Symptomatic and Clinical Improvement in Morbidly Obese Patients with Gastroesophageal Reflux Disease Following Roux-en-Y Gastric Bypass

Background: Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated. Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for this disease. Methods: One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity of their disease. Their preoperative symptoms were compared to those experienced postoperatively. Results: One hundred thirty patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy, 8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped from 43 to 30.2 kg/m². Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively. Conclusions: Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications is appropriate in selected cases.     

提上睑肌三阶梯手术矫正上睑下垂的临床应用

目的 探讨提上睑肌三阶梯手术矫正上睑下垂的适应范围及效果。方法 根据提上睑肌肌力和上睑下垂的程度，将患者分为三组。A组为提上睑肌肌力好，上睑呈轻度下垂者。单纯采用提上睑肌徙前术矫正。B组为提上睑肌有一定的肌力，上睑呈中度下垂者。在提上睑肌徙前术的基础上。行提上睑肌缩短术矫正。C组为提上睑肌肌力差，上睑呈重度下垂者。在提上睑肌徙前、缩短术的基础上行提上睑肌反折悬吊术矫正。结果 87例患者术后随访6～30个月，上睑缘位于角膜缘下1mm．眼睑弧度自然，两眼对称，眼睑闭合自如，无暴露性角膜炎及结膜脱垂等并发症，效果满意。结论 提上睑肌徙前、缩短、反折悬吊三阶梯手术，可广泛适用于矫正不同程度的上睑下垂。     

上睑下垂78例手术分析

用额肌悬吊术或提上睑肌缩短术治疗７８例上睑下垂病例，治愈７眼，基本治愈１２眼，矫正不足３眼，矫正过度２眼，笔者认为，术前分析病因；注意提上睑肌肌力的测定；采用适当的手术方法，是手术成功的关键。     

Direct imaging of the pelvic floor muscles using two-dimensional ultrasound: a comparison of women with urogenital prolapse versus controls

Objective  To evaluate the anatomy of the levator ani muscle in women with urogenital prolapse versus matched controls without prolapse using real-time two-dimensional (2-D) ultrasound.
Design  Prospective observational study.
Setting  Tertiary referral urogynaecology unit.
Population  Forty-three women with pelvic organ prolapse (POP) and 24 women (controls) attending a gynaecology clinic without prolapse.
Methods  All participants completed a standardised symptom questionnaire.
Main outcome measures  The morphology of the vagina and paravaginal tissue was recorded at different levels. The thickness of the levator ani and the hiatal area were measured at rest. Reproducibility of the method was assessed by repeated measurements to assess intra-observer variability and inter-observer variability.
Results  This method showed good intra-observer and inter-observer reproducibility and reliability. In controls, the pubococcygeus muscle showed more regular echogenicity with no evidence of trauma, whereas in women with prolapse the muscle had mixed echogenicity. ( P = 0.002). The mean thickness of the pubococcygeus did not differ between groups. The levator hiatal area was significantly larger in women with pelvic floor prolapse versus controls (17.8 cm² versus 13.5 cm², P < 0.001). This increase in hiatal area positively and significantly correlated with prolapse severity ( P < 0.001).
Conclusions  Morphology and hiatal area can be reliably imaged using 2-D ultrasound. Prolapse was related to changes in pelvic floor morphology and increased levator hiatal area. The use of 2-D ultrasound provides an important insight into the pathophysiology of prolapse.     

关于软腭下降机制的肌电图学研究

目的探讨软腭的下降机制。方法将腭舌肌、腭咽肌设定为软腭下降肌,用肌电图学的方法进行验证。结果在软腭下降时腭舌肌、腭咽肌都出现了肌活动电位,另外,腭舌肌、腭咽肌在讲话时也参与了构音运动。结论腭舌肌收缩使软腭下降、鼻咽腔开放,腭咽肌由于具有咽绞扼功能,不但可使软腭下降,还与咽腔闭锁密切相关。     

上睑下垂美容手术的解剖学设计和效果分析

目的探讨不对称性上睑下垂美容手术的设计要点以及术后美容效果。方法通过对33例不对称性上睑下垂患者术前双眼各自不同特点的分析,提出设计要点,同时对术后的美容效果进行评价。结果本组病例中美容效果优者占87.9%,良以上者占94.0%。结论双眼对称是眼部美容手术成功的关键,只有按照患者各自的解剖学特点设计手术,才能取得良好的美容效果。     

