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将会持续更新~
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远侧胃切除术
适应症
全身状态
局部状态 无远隔转移;癌肿位于胃下部、胃下部癌侵及胃中部者或者胃中部小的限局性癌;病情限于早期与进展期胃癌的第II、第III期病例;淋巴结转移范围在第III站以内。
术式选择
早期癌,癌底浆膜完全正常者,可行D1(清除第I站加No7或No7与No8淋巴结)手术。早期癌,癌底浆膜呈反应型者,应行D2手术。对可行根治术的进行期癌,多行D2+手术,或行D3手术。
手术步骤
1.切口
2.探查 首先探查Douglas窝有无转移癌结节,腹主动脉周围有无肿大淋巴结。其次,探查脾门、胰尾区及肠系膜根部有无癌浸润和淋巴结转移,用左手探查肝脏有无转移结节。最后仔细检查癌肿,确定:
www.symbian-guru.com/welcome/2009/02/how-to-use-s60-in-the-medical-field.html
How To Use S60 In The Medical Field
By Dotsisx on February 11th, 2009
Frequent readers of the Symbian-Guru blog know that I have been involved in the medical field for over 5 years now, being a recently graduated pharmacist and having just now become a medical science researcher. As a matter of fact, it is this involvement in the medical field that sealed my commitment towards S60 in the first place, when I discovered that I could have medical ebooks on my device and use them as a reference everywhere I go, instead of carrying dozens of heavy books. This goes in tandem with our deep belief here on Symbian-Guru that a mobile should enhance your everyday life and not complicate it or overshadow it.
Throughout the years, I have tried to find guides, applications, hints as to how to enhance my medical experience on S60, but always stumbled on Palm or Windows Mobile guides. There are ZERO guides for S60, well, as far as I (and Google search) know. So I decided to put together a list of tips to use for those of you who are in the medical field and carry S60 devices from Nokia or Samsung or LG (Nokia N95, N81, N82, N96, N79, N85, E71, E66, E90, 6210, 6220, 6110, 6120, 5800XM, Samsung Innov8,… and others as well).
The Free Solutions
Mobireader and free ebooks
Mobireader has been my battle sword for everything medical on my phone from my very first S60 days. I have already previewed it here on Symbian-Guru, and I can’t emphasize on how much useful this ebook reader has been. You can download the S60 version from their site or directly from your mobile by going to http://m.mobireader.com. After downloading the reader and installing it on your handset, you can google around to find free medical ebooks. I have done my fair share of searching and I can say without a doubt that I have found 3 awesome sources.
The first one is NCBI with 6 mobipocket ebooks. My personal favorites amongst these are Clinical Medicine which resembles a bit the Harrison’s in the way it is presented, as well as Medical Microbiology which is an absolutely awesome reference on infectious diseases and pathogens.
The second one is an eMedicine series of references. I downloaded these a long time ago and I can’t seem to remember where I got them. The zip file includes 16 mobipocket ebooks about different medical fields (critical care, nephrology, oncology, allergy and immunology, dermatology, transplantation, general surgery… to name a few).
The third one is Clinical Approaches (you have to register on their site to be able to download the ebook). It’s a reference of symptoms and clinical states, with the causes, the approach, the drugs to use,… for each of them. It’s a pretty neat and bulleted list of practical advices for medical students.
One last thing worth mentioning is that the free online dictionary, WordNet, was converted to the mobipocket format which you can download here. It’s not a medical dictionary per se, but it does contain a lot of basic information about medical terms, which might turn out to be highly useful, and is the next best thing to a medical dictionary. The best part is that you can use WordNet as the lookup reference inside Mobipocket.
Mobile-Optimized websites
The first website that you would want to bookmark on your S60 browser is Wapedia. I have reviewed Wapedia before but I think I haven’t mentioned enough how much I love it. It’s easily the best way to access Wikipedia (and we all know how much medical information is on there) on your mobile phone and offers the full Wikipedia experience in a mobile friendly format, with images, tables and tons of settings. Simply go to http://wapedia.mobi and choose your language. Worth noting is the fact that you can view Wapedia in different languages, and you can bookmark each one seperately. Personally, I have the Wapedia french and english pages bookmarked.
The second wesbite you’ll want to add is the National Library of Medicine mobile. The site contains links to search none other than THE reference for medical publications, PubMed, in several ways: direct search, journal abstracts, PICO, natural language search, and symptom and disease association search. The search results are presented with the article’s title, authors, journal, PubMed ID, as well as links to the abstract, the full text and related articles. Free articles will also open in a mobile friendly page, with images, tables, links, and everything working just fine. My only caveat is that there is no way to know whether an article is free or not before waiting for its page to load.
