Objective To explore early postoperative rebleeding risk factors of cirrhosis esophageal variceal ligation ( EVL) . Methods Eighty patients treated with EVL were divided into observation group ( 20 patients with postoperative rebleeding) and control group ( 60 patients without postoperative rebleeding) . Clinical data of both groups were compared and analyzed so as to explore early postoperative rebleeding risk factors. Results Early rebleeding incidence of 80 patients was 25% ,in which 3 patients died from improper diet. Esophageal varix rupture was the cause of early rebleeding. Portal vein thrombosis,liver function grade of Child-Pugh,hemoglobin,prothrombin time which were analyzed by Logistic retrospective analysis were independent risk factors ( P < 0. 01) . Among the grades of early postoperative bleeding in liver function,grade C ( OR = 65. 0) had obvious influence,the others were prothrombin time ( OR = 33. 5) ,hemoglobin ( OR = 22. 6) and portal hypertension( OR = 8. 6) . Conclusion According to the patient’s organism and rebleeding risk factors,EVL combined with non selective β-receptor blocker which has reduced rebleeding and complication rate can prolong the life of patients.

目的探讨芬太尼伍用丙泊酚在清醒状态下经无痛胃镜植入带膜镍钛记忆合金支架治疗晚期食管癌的疗效及安全性。方法本组32例经胃镜检查,病理细胞学证实为晚期食管恶性肿瘤,予以枸橼酸芬太尼0.8～1μg/kg,30s静脉注入,然后丙泊酚1mg/kg缓慢静脉注入,2min后进入清醒无痛状态。行胃镜下植入带膜镍钛记忆合金支架。观察术前、术中、术后平均动脉压、心率、血氧饱和度,有无麻醉意外,食管大出血、穿孔并发症;治疗术前、术后经食管钡餐对比管腔直径,狭窄程度按Stnoler分级法,统计满意度(有无畏惧心理、痛苦的感觉、是否可接受再次同样的治疗)。结果 32例均成功,术前、术中、术后平均动脉压、心率、血氧饱和度比较差异无统计学意义(P>0.05),无1例发生麻醉意外,术后均有不同程度胸痛,但无食管大出血、穿孔并发症;治疗术前狭窄管腔直径约(4±3)mm,术后直径约(12±1)mm,术后6h顺利进食,有效率及满意度100%。结论亚剂量芬太尼伍用小剂量丙泊酚在清醒状态下经无痛胃镜植入带膜镍钛记忆合金支架治疗晚期食管癌是安全,有效的姑息方法,可减轻患者术中痛苦、解决进食,值得推广应用。

>患者男,60岁,1周前因"不能进食,自行采用自制铁质扩张条插入食管后出现咳嗽、咳痰、呼吸困难"收治入院。患者2年前因发现食管癌(病理证实为鳞癌Ⅲ级)曾在我院胸外科行食管癌根治术,术后2个月因吻合口狭窄在我院行探条扩张术,此后2个月因吻合口狭窄放置6 cm食管内支架(支架位于距门齿19～25 cm处),再此后3个月因肿瘤复发堵塞食管支架上口再次置入4 cm支架(支架位于距门齿17～21 cm处),入院前1年因肿瘤再次堵塞颈段食管支架

Objective: To investigate the diagnosis and therapy of repiratory tract foreign body foreinfants. Method: Retrospective analysis of diagnosis and treatment was made in 30 cases of infants’ respiratory foreign body for last 4 years. Result: From 6 months to 5 years of age ( male:female = 2.3:1), 24 cases were vegetality foreign body ( 80%), 3 cases were chemical foreign body ( 10%) and 3 cases were animal foreign body ( 10%) whose operations were performed by trachea cannula and artifical ventilation under bronechoscope. Rate of success was 100% and there were no asphyxia and cardiopulmonary arrest complication. Conclusion: For infants under 5 years of age, especially under 3 years old, it is necessary to perform operation by trachea cannula and artificial ventilation under bronechoscope for respiratory foreign body because it can supply abundant oxygen and good respiratory situation. It can also shorten the time of examination and treatment and avoid glottial edema, asphyxia and cardiopulmonary arrest complication.