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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1007-1019页

作者： Stephanie Lee Stovall Jennifer A Kaplan Joanna K Law david r flum Vlad V Simianu Department of Surgery Virginia Mason Franciscan HealthSeattleWA 98101United States Department of Gastroenterology Virginia Mason Franciscan HealthSeattleWA 98101United States Department of Surgery University of Washington MedicalSeattleWA 98195United States

The disease burden of diverticulitis is high across inpatient and outpatient settings,and the prevalence of diverticulitis has increased.Historically,patients with acute diverticulitis were admitted routinely for intravenous antibiotics and many had urgent surgery with colostomy or elective surgery after only a few episodes.Several recent studies have challenged the standards of how acute and recurrent diverticulitis are managed,and many clinical practice guidelines(CPGs)have pivoted to recommend outpatient management and individualized decisions about surgery.Yet the rates of diverticulitis hospitalizations and operations are increasing in the United States,suggesting there is a disconnect from or delay in adoption of CPGs across the spectrum of diverticular disease.In this review,we propose approaching diverticulitis care from a population level to understand the gaps between contemporary studies and real-world practice and suggest strategies to implement and improve future care.

关键词： Diverticulitis Hospitalization Elective Emergent surgery Clinical guidelines Diverticular disease

rethinking elective colectomy for diverticulitis: A strategic approach to population health

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World Journal of Gastroenterology 2014年第44期20卷 16609-16614页

作者： Vlad V Simianu david r flum Department of Surgery Surgical Outcomes Research Center UW Medical Center University of Washington

Diverticulitis is one of the leading indications for elective colon resection. Surgeons are trained to offer elective operations after a few episodes of diverticulitis in order to prevent future recurrences and potential emergency. However, most emergency surgery happens during the initial presentation. After recovery from an episode, much of the subsequent management of diverticulitis occurs in the outpatient setting, rendering inpatient "episode counting" a poor measure of the severity or burden of disease. Evidence also suggests that the risk of recurrence of diverticulitis is small and similar with or without an operation. Accordingly, contemporary evaluations of the epidemiologic patterns of treatments for diverticulitis have failed to demonstrate that the substantial rise in elective surgery over the last few decades has been successful at preventing emergency surgery at a population level. Multiple professional societies are calling to "individualize" decisions for elective colectomy and there is an international focus on "appropriate" indications for surgery. The rethinking of elective colectomy should come from a patient-centered approach that considers the risks of recurrence, quality of life, patient wishes and experiences about surgical and medical treatment options as well as operative morbidity and risks.

关键词： Diverticulitis Colectomy Colostomy Indica-tions El

A Large Animal Survival Model to Evaluate Bariatric Surgery Mechanisms

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Surgical Science 2015年第8期6卷 337-345页

作者： Vlad V. Simianu Jonathan G. Sham Andrew S. Wright Skye D. Stewart Mouhamad Alloosh Michael Sturek david E. Cummings david r. flum Departments of Surgery University of Washington Seattle USA Department of Cellular and Integrative Physiology Indiana University School of Medicine Indianapolis USA Departments of Medicine University of Washington Seattle USA Departments of Health Services University of Washington Seattle USA

