复方硝苯地平软膏在肛门部手术后的临床应用研究

为研究复方硝苯地平软膏在肛门部手术后的临床应用效果，将166例肛门部手术后患者按随机数字表法分为3组，即治疗组（56例）、对照组（59例）和空白组（51例），分别给予复方硝苯地平软膏、消炎祛腐生肌膏、凡士林软膏换药，观察3组患者术后平均疼痛指数、排便疼痛指数、创面愈合时间、创面出血、创面水肿、肛门控便能力、心血管副作用、肛管动力学变化、肛门肌电图、住院时间等指标。结果显示，治疗组平均疼痛指数、排便疼痛指数低于对照组和空白组（P〈0．05），3组患者出血症状、肛门控便能力、住院时间差异无统计学意义（P〉0．05）。空白组创面水肿发生率高于治疗组和对照组（P〈0．05）。治疗组创面愈合时间短于对照组和空白组（P〈0．05）。肛管动力学变化：治疗组术后肛管静息压低于对照组和空白组（P〈0．05）；3组患者肛管收缩压差异无统计学意义（P〉0．05）。肛门肌电图检测：3组患者术后检测静息相及缩肛相的运动单位电位（MUP）分析显示，治疗组静息相MUP波幅（Am）、面积／波幅（Ar／Am）与对照组和空白组差异有统计学意义（P〈0．05），3组患者缩肛相MUPAm、面积（Ar）、Ar／Am、频率（Freq）的差异无统计学意义（P〉0．05）。心血管副作用：治疗组有5例（8．9％）出现头晕或头痛、面色潮红等反应，未予干预处理，其中4例为复杂性肛瘘患者，术后创面较大。空白组没有发现心血管相关反应。结果表明，复方硝苯地平软膏能有效减轻肛门部手术后疼痛，加快创面愈合，不良反应少，但在较大创口中应用，不良反应可能增加。     

龙珠软膏在肛裂术后的临床应用

观察龙珠软膏住肛裂术后廊用促进创面愈合的疗效,寻求一种更为有效的促进肛肠病术后创面愈合的治疗方法。选择肛裂术后患者60例,其中治疗组和对照组各30例,术后分别给予龙珠软膏和九华膏换药,1次／d。换药期间详细观察创面的宽度、深度、疼痛程度、水肿程度、肉芽生长指标,并进行评分。比较两组创面平均愈合时间。换药前后症状体征疗效和临床总疗效。结果显示,治疗组和对照组创面平均愈合时例分别为（19．80±2．78）d和（21．90±3．24）d,治疗组愈合速度明显快于对照组（P〈0．01）;水后第7天治疗疼痛的有效率分别为93．3％和80．0％,治疗水肿的有效率分别为96．2％和96．0％,治疗组减轻疼痛的疗效优于对照组（P〈0．05）,换药20d后创面疗效治疗组明显优于埘照组（P〈0．05）。结果表明,龙珠软膏能够加快创面愈合,减缓疼痛、水肿等早期不适症状体征,特别是在上皮爬行瘢痕形成时期具有明显疗效。     

两种术式治疗慢性肛裂对肛肠动力学变化的影响

本研究旨在于通过肛肠动力学检测探讨两种术式治疗慢性肛裂埘肛门功能的影响。将120例肛裂患者分别采用侧位内括约肌切断术（试验组60例）和后侧位内括约肌切断术（对照组60例）治疗．记录两组患者术前和术后直肠肛门反射（RAR）,肛管最大收缩压（AMCP）,肛管最长收缩时间（ALCT）,直肠静息压（RRP）和肛管静息压（ARP）等指标情况。结果显示,试验组和对照组术后肛管功能均得到明显改善,两组均取得良好效果,无明显的并发症;试验组ARP较对照组下降显著（P〈0．01）,两组间术前术后ALCT、RRP和AMCP差异无统计学意义（P〉0．05）;结果表明,肛裂手术后可引起一定的肛肠动力学变化,但肛门自制功能基本维持正常。     

病理性肛裂组织切除治疗慢性肛裂疗效观察

目的 探讨病理性肛裂组织切除治疗慢性肛裂的疗效。方法 回顾分析2019年9月至2020年4月在我院接受病理性肛裂组织切除手术46例慢性肛裂患者的临床及随访资料,观察患者手术时间、术中出血量、术后并发症情况、术后疼痛评分、手术前后肛管静息压变化及临床疗效。结果 本组患者手术时间（35.91±12.35）min,术中出血量（7.33±3.48）mL。术后出现尿潴留4例（8.70%）,切口感染1例（2.17%）,未出现切口出血、肛门失禁等并发症。术后24 h疼痛评分（3.43±0.91）分,术后48 h疼痛评分（3.00±0.73分,术后72 h疼痛评分（2.22±0.76）分,术后1周疼痛评分（0.67±0.63）分。术前肛管静息压（19.86±2.24）kPa,术后3周肛管静息压（10.396±1.97）kPa,差异具有统计学意义（P=0.000）。创面愈合时间为（24.26±5.14）d。本组患者治愈42例（91.30%）,好转4例（8.70%）,有效率100%。中位随访时间8.2个月,无复发病例。结论 病理性肛裂组织切除术治疗慢性肛裂安全、有效。     

