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《Surgery for obesity and related diseases》2019,15(6):822-826
BackgroundBile reflux is a factor in the appearance of severe esophagitis and Barrett’s esophagus, which have been reported after sleeve gastrectomy (SG). Incompetent lower esophageal sphincter and increased gastroesophageal acid reflux have been demonstrated after this operation. Some reports have shown bile content in the antrum during endoscopic control, but no investigations objectively confirm the presence of duodenogastric bile reflux in these patients.ObjectivesTo evaluate the presence of duodenogastric bile reflux (DGR) after SG in patients presenting reflux symptoms.SettingUniversity hospital.MethodsProspective study of 22 patients presenting reflux symptoms who underwent SG for morbid obesity and who received endoscopic evaluation and scintigraphic study to confirm esophagitis and duodenogastric bile reflux.ResultsErosive esophagitis was observed in 11 patients and Barrett’s esophagus in 2 patients. Seven patients (31.8%) presented positive DGR. Among them, 3 had type B and C esophagitis. The other 4 patients did not present esophagitis in spite of reflux symptoms.ConclusionDGR may be present in patients with gastroesophageal reflux after SG. This line of investigation requires further studies to confirm this hypothesis. 相似文献
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胆囊切除后十二指肠胃反流的临床研究 总被引:9,自引:0,他引:9
本研究通过检测14例胆囊结石病人胆囊切除术前后胃内胆酸含量,发现其十二指肠胃反流(DGR)发生率分别为8571%和100%,正常对照组为2143%,差异显著(P<0.01);同时检测手术前后血清胃泌素分别为16295±5628pg/ml、147.87±37.61pg/ml,均显著高于对照组10505±26.85pg/ml,而基础胃酸排量、最高胃酸排量与对照组比较无明显差异。作者分析,此种病人胃肠道激素改变是影响Oddi括约肌运动状态和胃-幽门-十二指肠协调运动的主要因素,亦即是引起DGR的基本原因,也是胆囊切除术后综合征的原因之一,其治疗可选用促胃肠动力药物。 相似文献
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Background: This article reports the technical aspects of laparoscopic choledochoduodenostomy (LCD) in patients with recurrent pyogenic cholangitis (RPC) and the perioperative results are also evaluated. This is a retrospective review of a prospectively maintained database. Methods: Twelve patients diagnosed to have RPC with the absence of intrahepatic stricture were selected for LCD during the period from 1995 to 2002. The majority of our patients had repeated attacks of cholangitis and had already undergone multiple sessions of endoscopic and operative lithotripsy. The LCD was performed using a five-port approach with the patient lying in the supine position. The stones were first cleared through the longitudinal supraduodenal choledochotomy followed by construction of a side-to-side diamond-shaped anastomosis of at least 15 mm between the bile duct and the first part of the duodenum using 2/0 monocryl in the single-layer method. Results: During the period from 1995 to 2002, 12 patients with RPC underwent LCD. There were 3 male and 9 female patients with a mean age of 62 (40–77). The median operation time was 137.5 min (90–270) and the median postoperative stay was 7.5 days (5–20). All cases were successful using the laparoscopic approach. Average analgesic requirement post operation was 126 mg (50–200 mg) intramuscular pethidine. There was one postoperative bile leak, and this complication was settled by conservative measures. Upon a mean follow-up of 37.6 months (6–91), there was no recurrent attack of cholangitis or any evidence of sump syndrome in this group of patients. Conclusion: LCD is a safe and effective drainage procedure for patients with RPC. Complications are uncommon and postoperative results are promising. 相似文献
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H. Wykypiel M. Gadenstätter F. A. Granderath P. J. Klingler G. J. Wetscher 《European Surgery》2002,34(5):296-302
Summary
Background: Gastro-oesophageal reflux disease has a complex pathophysiology. Therefore, therapeutic considerations should not only include
the peptic component of the disease.
Methods: A variety of studies in rats and in humans demonstrate the consequences of gastro-oesophageal reflux and medical and surgical
interventions in terms of inflammation, epithelial growth stimulation, apoptosis and oxidative stress in the epithelium of
the oesophagus.
Results: Gastro-oesophageal reflux disease consists of a variety of pathophysiologically important factors. These include changes
in the anatomy, gastro-oesophageal motility, epithelial growth, inflammation, apoptosis and molecular structure and may lead
to carcinogenesis. Surgery restores the antireflux barrier and improves oesophageal and gastric motility, thus preventing
the consequences of the disease.
Conclusions: Antireflux surgery provides a causative therapy of gastrointestinal reflux disease.
