共查询到20条相似文献,搜索用时 15 毫秒
1.
腹腔镜 Nissen胃底折叠术联合高选择性迷走神经切断术与
传统腹腔镜 Nissen胃底折叠术治疗胃食管返流病的临床疗效比较 总被引:1,自引:0,他引:1
目的:比较腹腔镜 Nissen胃底折叠术(LNF)联合高选择性迷走神经切断术(HS
V)(LNFHSV)与传统LNF治疗胃食管反流病(GERD)的临床效果,为LNFHSV的临床应用提供参考。
方法:选择实施 LNFHSV 的GERD 22例患者的临床资料,以同期实施LNF的36例GERD患者作为
对照,比较2组患者的平均手术时间、术中平均出血量、平均住院时间、术后恢复进食时间
和术后主要并发症发生率、烧心严重程度评分和术后Demeester评分等临床指标。 结果:2
组患者术中平均出血量、平均住院时间、术后恢复进食时间和术后主要并发症发生率比较差
异无统计学意义(P>0.05);LNFHSV组患者手术时间明显长于LNF组(P<0.05);LNFHSV组患者
术后烧心严重程度评分和Demeester评分明显优于LNF组(P<0.05)。结论: LNFHSV是
治疗GERD,尤其是伴有高胃酸分泌的GERD患者的有效手术方式,其治疗效果优于LNF。 相似文献
2.
目的观察腹腔镜Nissen胃底折叠术过程中不同年龄患儿的呼吸和循环功能的变化。方法33例接受Nissen胃底折叠术的患儿按年龄分为三组。Ⅰ组(n=13):1~12月;Ⅱ组(n=10):1~3岁;Ⅲ组(n=10):4~7岁。于气腹前5 min(T0)、气腹后10 min(T1)、气腹后60 min(T2)及停止气腹10 min(T3),分别记录各组患儿的心率(HR)、平均动脉压、气道峰压(Ppeak)、呼吸系统静态总顺应性(CRS)、呼气末二氧化碳分压(PETCO2)和动脉二氧化碳分压(PaCO2)等血气分析指标。结果与T0点比较,各组T1、T2点的HR、PETCO2、PaCO2与PETCO2的差值(Pa-ETCO2)和Ppeak均显著增高,CRS显著降低,三组中Ⅰ组的变化最为显著。结论在腹腔镜Nissen胃底折叠手术过程中,患儿的呼吸和循环功能均发生改变,其中1~12月龄患儿的变化最为显著,需加强麻醉管理。 相似文献
3.
目的 比较腹腔镜与开腹直肠癌手术治疗的近期疗效.方法 回顾性分析2009年1月至2012年3月首都医科大学附属北京友谊医院普外科直肠癌手术病例共138例,其中,腹腔镜手术82例,开腹手术56例,对比2组手术的近期疗效,包括手术根治性、术中情况、术后恢复情况及术后合并症等几方面.结果 腹腔镜组与开腹组术中出血分别为(103.0±93.1)mL和(158.0±130.1)mL,术后使用镇痛人数分别为18(22.0%)和29(51.8%),术后排气时间分别为(2.4±0.6)d和(2.8±0.9)d,术后排便时间分别为(3.3±1.0)d和(3.7±1.3)d,术后进食时间分别为(3.8±1.3)d和(4.6±2.0)d,住院时间分别为(19.6±7.1)d和(22.0±9.1)d,术后合并症发生率分别为14(17.1%)和21(37.5%),以上各项指标比较,差异均有统计学意义(P〈0.05),其余各项指标之间比较,差异无统计学意义.结论 腹腔镜直肠癌手术具有同开腹手术相同的根治效果,而且具有住院时间短、术中出血少、术后疼痛轻、胃肠功能恢复快及术后合并症少等优势. 相似文献
4.
