球囊扩张术治疗贲门失弛缓症

贲门失弛缓症是一种表现为进行性吞咽困难的疾病 ,以往以手术治疗为主。球囊扩张术是治疗本病的一种新的介入治疗技术。我院于 1998年 2月 2 0 0 1年 12月对 18例贲门失弛缓症患者行球囊扩张术治疗效果满意。现报道如下。1　资料与方法1.1　一般资料　　 18例患者 ,男 6例 ,女 12例 ,年龄 2 0～ 72岁 ,平均 4 4岁。病程为 3～ 2 4年 ,平均 8年。主要临床表现为 :吞咽困难 18例 ,返流 16例 ,烧心和胸痛 10例 ,体重减轻 12例。全部病例均经上消化道钡餐造影检查、内窥镜及病理证实 ,排除食管远端浸润癌 (假性失弛缓症 )。根据吴恩惠等[1] 对吞…     

球囊扩张和Heller肌切开治疗儿童贲门失弛缓症疗效和安全性的Meta分析

目的采用Meta分析方法评价球囊扩张（BD）和Heller肌切开（HM）治疗儿童贲门失弛缓症的有效性和安全性。方法检索PubMed、EMBASE、Cochrane图书馆、中国生物医学文献数据库、维普全文数据库和万方生物医学期刊数据库。检索的时间均从建库至2012年5月。获得BD和HM治疗儿童贲门失弛缓症的对照研究。由2名作者进行资料提取和文献质量评价。应用RevMan5.0软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果8篇文献进入Meta分析,均为非随机分组的对照研究。8篇文献均报道了两组的复发率和并发症发生率。BD组与HM组治疗儿童贲门失弛缓症复发率的差异有统计学意义（OR=4.07,95%CI：1.41～11.69,P=0.009）;两组并发症发生率的差异有统计学意义（OR=0.37,95%CI：0.15～0.90,P=0.03）。结论 HM治疗儿童贲门失弛缓症的复发率低于BD,并发症的发生率高于BD。因纳入文献质量较弱且样本量不大,明确结论仍需进一步研究。     

胃癌侵犯胃裸区的CT解剖及其临床意义

目的:探讨胃癌侵犯胃裸区(GBA)的CT解剖特点及其临床意义.方法:回顾性分析81例CT资料和临床资料完整的胃癌连续性病例,21例侵犯GBA,近侧胃癌(PGC)42例,远侧胃癌(DGC)39例.着重观察GBA受侵后宽度、厚度、密度的变化、左侧膈肌脚受累情况及腹膜后淋巴结转移情况.结果:(1)PGC与DGC在浸润深度、淋巴结转移、TNM分期方面有显著性差异;(2)PGC侵犯GBA发生率(40.5%)明显高于DGC(10.3%);(3)21例胃癌侵犯GBA病例中,有18例CT表现为GBA内软组织肿块(85.7%),9例左侧膈肌脚受侵(42.9%),10例膈下腹膜后淋巴结肿大(47.6%).结论:胃癌侵犯GBA有一定的CT表现特征和解剖基础,CT术前评价胃癌侵犯GBA有重要意义.     

可回收自膨防返流覆膜食道支架治疗食道贲门失弛缓症

目的探讨国产可回收自膨防返流覆膜食道支架在治疗食道贲门失驰缓症的临床应用。方法支架为南京微创医学科技有限公司产MTN-S型形状记忆镍钛合金可回收自膨防返流覆膜杯口球头食道支架,规格80/20mm(长度/直径),交替导丝,超硬导丝,导管,支架回收器。23例患者,钡餐确诊,最大年龄64岁,最小15岁,男性19人,女性4人。病程最长29年,最短12个月。狭窄程度1.0～5.0mm。在电视透视下,将导丝置入胃内(较困难者在胃镜帮助下置入导丝),沿导丝将置入器缓慢送入,支架远端置于胃内,近端在狭窄上方,开始释放,取出导丝和置入器,将回收线拉紧经鼻腔固定于耳廓上。两周时取出并复查钡餐。结果全部病例支架置入一次成功,术后感胸骨后钝痛,持续5～7d,用止痛药能缓解。有1例术后3d支架移入狭窄上方食道内,有2例分别于术后7d和12d滑入胃内,取出支架后重新置入。有1例患者术后1h出现恶心呕吐、疼痛性休克,经抢救无生命危险。所有病例两周时能顺利取出支架,未出现支架嵌顿现象,食道钡餐示狭窄有不同程度开放,达到15mm左右,解除了咽下困难。术后3个月、6个月、12个月钡餐或电话随访,最长者达43个月仍未出现咽下困难。结论支架扩张是随着支架进入体内后温度逐渐升高而扩张,作用于食道四周的力量均匀,疼痛轻微,不易引起食道破裂和出血,取出支架容易。该手术安全、简便、禁忌证少,由于国产支架大幅降低了费用,值得推广应用。     

