内镜下套扎术联合药物治疗食管静脉曲张出血的近期疗效观察

目的探讨内镜下食管静脉曲张套扎术联合药物治疗肝硬化上消化道出血的近期疗效。方法回顾性分析2007年3月至2009年12月143例肝硬化患者行食管静脉曲张套扎术治疗的资料。结果食管静脉曲张套扎术术后联合普奈洛尔、抑酸剂、生长抑素等药物治疗,明显降低早期再出血、食管溃疡、门脉高压性胃病等发生率;肝功能C级患者再出血率明显高于A级及B级患者;肝硬化有脾切除加断流术史者与无脾切除加断流术患者比较,食管静脉曲张复发率低。结论食管静脉曲张套扎术术后联合药物治疗可降低食管静脉曲张复发、食管静脉曲张出血早期再发率,减少食管溃疡、门脉高压性胃病发生率。食管静脉曲张套扎术是治疗食管静脉曲张出血安全有效的方法,疗效确切,提高了患者生存率。     

食管静脉曲张的手术治疗

食管静脉曲张的手术治疗浙江省中医院收治门静脉高压症食管静脉曲张２０４例（其中手术治疗１９３例），病因以血吸虫病肝硬变最多见，其次为肝炎后和门脉性肝硬变。对无上消化道出血史者，采用以脾切除为主的手术。对有出血史者，行周围型门体静脉分流术或断流术，两组效...     

TH胶在经皮经肝穿刺食管胃底静脉曲张栓塞治疗中的应用

目的评价TH胶在经皮经肝穿刺食管胃底静脉曲张栓塞中的应用价值。方法肝硬化门静脉高压并食管胃底静脉曲张患者20例，其中男性14例，女性6例。年龄25-72岁，平均年龄52岁。静脉曲张程度轻度2例，中度12例．重度6例。肝功能Child-Pau小分级A级15例，B级5例。采用经皮经肝门静脉穿刺途径，用TH胶灌注填塞曲张静脉，在拔出导管鞘时用1．2mlTH胶填塞肝脏穿刺通道。结果20例患者食管胃底静脉曲张即时闭塞率100％（20／20）．肝脏穿刺通道填塞良好，未出现肝包膜严重出血。肝功能各项指标在术后3d-过性升高，术后1个月恢复正常。17例患者随访6-12个月，随访期间无食管胃底静脉破裂出血。无死亡病例。结论TH胶能即时闭塞食管胃底的曲张静脉．治疗和预防曲张静脉破裂出血．也能够即时填塞肝脏穿刺通道，防止肝包膜下出血．在门静脉高压并食管胃底静脉曲张的介入栓塞治疗中具有重要的应用价值。     

经颈静脉途径肝内门体分流术治疗门脉高压食管静脉曲张出血的临床评估

经颈静脉途径肝内门体分流术治疗门脉高压食管静脉曲张出血的临床评估北京市解放军总医院经颈静脉途经肝内门体分流术ＴＩＰＳ治疗５０例，其中４９例为肝炎后肝硬化，１例为门静脉海绵窦样变，４５例有反复呕血及黑便史，５例无上消化道出血史，均有中－重度食管静脉曲张...     

