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溃疡性结肠炎患者“J”形回肠袋肛管吻合重建术后经4周的益生菌干预,其临床症状及内镜下表现的结果

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世界核心医学期刊文摘（胃肠病学分册） 2005年第7期1卷 57-58页

作者： Laake K.O. Bjφrneklett A. Aamodt G. 李翔 Dept. Med./Res. Inst. Int. Med. Rikshospitalet National University Hospital NO- 0027 Oslo Norway

Objective. Pouchitis is a common and troublesome condition in patients operat ed on with ileal- pouch- anal- anastomosis (IPAA). A disturbed microecology i n the pouch has been suggested as one possible explanation. In a previous double - blind, randomized, controlled study we demonstrated clinical improvement of s ymptoms in patients with ulcerative colitis (UC) operated on with IPAA, during i ntervention with live probiotic microbes Lactobacilli and Bifidobacteriae. The a im of the present study was to confirm our previous results in a much larger mat erial, including clinical symptoms, faecal flora and endoscopic evaluation, and to compare the results in UC/IPAA patients with those of patients with familial adenomatous polyposis (FAP) with IPAA and UC patients with ileorectal anastomosi s (IRA). Material and methods. Five hundred millilitres of a fermented milk prod uct (Cultura) containing live lactobacilli (La- 5) and bifidobacteriae (Bb- 12 ) was given daily for 4 weeks to 51 UC patients and 10 patients with FAP, operat ed on with IPAA, and six UC patients operated on for IRA. Stool samples were cul tured for examination of lactobacilli, bifidobacteriae, fungi and pH before, dur ing and after intervention. Before, during and after intervention, endoscopic ev aluation was performed. Categorized symptomatology was examined prospectively using diary cards in addition to an interview, before and on the last day of intervention. Results. The number of l actobacilli and bifidobacteriae increased significantly during intervention in t he UC patients operated on with IPAA and remained significantly increased one we ek after intervention. Involuntary defecation, leakage, abdominal cramps and the need for napkins (category I), faecal number and consistency (category II) and mucus and urge to evacuate stools (category III) were significantly decreased du ring intervention in the UC/IPAA group. In the FAP group there was a significant decrease in faecal leakage, abdominal

关键词：溃疡性结肠炎回肠袋临床症状随机对照试验不自主排便回肠直肠吻合术痛性痉挛血液学检查粪便样本吻合口漏

经后矢状径路的改良直肠拖出吻合巨结肠根治术治疗先天性巨结肠

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世界核心医学期刊文摘（儿科学分册） 2005年第8期1卷 44-44页

作者： Liem N.T. Hau B.D. Son H.T. 宁亮 Surgical Department National Hospital of Pediatrics 18/879 Lathanh Road Hanoi Viet Nam

Purpose: The objective of this study is to describe the surgical technique and clinical results of a modified Soave procedure through the posterior sagittal approach (PSAP) for Hirschsprung’s disease. Methods: The patient was placed in a prone jackknife position. The rectum was approached via PSAP keeping the exte rnal sphincter intact. The rectum was isolated and then divided approximately 2 cm from the dentate line. The rectum and sigmoid were freed up to the normal seg ment. The aganglionic and ganglionic segments were confirmed intraoperatively by frozen biopsy. The rectal mucosectomy was started 0.5 to 1 cm proximal to the d entate line, leaving 1 cm of the muscular cuff. The colon was then pulled throug h the anus. The aganglionic segment and transitional zone were removed. Coloanal anastomosis was fashioned 0.5 to 1 cm proximal to the dentate line. Results: Ni nety- six patients were operated on from January 2000 to July 2002, using the d escribed technique. Patient ages ranged from 2 to 36 months (median age, 81/2 mo nths). The aganglionic segment was located in the rectum in 56 patients and in t he sigmoid colon in 40 patients. The average length of bowel resected was 20 cm (range, 10- 35 cm). Combined laparotomy was performed in 2 patients and combine d laparoscopy surgery in 1 infant. There were no operative or postoperative deat hs. Anastomotic leakage occurred in 2 patients. Spontaneous defecation occurred in all patients. Conclusions: Posterior sagittal approach provides excellent exp osure of the operative field and decreases the major complications seen with the abdominal approach. The modified Soave procedure can easily be performed with P SAP.

关键词：先天性巨结肠巨结肠根治术矢状径齿状线不自主排便移行区黏膜切除术暴露术野卧位腹部手术

腹腔镜直肠拉出术治疗先天性巨结肠的临床预后:经腹部和经会阴术式的比较

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世界核心医学期刊文摘（儿科学分册） 2005年第5期1卷 56-56页

作者： Kubota A. Kawahara H. Okuyama H. 李丹 Department of Pediatric Surgery Osaka Med. Ctr. Res. Inst. M. Osaka Japan

Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome after this approach ha s not been reported. The purpose of this study was to compare the clinical outco me of PA and the conventional transabdominal approach (TA). Methods In the perio d between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distr ibution between the 2 groups. Clinical outcome was assessed 3 years after surger y. Results The operation time was comparable in the 2 groups (4.9 ±0.8 v 5.2 ±0.8 hr), whereas blood loss (98 ±52 v 36 ±30 mL) and postoperative complic ations requiring surgical intervention (26%v 0%) were significantly lower in g roup L. The incidence of postoperative enteritis (27%v 28%) and voluntary defe cation (more than once every/2 days) were compatible in the 2 groups (70%v 87% ). Soiling (small amount of involuntary stooling; > 1 per month)was significantl y less frequent in group L (45%v 14%). Conclusions Laparoscopically assisted E TP with PA is less invasive and can provide a better clinical outcome compared w ith TA in terms of postoperative soiling.

关键词：先天性巨结肠腔镜不自主排便失血量术后并发症排便次数大便失禁手术时间外科干预