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Endoloop-assisted polypectomy for large pedunculated colorectal

Endoloop-assisted polypectomy for large pedunculated colorectal
Endoloop-assisted polypectomy for large pedunculated colorectal

Endoloop-assisted polypectomy for large pedunculated colorectal polyps

P.Katsinelos,1J.Kountouras,2G.Paroutoglou,1A.Beltsis,1G.Chatzimavroudis,3C.Zavos,2I.Vasiliadis,1 T.Katsinelos,1B.Papaziogas3

1Department of Endoscopy and Motility Unit,Central Hospital,Ethnikis Aminis41,54635Thessaloniki,Greece

2Second Medical Clinic,Aristotle University of Thessaloniki,Ippokration Hospital,Thessaloniki,Greece

3Second Surgical Clinic,Aristotle University of Thessaloniki,Thessaloniki,Greece

Received:19October2005/Accepted:14March2006/Online publication:20July2006

Abstract

Background:The use of an endoloop may minimize the risk for bleeding after endoscopic polypectomy of large colorectal polyps.This study aimed to assess the safety and e?cacy of colonoscopic ligation of the stalk of large pedunculated polyps by means of an endoloop tech-nique,and to focus particular attention on the instances in which the use of this device was unsuccessful. Methods:This study retrospectively evaluated attempted endoloop endoscopic polypectomy in33patients (19men and14women;mean age,62.5years)with large pedunculated polyps.

Results:Application of the endoloop was impossible in four patients,and the snare became entangled with the loop in one patient.The remaining28patients under-went endoloop-assisted polypectomy.Bleeding occurred in four patients,either because the loop slipped of the stalk after polypectomy(2patients)or because a thin stalk(£4mm)was transected by the loop before polypectomy(2patients).

Conclusion:Colonoscopic polypectomy with an endo-loop may be safer than conventional polypectomy.The reasons for technical failure of this technique include a narrow left colon lumen,a thin stalk(£4mm),and close cutting in relation to the site of encirclement by the loop.

Key words:Colonoscopic ligation—Endoloop-as-sisted polypectomy—Large colorectal polyps—Large pedunculated polyps

Postpolypectomy bleeding is reported to occur in2%of all polypectomies.The risk of bleeding probably is greater with large polyps that have thick stalks[1–3]. The other important complications,namely,postpo-lypectomy coagulation syndrome(0.5–1%)[4]and per-foration(0.5%)[5]are less common.Bleeding can occur in the immediate postpolypectomy period,or may be delayed a few days[4]or up to30days[6].

Several endoscopic techniques have been developed to prevent bleeding.Injection of the stalk with epi-nephrine solution or sclerosants before transection is recommended to diminish the risk of postpolypectomy hemorrhage.However,epinephrine injection may pre-vent only procedural bleeding,whereas sclerosant injection may increase the risk of perforation[6].

More recently,mechanical hemostatic devices,such as endoloops[7–9]and clips[3],have been introduced for the prevention of early and delayed postpolypecto-my bleeding.Although anecdotal evidence suggests that use of the endoloop is relatively widespread in specialist therapeutic endoscopy units,surprisingly,few pub-lished studies have described the experience with this device[7–9].

We report our experience with the use of endoloops for colonoscopic resection of large pedunculated polyps in the current series,drawing particular attention to those instances in which endoloop application was ine?ective.

Patients and methods

This study reviewed patients in whom an endoloop-assisted polypec-tomy for colorectal polyps was attempted between October1999and September2005.A total of33patients(19men and14women;mean age,62.5years;range,41–87years)with large pedunculated polyps were included in the study.

The patients were treated in our department,which serves as a tertiary referral center for northern Greece.All the patients were identi?ed by colonoscopy performed in our department,by colleagues in other hospitals,or by private gastroenterologists.The ethics com-mittee of our hospital approved the initiation of this technique,and written informed consent was obtained from all the patients after

Correspondence to:P.

Katsinelos

Surg Endosc(2006)20:1257–1261

DOI:10.1007/s00464-005-0713-5

óSpringer Science+Business Media,Inc.2006

explanations detailing the risks and bene?ts of an endoloop-assisted or conventional polypectomy.

The inclusion criteria required the following:

?Pedunculated polyp in the colorectum with a head at least 10mm in diameter.Because there is a tendency to either overestimate or underestimate the polyp size at colonoscopy by almost one-third,even when using biopsy forceps for comparison,we used the absolute size of the polyps head and stalk,measured at its retrieval after the resection.

?Endoscopist determination that pedunculated polyp was benign in appearance and not ulcerated or indurated.

Endoscopic technique

After careful preparatory cleansing of the bowel using a polyethylene glucol-electrolyte solution,all colonoscopies were performed using a standard video colonoscope with the patient under conscious sedation by administration of midazolam and meperidine.When necessary,hyoscine-n-butylbromide was administered intravenously for colon relaxation,unless contraindicated,in which case,glucagon was intro-duced intravenously.

To minimize the degree of variability in polypectomy technique,all resections were performed by one of two experienced endoscopists (P.K.and G.P.).