Then there are 2 other ways to search PubMed, with quirks. The first one, Pubget (http://pubget.com/mobile) allows you to restrict your Pubmed searches by title and abstract, author, or even the articles from the latest issues of journals. Also, if the article is free, it won’t open it, but instantly download it to your phone, which is more than just awesome. The second one is Unbound Medline (http://www.unboundmedicine.com/medline/ebm) which will give you the same format of results as PubMed mobile, but adds the Full Citation link for each article, allowing you to check the credentials and abstract before opening the article. The best part is that it will only give you the Publisher Full Text link if the article is free, otherwise, you’re left with the abstract.
Another site you might want to add to your bookmarks is Epocrates (http://m.epocrates.com/iphone) which won’t work that well on the S60 Browser, but will work very nicely in Opera Mini.
Of course, when none of these work, you still have Google Search and you can always try to find what you’re looking for on it.
RSS Feeds
There are tons of medical-related RSS feeds that you might want to try, but I stumbled upon one of the best sources for them. If you go to BioMed Central’s list of Journals, you will see a long list of journals, most of which are Open Access (free full articles). The journals don’t have incredibly high Impact Factors, but they are a good way to stay updated with the news in the medical field of your choice. Simply open the Journals that you’re interested in, and look for the orange RSS icon next to the “Latest Articles Published in…” section. Add it to your RSS reader of choice (a personal preference goes to Google Reader on the computer and its iPhone mobile version). The RSS feed doesn’t include the full article, but it does include the title, abstract and authors. By simply opening it, you will get a link to download the full article as a PDF.
Podcasts
I am not a big fan of podcasts, but I know as a matter of fact that there are a lot of medical podcasts that you could download and listen to on your S60 device. My advice would be to look for them in the iTunes library then input their feed address into your S60 Podcasting application.
The Paid Solutions
Mobireader and paid ebooks
Although Mobireader is free, the Mobipocket site offers a huge library of paid ebooks, with one section dedicated to medical ebooks. These range from the silly cheap ebooks to the unbelievably expensive ones, but you can find just about anything there for your specialty. Mobipocket ebooks are DRM’ed and can be installed on any 4 devices at the same time, which isn’t half bad. Personally, I have purchased 7 ebooks of which my 3 favorites are dictionary-like:
A2Z drug Facts: an awesome drug reference.
ADR: although it stands for Arab Drug Reference, it’s a cheap alternative to A2Z and offers a lot more trade names, especially European and Arab ones, compared to the US-centric A2Z. Also I find that it has more details in the pharmacology sections.
Taber’s Cyclopedic Medical Dictionary: THE medical dictionary to have, bar none.
iSilo
iSilo is another ebook reader for S60 which reads ebooks in .pdb format. It’s available for purchase for around 20$, but you can still run it in Free Mode (with lots of limitations). The good part is that if you do some search, you will find tons of free medical ebooks in .pdb format compared to free Mobireader ebooks. A good place to start is MemoWare (look for ebooks in iSilo 3 format).
Skyscape
Skyscape are very well known in the medical field and they started offering their applications probably a year ago for S60. Their whole portfolio isn’t available for S60, but a great percentage of it is.
StyleTap and Palm apps
Another alternative to get medical applications on S60 would be to buy StyleTap, which I already previewed in beta and was later released. StyleTap would allow you to run Palm OS applications on your S60 device, and you can easily find medical (freeware and shareware) applications for Palm to run using Styletap.
In Conclusion
As you see, the possibilities are very numerous when it comes to accessing medical information on your S60 devices, especially when you have an open platform that allows you to run any kind of application, and a powerful browser to search for anything that isn’t available in those applications. I hope that this tutorial will help those who are still wondering how to get medical applications and information on their mobile device.
Are you in the medical field, or do you know someone who is? Do you use your mobile for medical information, and do you know any other tip about getting medical information on S60?
