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61.
目的:评价胃肠起搏器治疗胃动力紊乱性疾病的有效性和安全性。方法:胃肠起搏器治疗30例胃动力紊乱性疾病患者(治疗组),并与胃肠起搏空白输出机治疗组及普瑞博思治疗组对照比较。治疗前后检查胃电图,记录胃电频率、幅值,观察临床症状。结果:治疗组、空白组、普瑞博思组的临床症状总有效率分别为90.0%、46.6%、86.7%,治疗组和普瑞博思组的治疗前后症状积分比较差别有显著性(P<0.05);治疗组治疗后胃电图空腹、餐后平均频率较治疗前明显改善(P<0.05),趋向正常频率;普瑞博思组仅治疗后餐后胃电平均频率较治疗前有改善(P<0.05),空白组胃电频率治疗前后差异无统计学意义。结论:胃肠起博器治疗胃动力紊乱性疾病可改善临床症状及胃电生理的频率。 相似文献
62.
Kazumasa Fujitani Jaffer A. Ajani Christopher H. Crane Barry W. Feig Peter W. Pisters Nora Janjan Garrett L. Walsh Stephen G. Swisher Ara A. Vaporciyan David Rice Angela Welch Jackie Baker Josephine Faust Paul F. Mansfield MD 《Annals of surgical oncology》2007,14(4):1305-1311
Background Significant tumor downstaging has been achieved in patients with localized gastric or gastroesophageal adenocarcinoma by induction
chemotherapy and preoperative chemoradiotherapy (CTX–CTXRT). However, the influence of CTX–CTXRT on operative morbidity and
mortality has not yet been clarified. The aim of the present study was to document the frequency and nature of morbidity and
mortality after surgery combined with CTX–CTXRT, and identify factors predictive of postoperative complications in patients
with localized gastric or gastroesophageal adenocarcinoma.
Methods A prospectively collected database on 71 consecutive patients who underwent CTX–CTXRT at M.D. Anderson Cancer Center between
January 1997 and August 2004 was reviewed. Postoperative morbidity and mortality were investigated, and risk factors for overall
complications were identified by multivariate logistic regression analysis.
Results Overall morbidity and mortality rates were 38.0% (27 patients) and 2.8% (2 patients), respectively. Age greater than 60 years
[relative risk 11.3 (95% confidence interval 2.50–50.6)] and body mass index (BMI) of 26 kg/m2 or above [relative risk 4.08 (95% confidence interval 1.08–15.4)] were significant risk factors for overall complications.
Conclusions CTX–CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with
gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity. 相似文献
63.
目的探讨LigaSure在腹腔镜胃癌根治术中的应用价值。方法2001年7月~2007年7月,应用LigaSure行腹腔镜胃癌根治性切除术71例,按TNM分期,Ⅰ期15例,Ⅱ期33例,Ⅲa期23例。行根治性全胃切除术27例,根治性远侧胃大部切除术39例,根治性近侧胃大部切除术5例。采用腹腔镜辅助手术方法:以脐孔,左、右锁骨中线肋缘下,脐与剑突连线上、中1/3交界点为手术操作孔,术中扩大剑突下操作孔3~5cm为辅助切口。术中均采用LigaSure分离、处理血管,直接凝固切断包含直径达7mm血管的网膜及胃周血管;胃癌淋巴结清扫时,联合应用超声刀裸化血管,再用LigaSure钳夹凝固后,于闭合带远端剪断血管,完成腹腔镜下D2胃癌根治手术。结果71例均手术成功,无中转开腹,术中出血少,无术中、术后严重并发症发生,术后近期肺部感染3例、应激性溃疡出血1例、十二指肠残端漏1例(保守治愈)。LigaSure闭合胃周血管良好,未使用钛夹或腔镜专用切割吻合器(Endo—GIA)。71例随访4~72个月,平均38.6月,死亡11例(其中9例因肿瘤转移),远处转移10例,复发14例,2例术后远期吻合口狭窄。结论LigaSure行腹腔镜胃癌根治术安全、可靠,是腹腔镜手术理想的切割止血工具。 相似文献
64.
