咽喉反流对会厌囊肿的影响分析

目的 探讨咽喉反流对会厌囊肿的影响。方法 回顾性研究。纳入2020年11月—2021年5月蚌埠医学院第一附属医院耳鼻咽喉科头颈外科电子喉镜检查的170例患者的临床资料。其中,会厌囊肿患者79例（会厌囊肿组）,男29例、女50例,年龄（50±12）岁;会厌正常者91例（对照组）,男40名、女51名,年龄（47±10）岁。咽喉反流的判定采用反流症状指数（RSI）量表、反流体征评分（RFS）量表（RSI>13分和/或RFS>7分）。将性别、年龄、吸烟、饮酒、咽喉反流、辛辣饮食、职业暴露纳入单因素分析,分析会厌囊肿的影响因素;多因素采用logistic回归分析。结果 会厌囊肿组患者中存在咽喉反流38例（48.10%,38/79）,对照组中存在咽喉反流19例（20.88%,19/91）。单因素分析显示,咽喉反流、吸烟、辛辣饮食、职业暴露是会厌囊肿的影响因素,差异均有统计学意义（χ²=14.06、8.89、9.83、9.60,P值均<0.05）。进一步多因素logistic回归分析显示,咽喉反流（优势比=2.307,95%可信区间：1.104~4.820）及辛辣饮食（优势比=2.414,95%可信区间：1.241~4.698）为会厌囊肿的独立危险因素。结论 咽喉反流和辛辣饮食是会厌囊肿的独立危险因素。为预防会厌囊肿的发生,应积极治疗咽喉反流。     

支撑喉镜下环咽肌形态与咽喉反流关系的临床研究

目的 探讨显微喉手术中支撑喉镜下环咽肌呈现出的形态与咽喉反流症状间有无关联。方法 连续采集2013年8月—2014年10月海军总医院耳鼻咽喉头颈外科行显微喉手术治疗的147例患者的相关资料进行横断面研究,其中男96例、女51例,年龄15~71岁(中位年龄47岁)。根据反流症状指数量表(RSI)和反流体征量表(RFS)评分并分为2组:同时满足RSI>13分和RFS>7分者58例为反流组,其余89例为非反流组。在支撑喉镜下喉部手术结束时,将喉镜插入环后,暴露环咽肌,观察并按分型记录患者环咽肌形态,采用χ²检验进行组间比较。结果 147例患者中,3例环咽肌未暴露,其中反流组1例、非反流组2例;其余144例患者环咽肌暴露良好,反流组环咽肌暴露良好的57例中,半槛型36例(63.16%)、全槛型12例(21.05%)、平坦型9例(15.79%);非反流组环咽肌暴露良好的87例中,半槛型63例(72.42%)、全槛型11例(12.64%)、平坦型13例(14.94%)。两组患者环咽肌的形态差异无统计学意义(χ² =1.970, P>0.05)。结论 显微喉手术中支撑喉镜下观察环咽肌呈现出的形态与咽喉反流无关。     

幽门螺杆菌在胃食管反流病发病中的作用

目的 探讨幽门螺杆菌（Hp）在胃食管反流病（GERD）发病中的作用,为临床诊治GERD提供参考。方法 选取2016年 2月~2018年12月我院收治的胃食管反流病患者85例,设为GERD组,另选同期我院体检健康者30人为对照组,14C呼气试验法进行Hp检测,比较两组Hp感染阳性率、GERD不同症状程度者Hp感染阳性率以及反流性食管炎（RE）不同程度者Hp感染阳性率。结果 GERD组Hp感染阳性率（54.12%）高于对照组（46.67%）,差异无统计学意义（P＞0.05）;GERD轻度症状组、中度症状组、重度症状组及极重度症状组Hp感染阳性率分别为55.00%、52.00%、54.55%、55.56%,组间比较,差异无统计学意义（P＞0.05）;RE患者LA-A组、LA-B组、LA-C组及LA-D组Hp感染阳性率分别是57.14%、55.56%、47.06%、46.15%,组间比较差异无统计学意义（P＞0.05）。结论 幽门螺杆菌感染在胃食管反流病发生和发展过程中可能无相关性,但对于Hp阳性的GERD患者也应根据实际情况实施根除Hp治疗,以减少恶变几率。     

