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Ismail Cem Sormaz Gülçin Yegen Filiz Akyuz Fatih Tunca Yasemin Giles Şenyürek 《The Indian journal of surgery》2017,79(5):450-454
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, and extrahepatic metastases are typically found during disease progression. The incidence of adrenal metastasis (AM) from HCC in autopsy series ranges from 4.6 to 12.5%, and it is the second most common site of metastasis after the lungs. To date, there have been few reports of patients who underwent adrenalectomy for isolated AM from HCC after liver transplantation (LT). A woman aged 55 years was referred to our clinic for the evaluation of a right adrenal mass that was detected by abdominal ultrasonography at another center. She had undergone liver transplantation secondary to HCC and acute liver failure due to cryptogenic liver cirrhosis 138 months previously. She had been followed up for 5 years following LT after which she declined to continue with further follow-up. After radiologic and biochemical evaluation, she underwent adrenalectomy and the histopathologic examination revealed a 10 × 8 × 7-cm adrenal mass, which was considered to be an isolated AM from HCC. To our knowledge, this is the first case of isolated AM from HCC in the literature that was diagnosed 138 months after liver transplantation. Isolated AM from HCC after LT is rare and might be detected a long time after LT. Curative surgical resection of isolated metachronous AM from HCC in the absence of disseminated disease might provide for an acceptable disease-free period after adrenalectomy. 相似文献
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Niloufar Dusch Christel Weiss Philip Ströbel Peter Kienle Stefan Post Marco Niedergethmann 《Journal of gastrointestinal surgery》2014,18(4):674-681
Background
Long-term survival after resection for pancreas carcinoma has rarely been reported. Factors influencing long-term survival are still under debate. The aim of this study was to define predictors for long-term survival.Methods
Between 1972 and 2004, a total of 415 patients underwent resection. Data were collected in a prospective data base. Data of 360 patients were available for further analysis in 2011. All specimens of long-term survivors were histologically reviewed.Results
Long-term survivors (n?=?69) had a median survival of 91 months. Pathological re-evaluation of all specimens re-confirmed the diagnosis. Predictive factors for long-term survival in univariate analysis were no preoperative biliary stent, low CA 19-9 level, lack of blood transfusion, R0 resection, tumour diameter, and -grading, absence of lymph node or distant metastases, lymphangiosis, and perineural infiltration. Adjuvant chemotherapy showed a significant influence on overall survival but not on long-term survival. In multivariate analysis, lymph node ratio and volume of blood transfusion were predictors of long-term survival.Conclusion
Nearly 20 % of patients with pancreas carcinoma who undergo surgical resection have a chance of long-term survival. Survival beyond 5 years is predicted by clinical and tumour-specific factors. Adjuvant chemotherapy might prolong overall survival but is, according to these results, unable to contribute to long-term survival. There is still a risk of recurrence after a 5- or even a 12-year mark. Survival beyond 5 or even 12 years, therefore, does not assure cure. 相似文献4.
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Background The incidence of human immunodeficiency virus (HIV) infection is rising, and as a result, tuberculosis (TB) has become a resurgent
problem in many developed countries.
Objectives The aim of this study was to review the spectrum of abdominal TB and its surgical management in our institution.
Methods A retrospective review of all abdominal TB cases notified to the health authorities by our institution from Jan 01 to Oct
07 was performed.
Results There were 57 patients (37 men) with abdominal TB, with a median age of 47 (range 14–74) years. Active pulmonary TB was present
in 27 patients (47%). Positive HIV status was present in 30% and untested in 58%. The majority of patients underwent computed
tomography scans (n = 50, 88%). The main radiological findings included bowel thickening, lymphadenopathy, ascites, free gas suggestive of perforation,
and abscesses. The diagnosis of TB was confirmed on microbiological and/or histological examination in 72%, while the remaining
28% were diagnosed based on the clinical presentation and radiological imaging. All patients were commenced on anti-tuberculous
therapy. TB involved the small or large bowel in 33 patients, mesenteric lymphadenopathy in 24, peritoneum in 13, spleen in
seven, pancreas in two, anus in two, and the liver in two. Disseminated (including pulmonary) TB occurred in 27 patients (47%),
while isolated intra-abdominal TB occurred in the remaining 30 patients (53%). Twenty-five patients (44%) underwent surgery—16
laparotomies (six perforated viscus, five intestinal obstruction, three suspected malignancies, and two for suspected acute
abdomen), five laparoscopic procedures (four diagnostic, one gastrojejunostomy bypass for gastric outlet obstruction), two
appendicectomies, one drainage of abscess, and one anal fistulotomy.
