消化内镜隧道技术在上消化道固有肌层病变治疗中的应用效果

目的 探讨消化内镜隧道技术在上消化道固有肌层病变中的应用效果及安全性。方法 回顾性分析2015年12月至2019年1月安徽医科大学附属安庆医院行消化内镜隧道技术治疗的16例上消化道固有肌层病变患者的临床资料,其中9例贲门失弛缓症（AC）患者行经口内镜下肌切开术（POEM）,7例食管或贲门固有肌层起源的黏膜下肿瘤（SMT）患者行黏膜下隧道法内镜切除术（STER）,分析患者的手术情况、并发症,术后1~6个月随访,观察患者的临床症状改善情况。结果 16例患者均顺利完成手术,其中9例行POEM的患者平均手术时间（78.5±20.6）min;无1例出现严重并发症;术后1~6个月随访,患者吞咽困难症状均明显缓解。7例STER患者手术平均时间（48.5±18.0）min;肿瘤完整切除6例（85.7%）,1例因瘤体形态不规则,部分呈外生型生长,少许瘤体腔外残留;无1例出现严重并发症;6例肿瘤完整切除的患者术后1~6个月随访,未见病灶复发及残留。结论 消化内镜隧道技术治疗上消化道固有肌层病变疗效满意,安全可行。     

3D腹腔镜联合胃镜手术治疗贲门失弛缓症疗效分析

目的 评估3D腹腔镜联合胃镜食管Heller肌层切开+Dor胃底折叠术治疗贲门失弛缓症的临床价值.方法 回顾性总结从2013年11月至2015年7月北京同仁医院胸外科进行的16例3D腹腔镜联合胃镜食管Heller肌层切开+Dor胃底折叠术治疗16例贲门失弛缓症的临床资料.结果 所有患者均顺利完成手术,手术时间40~100 min,平均手术时间60 min,术中出血量均小于30 ml,无严重术后并发症,全部治愈出院,术后住院时间6~12 d.术后1个月行上消化道造影,食管最大直径均较术前明显减少.术后1个月复查24 h食管压力测定及pH值监测,无反流性食管炎发生.随访时间10~30个月,16例临床症状均完全消失,无明确复发病例.结论 3D腹腔镜联合胃镜食管Heller肌层切开+Dor胃底折叠术治疗贲门失弛缓症是一种安全易行且有效的外科治疗手段,临床上具有广泛的推广价值.     

经口内镜下肌切开术插管全身麻醉并发气胸1例

贲门失弛缓症（achalasia）是一种病因未明的食管下段括约肌运动功能障碍性疾病.经口内镜下环形肌切开术（peroral endoscopic myolomy,POEM）是日本学者Inoue等[1]于2010年报道的一种新的治疗贲门失弛缓症的方法,和其他手术一样,POEM术中及术后同样存在发生一定并发症的可能.作者通过阅读文献和实践发现,食管壁肌层分为内层环形肌和外层纵形肌,在POEM术中,一旦用力不当或手法不对,较易切断外层纵形肌,使食管内的气体直接进入纵隔、胸膜腔或腹腔,致纵隔及皮下气肿、气胸、气腹.如气管插管全身麻醉术中出现此并发症,应即时诊断,立即停止操作,通过胸腔穿刺抽气等对症治疗来维持患者生命体征的平稳.     

食管测压对19例贲门失弛缓症手术疗效分析

贲门失弛缓症(Achalasia,AC)是一种以吞咽时下食管括约肌(LES)不能正常松弛为特征,并伴有食管蠕动障碍和LES静息压增高的食管运动功能障碍性疾病,是最早被人类认加的食管动力性疾病之一,发病率约为十万分之一[1].食管测压在AC中具备特异性表现,如:食管体部非推进性的同步收缩、食管下括约肌压力(LESP)升高、LES松弛障碍、继发性收缩波增多等[2].AC的治疗主要针对LES,有药物、内镜下注射肉毒碱、球囊或探条扩张、硬化疗法、手术等,目前尚无公认疗法.近年来,胸腔镜或腹腔镜下LES肌层切开术受到重视,其充分的肌层切开长度及深度、严格限制胃壁肌层切开长度是减少并发症、保证疗效的关键之一[3-4].食道测压能提供准确的LES长度,可为手术切开长度提供依据,并可通过手术前后测压参数的改变,评估手术的疗效.我院对AC患者开展了胸腔镜下LES肌层切开术,并在术前术后行食管测压,对手术疗效作出初步评价.     