同样的 这些变通的方法与手段在blackberry上也是适用的
虽然在palm上有很多医学软件
但是这些软件只不过是我们的工具而已
真正要理解 运用 还是要靠我们的思考
平台与工具容易成为我们思考的陷阱
胃的胚胎期发生及其系膜韧带的演变形成
手术中如能逆胚胎过程寻得系膜、筋膜、网膜的层次间隙进行分离操作,则有利于真正做到“整块”(en-bloc)切除,而且损伤甚少,几无出血。胃周主要血管皆应在根部结扎、切断,做到网膜囊外根治切除术。
胚胎期胃腹侧系膜前部链接肝与膈肌,腹前壁和脐之间的连接部分,形成镰状韧带。后部连接肝到胃小弯及十二指肠首段,形成肝十二指肠韧带(内含肝蒂)与小网膜。
胃背侧系膜上半与膈肌连接形成胃膈韧带。脾门与胃上部与大弯间链接,形成胃脾韧带(内含胃短动、静脉)。自脾门向后链接于胃后壁者为脾肾韧带。背侧系膜尾段,其前层从胃大弯向下悬垂,后层与横结肠系膜、及横结肠融合。继续从横结肠向下悬垂与前层移行,构成大网膜。初生期,大网膜前、后叶之间尚有间隙,成人期则大部分融合、闭塞。但此融合紧密处在横结肠以下。
Toldt胰后筋膜 此筋膜位于胰体、尾后面。是由胃背侧系膜和脾向左移位,塌陷过程中覆盖在左肾、左肾上腺表面的部分,于胰体、尾后面与腹后壁腹膜融合形成的。
Treitz胰后筋膜 是胰头、十二指肠向右侧移行、塌陷,与腹后壁腹膜融合形成的。
胃癌根治手术的基本原则
经路捷近 切口开阔
尽早阻断癌肿的血行与淋巴流
避免对癌肿的机械性刺激
广范围的切除胃
系统的、彻底的清除胃周淋巴结
胃癌手术前检查与准备工作
不仅要做出胃癌定性的诊断,还要求做出定量的诊断。在此基础上判断癌肿的类型,决定手术适应症,设计手术方式。
癌肿的质和量检查:
胃镜检查。
放射线检查。
体检:仔细触诊左锁骨上区有无肿大、变硬的圆形淋巴结。肝脏是否肿大。直肠指检膀胱直肠窝有无肿块、硬结或者变硬。对生育期女病人进行阴道内诊,检查双侧卵巢是否肿大,子宫颈有无糜烂、出血、变硬,进而涂片找癌细胞。
B超检查。
钡剂灌肠。
CT检查以及血管造影。
全身状态的检查与处理:
1.一般检查
2.需要矫正的项目
改善贫血或低蛋白血症 纠正脱水及电解质紊乱 控制糖尿病 高血压、心率不齐及心脏功能欠佳 慢性肺疾病的治疗 联合脏器切除病例需做特殊准备
手术前一日的检查与处理
手术前一日上午,参加手术组的全体医师再次集体审核诊断是否确定,估计癌肿进展程度,有无远隔转移,扩散 ,是否为手术适应症,有无反手术指征。审核全身各项检查是否齐全,是否合乎手术要求,是否有误。预定手术方案,麻醉方法等事宜。这样可以补充准备的不足,最后统一确定治疗意见。
from《头颈部肿瘤放射治疗学》ISBN 781060260
在放射治疗(放疗)过程中,射线在杀伤肿瘤组织的同时,也会对正常组织产生影响,会产生放疗反应,严重时会发生放疗并发症。正常组织的放疗反应是恶性肿瘤放疗过程中必定要产生的,尽管程度不同,但经过一段时间后都可以部分或全部恢复;而多数的并发症常是不可逆转的,需要外科治疗或者会导致死亡,对这两者必须加以区分。
头颈部肿瘤根治性放疗时不良反应相对常见,且有时是不可避免的。
一、皮肤和黏膜反应
皮肤和黏膜的放疗不良反应很明显。在急性期皮肤表现为红斑反应,随剂量增加而加重,并相继出现色素沉着、脱毛和脱皮,剂量足够大时可出现湿性脱皮。随着兆伏级放疗的出现,即使对上皮肿瘤给予根治性放疗剂量,湿性脱皮也已很难见到。在喉和口咽癌的放疗中,6-7周给予60-70Gy剂量的60Co放疗后,颈部的放射性红斑并不少见。持久的毛发脱落常发生在湿性脱皮之后。放疗40-50Gy后就会出现暂时的脱发,毛发的再生可能是稀疏的。
应用解剖
由于胃癌手术学的发展和提高,外科医师只掌握传统的解剖学知识已嫌不足,必须对胃以及周围组织和脏器有较深入的了解,和相关的胚胎学与解剖学知识。
基于胃癌淋巴结扩散的规律,把胃分为三个部分,即将胃大弯和胃小弯各等分为三分,连接其对应点。三部分分别称为上部(C),中部(M)和下部(A)。从胃的横断面看,分为小弯(小),大弯(大),前壁(前),后壁(后)及全周(周)。
陈俊青 夏志平主编
人民卫生出版社 1997
ISBN 7-117-02854-8
下载地址:http://www.rayfile.com/files/7abeb245-ec72-11dd-8ca2-0019d11a795f/
超星的图书使用BooX Viewer阅读 下载地址:http://www.onlinedown.net/soft/37459.htm
用了一个wap插件 然后在黑莓的手机上打字 发表文章 方便