胃浆肌瓣包套的食管胃吻合术

目的 探讨预防食管,贲门癌手术后吻合口瘘和狭窄,返流性食管炎发生的方法。方法 对２７３例贲门癌,食管下段癌患者,随机分为治疗组１４５例,对照组１２８例,并分别采用胃浆肌瓣包套的食管胃吻合术及传统的食管胃二层同心圆吻合术。结果 治疗组无吻合口瘘及吻合口狭窄,返流性食管炎１０例。     

食管胃黏膜活瓣式吻合术在食管下段癌、贲门癌切除中的应用

目的 探讨食管下段癌、贲门癌切除后食管胃黏膜活瓣式吻合术的方法及临床体会.方法 肿瘤切除及淋巴结清扫后消化道重建时,剥除食管肌层及胃浆肌层,使黏膜延长3～4 cm,然后食管黏膜与胃黏膜分层吻合,浆肌层包埋,包埋后吻合口置入胃腔内2-3 cm,切除胃超过2/3以上时辅以大网膜包绕吻合口.结果 施行该吻合方法38例,均恢复顺利,近期并发症3例,其中心律失常1例,肺部感染1例,乳糜胸1例,均经保守治疗全部治愈,随访半年后均可顺利进普通饮食,无吻合口狭窄及反流性食管炎表现.结论 食管胃黏膜活瓣式吻合术可有效地预防吻合口漏、狭窄、反流等并发症.     

机械吻合与食管胃分层吻合术治疗食管和贲门癌的对比研究

目的比较机械吻合术与分层吻合术在预防食管和贲门癌手术后吻合口瘘、吻合口狭窄和食管反流并发症发生率的差异。方法将316例食管和贲门癌患者按入院顺序随机分为机械吻合组(162例,采用食管癌切除机械吻合术)和分层吻合组(154例,采用食管癌切除食管胃分层吻合术)。分别比较两组术后吻合口瘘、吻合口狭窄和食管反流并发症发生率。结果机械吻合组术后吻合口瘘和吻合口狭窄发生率分别为1.2%和2.0%,而分层吻合组则分别为3.9%和4.7%,两组比较P<0.01。两组胃食管反流的发生率(88.8%、89.3%)差异无统计学意义(P>0.05)。结论对于预防食管和贲门癌手术后吻合口瘘、吻合口狭窄方面,机械吻合优于分层吻合法。     

食管瓣片成形——食管胃套接术的临床应用

目的 探讨消除食管胃吻合术后吻合口瘘、吻合口狭窄及胃反注等手术方法。方法 食管两侧纵行剪开１．５ｃｍ,形成二叶瓣片。胃前壁造口为套接口,将二叶瓣片经胃套接口确保完全置入腔内。不缝粘膜层,仅将食管肌层与胃壁浆肌层做双层间断缝合,二层间距为３ｃｍ,以食管胃套接术代替食管胃吻合术。结果 临床应用１７６例,无手术死亡,无吻合口瘘,无吻合口狭窄及胃反流,效果满意。结论 （１）缝合粘膜层是食管胃吻合术后发生吻     

食管胃粘膜单层吻合套入术的临床应用

为降低食管、贲门癌切除术后吻合口瘘，狭窄及反流性食管炎等并发症，提高病人术后生活质量。采用食管胃粘膜单层缝合套入术重建食管胃消化道515例。全组无吻合口瘘发生。随诊1/2-3年未见有吞咽困难，钡透吻合宽度均在1.0cm以上，取头低位无钡剂反流现象。本术式操作简便。正确掌握这一吻合技术可降低食管贲门癌切除术后吻合瘘，狭窄及反流性食管炎等并发症。     

食管癌贲门癌术后吻合口瘘的预防（附584例报告）

为降低食管癌贲门癌术后吻合口瘘的发生率，应用深浅间隔进针吻合法或附加大网膜覆盖术，连续施行食管癌贲门癌切除５８４例，无吻合口瘘。说明此法对食管胃吻合口瘘及胸胃穿孔有较好的预防作用。食管胃浆肌层“∧”“∨”型缝合包埋，可避免外压因素所致的狭窄。针对瘘易发生的多环节“综合治理”，相对固定术式，熟练掌握吻合技术能有效防止吻合口瘘发生。     

食管胃吻合技术的改进及临床应用

为探讨食管肿瘤、贲门癌行肿瘤切除后,胃重建食管时食管胃吻合技术,以预防吻合口瘘及狭窄的发生。采用Gambee单层吻合法及全层间断单层吻合法相结合。结果采用此法吻合的168例患者死亡率仅0．6％,吻合口瘘发生率1．2％。无吻合口疤痕狭窄病例。结论认为此吻合法适用于食管胃吻合术,特别适用于贲门癌胃切除较多的弓下食管胃吻合术及食管癌切除食管胃颈部吻合术,有推广价值。     

进展期胃癌全胃切除"围巾式"食管-空肠吻合术(附121例报告)

目的 介绍“围巾式”食管-空肠吻合术预防术后吻合口瘘的临床经验。方法 分析1997年1月至2005年12月连续121例进展期胃癌全胃切除“围巾式”食管-空肠吻合术的临床结果。结果 手术死亡率1．65％（2／121）。存活的119例中，术后均未发生吻合口瘘和反流性食管炎。2000年12月以前，有4例（3．36％）术后发生吻合口狭窄，经胃镜下扩张治愈；改进技术后再无吻合口狭窄发生。结论 “围巾式”食管-空肠吻合术可减少进展期胃癌全胃切除术后吻合口并发症，安全、有效。     

