Barrett食管伴滑动性食管裂孔疝腹腔镜治疗疗效观察

目的探究合并滑动性食管裂孔疝的Barrett食管患者经腹腔镜下治疗后生活质量和食管黏膜病变的改善情况。 方法回顾性收集首都医科大学宣武医院胃食管反流中心2016年1月至2020年12月诊断为Barrett食管伴滑动性食管裂孔疝患者23例，接受腹腔镜食管裂孔疝修补+胃底折叠术，于术前和术后12周时行胃镜、胃食管反流病自测量表（Gerd Q）评分、反流症状指数（RSI）评分、健康调查量表36（SF-36）调查问卷，评估患者术后生活质量和食管黏膜改善情况。 结果23例伴滑动性食管裂孔疝的Barrett患者术后12周随访显示3例患者黏膜病变部分消退。患者术后GerdQ、RSI相较术前均有明显改善（GerdQ：5.78±1.54 vs 11.65±1.50，P=0.00；RSI：9.70±1.92 vs 18.57±3.01，P=0.00），SF-36量表仅在生理功能方面改善不明显（85.87±4.16 vs 86.43±3.12，P=0.31），生理职能、情感职能、活力、精神健康、社会功能、躯体疼痛和总体健康方面均明显改善（生理职能：66.43±6.13 vs 35.48±2.86，P=0.00；情感职能：73.74±4.91 vs 65.22±2.58，P=0.00；活力：56.96±3.80 vs 50.30±4.56，P=0.00；精神健康：62.09±4.89 vs 53.26±2.07，P=0.00；社会功能：81.39±4.42 vs 74.00±3.59，P=0.00；躯体疼痛：80.00±6.84 vs 75.30±10.27，P=0.00；总体健康：69.17±5.68 vs 60.17±4.61，P=0.00）。 结论腹腔镜食管裂孔疝修补+胃底折叠术对伴滑动性食管裂孔疝的Barrett食管患者生活质量和黏膜病变均有一定改善。     

When Fryn met Edward: Two rare syndromes in a single patient

A neonate born at our centre was diagnosed as Fryns Syndrome ie congenital diaphragmatic hernia with facial dysmorphism and distal limb anomalies, which is a rare disorder with only a few hundred cases reported till date.With high clinical index of suspicion and further evaluation, the diagnosis was confirmed. The baby was initially stabilized and later underwent repair of the diaphragmatic hernia. Despite best measures, the baby could not be salvaged. When severe, this can be lethal and diagnosis can only be made after autopsy. However, with early suspicion, better modalities of investigations available and improved NICU care, these babies can be salvaged. We report a case of Fryns Syndrome who was incidentally found to have Edward Syndrome as well. Such an extremely rare combination is yet to be reported in medical literature.Also with updated genetic studies, better diagnostics and treatment options coming up in future, there are chances to improve the survivability of these babies. It is prudent to document all such cases to aid in better understanding of the disease process.     

Imaging in neonatal respiratory disease

The purpose of this review is to describe the current state of the art in clinical imaging for NICU patients, divided into major areas that correspond to likely phenotypes of neonatal respiratory disease: airway abnormalities, parenchymal disease, and pulmonary vascular disease. All common imaging modalities (ultrasound, X-ray, CT, and MRI) are discussed, with an emphasis on modalities that are most relevant to the individual underlying aspects of disease. Some promising aspects of dynamic and functional imaging are included, where there may be future clinical applicability.     

腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效

目的探讨腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病患者的临床疗效。 方法选择2016年1月至2019年1月河北北方学院附属第二医院收治的108例食管裂孔疝合并胃食管反流病患者开展回顾性研究，按照不同手术方式将患者分为2组，每组患者54例。对照组行常规开腹手术，联合组行腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术，比较2组患者术前及术后6个月反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分。 结果2组术前反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异无统计学意义（P>0.05）；2组患者术后6个月反流症状与术前比较，均得到明显改善，差异有统计学意义（P<0.05）；2组术后反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异有统计学意义（P<0.05）。联合组患者的手术时间、术中出血量及术后住院时长均明显优于对照组，差异有统计学意义（P<0.05）。 结论腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术对HH合并胃食管反流病患者效果显著，有利于患者身体快速恢复，微创、安全且近期疗效满意。     

