生物可降解性尿道内支架修复战伤性尿道狭窄的研究

目的建立战伤性尿道狭窄动物模型,探讨生物可降解性尿道内支架对其进行重建修复的可行性。方法将新西兰雄兔28只分为两组,实验组(n=20):以定位爆炸法建立尿道狭窄模型。一月后行逆行尿道造影、尿道镜检查,并切除狭窄段尿道,行病理组织学观察证实。后置入人工合成生物可降解尿道内支架,置入术后2、4、8、12周分别行逆行尿道造影、尿道镜检查以及尿流动力学检测。并在以上各时间点处死5只动物,取狭窄处尿道组织,观察组织学修复重建情况。对照组(n=8):于实验组爆炸处理后4周和支架置入12周,分别取对照组4只动物与实验组对比观察。结果实验组所有动物爆炸后4周在尿道球部狭窄形成稳定狭窄模型(狭窄段长5～10 mm,尿道腔缩窄50%以上)。尿道内支架置入后2周,组织学观察见黏膜上皮新生迹象,并有炎性细胞浸润;4周时上皮新生明显,炎性细胞消失;8周时出现尿道平滑肌细胞再生,12周时见损伤后尿道组织结构完全修复,与正常尿道组织比较差异无统计学意义(P>0.05)。。同时间点尿道镜检查证实尿道腔隙、黏膜形态结构无异于正常对照组。尿流动力学检测显示两组间差异无统计学意义(P>0.05)。。结论应用成功建立的战伤性尿道狭窄动物模型,证实生物可降解性尿道内支架能作为修复战伤性尿道狭窄的理想材料,具有损伤小,易操作,功能恢复快的特点。     

Predicting Stricture in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A Logistic Regression Analysis

Gastrojejunostomy stricture after Roux-en-Y gastric bypass occurs in 3 to 27% of morbidly obese patients in the USA. We questioned whether preoperative patient characteristics, including demographic attributes and comorbid disease, might be significant factors in the etiology of stricture. In this study from November 2001 to February 2006 (51 months), at a high-volume bariatric center, of the 1,351 patients who underwent laparoscopic gastric bypass, 92 developed stricture (6.8%). All but two were treated successfully by endoscopic dilation. All patients stopped nonsteroidal anti-inflammatory medications 2 weeks prior to surgery and did not restart them. The operative procedure included the use of a 21-mm transoral circular stapler to create the gastrojejunostomy; the Roux limb was brought retrogastric, retrocolic. In an effort to reduce our center’s stricture rate, late in the study, U-clips used at the gastrojejunostomy were replaced by absorbable sutures, and postoperative H₂ antagonists were added to the treatment protocol. The change to absorbable polyglactin suture proved to be significant, resulting in a lower stricture rate. The addition of H₂ antagonists showed no significant effect. Following the retrospective review of the prospective database, univariate and multivariate logistic regression analyses identified factors associated with the development of stricture. Gastroesophageal reflux disease and age were each shown to be statistically significant independent predictors of stricture following laparoscopic gastric bypass. Presented at the 2006 Annual Meeting of the Society for Surgery of the Alimentary Tract, May 20–24, Los Angeles, CA (poster presentation).     

Non-steroidal anti-inflammatory drug (NSAID)-induced colonic strictures and perforation: A case report

Although non-steroidal anti-inflammatory drug-induced colopathy is well described, colonic perforations complicating non-steroidal anti-inflammatory drug intake are rare. We report a patient with rheumatoid arthritis who was on long-term diclofenac and presented with early colonic stricture formation and a caecal perforation, which to the best of our knowledge, has only been reported once before. It is important to suspect this diagnosis in patients on non-steroidal anti-inflammatory drug therapy who present with an acute abdomen.     