食管胃黏膜延长分层吻合的实验研究

目的　探讨食管胃吻合抗胃食管反流、预防吻合口瘘及狭窄的术式。　方法　选杂种犬 5 8条 ,随机分为实验组和对照组。实验组 :31条犬 ,自贲门横断 ,食管黏膜延长 1.5～ 2 cm;切除部分胃小弯 ,剥除大弯侧保留部分浆肌层 ,成形为宽 3～ 3.5 cm、长 4～ 5 cm黏膜管 ,行食管胃黏膜、肌层分层吻合。对照组 :2 7条犬 ,用“深套叠”术式。于术后 3～ 180天检测对比分析。　结果　两组突入胃内结构长度、肌层吻合口直径差别无显著性意义 (P>0 .0 5 ) ,黏膜游离缘直径差别有显著性意义 (P<0 .0 1) ;实验组能耐受较高胃内压 ,胃与食管压力差两组差别有显著性意义 (P<0 .0 1) ;突向胃腔内结构厚度两组相差 1倍以上 ;实验组成形黏膜血供良好 ,吻合口愈合及缝线脱落早于对照组。　结论　适当剥除肌层不引起黏膜缺血坏死 ;成形黏膜瓣薄软 ,具有良好的抗反流效果 ;黏膜层密缝对合严密、愈合快 ,能有效预防吻合口瘘的发生 ,不同平面吻合狭窄发生率低。     

兜底式食管胃吻合术的临床应用研究

摘要：目的评价兜底式食管胃吻合术对吻合口瘘、吻合口狭窄和胃食管反流的预防作用及效果,探讨蒙特利尔定义“胃食管反流病”诊断流程、标准在食管重建术后的实用价值和意义。方法回顾性分析2007年6月至2011年6月笔者医院采用两种术式共行食管癌和贲门癌切除1078例的临床资料,参考相关诊断标准制表,问卷调查两组患者术后吻合VI狭窄和胃食管反流的发病情况。试验组（兜底式食管胃吻合术）582例,男403例、女179例,年龄（60．4±12．6）岁。食管癌399例,贲门癌183例,弓上吻合392例,弓下吻合190例。对照组（传统食管胃端侧吻合术）496例,男343例、女153例,年龄（59．2±12．8）岁。食管癌322例,贲门癌174例,弓上吻合317例,弓下吻合179例。结果与传统食管胃端侧吻合术相比,兜底式吻合术后吻合VI瘘的发生率较低[0％（0／582）VS．1．0％（5／496）,x2=5．835,P=O．016）];胃食管反流症状亦较轻,而伴有食管外症状及需要服用制酸剂患者则更少[1．6％（33／541）VS．12．6％（57／453）,矿=23．564,P=O．000],术后吻合口狭窄率各为0．9％（5／539）和7．3％（34／465）（x2=25．124,P=O．000）,尤其是重度吻合I=I狭窄的发生率更低[0％（0／539）VS．4．7％（22／465）,X2=24．883,P=O．000]。两组5年生存率差异无统计学意义。结论兜底式吻合法在预防食管胃吻合VI瘘、吻合VI狭窄和胃食管反流的发生方面较传统术式为优;蒙特利尔定义胃食管反流诊断流程和标准适合于食管重建术后胃食管反流之诊断。     

"Free" and "exchangeable" or "trapped" and "non-exchangeable" water in cartilage

We repeated some of our own previous experiments, as well as some of Torzilli's recent experiments (11) on which he bases his conclusions relating to a nonexchangeable "trapped water" in cartilage. We are unable to confirm Torzilli's findings. We observed partition coefficients for 3H.HO very close to unity. That both the extrafibrillar and most of the intrafibrillar water is freely exchangeable and behaves as available water towards small solutes has been independently shown (3) for other collagenous tissues. All the different permutations of partition experiments have yielded results that are fully consistent with our original picture of the very major fraction of cartilage water being free.     

"Gas off" or "vaporizer off"

Editor—It is a common misconception that turning off thevaporizer while leaving the fresh gas flow (FGF) on, during     

"A" for Agency, "B" for Basal cell, "C" for Corticotulle, "D" for Danger

Without any proof, a governmental agency has decreed that Corticotulle was not enough efficient to be reimbursed by National Health Security. Dealing with treatment of basal cell carcinoma, another governmental agency has published recommendations which even do not follow basic rules of logic. This paper points out that economical and political methods are not scientific or medical ones.     

"Custom-fit" versus "off-the-shelf" ACL functional braces

Many sports medicine practitioners believe "custom-fit" functional braces are superior in performance to "off-the-shelf" braces for anterior cruciate ligament (ACL)-deficient knees. However, this is not well substantiated. This study compares a Donjoy custom-fit ACL brace (CE 2000), Donjoy off-the-shelf brace (Goldpoint), and an athletic taping technique to determine their role in our clinical practice. Five patients (3 men and 2 women) with isolated, unilateral, chronic ACL tears with an average age of 27 years (range: 19-35 years) were used to evaluate these three restraint systems. Anterior tibial laxity, quadriceps and hamstrings strength, endurance, standing long jump, brace migration with exercise, and pattern of muscle response to forced anterior tibial displacement were studied. Each patient was tested without a brace and then in each of the three test conditions (custom brace, off-the-shelf brace, and tape), with the order of testing randomized. The Donjoy custom-fit ACL functional brace did not reduce anterior laxity or improve standing long jump, muscle strength, endurance, or muscle response times significantly more than the off-the-shelf ACL brace. Both braces improved anterior stability over knee taping when the knee muscles were contracted under the low forces used in this study. After 1 hour of exercise, brace migration was significantly greater (P=.03) for the CE-2000 custom brace (18.6 mm) than for the Goldpoint off-the-shelf brace (4.5 mm). There appears to be no advantage to the more expensive custom-fit knee brace over the off-the-shelf brace.