利福昔明保留灌肠治疗婴儿痢疾性腹泻效果观察

目的探讨利福昔明保留灌肠治疗婴儿痢疾性腹泻的效果。方法将96例婴儿痢疾性腹泻患儿随机分为口服组和灌肠组各48例，口服组口服利福昔明治疗，灌肠组应用利福昔明保留灌肠。结果灌肠组治疗效果显著优于口服组（P〈0．01）。灌肠组用药过程中未见任何不良反应，口服组20例出现恶心、呕吐等不良反应。结论利福昔明灌肠治疗小儿痢疾性腹泻具有安全、起效快、疗效好、疗程短、不良反应少等特点。     

利福昔明保留灌肠治疗婴儿痢疾性腹泻效果观察

目的 探讨利福昔明保留灌肠治疗婴儿痢疾性腹泻的效果.方法 将96例婴儿痢疾性腹泻患儿随机分为口服组和灌肠组各48例,口服组口服利福昔明治疗,灌肠组应用利福昔明保留灌肠.结果 灌肠组治疗效果显著优于口服组(P＜0.01).灌肠组用药过程中未见任何不良反应,口服组20例出现恶心、呕吐等不良反应.结论 利福昔明灌肠治疗小儿痢疾性腹泻具有安全、起效快、疗效好、疗程短、不良反应少等特点.     

利福昔明联合马来酸曲美布汀治疗肠易激综合征40例疗效观察

目的:观察利福昔明联合马来酸曲美布汀治疗肠易激综合征患者的疗效。方法:选取我院2021年1月至2022年10月诊治的肠易激综合征患者80例，将其随机分为常规组和联合组，每组40例。常规组患者口服马来酸曲美布汀治疗，联合组患者口服利福昔明联合马来酸曲美布汀治疗，比较2组患者的疗效、炎症因子水平及不良反应发生情况。结果:联合组患者治疗总有效率明显高于常规组(P<0.05);治疗28 d, 2组患者白介素-1β(IL-1β)、白介素10(IL-10)、白介素-8(IL-8)水平均低于治疗前(P<0.05),且联合组低于常规组(P<0.05);联合组患者不良反应发生率高于常规组，但比较差异无统计学意义(P>0.05)。结论:利福昔明联合马来酸曲美布汀治疗肠易激综合征能在保证治疗安全性的基础上显著抑制炎性因子释放，疗效显著。     

慢性细菌性前列腺炎和肠易激综合征：利福昔明联合益生菌VSL#3的治疗效果

本研究评价了利福昔明联合益生菌VSL#3对慢性前列腺炎转化为微生物性前列腺精囊炎（PV）或前列腺精囊附睾炎（PVE）的作用。106例伴有细菌学治愈的慢性细胞性前列腺炎和肠易激综合征的男性不育患者随机予以利福昔明（200mg，20：／日，每月服用7日，持续12个月）和益生菌VSL#3（450×10^9CFU／日）治疗及无处理。95名患者（89．6％）完成治疗计划，纳入本研究。将患者分为四组：A组前6个月予治疗，后6月无治疗（n=26）；B组予12个月治疗（n=22）；C组前6个月不予治疗后6个月予治疗（n=23）；D组在12个月内均无治疗（n=24）。A组和B组患者慢性前列腺炎发生率最高（分别为88．5％和86．4％）。相反，D组患者前列腺炎发生率最低（33．4％）。前列腺炎进展为PV的发生率在B组（15．5％）和C组（13．6％）低于D组（45．8％）。B组和C组最终无患者进展为PVE，而D组有20．8％诊断为PVE。长期服用利福昔明联合益生菌VSL#3能有效降低伴有治愈的CBP伴IBS的男性不育患者的前列腺炎进展为更复杂形式的男性附属性腺感染。     

