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1.
游离空肠移植重建下咽颈段食管临床观察 总被引:1,自引:0,他引:1
目的:探讨游离空肠移植重建下咽颈段食管的可行性、技术操作方法及疗效。方法:回顾性分析采用游离空肠重建下咽颈段食管11例,其中喉癌术后复发1例,颈段食管癌2例,下咽癌8例。术中切除喉、下咽、颈段食管及部分颈段气管1例,切除喉、下咽及颈段食管8例,保留喉切除颈段食管2例。所有病例均给予颈淋巴清扫。术后放射治疗3例,剂量50~55Gy。结果:术后除1例移植肠管坏死改用前臂游离桡侧皮瓣卷成皮管移植重建外,其余10例均成活,成功率为90.9%。肠管成活病例中无咽瘘、感染等并发症发生,随访3~27个月,喉癌术后复发患者1例术后2个月肿瘤再发,出现吞咽梗阻。结论:游离空肠移植重建下咽颈段食管手术成功率高,恢复消化道的连续性安全可靠,内侧为黏膜的空肠瓣是下咽颈段食管极好的修复材料。 相似文献
2.
C. Rossi P. Cellocco F. Bizzarri E. Margaritondo G. Costanzo 《Journal of orthopaedics and traumatology》2005,6(3):145-149
Abstract
Surgical management of trapeziometacarpal joint osteoarthritis (OA) is still controversial. The aim of this study was to evaluate
and compare results of trapeziometacarpal arthrodesis and of tendon interposition arthroplasty. One hundred twenty-six patients
suffering from trapeziometacarpal OA underwent surgery between 1996 and 2001. Of these patients, 62 (78 thumbs) treated with
joint arthrodesis and 33 (41 thumbs) treated with tendon interposition arthroplasty with abductor pollicis longus (APL) have
been evaluated at follow-up and therefore entered this study. Mean age was 53 years, while the mean follow-up was 36 months.
Overall results were satisfactory in 84 patients with good pain improvement. Patients treated with arthrodesis showed better
functional ability in bi-digital pinch and grip strength. First finger opposition motion, however, was better conserved in
patients treated with interposition arthroplasty. Fusions had an 11.5% complication rate (9 thumbs) with nonunions, whereas
14.8% (6 thumbs) of patients treated with interposition arthroplasty developed 1 first metacarpal base collapse, resulting
in 1 first ray length reduction. Despite complications, however, patients did not report unsatisfactory results and generally
experienced marked pain reduction. This study shows that arthrodesis can be considered the treatment of choice in patients
suffering from trapeziometacarpal OA at Eaton stage III or less, whatever the age and when a good pinch strength is needed. 相似文献
3.
Yasuo Miyoshi Seigoh Mizumoto MD Hideo Akashi Eiji Kurokawa Hideyuki Mishima Keisuke Iihara Kohji Takami Masayuki Ohue Yukitoshi Aoki 《Surgery today》1990,20(6):711-714
A rare case of jejunal carcinoma coexisting with adenoma, situated 120 cm distal to the ligament of Treitz in a 53 year old
male, is reported herein. We also review cases of adenoma and carcinoma in the jejunum and ileum from the Japanese literature,
and discuss the histogenesis of carcinoma of the jejunum and ileum. 相似文献
4.
J. J. HOORWEG J. A. RAUWERDA G. A. CROLL A. J. C. MACKAAY E. K. J. RISSE N. DE VRIES R. M. TIWARI 《Clinical otolaryngology》1994,19(6):496-501
The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T3 carcinoma, 15 patients T4 and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The postoperative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins. 相似文献
5.
M. J. Stangl W. H. Schraut H. L. Moynihan T. K. Lee K. K. W. Lee 《Transplant international》1990,3(1):149-155
Abstract. Experimental evidence suggests that jejunal allografts are rejected as rapidly as are ileal grafts, despite their lesser content of lymphoid tissue as an immunologic stimulus. However, it may be possible to postpone the rejection of jejunal grafts more readily than that of ileal grafts by means of immunosuppressive therapy with cyclosporin (CyA). To test this, we used the rat model (BN-LEW) of orthotopic small-bowel transplantation. The proximal third of the small-bowel with one-third of the mesenteric lymph nodes (n= 20), or the distal ileal third with all of the mesenteric lymph nodes (n= 22), or the entire small-bowel (n= 23) was interposed after resection of an equivalent type and length of recipient bowel. CyA (15 mg/kg) was given to all of these rats for 5 days. Three additional control groups were not given CyA. The difference in graft/recipient survival among the groups receiving CyA and among those not on CyA therapy was not statistically significant. Antidonor hemagglutinin titers, the mixed lymphocyte culture (MLC) assay, and histologic examination of the allograft failed to show a mitigated rejection reaction for the recipients of jejunal grafts. The data show that short-term treatment with CyA prolongs graft survival. Equal doses of CyA, however, did not lead to prolonged survival of jejunal grafts or alter the course of rejection in comparison with that for ileal or whole-bowel transplants. 相似文献
6.