A detachable endoloop system is composed of an operating part and an attached loop (Fig.1).The operating part consists of a Te?on sheath 2.5mm in diameter and 195cm in working length,a stainless steel coil sheath 1.9mm in diameter,a hook wire,and a handle.En-doloops are currently available in diameters of 20and 30mm (MAJ-340and MAJ-254;Olympus,Tokyo,Japan).The larger loop can be opened to a size of 50·30mm.Moreover,the attached loop sloughs in 4to 7days.Endoloops are nonconductive and consist of a heat-treated elliptically shaped soft Te?on ring and a silicon rubber stopper that maintains the tightness of the loop.

Before use,the loop is retracted inside the plastic sheath for insertion through the accessory channel of the colonoscope.We prefer using a large-channel therapeutic endoscope that provides adequate suction alongside the inserted snare.

We maneuvered the scope so that the polyp was visualized at the 6o ?clock position on the video screen (Fig.2).A second assistant often was needed to hold the scope at the correct position.Patient moni-toring during colonoscopy and polypectomy included pulse oximetry.

After the loop had been extended and applied at the base of the stalk,it was tightened around the stalk by sliding the stopper,then detached from the operating part (Fig.3).To ensure su?cient tight-ening,we observed the color of the polyp head changing to dark red after ligation.A diathermic snare then was used to sever the stalk of the polyp above the tightened loop using electrosurgical coagulation current (20–30W;PSD-30;Olympus)(Fig.4).

After polypectomy,the polyp was captured with a basket catheter and gently extracted through the anus.The maximum diameter of the head and the stalk of the polyp was measured and recorded,then submitted for histologic evaluation.

Unless hematochezia occurred,the patients left the hospital after colonoscopic polypectomy.If hematochezia occurred,the patients

were hospitalized until hematochezia ceased and blood tests (hemo-globin–hematocrit)became stable.

Histologic examination

The polyps were pinned on a plate,?xed with 10%formalin,sliced into parallel sections,and stained with hematoxylin and eosin for histopa-thologic examination.Two experienced pathologists examined the sections.If cancer was detected,the decision to pursue a more aggres-sive treatment was based on the histologic features of the cancer,the distance from the resection margins,and the level of cancer invasion into the stalk of the polyp.In general,pedunculated polyps with car-cinoma invading the head neck or stalk require no further treatment,provided that the resection margins are free of cancer,the histology is well or moderately di?erentiated,and there is no lymphatic or vascular invasion.Polyps with carcinoma invading the submucosa carry a sig-ni?cant risk of lymph node metastases,and in such cases,patients were considered as candidates for additional radical surgery.If the patients refused operation,they were followed along with the other patients.

Complications

Polypectomy-induced bleeding was de?ned as intraprocedural (during polypectomy),early (within 24h),or delayed (>24h).The

diagnosis

Fig.1.An endoloop for endoscopic polypectomy of large peduncu-lated

polyps.

Fig.2.A large pedunculated polyp with a thick

stalk.

Fig.3.The endoloop has been tightened at the base of the stalk.1258

of early or delayed bleeding was based on the passage of fresh blood per rectum.If necessary,bleeding was controlled by hemoclip place-ment or heater probe treatment.Postcoagulation syndrome,caused by transmural thermal injury with resultant serosal in?ammation,was evaluated.This syndrome is characterized by localized abdominal pain,occasionally with fever.Perforation was de?ned as abdominal pain with fever,leucocytosis,and the presence of free air inside the abdominal cavity.

Follow-up evaluation

At discharge from the hospital,the patients and their relatives were instructed to contact the endoscopic team in case of any adverse event.To monitor complications,patients were contacted by telephone at the end of the ?rst and second week after the procedure and advised to undergo surveillance at 6months.

Results

In 4of the 33patients,application of the endoloop was not possible because of a narrow sigmoid colon lumen and polyp head size.These polyps were treated with piecemeal resection after injection of the stalk with 50%dextrose plus epinephrine (1:10000)solution.In another patient,the polypectomy snare became entangled with the endoloop in a way precluding transection of the peduncle,and the polyp was excised with piecemeal resection.These ?ve patients were excluded from the study.

In the remaining 28patients,the endoloop was correctly placed,and cutting of the polyp head was possible.The characteristics of the 28polyps are sum-marized in Table 1,and the outcome is depicted in Fig.5.The mean duration of the procedure was 17.8min (range,11–27min).The polyp head was 20mm or larger in 21lesions (63.8%),the largest being 28mm.The diameter of the stalk was 5mm or larger in 23lesions (89.1%),the largest being 7.1mm.

Intraprocedural bleeding occurred in two patients because the thin stalk (£4mm)was transected with the

tightening of the endoloop.In both cases,hypertonic dextrose 50%plus epinephrine (1:10000)solution was injected initially around the residual stalk followed by placement of three and four clips (HX-6UR-1;Olympus)on the stalks,respectively.

In two other patients,the endoloop slipped o?after polypectomy and showed delayed bleeding:the one patient on day 6and the other on day 7.They both were treated with hemoclipping.

In the ?ve cases of carcinoma,the cancer was limited to the mucosal layer in four lesions,whereas the depth of invasion was submucosal in the ?fth patient.In this patient,a subsequent colectomy with lymph node dis-section was performed because of possible lymph node metastases.Follow-up evaluation was available for a median of 32.4months (range,3–68months).Follow-up endoscopy was performed for 27patients.No recurrence of polyp nor appearance of cancer was observed.

