目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。
Surgerical treatment has been used for portal hypertension over a hundred years, and has evolved from various portosystemic shunts to devascularizations and selective shunts. Selective shunting, which has the advantages of long-term prevention from recurrent variceal bleeding and maintenance of hepatic portal vein perfusion, has developed from single distal splenorenal shunt to various procedures including distal splenocaval shunt, coronary caval shunt, coronary renal shunt, etc. Selective shunting can also be achieved after reconstruction of spontaneous portosystemic shunt. Preoperative portal venous system CT angiography, intraoperative ultrasound Doppler and portal vein pressure measurements may provide patients with a more reasonable treatment of choice.
【摘要】 目的 探讨无痛胃镜两种方式——清醒镇静和静脉麻醉下治疗食管静脉曲张或出血的可行性。 方法 2004年11月-2008年5月， 根据病情或患者要求，对13例患者行清醒镇静即静脉推注咪达唑仑+芬太尼，30例行静脉麻醉即静脉推注咪达唑仑+丙泊酚。43例患者中36例行套扎治疗，7例行1%乙氧硬化醇注射治疗。 结果 43例均成功完成治疗，急诊止血率100%（11/11），治疗后4周复查，显效24例，占55.8%，有效17例，占39.5%，无效2例，总有效率95.3%。静脉麻醉组术后遗忘度100%，清醒镇静组插镜过咽和治疗过程中发生恶心分别为76.9%、46.1%。两组患者在治疗过程中及治疗后均未发生大出血。 结论 无痛胃镜下行食管静脉曲张治疗安全、疗效确切，以硬化剂注射治疗者应采用静脉麻醉。【Abstract】 Objective To observe the effect of painless gastroscopy- conscious sedation and intravenous anesthesia on treating esophageal varices or bleeding. Methods From November 2004 to May 2008, according to the disease condition or patient′s requirements, anesthetists assessed 13 patients who underwent conscious sedation with the intravenous injection of midazolam + fentanyl; 30 patients underwent intravenous anesthesia with intravenous injection of midazolam+propofol. Thirty-six patients underwent set tie treatment, and seven underwent 1% aethoxysklerol injection therapy. Results AN of the 43 patients completed the treatment successfully, and the emergency bleeding rate was 100% (11/11). Four weeks after the treatment, 24 cases had apparent therapeutic effect, accounting for 55.8%; 17 patients had effect, accounting for 39.5%; 2 patients had no effect; the total effective rate was 95.3%. The postoperative forgotten degree of the patients in intravenous anesthesia group was 100%. The nausea rate happened during the mirrors inserting and treatment in the conscious sedation group was 76.9% and 46.1%, respectively. No hemorrhage occurred in both of the tow groups. Conclusion Painless endoscopic is safe and effective for esophageal varices. Intravenous anesthesia should be used in Sclerotherapy.
The pectoralis major myocutaneous flap was used to repair laryngopharyngeal and esophageal defect following radical excision of pharyngeal and inferior laryngeal carcinomas in 3 cases. The results were susscessful. The patients were follwedup for 6 months to 3 years. The deglutition functions were all reestablished, the general nutritional conditions were improved, and no recurrence or distant metastasis was observed. The advantages of this operative procedure were discussed.
ObjectiveTo observe the efficacy of dense ligation and non-dense ligation in treating severe esophageal varices. MethodsSixty cirrhotic patients with severe esophageal varices treated in our hospital between January 2009 and October 2011 were divided into two groups based on their operative ways.Group A was the dense ligation group including 32 patients,and group B was non-dense ligation group in which there were 28 patients.Six-shooter multi-band ligators were used for endoscopy.If the number of loop ligature collar was larger than six,it was regarded as dense ligation and the rest was regarded as non-dense ligation. ResultsIn group A,one month after first ligature,six patients were basically cured,24 were greatly improved,and two did not respond to the treatment,with a total effective rate of 93.8% and an average ligation of 1.94 times.In group B,one month after first ligature,one patient was basically cured,24 were greatly improved,and three did not respond to the treatment,with a total effective rate of 89.3% and an average ligation of 2.75 times. ConclusionDense ligation is a safe,reliable and effective approach for esophageal varices,which brings about a high disappearance rate of esophageal varices and reduced ligation frequency.
Objective To investigate the prevalence and predisposing factors of gastroesophageal reflux（GER）in patients with chronic obstructive pulmonary disease（COPD）and its impacts on the frequency of COPD exacerbations.Methods 50 patients with acute exacerbation of COPD were enrolled in the study.All patients filled a modified version of clinically validated standardized Mayo Clinic GER questionnaire.Pulmonary function tests（PFT），body mass index（BMI），serum albumin，and medications were recorded.The patients were divided in to GER group（13 patients with GER symptoms longer than one year and diagnosed GER by gastroscope） and non-GER group（37 patients without GER symptoms）.Results There were no significant differences in the BMI，serum albumin，use of inhaled steroids and theophylline between the two groups.Forced expiratory volume in one second as a percentage of the predicted value（FEV1%pred）（37% vs 38.3%，P=0.608.），residual volume % predicted（123.4 % vs 137.8%，P=0.222），and residual volume to total lung capacity（139.4% vs 141.5%，P=0.798） were not significantly different between the two groups.The number of COPD exacerbations per year was significantly higher in patients with GER compared to patients without GER（4.5 vs 1.3，P=0.006）.Conclusions The severity of airflow obstruction and the hyperinflation is unlikely to contribute to the development of GER.Patients with GER experience significantly more exacerbations per year when compared to patients without GER，suggesting more highlight warrant in treatment of GER in COPD patients.