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Ia V Goer N I Tutchenko A V Solomko G G Roshchin 《Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukra?ny, Naukove tovarystvo khirurhiv Ukra?ny》1990,(8):34-36
On the basis of treatment of 105 patients operated on for complicated duodenal ulcer disease, it was established that performance of the organ-preserving operation with the ulcer excision supplemented with the pylorus-restoring and pylorus-preserving intervention permitted to reduce considerably the incidence of duodenogastric reflux. 相似文献
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Takahiko Funabiki Yoichi Sakurai Masahiro Ochiai Yoshihisa Marugami Toshiki Matsubara Shigeru Hasegawa 《Journal of Hepato-Biliary-Pancreatic Surgery》1997,4(1):71-77
End-to-side choledochoduodenostomy was originally used for reconstruction between the duodenum and the biliary tree in iatrogenic bile duct stricture. However, we believe the procedure could be applied for various biliary disorders. We have recently shown the high carcinogenicity of biliary epithelium in patients with pancreaticobiliary maljunction, and consequently we recommend excision of the bile duct, along with appropriate reconstruction of the biliary system to divert the flow of pancreatic juice from bile fluid, to prevent carcinoma in biliary epithelium even in patients without dilatation of the bile duct. The conditions causing primary or recurrent bile duct stones must be removed. We employed this procedure for biliary reconstruction in 42 patients with pancreatico-biliary maljunction and in 30 patients with various benign biliary diseases, such as bile duct stones and benign biliary stenosis. We also used the procedure for palliation in 6 patients with malignant tumors around the head of the pancreas. Among these 78 patients over 20 years, we experienced 5 cases of reflux cholangitis with anastomotic stenosis, for which conservative dilatation was required. This procedure of end-to-side choledochoduodenostomy could be widely applicable for biliary reconstruction in terms of its being simplicity, minimal invasiveness and the establishment of a single physiological route for bile flow into the duodenum. 相似文献
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目的 探讨食管癌和贲门癌术后酸反流和十二指肠胃食管反流(DGER)的相互关系、反流特征以及对食管黏膜的损伤作用.方法 对32例食管癌和贲门癌术后病人进行烧心、反酸症状调查,应用电子胃镜检查、24 h食管pH和胆红素同步监测.结果 (1)胃食管反流症状的发生率65.6%,反流性食管炎的发生率为75.0%,其中2例发生Barrett食管,发生率为6.25%.(2)24 h食管pH和胆红素监测结果显示,28.1%的病人仅存在酸反流,15.6%仪存在DGER,53.1%同时有酸反流和DGER.DeMeeste评分与abs>0.14的时间百分比无明显的相关性(P=0.3109).平卧位pH<4.00的时间百分比和abs>0.14的时问百分比明显高于直立位(P<0.05).(3)通过比较在不同pH区间内胆红素的吸收率,显示在pH 3~6的区间内,胆红素abs>0.14的时间百分比明显高于其他区间(P<0.05).(4)DeMeester评分和胆红素abs>0.14的时间百分比与反流症状评分无明显的相关(P>0.05),与反流性食管炎评分呈正相关(P<0.05).结论 食管癌和贲门癌术后存在广泛的酸反流和DGER,反流形式以混合性反流为主(同时出现酸反流和DGER),混合性反流对食管黏膜的损伤作用更严重.酸反流和DGER均受体位影响.24 h食管pH和胆红素同步监测有助于揭示反流特征及反流物对食管黏膜的损伤作用. 相似文献
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Gastric emptying time,not enterogastric reflux,is related to symptoms after upper gastrointestinal/biliary surgery 总被引:2,自引:0,他引:2
Stavraka A Madan AK Frantzides CT Apostolopoulos D Vlontzou E 《American journal of surgery》2002,184(6):596-9; discussion 599-600
BACKGROUND: It has been suggested that symptoms from bile reflux gastritis are related to the frequency and degree of enterogastric reflux (EGR). METHODS: Patients with history of upper gastrointestinal surgery or cholecystectomy as well as control patients were studied. Presence of EGR, degree of EGR, and gastric bile emptying time were assessed and quantified via 99mTC scintillation imaging and then compared between symptomatic and asymptomatic patients. RESULTS: Patients with vagotomy and pyloroplasty, Billroth I, Billroth II, and cholecystectomy demonstrated statistically higher degrees of EGR compared with controls. Although asymptomatic and symptomatic patients with a history of upper gastrointestinal or biliary surgery demonstrated no statistically significant differences between incidence of EGR and degree of EGR, there was a statistically significant difference in gastric emptying time. CONCLUSIONS: Delayed gastric emptying time, not frequency or extent of EGR, was associated with the symptoms of bile reflux in patients who had previous upper gastrointestinal or biliary operations. 相似文献