Discussion

Postpolypectomy hemorrhage frequently is an unpre-dictable event that creates great anxiety and,like all complications,is best avoided.Bleeding after

colono-

Fig.4.After polypectomy the endoloop is left in place with no bleeding at the resection site.

Table 1.Characteristics of 28large pedunculated polyps removed by endoloop-assisted polypectomy Characteristics

Polyps Location

Descending colon 6Sigmoid colon 20Rectum

2

Mean size (mm)Head:n (range)17.8(11–26)Stalk:n (range) 5.4(3.8–7.1)Histology

Tubular adenoma 23Adenocarcinoma 5Complications

Intraprocedural bleeding 2Delayed bleeding 2Perforation

0Postcoagulation syndrome

Fig.5.Outcome of endoloop-attempted polypectomy of 33large pedunculated polyps.

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scopic polypectomy has been reported in0.3%to6.1% of cases,depending on the numbers of patients and the types of resected polyps studied[10].It is encountered mainly with removal of pedunculated polyps because of a large artery in the stalk[10,11].In earlier studies, bleeding usually occurred immediately after snaring, whereas in more recent reports,delayed hemorrhage accounts for about65%of postpolypectomy bleeding, and may occur as long as3to4weeks after polypec-tomy,although it most often occurs within the?rst24h. This is possibly attributable to the change from blended to coagulation current[12].

New strategies aimed at preventing bleeding after polypectomy include the endoloop technique,?rst introduced by Pontecorvo and Pesce[13]and developed by Hachisu[14],for endoscopic ligation of the stalk of large pedunculated polyps.Moreover,a signi?cant advantage of using loop ligation for large pedunculated polyps with a thick stalk is the ability to use greater electrosurgical generator power,including cutting or blended current for polypectomy,without fear of precipitating hemorrhage.

Despite the evidence that the endoloop is widely used prophylactically for polypectomy of large pedunculated polyps in therapeutic endoscopic practice,a literature search yielded only a few published reports on the use of this technique[7–9,15–22].However,the endoloop technique is very useful for removal of large pedunculated lesions[19].

Rey and Marek[7],in their preliminary results from the use of endoloop for prevention of postpolypectomy bleeding in15patients with large pedunculated polyps, reported no blood?ow immediately after polypectomy, and no delayed bleeding at a1-month follow-up assessment.In a randomized trial of endoloop applica-tion involving89patients with pedunculated colorectal polyps1cm in diameter,postpolypectomy bleeding occurred in none of the47patients assigned to the en-doloop arm,and in only5of the42patients(12%)in the control group(1immediate and4delayed).Moreover, the use of an endoloop reduced the duration of hospitalization after polypectomy[8].

Matsushita et al.[9]reported their experience using the endoloop for colonoscopic polypectomy of20large pedunculated polyps.In three patients,the loop slipped o?after polypectomy because the polyps were cut close to the site of encirclement,but no bleeding ensued. Bleeding occurred in four cases because the loop tran-sected the4-mm-thick stalk(1case),because the loop slipped(1case),and because the loop was insu?ciently tightened(2cases).A few case reports described use of the endoloop for other gastointestinal polyps including a large juvenile polyp[17],a submucosal colonic lym-phangioma[20],large colonic lipomas[18,21],and bleeding mesenteric vessels[22].

Our study is the second largest in the number of patients with large pedunculated polyps for whom the endoloop was used to ligate the stalk prophylactically before resection.One important point of the current series is that it showed the advantages and disadvan-tages of the device.In four patients,the polyps were located in the sigmoid colon with a narrow lumen be-cause of diverticulosis,making application of the en-doloop impossible.These polyps were excised with piecemeal polypectomy after injection of50%dextrose plus epinephrine(1:10000)solution in the stalk.This appears to be a safe and practical technique for endoscopic resection of large sessile colorectal polyps [23].

In contrast to the conventional metal snare,endo-loops have limited expansible force and sti?ness because of their thin nylon composition.Therefore,it may be challenging to place the endoloop in circumstances o?ering limited space for it to open fully,either due to the large size of the target lesion or due to the narrow luminal diameter.This problem is rarely encountered in the right colon,but can cause signi?cant technical dif-?culty in the left colon,particularly in the setting of severely stenotic diverticular disease.When the endo-loop cannot be maneuvered over the polyp,then,before polypectomy,we recommend either injection of dilute epinephrine(1:10000)plus dextrose50%into the stalk or clipping of the stalk with long clips to diminish the risk of bleeding.

In two patients,the stalks(£4mm)were transected when the endoloop was fully tightened.We believe that pedunculated polyps with thin stalks(£4mm)are a contraindication for this technique,whereas peduncu-lated polyps with stalks5mm or thicker are well-suited https://www.wendangku.net/doc/3f17664546.html,parable conclusions also have been reported by others[9].