Computed tomography of strangulated gastric hernia complicated by perforation and pneumothorax

A case of traumatic rupture of the diaphragm with partial gastric herniation is reported. The initial radiographic presentation was left lower lobe pneumonia. Subsequent strangulation and perforation of the stomach caused pneumothorax. Serial chest radiographs, computed tomography of the chest and abdomen with oral contrast, and a high index of suspicion were instrumental to the diagnosis. Pneumothorax, though rare, must be recognized as a morbid, obstructive phase complication of traumatic diaphragmatic hernia requiring immediate surgical intervention.     

食管异物合并严重并发症的临床治疗分析

目的 探讨食管异物合并严重并发症的治疗方法。方法 回顾性分析解放军总医院第一医学中心耳鼻咽喉头颈外科2014年7月-2018年7月收治的23例合并食管穿孔、颈胸部感染等严重并发症的食管异物患者的临床资料,其中男11例、女12例,年龄2~87岁,病程2～11 d。术前CT扫描评估异物位置、食管损伤及周围炎症情况,其中异物位于第一狭窄16例、第二狭窄4例、第三狭窄1例及第四狭窄2例,合并食管穿孔23例、食管周围炎17例、食管周围脓肿3例、颈部脓肿2例、纵隔脓肿1例。23例中,行经硬性食管镜异物取出术17例、颈侧切开探查异物取出术5例、开胸探查异物取出术1例,围手术期配合胃肠减压、抗感染、营养支持等综合措施治疗。术后根据Stooler分级标准评价食管损伤后食管狭窄程度。结果 本组23例均顺利完成手术;经手术及围手术期综合治疗,均顺利拔除鼻饲管,行颈侧切开和开胸探查的患者均顺利拔除伤口引流管,均痊愈出院。1例患者于术后1个月并发颈段食管狭窄Ⅱ级,行食管扩张治疗后恢复正常。患者出院后随访3～5个月,23例均正常进食普通饮食,标准食管狭窄程度Stooler分级均为0级。结论 伴有严重并发症的食管异物应依据异物嵌顿部位及患者临床表现采取不同的手术方法取出异物,同时给予围手术期胃肠减压、抗感染、营养支持等综合治疗措施,多学科联合施救是挽救患者生命的重要举措。     

Usefulness of the laparoscopic Heller-Dor operation for esophageal achalasia: introducing the procedure to our institution

Our institution introduced laparoscopic surgery for esophageal achalasia in 2001. The present report summarizes 15 cases of achalasia treated with laparoscopic Heller myotomy and anterior fundoplication according to the method of Dor, and we have investigated the therapeutic effects on specific symptoms such as dysphagia, reflux, and chest pain. From February 2001 through January 2007, the laparoscopic Heller-Dor operation was performed in 15 patients, including 7 men and 8 women. Achalasia was classified morphologically on esophagography as spindle type in 11 cases, flask type in 3 cases and sigmoid type in 1 case. The degree of esophageal dilatation was classified as grade I in 8 cases, grade II in 6 cases, and grade III in 1 case. Dysphagia was the main symptom and was present in all cases. The mean disease duration was 4.3 years (range, 5 months to 20 years), and the mean weight loss was 4.2 kg. All patients underwent endoscopic dilatation preoperatively. Intraoperative blood loss ranged from 0 to 100 mL (mean, 21 mL). Adequate Heller myotomy was considered more than 6 cm and more than 3 cm in the esophagus and the stomach, respectively. Injury to the esophageal mucosa occurred during the myotomy in 3 cases but could be repaired in all cases during the laparoscopic procedure. All patients reported an excellent level of satisfaction postoperatively. In conclusion, the laparoscopic Heller-Dor operation for esophageal achalasia is a useful procedure because the postoperative satisfaction level of patients is excellent. Despite the risk of mucosal injury, adequate Heller myotomy should be achieved to obtain a good prognosis. It is, therefore, of utmost importance to obtain mastery over the surgical technique to repair any mucosal injury that might occur.