肛提肌的形态学及其功能意义和临床应用

目的：探讨肛提肌表态及其与肛直肠的解剖关系和功能,为腊肠手术预防和治疗肛门失禁提供解剖学参考资料,方法：采用经福尔马林固0定的59具小儿尸体,3例成人盆部标本在3倍放大镜下解剖对照观察,结果：肛提肌是由许多细小的带状肌束分层叠连,自然铺展而成的一整块片状肌,按肌束的层次和肌纤维方向可分上,下两层和三块肌,耻骨尾骨肌和髂骨尾骨肌较薄,位在上层,耻骨直肠肌位在下层,耻骨直肠肌根据基肌纤维方向可分为五部,即会阴体部,肌袢部,联合中纵肌部,肛门外括约肌部和会阴浅横肌部,耻骨直肠肌肌袢部和耻骨尾骨肌肌袢在肛直曲两侧和后方呈内,外重叠关系,结论：肛提肌肌束的排列形式是认识,区别肛周肌群及其相互关系的关键,耻骨直肠肌并非单一肌袢,其会阴体部,肌袢部及联合纵肌部共同牵拉作用于肛管,分别与肛管直肠前,后角的形成和维持有关,临床应用应将前列腺提取及会阴体也纳入重点保护范围内。     

解剖性保留控尿肌群技术在腹腔镜根治性前列腺切除术中的临床应用价值

目的 探讨腹腔镜前列腺癌根治术（LRP）中解剖性保留控尿肌群技术对术后早期控尿功能恢复的影响,及其肿瘤学安全性。方法 回顾性队列研究。纳入2016年1月—2020年6月浙江大学医学院附属金华医院泌尿外科采用LRP治疗的前列腺癌患者共292例,将其中采用解剖性保留控尿肌群技术的83例纳入观察组;对另外209例接受经典前列腺癌根治术的患者与观察组患者进行1∶1倾向性评分匹配,选择其中83例纳入对照组。全组共166例,年龄45~75（64.0±7.3）岁,BMI 21~31（24.4±2.4）kg/m²。对比分析2组患者手术时间、术中出血量、术后病理TNM分期、Gleason评分、术后留置导尿时间、手术并发症和手术切缘阳性（PSM）率;采用Kaplan-Meier法评估患者3年、5年无生化复发（BCR）累积生存率;根据术后每天使用的尿垫数量进行控尿功能分级评估,分别于拔除导尿管后的当天（第1个24 h）、1周及1、3、6、12个月时,观察并对比2组患者控尿功能恢复情况。结果 2组患者年龄、临床分期、危险分级、膀胱颈和神经保留与否等临床基线特征比较,差异均无统计学意义（P值均>0.05）。全组166例均在腹腔镜下完成手术,术后恢复良好,无围手术期死亡病例。2组患者手术时间、术中出血量、术后病理TNM分期、术后Gleason评分、术后留置导尿时间和手术并发症比较,差异均无统计学意义（P值均>0.05）。观察组PSM率为10.84％（9/83）,低于对照组的13.25%（11/83）,但差异无统计学意义（χ²=0.23, P=0.633）。2组患者术后随访12~71个月,平均33.73个月。随访期间无死亡病例。观察组3年、5年无BCR累积生存率分别为90.2％和73.2%,对照组分别为91.4%和77.8%,2组差异无统计学意义（χ²=0.38, P=0.535）。在拔除导尿管后当天、1周及1、3、6个月,观察组完全控尿率分别为39.76%（33/83）、53.01%（44/83）、66.27%（55/83）、90.36%（75/83）和97.95%（81/83）,对照组为16.87%（14/83）、21.96%（18/83）、38.55%（32/83）、53.01%（44/83）和68.67%（57/83）;观察组控尿功能分级均优于对照组,差异均有统计学意义（Z=-4.24、-4.09、-3.78、-5.61、-4.99,P值均<0.001）;拔管后12个月,2组完全控尿率分别为98.80%（82/83）和93.98%（78/83）,控尿功能分级比较差异无统计学意义（Z=-1.67,P=0.094）。术后3个月,观察组控尿（完全+社交）率达100％（83/83）,高于对照组的73.49%（61/83）,差异有统计学意义（χ²=25.36, P<0.001）。结论 LRP中解剖性保留控尿肌群技术的应用有助于患者术后早期恢复控尿功能,且不影响手术的肿瘤学安全性。     

肛提肌裂孔面积与POP-Q分度用于评估女性盆腔器官脱垂的相关性研究

目的研究患者盆腔器官脱垂(POP)-Q评分评估的POP分度与肛提肌裂孔面积的相关性。方法选取2018年4月-2019年11月在长春市妇产医院就诊的女性患者999名为研究对象。收集患者POP-Q评分相关数据并进行分度评估,并行经会阴实时三维超声检查,对肛提肌裂孔面积进行测量。分析POP患者肛提肌裂孔面积与POP-Q分度的相关性。结果 POP分度与肛提肌裂孔的面积具有显著相关性(P<0.001),且随着分度的增高,裂孔面积不断增大。Ⅰ度的最佳截断值为25.05,Ⅱ度的最佳截断值为30.65,Ⅲ度的最佳截断值为34.05。POP-Q分度与肛提肌裂孔面积的相应关系为:0度<25.05 cm,共194例患者;Ⅰ度≥25.05 cm,共324例患者;Ⅱ度≥30.65,共278例患者;Ⅲ度≥34.05 cm,共203例患者。结论肛提肌裂孔面积用于评估POP分度具有良好的预测能力,可辅助临床医师诊断及后续治疗方案的选择。