早期活血、抗凝、袪聚对断流术后门静脉系统血栓形成的影响

目的探讨早期活血、抗凝、祛聚对断流术后门静脉系统血栓形成的影响。方法选取衡水市第三人民医院2006年1月～2013年12月收治的326例肝炎后肝硬化门静脉高压症并上消化道出血,并行贲门周围血管离断术患者,分为实验组（2009年2月～2013年12月收治,226例）和对照组（2006年1月～2009年1月收治,100例）。两组患者均进行贲门周围血管离断术,对照组术后常规预防性应用止血药物2～3d及术后综合治疗;实验组术中、术后不用止血药物,早期应用活血、抗凝、祛聚药物。观察两组对门静脉系统血栓形成的影响。结果实验组累计发生血栓为11例（4．42％）,对照组患者累计发生血栓为35例（35．00％）,两组比较差异有统计学意义（P〈0．05）。结论门静脉高压症贲门周围血管离断术后早期应用活血、抗凝、祛聚药物能明显降低血栓发生率,对围术期出血无明显影响,是防治门静脉血栓形成的安全有效的方法,有待在基层医院规范防治断流术后门静脉系统血栓形成得到推广。     

应用动态APACHEII评分指导门静脉高压症外科治疗

目的　应用 APACHE II连续评分判断门静脉高压症合并上消化道出血患者不同手术方式的预后。方法　对本院 2 0 0 2 .1～ 2 0 0 3.1 2间门静脉高压症合并上消化道出血手术的 4 7例患者 ,术前、术后 1、3、5、7d APACHE II连续评分 ,比较死亡组和非死亡组、断流手术组与断流加分流手术组 (联合组 )预后、死亡率与评分值关系。结果　 4 7例患者中断流手术 33例 ,分流手术 1 4例。死亡组术后 APACHE II连续评分逐日上升或居高不下且与生存组有显著差异 ;断流组术前评分低于联合手术组但无显著差异 ,而术后 1、3d断流组评分显著低于联合手术组 ,术后第 5、7d两组评分无显著性差异表现 ;断流组的死亡率小于联合手术组 ,但无显著性差异 ;利用 APACHE II术后死亡危险性 R公式对患者术前、术后 1、3、5和 7d APACHEII死亡危险系数评估 ,提示断流和联合手术两组不同时段的 APACHE II死亡危险性预测数中术后 7d的数值与实际发生数最为接近。结论　动态 APACHE II评分适用于门静脉高压合并上消化道手术预后的评估 ;断流术与联合手术早期评分有差异 ,5 d后无显著差异 ,且两者死亡率无显著差异 ;术后第 7d APACHE II死亡危险性预测数值与实际发生数最为接近     

Age-related differences in regeneration of dystrophic (mdx) and normal muscle in the mouse

The mdx mouse, a genetic homologue of human Duchenne muscular dystrophy (DMD), has been attributed with a greater regenerative capacity of its skeletal muscles. Here, we have tested the hypothesis that muscles of mdx mice regenerate better than those of nondystrophic animals. We studied muscle regeneration resulting from a denervation-devascularization injury (DD) of extensor digitorum longus muscle (EDL) at 3 weeks and 2 months in mdx and wild-type (C57BL/10) mice. Histological and morphometrical studies of muscle regeneration were made from 3 to 180 days later. When DD was performed in 3-week-old C57BL/10 mice, the percentages of nonperipheral nuclei in regenerated fibers decreased progressively over 3 months. This decrease did not occur in animals where DDs were performed at 2months, suggesting that two different populations of muscle precursor cells are mobilized in muscle regenration in mice at these two ages. Moreover, mdx EDL muscle regenerated similarly to the controls for up to 60 postoperative days, as shown by distribution of mean diameters and percentage of nonperipheral nuclei of muscle fibers. After 60 postoperative days, necrosis/regeneration characteristics of mdx muscles recurred, suggesting that mdx-regenerated muscle fibers remain susceptible to degeneration.© 1995 John Wiley & Sons, Inc.     

食管胃手工分层吻合术治疗食管癌、食管胃交界部癌的疗效观察

目的:探讨食管癌、食管胃交界部癌切除食管胃手工分层吻合术的疗效。方法:回顾性分析50例食管癌、食管胃交界部癌切除食管胃手工分层吻合术的恢复情况,统计吻合口瘘和狭窄的发生率,总结疗效和手术体会。结果:本组患者50例手术均顺利。2例吻合口炎症,5例慢性残胃炎,部分有胸痛、上腹胀痛、反酸、腹泻等症状,未出现吻合口瘘及狭窄。结论:食管胃手工分层吻合可以明显降低食管癌、食管胃交界部癌术后吻合口瘘和狭窄的发生,而且可以降低费用,值得临床推广应用。     

Use of a Roux Limb to Correct Esophagogastric Junction Fistulas after Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) can be complicated, in the early postoperative course, by an esophagogastric junction (EGJ) leak with very serious consequences. A 48-year-old woman developed an EGJ leak 3 days after LSG surgery and was treated with conservative measures. Finally, 6 weeks after the original surgery, a Roux limb was brought to the EGJ and anastomosed side-to-end to the fistula. At the beginning, the Roux limb was the only functioning outlet and finally, 2 months later, both pathways (the gastric sleeve and the Roux-en-Y) are patent at 3 months after surgery. The Roux limb resolved a dangerous EGJ leak after a LSG.     