组织胶内镜注射联合套扎法治疗重度食管胃底静脉曲张

背景：作为国内临床常用的组织黏合剂,组织胶可瞬间产生聚合反应,具有生物组织固化速度快的优点,治疗食管胃底静脉曲张破裂出血具有很好的效果。 目的：探讨内镜下组织胶注射联合套扎法治疗重度食管胃底静脉曲张的近、远期临床疗效。 方法：纳入90例重度食管静脉曲张合并胃底静脉曲张患者,其中男64例,女26例,年龄22-75岁,在内镜下采用组织胶注射治疗胃静脉曲张,联合食管静脉曲张套扎治疗食管静脉曲张。治疗后2-4周内复查内镜,观察止血率、静脉曲张、曲张静脉直径、红色征、门静脉高压胃病情况等近期疗效和不良反应;曲张静脉消除后随访3-39个月,观察静脉曲张情况、组织胶排胶情况和局部增生状况、再出血、复发等中远期临床疗效及并发症。 结果与结论：①近期疗效：与治疗前比较,治疗后患者曲张静脉数目明显减少、红色征发生率降低、静脉高压性胃病好转(P均 < 0.01),但3例发生早期再出血。组织胶在治疗2周-3个月开始排出,未发生与组织胶注射治疗直接有关的食管狭窄、穿孔、严重感染、异位栓塞等并发症。②中远期疗效：静脉曲张复发9例,5例发生远期再出血。表明经内镜注射组织胶联合密集套扎法治疗重度食管胃底静脉曲张或(和)出血疗效确切,操作成功率高,止血效果好,并能有效预防远期再次出血,复发率低。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

布加氏综合征外科治疗15例报告

目的：探讨布加氏综合征4种外科治疗方法的适应证及其优缺点。方法：2002年4月～2004年2月对15例BCS患者行外科手术治疗，其中根治术5例，腔房转流术3例，肠房转流术3例，下腔静脉狭窄段球囊扩张内植支架联合脾肾分流术4例。结果：全组手术均获成功，根治术及腔房转流术后并发右心衰各1例，肠房转流术后并发顽固性腹水1例。随访时间6～24个月，15例均获满意疗效。结论：4种外科治疗方法有各自不同的适应证，合理的术式选择是取得治疗成功的关键。     

内镜下食管胃静脉曲张精准断流术疗效观察

目的:观察内镜下食管胃静脉曲张精准断流术（ESVD）的疗效。 方法:选取2017年1月至2017年8月钦州市第一人民医院收治的门脉高压食管胃静脉曲张破裂出血患者80例为研究对象,依照患者入院顺序将其分成两组,每组40例。对照组给予内镜下套扎术治疗,观察组在内镜下实施ESVD术,记录两组手术一般情况及食管胃静脉曲张改善情况,并对比两组治疗后6个月内再出血率及并发症发生率。 结果:两组患者手术一般情况比较无显著差异（P>0.05）;观察组治疗有效率为85.00%,高于对照组的55.00%（P<0.05）;术后3、6个月观察组再出血率5.00%、10.00%,明显低于对照组的30.00%、40.00%（P<0.05）;术后6个月与对照组相比,观察组患者并发症发生率偏低,但无显著差异（P>0.05）。 结论:对门脉高压食管胃静脉曲张破裂出血患者在内镜下实施ESVD术后近期疗效较好,可促进患者恢复,远期疗效有待进一步观察。     

分流手术治疗门脉高压症并发上消化道出血的研究进展

食管、胃底部静脉曲张破裂出血是门静脉高压症最常见、最严重的并发症,出血量大、死亡率高,内科治疗效果不确切,而静脉一旦破裂,就会反复出血,而每次出血必将给肝带来严重损害,因此,应争取即时外科手术治疗。但因门静脉侧支吻合丰富,故治疗方法多种多样,而分流术在其中占有重要一席,它不但可以防止再出血,而且是预防发生肝昏迷的有效措施。目前分流主要有以下五种术式:①脾肾静脉分流术;②门腔静脉分流术;③脾腔静脉分流术;④肠系膜上、下腔静脉分流术;⑤经颈内静脉肝内门体分流术(TIPSS)。它们均切实降低了门脉压力,阻止了出血,取得了良好效果。     

经皮穿肝曲张静脉栓塞术联合部分脾栓塞术治疗食管胃底静脉曲张破裂出血的临床应用

食管胃底静脉曲张破裂出血是肝硬化门静脉高压常见的并发症,来势凶猛,出血量大,病死率高,静脉套扎及硬化剂治疗效果不满意,短期出血率较高。单纯经皮穿肝曲张静脉栓塞术（percutaneoustranshe—paticvaricealembolization,PTVE）急性止血效果好,但术后复发出血率高．远期疗效不理想。为此,笔者在既往PTVE基础上．联合部分脾栓塞术治疗胃底静脉曲张破裂出血,取得了良好的治疗效果,现报道如下。     

