食管的

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。

And There was no serious complication;②In the course ofinterventional therapy, Direct portal vein angiography demonstrated vena coronaria ventriculi(100%)andgastricveins(65.26%)andvenagastricaposterior38.43%, Angiography demonstrated venacoronariaventriculi communicate esophagus varicose veins, gastric veins and vena gastrica posterior communicategastric varicose veins. vena coronaria ventriculi had only a small percentage of double vein, about30.57%. The sites of vena coronaria ventriculi arising from the portal vein, splenic vein, portosplenic junction, were found in 52.06%、27.39%、20.55% respectively.③12 extrahepaticprotosystemic shunts were found in these patients. Include gastro-nephrosshuntof 3 cases, 7 caseswere splenetic- nephros shunt and 2 cases shown recanalization of umbilical vein .④The averageportal pressure before and after the procedure were 3.87±1.82kPa and 3.64±1.14kPa in 73patients, but to the time of rebleeding, it was 3.96±0.23kPa in the 11 cases.⑤There werethree kinds of variceal outcome: disappearance (54,low degree (19).⑥Spearman logisticanalyse and ANOVAtest shown liver function class, variceal degree of the splenic necrosis area,the blood direction in portal vein before operation and remain small collateral routes were thesignificant factors concerning outcome of varices.⑦The bleeding volume and portalhypertensive gastropathy are main risk factors of rebleeding.⑧The course of livercirrhosis is the risk factor of survival and extrahepatic portosystemic shunt , fine varices are thebeneficial factors to survival.⑨During all cases'followed-up data, the 1, 2, 3, 4, 5 yearcumulative survival rates and rebleeding rates were 17.81%, 28.77%, 38.36%, 43.84%, 47.95%and93.15%,91.78%,86.30%,83.56%,80.82%respectively. Conclusion The interventional disconnection treatment for liver cirrhosis and portalhypertension was designed suitability. It rapidlycontrol bleeding,butpressure of portal vein was notobvious high, perfusion was not low .it was compared with surgery therapeutic that interventionaldisconnection treatment was safe and had a significant clinical effect to hemorrhage and preventfrom rebleeding.

结果：①术后一过性发热62例(84.9%)，腹痛腹胀48例(65.8%)是介入断流术常见的并发症，未发生严重并发症；②门静脉造影显示胃冠状静脉、胃短静脉和胃后静脉的曲张分流的出现率是100%、65.26%和38.34%；显示食管静脉曲张主要由胃冠状静脉供血，胃静脉曲张主要由胃短静脉和胃后静脉供血；胃冠状静脉大多数为单支，少数为双支，其双支的出现率分别为30.57%；胃冠状静脉开口于门静脉主干的为52.06%，开口于脾静脉主干的为27.39%和开口于门脾静脉交汇处的为20.55%；③发现胃肾分流3例，脾肾分流7例、腹膜后门腔静脉分流2例，以及CTA检查发现脐静脉开放者2例；④73例患者介入断流术前和术后平均自由门静脉压力分别为3.87±1.82kpa和3.64±1.14kpa，前后比较存在显著性差异；11例再次介入手术患者的术前、术后和复发后的自由门静脉压力分别为4.02±0.24kpa、3.82±0.25kpa和3.93±0.23kpa ，前后比较发现首次术前与术后存在显著性差异，首次术前和复发出血术前门静脉压力比较无显著性差异；⑤介入术后复查曲张静脉转归基本消失54例，轻度19例；⑥Spearman相关分析和Logistic多因素回归分析，肝功能分级、静脉曲张程度、门脉血流方向和残存小侧支四个因素对曲张静脉转归有影响；Spearman相关分析和Logistic多因素回归分析门脉高压性胃病和出血量等因素对复发出血时间有影响；⑦COX回归分析，门体分流和曲张静脉转归两个因素对术后生存有影响；⑧术后随访6-70月，1、2、3、4、5年的累计复发出血率和累计生存率分别为17.81%、28.77%、38.36%、43.84%、47.95%和93.15%、91.78%、86.30%、83.56%、80.82%；结论：介入断流术治疗门脉高压食管胃底静脉曲张有独特的优点，可以快速直接控制曲张静脉出血而门静脉压力无显著增高，保证了肝脏灌注；与外科分流术相比适应证广、损伤轻、术后恢复快，不易遗漏曲张静脉；肝功能分级、曲张静脉程度、门脉血流方向和残存侧支血管对食管胃曲张静脉转归有影响；门脉高压性胃病对复发出血时间有影响；门体分流和曲张静脉转归对生存时间有影响。

Methods Thirty-six patients with caustic esophageal stricture were treated with colon interposition,the colon were brought up to the neck by retrosternal route and the esophagus were performed exclusion,four patients with atresic hypopharynx were treated with two staged operations.

