不同术式治疗慢传输型便秘的疗效比较

为探讨不同术式治疗慢传输型便秘的疗效及手术适应症,对40例经结肠慢传输试验确诊为慢传输型便秘的患者行手术治疗,其中11例行全结肠切除回肠直肠吻合术,18例行结肠次全切除升结肠直肠吻合术,6例行结肠区段切除术,5例行扩大的左半结肠切除术,并对其疗效及并发症进行统计分析。结果显示,采用不同术式治疗,患者取得不同的治疗效果,并存在不同的特点。（1）全结肠切除回肠直肠吻合术组有效率为90．9％,结肠次全切除升结肠直肠吻合术组有效率为94．4％,后者高于前者,但差异无统计学意义,P〉0．05。两组手术时间与肠功能恢复时间差异无统计学意义,P〉0．05;但结肠次全切除升结肠直肠吻合术术中失血量、膀胱功能恢复、术后并发症（顽固性腹泻、尿潴留、肛门失禁、性功能障碍等）发生率均优于全结肠切除回肠直肠吻合术组,差异有统计学意义,P〈0．05。（2）结肠部分切除术组（结肠区段切除术组＋扩大的左半结肠切除术组）有效率为81．8％,低于结肠次全切除升结肠直肠吻合术组,P〈0．05;其术后复发率高于结肠次全切除升结肠直肠吻合术组,P〈0．05;手术时间、术中失血量、肠功能及膀胱功能恢复时间、术后并发症发生率均优于结肠次全切除升结肠直肠吻合术组,P〈0．05。结果表明,不同术式对慢传输型便秘均有一定的治疗作用,尤以结肠次全切除升结肠直肠吻合术最为有效,具体术式的选择应根据结肠慢传输试验、钡灌肠检查及患者个体情况决定。     

成人巨结肠类缘病急诊手术14例

目的：探讨成人巨结肠类缘病急诊手术中的诊断及治疗方法。方法：14例成人巨结肠类缘病急诊手术患者,10例行术中快速冰冻病理检查,9例行病变肠段切除一期吻合、回肠造口术,4例行病变肠段切除、结肠造口术,1例行全结肠切除一期吻合术。结果：14例中12例术后恢复顺利,2例出现术后胃瘫。结论：成人巨结肠类缘病急诊手术行病变肠段切除一期吻合术是安全可行的,术中快速冰冻病理检查、肠管腹壁造口及术者经验对手术成功至关重要。     

乙状结肠扭转的诊断及治疗(附57例分析)

目的：总结乙状结肠扭转的诊治经验。方法：对57例乙状结肠扭转患者的临床表现及治疗方法进行回顾性分析。结果：32例行腹部X线平片检查,其中28例明确诊断,19例系钡灌肠检查显示“鸟嘴征”而作出诊断,7例通过结肠镜检查获得诊断,3例经剖腹探查证实本病;4例误诊或漏诊。非手术疗法9例,7例成功,50例行手术治疗,其中乙状结肠单纯复位15例,乙状结肠复位后固定6例,一期切除吻合术19例,10例行一期坏死肠袢切除结肠造口、二期降结肠直肠吻合术。治愈53例,死亡4例,复发2例。结论：老年腹痛、腹胀和便秘应考虑本病的可能。X线为首选检查。对于无肠坏死及腹膜炎的患者,行结肠镜检查有明显优点,对于有肠坏死及腹膜炎的患者,应及时手术治疗,一期肠切除吻合术宜慎用。     

全结肠切除手术9例报告

９６９年～１９９４年，我院收治溃疡性结肠炎患者３例，Ｇａｒｄｎｅｒ综合征１例及家族性息肉病５例，其中男８例，女１例，年龄１８～５３岁，平均３８岁。术前均经钡灌肠及纤维结肠镜检查并经病理检查确诊。９例中６例行全结肠切除回肠直肠吻合术，３例行全结肠直肠切...     