肺移植后肺结核17例临床特征分析

目的探讨肺移植术后肺结核的临床特征、诊断及治疗方案。方法回顾性分析2017年3月至2021年12月间中日友好医院行肺移植手术的424例受者中, 术后诊断肺结核17例的临床特点、治疗方案、疗效及预后。结果肺移植术后肺结核发病率为4%(17/424)。其中, 男性14例, 女性3例;中位年龄57岁;双肺移植12例。临床判定可能为供体来源结核感染8例, 术后获得性感染6例, 受者潜伏结核感染复燃3例;发生于术后1个月内11例, 术后1年内16例。分子生物学阳性7例, 其中1例为利福平耐药基因阳性;分子生物学+抗酸涂片阳性4例;分子生物学+结核杆菌培养阳性6例。13例行胸部CT检查, 结果显示病变位于上叶12例, 其中合并下叶病变2例, 双肺病变2例;有结节/空洞表现者10例。采用不含利福霉素方案治疗14例, 采用含利福布汀或利福喷汀方案2例。截至完稿, 临床治愈10例, 临床治疗有效2例, 死亡1例与结核致重症感染有关。结论肺移植供受体来源结核问题相对突出, 不含利福霉素抗结核方案对肺移植受者术后结核病具有一定的疗效和安全性。     

利福布汀对非结核分枝杆菌抗菌活性的初步探讨

目的观察利福布汀对非结核分枝杆菌的抗菌活性,探讨利福布汀对常见致病性非结核分枝杆菌的实验室耐药临界浓度,为临床合理应用利福布汀治疗非结核分枝杆菌病提供依据。方法采用液体培养基倍比稀释法检测利福布汀和利福平对50株非结核分枝杆菌（NTM）的最低抑菌浓度（MIC）。结果 （1）对34株鸟分枝杆菌复合群的MIC：76.5%（26/34）菌株的利福平MIC≥1μg/ml,而利福布汀MIC有85.3%（29/34）分布在0.125~2μg/ml,其中在0.125~1μg/ml的有25株;（2）6株偶然分枝杆菌的MIC：利福平的MIC多〉8μg/ml,而利福布汀的MIC为1~8μg/ml;（3）5株脓肿分枝杆菌的MIC：利福平的MIC〉64μg/ml,利福布汀的MIC为2~32μg/ml;（4）其他非结核分枝杆菌：利福平和利福布汀对蟾蜍分枝杆菌、堪萨斯分枝杆菌、戈登分枝杆菌、瘰疠分枝杆菌、不产色分枝杆菌的MIC分别为〉64μg/mlvs1μg/ml、2μg/mlvs0.25μg/ml、8μg/mlvs1μg/ml、4μg/mlvs1μg/ml、4μg/mlvs1μg/ml。结论初步得出利福布汀对常见致病性非结核分枝杆菌的实验室耐药临界浓度为4~8μg/ml。利福布汀对鸟分枝杆菌复合群、勘萨斯分枝杆菌的抗菌活性优于利福平;蟾蜍分枝杆菌、戈登分枝杆菌、瘰疠分枝杆菌、不产色分枝杆菌对利福平体外MIC值达到临床耐药浓度时,利福布汀对其仍有体外抗菌活性。     

预处理间充质干细胞的策略在炎症性肠病中的应用

间充质干细胞(MSCs)近年来被广泛应用于治疗免疫性及炎症性疾病, 对炎症性肠病(IBD), 尤其克罗恩病复杂肛瘘的临床治疗结果令人振奋。目前MSCs的临床前研究备受关注, 大量的研究致力于提高MSCs的疗效。其中, 通过使用细胞因子、药物、改变培养基等方法在体外预先处理MSCs以增强其疗效的策略——预处理MSCs的策略已经在包括IBD在内的众多疾病中被证实有效。本文主要就这一策略在IBD中的应用展开综述。     

炎性肠病45例手术治疗及疗效评价

目的 探讨炎性肠病的手术治疗方法 及疗效评估.方法 回顾性分析近6年经外科手术治疗的45例炎性肠病患者的临床资料.结果 急诊手术16例,Crohn病9例,溃疡性结肠炎(UC)7例.择期手术29例,Crohn病4例,UC 25例.其中13例Crohn病患者行小肠部分切除6例,内瘘者行小肠及结肠部分切除、吻合术1例,回肠穿...     