采用结肠代食管治疗36例食管腐蚀性瘢痕狭窄的患者，均经胸骨后径路上提结肠、腐蚀性食管狭窄段旷置，4例合并下咽闭锁的病人分两期手术。

Esophagectomy is preferred for patients with adenocarcinoma of the distal esophagus or gastroesophageal junction.

在食管远端或胃食管交界处的腺癌的病人主张食管切除术。

CD8~+ cell is the main T lymphocyte subset in spleen, and B lymphocyte mainly is IgG~+ cell, moreover the amount of these B lymphocytes could exceed CD3~+ T lymphocyte subset after 7 days. CD8~+ cell is the main T lymphocyte subset in tonsil of appendix, and B lymphocyte is IgM~+ cell, and the amount could exceed CD3~+ T lymphocytes after 35 days. After 21 days, B lymphocytes in esophago tonsil are the main IgA~+ cells and the amount exceeds CD3~+ lymphocytes. The amount of CD4~+ lymphocytes is more than CD8+ lymphocytes.4. CD3~+、CD4~+ and CD8~+ T lymphocytes in spleen mainly distribute in periarterial lymphoid sheath. However IgM~+、IgG~+ and IgA~+ cells mainly distribute in ellipsoid periarterial lymphoid sheath and germinal center. T lymphocytes in appendix tonsil mainly distribute in middle and inferior part of mucous and the B lymphocytes mainly in middle and mucous between 4~7 days. Whereafter T, B lymphocytes equably distribute in mucous. CD4~+ cells arrange tightly and mainly occupy the central part in aggregates of T lymphocytes in esophago tonsil and CD8~+ lymphocytes mainly distribute in periphery. Meanwhile B lymphocytes encircle the periphery of aggregates of T lymphocytes. The aggregates of B lymphocytes is mainly the germinal center with lots of IgM~+、IgG~+ and IgA~+ cells. Meanwihle T lymphocytes encircle the periphery of aggregates of B lymphocytes.5. There is an intimate relationship between the development of tissue structure of peripheral immune organs and lymphcytopoiesis. The maturation of tissue structure is stimulated by the immigration of lymphocytes and the mature tissue structure provides place where lymphocytes grow mature and functionate.

脾脏在21日龄时达到稳定，食管扁桃体和盲肠扁桃体均在35日龄时达到稳定；脾脏中T淋巴细胞亚群以CD8~+细胞为主，B淋巴细胞则以IgG~+细胞为主，并在7日龄后数量超过CD3~+T淋巴细胞；盲肠扁桃体中T淋巴细胞亚群以CD8~+细胞为主，B淋巴细胞以IgM~+细胞为主，并在35日龄后数量超过CD3~+T淋巴细胞；21日龄后，食管扁桃体中B淋巴细胞以IgA~+细胞为主，数量超过CD3~+细胞，CD4~+细胞的数量多于CD8~+细胞。4、在T、B淋巴细胞组织定位方面，脾脏中CD3~+、CD4~+和CD8~+T淋巴细胞主要分布在动脉周围淋巴鞘中，而IgM~+、IgG~+和IgA~+细胞主要分布在椭球周围淋巴鞘和生发中心中；4～7日龄时，盲肠扁桃体中T淋巴细胞主要分布在粘膜固有层的中下部区域，而B淋巴细胞则主要分布在中上部区域，随后各日龄T、B淋巴细胞均匀地分布在粘膜固有层中；在食管扁桃体的T淋巴细胞聚集物中，CD4~+细胞紧密排列，主要占据中央部位，CD8~+细胞主要散布在外周，同时B淋巴细胞又环绕在整个T淋巴细胞聚集物的外周；B淋巴细胞聚集物主要为生发中心，其中存在大量IgM~+、IgG~+和IgA~+细胞，同时T淋巴细胞又环绕在整个B淋巴细胞聚集物的外周。5、外周免疫器官的组织结构发育和淋巴细胞发生之间存在密切的关系，淋巴细胞迁入淋巴器官刺激组织结构的发育成熟，同时成熟的组织结构又为淋巴细胞发育成熟并行使功能活动提供场所。