In two of our patients,the endoloop slipped o?after polypectomy,with delayed bleeding occurring on days6and7,respectively.These bleeding events coincided with the fact that the attached loop usually sloughs in4to7days.The bleeding was successfully treated with the application of clips.For safe transec-tion of large pedunculated polyps,an adequate dis-tance from the ligated loop must be kept during cutting to avoid slippage of the loop.We also treated one patient in whom the polypectomy snare became entangled with the endoloop in a way that precluded transection of the peduncle.The polyp?s head was ex-cised by piecemeal resection.

Considering the aforementioned?ndings,the fol-lowing conclusions can be drawn about avoiding post-polypectomy bleeding by means of an endoloop technique.The type of lesion chosen for endoloop application appears to be essential.Furthermore, underlying colonic disease and polyps with extremely thin stalks and semipedunculated lesions are inappro-priate for endoloop placement.If the peduncle is4mm or less in diameter,it can be transected by a su?ciently tightened loop.It is doubtful that a loop is useful in this situation.Moreover,for broad semipedunculated le-sions,closure of the loop beneath the planned resection margin may not be possible.

In summary,the results of this study suggest that although colonoscopic resection of large pedunculated polyps using an endoloop is safe and e?ective,the problems encountered with this method show some of the limitations encountered with endoscopic therapy in preventing postpolypectomy bleeding when currently available instruments are used.

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to与for的用法和区别

to与for的用法和区别 一般情况下, to后面常接对象; for后面表示原因与目的为多。 Thank you for helping me. Thanks to all of you. to sb.表示对某人有直接影响比如,食物对某人好或者不好就用to; for表示从意义、价值等间接角度来说,例如对某人而言是重要的,就用for. for和to这两个介词,意义丰富,用法复杂。这里仅就它们主要用法进行比较。 1. 表示各种“目的” 1. What do you study English for? 你为什么要学英语? 2. She went to france for holiday. 她到法国度假去了。 3. These books are written for pupils. 这些书是为学生些的。 4. hope for the best, prepare for the worst. 作最好的打算,作最坏的准备。 2.对于 1.She has a liking for painting. 她爱好绘画。 2.She had a natural gift for teaching. 她对教学有天赋/ 3.表示赞成同情,用for不用to. 1. Are you for the idea or against it? 你是支持还是反对这个想法? 2. He expresses sympathy for the common people.. 他表现了对普通老百姓的同情。 3. I felt deeply sorry for my friend who was very ill. 4 for表示因为,由于(常有较活译法) 1 Thank you for coming. 谢谢你来。 2. France is famous for its wines. 法国因酒而出名。 5.当事人对某事的主观看法,对于(某人),对…来说(多和形容词连用)用介词to,不用for.. He said that money was not important to him. 他说钱对他并不重要。 To her it was rather unusual. 对她来说这是相当不寻常的。 They are cruel to animals. 他们对动物很残忍。 6.for和fit, good, bad, useful, suitable 等形容词连用,表示适宜,适合。 Some training will make them fit for the job. 经过一段训练,他们会胜任这项工作的。 Exercises are good for health. 锻炼有益于健康。 Smoking and drinking are bad for health. 抽烟喝酒对健康有害。 You are not suited for the kind of work you are doing. 7. for表示不定式逻辑上的主语,可以用在主语、表语、状语、定语中。 1.It would be best for you to write to him. 2.The simple thing is for him to resign at once. 3.There was nowhere else for me to go. 4.He opened a door and stood aside for her to pass.

初中语文古文赏析曹操《短歌行》赏析(林庚)

教育资料 《短歌行》 《短歌行》赏析(林庚) 曹操这一首《短歌行》是建安时代杰出的名作,它代表着人生的两面,一方面是人生的忧患,一方面是人生的欢乐。而所谓两面也就是人生的全面。整个的人生中自然含有一个生活的态度,这就具体地表现在成为《楚辞》与《诗经》传统的产儿。它一方面不失为《楚辞》中永恒的追求,一方面不失为一个平实的生活表现,因而也就为建安诗坛铺平了道路。 这首诗从“对酒当歌,人生几何”到“但为君故,沉吟至今”,充分表现着《楚辞》里的哀怨。一方面是人生的无常,一方面是永恒的渴望。而“呦呦鹿鸣”以下四句却是尽情的欢乐。你不晓得何以由哀怨这一端忽然会走到欢乐那一端去,转折得天衣无缝,仿佛本来就该是这么一回事似的。这才是真正的人生的感受。这一段如是,下一段也如是。“明明如月,何时可掇?忧从中来,不可断绝。越陌度阡,枉用相存。契阔谈宴,心念旧恩。月明星稀,乌鹊南飞。绕树三匝,何枝可依。”缠绵的情调,把你又带回更深的哀怨中去。但“山不厌高,海不厌深”,终于走入“周公吐哺,天下归心”的结论。上下两段是一个章法,但是你并不觉得重复,你只觉得卷在悲哀与欢乐的旋涡中,不知道什么时候悲哀没有了,变成欢乐,也不知道什么时候欢乐没有了,又变成悲哀,这岂不是一个整个的人生吗?把整个的人生表现在一个刹那的感觉上,又都归于一个最实在的生活上。“我有嘉宾,鼓瑟吹笙”,不正是当时的情景吗?“周公吐哺,天下归心”,不正是当时的信心吗? “青青子衿”到“鼓瑟吹笙”两段连贯之妙,古今无二。《诗经》中现成的句法一变而有了《楚辞》的精神,全在“沉吟至今”的点窜,那是“青青子衿”的更深的解释,《诗经》与《楚辞》因此才有了更深的默契,从《楚辞》又回到《诗经》,这样与《鹿鸣》之诗乃打成一片,这是一个完满的行程,也便是人生旅程的意义。“月明星稀”何以会变成“山不厌高,海不厌深”?几乎更不可解。莫非由于“明月出天山”,“海上生明月”吗?古辞说:“枯桑知天风,海水知天寒”,枯桑何以知天风,因为它高;海水何以知天寒,因为它深。唐人诗“一叶落知天下秋”,我们对于宇宙万有正应该有一个“知”字。然则既然是山,岂可不高?既然是海,岂可不深呢?“并刀如水,吴盐胜雪”,既是刀,就应该雪亮;既是盐,就应该雪白,那么就不必问山与海了。 山海之情,成为漫漫旅程的归宿,这不但是乌鹊南飞,且成为人生的思慕。山既尽其高,海既尽其深。人在其中乃有一颗赤子的心。孟子主尽性,因此养成他浩然之气。天下所以归心,我们乃不觉得是一个夸张。 .

