空肠营养管在胃癌术后的应用价值

目的：探讨空肠营养管在外科治疗中的应用价值。方法：观察60例空肠营养支持患者的肠道功能,营养状况以及水电解质平衡情况。结果：通过空肠营养管进行肠内营养支持的患者术后胃肠道功能恢复快,营养状况佳,预后佳,平均住院时间缩短。结论：空肠营养管在外科手术围手术期使用有很大的优点,可以加快病人肠道功能恢复,降低吻合口瘘发生率,加快病人恢复速度,减少病人住院时间,节约住院费用。     

急性肝衰竭患儿肠内营养干预研究

 目的探讨营养干预对急性肝衰竭患儿临床转归的影响。方法针对不同年龄段患儿,采用个体化营养干预、营养状况动态监测等方法,并根据患儿不同病程阶段进行营养素摄入量调整。结果营养干预后,患儿肝功能指标得到不同程度改善,其中反映肝脏合成功能的白蛋白及纤维蛋白等营养相关指标改善显著。结论及时有效的营养干预对恢复患儿正氮平衡、提高机体耐受能力、改善临床结局具有研究价值,值得深入探讨。     

胃十二指肠溃疡穿孔修补术后早期肠内肠外营养效果观察

目的：观察胃十二指肠溃疡穿孔修补术后早期应用肠内营养（EN）和肠外营养（PN）的临床效果。方法：选择行胃十二指肠溃疡穿孔修补术62例,随机分为观察组和对照组各31例。观察组术中将鼻胃肠管中的肠内营养管置入空肠内,术后采用PN＋EN序贯治疗;对照组术中置入普通胃管,术后采用全肠外营养（TPN）治疗。分别于术前1天和术后7天,检测体重、血浆清蛋白、血浆前清蛋白和血红蛋白水平;记录肛门排气时间和住院时间。结果：观察组术后7天血浆清蛋白、血浆前清蛋白、血红蛋白、体重等指标,均显著或非常显著高于对照组（P〈0．05,P〈0．01）;术后肛门排气时间和住院时间显著或非常显著短于对照组（P〈0．05,P〈0．01）。结论：早期EN＋PN支持治疗,可显著改善胃十二指肠溃疡穿孔术后患者的营养状况,促进肠道功能较快恢复。     

食道癌术后肠内营养的护理

目的探讨食道癌术后经营养管实施肠内营养的护理方法及其产生的临床效果。方法对76例食道癌术后患者经营养管给予肠内营养,提供细致认真的护理,包括注意控制营养液滴注速度、温度,保持管道通畅及预防并发症发生等。结果通过实施肠内营养及提供的护理措施,促进患者肠功能的恢复,改善患者的营养状况,减少了并发症的发生。结论严格护理的肠内营养,能有效缩短胃肠功能恢复时间,提高机体抵抗能力,促进伤口愈合,减少并发症的发生。     

重型颅脑损伤早期肠内营养支持的临床研究

目的 探讨颅脑损伤后早期肠内营养支持疗法的特点。方法 对40例经临床或CT证实为重型颅脑损伤病例随机分为两组，分别早期给予肠内营养（early enteral feeding,EEF)与肠外营养（total parenteral untrition,TPN)，在摄入同等热量、同等氮量的条件下，对两组有关临床数据进行比较。结果 EEF组24小时排氮量明显少于TPN组，氮平衡，肌酐身高指数（ICr)等营养指标优于TPN组。伤后28天，EEF组体重丢失显著少于TPN组，GCS评分较TPN组显著改善。结论 EEF可维持胃肠道粘膜结构的完整性，促进消化吸收功能的恢复，减轻伤后分解代谢，促进营养和意识状态的改善。     

脑卒中患者早期肠内营养的应用探讨

目的：探讨早期肠内营养对于改善急性脑卒中预后、营养状况，降低高代谢反应和维护胃肠道功能等方面的作用；为急性脑卒中患者早期启动肠内营养提供临床依据。方法：选取我院急性脑卒中病例（含出血性脑卒中及缺血性脑卒中）66例。病人均于入院后48h内给予营养支持，EEN组经营养管胃肠要素膳食；TPN组经深静脉置管滴注全胃肠外营养。并分别于入院后第1、7、14d，第28d监测患者体重、血清白蛋白和血糖、血红细胞及血红蛋白、皮质醇、24h尿总氮和尿肌酐等指标。结果：急性脑卒中患者早期肠内营养可降低TPN高血糖等代谢并发症，降低高分解代谢与应激反应的发生，更可以保护胃肠道结构和功能，防止茵群移位、二重感染的发生。结论：急性脑卒中患者对早期肠内营养有良好的耐受性，且可以显著降低医疗费用。     