皮下潜行肛门内括约肌侧方剪切术治疗肛裂40例

为观察皮下潜行肛门内括约肌侧方剪切术治疗肛裂的效果,对80例肛裂病人随机分为试验组与对照组各40例,分别行皮下潜行肛门内括约肌侧方剪切术与经典的括约肌侧切术,试验组与对照组病人在男女构成比、平均年龄及术后并发症发生率上均无统计学意义。试验组创口愈合时间为（5．2±1．0）d,明显短于对照组（12．4±2．9）d（P〈0．001）,术后疼痛评分试验组与对照组分别为（2．35±0．74）分及（3．25±2．85）分（P〈0．001）。两组病人肛裂均治愈,肛门功能均良好。结果表明,皮下潜行肛门内括约肌侧方剪切术能缩短创口愈合时间,减轻术后疼痛。     

生物蛋白胶封堵术治疗高位肛瘘的临床研究

目的探讨生物蛋白胶封堵术治疗高位肛瘘的临床应用。方法将我科2010年3月至2011年4月期间60例高位肛瘘,随机分为治疗组和对照组各30例。治疗组采用生物蛋白胶封堵术,对照组采用肛瘘切除术,比较两组术后创面愈合时间、创面换药疼痛、肛管压力测定。结果治疗组术后疼痛及创面愈合时间均比对照组低（P〈0．05）;复发率的差异无统计学意义（P〉0．05）;术后肛管静息压比较,差异有统计学意义（P〈0．05）。结论生物蛋白胶封堵术治疗高位肛瘘有较好的效果,能缩短伤口愈合时间,减轻术后换药疼痛,保护肛管静息压。     

口服尼氟地平降低肛管静息压使慢性肛裂愈合

/Cook TA…∥Br J Surg 1999;86:1269-1273 肛裂与内括约肌张力过高引起肛管静息压升高有关,传统的手术治疗常导致内括约肌损伤.近来,肛裂的治疗主要趋向于降低括约肌压力的替代疗法.三硝酸甘油(GTN)膏可以使大约1/3的肛裂患者痊愈,但其不良反应发生率高,而且用药部位及剂量还有争议.作为钙离子拮抗剂的尼氟地平常用来治疗失弛缓症,本文评价其降低肛管静息压从而使肛裂愈合的作用. 方法健康自愿者8例及慢性肛裂患者15例口服尼氟地平各5天和8周,剂量20mg,每日两次,用药前后进行肛管测压.对肛裂患者进行血压监测、疼痛评分,如8周后仍未愈合,改用GTN膏剂或括约肌切开.患者最低随访3个月. 结果健康自愿者首次服药后最大肛管静息压(MRP)可降低35%,服药5天后降低28%,肛裂患者服药后MRP降低36%.治疗期间疼痛评分明显降低,治疗8周后,8例痊愈,3例无症状.10例有面红,4例有轻微头痛.所有患者无体位性低血压及大便失禁. 讨论口服尼氟地平可降低肛管静息压,使慢性肛裂愈合,而且不必考虑局部用药的部位及剂量,优于局部治疗,关于口服最佳剂量尚需进一步研究. (蔡世荣摘詹文华校)     

高位虚挂线法与实挂线法治疗高位肛瘘的临床对比研究

为探讨高位虚挂线法治疗高位肛瘘在肛门功能保护及术后并发症方面的优势,将高位肛瘘80例患者随机分为治疗组和对照组,每组40例。术中分别以实挂线法和虚挂线法治疗,比较两组术后创面愈合时间、肛管静息压及最大收缩压的变化、术后肛管锁眼畸形、肛门漏气漏液、复发情况。结果显示,术后治疗组创面愈合时间较对照组短（P〈0．05）,肛管锁眼畸形发生率较对照组低（P〈0．05）;肛管静息压和最大收缩压方面,治疗组术后无明显变化（P〉0．05）,对照组术后较术前降低（P〈0．05）;治疗组未见术后肛门漏气漏液,对照组为20例（P〈0．05）;两组各有1例复发。结果表明,高位虚挂线法治疗高位肛瘘在创面愈合时间、术后并发症及减轻患者疼痛方面优于传统的实挂线法。     