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For的用法 1. 表示“当作、作为”。如: I like some bread and milk for breakfast. 我喜欢把面包和牛奶作为早餐。 What will we have for supper? 我们晚餐吃什么? 2. 表示理由或原因,意为“因为、由于”。如: Thank you for helping me with my English. 谢谢你帮我学习英语。 3. 表示动作的对象或接受者,意为“给……”、“对…… (而言)”。如: Let me pick it up for you. 让我为你捡起来。 Watching TV too much is bad for your health. 看电视太多有害于你的健康。 4. 表示时间、距离,意为“计、达”。如: I usually do the running for an hour in the morning. 我早晨通常跑步一小时。 We will stay there for two days. 我们将在那里逗留两天。 5. 表示去向、目的,意为“向、往、取、买”等。如: Let’s go for a walk. 我们出去散步吧。 I came here for my schoolbag.我来这儿取书包。 I paid twenty yuan for the dictionary. 我花了20元买这本词典。 6. 表示所属关系或用途,意为“为、适于……的”。如: It’s time for school. 到上学的时间了。 Here is a letter for you. 这儿有你的一封信。 7. 表示“支持、赞成”。如: Are you for this plan or against it? 你是支持还是反对这个计划? 8. 用于一些固定搭配中。如: Who are you waiting for? 你在等谁? For example, Mr Green is a kind teacher. 比如,格林先生是一位心地善良的老师。 尽管for 的用法较多,但记住常用的几个就可以了。 to的用法: 一:表示相对,针对 be strange (common, new, familiar, peculiar) to This injection will make you immune to infection. 二:表示对比,比较 1:以-ior结尾的形容词,后接介词to表示比较,如:superior ,inferior,prior,senior,junior 2: 一些本身就含有比较或比拟意思的形容词,如equal,similar,equivalent,analogous A is similar to B in many ways.

曹操《短歌行》其二翻译及赏析

曹操《短歌行》其二翻译及赏析 引导语:曹操(155—220),字孟德,小名阿瞒,《短歌行 二首》 是曹操以乐府古题创作的两首诗, 第一首诗表达了作者求贤若渴的心 态,第二首诗主要是曹操向内外臣僚及天下表明心迹。 短歌行 其二 曹操 周西伯昌,怀此圣德。 三分天下,而有其二。 修奉贡献,臣节不隆。 崇侯谗之,是以拘系。 后见赦原,赐之斧钺,得使征伐。 为仲尼所称,达及德行, 犹奉事殷,论叙其美。 齐桓之功,为霸之首。 九合诸侯,一匡天下。 一匡天下,不以兵车。 正而不谲,其德传称。 孔子所叹,并称夷吾,民受其恩。 赐与庙胙,命无下拜。 小白不敢尔,天威在颜咫尺。 晋文亦霸,躬奉天王。 受赐圭瓒,钜鬯彤弓, 卢弓矢千,虎贲三百人。 威服诸侯,师之所尊。 八方闻之,名亚齐桓。 翻译 姬昌受封为西伯,具有神智和美德。殷朝土地为三份,他有其中两分。 整治贡品来进奉,不失臣子的职责。只因为崇侯进谗言,而受冤拘禁。 后因为送礼而赦免, 受赐斧钺征伐的权利。 他被孔丘称赞, 品德高尚地位显。 始终臣服殷朝帝王,美名后世流传遍。齐桓公拥周建立功业,存亡继绝为霸 首。