The value of preopera- tive esophageal insufflation test, indications of this procedure, the advantages of the new surgical technique, and possible factors affecting successful TE speech were discussed. The TE fistula with using voice prosthesis technique has proved to be a rela- tively simple, safe and effective method of alaryn- geal speech rehabilitation.

本文就手术适应症、术前食管充气试验的意义，新手术技术的优点及影响气管—食管语言功能的因素等进行了讨论，认为行气管—食管造瘘术并应用发音管是—简单、安全、有效的无喉语言重建方法。

ObjectiveTo explore the therapeutic effect of sandostatin for rebleeding of esophageal varicosis treated by endoscopic varical band ligation. Methods 82 patients with cirrhosis after hepatitis B complicated with esophageal variceal bleeding were divided into EVL group and EVL group + sandostatin group. The therapeutic effects of the two methods were compared for esophageal varicosis.

目的探讨善宁对食管静脉曲张套扎术后再出血的防治作用方法82例乙型病毒性肝炎后肝硬化并食管静脉曲张随机分套扎组和套扎+善宁组，比较两治疗方法对食管静脉曲张的治疗效果。

Methods insert the stomach tube nasal cavity, with the help of intubating ferceps, take the stomach tube out of mouth cavity from the posterior wall of dysphagia, insert trachea catheter (cid 7.0~7.5) to esophagus, under the help of trachea catheter, insert the stomach tube to esophagus then take the trachea catheter out of the esophagus and vertical, cutting off, in the course of into esophagus.

经鼻腔插入胃管，用插管钳将胃管从咽后壁前取出口腔外，用id 7.0～7.5的气管导管插入食管，在气管导管诱导下将胃管经气管导管插入食管，然后将胃管向食管内送进，同时将气管导管退出，将胃管置入相当合适的深度后，固定胃管。

METHODS: The expression of Elk-1 in fresh esophageal cancer tissues and their corresponding normal mucosae was detected immunohistochemically by means of tissue microarray. Its correlation with clinical characteristics was evaluated and analyzed by univariate analysis. All statistical analyses were performed by SPSS version 13.0. RESULTS: Expression level of transcription factor Elk-1 increased in 78.5%(84/107) ESCC tissues compared with their matched normal esophageal epithelium.

方法应用高通量的组织芯片以及免疫组化技术，分析了107例食管鳞癌患者的Elk-1的表达情况，在其蛋白质水平上，研究Elk-1在食管鳞癌组织和配对的正常粘膜组织的差异表达量，探讨该转录因子在食管鳞癌中的表达与临床病理各变量之间的关系。

Methods Thirty-five healthy volunteers and forty-two patients clinically diagnosed as globus hystericus entered the study. The pressure of UES and the rate of UES relaxation were measured by Medtrontic Esophageal Manometry system . The larynx was examined using videolaryngoscopy. Results The mean of UES resting pressure was 47.54±9.52 mmHg in control group. The corresponding value in the patients was 65.31±15.02mmHg .

选择42例咽异感症患者作为病例组，采用丹麦产食管动力检测系统(Medtrontic Esophageal Manometry system)进行食管压力检测，观察UES静息压、UES长度和UES松弛率等食管动力学参数的变化，结果与35例正常组对照；同时采用电子喉镜录像系统(PENTAX VNL-1530)观察咽异感症患者的喉部体征，尤其注意杓区、杓间区、杓会厌皱襞等部位的特异性变化。

This one mode pays close attention to network credence foundation of the businessman very much.

这一模式非常关注商人的网络信用基础。

Cell morphology of bacterial ghost of Pasteurella multocida was observed by scanning electron microscopy and inactivation ratio was estimated by CFU analysi.

扫描电镜观察多杀性巴氏杆菌细菌幽灵和菌落形成单位评价遗传灭活率。