The effect of surgeon volume and hospital characteristics on in-hospital outcome after ureteral reimplantation in children

The aim of this study was to examine the association between surgeon and hospital characteristics on in-hospital outcome after ureteral reimplantation in children. Patients < 18 years undergoing vesicoureteral reimplantation (n = 3,109) were identified in Kids’ Inpatient Database, an administrative database containing discharge records from 27 states during 2000 in the US. Based on patient volume in 2000, surgeons were designated as low volume (< 11 procedures), medium volume (11–20 procedures) and high volume (> 20 procedures) surgeons. Length of stay and hospital charges were analyzed using multivariate linear regression analysis. A significant association between shorter length of stay and higher surgeon volume (p = 0.02) was observed that was independent of children’s hospital status, hospital volume and other hospital characteristics. Length of stay was 20% shorter when the procedure was performed by the highest volume surgeons compared to when performed by the lowest. No significant effect of surgeon volume on hospital charges, however, was observed. Higher surgeon volume was associated with shorter length of stay but no difference in hospital charges among children undergoing vesicoureteral reimplantation.     

Obstructive uropathy

Routine second trimester ultrasound screening has resulted in more infants diagnosed with antenatal hydronephrosis. Current recommendations suggest postnatal evaluation of all infants with a renal pelvic diameter >5 mm with ultrasound and voiding cystourethrogram (VCUG.) There are many etiologies of obstructive uropathy including ureteropelvic junction (UPJ) obstruction, ureterovesical junction (UVJ) obstruction, posterior urethral valves (PUV), prune belly syndrome, and vesicoureteral reflux (VUR). Obstructive uropathy can result in tubular damage and decreased nephron number. Tubular damage can result in sodium wasting, hyperkalemic acidosis, and nephrogenic diabetes insipidus. Most patients do not require renal replacement therapy in the neonatal period; however, chronic renal insufficiency can occur if the neonate has a significant reduction in nephron number or progressive renal damage from obstruction or infection.     

Effect of level of circular myotomy on oesophageal function in a piglet model

Oesophageal continuity is often difficult to obtain in long-gap oesophageal atresia, and a circular myotomy may be required to achieve oesophageal anastomosis. This study compared the effects of upper and lower segmental circular myotomy on oesophageal stricture formation, oesophageal motility, and the development of gastro-oesophageal reflux (GOR) in a piglet model. Group I underwent mid-oesophageal resection with upper segment myotomy (14); group II mid-oesophageal resection with lower segment myotomy (8); and group III oesophageal transection and anastomosis without resection (6). Normal motility data were obtained from 8 unmanipulated piglets. The incidence of stricture formation was high in all operated groups. Pseudodiverticula developed in all piglets after proximal myotomy, but not after transection or distal myotomy. Lower oesophageal sphincter pressure and mean amplitude of upper oesophageal contractions were similar after operation in all groups and in controls. GOR (number of reflux episodes/24 h, number of episodes of reflux lasting more than 5 min, and fraction of time pH less than 4.0) was worse after operation compared to controls. Within each group most manometric parameters and GOR worsened with time. We found no evidence that the level of circular myotomy (upper or lower) resulted in any significant difference in stricture rate, oesophageal motility, or severity of GOR. Given the difficulty of performing an upper myotomy in long-gap atresia, where the upper segment is often very short and pseudodiverticulum formation is common, a lower-segment circular myotomy would appear to be a reasonable alternative.     

食管裂孔疝伴胃食管反流病的胃食管动力学研究

目的:探讨食管裂孔疝(HH)伴胃食管反流病(GERD)患者与单纯HH及GERD患者之间的内镜、24h食管pH监测、食管测压、胃动力学检查之间的相关性.方法:经胃镜确诊的HH伴GERD患者61例,同期内镜确诊单纯HH患者28例,GERD患者30例,在一周内进行24h食管pH监测、食管下端括约肌(LES)压力测定及胃磁图测定胃半排空时间.结果: GERD中pH监测诊断同内镜诊断相符合占83.52%,不符合占16.48%.24h pH监测中,HH伴GERD组患者的总反流时间、卧位反流时间及立位反流时间百分比均显著高于GERD组和HH组,GERD组显著高于HH组;HH伴GERD组LESP显著低于HH组和GERD组,HH组LESP显著低于GERD组;HH伴GERD组LESL显著短于GERD组,HH伴GERD组和HH组LESL无显著差异,HH组LESL显著短于GERD组;HH伴GERD组LESR显著高于HH组和GERD组,HH组LESR显著高于GERD组;HH伴GERD组胃排空延缓者显著多于HH组,但与GERD组无显著差异,GERD组胃排空延缓者显著多于HH组.     