门静脉高压脾切除门奇静脉离断术后再出血的食管胃静脉曲张分类研究

目的：探讨门静脉（门脉）高压患者脾切除门奇静脉离断术（脾切断流术）后再发上消化道出血的平均时间、内镜下食管和胃静脉曲张的分类特点及门脉高压性胃病的发病率。方法：190例肝硬化门脉高压出血患者分为脾切断流术后再出血组（40例）和未行手术组（150例）,统计手术患者术后至首次出血的平均时间间隔,每组患者分别行内镜检查,观察并对比其曲张静脉的分型特点及门脉高压性胃病发生率。结果：脾切断流术后再发出血时间平均为24个月,再出血患者内镜皆提示存有食管和（或）胃静脉曲张,2组患者内镜下的曲张静脉分型构成比有明显差异,脾切断流术者以单纯食管静脉曲张及食管胃静脉曲张（GOV）1型为主,未发现孤立性胃静脉曲张（IGV）1型及IGV2型,60．0％患者存在门脉高压性胃病,其发病率及严重程度均高于未行手术组患者。结论：脾切断流术治疗门脉高压近期止血疗效确切,但术后曲张静脉并未有效消退,须强调手术的规范性,并在再出血高发时段定期内镜随访．及时掌握食管胃曲张静脉及门脉高压性胃病的发展情况,早期干预治疗,从而改善患者预后。     

Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry

BACKGROUND & AIMS: The aim of this study was to perform a detailed analysis of the mechanics leading to esophagogastric junction (EGJ) opening during transient lower esophageal sphincter relaxations (tLESRs) using high-resolution manometry coupled with simultaneous fluoroscopy. METHODS: Six subjects without hiatus hernia had endoclips placed at the squamocolumnar junction and 10 cm proximal. A 36-channel solid-state manometric assembly was placed spanning from stomach to pharynx, and subjects were studied for 2 hours after a high-fat meal. An esophageal pH electrode also was placed and fluoroscopy was initiated at the onset of a tLESR. Axial clip movement was measured during replay of the videotaped fluoroscopy and was correlated with manometric data. RESULTS: Ninety-three tLESRs were recorded, 62 tLESRs of which had good fluoroscopic visualization. Seventy-eight tLESRs had manometric evidence of flow and the majority had evidence of a common cavity (88%), but few were detected by the pH electrode. Esophageal shortening and crural diaphragm inhibition always preceded EGJ opening and common cavity. A positive pressure gradient between the stomach and the EGJ lumen of 7.1 mm Hg (interquartile range, 4.1-9.1 mm Hg) preceded the EGJ opening. CONCLUSIONS: Key events leading to the EGJ opening during tLESRs were LES relaxation, crural diaphragm inhibition, esophageal shortening, and a positive pressure gradient between the stomach and the EGJ lumen. The manometric signature of opening was pressure equalization within the EGJ, but this only occasionally was associated with pH evidence of reflux. Future investigations will need to analyze how this delicately balanced anatomic-physiologic system is perturbed in subjects with reflux disease.     

食管-胃交界性癌的临床特点分析

目的分析食管-胃交界性癌的临床特征,包括年龄、性别、病理等方面,探讨食管-胃交界性癌的发病特点。方法回顾分析该院2003年7月-2008年6月胃镜及术后病理确诊的食管-胃交界性癌患者的临床资料,并对其病理分型进行统计,分析其间是否存在差异。结果与65岁以下青年组相比,65岁以上高龄人食管-胃交界性癌发生率较高,且两组患者均以男性为主;病理类型提示以高龄组患者中以中、高分化腺癌常见,而青年组其病理类型不具有明显特殊性。结论食管-胃交界性癌在老年中发病率较高,且病理类型以中、高分化腺癌为主,这对临床的诊治有一定的指导意义。     

食管胃交界部腺癌全胃切除156例临床分析

目的探讨食管胃交界部腺癌的临床特点、手术方法及治疗经验,以提高临床中对于该项疾病的早期诊断与患者的术后生存率。方法选择济源市第二人民医院2007年12月—2012年4月收治的156例食管胃交界部腺癌患者为研究对象,并对所有患者的临床资料进行了较为详细的回顾性分析。结果156例食管胃交界部腺癌患者均顺利的完成了手术,且大部分的患者均未出现严重并发症,预后良好。结论运用全胃切除配合淋巴结清扫的方式来治疗食管胃交界部腺癌不仅安全和可靠,且具有显著的临床治疗效果,值得在临床中大力的推广与应用。