胃肠道手术早期肠内营养对术后感染影响的临床观察

目的探讨胃肠道术后早期肠内营养对术后感染的影响。方法对比早期肠内营养组(53例)与对照组(46例)术后感染和肠功能恢复情况。结果胃肠道术后早期肠内营养组术后肠鸣音恢复、排气、排便时间、术后感染率明显低于对照组。结论早期肠内营养能够降低胃肠手术术后感染率和促进胃肠功能的恢复。     

肠内肠外营养支持对胃癌患者术后营养和功能状态影响的研究

目的观察肠内(EN)肠外营养支持(PN)对胃癌术后营养和功能状态的影响。方法 62例进展期胃癌,随机分为EN组和PN组各31例。比较两组术前及术后营养状况,功能状态,术后肠功能恢复时间。结果PN组术后第5、第8天总蛋白、清蛋白和前清蛋白水平均低于术前水平(P<0.05)。EN组术后第8天血清总蛋白、清蛋白及前清蛋白与术前比较无显著差异(P>0.05);术后5 d EN组血清总蛋白前清蛋白水平高于PN组(P<0.05)。术后第8天,EN组血清总蛋白、清蛋白和前清蛋白水平均高于PN组(P<0.0 5)。EN组Karnofsky功能状态评分显著高于PN组(P<0.0 5);EN组体力状况分级为1～2级,PN组为2～3级。EN组肠功能恢复时间显著短于PN组(P<0.05)。结论 EN有助于改善胃癌患者术后营养状况和功能状态,促进胃肠功能恢复,防治术后并发症。     

胃癌手术围术期肠内营养与肠外营养支持治疗效果观察

目的：观察胃癌手术围术期肠内营养与肠外营养支持治疗效果。方法：将胃癌40例随机分为肠内营养治疗组（EN组）和肠外营养支持治疗组（PN组）各20例,EN组于术前2天开始应用肠内营养液,共9天;PN组于术后第1天起给予肠外营养支持,共7～10天。比较两组术前、术后第1、3、7天的PAB、ALB、TF、CD3、CD4、CD8、CD4/CD8、IgG、IgA、IgM、CRP、C3和C4水平变化,术后胃肠道功能恢复时间、住院时间、住院费用及并发症发生情况。结果：两组术后第1天PAB、ALB水平非常显著低于术前（P〈0.01）;EN组CD3、CD4、CD4/CD8水平显著高于PN组（P〈0.05）,CD8水平显著低于PN组（P〈0.05）;EN组IgG、IgA、IgM水平显著高于PN组（P〈0.05）;EN组CRP水平显著低于PN组（P〈0.05）;EN组术后胃肠道功能恢复时间显著早于PN组（P〈0.05）;住院时间、住院费用显著少于PN组（P〈0.05）。结论：胃癌手术围术期肠内营养治疗安全,效果优于肠外营养支持治疗。     

消化道肿瘤术后肠内营养与肠外营养联合治疗效果观察

目的探讨肠内营养（EN）联合肠外营养（PN）对消化道肿瘤患者术后支持效果,并与全肠外营养（TPN）进行对比研究。方法选择消化道肿瘤手术病例230例,随机分为EN＋PN组（119例）和PN组（111例）。EN＋PN组在术中进行空肠穿刺留置营养管术。分别于手术前、术后1 d、术后10 d检测临床生化指标和T淋巴细胞亚群,并比较两组患者感染等并发症,平均肠功能恢复和住院时间。结果两组患者白蛋白（ALB）、总蛋白（TP）、CD3＋和CD4＋细胞在术后第1天有所下降,术后10 d明显升高,EN＋PN组较PN组升高明显,具有显著性差异,且EN＋PN组肠功能恢复及住院时间短,并发症发生率低。结论早期肠内营养联合肠外营养可改善消化道肿瘤患者术后营养和免疫状态,减少并发症,缩短住院时间,有利于术后恢复。空肠穿刺留置营养管术可作为消化道肿瘤开腹手术患者营养支持的首选方法。     