经腹手术治疗贲门癌155例临床分析

目的 探讨治疗贲门癌的手术人路及吻合方法.方法 对155例贲门癌患者经腹切开膈肌脚入路,行胃浆肌瓣覆盖-食管胃黏膜吻合.结果 全组病例无死亡、无吻合口漏及食管切缘癌残留.术后并发症发生率5.8%.结论 经腹切开膈肌脚,行胃浆肌瓣覆盖-食管胃黏膜吻合术能有效地预防吻合口漏,适用于浸润食管长度<2cm的贲门癌的手术治疗.     

内镜黏膜下早期食管癌剥离术14例临床分析

目的 探讨内镜黏膜下剥离术(ESD)治疗早期食管癌的近期疗效和安全性.方法 胃镜检查发现的14例早期食管癌进行ESD治疗,记录手术时间、出血及穿孔等并发症发生率、一次性切除率和术后短期复发率.结果 14例食管癌病变范围超过食管1/2周的3例,小于食管1/2周的11例.病变直径2.0～4.0 cm.10例(71.4%)成功完成ESD治疗,平均手术时间70 min.14例患者中4例发生食管穿孔,穿孔发生率28.6%(4/14);1例术后发现少量皮下气肿.术中出血量平均30 ml,均经电凝、氩气刀(APC)、止血夹成功止血.10例成功ESD切除术后均获1、3、6个月随访,刨面基本愈合,无一例病变残留和复发.结论 在合适的早期食管癌病例选择性的开展ESD切除有效而安全.     

经肛门手术治疗小儿先天性巨结肠18例体会

目的探讨经肛门先天性巨结肠根治术的微创手术治疗方法。方法采用经肛门直肠肌鞘内病变黏膜切除,保留直肠肌鞘约6cm,沿结肠壁处理系膜血管,结肠拖出并在齿状线以上吻合。结果18例患儿经肛门完成手术,平均术后住院8d,随访3～24个月,患儿排大便2～4次/d,无明显大便失禁和肛门狭窄（术后坚持扩肛半年）。结论与开腹手术相比,本术式创伤小,无腹部并发症,不留手术瘢痕。     

改良腔镜技术在儿童先天性肌性斜颈手术治疗中的应用

目的：探讨改良腔镜技术在儿童先天性肌性斜颈(CMT)手术治疗中的应用效果。方法：选择2018年7月—2022年2月于赣州市妇幼保健院治疗的76例CMT患儿。所有患儿均采用改良腔镜技术进行患侧胸锁乳突肌松解离断手术治疗。统计治疗效果及手术前后胸锁乳突肌挛缩长度、头部偏斜角度及患侧颈部被动旋转活动度。结果：76例CMT患儿中优53例,良19例,可3例,差1例,优良率为94.74%(72/76);患儿的术后胸锁乳突肌挛缩长度短于术前,头部偏斜角度小于术前,患侧颈部被动旋转活动度大于术前,差异有统计学意义(P<0.05);76例CMT患儿的手术时间(58.92±3.87) min;术中未损伤到周围大血管及神经组织,出血少;术后有1例患儿出现同侧面部皮下气肿,但1 d后自行吸收;术后1个月所有患儿颈部皮肤弹性良好,未遗留明显瘢痕。结论：CMT患儿采用改良腔镜技术治疗有利于缩短胸锁乳突肌挛缩长度,改善患儿的颈部被动关节活动度及头部偏斜角度,治疗效果确切且并发症少,是治疗CMT的一种较为安全、有效术式。     

经肛门Soave Ⅰ期拖出术根治先天性巨结肠22例分析

目的 探讨先天性巨结肠新的手术方式和术后并发症的防治.方法 2004年10月至2007年12月我院采用经肛门Soave Ⅰ期拖出术治疗先天性巨结肠22例,观察术后并发症及排便情况.结果 全组手术顺利,切除病变肠营长度15～40 cm,平均23 cm;手术时间90～150 min,平均110 min;术中出血约10～50 ml.全组无死亡,无术中严重并发症,术后并发症少.术后1例出现污粪,2个月后污粪自行消失;1例出现腹胀,放置肛管后腹胀缓解,经低压回流灌肠1周治愈;1例出现便秘,经扩肛治疗3个月后痊愈.随访3～36个月,所有患儿排便1～3次/d.结论 经肛门Soave Ⅰ期拖出术治疗先天性巨结肠,手术操作简便、创伤小、术后恢复快、护理方便,无手术疤痕、术后并发症少,值得推广应用.     