目的:探讨腹腔镜下Heller肌切开加Dor胃底折叠术治疗贲门失迟缓症的治疗效果以及折叠术对术后返流症状的预防作用。方法:回顾性分析我院自2010年12月至2012年7月行腹腔镜下Heller肌切开加Dor胃底折叠术治疗贲门失迟缓症的患者资料,随访患者术后吞咽困难、反酸等症状,总结临床体会。结果:10例贲门失弛缓症患者顺利完成腹腔镜下Heller肌切开术并加做胃底折叠术,患者平均住院天数(13.2±4.1)d,术后住院天数(7.1±2.6)d,术中出血(5.2±1.9)mL,手术时间(78.5±26.8)min;术后无1人死亡,随访患者1例6个月时出现反酸症状,1例1年后出现吞咽困难症状。结论:腹腔镜下heller肌切开加Dor胃底折叠术应作为治疗贲门失迟缓症推荐方式。 相似文献
5.
目的 探讨妊娠期糖尿病及妊娠期糖耐量受损对母婴结局的影响.方法 2012年3~12月于我院定期产检的孕妇,葡萄糖筛查确诊为妊娠期糖耐量受损(GIGT组)140例,妊娠期糖尿病(GDM组)99例,选择同期住院无合并症的正常孕妇200例作为对照组.比较GIGT、GDM和正常孕妇的母婴结局.结果 GIGT组和GDM组孕妇中妊高症、早产、胎膜早破、羊水过多及产前感染发生率均明显高于对照组,差异有统计学意义(P<0.05);围生儿中低血糖、巨大儿、感染、新生儿窒息、畸形的发生率均明显高于对照组,差异有统计学意义(P<0.05).GIGT与GDM对妊娠结局的影响结果相似.结论 GIGT和GDM均影响孕妇及围生儿结局,导致母婴近期远期严重并发症的重要因素,对所有孕妇及时进行糖尿病筛查,及早发现、治疗,控制血糖于正常水平,能有效地降低母婴并发症的发生. 相似文献
6.
Hiroyuki Hanayama Masanori Katagata Takahiro Sato Hiroshi Nakano Takuro Matsumoto Takeshi Tada Yohei Watanabe Suguru Hayase Hirokazu Okayama Tomoyuki Momma Tsunetaka Kato Minami Hashimoto Jun Nakamura Takuto Hikichi Zenichiro Saze Koji Kono 《Fukushima journal of medical science》2022,68(3):169
Background: Laparoscopic and endoscopic cooperative surgery (LECS) is a well-recognized surgical procedure for gastric gastrointestinal stromal tumor (GIST). In this report, we describe the clinical outcomes of LECS procedures for gastric GIST in our institution. Methods: We performed LECS procedures, including classical LECS, inverted LECS, closed LECS, and combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), in 40 gastric intraluminal and intramural type GIST patients, whose tumors were ≤ 50 mm in diameter, between September 2012 and December 2020. The patient background, surgical outcomes, postoperative morbidity and mortality, as well as the tumors’ clinicopathological characteristics were analyzed retrospectively. Results: Pathological findings showed that most patients had a low or very low risk of tumor recurrence, while one patient had a high risk according to the modified-Fletcher’s classification. The median length of postoperative hospital stay was 7 days. Only one patient had severe postoperative grade III complications according to the Clavien-Dindo (C-D) classification, after closed LECS, but was treated successfully with endoscopic hemostasis for postoperative hemorrhage. The remaining patients treated with LECS did not have severe complications. During the follow-up period (median, 31 months), all patients were disease-free, with no tumor recurrence or metastases. Conclusion: LECS is a safe surgical procedure for gastric intraluminal and intramural type GIST ≤ 50 mm in diameter, with good clinical outcomes. 相似文献
7.
Thebeneficialeffectofcarotidendarterectomy (CEA)inpatientswithseverecarotidstenosishasbeenwelldocumentedinprospectiverandomizedcontrolledtrials ,1,2andthenumberofCEAproceduresperformedintheWesthasbeenincreasingsincethattime 3,4 Itisnowthemostcommonperiphe… 相似文献
8.
