BACKGROUND: Anomalous pancreaticobiliary junction is often associated with biliary tract carcinoma and acute pan- creatitis. We assessed the value of image analysis in the diag- nosis of patients with anomalous pancre...BACKGROUND: Anomalous pancreaticobiliary junction is often associated with biliary tract carcinoma and acute pan- creatitis. We assessed the value of image analysis in the diag- nosis of patients with anomalous pancreaticobiliary junction (APBJ) and the principles for the treatment of APBJ. METHODS: Sixty-four patients with APBJ were subjected to ultrasound imaging, endoscopic retrograde cholangio- pancreatography (ERCP) and magnetic resonance cholan- giopancreatography (MRCP) before surgery. The diagnos- tic accuracy of image analysis and their surgical outcomes were evaluated retrospectively. RESULTS: On ERCP and MRCP, the length of the com- mon channel was calculated to be 15 mm or longer in all patients, and the angle of the junction was more than 75° in 49 (76.6%) of the 64 patients. Of the 64 patients, 28 were defined of pancreatic duct type (P-C) (28/64, 43.75%), 32 bile duct type (C-P) (32/64, 50%), and 4 common chan- nel type (4/64, 6.25%). CONCLUSIONS: Patients with APBJ are often associated with biliary tract and pancreatic diseases, and early detec- tion and correct surgical treatment could avoid serious complications. ERCP and MRCP are accurate in the diag- nosis of APBJ.展开更多
目的 分析完全腹腔镜近端胃切除食管残胃吻合的临床疗效,为治疗早期近端胃癌提供新的手术方法。方法 回顾性分析2019年1月-2021年6月于解放军总医院第一医学中心普通外科医学部行近端胃切除术的80例早期胃癌患者的临床资料。根据手术方...目的 分析完全腹腔镜近端胃切除食管残胃吻合的临床疗效,为治疗早期近端胃癌提供新的手术方法。方法 回顾性分析2019年1月-2021年6月于解放军总医院第一医学中心普通外科医学部行近端胃切除术的80例早期胃癌患者的临床资料。根据手术方式不同分为完全腹腔镜近端胃癌切除术组(n=36)与腹腔镜辅助近端胃癌切除术组(n=44)。比较两组围手术期情况、远期并发症发生情况及生存状况。结果 完全腹腔镜近端胃癌切除术组腹部切口长度[(59.9±4.7) mm vs.(119.7±8.3) mm,P<0.001]、首次排气时间[(58.2±15.3) h vs.(66.8±16.4) h,P=0.019]及术后住院时间[(7.6±1.1) d vs.(9.2±1.3) d,P<0.001]均短于腹腔镜辅助近端胃癌切除术组,手术时间[(186.9±16.4) min vs.(154.0±17.2) min,P<0.001]长于腹腔镜辅助近端胃癌切除术组。两组术中出血量、淋巴结清扫数目和首次进流食时间差异无统计学意义(P>0.05),且均未发生需外科干预的早期并发症。随访期间两组无患者死亡,未出现复发或转移。完全腹腔镜近端胃癌切除术组反流性食管炎发生率低于腹腔镜辅助近端胃癌切除术组,差异有统计学意义[16.7%(6/36) vs.38.6%(17/44),P=0.031]。两组胃动力不足、残胃炎、吻合口狭窄、吻合口溃疡发生率差异无统计学意义(P>0.05)。结论 完全腹腔镜近端胃切除食管残胃吻合具有安全性好、术后恢复快、抗反流等特点,值得临床应用推广。展开更多
AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ malformations.METHODS Patients with symptomatic congenital...AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ malformations.METHODS Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study.Measurements of the following craniometrical parameters were taken in flexed and extended neck position:Atlanto-dental interval(ADI),distance of the odontoid tip to the Chamberlain’s line,and the clivus-canal angle(CCA).Assessment of the facet joints congruence was also performed in both positions.Comparison of the values obtained in flexion and extension were compared using a paired Student’s t-test.RESULTS A total of ten patients with a mean age of 37.9 years were included.In flexion imaging,the mean ADI was1.76 mm,the mean CCA was 125.4°and the mean distance of the odontoid tip to the Chamberlain’s line was+9.62 mm.In extension,the mean ADI was1.46 mm(P=0.29),the mean CCA was 142.2°(P<0.01)and the mean distance of the odontoid tip to the Chamberlain’s line was+7.11 mm(P<0.05).Four patients(40%)had facetary subluxation demonstrated in dynamic imaging,two of them with mobile subluxation(both underwent CVJ fixation).The other two patients with a fixed subluxation were not initially fixed.One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan.Patients with basilar invagination had a lower CCA variation compared to the whole group.CONCLUSION Craniometrical parameters,as well as the visualization of the facets location,may change significantly according to the neck position.Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability.Future studies addressing the relationship between craniometrical changes and neck position are necessary.展开更多
At present,treatment for celiac disease includes a strict gluten-free diet.Compliance,however,is difficult and gluten-free food products are costly,and,sometimes very inconvenient.A number of potential alternative mea...At present,treatment for celiac disease includes a strict gluten-free diet.Compliance,however,is difficult and gluten-free food products are costly,and,sometimes very inconvenient.A number of potential alternative measures have been proposed to either replace or supplement gluten-free diet therapy.In the past,non-dietary forms of treatment were used(e.g.,corticosteroids) by some clinicians,often to supplement a gluten-free diet in patients that appeared to be poorly responsive to a gluten-free diet.Some of new and novel non-dietary measures have already advanced to a clinical trial phase.There are still some difficulties even if initial studies suggest a particularly exciting and novel form of non-dietary treatment.In particular,precise monitoring of the response to these agents will become critical.Symptom or laboratory improvement may be important,but it will be critical to ensure that ongoing inflammatory change and mucosal injury are not present.Therapeutic trials will be made more difficult because there is already an effective treatment regimen.展开更多
食管胃交界处腺癌(adenocarcinoma of esophagogastric junction,EGJA)有其独特的解剖学位置,同时又位于鳞状上皮与柱状上皮交界之处,其生物学特性不同于食管癌和胃癌,诊断分型一直存在众多的争议,治疗模式在学术界也始终没有公认的&qu...食管胃交界处腺癌(adenocarcinoma of esophagogastric junction,EGJA)有其独特的解剖学位置,同时又位于鳞状上皮与柱状上皮交界之处,其生物学特性不同于食管癌和胃癌,诊断分型一直存在众多的争议,治疗模式在学术界也始终没有公认的"金标准",特别是局部进展期EGJA的治疗策略更是难以抉择。随着影像学技术的发展和各项大型临床研究结果的公布,EGJA的治疗日益个体化,同时也凸显了多学科协作的重要性。本文将针对以上问题对EGJA的最近进展做一综述。展开更多
文摘BACKGROUND: Anomalous pancreaticobiliary junction is often associated with biliary tract carcinoma and acute pan- creatitis. We assessed the value of image analysis in the diag- nosis of patients with anomalous pancreaticobiliary junction (APBJ) and the principles for the treatment of APBJ. METHODS: Sixty-four patients with APBJ were subjected to ultrasound imaging, endoscopic retrograde cholangio- pancreatography (ERCP) and magnetic resonance cholan- giopancreatography (MRCP) before surgery. The diagnos- tic accuracy of image analysis and their surgical outcomes were evaluated retrospectively. RESULTS: On ERCP and MRCP, the length of the com- mon channel was calculated to be 15 mm or longer in all patients, and the angle of the junction was more than 75° in 49 (76.6%) of the 64 patients. Of the 64 patients, 28 were defined of pancreatic duct type (P-C) (28/64, 43.75%), 32 bile duct type (C-P) (32/64, 50%), and 4 common chan- nel type (4/64, 6.25%). CONCLUSIONS: Patients with APBJ are often associated with biliary tract and pancreatic diseases, and early detec- tion and correct surgical treatment could avoid serious complications. ERCP and MRCP are accurate in the diag- nosis of APBJ.
