切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 376 -382. doi: 10.3877/cma.j.issn.1674-392X.2024.04.004

论著

机器人与腹腔镜食管裂孔疝修补术对比研究
刘明昊1, 李晨2, 王冰2, 万政2, 田文2,()   
  1. 1. 100853 北京,解放军医学院;100853 北京,中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科
    2. 100853 北京,中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科
  • 收稿日期:2024-07-03 出版日期:2024-08-18
  • 通信作者: 田文
  • 基金资助:
    军队保健专项课题项目(21BJZ14)

A comparative study of robotic surgery versus laparoscopic repair of hiatal hernia

Minghao Liu1, Chen Li2, Bing Wang2, Zheng Wan2, Wen Tian2,()   

  1. 1. Medicel School of Chinese PLA, Beijing 100853, China; Department of Thyroid & Hernia Surgery, Medical Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    2. Department of Thyroid & Hernia Surgery, Medical Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2024-07-03 Published:2024-08-18
  • Corresponding author: Wen Tian
引用本文:

刘明昊, 李晨, 王冰, 万政, 田文. 机器人与腹腔镜食管裂孔疝修补术对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 376-382.

Minghao Liu, Chen Li, Bing Wang, Zheng Wan, Wen Tian. A comparative study of robotic surgery versus laparoscopic repair of hiatal hernia[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(04): 376-382.

目的

探讨食管裂孔疝患者采用机器人术式与腹腔镜术式进行食管裂孔修补的疗效。

方法

回顾性分析2015年3月至2024年4月,中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科收治的食管裂孔疝患者的临床资料。共计纳入128例患者,依据手术方法的不同,分为机器人组30例,腹腔镜组98例。统计患者术前基线资料、围手术期资料及术后症状改善情况。进一步通过年龄将患者进行分组,比较不同年龄的患者通过两种术式的获益情况。

结果

与腹腔镜组相比,机器人组患者术中出血量较少(20.0 ml比35.0 ml)、术后排气时间较短(2.0 d比3.0 d)、术后住院时间较短(4.0 d比5.0 d)、术后首日疼痛数字评定量表评分较低(3.0分比4.0分),而手术时间更长(120.0 min比101.5 min)、住院总费用更高(61 564元比40 407元),以上各项差异均有统计学意义(P<0.05)。术后中位随访时间51个月,2组患者症状均较术前得到改善。在中青年患者中,与腹腔镜组相比,机器人组患者术中出血量较少、术后排气时间短、手术时间较长、住院所需费用更多(分别为20.0 ml比32.5 ml,2.0 d比3.0 d,118.5 min比100.0 min,62 200元比40 027元),差异均有统计学意义(P<0.05);而在术后住院时间及疼痛情况并无明显获益(P>0.05)。在老年患者中,机器人组术中出血相对较少、术后排气时间及住院时间更短、术后疼痛评分更低、手术时间更长及住院费用相对较高(分别为20.0 ml比35.0 ml,2.0 d比3.0 d,4.0 d比5.0 d,3.0分比4.0分;120.0 min比110.0 min和60 263元比40 749元),差异均有统计学意义(P<0.05)。中青年患者及老年患者的术后症状均较术前缓解。

结论

不论是通过腹腔镜术式还是机器人术式,食管裂孔疝患者均可从手术中获益,两者相比,机器人术式可以为老年患者带来更明显的获益。

Objective

To investigate the efficacy of robot-assisted versus laparoscopic repair for patients with hiatal hernia (HH).

Methods

A retrospective analysis was conducted on the clinical data of patients with hiatal hernia treated in the Department of Thyroid & Hernia Surgery, Medical Department of General Surgery, the First Medical Center of Chinese PLA General Hospital from March 2015 to April 2024. A total of 128 patients were included and divided into two groups based on the surgical method: the robotic group (30 cases) and the laparoscopic group (98 cases). Preoperative baseline data, perioperative data, and postoperative symptom improvement were analyzed. Patients were further stratified by age to compare the benefits of the two surgical methods across different age groups.