胃康复治疗脾虚证胃癌前病变对胃粘膜组织细胞病理学的影响

目的 :观察胃康复冲剂治疗胃粘膜肠化生 (IM)和不典型增生 (ATP)的临床病理疗效。 方法 :中西医证病结合 ,辨证施治 ,随证加减应用胃康复冲剂作为治疗组 (6 1例 ) ,不予辨证用胃苏冲剂作为对照组 (5 4例 )。治疗前后均作胃镜检查 ,取胃窦部粘膜作病理诊断、肠化生和不典型增生的病理分度 ,以及组织化学染色肠化生分型。 结果 :治疗组的症状疗效和病理疗效明显优于对照组 ,P <0 .0 5～ 0 .0 0 1。 结论 :胃康复冲剂能够在改善临床症状的同时逆转肠化生和不典型增生     

炎症性肠病规范化外科治疗值得注意的几个问题

近年来,由于药物尤其是生物制剂的不断开发和广泛应用,为炎症性肠病的治疗带来了新的希望和治疗选择。然而,手术仍然是治疗炎症性肠病不可或缺的重要手段,尤其对于复杂炎症性肠病,外科治疗起到核心作用。在外科治疗方面,炎症性肠病区别于胃肠道肿瘤等疾病的最大特点是其缺乏统一规范的围手术期处理方案及手术方式。炎症性肠病病人由于发病年龄、疾病表现、疾病部位及用药史不同,使其具有很强的个体化特点;由于合并肠道狭窄、瘘、腹腔脓肿等并发症,在围手术期处理和手术操作技巧等方面有许多值得研究和探索的空间。     

VALUE OF SMALL BOWEL ENEMA IN INCOMPLETE INTESTINAL OBSTRUCTION

The usefulness of small bowel enema X-ray examination was evaluated in 11 patients in whom a provisional diagnosis of Incomplete small bowel obstruction was made. Dilute barium was introduced through a nasojejunal tube. In one patient intubation of the Jejunum was unsuccessful. In six patients the suspected obstruction was confirmed and information obtained about the site of obstruction. The small bowel enema X-ray examination was normal in three patients and subsequent clinical outcome was uneventful. In one patient, with normal findings on small bowel enema X-ray examination, acute obstruction developed after two days, necessitating operation. Small bowel enema X-ray examination appears a worthwhile adjuvant to clinical assessment but decisions for operative intervention still need to be based on clinical evaluation of patients.     

Prediction of small bowel viability using Doppler ultrasound. Clinical and experimental evaluation.

The operative determination of small bowel viability following strangulation obstruction or mesenteric vascular occlusion remains a problem. In the canine model, Doppler ultrasound was used to predict intestinal viability in segments of small bowel subjected to mesenteric venous occlusion. This was compared with small bowel electromyography and the short- and long-term clinical courses. If flow was consistently heard on the antimesenteric border, the bowel remained viable, had return of slow waves on electromyography, and did not develop strictures during a six-month follow-up period. Four clinical cases are presented where Doppler ultrasound was utilized to supplement the usual methods of determining small bowel viability. Doppler ultrasound is a rapid, noninvasive method of determining small bowel viability.     

术后早期炎性肠梗阻42例诊治观察

目的探讨术后早期炎性肠梗阻的发病机制、临床特点、诊治方法及预防措施。方法对2008年10月至2012年7月山西省定襄县中医院收治的42例腹部手术后早期炎性肠梗阻患者的临床资料进行回顾分析,42例患者均表现为排气后肠蠕动一度恢复、进食后又出现以腹胀为主的肠梗阻症状,经查体和X线腹部平片确诊。结果 40例经保守治疗后治愈,于5～21d（中位时间9d）肠蠕动重新恢复,效果良好。2例保守治疗2周不见缓解,1例由于黏连导致血运障碍而行部分小肠切除术,另1例腹腔肠管广泛黏连、扩张,行黏连松解术并肠排列术,中位治愈时间为15d。结论术后早期炎性肠梗阻,多发于腹部手术后2周以内,治疗取决于引起梗阻的原因及临床病情进展情况,首选保守治疗。     

Computer-aided diagnosis of the character of bowel obstruction.