食管下段胃近端切除、回盲肠间置术治疗门静脉高压症术后再出血

目的探讨食管下段胃近端切除,回盲肠间置术治疗门静脉高压症术后再出血的疗效。方法1998~2004年广西医科大学附属第一医院采用食管下段胃近端切除,回盲肠间置术治疗断流术术后再出血5例。结果5例均获随访,最长6年,最短2年。随访期无食管静脉曲张,无复发出血。无术后近期死亡、并发症。结论食管下段胃近端切除、回盲肠间置术治疗门静脉高压症术后再出血止血确切,是一种比较理想的手术方法。     

Mesocaval and distal splenorenal shunts: Effect on hepatic function,hepatic hemodynamics,and portal systemic encephalopathy

Summary The effect of the mesocaval interposition shunt (n=12) and the distal splenorenal shunt (n=9) on the wedged hepatic venous pressure, the estimated hepatic blood flow, quantitative hepatic function, and the rate of portal systemic encephalopathy was evaluated in 21 patients who had bled from esophageal varices. After mesocaval shunt the wedged hepatic venous pressure was significantly reduced by 42% (from 26±3 mm Hg to 15±5 mm Hg,P<0.001) compared to 16% only (from 25±3 mm Hg to 21±2 mm Hg,P<0.005) after distal splenorenal shunt. The estimated hepatic blood flow also decreased significantly after mesocaval shunt by 61% (from 1.45±0.46 l/min to 0.56±0.25 l/min,P<0.001) compared to 29% (from 1.29±0.32 l/min to 0.91±0.39 l/min,P<0.05) after distal splenorenal shunt. Despite significantly different influences of both types of shunt operations on wedged hepatic venous pressure and estimated hepatic blood flow (P<0.001), postoperative changes of hepatic function were comparable in both groups of patients. The galactose elimination capacity, the initial plasma disappearance rate of Bromsulphalein, and the plasma ratio of valine, leucine, and isoleucine to phenylalanine and tyrosine were reduced by 13%, 26%, and 29%, respectively, after mesocaval shunt, compared to 12%, 25%, and 17% after distal splenorenal shunt. Only two patients of the mesocaval shunt group with the largest decrease in estimated hepatic blood flow developed portal systemic encephalopathy postoperatively, and the distal splenorenal shunt patients with their minor hemodynamic sequelae remained free of portal systemic encephalopathy.Abbreviations AP Serum alkaline phosphatase - BSP Bromsulphalein - BSP-k_i Initial plasma disappearance rate constant of BSP - BSP-45 min Plasma retention of BSP 45 min after i.v. injection - C_a Concentration of ICG in arterial blood - C_hv Concentration of ICG in hepatic venous blood - ChE Serum cholinesterase - DSRS Distal splenorenal shunt - EHBF Estimated hepatic blood flow - E-ICG Hepatic extraction of ICG - FHVP Free hepatic venous pressure - GEC Galactose elimination capacity - GPT Serum glutamic pyruvic transaminase - HCT Hematocrit - ICG Indocyanine green - MCS Mesocaval shunt - MRUS Maximal rate of urea synthesis - NCT Number-connection test - PHG Portohepatic gradient - PSE Portal systemic encephalopathy - PT Prothrombin time - PVP Portal venous pressure - R Removal of ICG - V + L + I/P + T Molar ratio of valine + leucine + isoleucine/phenylalanine + tyrosine - WHVP Wedged hepatic venous pressure     

Surgery for variceal bleeding in cirrhosis: a review of our experience and present concepts.

