内镜超声引导下肉毒杆菌毒素注射治疗贲门失弛缓症临床疗效观察

目的探讨超声胃镜引导下肉毒杆菌毒素注射治疗贲门失弛缓症的临床疗效。方法45例贲门失弛缓症患者，分为球囊扩张、肉毒杆菌毒素注射及Heller手术3组，观察治疗前、治疗后6个月和12个月患者临床症状计分和钡餐检查中食管宽度。结果3组患者治疗后吞咽困难、胸痛和反流症状的计分以及食管钡餐检查食管最大宽度均明显低于治疗前（P〈0．05），且3组间临床症状改善程度差异无统计学意义（P〉0．05），但扩张组和Heller手术组各有1例发生食管穿孔并发症，肉毒杆菌毒素组无并发症发生，患者耐受良好。结论超声胃镜引导下肉毒杆菌毒素注射是治疗贲门失弛缓症安全、有效的方法。     

贲门失弛缓症治疗方式的探讨

目的比较胸腔镜辅助Heller手术、开胸Heller手术、消化内镜下球囊扩张及消化内镜下肉毒毒素注射治疗贲门失弛缓症疗效，探讨贲门失弛缓症合理有效的治疗方法。方法81例贲门失弛缓症患者按不同治疗方式分为4组：胸腔镜辅助Heller手术18例；开胸Heller手术21例；消化内镜下球囊扩张22例；肉毒毒素注射治疗20例。比较各组治疗前后症状评分、食管末端直径、食管下段括约肌压力、食管末端pH和各组有效率。结果4组患者治疗前后相比，症状评分、食管末端直径、食管下段括约肌压力、食管末端pH差异均有统计学意义（P〈0．05），治疗有效率胸腔镜组为94．4％、开胸组为95．2％、球囊扩张组为63．6％、肉毒素注射组为55．0％，Heller手术较消化内镜下治疗更为有效（P〈0．05）。结论Heller手术治疗效果较球囊扩张及肉毒素注射为佳，胸腔镜辅助Heller手术较开胸Heller手术具有创伤小、恢复快、住院时间短等优势。     

气囊扩张和肉毒毒素注射治疗贲门失弛缓症中远期疗效比较的荟萃分析

背景：一些随机对照试验比较了气囊扩张和肉毒毒素注射治疗贲门失弛缓症的中远期疗效。但结论不尽一致。目的：评价气囊扩张和肉毒毒素注射治疗贲门失弛缓症的中远期疗效。方法：通过GUT、中国生物医学文献数据库（CBMdisc）、PubMed和维普中文科技期刊全文数据库（VIP）检索有关比较气囊扩张和肉毒毒素注射治疗贲门失弛缓症中远期（6～12个月）疗效的研究，行荟萃分析。应用RevMan4．2软件，采用固定效应模型分析各研究中两组中远期症状缓解率的OR值，荟萃分析总OR值。结果：气囊扩张组贲门失弛缓症的中远期症状缓解率显著高于肉毒毒素注射组（OR：3．06，95％CI：1．82～5．14，P〈0．0001）。结论：气囊扩张治疗贲门失弛缓症的中远期疗效显著优于肉毒毒素注射疗法，临床医师可根据患者的耐受程度、治疗需达到的目的等因素选择治疗方案。     

内镜下注射肉毒毒素治疗贲门失弛缓症的研究

将48例贲门失弛缓症患者随机分为两组，A组注射肉毒毒素治疗，B组用小气囊扩张治疗。分别于治疗后1周、3个月和1年比较两组患者的临床症状积分、下食管插约肌的压力（LESP）、松弛率（LESRR）。结果：治疗后1周、3个月和1年的有效率及治疗前后LESP、LESRR的差值，注射肉毒毒素组均高于小气囊扩张组；两组均无并发症发生。认为内镜下食管下括约肌内注射肉毒毒素治疗贲门失弛缓症的近期疗效高，且患者痛苦小。     

贲门失弛缓症的治疗进展

贲门失弛缓症是一种病因不明的食管功能性疾病，目前对其治疗主要是缓解临床症状，本比较四种治疗贲门失弛缓症的方法即药物治疗、肉毒毒素治疗、球囊扩张以及肌切开术的疗效，用于选择治疗贲门失弛缓症的最佳方案。     

贲门失弛缓症的治疗进展

贲门失弛缓症是一种病因不明的食管功能性疾病,目前对其治疗主要是缓解临床症状,本文比较四种治疗贲门失弛缓症的方法即药物治疗、肉毒毒素治疗、球囊扩张以及肌切开术的疗效,用于选择治疗贲门失弛缓症的最佳方案。     