Conclusions Although TB is eminently treatable medically, surgery is still often required for suspected or confirmed abdominal TB presenting
with acute complications or as atypical diagnostic problems. The role of laparoscopy is likely to be more significant in future
in the management of abdominal TB. 相似文献
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Torzilli G Palmisano A Del Fabbro D Marconi M Donadon M Spinelli A Bianchi PP Montorsi M 《Annals of surgical oncology》2007,14(4):1347-1355
BACKGROUND: Preliminary results showed that contrast-enhanced intraoperative ultrasonography (CEIOUS) could provide information not obtainable with conventional IOUS during surgery for hepatocellular carcinoma (HCC). The aim of the study was to prospectively validate the role of CEIOUS on the basis of a larger experience and to establish a new classification that takes into account its findings. METHODS: Eighty-seven consecutive patients underwent hepatecomies for HCC. Those patients with new lesions at IOUS underwent CEIOUS: for that patients received intravenously 4.8 mL sulphurhexafluoride microbubbles. Pattern of enhancement was classified in 4 categories: A1 (full enhancement in the arterial phase and wash-out in the delayed phases), A2 (intralesional signs of neovascularization during all phases), A3 (no nodular enhancement but detectability during the liver enhancement), and B (undetectability during the liver enhancement). Resection was recommended for A1-3 nodules and no treatment for B nodules. RESULTS: Twenty-nine patients (33%) had 59 new lesions at IOUS and underwent CEIOUS. Twenty-seven nodules showed a B pattern at CEIOUS and were not removed; 32 nodules were classified as A1 in 5 patients, A2 in 11 patients, and A3 in 16 patients. The nodules were removed, and by histology, five A1, nine A2, and six A3 nodules were confirmed to be HCC. CEIOUS modified the operative decision making in 79% of these patients. CONCLUSIONS: CEIOUS is useful during surgery for HCC; it complements the accuracy of IOUS and affects the radicalness of the surgical. Specificity of CEIOUS has to be further improved, although intrinsic drawbacks exist in the diagnostic criterion of tumor vascularity. 相似文献
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Terence C. Chua BScMed Tristan D. Yan PhD Michelle E. Smigielski Katherine J. Zhu MBBS Keh M. Ng MBBS Jing Zhao MD David L. Morris MD 《Annals of surgical oncology》2009,16(7):1903-1911
Background Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) has been recognized as a treatment option
for pseudomyxoma peritonei. This study reports the survival outcomes, clinicopathological prognostic factors, and a learning
curve from a single institution’s experience.
Methods Patients with pseudomyxoma peritonei underwent CRS and PIC, which was comprised of hyperthermic intraperitoneal chemotherapy
(HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC), according to a standardized treatment protocol in
our institution. Clinicopathological factors were analyzed to determine their prognostic value for survival using univariate
and multivariate analysis. Time period comparison was performed to study the effect of a learning curve.
Results A total of 106 patients (43 men and 63 women) were treated. The mortality rate was 3% and severe morbidity rate was 49%.
The median follow-up was 23 (range, 0–140) months. The overall median survival was 104 months with a 5-year survival rate
of 75%. The progression-free survival was 40 months with a 1-year progression-free survival rate of 71%. Factors influencing
survival include histopathological type of tumor, use of both HIPEC and EPIC, peritoneal cancer index, completeness of cytoreduction,
and severe morbidity. The results demonstrate a learning curve where patients with a higher peritoneal cancer index (PCI)
were treated, reduced amount of blood products required, more patients undergoing HIPEC and the combined HIPEC and EPIC, more
redo-procedures performed, and a longer progression-free survival.