Significant association of strictures and internal fistula formation in Crohn’s disease

Intestinal inflammation in Crohn’s disease (CD) may be complicated by the occurrence of strictures and fistulae. The pathogenesis of fistula formation is unknown. We therefore wanted to determine whether mechanical factors might contribute to the development of fistulae. Furthermore, we tried to define the path of internal fistulae through the muscular layer. For this purpose, surgical resection specimens from 42 consecutive patients with CD were prospectively studied. In gross examination the whole bowel was cut into circumferential cross sections 0.3 cm thick. Abnormal areas were histologically examined. Strictures were found in 38 patients (90.5%), and fistulae were observed in 27 (64.3%) patients. In 11 (40.7%) specimens fistulae were found within a stricture, in 15 (55.6%) at the proximal end, and in 1 (3.7%) no stricture was found. In 7 (25.9%) cases with fistulae, herniated mucosa was found within the muscularis propria or the subserosa. In 7 (25.9%) cases a blood vessel was identified near a fistula traversing the muscularis propria. From these findings we conclude that that mechanical factors may contribute to fistula formation. This is further supported by the fact that fistulae appear to traverse the muscular layer along piercing vessels. Received: 21 January 2000 / Accepted: 7 March 2000     

针刺防治实验性动脉再狭窄模型大鼠抗氧自由基作用的初步研究

目的：探讨针刺治疗动脉再狭窄的作用机理。方法：用空气干燥法诱发大鼠颈总动脉再狭窄模型。以复方丹参注射液作对照。观察针刺对动脉再狭窄模型大鼠颈总动脉去内皮损伤的内膜增生及氧自由基的影响。结果：针刺能抑制动脉去内皮损伤的内膜增生。升高模型大鼠血清中超氧化物歧化酶（SOD）的活性。降低丙二醛（MDA）的含量。结论：针刺具有抗氧自由基的能力。逆转动脉再狭窄的病理进程，对动脉再狭窄具有较好的防治作用。     

食管支架治疗食管良恶性狭窄的临床应用

对16例食管良恶性狭窄患者采用食管支架置入进行治疗。其中食管-胃吻合口狭窄9例，食管癌7例，全部支架置入术均经口腔在X线监视下进行。支架置入后24小时随访观察，食管留置均获成功，未出现技术问题。支架置入后临床症状均得到缓解，所有病人摄食能力均有不同程度的改善。作者认为：食管支架对食管良恶性狭窄的治疗是一种方便、安全、有效的治疗方法，并可提高患者的生活质量。     

Management of panurethral strictures

IntroductionPan-urethral stricture, involving the penile and bulbar urethra, is a common urological problem on the South Asian subcontinent. It represents a particularly difficult challenge to manage and there is a relative paucity of literature on the subject. In India, Lichen Sclerosus (LS) is the most common cause of pan-urethral stricture, followed by iatrogenic causes.2 stage surgery is not scientific in lichen sclerosus as this is a disease of genital skin. We present our experience of pan-urethral stricture repair using a single-stage, one-sided dissection, dorsal onlay repair with oral mucosa graft.Subjects and methodsWe retrospectively reviewed the records of 318 consecutive men undergoing management of pan-urethral stricture from June 1995 to December 2014. The median age was 44.6 years and the mean stricture length 14 cm. The median follow-up was 59 months. The strictures were approached through a perineal incision, limiting dissection to only one side of the urethra. The penis was invaginated to provide access to the entire length of anterior urethra in a single-stage, and two oral mucosal grafts were dorsally placed.ResultsThe outcome was considered a success if the patient needed no further instrumentation, including dilation or urethrotomy. The overall success rate was 84.90%, with a success rate of 89.39% in primary urethroplasty, and 57.85% in patients who had previous failed urethroplasty. Most recurrent strictures occurred at the proximal end of the graft.ConclusionsRepair of pan-urethral stricture in a single-stage, with one-sided dissection and dorsal onlay of oral mucosa, is a minimally invasive technique that is simple, fast, safe, effective and reproducible in the hand of any surgeon.