内镜下球囊扩张联合括约肌内肉毒毒素注射治疗贲门失弛缓症的临床疗效

目的 探讨内镜下球囊扩张联合肉毒毒素注射治疗贲门失弛缓症的临床疗效.方法 选择86例贲门失弛缓症患者,其中41例接受内镜下单纯球囊扩张治疗,45例接受球囊扩张联合肉毒毒素注射治疗.分别于治疗前及治疗后1周、3个月、12个月时进行下食管括约肌压力、下食管括约肌松弛率检测和临床症状积分评测,观察其治疗后下食管括约肌压力、括约肌松弛率的变化以及临床疗效.结果 联合治疗患者治疗后1周、3个月、12个月有效率分别为91.11％ (41/45)、88.99％ (40/45)、80.00％( 36/45),单纯治疗患者则分别为60.98％ (25/41)、39.02％( 16/41)、19.52％(8/41);两组同时间点有效率比较差异有统计学意义(P＜0.05或＜0.01).联合治疗患者治疗前及治疗后1周、3个月、12个月时下食管括约肌压力分别为(47.04±6.49)、(25.17±2.76)、(27.86±2.43)、(31.97±3.21)mmHg,下食管括约肌松弛率分别为(38.79±3.26)％、(58.84±5.42)％、(55.35±5.64)％、(51.05±5.93)％;单纯治疗患者同时间点下食管括约肌压力分别为(46.56±6.63)、(31.15±1.31)、(38.83±2.36)、(43.40±1.27)mmHg,下食管括约肌松弛率分别为(37.36±4.03)％、(47.48±6.11)％、(44.15±5.89)％、(39.45±4.96)％;两种治疗方法以上两指标同时间点比较差异均有统计学意义(P均＜0.05),且患者均无严重并发症发生.结论 球囊扩张联合肉毒毒素注射治疗贲门失弛缓症能有效改善患者临床症状及食管动力学状态.     

贲门失弛缓症的治疗

贲门失弛缓症是一种病因尚未明确、累及食管平滑肌和下食管括约肌（LES）的动力障碍性疾病。以吞咽时食管体部蠕动消失、LES松弛障碍为特征。本病的治疗方式包括药物、注射肉毒杆菌毒素、气囊扩张术和肌切开术,旨在降低LES压力,促进食管排空,多数患者可获得较理想的结局。本文就贲门失弛缓症的治疗现状作一综述。     

气囊扩张和肉毒毒素注射治疗贲门失弛缓食管动力变化的比较

目的 了解经内镜气囊扩张和肉毒毒素注射2种方法治疗贯门失弛缓症后食管动力的改变。方法 118例经内镜、钡餐及食管测压确诊为贲门失弛缓症患者随机分为2组:扩张组56例,注射组62例,分别采用内镜下气囊扩张和肉毒毒素注射方法。治疗前、治疗后1周内测定下食管括约肌压力(LESP)、下食管括约肌松弛压(LESRP)以及下食管括约肌松弛率(LESR)等指标,并观察患者症状缓解情况。结果 2组治疗前食管动力学3个指标无统计学差异,扩张组治疗后LESP降至(6.03±3.45)mm Hg,LESRP为(-0.11±2.34)mm Hg,LESRR升至92.50％±13.86％,与治疗前相比,差异均有显著性意义。注射组治疗后LESP降至(23.16±16.17)mm Hg,与治疗前相比,差异有显著性意义,LESRP、LESRR与治疗前相比,差异无显著性意义。临床疗效,扩张组:显效45例,改善11例;注射组:显效15例,改善38例,无效9例。结论 气囊扩张法治疗贲门失弛缓近期疗效较肉毒毒素注射法要好,临床症状的改善同LESP及LESRP的降低,特别是LESRP的降低有非常密切的对应关系。     

气囊扩张与肉毒毒素注射联合治疗贲门失弛缓症的临床研究

目的：比较单纯小气囊扩张、单纯肉毒毒素(BT)注射和两者联合治疗贲门失弛缓症的疗效与副作用。方法：48例患者随机被分为3组：扩张组只用小气囊扩张治疗；注射组只注射BT治疗；联合组两种方法联合应用。分别于术前，治疗后1周、3个月和1年时比较3组患者的临床症状积分(有效率)、下食管括约肌的压力(LESP)、松弛率(LESRR)。结果：在治疗后1周、3个月和1年时，有效率及治疗前后LESP和LESRR的差值，联合组和注射组该3项指标均高于扩张组；在治疗后l周和3个月时，联合组与注射组相比无明显差异；但1年时，联合组高于注射组。3组均无并发症发生。结论：小气囊扩张术与下食管括约肌内注射BT联合治疗贲门失弛缓症，具有疗效高、持续时间长、患者痛苦小等优点。值得临床上推广应用。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.