慢传输型便秘合并成人巨结肠32例临床诊治

目的总结慢传输型便秘合并成人巨结肠的诊断和治疗经验。方法回顾性分析2007年10月至2011年6月收治的32例慢传输型便秘合并成人巨结肠患者的临床资料。结果32例患者中男15例,女17例,年龄18～56岁,均符合罗马Ⅲ便秘诊断标准。结肠传输试验提示结肠传输缓慢;钡灌肠及排粪造影提示肠管狭窄段位于横结肠3例,降结肠4例．直肠20例,横结肠或降结肠与直肠同时存在狭窄段5例;肛门直肠测压显示23例直肠肛门抑制反射消失,另9例未见异常。手术治疗行巨结肠切除、结肠部分切除、结肠结肠侧侧吻合术7例;巨结肠切除、结肠次全切除、结肠直肠下端改良Duhamel吻合术16例：结肠全切除、回肠储袋J-Poueh与直肠下端改良Duhamel吻合术9例。术后无并发症发生,随访3～47个月,18例患者排粪功能优,9例良,5例～般。结论慢传输型便秘临床诊治中应警惕合并成人巨结肠：详细询问病史和对辅助检查的综合分析是减少漏诊和误诊的关键。手术切除范围应包括病变的巨结肠和有慢传输的结肠．并按巨结肠根治术方式进行吻合。     

结肠脾曲综合征19例分析

目的：探讨结肠脾曲综合征的临床表现、诊断方法及治疗手段。方法：通过钡灌肠确诊,3例单纯性结肠脾曲综合征采用非手术治疗,16例症状严重的患者行手术治疗。结果：全组病人症状均缓解,无手术并发症发生。结论：结肠脾曲综合征诊断主要依据X线钡灌肠造影,手术是该病的有效治疗手段。     

手术对儿童非结肠无神经节细胞症和肛门直肠畸形所致顽固性便秘是否有意义?

作者回顾分析了匹兹堡儿童医院 1 996- 2 0 0 1年间 1 37例结肠和直肠动力学检查便秘患儿的病历 ,所有患儿均做了直肠活检、脊柱磁共振、结肠造影等检查 ,排除了解剖学异常及神经系统发育缺陷性疾病所致的顽固性便秘。其中 1 9例经内科治疗或顺行结肠灌肠法 ( Malond手术 ,3例 )不能缓解 (女 1 0例 ,7.6± 3.9岁 ) ,经结肠和肛门直肠测压评估异常者行手术治疗。结肠动力学异常分布及手术方法 :近端结肠异常行次全结肠切除一期吻合 2例 ;全结肠异常行全结肠切除术 2例 ;远端及乙状结肠异常 1 3例 ,其中行拖出式手术 5例 ,次全结肠切除并造口…     

小儿乙状结肠冗长症的诊治体会

目的：探讨小儿乙状结肠冗长症的诊断和治疗。方法：通过对收治9例乙状结肠冗长症的临床资料、钡灌肠辅助检查情况，保守治疗和手术治疗两种治疗方法进行分析。结果：保守治疗症状有改善，手术治疗效果满意。结论：小儿乙状结肠冗长症诊断首选钡灌肠，治疗方法首选非手术治疗，无效时，可采用乙状结肠直肠切除，降结断肠直肠斜形吻合。     

经脐和肛门自然腔道联合腹腔镜结肠次全切除一例

患儿,男,6个月.因生后腹胀、便秘而入住河北医科大学第二医院,术前经钡灌肠及肛管直肠测压诊断为先天性长段巨结肠症.X线造影显示其移行段达结肠脾曲,结肠继发扩张已达结肠肝曲.行腹腔镜监视下经肛门自然腔道直肠内拖出结肠次全切除术.     

改良式Duhamel术治疗先天性巨结肠42例报告

目的 报告改良式Duhamel术治疗先天性巨结肠症及其手术效果。方法 42例患儿经组织学检查或钡灌肠诊断为先天性巨结肠症；方法为切除扩张变性的结肠，于腹膜反折下横断直肠，直肠残端缝合关闭；探通直肠后隧道至齿状线水平，于直肠后壁齿状线上方0．5cm处横形切开直肠后壁，结肠近端拖出，结肠后壁与直肠后壁切开远端吻合；结肠前壁与直肠后壁用特制环钳钳夹吻合。结果 手术后环钳脱落时间平均为8d。无术中术后并发症。随访4个月～3年，除1例行全结肠切除患儿解稀便外，其他患儿大便均成形，2～4次／d。结论 改良式Duhamel术治疗先天性巨结肠症安全有效，远期效果满意。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.