目的 探讨腹腔镜下膀胱全切除原位回肠代膀胱术的围术期护理体会.方法 本组针对24例膀胱癌患者,均行腹腔镜下膀胱全切除原位回肠代膀胱术,并将其随机分为对照组及实验组,每组12例,对照组实施常规护理干预,实验组实施针对性围术期护理干预,比较分析治疗及护理效果.结果 两组患者复发率及患者满意度有显著差异(P<0.05).结论 加强围术期护理对腹腔镜下膀胱全切除原位回肠代膀胱术意义重大,值得推广应用. 相似文献
9.
目的评价经腹Heller手术附加Dor部分胃底折叠术治疗贲门失弛缓症的疗效,比较不同胃壁肌层切开长度对术后疗效的影响。方法回顾性分析1983年12月-2010年1月间经腹Heller手术附加部分胃底折卺术治疗的56例贲门失弛缓症患者的临床资料。患者按照胃壁肌层的切开长度分为A组(胃壁肌层切开长度〈2cm组)和B组(胃壁肌层长度≥2cm组),比较两组患者手术治疗后的症状评分、胃食管返流情况及食管末端直径变化。结果56例随访6个月~5年,无同手术期死亡和严重并发症。术后6~18个月评分优良者53例,症状改善者3例。术后5例m现反流症状。两组的疗效评分和胃食管返流发生率的差异无统计学意义。结论经腹Heller手术附加Dor术治疗贲门失弛缓症时,胃壁肌层切开长度可以〉2cm。减少经腹Heller手术后胃食管反流的关键在于附加合适的抗反流措施。 相似文献
10.
11.
目的评价糖调节受损(IGR)不同亚型患者的胰岛素分泌功能和胰岛素敏感性,考察2年后糖耐量状态的自然转归情况。方法对92例IGR患者完成为期2年的随访。基线和随访时均进行75 g口服葡萄糖耐量试验(OGTT)。以稳态模型(HOMA)法β细胞功能指数(HOMA-β)和β细胞分泌功能指数(第一时相分泌功能指数BCF-Ⅰ和第二时相分泌功能指数BCF-Ⅱ)评价胰岛素分泌功能,以HOMA法胰岛素抵抗指数(HOMA-IR)评价肝脏胰岛素敏感性,以胰岛素敏感指数(ISI)评价外周胰岛素敏感性。结果根据基线OGTT结果,92例IGR患者分为单纯空腹血糖受损组(I-IFG组,n=16)、单纯糖耐量受损组(I-IGT组,n=66)和混合糖调节受损组(CGI组,n=10),三组患者年龄、性别构成、超重和(或)肥胖者比例以及血压和血脂指标比较差异均无统计学意义(P>0.05);基线时HOMA-IR从高到低依次为CGI组、I-IFG组和I-IGT组,ISI从低到高依次为CGI组、I-IGT组和I-IFG组,BCF-Ⅰ从低到高依次为I-IFG组、CGI组和I-IGT组,组间比较差异均有统计学意义(P<0.05)。在2年随访期内,20例IGR患者发展为糖尿病,累积发生率为21.7%。结论 IGT是IGR的主要表现形式。I-IFG人群的β细胞第一时相分泌功能受损最为明显;CGI人群的肝脏及外周胰岛素抵抗最为严重;I-IFG人群肝脏胰岛素抵抗较I-IGT人群严重,而外周胰岛素抵抗情况则相反。 相似文献
12.
Dilated intercellular spaces in gastroesophageal reflux disease patients and the changes of intercellular spaces after omeprazole treatment 总被引:1,自引:0,他引:1
Background Gastroesophageal reflux disease (GERD) is a common disorder. Dilation of intercellular spaces of esophageal epithelium has been revealed at transmission electron microscopy both in the rabbit acid-perfused esophagus and in esophageal biopsies from GERD patients. This study aimed to observe the changes of the intercellular spaces of squamous epithelium of lower esophagus in patients with GERD and the changes of intercellular spaces of patients with erosive esophagitis (EE) before and after omeprazole treatment.