Results

Compared to the laparoscopic group, the robot-assisted group exhibited less intraoperative bleeding (20.0 ml vs. 35.0 ml), shorter postoperative gas evacuation (2.0 days vs. 3.0 days), shorter postoperative hospitalization time (4.0 days vs. 5.0 days), and lower pain numerical rating scale score on the first day after surgery (3.0 points vs. 4.0 points), albeit with longer operative times (120.0 min vs. 101.5 min) and higher total hospital costs (61 564 yuan vs. 40 407 yuan), the above differences were statistically significant (P<0.05), During follow-up after surgery, symptoms improved in both groups of patients compared to preoperative conditions. Additionally, among young and mid aged patients, compared to laparoscopy, those in the robotic group experienced less intraoperative bleeding and shorter postoperative gas evacuation. However, robotic surgeries had longer operative times and incurred total hospital costs, with statistically significant differences (20.0 ml vs. 32.5 ml, 2.0 days vs. 3.0 days, 118.5 min vs. 100.0 min, 62 200 yuan vs. 40 027 yuan; P<0.05). There were no significant benefits observed in terms of postoperative hospitalization time or pain scores (P>0.05). In elderly patients, robotic-assisted surgery is associated with significantly reduced intraoperative bleeding, shorter postoperative gas evacuation, postoperative hospitalization time and lower postoperative pain scores. However, it is also linked to longer operative times and relatively higher hospitalization costs, with these differences being statistically significant (20.0 ml vs. 35.0 ml, 2.0 days vs. 3.0 days, 3.0 points vs. 4.0 points, 120.0 min vs. 110.0 min, 60 263 yuan vs. 40 749 yuan; P<0.05). Postoperative symptoms improved in both middle-aged and elderly patients compared to preoperative conditions.

Conclusion

Whether through laparoscopic or robot-assisted approaches, patients with hiatal hernia can benefit from surgery, However, robotic-assisted surgery offers more significant advantages for elderly patients compared to laparoscopic techniques.