多层螺旋CT对腹股沟疝的分型鉴别及应用价值

目的分析多层螺旋CT对腹股沟疝的分型鉴别及应用价值。 方法选择2018年5月至2021年3月于宁国市人民医院外科收治的102例腹股沟疝患者作为研究对象，观察分析多层螺旋CT检查斜疝、直疝、股疝的类型，多层螺旋CT诊断与手术结果对比，多层螺旋CT检查的诊断效能，多层螺旋CT横断位、冠状位及矢状位的诊断符合率，多层螺旋CT检查腹股沟疝的影像学征象。 结果102例患者中单纯性斜疝70例，单纯性直疝20例，单纯性股疝5例，左侧复发性腹股沟直疝2例，右侧嵌顿性腹股沟股疝5例。CT诊断与手术结果相符的斜疝占64.71%（66/102），直疝占16.67%（17/102），股疝占6.86%（7/102）。多层螺旋CT诊断斜疝的特异度、灵敏度、阳性预测值分别为8.33%、91.67%、91.67%；直疝的特异度、灵敏度、阳性预测值分别为15.00%、85.00%、85.00%；股疝的特异度、灵敏度、阳性预测值分别为30.00%、70.00%、70.00%。多层螺旋CT冠状位的诊断符合率为99.02%，稍高于矢状位的98.04%（P>0.05）；冠状位的诊断符合率为99.02%，明显高于横断位的75.49%（P<0.05）；矢状位的诊断符合率为98.04%，明显高于横断位的75.49%（P<0.05）。102例患者共有疝囊105个，斜疝患者有72个疝囊，直疝患者有23个疝囊，股疝患者有10个疝囊。93.06%（67/72）的斜疝疝囊的腹股沟管内环扩大，直疝及股疝疝囊的腹股沟管内环均正常；斜疝及直疝疝囊均无股三角填塞，股疝疝囊均股三角填塞；斜疝及股疝疝囊均无侧新月征，82.61%（19/23）的直疝疝囊具有侧新月征；斜疝及直疝疝囊位于腹股沟韧带的前方，股疝疝囊均位于腹股沟韧带的后方；90.28%（65/72）的斜疝疝囊壁位于腹壁下动脉的外侧，直疝疝囊壁位于腹壁下动脉的内侧，股疝疝囊壁位于腹壁下动脉的后下方。 结论多层螺旋CT检查有助于腹股沟疝的诊断，与临床对腹股沟区解剖结构的了解相结合，对腹股沟直疝、斜疝及股疝的分型具有重要价值。     

TAPP与TEP治疗腹股沟疝的临床对比研究

目的探讨TAPP与TEP治疗腹股沟疝的临床治疗效果。方法选取2015年1月-2017年12月至本院行腹腔镜疝修补手术的单侧腹股沟疝患者134例为观察对象,按手术方式的不同随机分为TEP组及TAPP组两组。对比分析两组的手术时间、手术出血量、住院时间、住院费用、术后24 h急性疼痛评分(VSA)、并发症发生率。结果 TEP组手术时间、住院费用明显短于或少于TAPP组,差异具有统计学意义。术后24 h急性疼痛评分(VSA)两组相比差异无统计学意义。TEP与TAPP在手术出血量、住院时间、并发症发生率方面差异无统计学意义。结论 TAPP并不增加术后早期急性疼痛的发生率,TAPP与TEP均是治疗腹股沟疝的有效方式。     

Minimally invasive inguinal lymphadenectomy

The focus of this article is not purely on the technical aspects of a novel procedure, but also the considerations a team might pursue in adopting, modifying, or developing a new procedure of any type. Performing a minimally invasive inguinal lymphadenectomy is challenging even to individuals experience in laparoscopic techniques and with open lymphadenectomy. This article summarizes the approach to adopting any new technique and specifically addresses the learning curve for minimally invasive lymphadenectomy. In addition, specific technical aspects of the procedure are enumerated.