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This study reviews current data regarding duodenogastric and gastroesophageal bile reflux-pathophysiology, clinical presentation, methods of diagnosis (namely, 24-hour intraluminal bile monitoring) and therapeutic management. Duodenogastric reflux (DGR) consists of retrograde passage of alkaline duodenal contents into the stomach; it may occur due to antroduodenal motility disorder (primary DGR) or may arise following surgical alteration of gastoduodenal anatomy or because of biliary pathology (secondary DGR). Pathologic DGR may generate symptoms of epigastric pain, nausea, and bilious vomiting. In patients with concomitant gastroesophageal reflux, the backwash of duodenal content into the lower esophagus can cause mixed (alkaline and acid) reflux esophagitis, and lead, in turn, to esophageal mucosal damage such as Barrett's metaplasia and adenocarcinoma. The treatment of DGR is difficult, non-specific, and relatively ineffective in controlling symptoms. Proton pump inhibitors decrease the upstream effects of DGR on the esophagus by decreasing the volume of secretions; promotility agents diminish gastric exposure to duodenal secretions by improving gastric emptying. In patients with severe reflux resistant to medical therapy, a duodenal diversion operation such as the duodenal switch procedure may be indicated. 相似文献
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Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty 总被引:1,自引:0,他引:1
D Lorusso F Pezzolla C Montesani P Giorgio M L Caruso A Cavallini V Guerra G Misciagna 《The British journal of surgery》1990,77(11):1305-1307
Sixteen patients who had undergone cholecystectomy plus sphincteroplasty, 14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids (by an enzymatic method) and single bile acids in the gastric juice by high performance liquid chromatography. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. There was a statistically significant difference in fasting bile reflux between the three groups (Kruskal-Wallis test, P less than 0.001), and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group (P less than 0.05) and the control group (P less than 0.01). The distribution of chronic antral atrophic and superficial gastritis was different in the three groups (chi 2 test, P less than 0.005). Chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty (P less than 0.01), while chronic superficial gastritis was more frequent in cholecystectomized patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone, and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage. 相似文献
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Li WangAn ping Su PhD Yi ZhangMin Yang MD Peng ju YueBo le Tian PhD 《The Journal of surgical research》2014
Background
The incidence of alkaline reflux gastritis (ARG) after pancreaticoduodenectomy (PD) is high. Although Braun enteroenterostomy (BEE) may reduce ARG, BEE may result in marginal ulcers (MUs) due to the additional anastomotic stoma. We conducted this study to compare clinical outcomes of using a modified BEE (MBEE) with traditional gastrojejunostomy (TGJ), by inducting a purse-string suture instead of an additional anastomotic stoma.Materials and methods
All 62 patients underwent standard PD at the Department of Hepatobiliopancreatic Surgery of West China Hospital between January 1, 2008 and January 31, 2012. Demographics, perioperative and postoperative factors, and follow-up morbidity were compared in those patients who underwent MBEE (n = 32, three patients were lost to follow-up) to those who underwent TGJ (n = 30, nine patients were lost to follow-up).Results
Patients who underwent the MBEE experienced a decrease in total morbidity including ARG and MUs, relative to those who underwent TGJ (24.1% versus 58.3%, P = 0.011). With regard to the MBEE group, the total ARG rate was statistically significantly lower compared with the TGJ group (13.8% versus 37.5%, P = 0.046). In addition, the incidence of MUs was reduced.Conclusions
In patients undergoing PD, the MBEE was safely performed with significantly more patients having reduced incidence of ARG and related sequela compared with those who underwent TGJ. These results support further study of patients undergoing gastroenterostomy after resection of the distal stomach in larger, randomized studies. 相似文献17.
胃食管吻合术后胃食管反流的研究 总被引:26,自引:2,他引:24
目的 研究食管癌和贲门癌术后不同位置的食管胃吻合口和时间因素对胃食管反流程度的影响。方法 对39例食管癌和贲门癌术后病人进行24h食管pH监测、电子胃镜检查,其中食管胃弓上吻合组(A组)21例,弓下吻合组(B组)18例。结果 (1)A组DeMeester评分和反流性食管炎评分均明显低于B组(P〈0.05)。(2)随着时间的推移A组和B组DeMeester评分无明显的改变(P〉0.05)。结论 不同位置的食管胃吻合口影响胃食管反流程度,食管胃吻合口位置越高胃食管反流和反流性食管炎程度越轻。时间因素对胃食管反流程度无明显的影响。 相似文献
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