食管切开术

To discuss the feasibility and therapeutic effect of laparoscopic Heller-Dor operation with intraoperative gastroscope in the treatment of esophageal achalasia.

目的 探讨腹腔镜联合胃镜食管Heller肌切开加Dor胃底折叠术治疗贲门失弛缓症的可行性及疗效。

The observing parameters of OAA/S scores, BIS, BP, HR, SpO2, theoretical and actual times of pushbutton by the patient and the patient's satisfaction were recorded on seven time-points include before PCS, 5min after PCS, esophagoscope introducing, Oddis sphincter dissecting, bile duct imaging, end of procedure and recovery period.

记录给药前、给药5min、内窥镜插入食管、Oddis括约肌切开、造影、术毕、苏醒期七个时点的OAA/S镇静评分、脑电双频指数值、BP、HR、SpO2及病人按压次数和实际给药次数，以及病人对使用PCS的满意程度。

Methods:from 1988 to 2004, 26 patients (25 males and 1femal, aged from 28～72 years old) with esophagus rupture were treated. among the 26 cases, 2 cases received conservative treatment; 6 cases' esophaguses were slit to extirpate heterogeneous things; 3 cases received thorax and mediastinal conduction added gastrostomy or jejunostomy; 14 cases received esophagus hernioplasty; 1case was put the metallic bracket into esophagus and then received esophagus resection and esophagus -gastric anastomosis in the second period.

1988～2004年收治食管破裂患者26例，其中男25例，女1例，年龄28～72岁。26例患者中，2例保守治疗，6例切开食管摘取异物，3例行胸腔、纵隔引流加空肠及胃造瘘术，14例行食管修补术，1例行食管内带膜金属支架植入，二期再行食管切除食管胃吻合术。

objective to discuss perioperative complication and management of patient with high risk copd following esophagectomy.methods 45 patients with high risk copd underwent esophagectomy with epidural block combined with general anesthesia.perioperative treatment included smoking cessation,chest physiotherapy,prevention and control of infection of air way and appropriate bronchodilators of air way,breathing exercises,nutrition support and oxygen therapy.painkiller was instilled after surgery,early exercises,ensuring unobstruction of the air way,mechanical ventilation was applied when needed.results 3 had hypoxaemia in operation.after surgery,all patients had spo2 somewhat declined.6 had lung infection.6 were removed of bronchial secretion by bronchoscope.2 were supported by ventilator by using intubation.2 underwent tracheotomy.1 had disturbances of acid base balance and treated by using hydrochloric acid muriatic acid.all patients recovered rather smoothly and discharged from hospital.conclusion high risk copd is not the absolute contraindication of esophagectomy.active management before and after surgery ensures the safety and recovery of patients.

目的 探讨重度慢性阻塞性肺疾病简称慢阻肺病人食管切除术围手术期常见并发症及其处理。方法 45例重度慢阻肺的病人在全麻联合硬膜外阻滞下进行开胸食管切除手术，围手术期处理包括术前戒烟、胸部理疗、预防和控制呼吸道感染、解痉化痰、呼吸功能锻炼、营养支持和氧疗；术后硬膜外镇痛、早期锻炼、保持呼吸道通畅，部分病人予以呼吸支持。结果术中3例出现低氧血症。术后所有病人pao2均有不同程度的下降，6例出现肺部感染，6例行纤维支气管镜吸痰，2例通过气管插管给予呼吸机支持，2例行气管切开术，1例酸碱平衡紊乱使用盐酸精氨酸治疗。所有病人均痊愈出院。结论重度慢阻肺病人并非开胸食管切除手术的绝对禁忌证，积极的术前准备和严格的术后管理可减少和控制术后急性发作，有助于确保此类病人的围手术期安全和康复。

Methods:A case with achalasia treated with laparoscopic modified Heller myotomy combined with toupet fundoplication was reported.

经腹腔镜行食管贲门括约肌切开术（改良Heller手术加胃底折叠术治疗贲门失弛缓症1例。

Gastroenterography and endoscopy are major diagnostic methods,and selected arteriography is valuable to small bowel leiomyoneoplasms:Esophageal leiomyomas were ablated through longitudinal incisions from out of the mucomembrane and gastroenterological leiomyoneoplasms were excised by partial organ excisions.

消化道造影和内窥镜检查是主要的诊断手段，选择性动脉造影对小肠平滑肌肿瘤有较大诊断意义。食管平滑肌瘤行肌层纵行切开粘膜外肿瘤摘除术，胃肠道的平滑肿瘤以所在处部分器官切除为主。

Fancy gold-plated dangling earrings with facetted White Opal crystals.

花式镀金悬垂耳环与facetted白欧泊水晶。

This essay chooses the study aim from biology teachers in middle school in Shi Jiazhuang which tells us that most of the middle school biology teachers in Shi Jiazhuang have the"burnout", lower successfulness, individualize.

本文选取石家庄市初中生物教师作为研究对象，运用问卷调查的方法对石家庄市初中生物教师职业倦怠的现状进行调查，调查结果发现，石家庄市初中生物教师这一群体普遍存在职业倦怠，情感枯竭程度偏高，成就感偏低，去个性化程度最为严重。