Methods Outpatients having GERD symptoms for more than 3 months and volunteers were collected. All of them underwent gastroendoscopy and 24-hour ambulatory pH monitoring. Biopsies were taken from the lower esophagus (2 cm above Z-line) for electron microscope examination. Five healthy volunteers, six non-erosive reflux disease (NERD) patients, and five EE patients were enrolled. Intercellular spaces of GERD patients and controls were calculated. Then we selected 20 patients with EE diagnosed by gastroendoscopy. All of them were treated with omeprazole (Losec, 20 mg bid) for 4 weeks then underwent gastroendoscopy again. Biopsies were taken from 2 cm above Z-line for electron microscope examination. All the patients completed the questionnaire about reflux symptoms before and after treatment.
Results Intercellular spaces of esophageal epithelial cell in volunteers, NERD patients and EE patients were (0.37±0.07)μm, (1.31±0.08)μm, and (1.33±0.14)μm, respectively, with significant differences between the control group and the NERD group (P=0.000). In the 20 EE patients, the mean intercellular space before treatment was (1.14±0.15) μm After treatment the intercellular space was (0.51±0.18)μm, a significant difference compared with pre-treatment measurements (P=0.000). Conclusions Dilated intercellular spaces (DIS) were seen in both NERD and EE cases. The dilated intercellular spaces of esophaaeal epithelium in EE patients could be recove 相似文献
Methods Outpatients having GERD symptoms for more than 3 months and volunteers were collected. All of them underwent gastroendoscopy and 24-hour ambulatory pH monitoring. Biopsies were taken from the lower esophagus (2 cm above Z-line) for electron microscope examination. Five healthy volunteers, six non-erosive reflux disease (NERD) patients, and five EE patients were enrolled. Intercellular spaces of GERD patients and controls were calculated. Then we selected 20 patients with EE diagnosed by gastroendoscopy. All of them were treated with omeprazole (Losec, 20 mg bid) for 4 weeks then underwent gastroendoscopy again. Biopsies were taken from 2 cm above Z-line for electron microscope examination. All the patients completed the questionnaire about reflux symptoms before and after treatment.
Results Intercellular spaces of esophageal epithelial cell in volunteers, NERD patients and EE patients were (0.37±0.07)μm, (1.31±0.08)μm, and (1.33±0.14)μm, respectively, with significant differences between the control group and the NERD group (P=0.000). In the 20 EE patients, the mean intercellular space before treatment was (1.14±0.15) μm After treatment the intercellular space was (0.51±0.18)μm, a significant difference compared with pre-treatment measurements (P=0.000). Conclusions Dilated intercellular spaces (DIS) were seen in both NERD and EE cases. The dilated intercellular spaces of esophaaeal epithelium in EE patients could be recove 相似文献
13.
目的探讨食管引流型喉罩在高血压患者腹腔镜胆囊切除术中应用的有效性和安全性。方法拟行胆囊切除术的高血压患者60例,随机分为30例食管引流型喉罩组(P组)和30例气管插管组(T组),记录麻醉诱导前后、插管及拔管前后各时间点的平均动脉压(MAP)和心率(HR);记录间歇通气10min时、气腹10min时和气腹20min时的分钟通气量(MV)、气道峰压(Ppeak)、潮气量(VT)和呼气末二氧化碳分压(PETCO2);并记录拔管及术后并发症的发生情况。结果插入及拔除气管插管或喉罩时,T组MAP和HR变化有统计学意义(P<0.05),P组MAP和HR变化无统计学意义(P>0.05);两组插管后间歇通气10min时和气腹10min时、气腹20min时的Ppeak、VT、MV、PETCO2差异无统计学意义(P>0.05),气腹10min时和气腹20min时两组Ppeak和PETCO2均高于间歇通气10min时(P<0.05);P组安静拔管例数多于T组(P<0.01),术后不良反应发生例数较T组少(P<0.05~0.01)。结论食管引流型喉罩用于高血压患者腹腔镜胆囊切除术,术中及术后血压波动小,通气可靠,且术后并发症少。 相似文献
14.
