婴儿泌尿系感染中CRP与膀胱输尿管反流的相关性分析

目的 通过分析性别、临床症状、血白细胞计数、血CRP、尿白细胞计数、尿培养与泌尿系超声显示膀胱输尿管反流的相关性,探讨门诊泌尿系感染患者伴有膀胱输尿管反流的相关因素.方法 收集新世纪妇儿医院2013年9月至2016年8月泌尿系感染并进行泌尿系超声的婴儿患者57例,对其临床特点、实验室检查及与膀胱输尿管反流的相关性进行回顾性分析.结果 婴儿泌尿系感染发病的性别差异不明显,临床以全身症状为主,发热有时是唯一症状.泌尿系超声显示膀胱输尿管反流及无膀胱输尿管反流的两组中,患儿性别、发热情况、血白细胞计数、尿白细胞计数、尿培养均无明显差异;膀胱输尿管反流组CRP增高者16例(80.0％)高于非膀胱输尿管反流组[8例(21.6％)],差异有统计学意义(P＜0.01).结论 门诊泌尿系感染患儿如CRP增高建议积极进行泌尿系超声检查,以期尽早发现膀胱肾输尿管反流.     

围绝经期女性胃食管反流病的临床特征分析

目的 分析围绝经期女性胃食管反流病(GERD)的临床特点,提高对该期女性GERD的认识.方法 对该院2014年1月至2015年12月门诊及住院确诊GERD的246例患者的临床资料、胃镜检查及24 h食管阻抗-pH监测结果进行回顾性分析;按性别将患者分为女性组和男性组,根据月经情况又将女性组分为围绝经期组和非围绝经组2个亚组,对比分析各组患者的临床特点.结果 女性组NERD所占比例较男性组高,以非典型症状为主诉的发生率也高于男性组,差异均有统计学意义(P＜0.05);女性组中围绝经期组、非围绝经组反酸发生率均低于男性组(P＜0.05);围绝经期组弱酸反流次数与非围绝经组和男性组比较差异均有统计学意义(P＜0.05).结论 围绝经期女性GERD多以非典型症状为主要表现,内镜、24 h食管阻抗-pH联合监测是诊断围绝经期女性GERD的选择.     

玄参甘桔汤治疗急性放射性食管炎临床研究

目的:探讨中药方剂玄参甘桔汤治疗急性放射性食管炎的疗效。方法:选择行放射治疗的颈胸部肿瘤患者80例,随机分为治疗组和对照组,在放疗1~2周、食管受照射剂量达10~20Gy时,治疗组服用玄参甘桔汤,对照组服用食管炎合剂(生理盐水、利多卡因、庆大霉素、地塞米松),分别对其疗效进行观察。结果:2组均出现不同程度的放射性食管炎反应,治疗组症状明显缓解,其中显效21例,有效16例,无效3例,有效率92.5%。对照组显效5例,有效15例,无效20例,有效率为50.0%,2组比较,差异有统计学意义(P0.05)。结论:玄参甘桔汤协同放疗可明显降低放疗的不良反应,可有效治疗和预防放射性食管炎,有助于放射治疗的顺利完成,提高放疗效果。     

Legg-Perthes病动物模型设计与评价

目的：设计制作静脉回受阻Legg-Perthes病动物模型，并对其进行观察评价。方法：选择健康杂种幼犬20只，雌雄不拘。采用自身对照方法，一侧髋用来实验，一侧髋作为对照，应用套针经皮大于转子下方穿入股骨颈中央达股骨头颈部骺板远侧，注入1ml医用TH胶，于实验不同时期行骨骺后内压、X线、CT检查，组织标本行常规病理检查，结果：实验制作了影像及组织病理变化类似于人类Legg-Perthes病的动物模型。结论：此模型设计合理，制作方法简单，重复性较强。     

食管胃黏膜延长分层吻合的实验研究

目的　探讨食管胃吻合抗胃食管反流、预防吻合口瘘及狭窄的术式。　方法　选杂种犬 5 8条 ,随机分为实验组和对照组。实验组 :31条犬 ,自贲门横断 ,食管黏膜延长 1.5～ 2 cm;切除部分胃小弯 ,剥除大弯侧保留部分浆肌层 ,成形为宽 3～ 3.5 cm、长 4～ 5 cm黏膜管 ,行食管胃黏膜、肌层分层吻合。对照组 :2 7条犬 ,用“深套叠”术式。于术后 3～ 180天检测对比分析。　结果　两组突入胃内结构长度、肌层吻合口直径差别无显著性意义 (P>0 .0 5 ) ,黏膜游离缘直径差别有显著性意义 (P<0 .0 1) ;实验组能耐受较高胃内压 ,胃与食管压力差两组差别有显著性意义 (P<0 .0 1) ;突向胃腔内结构厚度两组相差 1倍以上 ;实验组成形黏膜血供良好 ,吻合口愈合及缝线脱落早于对照组。　结论　适当剥除肌层不引起黏膜缺血坏死 ;成形黏膜瓣薄软 ,具有良好的抗反流效果 ;黏膜层密缝对合严密、愈合快 ,能有效预防吻合口瘘的发生 ,不同平面吻合狭窄发生率低。     

Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication

The aim of this study was to determine whether preoperative physiologic factors can account for and be used to predict the development of postoperative dysphagia after laparoscopic Nissen fundoplication. One hundred sixty-three patients with gastroesophageal reflux disease underwent laparoscopic Nissen fundoplication with a median follow-up of 14 months (range 6 to 81 months). Preoperative dysphagia was present in 37% (60 of 163) and was relieved in all but five patients (92%). Female sex (P = 0.01) and the presence of a stricture (P = 0.02) were the only preoperative variables associated with the presence of preoperative dysphagia. Eight percent (8 of 103) of patients without preoperative dysphagia developed new-onset dysphagia, and of these 63% (5 of 8) had a normal lower esophageal sphincter (LES) (pressure >6 mm Hg; length >2 cm; abdominal length >1 cm). New-onset dysphagia was significantly more common in patients with a normal LES (22% [5 of 23] vs. 4% [3 of 80], P = 001). Patients with a normal LES had almost a sixfold increase in the risk of developing dysphagia as those with an abnormal LES (relative risk = 5.8). Only a preoperative normal LES (P = 0.02) or mean LES pressures (P = 0.04) were positively associated with the development of postoperative dysphagia. The severity of this dysphagia also showed a strong positive trend of increasing with mean preoperative LES pressures (P = 0.07). Finally, preoperative LES pressure significantly correlated with postoperative LES pressure (r = 0.48, P = 0.01) and with mean residual LES (nadir) pressure (r = 0.33, P = 0.05) offering insight into the mechanism of this dysphagia. In conclusion, preoperative LES parameters play a role in the development of dysphagia after laparoscopic Nissen fundoplication. Patients with a normal LES or high mean LES pressures are at increased risk for developing this complication and should be informed of this before laparoscopic Nissen fundoplication. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Ga., May 20–23, 2001.     

Differential molecular changes in patients with asymptomatic long-segment Barrett's esophagus treated by antireflux surgery or medical therapy

Background

The Barrett's to adenocarcinoma sequence is characterized by molecular changes including activation of nuclear factor-κB (NF-κB) and related cytokines. In this observational nonrandomized study this molecular environment was compared in matched asymptomatic cohorts who had undergone either fundoplication or therapy with proton pump inhibitors (PPIs).

Methods

Asymptomatic patients with long-segment Barrett's esophagus had endoscopic biopsy specimens taken from 2 cm below the squamocolumnar junction for measurement of activated NF-κB and a panel of cytokines and growth factors.

Results

Thirty-seven patients were recruited (surgical: n = 18, medical: n = 19). The mean patient age was 51 years, and the mean follow-up period was 5.6 years. There were no differences in the length of Barrett's segment and endoscopic and histopathologic features in both groups. Mean activated NF-κB p50 and p65 subunits, interleukin (IL)-1α, IL-1β, and interleukin-8 levels, were significantly (P < .05) lower in the surgically treated group.

Conclusions

This study provides proxy support to the thesis that antireflux surgery may provide an environment that is less inflammatory and tumorigenic than that observed in medically treated patients.     

Laparoscopic transgastric esophageal mucosal resection: 4-year minimum follow-up

Background

The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.

Methods

Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed.

Results

Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation.

Conclusions

Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus.     

Pseudoachalasia occurring after laparoscopic Nissen fundoplication and crural mesh repair

Background Benign esophageal pseudoachalasia is a rare condition. Discussion We report the case of a 70-year-old man who complained of severe dysphagia after laparoscopic Nissen fundoplication and crural mesh repair performed for long-standing gastroesophageal reflux disease. Severe dysphagia and nocturnal aspiration developed soon after the operation. A marked dilatation of the esophageal body and a manometric pattern resembling achalasia was documented. Results Endoscopic balloon dilatation was ineffective. Five months after the initial operation, the patient underwent revisional laparoscopic surgery that consisted of Nissen’s wrap takedown, enlargement of the hiatus with partial resection of the mesh, Heller myotomy, and Dor fundoplication. After a 2-year follow-up, the patient is doing well and is free of symptoms.