Objective To evaluate the effect of surgical management of primary venous reflux disease in lower extremity. Methods Literatures about the surgical management of venous reflux disease in lower extremity were collected and reviewed. Results In patients with primary venous reflux disease,comprehensive surgical management of concomitant superficial,deep and perforating veins might greatly improve the clinical effect. Conclusion Comprehensive surgical management will be the direction of surgical management of primary venous reflux disease in lower extremity.
ObjectiveTo prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy and RouxenY gastrojejunostomy after proximal subtotal gastrectomy.MethodsTwentysix cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or even number of the admission number.After proximal subtotal gastrectomy and esophagogastrostomy, the control group underwent pyloroplasty while the experimental group with pyloruspreserving RouxenY gastrojejunostomy.The inflammatory reaction of the tissue obtained at the esophagogastric junction using a fiber gastroscope was observed after half year of postoperative followup in the two groups.An examination of gastric emptying of a radionuclidelabeled test meal were performed.According to the Visick score of followup data,the effects of operation were evaluated.The 5year survival rate was also evaluated.ResultsThe postoperative gastrointestinal symptoms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclidelabeled test meal showed that the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagogastric junction showed that the inflammatory reaction in the experimental group was slighter than that in the control group.There was no significant difference between the two groups in the survival rate.ConclusionFor patients with carcinoma of the gastric fundus and cardia, after proximal subtotal gastrectomy and esophagogastrostomy,compared with pyloroplasty,pyloruspreserving RouxenY gastrojejunostomy can decrease the reflux esophagitis,and relieve the postoperative gastrointestinal symptoms.
The antireflux spur-valvewas originally designed for the Roux-Y cholenterostomy. It is made by plication of the two upper limbs of the "Y" after the removal of the seromusculature from the biliary limb, so that the conjoined wall-in-between will he compassed deviating to the biliary, side to form a spur value. It could successfully stop the reflux due to normal peristalsis or intestinal distension. This value was primarily used in choledochal cyst and biliary atresia for more than 100 cases, and also applielied to many other operations for perventing reflux, including: gastroesophageal refluk-Nissen fundoplication, colon replacement of esophagus, side to side shert-circuit of intestinal obstruction, and Kock scontinent ileoslomny. The detailed procedures were described.
ObjectiveTo compare the antireflux effects of lip reinforcement, His angle reconstruction with fundoplication, and mechanical anastomosis only in mechanical anastomosis for esophageal and cardiac carcinoma. MethodsOne hundred and seventysix patients with esophageal or cardiac carcinoma admitted to this hospital between March 2008 and October 2009 were included, which were divided into mechanical anastomosis group (n=42), His angle reconstruction group(n=56), and lip reinforcement group (n=78) according to the sequence of admission. Mechanical anastomosis only, mechanical anastomosis His angle reconstruction with fundoplication, and mechanical anastomosis liptype reinforcement were performed in the corresponding group, respectively. Endoscopy and biopsy were conducted to evaluate the antireflux effects on 3 months after operation. ResultsThere were no differences on the gender, age, tumor location, anastomosis site, and incision among three groups (Pgt;0.05). The reflux rates of the mechanical anastomosis group, His angle reconstruction group, and lip reinforcement group were 69.05%, 28.57%, and 14.10%, respectively. The reflux rates in the lip reinforcement group and His angle reconstruction group were significantly lower than those in the mechanical anastomosis group (χ2=37.088, P=0.000; χ2=15.833, P=0.000), moreover, the rate in the lip reinforcement group was significantly lower than that in the His angle reconstruction group (χ2=4.241, P=0.039). There was no anastomotic leakage in the lip reinforcement group and all patients safely discharged from hospital after surgery, only 2 patients had moderately anastomotic stenosis and both of them had good recovery with endoscopic dilatationl. The reflux after operation was independent of anastomosis sites (Pgt;0.05). ConclusionBoth liptype reinforcement and His angle reconstruction can improve the ability of antireflux, liptype reinforcement is better and simple to mainpulate.
ObjectivesTo systematically review the efficacy and safety of hydrotalcite in the treatment of reflux esophagitis (RE).MethodsCBM, CNKI, WanFang Data, VIP, PubMed, EMbase, The Cochrane Library, Web of Science and Scopus databases were searched online to collect randomized clinical trials (RCTs) of hydrotalcite or hydrotalcite plus PPI versus PPI alone in the treatment of RE from inception to June 30th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 655 patients were included. The results of meta-analysis showed that: after 4-8 weeks of treatment, there was no significant difference between hydrotalcite vs. PPI regarding RE healing rates (RR=0.87, 95%CI 0.76 to 1.00, P=0.05). However, there were significant increases in RE healing rate (RR=1.22, 95%CI 1.14 to 1.31, P<0.001) and symptom relief rate (RR=1.36, 95%CI 1.12 to 1.66,P<0.01) between hydrotalcite plus PPIvs. PPI alone. Similar increases of RE healing rate (RR=1.16, 95%CI 1.08 to 1.25, P<0.001) and symptom relief rate (RR=1.12, 95%CI 1.04 to 1.20,P<0.01) were seen in patients with refractory RE. No increase of adverse effect rate was shown with hydrotalcite or hydrotalcite plus PPI compared to PPI alone.ConclusionsCompared with PPI alone, hydrotalcite plus PPI confers a statistically significant improvement of healing rate and symptom relief rate, while it does not increase adverse effect rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.