A computer programme for the differential diagnosis of bowel obstruction was created and put into clinical practice to accelerate and simplify the diagnostic process. The training material was 503 cases of bowel obstruction admitted to the Surgical Clinic of Kaunas Medical University during 1990-1996. Based on 36 statistically significant anamnestical, clinical, laboratory investigations and plain abdominal X-ray findings, the computer programme was built up using a Bayesian formula. Retrospectively, the prognostic diagnosis was compared with the final clinical diagnosis based on instrumental or operative findings. Then, in a control group of 136 patients, the prospective prognostic diagnosis was obtained. The accuracy of the prognostic diagnosis in the control group of patients with complete small bowel obstruction amounted to 88.7% and for the patients with complete large bowel ileus 95.8%. Prognostic accuracy for partial small bowel obstruction was the most precise (96.1%) and for partial large bowel ileus (87.5%). The overall diagnostic accuracy of the computer algorithm was 92.6%. All cases were classified. This computer algorithmic programme for the differential diagnosis of the character of mechanical bowel obstruction has markedly shortened and facilitated the process of diagnosis of ileus.     

脊髓损伤伴神经源性肠功能障碍患者肠道管理最佳证据总结

目的 总结脊髓损伤伴神经源性肠功能障碍患者肠道管理的最佳证据,为改善患者肠道功能提供依据。方法 检索国内外相关循证资源网站及数据库中关于脊髓损伤肠道功能障碍患者肠道管理证据。对纳入文献进行方法学质量评价和证据提取。结果 共纳入17篇文献,其中指南7篇、专家共识5篇、系统评价3篇、随机对照试验2篇。总结了关于肠道功能评估方法、评估量表、健康教育、饮食干预、药物干预、行为干预及手术干预7个方面的26条证据。结论 脊髓损伤伴神经源性肠功能障碍患者最佳证据可为临床医护人员评估患者肠道功能及采取干预措施提供依据,实际应用中应结合临床实际情况和患者需求选择证据。     

Portal venous air in an adult patient with obstructive small bowel volvulus

BACKGROUND: Diagnosis of small bowel volvulus is frequently delayed often resulting in bowel ischaemia and infarction and impairing clinical outcome. Instant and correct diagnosis and subsequent adequate surgery may improve the outcome. METHODS: We describe a 19-year-old female with small bowel obstruction due to volvulus in whom the diagnosis was suspected based on the finding of air in the bowel wall and in the portal vein on a plain abdominal radiograph. CONCLUSIONS: Air, present in the portal vein and bowel wall on a plain abdominal X-ray, suggests bowel ischaemia or necrosis and that the need for laparotomy is urgent.     

原发性小肠肿瘤的诊断与治疗

目的 探讨小肠肿瘤的临床特点以及影响小肠恶性肿瘤预后的因素。方法 回顾分析1974年－1999年收治的42例原发性小肠肿瘤病例（不包括壶腹周围癌）的临床资料。结果 本组小肠性肿瘤6例中5例为平滑肌瘤,1例为腺瘤;恶性肿瘤36例,其中恶性淋巴瘤17例（47．2％）,腺癌11例（30．6％）,平滑肌肉瘤6例（16．7％）,类癌1例（2．8％）,神经纤维肉瘤1例（2．85）。临床症状无特异性,内镜和消化道钡餐是主要诊断手段。50％的恶性病例在手术时已有远处转移,仅18例（50％）根治性切除。36例获随访。小肠恶性肿瘤患者术后5年生存率为47．3％。远处转移和肿瘤大小对生态率有显著影响。结论 早期诊断、早期治疗是提高小肠恶性肿瘤预后的主要手段,对无远处转移后应争取行根治术。     

Preoperative characteristics and postoperative behavior of bowel wall on risk of recurrence after conservative surgery in Crohn's disease: a prospective study

