全胃切除术后消化道重建术式探讨

目的：探讨全胃切除术后不同食管空肠吻合方式的治疗效果。方法：对56例施行全胃切除术患者的临床资料进行分析。对全胃切除后消化道重建分别采用食管空肠Roux-en-Y吻合术（16例）、P型空肠襻食管空肠Roux-en-Y吻合术（26例）和空肠贮袋食管空肠Roux-en-Y吻合术（14例）。观察患者术后1个月、6个月的营养状态和生活质量。结果：P型空肠襻组和空肠贮袋组术后1个月、6个月营养状态和生活质量较好。结论：P型空肠襻和空肠贮袋Roux-en-Y吻合术是全胃切除术后消化道重建比较理想的术式。     

保留胃窦的间置空肠双通道术式在食管胃结合部癌根治术中的应用探讨

目的探讨保留胃窦的间置空肠双通道术式在食管胃结合部癌(AEG)根治术中的临床应用价值。方法对66例SiewertⅡ、Ⅲ型食管胃结合部癌,分别采取保留胃窦的间置空肠双通道术式(28例)和全胃切除Roux-en-Y空肠食管吻合术式(38例),回顾性分析对比两组手术患者在手术时间、出血量、术后肠功能恢复时间以及术后并发症发生率等方面有无差异。结果保留胃窦的间置空肠双通道术式组,与全胃切除Roux-en-Y空肠食管吻合术组对比,除在术后肛门排气时间和进食流质时间两个方面略有差异外,无论在手术时间、术中出血量、住院时间以及术后早期并发症的发生率均无明显差异。此外,保留胃窦的间置空肠双通道术式组在术后的反流性食管炎发生也要低于全胃切除Roux-en-Y空肠食管吻合术组。随访6¹8个月,患者近期生活质量满意。结论保留胃窦的间置空肠双通道术式,因残胃有一定储袋作用,且进食具备双通道路径,能较好地预防反流性食管炎和倾倒综合征。同时,保留了十二指肠路径,能有效刺激胆汁分泌,降低胆结石的发生率。此外,此术式清扫、切除范围合理,手术创伤相对较小,是SiewertⅡ、Ⅲ型AEG根治术较理想的消化道重建方式之一。     

胃癌患者远端胃大部分切除术重建方法探讨

目的:探讨Roux-en-Y式食管空肠消化道重建术与BillrothⅠ式消化道重建术在胃癌患者远端胃大部分切除术中的应用。方法:选取我院2015年10月～2017年7月收治的胃癌行远端胃大部分切除术患者67例为研究对象,依据治疗方案不同分为A组33例与B组34例。A组行BillrothⅠ式消化道重建术,B组行Roux-en-Y式食管空肠消化道重建术,比较两组术后并发症发生情况、手术前后各营养指标及手术前后SF-36评分。结果:B组并发症发生率明显低于A组,P0.05;术后6个月B组血清总蛋白、白蛋白、血红蛋白水平均明显高于A组,P0.05;术后6个月,B组SF-36评分明显高于A组,P0.05。结论:与BillrothⅠ式消化道重建术相比,Roux-en-Y式食管空肠消化道重建术更有助于降低胃癌患者远端胃大部分切除术后并发症发生率,且可改善患者营养状况及生活质量。     

间置空肠消化道重建术对患者营养状况的影响

目的　评估间置空肠法(JIP)是否是一种理想的全胃切除后消化道重建术。方法　对 20 例 JIP组术后3~6个月的营养指标,肠道功能进行测评,同时与23例Roux-en-Y消化道重建术(RYP)组进行比较。结果　两组患者术后营养状况明显优于术前(P<0 01),JIP组较RYP组改善更明显(P<0 01)。结论　JIP法是全胃切除术后较为理想的消化道重建手术方式。     

胃空肠改良Roux-en-Y吻合术的应用体会

目的 探讨胃空肠Roux-en-Y吻合术改良术式的临床应用价值,选择更为合理的消化道重建方式.方法 2005年3月至2010年3月对42例胃十二指肠溃疡和胃癌患者采用改良Roux-en-Y吻合术术式,即胃空肠袢式吻合加Braun吻合,同时阻断空肠输入袢,完成消化道重建,并进行回顾性分析.结果 全组手术患者无死亡,术后无电解质紊乱,无明显碱性反流性胃炎,无吻合口瘘、溃疡、出血、狭窄,无Roux潴留综合征等并发症出现.结论 胃空肠改良Roux-en-Y吻合术将传统的Roux-en-Y吻合术与BillrothⅡ式吻合术相结合,并加以改良,操作简单,减少了术后并发症,提高了患者术后生存质量,是一种值得推广的手术方法.     