小肠大量切除保留回盲瓣的意义

目的探讨大量小肠切除后,保留回肠末端回盲瓣的意义。方法回顾分析我院1995年以来13例大量小肠切除后,仅能保留10 cm以内回肠末端的患者的临床资料。结果全组均未出现明显短肠综合征表现。结论对于肠绞窄、外伤、肿瘤等原因导致切除大量病变肠管后,保留回盲瓣对于预防短肠综合征有重要临床意义,保留回盲瓣对于营养物质在小肠内的吸收、防止结肠内细菌向小肠迁移寄生有其生理意义。     

全胃切除术后消化道重建术式选择:间置空肠法与Roux-en-Y吻合法之比较

目的 :探讨理想的全胃切作术后重建方式。方法 :对 32例间置空肠术及 4 4例Roux -en -Y重建术后一年随访资料进行对比。结果 :间置空肠组每日进餐次数较后者少 (p <0 0 5 ) ,每餐进食量及代胃肠段最大直径较后者大 (p <0 . 0 5 ) ;且后者有倾倒症状 4例 ,胆汁返流 3例。但反映营养状况的体重变化、血色素及总蛋白、白蛋白量两组差异无显著性 (p>0 0 1)。结论 :间置空肠法营养状况的改善虽然并不优于Roux -Y法 ,但术后不适少于后者 ,因此适宜的患者应优选间置空肠法重建消化道。     

Current management of inflammatory bowel disease

Since the etiology and cure for inflammatory bowel disease remain elusive, treatment is still largely empiric. The major goals of therapy include control of bowel inflammation and alleviation of symptoms. Careful attention must be directed toward special problems when appropriate, such as short bowel syndrome, perianal disease, extraintestinal disease manifestations, and cancer surveillance. Standard and new forms of medical therapy and the approach to special problems will be discussed.     

Technetium-99m triethylene tetramine polystyrene resin gastric emptying studies in patients with various upper gastrointestinal diseases

The gastric emptying study using Tc-99m triethylene tetramine polystyrene resin with or without metoclopramide hydrochloride was used in six patients with different disease entities: achalasia, gastric lymphoma, primary amyloidosis, Zollinger-Ellison syndrome, duodenal diverticulum, and short bowel syndrome. All patients had abnormally prolonged gastric emptying times. The patient with gastric lymphoma and the patient with Zollinger-Ellison syndrome had virtually no effect from metoclopramide. The patient with a duodenal diverticulum and the patient with short bowel syndrome had partial and good response to metoclopramide, respectively. Endoscopic and/or autopsy examinations in patients with achalasia, Zollinger-Ellison syndrome, primary amyloidosis, and duodenal diverticulum proved the patency of the pyloric canal. The patient with gastric lymphoma had a mass associated with marked pyloric narrowing and lymphoma cell infiltration of the gastric wall, to explain the abnormal gastric emptying. The gastric emptying study with or without metoclopramide may be used noninvasively to measure gastric function, to determine the nature of gastric outlet obstruction, and to evaluate therapy with metoclopramide.     

Imaging in severe acute respiratory syndrome (SARS)

Severe acute respiratory syndrome (SARS) is a highly infectious disease caused by a novel coronavirus, and has become pandemic within a short period of time. Imaging plays an important role in the diagnosis, management and follow-up of patients with SARS. The current status of imaging in SARS is presented in this review.     

Atherectomy of the distal aorta using a "kissing-balloon" technique for the treatment of blue toe syndrome.

Continuous positive airway pressure (CPAP) administered as a mixture of oxygen and compressed air via nasal prongs has dramatically improved survival rates and lessened the frequency of barotrauma and bronchopulmonary dysplasia in the premature infant with respiratory distress syndrome. Associated with the increased use of nasal CPAP has been the development of marked bowel distension (CPAP belly syndrome), which occurs as the infant's respiratory status improves and the baby becomes more vigorous. To identify contributing factors, we prospectively compared 25 premature infants treated with nasal CPAP with 29 premature infants not treated with nasal CPAP. Infants were followed up for development of distension, defined clinically as bulging flanks, increased abdominal girth, and visibly dilated intestinal loops. We evaluated birth weight, weight at time of distension, method of feeding (oral, orogastric tube), and treatment with nasal CPAP and correlated these factors with radiologic findings. Of the infants who received nasal CPAP therapy, gaseous bowel distension developed in 83% (10/12) of infants weighing less than 1000 g, but in only 14% (2/14) of those weighing at least 1000 g. Only 10% (3/29) of infants not treated with nasal CPAP had distension, and all three weighed less than 1000 g. Presence of sepsis and method of feeding did not correlate with occurrence of distension. Neither necrotizing enterocolitis nor bowel obstruction developed in any of the patients with a diagnosis of CPAP belly syndrome. Our study shows that nasal CPAP, aerophagia, and immaturity of bowel motility in very small infants were the major contributors to the development of benign gaseous bowel distension.     