OBJECTIVE: To evaluate in patients with Crohn's disease, using transabdominal ultrasound, the morphologic characteristics of the diseased bowel wall before and after conservative surgery and to assess whether these characteristics and their behavior in the postoperative follow-up are useful and reliable prognostic factors of clinical and surgical recurrence. SUMMARY BACKGROUND DATA: Ultrasound is effective for evaluating the thickness of bowel wall, the most typical and constant finding of Crohn's disease. No data are currently available concerning the behavior of the diseased intestinal wall after conservative surgery and whether the preoperative characteristics of bowel wall or its behavior after conservative surgery may predict recurrence. METHODS: In 85 consecutive patients treated with strictureplasty and miniresections for Crohn's disease, clinical and ultrasonographic evaluations were performed before and 6 months after surgery. Assessed before surgery were the maximum bowel wall thickness, the length of bowel wall thickening, the bowel wall echo pattern (homogeneous, stratified, and mixed), and the postoperative bowel wall behavior, classified as normalized, improved, unchanged, or worsened. RESULTS: A significant correlation was found between a long preoperative bowel wall thickening and surgical recurrence. Bowel wall thickness after surgery was unchanged or worsened in 43.3% of patients; in these patients, there was a high frequency of previous surgery. Patients with unchanged or worsened bowel wall thickness had a higher risk of clinical and surgical recurrence compared with those with normalized or improved bowel wall thickness. CONCLUSION: With the use of abdominal ultrasound, the authors found that the thickening of diseased bowel wall may unexpectedly improve after conservative surgery, and this is associated with a favorable outcome in terms of clinical and surgical recurrence. In addition to its diagnostic usefulness, ultrasound also provides reliable prognostic information concerning clinical and surgical recurrence in patients with Crohn's disease in the postoperative follow-up.     

Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction.

OBJECTIVE: The authors determined the utility of sonography compared with plain x-rays in the diagnosis of bowel obstruction. In a contemporaneous group of patients, they compared the cost of operative versus nonoperative management of small bowel obstruction. SUMMARY BACKGROUND DATA: Nonoperative treatment of simple bowel obstruction usually succeeds. However, because of the difficulty in assured diagnosis and the possibility of strangulation or other complication, exploration of suspected bowel obstruction is recommended. Most of these explorations could be avoided if diagnostic accuracy were better, yielding a desirable decrease in the overall cost of managing bowel obstruction. METHODS: Fifty patients whose clinical or plain x-ray findings suggested bowel obstruction underwent prospective evaluation by abdominal sonography and by flat and upright abdominal x-rays. Presence or absence of bowel obstruction was determined at laparotomy and by clinical evolution of the abdominal episode. Direct costs of care were determined from the hospital and physician bills of 54 patients treated contemporaneously with the sonography study. RESULTS: Sonography demonstrated bowel obstruction by showing fluid-filled dilated bowel loops proximal to collapsed bowel in 22 patients with one false-positive and three false-negative examinations. X-rays demonstrated bowel obstruction in 32 patients with nine false-positive and one false-negative examination. Cost data showed that operative treatment of simple bowel obstruction increased costs nearly eightfold. CONCLUSIONS: Sonography is as sensitive but more specific than plain x-rays in the diagnosis of bowel obstruction. Management based on sonographic findings has the potential to reduce costs of surgical care.     

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??Personalized management strategies for malignant bowel obstruction ZHOU Zong-guang*, YIN Yuan, YU Yong-yang, et al. *Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
Corresponding author: ZHOU Zong-guang, E-mail??zhou767@163.com
Abstract With the incidence of abdominal malignancies keeping to increase, malignant bowel obstruction, including complete or incomplete bowel obstruction caused by primary abdominal malignancies of gastrointestinal tract??mesentery and pelvis, and recurrent or metastatic tumor, has become the most common and troublesome clinical problems. As the conditions of the disease including the location and severity of obstruction, stage of the malignancy, and the general condition and comorbidity of the patients vary greatly, it is challenges for the surgeons that the clinical skills and knowledge updating of physicians, and multi-discipline team??MDT??cooperation, suggesting that patients would benefit from strategy treatment plan considering both the relieving obstruction and the managing tumor at the same time. In fact, different surgeons on the management of malignant bowel obstruction may produce completely different prognosis??depending on technical specification and surgical experience of the surgeons. The purpose of this article is to try to summarize a personalized management strategy for patients with malignant bowel obstruction based on the clinical features of the disease in China, the treatment principle of abdominal malignancies and clinical practice experience.