幽门螺旋杆菌感染对反流性食管炎发病和治疗的影响

目的探讨幽门螺旋杆菌（HP）感染对反流性食管炎（RE）发病和治疗的影响。方法收集西安市中心医院2011年6月至2013年6月的门诊病人642例，记录其性别、年龄、体重、反流性食管炎分级及HP感染严重程度。结果RE组HP（＋）感染率明显高于HP（-），差异有统计学意义（P〈0．05），而非RE组HP（＋）感染率与HP（-）间无明显差异（P〉0．05）。b组（C—D级）患者HP感染（＋＋／＋＋＋）明显高于a组（A—B级），差异有统计学意义（P〈0．05）。A组（HP根除＋PPI）与B组（PPI）GERD—Q评分、心理SF-36评分和生理SF-36评分相比无明显差异（P〉0．05）。结论HP感染与反流性食管炎的发病可能存在一定的关联，根除HP未能明显改善反流性食管炎的预后。     

氟哌噻吨美利曲辛联合兰索拉唑对咽喉反流伴焦虑(抑郁)患者的疗效

目的:分析氟哌噻吨美利曲辛联合兰索拉唑治疗咽喉反流伴焦虑(抑郁)患者临床疗效。方法:选取我院2015年6月-2017年6月耳鼻喉科收治的150例咽喉反流伴焦虑(抑郁)患者,随机分为联合组(75例)和对照组(75例)。对照组给予兰索拉唑,联合组加用氟哌噻吨美利曲辛治疗。比较两组患者焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、RSI评分、胃蛋白酶浓度及临床疗效。结果:治疗后,联合组SAS评分(t=9.147,P0.001)、SDS评分(t=9.714,P0.001)显著低于对照组,联合组咽异物感(t=3.154,P0.05)、清嗓(t=3.129,P0.05)、吞咽困难(t=2.705,P0.05)、慢性咳嗽(t=2.292,P0.05)、呼吸困难(t=3.220,P0.05)等症状评分显著低于对照组,联合组胃蛋白酶浓度(t=2.887,P0.05)显著低于对照组,联合组治疗总有效率(χ~2=5.374,P0.05)显著高于对照组。结论:氟哌噻吨美利曲辛联合兰索拉唑能够有效缓解咽喉反流伴焦虑(抑郁)患者焦虑(抑郁)情绪,临床疗效显著。     

双源螺旋CT对非缺血性二尖瓣反流机制的研究

目的运用双源螺旋CT（DSCT）探寻非缺血性二尖瓣反流的反流机制。方法超声诊断为二尖瓣反流并行CT俭查的46例患者．其中男性28例,女性18例;年龄37～81岁,平均年龄63．57岁。二尖瓣反流组依据多普勒超声检查分为轻度反流组（20例）、中度反流组（14例）、重度反流组（12例）。分别在cT图像上测量收缩中期幕状面积、幕状高度、二尖瓣瓣环前后径、联合间距离等二尖瓣装置形态参数。另随机选择无二尖瓣反流的体检者43例作为止常埘照组．．结果小同程度二尖瓣反流组在幕状面积、幕状高度、瓣环前后径、收缩中期和舒张末期瓣环面积较正常对照组差异有统计学意义（P〈O．05）。而瓣环联合间径差异无统计学意义（P〉0．05）。不同程度二尖瓣反流组在舒张期左心室短轴长度、球形度．收缩期左心室长径、舒张末期容积（EDV）、收缩末期容积（ESV）差异有统计学意义（P〈0．05）,、乳头肌间距变化度、左心事长径位移度组间差异均无统计学意义（P〉0．05）。结论DSCT功能检查对二尖瓣反流机制研究有重要价值,、非缺血性二尖瓣反流乃因心室-瓣膜环受过重前负荷而扩张．导致前外侧乳头肌腱索对前叶体部的过度牵拉．致使精确闭合的双侧瓣叶产毕前叶的云云h不对称导计对合而稠的减少,产生反流。     

