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61.
62.
贲门癌切除机械吻合术后的胃食管反流 总被引:3,自引:1,他引:3
目的:探讨贲门癌切除食管胃机械吻合术后重建食管与胃食管反流之间的关系.方法:对30例术后患者进行食管胃压力测定,其中16例行24h食管pH监测,12例行内镜检查和病理学检查.结果:测压结果显示:吻合口与吻合口下方的静息压相似,比较差异无显著性(P>0.05),而吻合口上方静息压增高,平均为3.42mmHg,经比较吻合口上方和吻合口下方差异有显著性(P<0.05).值得注意的是其压力值(3.42mmHg)远低于正常括约肌的静息压(10~45mmHg),因此其抗反流作用的程度是有限的.本组16例术后食管24h pH监测表明食管的酸暴露时间延长,食管酸暴露时间百分比平均为13.78%,为正常人的11倍,反流次数增加,最长反流时间达43min,说明手术后的胃食管反流是客观存在的.内镜检查和病理检查,83.3%有异常现象及食管炎征象,进一步证实术后患者有不同程度的反流性食管炎.结论:1)贲门癌切除食管胃吻合术后存在胃食管反流.2)反流的发生不因机械吻合或手工吻合而异.3)反流的发生与术后时间长短无关.4)24h食管pH监测是最敏感的观察方法.5)半卧位睡眠是预防反流的有效方法.6)反流的治疗主要应用促动力药和粘膜保护剂. 相似文献
63.
Background Duodenogastric reflux is known to cause an increased frequency of cancer in the glandular portion of the stomach in rats. Furthermore, it is debated whether inhibition of gastric acid secretion may promote gastric carcinogenesis. In the present study we examined the combined effect of gastroduodenal reflux and acid inhibition with respect to the development of gastric carcinoma in the rat.Methods Following the construction of a gastrojejunostomy in male Wistar rats, half of them were given the proton pump inhibitor lanzoprazole for 1 year. The rats were then killed and the pH in the stomach and gastrin in blood were measured. The stomach was examined macroscopically as well as histologically.Results Gastrin levels at autopsy were significantly increased in treated rats compared to the control group, confirming an effect of lanzoprazole on gastric acid secretion. Body weight was significantly reduced in the treated rats. Thirty of 79 rats developed gastric cancer, and they were all adenocarcinomas of the Lauren intestinal type. Gastric cancers occurred significantly more often in lanzoprazole-treated rats (50%) compared with controls (27%).Conclusion Lanzoprazole given orally enhances the carcinogenic effect of duodenogastric reflux in rats. 相似文献
64.
Subjective and functional results after total gastrectomy: prospective study for longterm comparison of reconstruction procedures 总被引:7,自引:0,他引:7
Shinya Adachi Satoshi Inagawa Tsuyoshi Enomoto Eiji Shinozaki Tatsuya Oda Toru Kawamoto 《Gastric cancer》2003,6(1):0024-0029
Background:
Many reconstruction procedures have been developed in efforts to resolve patients' complaints after total gastrectomy. However,
there have been few reports of longterm comparisons between reconstruction procedures, especially with regard to the prevention
of duodenal food passage. This study was undertaken to compare the longterm subjective and functional results among Roux-en-Y
esophagojejunostomy (R-Y), R-Y with pouch (P-Y), and jejunal interposition with pouch (P-I) after total gastrectomy.
Methods:
Consecutive patients requiring curative total gastrectomy were enrolled in this prospective study by the envelope method.
Results:
Hospital stay was longer following a P-I than an R-Y or a P-Y. Over 50% of R-Y patients complained of heartburn, and 20%
of R-Y patients showed dumping syndrome throughout the postoperative period, with this rate being significantly different
from rates in the other two groups. P-Y patients complained of early satiety in the late postoperative period, while P-I patients
complained of early satiety in the early postoperative period. The nutritional index in P-I patients was higher than those
in patients with the other two procedures. Gastrointestinal and hepatobiliary dual scintigraphy (GHDS) showed that the rate
of bile reflux with an R-Y was relatively high after surgery. Food reflux with a P-Y was increased (9.4% to 11.1%), but with
a P-I food reflux was decreased at 3 years after surgery (13.3% to 9.9%). Patients with a P-Y had a faster recovery of body,
weight in the early postoperative period; however, at 5 years after operation, body weight recovery with a P-I was greatest.
Conclusion:
Reconstruction should be performed with pouch formation after total gastrectomy with curative intent.
Received: March 7, 2002 / Accepted: September 26, 2002
Acknowledgments This study was partly supported by the University of Tsukuba Research Project.