Conclusions This report demonstrates long-term survival outcomes, acceptable perioperative outcomes, and a learning curve associated
with the treatment of patients with pseudomyxoma peritonei. 相似文献
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Galun DA Bulajic P Zuvela M Basaric D Ille T Milicevic MN 《World journal of surgery》2012,36(7):1657-1665
Background
Patients with large-size (>10?cm) hepatocellular carcinoma (HCC) in Child B cirrhosis are usually excluded from curative treatment, i.e., hepatic resection, because of marginal liver function and poor outcome. This study was designed to evaluate the feasibility of the radiofrequency (RF)-assisted sequential “coagulate-cut liver resection technique” in expanding the criteria for resection of large HCC in cirrhotic livers with impaired liver function.Methods
Forty patients with Child-Pugh A or B cirrhosis underwent liver resection from December 1, 2001 to December 31, 2008. Of these, 20 patients (13 Child-Pugh A and 7 Child-Pugh B) with advanced stage HCC (stage B and C according to Barcelona-Clinic Liver Cancer Group) underwent major liver resection. The two groups were comparable in terms of patient age, liver cirrhosis etiology, tumor number, and size.Results
All resections were performed without the Pringle maneuver. There was no significant difference found between the two groups regarding resection time, perioperative transfusion, postoperative complications, hospital stay, and day 7 values of hemoglobin and liver enzymes. Likewise, there was no significant difference found in the overall survival between Child A and Child B patients who underwent major liver resectionConclusions
RF-assisted sequentional “coagulate-cut liver resection technique“ may be a viable alternative for management of patients with advanced HCC in cirrhotic liver with impaired function. 相似文献10.
Junichi Shindoh MD PhD Andreas Andreou MD Thomas A. Aloia MD Giuseppe Zimmitti MD Gregory Y. Lauwers MD Alexis Laurent MD David M. Nagorney MD Jacques Belghiti MD Daniel Cherqui MD Ronnie Tung-Ping Poon MS FRCS Norihiro Kokudo MD PhD Jean-Nicolas Vauthey MD 《Annals of surgical oncology》2013,20(4):1223-1229
Background
Excellent long-term outcomes have been reported recently for patients with small (≤2 cm) hepatocellular carcinoma (HCC). However, the significance of microvascular invasion (MVI) in small HCC remains unclear. The purpose of this study was to determine the impact of MVI in small HCC up to 2 cm.Methods
In 1,109 patients with solitary HCC from six major international hepatobiliary centers, the impact of MVI on long-term survival in patients with small HCC (≤2 cm) and patients with tumors larger than 2 cm was analyzed.Results
In patients with small HCC, long-term survival was not affected by MVI (p = 0.8), whereas in patients with larger HCC, significantly worse survival was observed in patients with MVI (p < 0.0001). In multivariate analysis, MVI (hazard ratio [HR] 1.59; 95 % confidence interval (CI) 1.27–1.99; p < 0.001), elevated alpha-fetoprotein (HR 1.41; 95 % CI 1.11–1.8; p = 0.005), and higher histologic grade (HR 1.29; 95 % CI 1.01–1.64; p = 0.04) were significant predictors of worse survival in patients with HCC larger than 2 cm but were not correlated with long-term survival in small HCC. When the cohort was divided into three groups—HCC ≤2, >2 cm without MVI, and HCC >2 cm with MVI—significant between-group survival difference was observed (p < 0.0001).Conclusions
Small HCC is associated with an excellent prognosis that is not affected by the presence of MVI. The discriminatory power of the 7th edition of the AJCC classification for solitary HCC could be further improved by subdividing tumors according to size (≤2 vs. >2 cm). 相似文献11.