改善行为方式对胃食管反流病的治疗作用

目的探究行为方式的改善对胃食管反流病的治疗作用。方法入选102例胃食管反流病患者随机分为两组,其中对照组（51例）予以常规药物治疗,研究组（51例）在药物治疗的基础上加用行为方式的干预。治疗8周后,分析比较两组患者的相关临床资料。结果治疗8周后,研究组患者在反酸、胸骨后疼痛、烧心、食管反流、嗳气、吞咽不适等症状方面有显著的改善（P〈0.05）,内镜下分级情况也有显著的改善,并且与对照组相比较,效果更明显（P〈0.05）。对照组的总有效率为78.53%,研究组的总有效率为94.12%,两组之间具有统计学差异（P〈0.05）。结论行为方式的改善对胃食管反流病具有显著的治疗效果,既经济又简单易行。     

不同认知功能障碍程度阿尔茨海默病患者海马、内嗅皮层体积变化及其与MMSE评分的关系

目的 探讨不同认知功能障碍程度的患者阿尔兹海默病（AD）海马、内嗅皮层体积的变化,及其与简易精神状态检查表（MMSE）评分的相关性。方法 横断面研究。纳入2017年9月—2021年9月联保部队第九六〇医院淄博院区86例AD患者临床和影像学资料,其中男54例、女32例,年龄55~87（73.9±8.1）岁。根据临床痴呆评定量表（CDR）评分将86例患者分为3组,其中36例CDR评分0.5分患者为轻度认知障碍（MCI）组,21例1分患者为轻度AD组,29例2~3分患者为中重度AD组。患者均应用MRI测量双侧海马体积、内嗅皮层体积,采用MMSE评分评估患者认知功能。观察指标：（1）比较3组患者性别、年龄、受教育年限等临床基线资料,以及MMSE评分;（2）比较3组患者海马体积和内嗅皮层体积;（3）分析AD患者MMSE评分与海马、内嗅皮层体积的相关性。结果 （1）3组患者性别、年龄、受教育年限等临床基线资料比较差异均无统计学意义（P值均>0.05）。MCI组、轻度AD组、中重度AD组患者MMSE评分依次降低,差异有统计学意义（F=113.29,P<0.001）。（2）MCI组、轻度AD组、中重度AD组左右侧海马体积MRI测量值分别为（3.24±0.32）cm³和（3.22±0.31）cm³、（2.72±0.53）cm³和（2.84±0.56）cm³、（2.31±0.55）cm³和（2.46±0.54）cm³,左右侧内嗅皮层体积分别为（1.42±0.26）cm³和（1.39±0.27）cm³、（1.28±0.24）cm³和（1.24±0.25）cm³、（1.04±0.31）cm³和（1.06±0.34）cm³。3组患者左右侧海马体积、内嗅皮层体积MRI测量值比较,均为MCI组>轻度AD组>中重度AD组,差异均有统计学意义（P值均<0.05）。（3）86例AD患者MMSE评分10~27（20.9±5.2）分,与左右两侧海马体积、内嗅皮层体积MRI测量值均呈正相关（r=0.82、0.81、0.73、0.72,P值均<0.001）。结论 随着认知功能障碍程度的加重,AD患者海马、内嗅皮层体积MRI测量值逐渐减小,且MMSE评分与海马、内嗅皮层体积存在相关性。     

265例胃内胆汁反流现象相关因素分析

目的分析胃内胆汁反流现象的相关因素，提供有助于胆汁反流性胃炎诊断的，临床依据。方法对我院近5年来胃镜检查时265例有黏液湖黄染和黏膜有胆汁斑块附着、且无胃手术史的患者和无胆汁反流慢性胃炎248例患者进行临床表现、内镜诊断和病理组织学改变及快速尿素酶试验结果对比进行总结，分析其相关因素及临床表现特点。结果黏液湖黄染和黏膜黄染者多见于30～60岁的慢性胃炎患者，其它多见球部溃疡，快速尿素酶试验阳性者占23．3％，病理组织学改变见胃小凹增生者极少。临床表现以上腹饱胀、进食胀痛多见，但无特异性表现。结论胆汁反流是慢性胃炎时内镜下多见的一种表现，也是慢性胃炎和消化性溃疡发病机制中重要的损害因素。Hp感染和胆汁反流对胃黏膜的损害是两个独立因素。     

