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51.
良性上消化道疾病的食管动力学变化 总被引:2,自引:0,他引:2
目的:探讨良性上消化道疾病患者食管动力学的变化情况。方法:对32例良性上消化道疾病患者进行食管测压检查。结果:34.38%的病例LESP减低,87.5%出现吞咽后同不收缩,53.13%出现自发性同步收缩,28.13%正常需动收缩完全消失,50%出现远端食管平均收缩压力减低,56.25%出现远端食管低压收缩。结论:本组病例多有远端食管运动功能障碍,以吞咽后同步收缩为主,其与反流性食管炎以及一些临床症 相似文献
52.
为探讨pH电极位置对反流性食管炎酸监测的影响,将60例反流性食管炎随机分为对照(C)组和试验(T)组。 C组 30例用测压法将 pH电极置于下食管括约肌(LES)上缘 5 cm处;T组 30例用 pH梯度法将电极放于胃食管连接处(GEJ)上方 5 cm处。连续 24 h pH监测。结果显示,C与T组前鼻孔至GEJ平均距离分别为(46. 2±4.1) cm与(46. 5±4. 5) cm,两者无明显差异(P=0. 8)。两组前鼻孔至GEJ平均距离(46. 3±4. 3) cm比 C组前鼻孔至LES上缘平均距离(43. 3±3. 1) cm低 3. 0 cm(P=0. 0003)。食管酸监测的 pH<4,总百分时间和总计分在T组(8.5和 45. 5)和T组中GEJ>LES上缘+3 cm和<-3cm范围者(10. 0和 99. 3)较C组(4. 8和 26. 3)均有明显增高, P均<0. 01),而T组中GEJ≤LES上缘+3 cm和≥-3 cm范围者(7. 1和 39. 4)则无明显差异( P均>0. 05)。研究结果表明,因 GEJ常比 LES上缘偏低,故以 GEJ安放电极(尤其是GEJ>LES上缘 + 3cm或<- 3cm范围者)对反流性食管炎行 pH监测时 相似文献
53.
Vesicoureteric reflux (VUR) is a major problem in completely duplicated ureters. So far, the treatment of choice has been the reimplantation of the two ureters in their common sheath, the ureterocystoneostomy en bloc according to Politano-Leadbetter's or Cohen's procedure. In recent years, some pediatric surgeons and urologists have questioned the efficacy of this method. We therefore analyzed 62 children with 69 duplicated ureters treated en bloc by Politano-Leadbetter's procedure during the 20-year period 1971 – 1990. Postoperative follow-up was up to 16 years. We noted only 1 recurrence of reflux as well as 2 stenoses. Long-term results as far as function was concerned were also favorable in 40 duplicated renal units. Thus, ureteral reimplantation en bloc remains a simple and safe procedure for treating VUR in completely duplicated ureters. 相似文献
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Background: Advocates of the Toupet partial fundoplication claim that the procedure has a lower rate of the side effects of dysphagia
and gas bloat than a complete Nissen fundoplication. However, there is increasing recognition that reflux control is not always
as good with the Toupet procedure as with the Nissen. Therefore, we set out to evaluate the factors contributing to success
and failure in patients who underwent laparoscopic modified Toupet fundoplication (LTF).
Methods: A total of 143 patients undergoing LTF for documented gastroesophageal reflux disease (GERD) were evaluated prospectively
in regard to their outcomes over a 4-year period. All patients had preoperative esophagogastroduodenoscopy (EGD) and manometry;
24-h pH testing was used selectively. Esophageal manometry was requested of all patients 6 weeks postoperatively. Clinical
follow-up was by office visit or questionnaire every 6 months after surgery; patients with significant problems were investigated
further. Failure was defined as the development of recurrent reflux documented by endoscopy, 24-h pH test, or wrap disruption
on barium swallow, or severe dysphagia persisting >3 months and requiring surgical revision.
Results: At a mean follow-up of 30 months (range, 3–51), 21 of 143 patients failed LTF; two had dysphagia and 19 had recurrent reflux.
