合并肥胖的胃食管反流病外科策略选择

胃食管反流病(gastroesophageal reflux disease, GERD)和肥胖均已经成为影响全球健康的严重问题.对于合并肥胖的GERD患者的外科治疗策略选择仍是临床诊疗工作的难点,特别是肥胖加剧了GERD发生,而单纯的抗反流手术对肥胖病人疗效有限,目前减重手术是治疗这类患者的较好选择. Roux-en-Y胃旁路术是这类患者的最佳选择.对于术后复发患者的修正手术仍有待规范.另外,近年来不断兴起的新型抗反流减重手术,有望成为合并肥胖的GERD患者的有效替代治疗措施.     

腹腔镜Nissen胃底折叠术治疗老年胃食管反流病23例

<正>胃食管反流病(GERD)以胃灼痛、反酸为主要特征,并发症包括食管溃疡、食道狭窄及巴雷特食管(BE)等。手术治疗GERD主要是强调避免其并发症。Geagea及Dallemagne等于1991年首次报道了腹腔镜Nissen胃底折叠术(LNF)治疗GERD,与药物治疗相比手术治疗的长期抗反流效果更为明显,而在欧美国家腹腔镜手术治疗GERD是增长最快的术式,相比     

胃食管反流病的内镜治疗

胃食管反流病（GERD）的治疗目前主要是依靠抑酸剂和胃动力药物控制症状，但部分病例反复发作、无法停药，甚至少数患者经药物治疗症状无法缓解。对于严重或顽固的GERD以往需外科或腹腔镜下手术治疗，但存在创伤大，术后难以修复及部分病例效果不满意等诸多难题。近些年来，国内外开始在内镜下治疗GERD，初步显示出操作方便、创伤较小、安全性及疗效较好的效果。本文对近几年的GERD内镜治疗作一综述。     

肠促胰岛素在减肥手术治疗肥胖2型糖尿病患者中的作用

肥胖和2型糖尿病的患病率呈逐年增高的趋势.减肥手术作为减轻体质量的有效方法,近年来逐渐得到广泛的应用.其主要分为限制型手术、吸收不良型手术及联合型手术.减肥手术在减轻体质量的同时也使肥胖患者的糖尿病得到了缓解,但其缓解糖尿病的机制目前尚不完全清楚.除了体质量减轻、摄食减少外,关于肠促胰岛素在减肥手术中的作用也受到了越来越多的重视.本文对减肥手术的术式、疗效、安全性及治疗糖尿病的可能机制进行讨论.     

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

AIM： To demonstrate that age does not influence the choice of treatment for gastroesophageal reflux disease （GERD）. We hypothesized that the outcome of total fundoplication in patients 〉 65 years is similar to that of patients aged ≤ 65 years. METHODS： Four hundred and twenty consecutive patients underwent total laparoscopic fundoplication for GERD. Three hundred and fifty-five patients were younger than 65 years （group Y）, and 65 patients were 65 years or older （group E）. The following elements were considered： presence, duration, and severity of GERD symptoms; presence of a hiatal hernia; manometric evaluation, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. RESULTS： Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severity of erosive esophagitis. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 92.9% young patients and 91.9% elderly patients. CONCLUSION： Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.     

胃食管反流病大鼠模型探讨

胃食管反流病GERD为消化科常见病之一,其发病机制复杂。大鼠模型可用来研究GERD的发病机制并为新的临床治疗方式带来希望。目前国内外有两类方法构建GERD大鼠模型,一类是外源性食管灌注化学物质诱发,另一类是手术干预改变大鼠胃肠道生理结构来实现。本综述主要从急性GERD大鼠模型和慢性GERD大鼠模型两大方面探讨。     

胃食管反流病的蒙特利尔定义浅析

1 GERD蒙特利尔定义产生的背景 1934年,美国胃肠病学家Winkelstein首次将烧心症状与反流导致的食管炎联系起来[1],从而逐渐建立了胃食管反流病(GERD)这一概念.随着研究的深入,人们逐渐了解到GERD是一种常见病,在世界范围内发病率有所不同:西欧和北美GERD症状患病率为10%～20%[2];亚洲国家患病率略低,日本的研究显示GERD症状患病率约6.6%[3],韩国为3.5%[4];中国北京和上海两地同时进行调查显示GERD患病率为5.77%[5].近年来,GERD的患病率有逐渐上升的趋势,引起了人们越来越多的关注.     

牙酸蚀症患者胃食管反流病相关知识横断面调查

目的 调查牙酸蚀症患者对胃食管反流病(GERD)相关知识的了解状况.方法 使用自行设计的调查问卷,采用随机抽样方法,对门诊148例牙酸蚀症患者进行GERD相关知识和症状调查.结果 34.5％牙酸蚀症患者存在GERD症状,仅有9.5％患者知晓GERD是牙酸蚀症的病因,对GERD危险因素知晓率均低于50％.结论 牙酸蚀症患者对GERD相关知识了解较少,应对其进行GERD相关知识的教育,以改善其预后.     

惠州地区胃食管反流病与肠易激综合征重叠的特征

目的 探讨惠州地区胃食管反流病（GERD）重叠肠易激综合征（IBS）的症状特征.方法 采用整群、分层、随机抽样的方法,收集到61例GERD症状人群,其中12例（19.7％） GERD重叠IBS患者、49例单纯GERD患者,记录其人口统计学资料以及症状严重程度,对结果进行统计分析.结果 GERD重叠IBS组男女比例为1：1.4,其症状较单纯GERD组严重（P＜0.05）.结论 GERD与IBS的重叠现象多见,患者多为女性,且症状更严重.     

胃食管反流病合并食管裂孔疝的诊治

胃食管反流病(GERD)与食管裂孔疝(HH)常合并发生，本文对这两种疾病最新诊治情况进行了报道。GERD合并HH可通过典型GERD症状及食管外症状进行初步识别，联合胃镜、24 h食管pH/阻抗监测及高分辨率食管测压、上消化道钡餐造影、胸腹部CT进一步明确诊断。治疗包括生活饮食习惯的改善、药物治疗及手术治疗。质子泵抑制剂(PPI)是最常用且最有效的药物，HH是引起GERD难治的重要原因之一，常需要双倍剂量PPI，夜间症状明显患者需睡前加用H2受体拮抗剂。合并HH的严重食管炎患者需长期维持治疗。对于药物治疗效果不佳者，可选择手术治疗。     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

高血压降压治疗目标的再认识

根据传统的高血压水平的定义,1993年WHO高血压治疗指南提出血压控制目标为<140/90mm Hg(1mm Hg=0.133kPa),但是并非所有患者都必须将血压降至同一水平,而应根据患者情况进行个体化治疗。Framingham进行的一项长达10～12年的心血管事件研究发现,第5年后,正常上限血压[收缩压(SBP     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.