Background
It is a technical challenge to perform laparoscopic splenectomy (LS) on patients with liver cirrhosis. The purpose of this article is to share our experience with performing LS in the setting of hypersplenism secondary to liver cirrhosis.Methods
A total of 43 LSs for hypersplenism secondary to liver cirrhosis were performed between September 2003 and January 2013. The patients studied in this series were consecutively enrolled. All of the surgeries were performed by a single surgeon. We divided our patients into two groups based on whether splenogastric ligament-entranced laparoscopic splenectomy (SLELS) was used. Data were collected retrospectively by chart review.Results
The patients in the two groups had comparable demographic characteristics. Patients who underwent LS with SLELS (group 2) required less operating time (195.2 ± 45.8 vs. 227.7 ± 52.1 min, p = 0.042) and suffered less blood loss (160.4 ± 107.6 vs. 270.1 ± 231.2 ml, p = 0.031). No significant difference was found in terms of blood transfusion, conversion, postoperative hospital stay, and complications.Conclusions
It is safe and feasible to perform LS on patients with hypersplenism secondary to liver cirrhosis. In the procedure of SLELS, we highlight the importance of sufficient elevation the upper pole of the spleen. 相似文献12.
Satoru Tamura Shunsaku Nishihara Masaki Takao Takashi Sakai Hidenobu Miki Nobuhiko Sugano 《The Journal of arthroplasty》2017,32(3):877-882
Background
Functional anteversion and inclination of the cup change as the pelvic sagittal inclination (PSI) changes. The purposes of this study were to investigate the chronological changes of PSI during a 10-year follow-up period after total hip arthroplasty (THA) and to report the characteristics of patients who showed a greater than 10° change in the PSI from the supine to the standing position.Methods
The subjects were 70 patients who were followed up for 10 years after THA. PSI values in the supine and standing positions were measured by 2D-3D matching using computed tomography images and pelvic radiographs. PSI values before THA and 1, 5, and 10 years after THA were compared in both the supine and standing positions.Results
Supine PSI showed less than 5° of change, whereas standing PSI showed a significant decrease with time over the 10-year period. Although 43% of patients with less than 10° of difference in the PSI between the supine and standing positions before THA increased PSI posteriorly (reclining) more than 10° in standing from the supine position at 10 years, no late dislocation was observed.Conclusion
Supine PSI showed no significant change, but standing PSI showed a significant increase posteriorly with time over a 10-year period. However, this PSI change did not reach the level that it caused negative consequences such as late dislocation. The pelvic position in the supine position might still be a good functional reference position of the pelvis for aiming to achieve proper cup alignment at 10 years. 相似文献13.
Chin-Ta Lin Kuo-Feng Hsu Teng-Wei Chen Jyh-Cherng Yu De-Chuan Chan Chih-Yung Yu Tsai-Yuan Hsieh Hsiu-Lung Fan Shih-Ming Kuo Kuo-Piao Chung Chung-Bao Hsieh 《World journal of surgery》2010,34(9):2155-2161
Background
Compared to transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC), stage B in the Barcelona Clinic Liver Cancer (BCLC) classification, the role of hepatic resection remains unclear. The present study compared the long-term outcome of hepatic resection with TACE in the treatment of BCLC stage B HCC.Methods
A total of 171 patients with BCLC stage B, Child’s classification A (Child A), HCC were included in this retrospective study. Of these, 93 patients underwent hepatic resection (group I) and 73 patients received TACE (group II). We evaluated the long-term outcome and therapy-related mortality in both groups. The risk factors of mortality were assessed. The survival curve was analyzed by the Kaplan–Meier method.Results
The 1-, 2-, and 3-year overall survival rates for the two groups after hepatic resection and TACE were 83%, 62%, 49% and 39%, 5%, 2%, respectively (P < 0.0001). We did not observe significant differences in the therapy-related mortality between the two groups (P = 0.78). Treatment modality and serum albumin level were independent risk factors for survival by Cox regression analysis.Conclusions
Our study demonstrated that hepatic resection for BCLC stage B, Child A HCC patients had better survival rates than TACE group. Thus, hepatic resection is indicated in selected patients with BCLC stage B. 相似文献14.
