ObjectiveTo develop an experimental model of gastroesophageal reflux-induced esophageal stricture in rats and explore the mechanism of esophageal stricture. MethodsA total of 30 male Sprague-Dawley (SD) rats by random number table method were randomly divided into three groups as follows: an operation+acid perfusion group, first the models of lower esophageal sphincter relaxation and hiatal hernia were made, and then the rats’ esophagus were perfused with hydrochloric acid-pepsin; acid perfusion group, the rats’ esophagus were directly perfused with hydrochloric acid-pepsin; and control group, rats’ esophagus were perfused with normal saline. After 4 weeks of continuous perfusion, the esophageal mucosal injury of SD rats in each group were observed, and the concentrations of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-18] in esophageal tissues were detected by enzyme-linked immunosorbent assay. ResultsIn the operation+acid perfusion group, esophageal stricture was formed in 2 SD rats, but no esophageal stenosis was found in the acid perfusion group and the control group. The body weight of rats in the operation+acid perfusion group and the acid perfusion group were lower than that in the control group (P<0.05). The esophageal mucosal injury scores of rats in the operation+acid perfusion group and the acid perfusion group were higher than that in the control group (P<0.001), and the operation+acid perfusion group was higher than that in the acid perfusion group (P=0.014). The concentrations of TNF-α, IL-1β and IL-18 in esophageal tissues were higher in the operation+acid perfusion group and the acid perfusion group than that in the control group (P<0.001), and the operation+acid perfusion group was higher than that in the acid perfusion group (P<0.001). ConclusionsThe anti-reflux barrier is an important part of preventing gastroesophageal reflux disease. The destruction of anti-reflux barrier, hydrochloric acid-pepsin perfusion and inflammatory cytokines jointly induced esophageal inflammation and injury, and even caused esophageal stricture.
Objective To investigate the feasibility and efficacy of transcatheter directed thrombolysis （TDT） approach in treatment for deep venous thrombosis （DVT） of lower limbs and as compared with trans-dorsal pedis vein thrombolysis （TPVT） approach. Methods The clinical data of 437 patients with acute DVT （184 males and 253 females） at the age of （43±12） years （range 19-76 years） from July 2008 to January 2012 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Patients in the group TDT received TDT were 293 cases， 32 inferior vena cava filters were implanted. Patients in the group TPVT received TPVT were 65 cases， 4 inferior vena cava filters were implanted. Results The resolution time of thrombus in the group TDT was shorter than that in the group TPVT （6 d versus 9 d， P＜0.05）. The circumference difference of leg or upper leg before and after treatment in the TDT group was significantly greater than that in the TPVT group （P＜0.05）. The rate of venous patency was （65.2±15.4）% and preservation rate of valvular function was （78.2±12.6）% in the group TDT， and which was （63.8±16.3）% and （91.1±10.7）% in the group TPVT， respectively. The differences of venous patency rate was not statistically significant（P＞0.05） between two groups， but the prevervation rate of valvular function was significant difference （P＜0.05） .Hematomas in 3 cases and gross hematuria in 4 cases were observed， and displacement of inferior vena cava filter occurred in 1 patient in the group TDT. The gums bleed or gross hematuria in 5 cases were observed in the group TPVT. Conclusions Both TDT and TPVT can effectively relieve symptoms. TDT can shorten the course of disease， but itincreases functional damage of the deep vein valvular.
ObjectiveTo evaluate laparoscopic anti-reflux surgery for treatment of chronic obstructive pulmonary disease (COPD) associated with gastroesophageal reflux disease (GERD).MethodsA total of 20 patients with GERD and COPD underwent laparoscopic anti-reflux procedure in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017. The reflux diagnostic questionnaire, pulmonary function, COPD assessment test scale, 24-hour esophageal pH-impedance monitoring and esophageal pressure measurement were performed in all patients. All drug-refractory patients underwent the laparoscopic anti-reflux surgery. After 12 months follow-up, the parameters of COPD and GERD were evaluated again.ResultsTwenty patients with COPD and GERD were successfully performed laparoscopic anti-reflux surgery, no hernia patch repair patient and death patient occurred. There was no esophageal rupture, bleeding, infection, and other serious postoperative complications. Although 8 patients had the different degree dysphagia and 10 patients had the different degree abdominal distention, they all relieved themselves. Twenty patients with GERD and COPD were followed up for 1 year. Compared with the values before treatment, the GERD symptom score, reflux times, DeMeester score, and COPD assessment test score of the patients were significantly reduced (P<0.05), the lower esophageal sphincter pressure, percentage of forced expiratory volume in one second (FEV1) in the predicted value and FEV1/forced vital capacity (FVC) were significantly increased (P<0.05) after the treatment. According to the grading standard of The Global Initiative for Chronic Obstructive Lung Disease (GOLD), 5 cases of grade Ⅰ, 2 cases of grade Ⅱ and 1 case of grade Ⅲ were cured; 1 case of grade Ⅰ, 4 cases of grade Ⅱ and 4 cases of grade Ⅲ were improved; 1 case of grade Ⅰ, 1 case of grade Ⅱ and 1 case of grade Ⅳ were ineffective. The total effective rate was 85% (17/20).ConclusionsCOPD is closely related to GERD. Laparoscopic anti-reflux surgery can not only effectively treat GERD, but also markedly improve COPD.