Background: The impact of roux-en-Y gastric bypass (rYGB) on type 2 diabetes mellitus is thought to result from upper and/or lower gut hormone alterations. Evidence supporting these mechanisms is incomplete, in part because of limitations in relevant bariatric-surgery animal models, specifically the lack of naturally insulin-resistant large animals. With overfeeding, Ossabaw swine develop a robust metabolic syndrome, and may be suitable for studying post-surgical physiology. Whether bariatric surgery is feasible in these animals with acceptable survival is unknown. Methods: Thirty-two Ossabaws were fed a high-fat, high-cholesterol diet to induce obesity and insulin resistance. These animals were assigned to rYGB (n = 8), rYGB with vagotomy (rYGB-V, n = 5), gastrojejunostomy (GJ, n = 10), GJ with duodenal exclusion (GJD, n = 7), or sham operation (n = 2) and were euthanized 60 days post-operatively. Post-operative changes in weight and food intake are reported. results: Survival to scheduled necropsy among surgical groups was 77%, living an average of 57 days post-operatively. Cardiac arrest under anesthesia occurred in 4 pigs. Greatest weight loss (18.0% ± 6%) and food intake decrease (57.0% ± 20%) occurred following rYGB while animals undergoing rYGB-V showed only 6.6% ± 3% weight loss despite 50.8% ± 25% food intake decrease. GJ (12.7% ± 4%) and GJD (1.2% ± 1%) pigs gained weight, but less than sham controls (13.4% ± 10%). Conclusions: A survival model of metabolic surgical procedures is feasible, leads to significant weight loss, and provides the opportunity to evaluate new interventions and subtle variations in surgical technique (e.g. vagus nerve sparing) that may provide new mechanistic insights.

关键词： Ossabaw Bariatric Surgery roux-en-Y Gastric Bypass Weight Loss Metabolic Syndrome

如何诠释带有主观指标的外科试验避免偏倚行为

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美国医学会杂志（中文版） 2007年第6期26卷 358-359页

作者： david r. flum 武文（译）戴尅戎（校）严孟宁（校） Department of Surgery University of Washington Seattle 不详

在JAMA杂志中，有两篇文献报道了“脊柱患者疗效试验（Spine Patient Outcomes research Trial，SPOrT）结果。其中一篇是有关持续性椎间盘相关疼痛和神经症状患者随机接受椎间盘切除术或非手术常规治疗（通常包括单独进行或联合进行患... 详细信息

在JAMA杂志中，有两篇文献报道了“脊柱患者疗效试验（Spine Patient Outcomes research Trial，SPOrT）结果。其中一篇是有关持续性椎间盘相关疼痛和神经症状患者随机接受椎间盘切除术或非手术常规治疗（通常包括单独进行或联合进行患者教育、抗炎药治疗和物理治疗）的多中心试验。研究人员考虑到许多患者会因上述两种治疗方式的风险不同而拒绝接受随机治疗，因此引入了平行对照观察法，以便对符合随机试验但拒绝接受随机治疗的患者加以研究。参加随机试验与观察性队列研究的患者几乎所有特征均相似，随访2年。

关键词：疗效试验椎间盘切除术外科诠释行为偏倚随机治疗常规治疗

红细胞压积水平与手术预后的关系：观察的把握度

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美国医学会杂志（中文版） 2008年第1期27卷 50-51页

作者： Farhood Farjah, MD david r. flum, MD, MPH 公磊(译) 祝学光(校) Department of Surgery University of Washington Seattle. Dr Flum is Contributing Editor JAMA. 不详

在JAMA杂志中，Wu及其同事报告了行非心脏大手术的退伍军人（多为男性）术前红细胞压积水平与术后不良事件的关系。该队列研究结果显示，对于多数男性患者而言，红细胞压积高于或低于正常水平均与术后早期死亡和心脏事件发生危险增加相... 详细信息

在JAMA杂志中，Wu及其同事报告了行非心脏大手术的退伍军人（多为男性）术前红细胞压积水平与术后不良事件的关系。该队列研究结果显示，对于多数男性患者而言，红细胞压积高于或低于正常水平均与术后早期死亡和心脏事件发生危险增加相关。作者建议，今后的研究应进一步评估通过纠正贫血或红细胞增多症来降低术后不良事件危险的影响。

关键词：红细胞压积手术预后积水把握度非心脏大手术术后早期死亡红细胞增多症不良事件

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水平井的筛选标准

石油勘探开发情报 1998年第6期 37-41页

作者： flum.,rW 许房燕

本文讨论了三种水平井油藏的筛选和分类方法的应用，及他们的优缺点，这三种方法是：类比法，模式分析法和常规油藏模拟法。

关键词：水平井钻井油藏数值模拟