Salvatore Pucciarelli MD Giuseppe Gagliardi MD Isacco Maretto MD Sara Lonardi MD Maria Luisa Friso MD Emanuele Urso MD Paola Toppan MD Donato Nitti MD 《Annals of surgical oncology》2009,16(4):893-899
Background This study sought to evaluate the long-term outcome and complications, and occurrence of second malignancy after preoperative
chemoradiotherapy (pCRT) for rectal cancer.
Methods One hundred twenty-three consecutive patients (78 men, 45 women) with locally advanced mid-low rectal cancer underwent pCRT
between 1994 and 2002. Patients were followed up by one surgeon with a standard protocol, and data were prospectively recorded
in a dedicated database. No patient was lost to follow-up. Complications were defined as late if they occurred >6 months after
surgery. Overall and disease-free survival were calculated by the Kaplan-Meier method.
Results Of 123 patients, 111 underwent an R0 procedure. The rate of pathologic complete response was 16% (n = 20 patients). At a median follow-up of 95 (range, 56–160) months, 50 late complications occurred in 41 patients, 21 of
whom required surgery. In seven cases, the complications were clearly CRT related and were significantly associated with the
total dose of radiation delivered (P < .05). The estimated 5- and 10-year overall survival was 76% and 67%, respectively. The estimated 5- and 10-year disease-free
survival was 83% and 82%, respectively. In 18 of 19 patients who experienced recurrence (local, n = 3; distant, n = 16), it occurred within 48 months from surgery. The most frequent site of metastasis as first site of recurrence was the
lung (9 of 19). The most frequent second primary malignancy was lung cancer (3 of 8).
Conclusions Despite satisfactory oncological outcome, late morbidity after pCRT is relevant and related to the radiotherapy dose used.
Most recurrences and second malignancies were located in the lung. 相似文献
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Brian K. P. Goh London L. P. J. Ooi Peng-Chung Cheow Yu-Meng Tan Hock-Soo Ong Yaw-Fui A. Chung Pierce K. H. Chow Wai-Keong Wong Khee-Chee Soo 《Journal of gastrointestinal surgery》2009,13(6):1071-1077
Introduction Presently, the need for and choice of preoperative localization tests for insulinomas remain controversial. We report the
results from a single institution experience whereby the management policy adopted was that of accurate preoperative localization
before surgical exploration.
Materials and Methods From 1990 to 2008, 17 patients with a clinical and biochemical diagnosis of an insulinoma who underwent surgery were retrospectively
reviewed. The diagnosis of all insulinomas were confirmed pathologically.
Results All tumors were localized preoperatively and an average of 2.2 preoperative localization studies including 1.4 noninvasive
studies and 0.8 invasive studies were utilized per patient. Invasive localization modalities were more sensitive (92%) than
noninvasive modalities in localizing insulinomas (71%). Intra-arterial calcium stimulation with hepatic venous sampling was
the most sensitive invasive modality (100%), whereas magnetic resonance imaging was the most sensitive noninvasive modality
(63%). Fifteen of 17 tumors (88%) were localized intraoperatively via inspection/palpation and/or intraoperative ultrasonography.
Both insulinomas which were not localized intraoperatively were localized correctly to the distal pancreas via preoperative
transhepatic portal venous sampling. None of the patients required a blind resection or surgical reexploration for failed
localization. All 17 patients underwent complete surgical resection which included eight enucleations and nine distal pancreatectomies
with a cure rate of 94% (16/17) at a median follow-up of 35 (range, 1–217) months. The postoperative morbidity and long-term
outcome of enucleation was similar to distal pancreatectomy despite a higher rate of microscopic margin involvement.
Conclusion Accurate preoperative localization of insulinomas is useful as it eliminates the need for blind distal pancreatectomy and
avoids reoperation. Complete surgical resection is the treatment of choice, and whenever possible, a pancreas-sparing approach
such as enucleation should be adopted. 相似文献
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Skye C. Mayo Andrew D. Shore Hari Nathan Barish Edil Christopher L. Wolfgang Kenzo Hirose Joseph Herman Richard D. Schulick Michael A. Choti Timothy M. Pawlik 《Journal of gastrointestinal surgery》2010,14(10):1578-1591
Introduction
National Comprehensive Cancer Network (NCCN) guidelines recommend hepatic resection and lymphadenectomy (LND) for gallbladder adenocarcinoma (GBA). We sought to evaluate compliance with these recommendations and to assess trends in the management and survival of patients with GBA. 相似文献17.