The major cause of portal hypertension in Western countries is nutritional cirrhosis (parenchymal block) related to alcoholism. A third of those patients die of variceal bleeding when increased pressure within the varices precipitates bleeding. Construction of portal systemic shunts is aimed at reducing the pressure within the varices and thereby decreasing the risk of bleeding. However, it increases the incidence of hepatic encephalopathy and hence should be used only in patients who have bled. The remaining function appears to be the main factor that determines survival and the incidence of encephalopathy in obese individuals. Portacaval shunts almost completely eliminate the risk of bleeding. There is a greater incidence of hepatic encephalopathy with this procedure than with other shunts. The splenorenal shunt and the distal splenorenal shunt appear to work well in selected patients. Technically, it is a more difficult procedure. The interposition mesocaval shunt is technically easier and is also helpful in patients with ascites. Its post-shunt encephalopathy rate, however, is higher than the splenorenal shunt or the distal splenorenal shunt, though less than the portacaval shunts. Experience with the newer arterialized portacaval and coronary caval shunts is limited. A non-shunt procedure, such as the one described by Sugiura, with impressive results and follow-up may become more acceptable as experience grows.     

善宁对食管静脉曲张套扎术后再出血的防治

目的探讨善宁对食管静脉曲张套扎术后再出血的防治作用。方法82例乙型病毒性肝炎后肝硬化并食管静脉曲张随机分为套扎组（A组）和套扎＋善宁组（B组）,比较两种治疗方法对食管静脉曲张的治疗效果。结果B组的再发出血率、静脉曲张复发率及并发症发生率明显低于A组。结论套扎联合善宁是治疗肝炎后肝硬化食管静脉曲张的较为理想的方法。     

体外冲击波和经皮肾镜气压弹道对复杂性泌尿系统结石治疗中的应用分析

目的 比较经皮肾镜气压弹道碎石术与体外冲击波碎石术用于治疗复杂性泌尿系统结石的效果.方法 选取复杂性泌尿系统结石患者72例,随机组肾镜组(36例)行经皮肾镜气压弹道碎石术治疗,体外组(36例)行体外冲击波碎石术治疗,比较两组碎石成功、术中出血并发症等情况.结果 肾镜组与体外组一次碎石成功率分别为97.22％与91.67...     

子宫B-Lynch缝合技术在预防剖宫产产后出血中的应用价值

目的 研究子宫B-Lynch缝合技术治疗剖宫产产后出血的应用价值。方法 选择2015年5月~2018年3月在本院收治的行剖宫产且需行预防性止血措施的孕妇70例作为研究对象,随机分为对照组与研究组,每组35例。对照组采用传统宫腔填塞法治疗,研究组采用子宫B-Lynch缝合技术治疗,比较两组孕妇的止血效果、术后并发症发生率以及不同时间段的尿量与阴道出血量。结果 治疗后,研究组产妇不同阶段的尿量与阴道出血量均优于对照组孕产妇,差异有统计学意义（P＜0.05）。其中,研究组孕妇的临床止血总有效率与术后并发症总发生率分别为97.14%与5.72%,对照组孕妇的临床止血总有效率与术后并发症总发生率分别为74.29%与28.57%,差异有统计学意义（P＜0.05）。结论 采用子宫B-Lynch缝合技术对剖宫产孕妇进行产后出血治疗,可在有效提高临床止血疗效的同时不断减少其术中与术后阴道出血量,并且还有利于增加排尿量,在最小化术后并发症发生率的基础上为其营造良好的预后效果。     

背包式缝合技术治疗剖宫产术宫缩乏力性 产后大出血中的效果观察

目的 观察背包式缝合技术治疗剖宫产术患者宫缩乏力性产后大出血的临床效果,评价其应用价值,希望能够为宫缩乏力性产后大出血的治疗提供有效参考。方法 选择2016年4月12日~2017年4月16日我院收治173例剖宫产术患者作为研究对象,83例行常规方式治疗的患者纳入常规组,90例接受背包式缝合技术治疗的患者纳入实验组,对两组患者的术中出血量、手术时间、术后24 h出血量、术后切口感染展开分析。结果 实验组患者术中出血量、手术时间、术后24 h出血量均明显优于常规组,组间比较差异有统计学意义（P＜0.05）。常规组5例患者术后切口发生感染,发生率为6.02%;实验组2例患者术后并发切口发生感染,发生率为2.22%,组间比较差异有统计学意义（P＜0.05）。结论 采用背包式缝合技术治疗剖宫产术患者宫缩乏力性产后大出血,安全且可靠,手术时间短,能够为产妇快速止血,术后感染发生率低,值得推广应用。     

