目的 探讨全胃切除术后消化道重建方式的选择。 方法 我院2001年6月至2006年6月期间对182例胃癌患者全胃切除术后分别行空肠ρ袢代胃术(PRY)69例和非离断式食管空肠改良Roux-en-Y吻合术(URY)113例。 分析手术时间、术后进食情况、消化道症状及营养状况的差异。结果 非离断式食管空肠改良Roux-en-Y吻合术手术时间短于空肠ρ袢代胃术，且无Roux潴留综合征（RSS）发生。 2种术式术后患者营养状况并无明显差异。结论 非离断式食管空肠改良Roux-en-Y吻合术操作简单、并发症少、术后恢复良好，可以推荐作为全胃切除术后的消化道重建术式。
ObjectiveTo observe the effect of continuous renal replacement therapy (CRRT) on serum phosphate level in patients after cardiac surgery. MethodA single-center retrospective observational study was conducted on 30 patients received CRRT after cardiac surgery. There were 14 males and 16 females with mean age of 57.0±10.8 years (ranged 37-79 years). A total of 16 patients underwent CRRT with continuous veno-venous hemofiltration (CVVH), and 14 patients with continuous veno-venous hemodiafiltration (CVVHDF). The serum phosphate level was measured before treatment, at 24 h, and 48 h during therapy and 24 h after phosphate salt supplementation. ResultsThe level of serum phosphate at 24 h and 48 h during CRRT was decreased (0.6±0.4 mmol/L vs. 0.4±0.2 mmol/L vs. 1.1±0.3 mmol/L, P<0.01). After intravenous phosphate salt supplementation, serum phosphate level got increased (0.6±0.3 mmol/L, P<0.01). There was no statistical difference in serum phosphate level between CVVH and CVVHDF (P>0.05). ConclusionHypophosphatemia occurs frequently during CRRT, particularly with long treatment time. Phosphate salt supplementation is necessary. The dosage of the supplementation should be adjusted personally based on the regularly monitoring results of serum phosphate tests.
ObjectivesTo investigate simple assess method of the degree of low transvalvular gradient aortic stenosis patients with impaired left ventricular function and to investigate aortic valve replacement indications, short and mid-term outcome of this kind of patients. MethodsWe retrospectively analyzed the clinical data of 21 low-gradient patients with impaired left ventricular function in our hospital from January 2011 through May 2014. There were 15 males and 6 females aged 41-66 (54.6± 10.7) years with mean aortic transvalvular gradient less than 40 mm Hg and left ventricular ejection fraction (LVEF) less than 50%. ResultsIn response to dobutamine echocardiography stress test, 20 patients underwent aortic valve replacement. The result of intraoperative pathology showed 11 patients were with bicuspid aortic valve malformation, 4 patients with degenerative changes, 4 patients with rheumatic disease. During the same period, 3 patients underwent atrial fibrillation ablation, 1 patient with ascending aorta replacement, 2 patients with coronary artery bypass grafting, 1 patient with mitral valvuloplasty. One patient died of multiple organ failure on the fourth day after operation. The remaining patients recovered. The patients were followed up for 3 to 37 months after operation. Heart function of majority improved to gradeⅠorⅡin 3 months after surgery. The result of echocardiogram showed prosthetic valve function was good and LVEF increased (preoperative 35.7%± 8.2% vs. postoperative 49.4%± 7.2%). One patient suffered sudden death of unknown cause in the 11th months after operation. ConclusionsFor patients whose dobutamine echocardiography stress test displayed with true severe aortic stenosis and left ventricular contractile reserve capacity, after aortic valve replacement and relief of the obstruction, the left ventricular afterload decreases significantly, the left ventricular function also improves, LVEF and the quality of life improve significantly after operation.