聚合诸侯捍卫中原,匡正天下功业千秋。号令诸侯以匡周室,主要靠的不是 武力。 行为磊落不欺诈,美德流传于身后。孔子赞美齐桓公,也称赞管仲。 百姓深受恩惠,天子赐肉与桓公,命其无拜来接受。桓公称小白不敢,天子 威严就在咫尺前。 晋文公继承来称霸,亲身尊奉周天王。周天子赏赐丰厚,仪式隆重。 接受玉器和美酒,弓矢武士三百名。晋文公声望镇诸侯,从其风者受尊重。 威名八方全传遍,名声仅次于齐桓公。佯称周王巡狩,招其天子到河阳,因 此大众议论纷纷。 赏析 《短歌行》 (“周西伯昌”)主要是曹操向内外臣僚及天下表明心 迹,当他翦灭群凶之际,功高震主之时,正所谓“君子终日乾乾,夕惕若 厉”者,但东吴孙权却瞅准时机竟上表大说天命而称臣,意在促曹操代汉 而使其失去“挟天子以令诸侯”之号召, 故曹操机敏地认识到“ 是儿欲据吾著炉上郁!”故曹操运筹谋略而赋此《短歌行 ·周西伯 昌》。 西伯姬昌在纣朝三分天下有其二的大好形势下, 犹能奉事殷纣, 故孔子盛称 “周之德, 其可谓至德也已矣。 ”但纣王亲信崇侯虎仍不免在纣王前 还要谗毁文王,并拘系于羑里。曹操举此史实,意在表明自己正在克心效法先圣 西伯姬昌,并肯定他的所作所为,谨慎惕惧,向来无愧于献帝之所赏。 并大谈西伯姬昌、齐桓公、晋文公皆曾受命“专使征伐”。而当 今天下时势与当年的西伯、齐桓、晋文之际颇相类似,天子如命他“专使 征伐”以讨不臣,乃英明之举。但他亦效西伯之德,重齐桓之功,戒晋文 之诈。然故作谦恭之辞耳,又谁知岂无更讨封赏之意乎 ?不然建安十八年(公元 213 年)五月献帝下诏曰《册魏公九锡文》,其文曰“朕闻先王并建明德, 胙之以土,分之以民,崇其宠章,备其礼物,所以藩卫王室、左右厥世也。其在 周成,管、蔡不静,惩难念功,乃使邵康公赐齐太公履,东至于海,西至于河, 南至于穆陵,北至于无棣,五侯九伯,实得征之。 世祚太师,以表东海。爰及襄王,亦有楚人不供王职,又命晋文登为侯伯, 锡以二辂、虎贲、斧钺、禾巨 鬯、弓矢,大启南阳,世作盟主。故周室之不坏, 系二国是赖。”又“今以冀州之河东、河内、魏郡、赵国、中山、常 山,巨鹿、安平、甘陵、平原凡十郡,封君为魏公。锡君玄土,苴以白茅,爰契 尔龟。”又“加君九锡,其敬听朕命。” 观汉献帝下诏《册魏公九锡文》全篇,尽叙其功,以为其功高于伊、周,而 其奖却低于齐、晋,故赐爵赐土,又加九锡,奖励空前。但曹操被奖愈高,心内 愈忧。故曹操在曾早在五十六岁写的《让县自明本志令》中谓“或者人见 孤强盛, 又性不信天命之事, 恐私心相评, 言有不逊之志, 妄相忖度, 每用耿耿。