Mohammad Khalid Jamal M.D. Eric J. DeMaria M.D. Jason M. Johnson D.O. Brennan J. Carmody M.D. Luke G. Wolfe M.S. John M. Kellum M.D. Jill G. Meador R.N. 《Surgery for obesity and related diseases》2005,1(6):655-516
BACKGROUND: We hypothesized that major co-morbidities affect survival and complications after gastric bypass. METHODS: A total of 1465 patients undergoing laparoscopic and open gastric bypass between 1995 and 2002 were studied. Patients with a body mass index >or= 35 kg/m(2) and major co-morbidities (group 1, n = 1045) were compared with patients with a body mass index >or= 40 kg/m(2) with minor/no co-morbidities (group 2, n = 420). RESULTS: Group 1 patients were older (43 versus 36 years, P < 0.001) and had a greater BMI (53 versus 50 kg/m(2), P < 0.001). Early postoperative complications were greater in group 1 than in group 2 and included leaks (4.1% versus 1.2%, P < 0.0032) and wound infections (3.9% versus 1.4%, P < 0.0133). Procedure-related mortality in the series was 1.7%. Mortality was 10-fold greater in group 1 (2.3% versus 0.2%, P < 0.0032). The incidence of small bowel obstruction, incisional hernia, and pulmonary embolism was similar in the two groups. Excess weight loss was significantly greater in group 2 (68% versus 62%, P < 0.001) at 1 year. Resolution of group 1 co-morbidities was great, including hypertension in 62%, diabetes in 75%, venous stasis disease in 96%, and pseudotumor cerebri in 98%. CONCLUSION: Outcomes analysis of obesity surgery requires risk stratification. The very low mortality rates in published studies are likely explained by surgical treatment of low-risk patients with minor co-morbidities, such as those seen in group 2. However, despite the increased perioperative risk, the group 1 patients (with major co-morbidities) demonstrated dramatic resolution of their co-morbid conditions, justifying the decision to go forward with surgery. The data support a radical change in treatment philosophy in which morbidly obese individuals should be offered bariatric surgery before major co-morbid conditions develop as a strategy to decrease the operative risk. 相似文献
65.
66.
Effects of gastric bypass procedures on bone mineral density,calcium, parathyroid hormone,and vitamin d 总被引:2,自引:0,他引:2
Jason M. Johnson James W. Maher Isaac Samuel Deborah Heitshusen Cornelius Doherty Robert W. Downs 《Journal of gastrointestinal surgery》2005,9(8):1106-1111
Weight loss after gastric bypass procedures has been well studied, but the long-term metabolic sequelae are not known. Data
on bone mineral density (BMD), calcium, parathyroid hormone, and vitamin D were collected preoperatively and at yearly intervals
after gastric bypass procedures. A total of 230 patients underwent preoperative BMD scans. Fifteen patients were osteopenic
preoperatively, and three patients subsequently developed osteopenia postoperatively within the first year. No patient had
or developed osteoporosis. At 1 year, total forearm BMD decreased by 0.55% (n = 91; P = .03) and radius BMD had increased overall by 1.85% (n = 23; P = .008); both total hip and lumbar spine BMD decreased by
9.27% (n = 22; P < .001) and 4.53% (n = 31; P < .001), respectively. By the second postoperative year, BMD in the total forearm had decreased an additional 3.62% (n =
14; P<.001), whereas radius BMD remained unchanged. Although total hip and lumbar spine BMD significantly decreased at 1 year,
by year 2 both total hip and lumbar spine BMD only slightly decreased and were not significantly different from before the
operation. Serum calcium decreased from 9.8 mg/dL to 9.2 during the first year (not significant [NS]) and then to 8.8 (NS)
by the second year. Parathyroid hormone increased from 59.7 pg/mL (nl 10-65 pg/mL) preoperatively to 63.1 during year 1 (NS)
and continued to increase to 64.7 by year 2 (NS). No difference was noted among levels of 25-hydroxy vitamin D preoperatively
(25.2 ng/mL; nl 10-65 ng/mL), at 1 year (34.4), and at 2 years (35.4). Our data indicate that bone loss is highest in the
first year after gastric bypass with stabilization, and that, in some cases, there is an increase in bone density after the
first year.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18,
2005 (oral presentation). 相似文献
67.
Stacie E. Perlman M.D. Randolph B. Reinhold M.D. Geoffrey S. Nadzam M.D. 《Surgery for obesity and related diseases》2007,3(4):428-433
BACKGROUND: Little is known about the level of knowledge and comfort with bariatric surgery among family practice physicians. METHODS: Surveys were sent to all family practitioners in Connecticut querying the practice type and knowledge of bariatric surgery. The results were analyzed for the prevalence of opinion. RESULTS: Of 620 surveys sent out, 129 (21%) were completed. Of the 129 respondents, 73% were men, aged 31-79 years, and 92% were board certified, with an average of 19 years' experience. The average body mass index of respondents was 26 kg/m2 (range 16-40). Only 4% of respondents had a body mass index >30 kg/m2. Physicians reported a patient obesity rate of 43%. Of the 129 respondents, 88% believed obesity was difficult to control with diet and exercise alone. Only 6% thought obesity was best controlled surgically. Also, 85% of respondents had referred a patient for gastric bypass, although only 57% were comfortable explaining the procedure. The most common reason for refusal to refer was fear of complications and death. Additionally, 55% correctly listed a body mass index of 40 kg/m2 as qualifying for bariatric surgery without comorbidities; 48% identified the mortality rate of surgery as <1%, with 4% of respondents reporting >10%; and 84% were familiar with gastric bypass, 66% with LapBand, 33% with vertical banded gastroplasty, and 5% with duodenal switch. The respondents believed that nausea was the most common side effect, followed by anemia and fatigue. Finally, 53% believed bowel obstruction was common. CONCLUSIONS: The results of our study have shown that misconceptions about bariatric surgery exist in the family practice community despite the increasing frequency of these procedures. Educational programs need to be designed to assist family practitioners in treating and referring obese patients. 相似文献
68.