表1 2组患者术前基线资料比较
临床资料 腹腔镜组(n=98) 机器人组(n=30) Z/χ2/ t P
年龄[岁, M(Q1,Q3)] 56.5 (49.0, 63.0) 62.0 (53.3, 64.8) -1.932 0.053
性别[例(%)]     1.778 0.182
女性 45 (45.9) 9 ( 30.0)    
男性 53 (54.1) 21 ( 70.0)    
体重指数[kg/m2, M(Q1,Q3)] 25.33 (23.76, 27.55) 26.30 (24.72, 27.44) -0.667 0.505
原发性高血压[例(%)] 15 (15.3) 2 ( 6.7) 0.833 0.361
冠心病[例(%)] 9 ( 9.2) 3 ( 10.0) 0.000 1.000
有吸烟史[例(%)] 28 (28.6) 7 ( 23.3) 0.108 0.742
有饮酒史[例(%)] 14 (14.3) 5 ( 16.7) 0.001 0.978
腹部手术史[例(%)] 15 (15.3) 3 ( 10.0) 0.186 0.666
糖尿病[例(%)] 7 ( 7.1) 1 ( 3.3) 0.104 0.747
症状[例(%)]     1.290 0.256
消化道症状 77 (78.6) 27 ( 90.0)    
消化道外症状 21 (21.4) 3 ( 10.0)    
症状持续时间[例(%)]     3.892 0.143
<5年 48 (49.0) 10 ( 33.3)    
5~10年 15 (15.3) 9 ( 30.0)    
>10年 35 (35.7) 11 ( 36.7)    
近期加重[例(%)] 35 (35.7) 15 ( 50.0) 1.415 0.234
应用PPI[例(%)] 64 (65.3) 18 ( 60.0) 0.098 0.755
CT确诊[例(%)] 19 (19.4) 7 ( 23.3) 0.044 0.833
消化道造影确诊[例(%)] 37 (37.8) 9 ( 30.0) 0.310 0.577
食管测压确诊[例(%)] 58 (59.2) 16 ( 53.3) 0.127 0.721
pH测定确诊[例(%)] 62 (63.3) 21 ( 70.0) 0.209 0.647
胃镜确诊[例(%)] 69 (70.4) 17 ( 56.7) 1.393 0.238
ASA分级[例(%)]     0.524 0.469
≤Ⅱ级 93 (94.9) 30 (100.0)    
>Ⅱ级 5 ( 5.1) 0 ( 0.0)    
血红蛋白(g/L, ±s) 138.26±16.26 137.37±13.00 0.273 0.785
红细胞计数(×1012/L,±s) 4.55±0.53 4.52 ±0.31 0.316 0.752
白细胞计数[×109/L, M(Q1,Q3)] 5.52 (4.69, 6.72) 5.78 (4.92, 7.22) -0.760 0.448
血小板计数[×109/L, M(Q1,Q3)] 221.00 (199.00, 270.00) 223.00 (176.50, 250.00) -1.457 0.145
表2 2组患者围手术期及术后随访情况比较[例(%)]
表3 中青年、老年患者中不同术式的2组患者术前基线资料比较[例(%)]
基线资料 中青年 老年
腹腔镜组(n=60) 机器人组(n=10) Z/t/χ2 P 腹腔镜组(n=38) 机器人组(n=20) Z/t/χ2 P
年龄[岁, M(Q1,Q3)] 50.0(45.0, 55.0) 49.5(45.0, 53.0) -0.337 0.736 64.0(63.0, 66.5) 63.5(62.0, 66.0) -0.775 0.438
性别[例(%)]     0.583 0.445     1.908 0.167
女性 23 (38.3) 2 ( 20.0)     22 (57.9) 7 ( 35.0)    
男性 37 (61.7) 8 ( 80.0)     16 (42.1) 13 ( 65.0)    
体重指数(kg/m2,±s) 26.21±3.47 25.04±1.69 1.041 0.302 25.30±2.15 26.30±2.21 -1.668 0.101
原发性高血压[例(%)] 9 (15.0) 2 ( 20.0) 0.000 1.000 6 (15.8) 0 ( 0.0) 2.026 0.155
冠心病[例(%)] 3 ( 5.0) 2 ( 20.0) 1.086 0.297 6 (15.8) 1 ( 5.0) 0.600 0.438
有吸烟史[例(%)] 21 (35.0) 3 ( 30.0) 0.000 1.000 7 (18.4) 4 ( 20.0) 0.000 1.000
有饮酒史[例(%)] 9 (15.0) 0 ( 0.0) 0.643 0.423 5 (13.2) 5 ( 25.0) 0.592 0.442
腹部手术史[例(%)] 13 (21.7) 1 ( 10.0) 0.182 0.669 2 ( 5.3) 2 ( 10.0) 0.017 0.895
糖尿病[例(%)] 2 ( 3.3) 0 ( 0.0) 0.000 1.000 5 (13.2) 1 ( 5.0) 0.266 0.606
症状[例(%)]     2.110 0.146     0.000 1.000
消化道症状 44 (73.3) 10 (100.0)     33 (86.8) 17 ( 85.0)    
消化道外症状 16 (26.7) 0 ( 0.0)     5 (13.2) 3 ( 15.0)    
症状持续时间[例(%)]     4.815 0.090     3.425 0.180