基层医院开展阴式子宫手术治疗妇科疾病的体会

目的探讨经阴道手术治疗子宫疾病在基层医院的可行性及应用价值。方法对我院2010.01~2013.12共72例子宫疾病经阴道手术治疗(单纯全子宫切除术36例,次全子宫切除术6例,子宫肌瘤剔除术18例,子宫切除加阴道壁修补术12例)进行回顾性分析,统计手术成功率、手术时间、术中出血量、术中及术后并发症。结果手术成功率98.6%,中转开腹率1.4%,手术平均时间为(78.6±28.2)min,术中出血为(128.2±36.7)ml,术中术后并发症2例(2.8%)。结论阴式子宫手术治疗妇科疾病不开腹,具备微创和安全的优点,不需要昂贵的设备,只要掌握好适应症,尤其适合基层医院开展,值得推广应用。     

多径路快速安全暴露门静脉和肠系膜上静脉在胰十二指肠切除术中的应用

目的探讨多径路快速安全暴露门静脉(PV)和肠系膜上静脉(SMV)在胰十二指肠切除术中的应用效果。方法回顾性分析我院2005年10月至2013年10月80例行胰十二指肠切除术的胰头癌患者的临床资料,根据PV/SMV暴露方法的不同分为2组,每组40例,观察组采用多径路快速安全暴露法,对照组采用传统暴露法,对比2组疗效。结果观察组手术成功率为90.0%(36/40),显著高于对照组72.5%(29/40),观察组手术时间(360.6±58.7)min和术中出血量(600.4±36.8)mL均显著低于对照组(414.2±81.3)min和(788.8±57.9)mL,观察组3年死亡率65.0%(26/40),显著低于对照组86.1%(31/36),差异均具有统计学意义(P0.05)。结论多径路快速安全暴露PV/SMV应用于胰十二指肠切除术中可提高手术成功率,缩短手术时间,减少术中出血量和术后不良反应,提高长期存活率。     

Improvement of survival rate in patients with cardiogenic shock by using nonpulsatile and pulsatile ventricular assist device.

Between January 1988 and January 1992, 65 patients (pts) had a ventricle assist device (VAD) inserted in our clinic. In 24 pts a VAD was applied because of primarily unsuccessful weaning from cardiopulmonary bypass (Group A). In a further 24 pts (Group B) a VAD was installed for the therapy of refractive cardiogenic shock (CS) after initially successful cardiac surgery (n = 21) and after acute myocardial infarction (n = 3). Twelve pts were bridged to heart transplantation (Group C) and five had a VAD inserted for various other reasons (Group D). In 36 (55.4%) of the total 65 pts a nonpulsatile VAD (Biomedicus 540) was used: 10 in Group A; 20 in B, 3 in C and 3 in D. In 29 pts (44.6%) a pulsatile VAD (Abiomed BVS 5000) was used: 14 in Group A, 4 in B, 9 in C and 2 in D. Weaning rate and long-term survival rates were 50% and 46% respectively in Group A and 38% and 42% in Group B. Seven pts from Group C were transplanted and six are long-term survivors. Two pts (40%) in Group D were discharged from hospital. Major postoperative complications were bleeding (46%), thromboembolism (14%), multiple organ failure (11%), renal failure (11%), arterial embolism (4.6%), sepsis (3%). The results indicate that application of a VAD can be recommended in pts with postcardiotomy CS to allow recovery of cardiac function and in pts with irreversible ventricular damage as bridging to HTX.