G. Bogeski N. P. Lean P. D. Kitchener A. Timar-Peregrin G. J. Sanger† A. D. Shafton & J. B. Furness 《Neurogastroenterology and motility》2003,15(4):417-425
Distension of the intestine is commonly used to elicit reflex responses at other sites in the gastrointestinal tract, and also to evaluate pain of intestinal origin. The sensory neurones, that initiate the reflexes or pain responses, react to the forces generated in the wall of the intestine. Thus, the responses of the intestine at the site of distension, particularly changes in contractile activity, influence the signals from the gut. In the present work we have analysed the relationship between distension and pressure changes in the jejunum of the rat, in vivo. Isovolumic distension for 5 min caused an initial pressure increase which declined quickly in the first 30 s, and then declined more slowly. Phasic pressure increases were superimposed on the baseline pressure change. Hexamethonium blocked the phasic pressure increases, whereas the initial rapid and subsequent slower pressure decline during distension persisted. Inhibition of nitric oxide synthase (NOS) increased intraluminal pressure and caused increased frequency and irregularity of phasic pressure increases. However, the decline in jejunal pressure during distension was not changed by inhibition of NOS. The pressure decline during isovolumic distension was similar whether saline or paraffin oil were used to distend the intestine, indicating that the decline was not due to increased hydrostatic pressure causing water and electrolyte to cross the mucosal epithelium from the lumen to the intestinal interstitium. Hyoscine had no significant effect on the pressure profile when the intestine was distended. However, when the systemic or the local circulation of the jejunum was infused with nicardipine, the pressure that was achieved during isovolumic distension was less, although the rate of change in pressure during the slow decline was similar. It is concluded that distension evokes phasic pressure increases in the jejunum, that are nerve-mediated, and increases the tension in the wall through a stretch-activated increase in contractile force generated by the circular muscle. The decline in pressure during maintained distension is primarily a consequence of visco-elastic properties of the wall of the intestine. 相似文献
7.
食管癌切除结肠代食管术44例 总被引:4,自引:1,他引:3
我们于1989年3月至1993年8月间,为44例食管癌病人行食管癌切除、结肠代食管术。包括上段癌23例,中段癌18例,下段癌3例;其中上段癌病变长于7cm者6例,中段癌病变长于8cm者5例及下段癌中2例既往曾行胃大部切除术且病变长于9cm者均先行术前放疗,放疗剂量为30~40Gy。40例(90.9%)以结肠左动脉升支供血的横结肠行顺蠕动方向吻合,结果手术死亡1例,颈部吻合口瘘9例(20.45%)。我们认为本术式对中、上段癌病人疗效较满意,建议多采用以结肠左动脉为血供的横结肠作为移植段行顺蠕动方向吻合,为减少术后并发症,应注意加强病人围手术期的处置和护理。 相似文献
8.
Torres JC 《Obesity surgery》1994,4(3):279-284
Selective proximal vagotomy and posterior truncal vagotomy have been performed in 71 consecutive gastric bypass (GBP) patients
from June 1991 to December 1992. Vagotomy was used to prevent or diminish the incidence of marginal ulcer in GBP patients.
Anterior and posterior highly selective proximal vagotomy with circular-instrument stapled gastrojejunostomy in patients undergoing
GBP distal Roux-en-Y with jejunal interposition had no marginal ulcer complications (minimal follow-up 18 months). 相似文献
9.
N. M. A. Bax M. H. Rövekamp A. J. Pull ter Gunne D. C. van der Zee 《Pediatric surgery international》1994,9(7):483-485
Since 1988, four children with long-gap esophageal atresia have undergone one-stage orthotopic jejunal pedicle-graft interposition at the age of 2 to 3 months. Obtaining enough jejunal length was no problem and major early complications did not occur. In one patient stenosis of the distal anastomosis was problematic and required corrective surgery. None of the patients demonstrated jejunitis as a result of gastroesophageal reflux. With follow-up periods of 12, 27, 46, and 60 months, all patients are doing well. It is concluded that the jejunum is a better esophageal substitute than is generally appreciated. 相似文献
10.
Gumbs MA Girishkumar H Yousuf A Levy L Patel M Narasimha V 《Postgraduate medical journal》2000,76(896):367-369
Two cases of jejunal strictures caused by Histoplasma capsulatum in AIDS patients are presented. Both patients were intravenous drug abusers. One patient, who was being treated for Pneumocystis carnii pneumonia, presented with jejunal perforation and the other presented with lower gastrointestinal bleeding and intestinal obstruction. On exploration, both patients were found to have jejunal strictures; one had intestinal perforation, and the other had intestinal obstruction with ulcers and strictures resulting in gastrointestinal bleeding. In areas where it is endemic, histoplasmosis is rarely disseminated. Dissemination is most commonly seen in immunosuppressed patients. Dissemination and extrapulmonary histoplasmosis is now included in the case definition of AIDS. 相似文献