Failure was associated with preoperative findings of a defective lower esophageal sphincter (LES) (14/21), complicated esophagitis
(13/21), and failure to divide short gastric vessels (12/19) (chi-square p < 0.05). Defective esophageal body peristalsis, present in 14 patients, resulted in failure in six cases. Presence of either
complicated esophagitis or a defective LES was associated with a 3-year 50% success rate, whereas presence of mild esophagitis
and a normal LES was reflected in a 96% 3-year success rate.
Conclusion: Laparoscopic Toupet fundoplication should be reserved for milder cases of GERD, as assessed by manometry and endoscopy.
Received: 29 June 1998/Accepted: 2 July 1999 相似文献
58.
Polito C La Manna A Mansi L Rambaldi PF Papale MR Marte A Di Toro R 《Pediatric nephrology (Berlin, Germany)》1999,13(9):876-879
Body growth was studied in 32 subjects with vesicoureteric reflux (VUR), diagnosed following the prenatal finding of urinary
tract dilatation, who had normal renal filtration function and who received antibacterial prophylaxis by the first few days
of life. They were followed for 1–5 years (mean 2.3 years). Most had persistent VUR during the 1st year of life. Body growth
performance was compared with that of 94 subjects with VUR diagnosed and treated by us after the neonatal period. During the
follow-up period, none of the patients with prenatally detected VUR had a height Z score below –2, nor a weight-for-height
index below 90%, and 1 had variations in height Z score ≥1. The difference in the percentage of patients with prenatally detected
VUR (1/32) and those with VUR diagnosed and treated after the neonatal period (20/94) who had variations in height Z score
≥1 was significant (P=0.035). Patients with prenatally detected VUR and normal renal filtration function, given antibacterial prophylaxis by the
first few days of life, have normal body growth, although VUR still persists.
Received: 19 March 1998 / Revised: 10 February 1999 / Accepted: 10 February 1999 相似文献
59.
Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy 总被引:2,自引:0,他引:2
Conducting the qualitative evaluation of reconstruction methods is difficult because of their complexity. The aim of the present
study was to compare esophageal bile and food reflux by performing gastrointestinal and hepatobiliary dual scintigraphy (GHDS)
after various methods of reconstruction following total gastrectomy. Of 17 patients studied, 4 had undergone Roux-en-Y anastomoses
(R-Y); 6, jejunal pouch-Y anastomoses (P-Y); and 7, jejunal pouch interposition (P-I). GHDS was performed 1 year after surgery
using111In-diethylene triamine pentaacetic acid administered orally, and99mTc-pyridoxyl-5-methyl tryptophan administered intravenously. Imaging data from a gamma camera were stored in and processed
by a data analyzer. Three patients who had undergone R-Y and one who had undergone P-I complained of heartburn, while one
who had undergone R-Y, two who had undergone P-Y, and three who had undergone P-I complained of a feeling of fullness. Esophageal
bile reflux was confirmed by GHDS in four of the patients who had undergone R-Y, one who had undergone P-Y, and four who had
undergone P-I. Moreover, GHDS demonstrated food retention in two patients who had undergone R-Y, five who had undergone P-Y,
and four who had undergone P-I. Weight loss was closely related to the esophageal reflux of bile or food which can be accurately
detected by GHDS. Despite the absence of heartburn, patients diagnosed as having bile reflux by GHDS showed poor recovery
of body weight. 相似文献
60.
Roux-Y Gastric Bypass: an effective anti-reflux procedure 总被引:1,自引:0,他引:1
Gastric limiting procedures have made an improvement in the lives of those patients in whom they have been successful. Not
only have there been marked improvements in diabetes, hypertension, and arthritis, but there have been a number of other ‘spin-offs’,
not the least of which is control of reflux esophagitis by totally eliminating the secretion of the parietal cell mass of
the stomach from rising into the esophagus. We compared a group of 100 obese patients with reflux esophagitis who underwent
Roux-Y gastric bypass (RYGBP) to a normalsized group of 23 patients on whom we had done Nissen fundoplications in the past.
Visick gradings I-II of 100% vs 87%, respectively, may indicate a superiority of RYGBP over the Nissen procedure. Although
the groups and time periods are too divergent to draw statistically significant conclusions, one can see that the RYGBP population
was apparently better served considering their cure of ‘heartburn’ and other reflux symptoms as well as their achievement
of sustained weight loss. 相似文献