目的研究重组人生长激素(rhGH)对生长激素受体(GHR)不同表达状态裸鼠人胃癌移植瘤生长及血管内皮生长因子(VEGF)表达的影响。方法采用免疫细胞化学染色法筛选出GHR阳性和阴性表达的细胞株各1株,分别接种于24只裸鼠皮下。将两种细胞接种裸鼠均随机分为对照组(0.9%NaCl,0.2ml/d)、低剂量rhGH组(0.5U·kg^-1·d^-1,0.2ml/d)和高剂量rhGH组(2.5U·kg^-1·d^-1,0.2mL/d)3组,每组8只,各组均连续给药14d,观察并记录裸鼠体重和肿瘤体积变化;采用酶联免疫吸附法测定各组裸鼠血清VEGF含量,免疫组织化学方法检测胃癌组织中VEGF蛋白表达,RT-PCR方法检测胃癌组织VEGFmRNA水平变化。结果筛选出GHR阳性表达的人胃癌细胞株SGC-7901和阴性表达的MKN-45。对于GHR^+SGC-7901接种裸鼠,rhGH给药组皮下移植瘤体积较对照组增大(P〈0.05),且高剂量rhGH组促增长效应最为显著(P〈0.05),3组间体重差异无统计学意义(P〉0.05);高剂量rhGH组的血清VEGF浓度为(252.94±15.32)ng/L,明显高于对照组的(49.94±5.73)ng/L和低剂量rhGH组的(167.60±9.54)ng/L(P〈0.05);对照组VEGF表达为中度阳性,rhGH给药组呈强阳性;高剂量rhGH组肿瘤组织中VEGFmRNA相对表达量为0.6470±0.0447,明显高于对照组的0.3230±0.0258和低剂量rhGH组的0.4120±0.0351(P〈0.05)。对于GHR—MKN-45接种裸鼠,rhGH给药组体重明显大于对照组(P〈0.05);肿瘤体积大小、血清VEGF水平、肿瘤组织VEGF蛋白及mRNA表达,3组间差异均无统计学意义(P〉0.05)。结论rhGH能促进GHR阳性表达的SGC-7901移植瘤生长,并促进VEGF表达增高;对于GHR阴性的MKN-45移植瘤,则没有表现出明显的促肿瘤生长及促VEGF表达效应。GHR存在可能是rhGH影响VEGF分泌的关键靶点。 相似文献
69.
Alberto Salinas M.D. Harry M. Salinas B.Sc. Edwin Santiago Ph.D. Wilfredo García M.D. Queta Ferro R.D. Mariemma Antor M.Sc. 《Surgery for obesity and related diseases》2009,5(4):455-458
BackgroundSilastic ring vertical gastric bypass (SRVGB) with jejunal interposition is our standard operation for morbidly obese patients. We present the results of 5 years of follow-up in a cohort of patients who underwent SRVGB in 2001.MethodsThe records of all 160 consecutive patients who underwent SRVGB from January to December 2001 were reviewed. Of the 160 procedures, 143 were primary open cases, 14 were revisions from restrictive procedures, and 3 were laparoscopic cases. At 5 years, the body mass index and percentage of excess weight loss was available for 133 patients (83%) at office visits (n = 91, 68.4%), by telephone (n = 40, 30.1%), or by e-mail (n = 2, 1.5%).ResultsOf the 160 patients, 121 were women and 39 were men, with a mean age of 33.15 ± 10.0 years, percentage of ideal body weight of 195.7% ± 40.8%, and body mass index of 44.6 ± 9.3 kg/m2. The mean hospital stay was 3 ± 1 days. One patient (.6%) died of a pulmonary embolus. Early complications included 3 cases (1.87%) of upper gastrointestinal bleeding and 4 gastric leaks (2.5%): 2 (1.36%) from primary cases and 2 (14.29%) from revisional cases. Late complications included 32 patients (20%) with incisional hernias, 20 (12.5%) with anemia, 14 (8.8%) with dumping, 4 (2.5%) with gastrojejunal stricture, 2 (1.25%) with intestinal obstruction, and 2 (1.25%) requiring silastic ring surgical removal. The 5-year follow-up data were available for 133 patients (83%). The mean body mass index in this group was 27 ± 5 kg/m2, with a percentage of excess weight loss of 83% ± 18.3% at 5 years postoperatively.ConclusionThe results of our study have shown that SRVGB is an effective operation for promoting lasting weight loss, with acceptable mortality and complication rates. 相似文献
70.
Keiichi Maruyama Professor 《中国现代普通外科进展》2007,10(3):186-187
Mortality rate of gastric cancer in Japan had been the highest in the world. Development of early detection and effective treatment was the most impor-tant social demand. For the early detection, Japan de-veloped “double contrast X-ray”, “endoscopy and en-doscopic biopsy”, and “mass screening system”. The Japanese nationwide registry collected data of 273,142 gastric cancer patients in the last 30 years. By the ef-forts of early detection, proportion of Stage I cancer increased from 22.5% to 58.1% in the registry. Cu-mulative 5 year survival rate of resected cases was improved from 37.5% (1962) to 68.8% (1991). Im-provement was remarkable for Stage-II; from 47.7% to 70.3%, and for Stage-III, from 26.4% to 45.0%. 相似文献