Ovarian dermoid cyst complicated by small bowel obstruction,entero-ovarian fistula formation,and malignant degeneration

Dermoid cysts, or mature cystic teratomas, are complicated by malignant degeneration in only 1–2% of cases. Rarely, dermoid cysts result in complications of small bowel obstruction or entero-ovarian fistula formation. In the current report we present the case of a 59-year-old female with a known dermoid cyst who presented with leukocytosis and was discovered to have a small bowel obstruction at the level of an ileo-ovarian fistula. The patient was taken to the operating room and was treated with total abdominal hysterectomy, bilateral salpingo-oopherectomy, and short segment small bowel resection. Review of the surgical pathology revealed areas of malignant degeneration within the dermoid cyst to squamous cell carcinoma. To our knowledge, this is only the second reported case of an ovarian dermoid cyst complicated by small bowel obstruction, entero-ovarian fistula formation, and malignant degeneration.     

保留回盲瓣在预防短肠综合征中的应用

目的　研究广泛切除小肠后 (残留不足 60cm) ,保留回盲瓣在预防短肠综合征方面应用的意义。方法　 7例肠梗阻、血管栓塞广泛肠坏死、外伤等原因导致小肠大部被切除后 ,剩余小肠在 40～ 60cm 5例 ;3 0～ 40cm 1例 ;2 5cm 1例。手术要点 :( 1)判断回盲部的回结肠动脉终末支有血运 ,才能保留回盲部。 ( 2 )拟吻合的肠切端必须有动脉出血。 ( 3 )切除无血运小肠时 ,采用紧贴肠壁游离系膜。 ( 4 )经阑尾残端置入橡皮管经回盲部到吻合口近端的小肠内 ,起减压作用。 ( 5 )早期应用肠外营养 ( parenteralnutrition ,PN)。 结果　无吻合口瘘。术后 2～ 3周进食后均出现大量腹泻 ,3～ 4周腹泻减少。半年以上均脱离PN治疗。结论　保留回盲瓣对于预防短肠综合征的发生有显著效果。     

Emergent Treatment of Acute Embolic Superior Mesenteric Ischemia with Combination of Thrombolysis and Angioplasty: Report of Two Cases

We successfully revascularized the acutely occluded superior mesenteric artery (SMA), caused by a thromboembolus, with a combination of thrombolysis and percutaneous transluminal angioplasty (PTA) in 2 patients. Considerable percent luminal reduction (>90%) was still observed after thrombolysis in both patients. Subsequent adjunctive balloon angioplasty produced sufficient luminal diameter of the SMA (<20% luminal reduction). No serious acute procedural complication occurred. The time from onset to partial reperfusion by thrombolysis was approximately 4.5 and 5.5 hours. Approximately 1 week after the combination therapy, colonoscopy and a small bowel radiocontrast series showed localized mucosal ischemia with mild erosions and ulcerations in the terminal ileum and ascending colon in 1 patient. Subsequent bowel resection was required but the resection was short (<20 cm). The other patients bowel condition was good and did not require any surgical treatment. The present cases suggest that combination therapy is useful for achieving rapid and sufficient revascularization of acute proximal thromboembolic SMA occlusion, and prevents the considerably broad bowel necrosis that requires surgical bowel resection, resulting in short bowel syndrome.     

Malabsorption of thyroxine, calcium, and vitamin D in a thyroparathyroidectomized woman: efficacy of therapy with medium-chain triglyceride oil

A 28-year-old woman with surgically induced hypothyroidism and hypoparathyroidism required large doses of replacement medications due to malabsorption from short bowel syndrome. Malabsorption of thyroxine was documented using the technique of double isotope radioiodothyronine turnover studies. Therapy with medium-chain triglyceride oil improved her malabsorption and favorably influenced the absorption of her medications.