文摘目的 分析完全腹腔镜近端胃切除食管残胃吻合的临床疗效,为治疗早期近端胃癌提供新的手术方法。方法 回顾性分析2019年1月-2021年6月于解放军总医院第一医学中心普通外科医学部行近端胃切除术的80例早期胃癌患者的临床资料。根据手术方式不同分为完全腹腔镜近端胃癌切除术组(n=36)与腹腔镜辅助近端胃癌切除术组(n=44)。比较两组围手术期情况、远期并发症发生情况及生存状况。结果 完全腹腔镜近端胃癌切除术组腹部切口长度[(59.9±4.7) mm vs.(119.7±8.3) mm,P<0.001]、首次排气时间[(58.2±15.3) h vs.(66.8±16.4) h,P=0.019]及术后住院时间[(7.6±1.1) d vs.(9.2±1.3) d,P<0.001]均短于腹腔镜辅助近端胃癌切除术组,手术时间[(186.9±16.4) min vs.(154.0±17.2) min,P<0.001]长于腹腔镜辅助近端胃癌切除术组。两组术中出血量、淋巴结清扫数目和首次进流食时间差异无统计学意义(P>0.05),且均未发生需外科干预的早期并发症。随访期间两组无患者死亡,未出现复发或转移。完全腹腔镜近端胃癌切除术组反流性食管炎发生率低于腹腔镜辅助近端胃癌切除术组,差异有统计学意义[16.7%(6/36) vs.38.6%(17/44),P=0.031]。两组胃动力不足、残胃炎、吻合口狭窄、吻合口溃疡发生率差异无统计学意义(P>0.05)。结论 完全腹腔镜近端胃切除食管残胃吻合具有安全性好、术后恢复快、抗反流等特点,值得临床应用推广。
文摘AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ malformations.METHODS Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study.Measurements of the following craniometrical parameters were taken in flexed and extended neck position:Atlanto-dental interval(ADI),distance of the odontoid tip to the Chamberlain’s line,and the clivus-canal angle(CCA).Assessment of the facet joints congruence was also performed in both positions.Comparison of the values obtained in flexion and extension were compared using a paired Student’s t-test.RESULTS A total of ten patients with a mean age of 37.9 years were included.In flexion imaging,the mean ADI was1.76 mm,the mean CCA was 125.4°and the mean distance of the odontoid tip to the Chamberlain’s line was+9.62 mm.In extension,the mean ADI was1.46 mm(P=0.29),the mean CCA was 142.2°(P<0.01)and the mean distance of the odontoid tip to the Chamberlain’s line was+7.11 mm(P<0.05).Four patients(40%)had facetary subluxation demonstrated in dynamic imaging,two of them with mobile subluxation(both underwent CVJ fixation).The other two patients with a fixed subluxation were not initially fixed.One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan.Patients with basilar invagination had a lower CCA variation compared to the whole group.CONCLUSION Craniometrical parameters,as well as the visualization of the facets location,may change significantly according to the neck position.Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability.Future studies addressing the relationship between craniometrical changes and neck position are necessary.
文摘At present,treatment for celiac disease includes a strict gluten-free diet.Compliance,however,is difficult and gluten-free food products are costly,and,sometimes very inconvenient.A number of potential alternative measures have been proposed to either replace or supplement gluten-free diet therapy.In the past,non-dietary forms of treatment were used(e.g.,corticosteroids) by some clinicians,often to supplement a gluten-free diet in patients that appeared to be poorly responsive to a gluten-free diet.Some of new and novel non-dietary measures have already advanced to a clinical trial phase.There are still some difficulties even if initial studies suggest a particularly exciting and novel form of non-dietary treatment.In particular,precise monitoring of the response to these agents will become critical.Symptom or laboratory improvement may be important,but it will be critical to ensure that ongoing inflammatory change and mucosal injury are not present.Therapeutic trials will be made more difficult because there is already an effective treatment regimen.
文摘食管胃交界处腺癌(adenocarcinoma of esophagogastric junction,EGJA)有其独特的解剖学位置,同时又位于鳞状上皮与柱状上皮交界之处,其生物学特性不同于食管癌和胃癌,诊断分型一直存在众多的争议,治疗模式在学术界也始终没有公认的"金标准",特别是局部进展期EGJA的治疗策略更是难以抉择。随着影像学技术的发展和各项大型临床研究结果的公布,EGJA的治疗日益个体化,同时也凸显了多学科协作的重要性。本文将针对以上问题对EGJA的最近进展做一综述。