MRI在椎间孔镜腰椎间盘切除术治疗腰椎间盘突出症疗效评价中的应用

目的 探讨MRI在椎间孔镜腰椎间盘切除术治疗腰椎间盘突出症疗效评价中的应用价值。方法 回顾性研究。纳入2018年2月—2020年9月北京积水潭医院收治的500例腰椎间盘突出症患者的临床资料。其中男343例,女157例;年龄25~70（50.6±10.4）岁;均为单节段椎间盘突出,L_4/5273例、L₅/S₁227例。患者均行椎间孔镜术治疗。分别于手术前和手术后1、6个月行MR检查。观察指标：（1）评估手术疗效,比较术前和术后1、6个月患者的疼痛视觉模拟评分法（VAS）评分、日本骨科协会（JOA）评分;（2）测量术前和术后不同时间的椎间盘还纳值、硬膜外压痕纵轴值;（3）观察术前和术后不同时间椎间孔、侧隐窝的狭窄发生率,计算手术后不同时间患者椎间隙高度率的变化;（4）分析术后1个月硬膜外压痕纵轴值与患者疼痛VAS评分、JOA评分的相关性。结果 500例患者均顺利完成手术,术后随访1~6个月。患者术后症状均得到缓解。（1）患者术后1、6个月的VAS评分分别为（4.81±0.94）和（2.50±0.65）分,均低于手术前的（7.14±1.48）分;JOA评分分别为（20.64±3.26）和（27.03±2.45）分,均高于术前的（16.06±2.31）分,差异均有统计学意义（F=4.62、P=0.010;F=4.15、P=0.016）。（2）患者术后1、6个月的硬膜外压痕纵轴值分别为（6.37±2.47）、（6.37±2.65）mm,均低于术前的（8.45±3.21）mm,差异有统计学意义（F=92.34,P<0.001）;术后1、6个月的椎间盘还纳值分别为（5.25±2.06）、（5.30±2.34）mm,差异无统计学意义（t=0.36,P=0.720）。（3）术后1、6个月患者的椎间孔狭窄发生率分别为11.2%（56/500）、3%（15/500）,侧隐窝狭窄发生率分别为6.2%（31/500）、1%（5/500）,均低于术前的48.2%（241/500）和20.4%（102/500）,差异均有统计学意义（χ²=352.01、120.71,P值均<0.001）。术后1、6个月患者的椎间隙高度比较,差异无统计学意义（t=1.57、P=0.116）。（4）术后1个月硬膜外压痕纵轴值与患者VAS评分呈正相关（r=0.73,P=0.015）,与JOA评分呈负相关（r=-0.68,P=0.023）。结论 MRI可作为评估椎间孔镜治疗腰椎间盘突出症疗效的有效影像学方式。     

Activation of brain stem neurons by irritant chemical stimulation of the throat assessed by c-fos immunohistochemistry

The method of c-fos immunohistochemistry was used to identify the brain stem distribution of neurons activated following irritant chemical stimulation of the laryngopharyngeal mucosa. In pentobarbital-anesthetized rats, either water (control), nicotine (600 mM, 1 ml) or capsaicin (330 μM, 1 ml) was applied to the pharynx via a cannula placed posterior to the soft palate. Following nicotine and capsaicin, there was a significant increase in fos-like immunoreactivity (FLI) compared with controls in the following areas: nucleus of the solitary tract from the level of the pyramidal decussation caudally to the level of the area postrema rostrally; dorsomedial aspect of trigeminal subnucleus caudalis (Vc); and paratrigeminal islands interspersed in the spinal trigeminal tract. There was significantly more FLI in Vc and paratrigeminal nuclei following capsaicin than following nicotine, while the reverse was true for NTS. In addition, there was a significant increase in FLI in area postrema and the ventrolateral medullary region dorsal to the lateral reticular nucleus following nicotine but not capsaicin. The distributions of FLI in NTS, area postrema, Vc, and paratrigeminal nuclei are consistent with prior anatomical tract-tracing studies and suggest roles for these brain stem regions in mediating sensory and reflex responses to irritant chemical stimulation of the upper respiratory mucosa. Electronic Publication     