改良胃空肠Roux-en-Y吻合术临床探讨

目的:分析研究改良胃空肠Roux-en-Y吻合术的临床应用效果及其价值。方法:选取2012年3月²013年5月在我院接受治疗的60例胃肠疾病患者,随机分为观察组40例和对照组20例,观察组患者手术方式选择改良胃空肠Roux-en-Y吻合术,对照组手术方式为标准胃空肠Roux-en-Y吻合术,比较两组患者的手术时间、术中出血量及术后并发症情况。结果:观察组的手术时间、术中出血量、术后并发症发病率均优于对照组(P<0.05),具有统计学意义。结论:相比于以往标准的Roux-en-Y吻合术,改良后的胃空肠Roux-en-Y吻合术临床效果更加显著,具有手术时间短、创伤小、并发症发病率低的优点,值得临床推广和应用。     

全胃切除食管-空肠roux-en-y吻合术治疗37例进展期近端胃癌的临床研究

目的观察全胃切除食管-空肠roux-en-y吻合术在进展期近端胃癌中的应用价值。方法选取收治的进展期近端胃癌患者74例,根据手术方案分为对照组和试验组各37例。对照组给予近端胃切除-胃食管吻合术,试验组行全胃切除食管-空肠roux-en-y吻合术。观察对比两组手术时间、住院时间、术后排气时间、淋巴结清扫数目、并发症,并于术后6个月随访两组生活质量。结果试验组淋巴结清扫数目显著多于对照组(P0.05),两组术后排气时间、住院时间、手术时间比较,无显著差异(P0.05);试验组并发症发生率为10.81%,显著低于对照组的32.44%(P0.05);术后6个月随访,两组均无脱落病例,试验组生活质量与对照组比较,无显著差异(P0.05)。结论进展期近端胃癌采取全胃切除食管-空肠roux-en-y吻合术,可提高淋巴结清扫数目,降低并发症。     

胃癌全胃切除术后二种消化道重建术式的比较

目的探讨胃癌全胃切除术后消化道重建术式。方法68例胃癌患者全胃切除术后的消化道生建术式分为两组,I组采用P型食管空肠改良Roux—en-Y吻合术,Ⅱ组采用食管空肠吻合术,比较二种重建术式的临床效果。结果手术时间I组少于Ⅱ组,3个月后抗反流性食管炎作用、营养障碍I组好于Ⅱ组;术后1～2年两组患者生存率差异无统计学意义。结论P型食管空肠改良Roux-en—Y吻合术可促进术后患者消化功能,可作为全胃切除术后消化道重建术式的首选．     

胃癌全胃切除术后不同消化道重建术式的临床应用比较

目的比较并分析胃癌全胃切除术后不同消化道重建术式的临床应用效果和安全性,以找到最佳的消化道重建术式来延长患者的生命并提高患者的生活质量。方法选取我院2013年8月~2014年8月收治的胃癌且行全胃切除术后的患者100例,将其作为临床研究对象,采用随机数字表法将其分为两组,对照组采用袢式Braun吻合术进行消化道重建,试验组采用"p"式空肠袢空肠食管Roux-en-Y吻合术进行消化道重建,对比经过手术后,对患者的手术时间,术中出血量,住院时间以及手术不良反应和安全性进行比较。结果试验组的总有效为96.00%,对照组为70.00%,两组比较差异有统计学意义,P0.05。试验组不良反应发生率30.00%,对照组不良反应发生率56.00%,两组比较差异有统计学意义,P0.05。结论采用"p"式空肠袢空肠食管Roux-en-Y吻合术进行全胃切除术后消化道重建的临床效果较为明显,缓解了患者的消化障碍且整体过程安全可靠,患者以及患者家属较为满意,因此值得我们在临床上进行广泛应用。     

食管空肠Roux-en-Y吻合与间置空肠代胃在胃癌根治术后的应用效果比较

目的比较食管空肠Roux-en-Y吻合与间置空肠代胃在胃癌根治术后的应用效果及对患者消化道功能恢复的影响。方法将63例早期近端胃癌患者根据吻合方法不同分为A组(n=33)和B组(n=30)。A组给予根治性近端全胃切除+食管空肠Roux-en-Y吻合术,B组给予根治性近端胃大部切除+食管残胃间置空肠代胃治疗。比较两组的手术指标、术后胃肠功能恢复指标、营养状况、血清胃肠激素水平、胃肠道症状评分和并发症发生情况。结果B组的手术时间长于A组,消化道重建时间、肠鸣音恢复时间、肛门排气时间、术后首次进流食时间、住院时间均短于A组,术中出血量少于A组,淋巴结清扫数目多于A组(P<0.05)。术后10 d,两组的血红蛋白、总蛋白、血清胃泌素、胃动素水平均低于术前,但B组高于A组(P<0.05);术后半年,两组的血红蛋白、总蛋白水平高于术后10 d,血清胃泌素、胃动素水平低于术后10 d,但B组均高于A组(P<0.05)。术后3、6个月,两组的胃肠道症状评分均低于术前,且B组低于A组(P<0.05)。两组的并发症总发生率无显著差异(P>0.05)。结论根治性近端胃大部切除+食管残胃间置空肠代胃治疗胃癌患者,可明显改善消化道功能,提高术后营养状况,且对胃肠激素水平影响较小。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.