ABSTRACT
Laparoscopic techniques are more and more poplular in proximal gastrectomy. The traditional esophagogastric anastomosis may lead to severe reflux esophagitis after surgery, affecting patient's quality of life. In recent years, multiple methods of digestive tract reconstruction after laparoscopic proximal gastrectomy capable of resisting reflux have been applied to the clinic. Combining the results of the latest clinical studies and our clinical experience, we elaborate the views on digestive tract reconstruction after laparoscopic proximal gastrectomy. Esophagogastric anastomosis (posterior esophagogastric anastomosis, anterior esophagogastric anastomosis, gastric tube reconstruction, lateral esophagogastric anastomosis, Kamikawa anastomosis and modified Kamikawa anastomosis, etc.) and esophagojejunal anastomosis (interposition jejunum, interposition jejunum with pouch, and double-channel anastomosis, etc.) are mainly discussed. Of course, the anti-reflux mechanisms of different surgical procedures are not the same, the anti-reflux effects are variable, and the surgical difficulties under laparoscopy are also different. Therefore, how to choose a rational reconstruction method after proximal gastrectomy needs to be comprehensively considered based on patient's own situation and technical level of the surgeons.
Subject(s)
Humans , Anastomosis, Surgical/methods , Esophagitis, Peptic/surgery , Gastrectomy/methods , Jejunum/surgery , Laparoscopy , Quality of Life , Retrospective Studies , Stomach Neoplasms/surgeryABSTRACT
Transurethral resection of the prostate (TURP) is a gold standard for the treatment of BPH. However, for large-volume BPH, TURP has its disadvantages of longer operation time, more residual glands, more intraoperative bleeding, lower efficiency, and longer hospital stay, which increase the risks of surgery and postoperative symptomatic recurrence. Therefore, minimally invasive treatment of large-volume BPH remains a clinical challenge. This paper focuses on the status quo and prospects of minimally invasive treatment of large-volume BPH, hoping to give some help with clinical practice.
ABSTRACT
Objective To evaluate the clinical efficacy of alprostadil in patients with septic shock associated with acute respiratory distress syndrome (ARDS),and to explore its possible mechanism.Methods From January 2015 to June 2016,patients with septic shock associated with ARDS and meeting the inclusion criteria were involved in the study in department of critical care medicine in First Hospital of Lanzhou University and randomly divided into the control group and alprostadil group.The standard treatment was given in control group,alprostadil 10μg 2/d was given in alprostadil group on base of standard treatment.Monitoring indexes were recorded in 1,3 and 6 days after enrollment.General condition of patients,APACHE Ⅱ score,ventilator conditions (PO2,PCO2,RR,PEEP,FiO2,oxygenation index,airway resistance,lung compliance),mechanical ventilation time,ICU stay time,hospital follow-up,28-day follow-up,immune index (CD4+/CD8+),inflammatory markers (CRP,PCT,IL-6) were monitored.Results Sixty-five patients were included in this study,32 in control group and 33 in alprostadil group.At 3 and 6 days after the treatment,APACHE Ⅱ score,respiratory rate (RR),the inspired oxygen concentration (FiO2),airway resistance,and C reactive protein (CRP),procalcitonin (PCT)-6 and interleukin (IL-6) levels significantly decreased,compared with pretreatment and 1 day posttreatment,in the two groups and lower in alprostadil group than in the control group on the 6th day (P＜0.05);at the same time,these indexes such as arterial partial pressure of oxygen (PaO2),lung compliance,oxygenation index,CD4+/CD8+ significantly increased 3 and 6 days after the treatment compared with pretreatment and 1 day posttreatment in the two groups,and on the 6thday,significantly higher in the alprostadil group than in the control group (P＜0.05).Time of mechanical ventilation,ICU stay and hospital stay in the alprostadil group was respectively lower than that in the control group (P＜0.05);The hospital mortality and the 28-day mortality rate were significantly lower in the alprostadil group than in the control group (P＜0.05).Conclusion Alprostadil can improve the lung function in patient with septic shock associated with ARDS,shorten the time of mechanical ventilation,ICU stay and hospital stay,and reduce the mortality rate,which may be associated with that alprostadil reduces systemic inflammatory reaction and enhance immunity by improving microcirculation.