Differences in Clinical Characteristics between Patients with Non-Erosive Reflux Disease and Erosive Esophagitis in Korea

Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.     

胃腔食管化手术在返流性食管炎治疗中的应用

目的:探寻胃腔食管化手术防治返流性食管炎的疗效.方法:选择中下段食管癌、食管裂孔疝病人共40例,随机分为A、B两组,每组20例.在外科治疗原发病的基础上,A组采用胃腔食管化术式、B组采用传统手术方式行抗返流治疗.观察两组病人的临床疗效(包括问卷调查、内窥镜检查、食管粘膜病理学检查)并进行比较.结果:两组病人均顺利完成手术,无手术死亡,无吻合口瘘.随访0.5～3 a,A组有返流性食管炎临床症状1例(5%),胃镜检查证实有食管粘膜糜烂1例(5%);B组有返流性食管炎的临床症状7例(35%),胃镜检查有食管糜烂4例(22%),食管下段粘膜溃疡2例(11%),食管裂孔疝复发1例(5%);两组比较差异有统计学意义(P＜0.05).结论:胃腔食管化术式用于部分外科疾病所引起的返流性食管炎的预防和治疗,其效果好,操作简单,安全可靠.     

Urodynamic and Histological Changes in a Sterile Rabbit Vesicoureteral Reflux Model

This study aimed to investigate pressure changes of renal pelvis and histological change of kidneys in a surgically induced sterile rabbit vesicoureteral reflux (VUR) model. Five rabbits served as a control group, 7 as the sham-operated group, and 8 served as the VUR group. Three weeks later, urodynamic studies were performed, and histological examinations evaluated degree of inflammation, fibrosis, and tubular damage in the kidneys. At a low infusion rate, renal pelvic pressure in the VUR group was stable until late filling phase and then increased slightly. At a high infusion rate, the renal pelvic pressures of the sham-operated and control groups were stable until late filling phase and then increased slightly, whereas the renal pelvic pressure in the VUR group steadily increased from mid filling phase. Focal thinning of the tubular epithelium and interstitial widening were observed in certain cortical areas of refluxing kidneys, without inflammatory cell infiltration. Obvious changes in the mean diameters of distal tubules and extracellular matrix volume fractions were observed in two highly refluxing kidneys. High pressure reflux with bladder instability may result in renal cortical changes.     

Does an anatomical sphincter exist in the distal esophagus?

The presence or absence of a lower esophageal sphincter (LES) has been a matter of debate. The aim of the present study was to revisit the gastro-esophageal region in an attempt to elucidate further the presence or absence of such a structure. The distal part of the esophagus was investigated in 12 fixed and 2 fresh cadavers with the aid of a dissecting microscope. Our findings demonstrated a clear thickening of the circular muscle layer of the gastro-esophageal region in all specimens. The mean length of this muscular thickening was measured to be 3.1 cm. The thickest part of this segment was at its midsection. This midpart had a mean thickness of 5.4 mm. The thickness of the esophagus immediately superior to the sphincter had a mean of 2.7 mm. We believe that the findings of the present study strongly suggest the presence of an internal esophageal sphincter in the distal esophagus. Physiologic experimentation would now be necessary to verify our morphological findings.     

Clinical Value of Persistent but Downgraded Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Injection in Children

We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 ± 0.39 per year and 0.07 ± 0.32 per year in VUR resolved children (P < 0.001), and 0.76 ± 1.18 per year and 0.20 ± 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.