<5年 28 (46.7) 4 ( 40.0)     20 (52.6) 6 ( 30.0)    
5~10年 12 (20.0) 5 ( 50.0)     3 ( 7.9) 4 ( 20.0)    
>10年 20 (33.3) 1 ( 10.0)     15 (39.5) 10 ( 50.0)    
近期加重[例(%)] 22 (36.7) 5 ( 50.0) 0.203 0.652 13 (34.2) 10 ( 50.0) 0.785 0.376
应用PPI[例(%)] 40 (66.7) 6 ( 60.0) 0.003 0.959 24 (63.2) 12 ( 60.0) 0.000 1.000
CT确诊[例(%)] 10 (16.7) 2 ( 20.0) 0.000 1.000 9 (23.7) 5 ( 25.0) 0.000 1.000
消化道造影确诊[例(%)] 24 (40.0) 2 ( 20.0) 0.737 0.391 13 (34.2) 7 ( 35.0) 0.000 1.000
食管测压确诊[例(%)] 33 (55.0) 2 ( 20.0) 2.917 0.088 25 (65.8) 14 ( 70.0) 0.001 0.976
pH测定确诊[例(%)] 34 (56.7) 6 ( 60.0) 0.000 1.000 28 (73.7) 15 ( 75.0) 0.000 1.000
胃镜确诊[例(%)] 44 (73.3) 7 ( 70.0) 0.000 1.000 25 (65.8) 10 ( 50.0) 0.785 0.376
ASA分级[例(%)]     0.000 1.000     0.082 0.774
≤Ⅱ级 57 (95.0) 10 (100.0)     36 (94.7) 20 (100.0)    
>Ⅱ级 3 ( 5.0) 0 ( 0.0)     2 ( 5.3) 0 ( 0.0)    
血红蛋白(g/L,±s) 140.33±15.74 131.50±15.48 1.646 0.104 134.97±16.73 140.30±10.82 -1.286 0.204
红细胞计数(×1012/L,±s) 4.64±0.53 4.47±0.29 1.010 0.316 4.41±0.51 4.54±0.33 -1.076 0.287
白细胞计数[×109/L, M(Q1,Q3)] 5.52 (4.69, 6.30) 5.78 (5.12, 6.43) -0.722 0.470 5.43 (4.84, 7.30) 5.78 (4.78, 7.54) -0.524 0.600
血小板计数[×109/L, M(Q1,Q3)] 245.00(206.00, 278.50) 225.00(179.50, 238.00) -1.654 0.098 214.00(195.00, 231.75) 223.00(179.50, 252.00) -0.049 0.961
表4 中青年、老年患者中不同手术方法的2组患者围手术期及术后随访情况比较
观察指标 中青年 老年
腹腔镜组(n=60) 机器人组(n=10) Z/χ2 P 腹腔镜组(n=38) 机器人组(n=20) Z/χ2 P
出血量[ml, M(Q1,Q3)] 32.5(30.0, 40.0) 20.0(20.0, 25.0) -4.389 <0.001 35.0(30.0, 40.0) 20.0(18.8, 25.0) -6.284 <0.001
术中输注晶体液量[ml, M(Q1,Q3)] 1500.0(1100.0, 1600.0) 1200.0(1100.0, 1500.0) -0.338 0.736 1100.0(1100.0, 1600.0) 1600.0(1100.0, 2100.0) -1.867 0.062
术中输注胶体液量[ml, M(Q1,Q3)] 500.0(0.0, 500.0) 500.0(0.0, 500.0) -0.201 0.841 0.0(0.0, 500.0) 500.0(0.0, 500.0) -1.095 0.273
手术时间[min, M(Q1,Q3)] 100.0(80.8, 103.3) 118.5(110.0, 135.0) -4.403 <0.001 110.0(100.5,110.0) 120.0(114.8,127.0) -5.108 <0.001
应用补片[例(%)] 38 (63.3) 6 (60.0) 0.000 1.000 22 (57.9) 13 ( 65.0) 0.059 0.808
术后排气时间[d, M(Q1,Q3)] 3.0 (2.0, 3.0) 2.0 (2.0, 2.0) -3.399 0.001 3.0 (3.0, 3.0) 2.0 (2.0, 3.0) -3.321 0.001
术后住院时间[d, M(Q1,Q3)] 5.0(5.0, 5.0) 5.0(4.0, 5.0) -1.807 0.071 5.0 (5.0, 7.0) 4.0 (4.0, 5.0) -4.911 <0.001
术后首日疼痛评分[分, M(Q1,Q3)] 4.0 (4.0, 4.0) 4.0 (3.3, 4.0) -0.282 0.778 4.0 (4.0, 4.0) 3.0 (2.0, 3.0) -3.728 <0.001
住院费用[元, M(Q1,Q3)] 40 027(36035, 47156) 62 200(52041, 70497) -4.977 <0.001 40 749(31568, 47156) 60 263(51543, 63483) -6.273 <0.001