2008年浙师大《外国文学名著鉴赏》期末考试答案

(一)文学常识 一、古希腊罗马 1.(1)宙斯(罗马神话称为朱庇特),希腊神话中最高的天神,掌管雷电云雨,是人和神的主宰。 (2)阿波罗,希腊神话中宙斯的儿子,主管光明、青春、音乐、诗歌等,常以手持弓箭的少年形象出现。 (3)雅典那,希腊神话中的智慧女神,雅典城邦的保护神。 (4)潘多拉,希腊神话中的第一个女人,貌美性诈。私自打开了宙斯送她的一只盒子,里面装的疾病、疯狂、罪恶、嫉妒等祸患,一齐飞出,只有希望留在盒底,人间因此充满灾难。“潘多拉的盒子”成为“祸灾的来源”的同义语。 (5)普罗米修斯,希腊神话中造福人间的神。盗取天火带到人间,并传授给人类多种手艺,触怒宙斯,被锁在高加索山崖,受神鹰啄食,是一个反抗强暴、不惜为人类牺牲一切的英雄。 (6)斯芬克司,希腊神话中的狮身女怪。常叫过路行人猜谜,猜不出即将行人杀害;后因谜底被俄底浦斯道破,即自杀。后常喻“谜”一样的人物。与埃及狮身人面像同名。 2.荷马,古希腊盲诗人。主要作品有《伊利亚特》和《奥德赛》,被称为荷马史诗。《伊利亚特》叙述十年特洛伊战争。《奥德赛》写特洛伊战争结束后,希腊英雄奥德赛历险回乡的故事。马克思称赞它“显示出永久的魅力”。 3.埃斯库罗斯,古希腊悲剧之父,代表作《被缚的普罗米修斯》。6.阿里斯托芬,古希腊“喜剧之父”代表作《阿卡奈人》。 4.索福克勒斯,古希腊重要悲剧作家,代表作《俄狄浦斯王》。5.欧里庇得斯,古希腊重要悲剧作家,代表作《美狄亚》。 二、中世纪文学 但丁,意大利人,伟大诗人,文艺复兴的先驱。恩格斯称他是“中世纪的最后一位诗人,同时又是新时代的最初一位诗人”。主要作品有叙事长诗《神曲》,由地狱、炼狱、天堂三部分组成。《神曲》以幻想形式,写但丁迷路,被人导引神游三界。在地狱中见到贪官污吏等受着惩罚,在净界中见到贪色贪财等较轻罪人,在天堂里见到殉道者等高贵的灵魂。 三、文艺复兴时期 1.薄迦丘意大利人短篇小说家,著有《十日谈》拉伯雷,法国人,著《巨人传》塞万提斯,西班牙人,著《堂?吉诃德》。 2.莎士比亚,16-17世纪文艺复兴时期英国伟大的剧作家和诗人,主要作品有四大悲剧——《哈姆雷特》、《奥赛罗》《麦克白》、《李尔王》,另有悲剧《罗密欧与朱丽叶》等,喜剧有《威尼斯商人》《第十二夜》《皆大欢喜》等,历史剧有《理查二世》、《亨利四世》等。马克思称之为“人类最伟大的戏剧天才”。 四、17世纪古典主义 9.笛福,17-18世纪英国著名小说家,被誉为“英国和欧洲小说之父”,主要作品《鲁滨逊漂流记》,是英国第一部现实主义长篇小说。10.弥尔顿,17世纪英国诗人,代表作:长诗《失乐园》,《失乐园》,表现了资产阶级清教徒的革命理想和英雄气概。 25.拉伯雷,16世纪法国作家,代表作:长篇小说《巨人传》。 26.莫里哀,法国17世纪古典主义文学最重要的作家,法国古典主义喜剧的创建者,主要作品为《伪君子》《悭吝人》(主人公叫阿巴公)等喜剧。 五、18世纪启蒙运动 1)歌德,德国文学最高成就的代表者。主要作品有书信体小说《少年维特之烦恼》,诗剧《浮士德》。 11.斯威夫特,18世纪英国作家,代表作:《格列佛游记》,以荒诞的情节讽刺了英国现实。 12.亨利·菲尔丁,18世纪英国作家,代表作:《汤姆·琼斯》。 六、19世纪浪漫主义 (1拜伦, 19世纪初期英国伟大的浪漫主义诗人,代表作为诗体小说《唐璜》通过青年贵族唐璜的种种经历,抨击欧洲反动的封建势力。《恰尔德。哈洛尔游记》 (2雨果,伟大作家,欧洲19世纪浪漫主义文学最卓越的代表。主要作品有长篇小说《巴黎圣母院》、《悲惨世界》、《笑面人》、《九三年》等。《悲惨世界》写的是失业短工冉阿让因偷吃一片面包被抓进监狱,后改名换姓,当上企业主和市长,但终不能摆脱迫害的故事。《巴黎圣母院》 弃儿伽西莫多,在一个偶然的场合被副主教克洛德.孚罗洛收养为义子,长大后有让他当上了巴黎圣母院的敲钟人。他虽然十分丑陋而且有多种残疾,心灵却异常高尚纯洁。 长年流浪街头的波希米亚姑娘拉.爱斯梅拉达,能歌善舞,天真貌美而心地淳厚。青年贫诗人尔比埃尔.甘果瓦偶然同她相遇,并在一个更偶然的场合成了她名义上的丈夫。很有名望的副教主本来一向专心于"圣职",忽然有一天欣赏到波希米亚姑娘的歌舞,忧千方百计要把她据为己有,对她进行了种种威胁甚至陷害,同时还为此不惜玩弄卑鄙手段,去欺骗利用他的义子伽西莫多和学生甘果瓦。眼看无论如何也实现不了占有爱斯梅拉达的罪恶企图,最后竟亲手把那可爱的少女送上了绞刑架。 另一方面,伽西莫多私下也爱慕着波希米亚姑娘。她遭到陷害,被伽西莫多巧计救出,在圣母院一间密室里避难,敲钟人用十分纯朴和真诚的感情去安慰她,保护她。当她再次处于危急中时,敲钟人为了援助她,表现出非凡的英勇和机智。而当他无意中发现自己的"义父"和"恩人"远望着高挂在绞刑架上的波希米亚姑娘而发出恶魔般的狞笑时,伽西莫多立即对那个伪善者下了最后的判决,亲手把克洛德.孚罗洛从高耸入云的钟塔上推下,使他摔的粉身碎骨。 (3司汤达,批判现实主义作家。代表作《红与黑》,写的是不满封建制度的平民青年于连,千方百计向上爬,最终被送上断头台的故事。“红”是将军服色,指“入军界”的道路;“黑”是主教服色,指当神父、主教的道路。 14.雪莱,19世纪积极浪漫主义诗人,欧洲文学史上最早歌颂空想社会主义的诗人之一,主要作品为诗剧《解放了的普罗米修斯》,抒情诗《西风颂》等。 15.托马斯·哈代,19世纪英国作家,代表作:长篇小说《德伯家的苔丝》。 16.萨克雷,19世纪英国作家,代表作:《名利场》 17.盖斯凯尔夫人,19世纪英国作家,代表作:《玛丽·巴顿》。 18.夏洛蒂?勃朗特,19世纪英国女作家,代表作:长篇小说《简?爱》19艾米丽?勃朗特,19世纪英国女作家,夏洛蒂?勃朗特之妹,代表作:长篇小说《呼啸山庄》。 20.狄更斯,19世纪英国批判现实主义文学的重要代表,主要作品为长篇小说《大卫?科波菲尔》、《艰难时世》《双城记》《雾都孤儿》。21.柯南道尔,19世纪英国著名侦探小说家,代表作品侦探小说集《福尔摩斯探案》是世界上最著名的侦探小说。 七、19世纪现实主义 1、巴尔扎克,19世纪上半叶法国和欧洲批判现实主义文学的杰出代表。主要作品有《人间喜剧》,包括《高老头》、《欧也妮·葛朗台》、《贝姨》、《邦斯舅舅》等。《人间喜剧》是世界文学中规模最宏伟的创作之一,也是人类思维劳动最辉煌的成果之一。马克思称其“提供了一部法国社会特别是巴黎上流社会的卓越的现实主义历史”。

