RÉSUMÉ
Objective:To construct an evaluation the index system of entrustable professional activities for resident training doctors in psychiatric department,and to provide reference for formulating training strategies and assessment standards.Entrustable professional activities refers to the ability of trainees to perform and complete spe-cific clinical tasks independently after they have been trusted.Methods:Through documental analysis and semi-structured interviews,the item database of entrustable professional activities for psychiatric resident training physi-cians was established.Delphi consultation was conducted among 63 experts in the field of psychiatry from 7 national resident training bases and 3 medical colleges in China.Indicators were comprehensively screened and sorted out,and indicators at all levels and their weights were determined by the analytic hierarchy process.Results:A hierarchi-cal evaluation index system of entrustable professional activities for psychiatric resident training doctors was con-structed,including 4 first-level indicators,17 second-level indicators and 68 third-level indicators.The weights of the first-level,second-level and third-level indicators were determined.Conclusion:The evaluation index system of en-trustable professional activities is comprehensive and systematic,which is suitable for clinical work and convenient for practical application.It could provide quantitative standards for the assessment of psychiatric residents and pro-mote the improvement of training quality.
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Objective To evaluate the effect of LC+LCBDE and EST+LC in treating the cho-leeystolithiasis with choledocholithiasis. Methods The clinical data of 256 patients treated in our hos-pital were retrospectively analyzed. Of the 256 patients, 132 were treated by LC+LCBDE and 124 by EST combined with LC. The clinical data of the two groups was compared in operation success rate, operation time and cost, complication rate and operative hospital stay. Results There was no statisti-cal difference in the operation success rate, complication rate, operative hospital stay between 2 groups. However, there were significant differences in the operation time and cost between the 2 gruops. Conclusion There are respective indications, advantages and disadvantages in the two groups. EST+LC is the better choice for patients with a CBD<1.0 cm in diameter, stones impacted in the distal CBD, or old age. Otherwise, the better way is LC+LCBDE for patients with a CBD>1. 0 cm in diameter and multiple choledocholithiasis, especially in young and middle-aged people.
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Objective To understand the relationship between Hp infection and treatment role in perioperative period patients with liver cirrhosis.Methods Hp in gastric juice and ammonia concentration in blood were examined in 32 patients with liver cirrhosis.Results ⑴The rate of Hp infection was 62 1% in 32 patients with liver cirrhosis.⑵There was no obviously difference in the blood ammonia concentration between both patients with Hp positive and negative.⑶The blood ammonia concentration after Hp eradication was significantly lower than that before eradication.Conclusions Hp infection could partly contribute to occur the hyperammoniaemia in patients with liver cirrhosis.Hp should be checked routinely in perioperative period patients with liver cirrhosis.The eradication of Hp is necessary to prevent and treat the hyperammoniaemia in operative patients with liver cirrhosis.
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Objective To evaluate the effect of combined laparoscopic and endoscopic treatment for cholelith of gallbladder and common bile duct(CBD).Methods Diagnosis was established in 44 patients by ERCP , and endoscopic Oddi′s sphincteromy (EST) was performed in all patients, then choledocholith was removed by endoscopic netbasket and balloon. 3～5 days after laparoscopic cholecystectomy(LC) was carried out. Results The success rate of combined treatment in this study was 98%(43/44), and stones were removed in 100%(44/44). There was no conversion to open surgery in our series, and no severe complications. All patients were discharged in 5～15 days postoperatively. Conclusions Combined laparoscopic and endoscopic procedure is a safe and effctive method to treat patients suffering from cholelith of the gallbladder and CBD.
RÉSUMÉ
Objective To evaluate the effect of laparoscopic cholecystectomy(LC) combined with bile duct exploration and stone removal(BDE) and LC with endoscopic sphincterotomy(EST) in treating cholecystolithiasis with choledocholithiasis.Methods Among 256 cases of cholecystolithiasis and choledocholithlasis,132 patients were treated by LC+LCBDE,and 124 cases by EST combined with LC.The operation success rate,operation time and cost,complication rate,and length of hospital stay of the two groups were compared.Results There was no statistical difference in the operation success rate,complication rate,stone clearance rate,and average hospital stay between the two groups,but EST+LC group had significantly longer operation time and higher cost.Conclusions There are respective indications,advantages and disadvantages in the two groups.EST+LC is the better choice for patients with diameter of CBD1.0cm and with multiple choledocholithiasis,especially for middle-aged patients,the better way is LC+LCBDE.