术前GERD-Q评分[分, M(Q1,Q3)] 10.50(9.00, 12.00) 8.50(8.00, 10.50) -1.618 0.106 10.50(8.00, 15.00) 12.50(9.00, 14.00) -0.840 0.401
术后GERD-Q评分[分, M(Q1,Q3)] 6.00(6.00, 7.00) 6.00(6.00, 6.00) -0.580 0.562 6.00(6.00, 7.00) 6.00(6.00, 6.00) -1.129 0.259
[1]
Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the management of hiatal hernia[J]. Surg Endosc, 2013, 27(12): 4409-4428.
[2]
何岚, 郑松柏. 老年食管裂孔疝的诊治进展[J]. 老年医学与保健, 2021, 27(6): 1332-1335.
[3]
Cocco AM, Chai V, Read M, et al. Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication[J]. Surg Endosc, 2023, 37(3): 1994-2002.
[4]
Stein J, Connor S, Virgin G, et al. Anemia and iron deficiency in gastrointestinal and liver conditions[J]. World J Gastroenterol, 2016, 22(35): 7908-7925.
[5]
Liu X, Ma Q, Chen J, et al. A protocol for developing core outcome sets for laparoscopic hiatal hernia repair[J]. Trials, 2022, 23(1): 907.
[6]
Addo A, Carmichael D, Chan K, et al. Laparoscopic revision paraesophageal hernia repair: a 16-year experience at a single institution[J]. Surg Endosc, 2023, 37(1): 624-630.
[7]
田文, 郗洪庆, 卫勃, 等. 机器人辅助食管裂孔疝修补术及胃底折叠术2例报告及文献复习[J]. 中国实用外科杂志, 2015,35(5): 519-521.
[8]
Slater BJ, Dirks RC, McKinley SK, et al. SAGES guidelines for the surgical treatment of gastroesophageal reflux(GERD)[J]. Surg Endosc, 2021, 35(9): 4903-4917.
[9]
Hanly EJ, Talamini MA. Robotic abdominal surgery[J]. Am J Surg, 2004, 188(4A Suppl): 19S-26S.
[10]
Sowards KJ, Holton NF, Elliott EG, et al. Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience[J]. Surg Endosc, 2020, 34(6): 2560-2566.
[11]
Gerull WD, Cho D, Arefanian S, et al. Favorable peri-operative outcomes observed in paraesophageal hernia repair with robotic approach[J]. Surg Endosc, 2021, 35(6): 3085-3089.
[12]
Owen B, Simorov A, Siref A, et al. How does robotic anti-reflux surgery compare with traditional open and laparoscopic techniques: a cost and outcomes analysis[J]. Surg Endosc, 2014, 28(5): 1686-1690.
[13]
Ekeke CN, Vercauteren M, Baker N, et al. Surgical Techniques for Robotically-Assisted Laparoscopic Paraesophageal Hernia Repair[J]. Thorac Surg Clin, 2019, 29(4): 369-377.
[14]
Tartaglia N, Pavone G, Di Lascia A, et al. Robotic voluminous paraesophageal hernia repair: a case report and review of the literature[J]. J Med Case Rep, 2020, 14(1): 1-6.
[15]
Mendes V, Bruyere F, Escoffre JM, et al. Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries[J]. J Robot Surg, 2020, 14(1): 115-121.
[16]