Abhilasha Sharma Praveen Kumar Sharma Pankaj Puri 《Medical Journal Armed Forces India》2018,74(3):250-254
Background
Gastroesophageal reflux disease (GERD) is a commonly prevalent gastrointestinal disorder in adults. Very few studies on magnitude of GERD in student community have been done and there is none so far from India. Rigorous MBBS curriculum makes medical students prone for reflux symptoms. Hence, this study was conducted to determine the prevalence of GERD in medical students and the potential risk factors associated with it.Methods
This was a cross sectional observational study conducted on medical students in a premier medical college of India. All participants were interviewed for GERD symptoms using the validated questionnaire on frequency scale for the symptoms of GERD. Additional 11 questions include enquiries on medical history and lifestyle factors.Results
Of the 600 students, 150 (25%) had GERD symptoms. Of these, 88 (58.6%) had mild, 58 (38.6%) moderate, and 4 (2.7%) severe reflux symptoms. Fifty eight (38.6%) of students with GERD had associated dyspepsia. On univariate analysis higher BMI, final years of MBBS course, use of NSAID or alcohol, inadequate sleep, sleeping within one hour of taking dinner, missing breakfast regularly and quick eating were significantly associated with GERD (p < 0.05).Conclusions
Prevalence of symptoms of GERD in medical students is 25%, majority had mild symptoms. Associated dyspeptic symptoms were present in 38.6%. Factors predisposing to GERD in them are higher BMI, final years of MBBS course, use of NSAID, inadequate sleep, sleeping within one hour of taking dinner, missing breakfast on regular basis and quick eating. 相似文献15.
<正>慢性肾脏病(chronic kidney diseases,CKD)是危害人类健康的常见疾病,CDK4~5期患者因长期肾功能不全存在肾性贫血,内环境紊乱,机体耐受力和免疫力较差[1-3]。胃癌是我国最常见的消化道恶性肿瘤之一,发病人数和死亡人数居各种恶性肿瘤的第三位[4]。结直肠癌发病率仅次于胃癌。胰腺癌发病率低,但预后差[4]。手术是胃肠胰肿瘤的主要治疗方法,但CKD患者行肿瘤切除,围手术期管理比较复杂,目前鲜有报道。2019年6月至2021年12月,浙江省人民医院胃肠胰外科收治8例CKD4~5期胃肠胰肿瘤患者,微创完成根治术,现将围手术期管理体会报道如下。 相似文献
16.
目的:研究糖耐量减低(IGT)合并冠心病患者冠脉病变的特点.方法:163例明确诊断冠心病患者,行口服葡萄糖耐量试验,合并糖耐量减低59例,正常糖代谢40例,检测两组BMI、腰围、血糖、血压、血脂等,冠脉造影比较两组冠状动脉病变情况.结果:与NGT组相比,IGT组存在体重指数、腰围及血脂明显异常.冠脉造影结果显示,IGT组与NGT组相比较,双支以上病变明显增多,具有显著统计学意义(P<0.05);在受累血管方面,左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)、左主干(LM)均可受累,两组均以LAD为主;就血管狭窄程度而言,IGT组与NGT组相比,血管狭窄程度大于75%明显增多,具有统计学意义(P<0.05).结论:糖耐量减低合并冠心病时,腰围、体重指数增加,血脂异常明显,血管病变以多支病变为著,且血管狭窄程度严重. 相似文献
17.
目的 观察腹腔镜Nissen胃底折叠术过程中不同年龄患儿的呼吸和循环功能的变化.方法 33例接受 Nissen胃底折叠术的患儿按年龄分为三组.Ⅰ 组(n=13):1~12月;Ⅱ组(n=10):1~ 3岁;Ⅲ组(n=10):4~7岁.于气腹前5 min(T0)、气腹后10 min(T1)、气腹后60 min(T2)及停止气腹10 min(T3),分别记录各组患儿的心率(HR)、平均动脉压、气道峰压(Ppeak)、呼吸系统静态总顺应性(CRS)、呼气末二氧化碳分压(PETCO2)和动脉二氧化碳分压(PaCO2)等血气分析指标.结果 与T0点比较,各组T1、T2点的HR、PETCO2、PaCO2与PETCO2 的差值(Pa-ETCO2)和Ppeak均显著增高,CRS显著降低,三组中Ⅰ 组的变化最为显著.结论 在腹腔镜Nissen胃底折叠手术过程中,患儿的呼吸和循环功能均发生改变,其中1~12月龄患儿的变化最为显著,需加强麻醉管理. 相似文献
18.