Offprint requests to: S. Adachi 相似文献
65.
目的 了解十二指肠胃食管反流(DGER)所致急性气管炎的病理学变化。方法 将实验组的幼兔复制成DGER动物模型,应用光镜和扫描电镜观察气管组织。结果 气管粘膜层的纤毛及柱状上皮细胞变性、脱落;粘膜下层炎性水肿。结论 DGER反流液中的胃酸和胆汁酸等双重攻击因子可直接导致气管的化学性炎症损伤。 相似文献
66.
Assessment of adolescent varicocele 总被引:4,自引:0,他引:4
Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10–20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation. 相似文献
67.
新生儿胃食管反流发病机理的研究 总被引:10,自引:0,他引:10
为探讨新生儿胃食管反流(GER)的发病机理,对38例经钡餐造影诊为GER的患儿进行食管pH值动态监测和食管动力功能检查,15例无症状儿作对照组。结果:GER组各项反流指标均显著大于对照组。38例中18例为生理性GER,20例为病理性GER。病理性反流组下食管括约肌压力(LESP)和屏障压(BP)均显著低于对照组,而食管功能的其他指标则差异无显著意义。以总pH值<4百分时间2.77%和综合评分8.92为95%参考值上限,则GER组病理性反流的检出率为55.3%(21/38),高于对照组的6.7%(1/15)(P<0.01)。LESP和BP的95%参考值下限分别为8.39kPa、8.15kPa,对照组无一例LESP低下,GER组LESP降低占15.7%(6/38),二组差异无显著意义(P>0.05)。提示:新生儿期食管功能已成熟,新生儿GER的发生不单是LESP降低这一因素,还可能与短暂下食管括约肌松驰有关。 相似文献
68.
Hiroshi Tanaka Toru Nakahata Ryosuke Ito Norio Onodera Shinobu Waga 《Pediatrics international》1998,40(4):367-369
Abstract A male infant with bilateral small kidneys associated with both proximal and distal tubular dysfunction, who showed chronic renal failure soon after birth, is reported. He was also noted to have both proximal and distal type of renal tubular acidosis. The small kidneys were thought to be due to renal hypodysplasia associated with bilateral severe vesicoureteral reflux, by radiological findings. An alkalization therapy with chemo-prophylaxis seemed to be of benefit in slowing the progression of renal failure in this case. 相似文献
69.
凹凸棒石粉对胆汁的吸附作用 总被引:5,自引:0,他引:5
目的 :探索降低反流胆汁中胆酸浓度的有效国产药物。方法 :以凹凸棒石粉或双八面体蒙脱石 (思密达 )吸附胆汁反流症患者胃液 ,检测并比较吸附前后胃液总胆酸和三羟胆酸含量 ,同时比较凹凸棒石粉剂和双八面体蒙脱石对胆酸的吸附能力。结果 :吸附前三羟胆酸和总胆酸含量分别为 (10 5 .71± 43.35 )μg/ ml和 (2 71.5 0± 77.5 0 )μmol/ L ,经凹凸棒石粉或双八面体蒙脱石吸附后三羟胆酸含量分别为 (32 .32± 18.36 )μg/ m l和 (2 9.13± 17.0 2 )μg/ ml,总胆酸含量分别为 (130 .0 1± 30 .94)μm ol / L与 (76 .90± 41.80 )μm ol/ L ,吸附前后三羟胆酸和总胆酸含量有显著差异 (P<0 .0 1) ,而经凹凸棒石粉或双八面体蒙脱石吸附后三羟胆酸和总胆酸含量无显著差异 (P>0 .0 5 )。 结论 :凹凸棒石粉对胆酸有较强的吸附作用 ,与双八面体蒙脱石无显著差异 ,有良好的临床应用前景。 相似文献
70.
匀气汤对返流性食管炎患者食管粘膜形态及食管动力学的影响 总被引:7,自引:0,他引:7
目的:观察匀气汤对返流性食管炎患者食管膜形态及食管动力学的影响。方法:42例返流性食管炎患者,按照中医辨证分为肝胃不和、脾胃虚寒(DC组)和肝胡化热(H组)3个证型组。分别以匀气汤Ⅰ、Ⅱ、Ⅲ号进行4周治疗。治疗前后计算症状积分,检查胃镜并测定食管动力学变化。结果:(1)症状绘解率81.1%,其中D组症状缓解率低下Ⅰ组和H组;(2)食管粘膜治愈率61.1%,有效率90.5%,无效率9.5%,治愈率 相似文献