Gerull WD, Cho D, Kuo I, et al. Robotic Approach to Paraesophageal Hernia Repair Results in Low Long-Term Recurrence Rate and Beneficial Patient-Centered Outcomes[J]. J Am Coll Surg, 2020, 231(5): 520-526.
[17]
Tolboom RC, Draaisma WA, Broeders IA. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study[J]. J Robot Surg, 2016, 10(1): 33-39.
[18]
Soliman BG, Nguyen DT, Chan EY, et al. Robot-assisted hiatal hernia repair demonstrates favorable short-term outcomes compared to laparoscopic hiatal hernia repair[J]. Surg Endosc, 2020, 34(6): 2495-2502.
[19]
Panse NS, Prasath V, Quinn PL, et al. Economic evaluation of robotic and laparoscopic paraesophageal hernia repair[J]. Surg Endosc, 2023, 37(9): 6806-6817.
[20]
徐徐, 刘曼, 王丹. 老年胃食管反流病治疗现状和进展[J]. 中国老年学杂志, 2023, 43(21): 5371-5375.
[21]
Luo E, Velanovich V. Hiatal Hernia Repair and Anti-Reflux Surgery in Older Patients: A Brief Communication[J]. J Gastrointest Surg, 2023, 27(12): 3043-3044.
[1] 王杰, 袁泉, 王玥琦, 乔佳君, 谭春丽, 夏仲元, 刘守尧. 溃疡油在糖尿病足溃疡治疗中的应用效果及安全性观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 480-484.
[2] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[3] 池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[4] 任传富, 杨志, 徐恩, 何梓芸, 罗板鑫, 陈新, 夏雪峰. 腹腔镜疝修补术联合胃底折叠术治疗食管裂孔疝合并胃食管反流病40 例临床分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 507-511.
[5] 李义亮, 苏拉依曼·牙库甫, 麦麦提艾力·麦麦提明, 克力木·阿不都热依木. 机器人与腹腔镜食管裂孔疝修补术联合Nissen 胃底折叠术短期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 512-517.
[6] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[7] 王小琴, 汪丽, 崔建英. 无张力疝修补术治疗慢性肾功能衰竭合并腹股沟疝患者的疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 538-542.
[8] 詹济玮, 蔡柳春, 温琼娜, 郭石生, 温春妹, 温鹤明. 布地格福联合噻托溴铵治疗AECOPD 的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 823-826.
[9] 张蕾, 彭超, 周应芳. 直肠阴道隔子宫内膜异位症腹腔镜手术技巧[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 257-261.
[10] 张宗明, 董家鸿, 何小东, 王秋生, 徐智, 刘立民, 张翀. 老年胆道外科热点问题的争议与思考[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 754-762.
[11] 梁艳娉, 列诗韵, 王艺穗, 吴晓瑛, 林颖. 基于内镜操作细节记录系统构建胃底静脉曲张内镜下组织胶注射术的标准化管理方案[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 705-709.
[12] 陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[13] 史彬, 司远. 益气和络方联合缬沙坦治疗气阴两虚兼血瘀证IgA 肾病的疗效观察[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 306-312.
[14] 韩俊岭, 王刚, 马厉英, 连颖, 徐慧. 维生素D 联合匹维溴铵治疗腹泻型肠易激综合征患者疗效及对肠道屏障功能指标的影响研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 560-564.
[15] 阳跃, 庹晓晔, 崔子豪, 欧阳四民, 林海阳, 胡景宇, 胡银, 李涛, 赵景峰, 郝岱峰, 冯光. 改良“阅读者”皮瓣修复骶尾部压疮的疗效[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 751-755.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?