目的 观察针刺胃食管反流病(GERD)患者督脉背段第3~9胸椎棘突下的压痛变化及其临床意义。方法 将60例GERD患者,随机分为针刺组和西药组,每组30例。针刺组取T3(身柱)、T4(非穴位)、T5(神道)、T6(灵台)、T7(至阳)、T8(非穴位)、T9(筋缩),隔日治疗1次,1周3次;西药组口服奥美拉唑肠溶胶囊,20mg/次,每日2次,疗程均为8周。2组在治疗前后填写反流性疾病诊断问卷(RDQ)并在T3~T9棘突下进行压痛程度评价和压痛阈值评估。结果 针刺组愈显率70%,对比西药组43.3%,差异有显著性意义(P<0.05);针刺组治疗后在T3~T9段的压痛程度缓解优于西药组(P<0.05);在T5~T7段的压痛阈值提高大于西药组(P<0.05)。结论 针刺督脉背部T3~T9段棘突下治疗GERD的疗效优于西药组,并且针刺后的压痛阈值也比西药组显著升高,因此可以将督脉背段压痛作为评估针刺治疗GERD效果的指标。 相似文献
19.
目的:探讨糖耐量减低的晚期妊娠妇女胰岛素抵抗水平及相关因素。方法:回顾性分析2008年6月~2010年6月我院收治的112糖耐量减低的晚期妊娠妇女的临床资料,设为观察组;并以我院同期收治的112例健康妊娠妇女为对照组。比较两组监测结果异同。结果:观察组患者空腹血糖、餐后2h血糖、空腹胰岛素、餐后1h胰岛素水平及糖化血红蛋白水平明显高于对照组,两组比较,差异具有统计学意义(P〈0.05),观察组体重指数异常比例明显高于对照组,经χ^2检验组间差异具有统计学意义(P〈0.05)。结论:妊娠晚期对糖耐量减低的孕妇进行监测,并根据监测结果进行适当的对症处理具有重要的临床意义。 相似文献
20.
目的 探讨翻转法机械吻合加Nissen胃底折叠术在食管胃主动脉弓下吻合中的抗反流作用.方法 回顾性调查河南省人民医院胸部肿瘤中心2009年7月至2010年12月共103例食管胸下段癌及食管胃交界癌患者行翻转法机械吻合加Nissen胃底折叠术(试验组)的情况,与同期常规食管胃机械吻合术130例(常规组)对比手术情况及术后吻合口愈合、胃食管反流程度等.结果 手术吻合时间试验组为(16.4±2.0) min,常规组为(14.0±1.8) min(t=-9.38,P<0.01).两组均无吻合口瘘发生.术后并发症试验组为13例,常规组为23例(x2=1.13,P=0.36).吻合口狭窄率试验组为4.8% (5/103),常规组为6.9% (9/130),组间差异无统计学意义(x2=0.44,P=0.58).吻合口炎发生率试验组为17.4%( 18/103),常规组为17.7% (23/130),组间差异无统计学意义(x2=0.002,P=0.96).胃镜提示反流性食管炎发生率分别为试验组15.5%( 16/103)和常规组22.3%(29/130),组间差异无统计学意义(x2=2.57,P=0.46).应用胃食管反流问卷GerdQ调查反流症状(以总分≥8分为诊断标准),试验组32/103例(31.1%),常规组64/130例(49.2%),两组对比差异有统计学意义(x2 =7.825,P=0.007).结论 翻转法机械吻合加Nissen胃底折叠术操作简便并具有显著的抗反流作用,推荐在食管胃主动脉弓下吻合中使用. 相似文献