterostomy specialty nursing can improve the preoperative positioning accuracy of enterostomy，reduce the skin complications around enterostomy, and improve the nursing satisfaction of enterostomy patients.

Effect of targeted nursing on elderly patients after laparoscopic appendectomy

PENG Zhongyan, PENG min, CAO Hongmei, CHEN Yuyan

2023, 11(3):  72. 

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Objective To study the effect of targeted nursing on elderly patients after laparoscopic appendectomy (LA). Method 72 elderly patients with LA acute appendicitis admitted from January 2020 to January 2022 were randomly divided into study group (36 cases) and control group (36 cases); The control group received routine nursing and the study group received targeted nursing; The levels of coagulation function indexes [fibrinogen (FIB), D-Dimer (D-D)] and the scores of quality of life were compared between the two groups before and after the intervention. Result Before the intervention, there was no significant difference in the level of coagulation function and the score of quality of life between the two groups (P ＞ 0.05); Compared with before the intervention, the level of coagulation function index was lower and the score of quality of life was higher in the two groups after the intervention (P ＜ 0.05); After the intervention, the level of coagulation function index and thrombosis rate in the study group were lower than those in the control group, and the score of quality of life and satisfaction were higher (P ＜ 0.05). Conclusion The application of targeted nursing in elderly patients with acute appendicitis can effectively improve the coagulation function and prevent lower extremity deep venous thrombosis, as well as improve their quality of life and satisfaction.