胃大部切除术后食管癌的手术治疗(附10例报告)

近年来发现胃大部切除术后又患食管癌并不少见。1988年以前,我们对此类病人除少数用结肠代食管外,常因手术复杂、并发症多而放弃手术。从1989年6月以来,我们对10例采用食管残胃吻合术,效果良好,现报告如下。一、一般资料男性9例,女性1例;年龄42～65岁。肿瘤病变长度3～8cm,其中1例食管双癌。从胃大部切除后至患食管癌时间最短4年,最长25年。胃大部切除术式均为Billorth Ⅱ式。全组病例于胃术后消化道功能均基本正常。二、手术方法经左第六肋间切口进胸,探查后如能切除,则从膈上向上游离食管至适当高度,并将食管周围淋巴结清扫。后切开左膈肌探查腹腔情况,如粘连     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

半导体激光治疗老年人压疮疗效观察

目的探讨半导体激光局部照射治疗老年人压疮疗效.方法:收集2012年1月-2015年6月48例压疮患者,分为半导体组和常规组各24例.常规组采用常规治疗,半导体组采用半导体激光加常规治疗,10 d为1个疗程,不超过3个疗程.疗程结束后比较两组疗效.结果:半导体组压疮愈显率为83.33％,创面愈合时间为(12.75±5.51)d,常规组分别为54.17％和(19.63±8.65)d,组间差异有统计学意义(P＜0.05),两组均未见不良反应.结论:半导体激光加常规治疗压疮效果肯定,无明显不良反应,且操作简便.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

HACCP在学校集体食堂卫生管理中的应用研究

目的 通过HACCP在学校集体食堂管理中的应用,提高食品卫生水平,保障学生的身体健康。方法 HACCP原则。结果 食品卫生达到较高水平,极大地减少了食物中毒的发生。结论 提示HACCP原则可在学校集体食堂的卫生管理中发挥有效作用。     

The role of the gut flora in the reduction of sulphinpyrazone in the rat

Sulphinpyrazone underwent both reduction to a sulphide and oxidation to a sulphone after parenteral administration to normal Wistar rats. Oral administration was associated with a bioavailability of about 75% and with a 3-fold greater formation of the sulphide. However, no sulphide was detected in the plasma after oral administration of sulphinpyrazone to germ-free (BD/X) rats or normal rats treated with oral antibiotics. In vitro studies showed that the major site of reduction of sulphinpyrazone was the contents of the hind gut with little activity detected in the liver or other tissues. The sulphide was oxidised in vivo to sulphinpyrazone and small amounts of sulphone, while the latter underwent only slight reduction to sulphinpyrazone, but did not give detectable levels of the sulphide. These data suggest that the gut microflora are the main site of reduction of sulphinpyrazone in the rat in vivo.     

Pharmacological analysis of the participation of the catecholaminergic system in the development of the abstinence syndrome in rats

The behavioural activity of rats in "the open field" was studied. It was revealed that rats alcoholized for 8 months do not practically differ in their behavioural indicators from the intact ones. After the discontinuation of alcohol marked disturbances appear in their behaviour, that are arrested by apomorphine (0,1 mg/kg). In intact animals dopamine (50 mkg into the brain ventricles) induces behavioural disorders similar to those in rats during abstinence. Noradrenaline does not induce similar disorders. A conclusion is made on the dopaminergic nature of disorders in the behaviour of rats in the state of alcohol abstinence.     

Problems in the evaluation of hypnosis in the treatment of alcoholism

Although hypnotherapy has been applied to alcoholism for over a century and is accepted by the AMA as a medically valid technique, the effectiveness of hypnosis in treating alcoholics remains controversial. Systematic evaluation has been hampered by the unique role of hypnosis as a cultural artifact, by problems in defining and verifying hypnotic intervention, by individual and situational variation in hypnotizability, and by difficulty in separating hypnosis from the therapies to which it is applied. Clinicians using hypnosis are likely to continue to base their claims for its effectiveness on intuition, especially since no study has demonstrated that hypnotherapy is contraindicated for patients requesting its use.