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Christos Karefylakis Ingmar Näslund David Edholm Magnus Sundbom F. Anders Karlsson Eva Rask 《Obesity surgery》2014,24(3):343-348
Background
The primary aim of this study was to evaluate the prevalence of vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass. Secondly, we have tried to assess predictors for vitamin D deficiency.Methods
Five hundred thirty-seven patients who underwent primary Roux-en-Y gastric bypass surgery between 1993 and 2003 at the Örebro University Hospital and Uppsala University Hospital were eligible for the study. Patients were asked to provide a blood sample between November 2009 and June 2010 and to complete a questionnaire about their postoperative health status. Serum values of 25-OH vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium were determined.Results
Follow-up was completed in 293 patients, of which 83 % were female, with an age of 49?±?9.9 years after a median time of 11?±?2.8 years. Vitamin D, PTH and albumin-corrected calcium values were 42?±?20.4 nmol/L, 89.1?±?52.7 ng/L and 2.3?±?0.1 mmol/L, respectively. Of all patients, 65 % were vitamin D deficient, i.e. 25-OH vitamin D <50 nmol/L, and 69 % had PTH above the upper normal reference range, i.e. >73 ng/L. Vitamin D was inversely correlated with PTH levels (p?<?0.001) and positively correlated with calcium (p?=?0.016). Vitamin D did not correlate with ALP. The only factor found to predict vitamin D deficiency was high preoperative body mass index (BMI) (p?=?0.008), whereas gender, age, time after surgery and BMI at follow-up did not.Conclusions
Vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass (RYGB) were confirmed in our study because 65 % of patients had vitamin D deficiency, and 69 % had increased PTH levels more than 10 years after surgery. These data are alarming and highlight the need for improved long-term follow-up. Vitamin D deficiency does not seem to progress with time after surgery, possibly due to weight loss. Only preoperative BMI, cutoff point 43 kg/m2, was a predictor of vitamin D deficiency at follow-up. Improved long-term follow-up of patients that undergo RYGB is needed. 相似文献19.
da Rocha JR Ribeiro U Sallum RA Szachnowicz S Cecconello I 《Annals of surgical oncology》2008,15(10):2903-2909
Background Subtotal esophagectomy and gastric pull-up with cervical anastomosis is the main treatment for advanced achalasia. This surgical
technique has been associated to esophagitis and also Barrett’s epithelium following esophagectomy.
Aim To analyze late clinical, endoscopic, and pathologic findings in the esophageal stump (ES) mucosa after subtotal esophagectomy
in patients treated for advanced chagasic achalasia.
Methods 101 patients submitted to esophagectomy and cervical gastroplasty were followed-up prospectively for a mean of 10.5 ± 8.8 years.
All patients underwent clinical, endoscopic and histopathological evaluation every 2 years. Gastric acid secretion was also
assessed.
Results The incidence of esophagitis in the esophageal stump (45.9% at 1 year; 71.9% at 5 years, and 70.0% at 10 years follow-up);
gastritis in the transposed stomach (20.4% at 1 year, 31.0% at 5 years, and 40.0% at 10 or more years follow-up), and the
occurrence of ectopic columnar metaplasia and Barrett’s Esophagus in the ES (none until 1 year; 10.9% between 1 and 5 years;
29.5% between 5 and 10 years; and 57.5% at 10 or more years follow-up), all rose over time. Gastric acid secretion returns
to its preoperative values 4 years postoperatively. Esophageal stump cancer was detected in the setting of chronic esophagitis
in five patients: three squamous cell carcinomas and two adenocarcinomas.
Conclusion (1) Esophagitis and Barrett’s esophagus in the esophageal stump rose over time. (2) These mucosal alterations and the development
of squamous cell carcinoma and adenocarcinoma are probably due to exposure to duodenogastric reflux, and progressively higher
acid output in the transposed stomach. 相似文献