舒肝健胃丸联合多潘立酮及法莫替丁治疗胆汁返流性胃炎疗效观察

目的观察舒肝健胃丸联合吗丁啉及法莫替丁片治疗胆汁返流性胃炎（BRG）肝胃不和型的临床疗效。方法选择65例肝胃不和型BRG患者随机分为2组,对照组30例给予口服多潘立酮片、法莫替丁片治疗,治疗组35例在对照组治疗的基础上加用疏肝健胃丸治疗,治疗28d后观察患者症状变化及内镜检查情况。结果治疗组总有效率91.43%高于对照组的63.33%;疗程结束后6个月,治疗组复发率为20.00%低于对照组的35.00%,差异均有统计学意义（P均〈0.05）。结论疏肝健胃丸联合多潘立酮片、法莫替丁片治疗肝胃不和型胆汁返流性胃炎（BRG）疗效显著,在改善临床症状、降低复发率方面更显优势。     

抗反流方治疗反流性食管炎临床研究

目的观察抗反流方治疗反流性食管炎(RE)的疗效及其对胃食管反流及胃排空的影响。方法63例RE患者随机分为治疗组(31例)和对照组(32例),前者予以抗反流方治疗,后者予以法莫替丁和西沙必利治疗,疗程均为8周。观察两组治疗前后临床疗效、反流指数和胃排空率变化。结果抗反流方能有效改善RE患者的临床症状和内镜下形态学改变,与对照组相当(P>0.05);抗反流方能降低反流指数(P<0.05)、增加胃排空率(P<0.01)。结论抗反流方能促进胃排空,改善胃食管反流以缓解RE。     

莫沙必利与雷贝拉唑联合治疗42例反流性食管炎的效果

目的探讨莫沙必利与雷贝拉唑联合治疗反流性食管炎的效果。方法2008年2月～2013年2月期间前来我院治疗反流性食管炎的84例患者,随机分成两组,治疗组给予莫沙必利联合雷贝拉唑,对照组给予法莫替丁联合莫沙必利。对两组患者的临床疗效以及胃镜下疗效进行对比。结果治疗组无论是临床疗效,还是胃镜下疗效均显著优于对照组（P〈0．05）。结论对于反流性食管炎患者给予莫沙必利同雷贝拉唑联合的治疗方法,不但治疗效果十分显著,且服用方法非常方便,值得推广至相应临床。     

胃力康与多潘立酮治疗反流性食管炎临床疗效和安全性比较

目的：观察胃力康治疗反流性食管炎的临床疗效和安全性。方法：80例反流性食管炎患随机分为胃力康组40例，用胃力康颗粒10g,po,tid；多潘立酮多潘立酮组40例，用多潘立酮10mg,po,tid，疗程均为6wk。结果：胃力康在治疗6wk后打嗝、反酸，反食，胃部不适和吞咽后胸痛等症状改善，总有效率为85．0％，多潘立酮总有效率为60．0％（P＜0．05）。结论：胃力康能明显缓解反流性食管炎患的临床症状，疗效优于多潘立酮，不良反应轻微，是治疗反流性食管炎有效，安全的药物。     

质子泵抑制剂及香砂养胃丸联合黛力新治疗非糜烂性反流病临床研究

目的观察质子泵抑制剂（PpI）奥美拉唑、香砂养胃丸联合黛力新（氟哌噻吨美利曲辛片）治疗社区非糜烂性反流病（NERD）的临床疗效及安全性。方法选择2011年3月至2013年9月在该中心门诊及住院诊断为NERD患者共66例,随机分为PPI联合香砂养胃丸治疗组22例,PPI联合黛力新治疗组22例,PPI、香砂养胃丸联合黛力新治疗组22例。采用中国胃食管反流病研究组制定的耐信量表（RDQ）对患者治疗前及治疗12周后症状积分及有效率进行评分。结果经过12周治疗,PPI、香砂养胃丸联合黛力新治疗组总有效率为95．45％,显著高于其他两组（PPI联合香砂养胃丸治疗组为68．18％,PPI联合黛力新治疗组为81．82％）,差异有统计学意义（P〈0．05）;PPI、香砂养胃丸联合黛力新治疗组患者RDQ评分与其他两组比较有显著改善,差异有统计学意义（P〈0．05）。三组不良反应比较,差异无统计学意义（P〉O．05）。结论在PPI、香砂养胃丸治疗基础上加用黛力新能显著改善NERD患者临床症状,提高疗效,改善患者生活质量。     

铝碳酸镁对十二指肠液反流所致大鼠食管病变的防治作用

目的　通过动物实验 ,研究十二指肠液反流对食管上皮的损伤及评价铝碳酸镁对食管粘黏损伤的预防和治疗作用。方法　 16 0只SD大鼠 ,♂ ,2 0只为正常空白对照 (C组 ) ,14 0只行全胃切除 +食管空肠吻合术 ,术后 2周存活的大鼠随机分为A、B两组 ,A组予以铝碳酸镁管喂 ,B组管喂等量的生理盐水 ,术后 10周处死所有的大鼠 ,对食管上皮进行大体形态、病理学及电镜观察。结果　A、B两组的食管有程度不同的反流性食管炎 ,组织学表现为炎症、糜烂、溃疡、鳞状上皮增生、Barrett上皮化生及不典型增生。B组的炎症程度重于A组 (P <0 .0 1) ,Barrett上皮化生及不典型增生的发生率明显高于A组 (P <0 .0 5 )。B组有 1例食管微灶腺癌形成。扫描及透射电镜发现B组有Barrett化生的食管上皮典型分泌型肠上皮的特征。结论　铝碳酸镁能有效保护十二指肠液反流的食管粘黏 ,预防及治疗因其所致的多种病理学损害