for和to区别

1.表示各种“目的”,用for (1)What do you study English for 你为什么要学英语? (2)went to france for holiday. 她到法国度假去了。 (3)These books are written for pupils. 这些书是为学生些的。 (4)hope for the best, prepare for the worst. 作最好的打算,作最坏的准备。 2.“对于”用for (1)She has a liking for painting. 她爱好绘画。 (2)She had a natural gift for teaching. 她对教学有天赋/ 3.表示“赞成、同情”,用for (1)Are you for the idea or against it 你是支持还是反对这个想法? (2)He expresses sympathy for the common people.. 他表现了对普通老百姓的同情。 (3)I felt deeply sorry for my friend who was very ill. 4. 表示“因为,由于”(常有较活译法),用for (1)Thank you for coming. 谢谢你来。

(2)France is famous for its wines. 法国因酒而出名。 5.当事人对某事的主观看法,“对于(某人),对…来说”,(多和形容词连用),用介词to,不用for. (1)He said that money was not important to him. 他说钱对他并不重要。 (2)To her it was rather unusual. 对她来说这是相当不寻常的。 (3)They are cruel to animals. 他们对动物很残忍。 6.和fit, good, bad, useful, suitable 等形容词连用,表示“适宜,适合”,用for。(1)Some training will make them fit for the job. 经过一段训练,他们会胜任这项工作的。 (2)Exercises are good for health. 锻炼有益于健康。 (3)Smoking and drinking are bad for health. 抽烟喝酒对健康有害。 (4)You are not suited for the kind of work you are doing. 7. 表示不定式逻辑上的主语,可以用在主语、表语、状语、定语中。 (1)It would be best for you to write to him. (2) The simple thing is for him to resign at once.

外国名著赏析论文

题目:浅析从简爱到女性的尊严和爱 学院工商学院 专业新闻学3 学号 姓名闫万里 学科外国文学名着赏析 [摘要] 十九世纪中期,英国伟大的女性存在主义先驱,着名作家夏洛蒂勃朗特创作出了她的代表作--《简爱》,当时轰动了整个文坛,它是一部具有浓厚浪漫主义色彩的现实主义小说,被认为是作者"诗意的生平"的写照。它在问世后的一百多年里,它始终保持着历史不败的艺术感染力。直到现在它的影响还继续存在。在作品的序幕、发展、高潮和结尾中,女主人公的叛逆、自由、平等、自尊、纯洁的个性都是各个重点章节的主旨,而这些主旨则在女主人公的爱情观中被展露的淋漓尽致,它们如同乌云上方的星汉,灼灼闪耀着光芒,照亮着后来的女性者们追求爱情的道路。? [关键词] 自尊个性独特新女性主义自由独立平等 《简爱》是一部带有自转色彩的长篇小说,它阐释了这样一个主题:人的价值=尊严+爱。从小就成长在一个充满暴力的环境中的简爱,经历了同龄人没有的遭遇。她要面对的是舅妈的毫无人性的虐待,表兄的凶暴专横和表姐的傲慢冷漠,尽管她尽力想“竭力赢得别人的好感”,但是事实告诉她这都是白费力气的,因此她发出了“不公平啊!--不公平!”的近乎绝望的呼喊。不公平的生长环境,使得简爱从小就向往平等、自由和爱,这些愿望在她后来的成长过程中表现无疑,

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双宾语tofor的用法

1. 两者都可以引出间接宾语,但要根据不同的动词分别选用介词to 或for: (1) 在give, pass, hand, lend, send, tell, bring, show, pay, read, return, write, offer, teach, throw 等之后接介词to。 如: 请把那本字典递给我。 正:Please hand me that dictionary. 正:Please hand that dictionary to me. 她去年教我们的音乐。 正:She taught us music last year. 正:She taught music to us last year. (2) 在buy, make, get, order, cook, sing, fetch, play, find, paint, choose,prepare, spare 等之后用介词for 。如: 他为我们唱了首英语歌。 正:He sang us an English song. 正:He sang an English song for us. 请帮我把钥匙找到。 正:Please find me the keys. 正:Please find the keys for me. 能耽搁你几分钟吗(即你能为我抽出几分钟吗)? 正:Can you spare me a few minutes? 正:Can you spare a few minutes for me? 注:有的动词由于搭配和含义的不同,用介词to 或for 都是可能的。如: do sb a favou r do a favour for sb 帮某人的忙 do sb harnn= do harm to sb 对某人有害

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短歌行赏析

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