复方硝苯地平软膏在混合痔术后的应用

目的：研究复方硝苯地平软膏在混合痔术后的临床应用。方法：将135例混合痔术后患者随机分为4组：治疗组、地平组、消炎膏组、对照组,分别给予复方硝苯地平软膏、0.2%硝苯地平软膏、消炎祛腐生肌膏、凡士林软膏换药。结果：治疗组在平均疼痛指数、排便疼痛指数方面低于消炎膏组及对照组（P〈0.05）。对照组创面水肿多于其他3组（P〈0.05）,治疗组创面愈合时间短于其他3组（P〈0.05）。治疗组和地平组的术后肛管静息压低于消炎膏组和对照组（P〈0.05）。结论：复方硝苯地平软膏能有效减轻混合痔术后肛门疼痛,加快创面愈合,无明显不良反应。     

吻合器痔上黏膜环切钉合术与超声引导下痔动脉结扎术治疗Ⅲ度混合痔术后肛管直肠压力的比较研究

目的比较吻合器痔上黏膜环切钉合术（PPH）与超声引导下痔动脉结扎术（DGHAL）治疗Ⅲ度混合痔术后肛管直肠压力。方法前瞻性入组2010年问在武汉市第八医院肛肠外科住院治疗的114例Ⅲ度混合痔患者,根据患者选择分别予以PPH术（63例）或DGHAL术（51例）。术后第2、6、12及18月对所有病例进行肛门直肠测压,测压指标包括直肠静息压、肛管静息压、肛管最大收缩压和肛管高压带长度。结果术后各随访时间点,DGHAL组患者肛管静息压均明显高于PPH组[术后2月：（56．2±2．6）mmHg比（43．2±3．1）mmHg;术后6月：（55．2±2．1）mmHg比（45．1±2．5）mmHg;术后12月：（53．2±3．0）mmHg比（40．2±3．2）mmHg;术后18月：（55．3±2．6）mmHg比（43．2±2．5）mmHg;均P〈0．01];肛管高压带长度亦明显长于PPH组[术后2月：（3．45±0．14）cm比（2．95±0．22）cm;术后6月：（3．46±0．12）cm比（2．94±0．26）cm;术后12月：（3．45±0．12）cm比（3．01±0．21）cm;术后18月：（3．56±0．12）cm比（3．02±0．23）cm;均P〈0．01]。但两组患者肛管最大收缩压和直肠静息压的差异则无统计学意义（均P〉0．05）。结论DGHAL和PPH术均为治疗Ⅲ度混合痔的有效术式,但DGHAL术在缩短肛门功能恢复时间和维护肛门功能方面更值得肯定。     

Comparison of topical glyceryl trinitrate ointment and oral nifedipine in the treatment of chronic anal fissure

This study was designed to compare the effect of topical glyceryl trinitrate (GTN) and oral nifedipine treatments on maximal anal resting pressure (MARP) and subsequently to assess their effectiveness in healing of chronic anal fissure (CAF). Patients were allocated randomly to receive either oral nifedipine retard (10 patients) 20 mg twice daily or instructed to apply glyceryl trinitrate (0.2 percent) ointment (10 patients) into the lower half of the anal canal twice daily. They were reviewed and assessed at the first visit and every fortnight for measurement of MARP, pain scores, blood pressure, pulse rate, healing of the fissure and adverse effects. Treatment were continued until healing had occurred or for up to 8 weeks. MARP values before and after application of the GTN ointment was 113.2 cm H2O and 72.5 cm H2O respectively (P < 0.001). Nifedipine caused a reduction in mean MARP from 105.2 to 74.0 cm H2O (P < 0.001). Linear analogue pain scores were significantly reduced after 2 weeks treatment with GTN and nifedipine (P < 0.001) and continued throughout the treatment period. At the end of the study; 7 of the 10 patients in the GTN group were deemed to be healed (5) or improved (2), compared with 6 of the 10 patients in the nifedipine group (5 healed, 1 improved). Headaches occurred in 3 patients in the GTN group, compared with one patient in the nifedipine group. There was no significant difference between GTN and nifedipine in terms of reduction in MARP and pain score, healing of the fissure and incidence of early recurrence and side effects of treatments. We conclude that GTN ointment and oral nifedipine are equally effective in the treatment of chronic anal fissure.     

A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure

BACKGROUND: Anal fissure in children usually is treated by sitz baths, stool softeners, and analgesic ointments. However, some cases are intractable to the treatment. In recent years, it has been reported that nitric oxide donors such as local glyceryl-trinitrate (GTN) ointment causes a reversible chemical sphincterotomy. Although the GTN ointment can be an alternative therapy for adult cases, it has not yet been studied in the children who suffer from anal fissure. METHODS: Sixty-five children with anal fissure were divided randomly into 3 groups. Each group received double-blinded a topical ointment that contained either 0.2% GTN, 10% lidocaine, or placebo. These ointments were applied to the lowest part of the anal canal twice daily. Patients were periodically reviewed, and the study was ended after 8 weeks. RESULTS: Complete healing of the fissure occurred in 26 of 31 (83.9%) patients treated with GTN, 7 of 14 (50%) patients treated with lidocaine, and 6 of 17 (35.2%) treated with placebo. In 29 of 31 (93.5%) GTN-treated patients, a total relief of symptoms was observed, whereas this occurred in 7 of 14 (50%) treated with lidocaine and 6 of 11 (35.3%) in the placebo group. The differences between the study group and control groups were highly statistically significant (P < .001). CONCLUSION: The majority of children suffering from anal fissure will be cured and have relief of symptoms after topical application of GTN ointment to the anal canal.     

Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure: prospective, randomized trial

Introduction: Topical nitroglycerin (GTN) is one of the medical treatments of choice in chronic anal fissure. The present prospective, randomized, clinical trial was conducted to study the symptomatic relief, healing, and changes in the maximum anal resting pressure (MARP) in patients with chronic anal fissure comparing topical GTN and lateral sphincterotomy. Methods: Forty consecutive patients with chronic anal fissure were randomized for treatment with either topical GTN or internal sphincterotomy (20 patients in each group). Anal manometry was done before treatment in all patients, and 1 h after application of GTN or sphincterotomy. Patients were followed at 2‐weekly intervals for 6 weeks for symptomatic relief and healing. Results: Both GTN and sphincterotomy brought about a highly significant, but comparable drop in the MARP after treatment (P < 0.0001 in both groups). Sphincterotomy relieved pain much earlier compared to GTN (70% vs 40% at 2 weeks, P = 0.0032); but after 4 weeks of treatment, pain relief in both groups was comparable. Healing in the sphincterotomy group was also earlier than with GTN (55% vs 0% at 2 weeks, P < 0.0001; and 85% vs 30% at 4 weeks, P < 0.0001); but after 6 weeks, healing in both groups was comparable. Sphincterotomy had a significant incidence of minor, short‐term complications; it also required surgical expertise, theatre time, and day‐care beds. Nitroglycerin is safe, with mild and tolerable side‐effects of headache and local burning sensation. Conclusion: Topical GTN should be the initial treatment in chronic anal fissure. Lateral sphincterotomy should be reserved for patients with severe disabling pain (because pain relief is much faster), and for patients not responding to at least 4 weeks of GTN therapy.     

复方生肌膏促进肛裂术后创面愈合的临床观察

为观察复方生肌膏在促进肛裂术后创面愈合及减少术后并发症的作用,将肛裂术后患者92例分为治疗组49例和对照组43例,治疗组在术后使用复方生肌膏外敷治疗,对照组术后使用马应龙麝香痔疮膏外敷治疗。结果显示,治疗组在减轻疼痛、促进创面愈合、缩短愈合时间等方面的疗效均明显优于对照组（P〈0．05或P〈0．01）。结果表明,复方生肌膏具有促进肛裂术后创面愈合,缓解疼痛的作用。     

复方角菜酸酯栓治疗婴幼儿肛裂疗效观察

为观察复方角菜酸酯栓治疗婴幼儿肛裂的临床疗效,对125例婴幼儿肛裂患儿分别应用复方角菜酸酯栓62例（观察组）和红霉素软膏63例（对照组）进行临床观察。结果显示．治疗1周和2周后,观察组患儿治愈率、好转率及总有效率（67．7％、25．8％、93．5%、98．4％、1．61％和100％）明显高于对照组（42．9％、22．2％、65．1％、50．8％、17．5％和68．3％）（P均〈0．01）。结果表明．复方角菜酸酯栓治疗婴幼儿肛裂疗效显著。使用方便,无不良反应。     

2％硝苯地平生肌玉红膏治疗肛裂临床观察

为观察2％硝苯地平生肌玉红膏局部外用治疗肛裂的疗效,将62例肛裂患者随机分为治疗组和对照组各31例,分别采用2％硝苯地平生肌玉红膏和马应龙麝香痔疮膏涂抹于肛裂裂口处,每日2次,急性肛裂治疗1周,慢性肛裂治疗6周,进行疗效对比。结果显示,总有效率治疗组（96．8％）明显优于对照组（80．6％）,总治愈率治疗组（64．5％）亦优于对照组（45．1％）。结果表明,2％硝苯地平生肌玉红膏局部外用治疗肛裂有良好的疗效。     

侧切加扩肛治疗陈旧性肛裂临床观察

为探讨治疗陈旧性肛裂的有效方法,将128例陈旧性肛裂患者分为两组,治疗组64例采用侧方内括约肌部分切断术（侧切法）并充分扩肛I对照组64例采用后正中位栉膜带和内括约肌切断术（后切法）。结果显示,治疗组治愈时间为（18．5±2．2）d,对照组治愈时间为（23．3±2．9）d（P〈O．01）;治疗组术后复发2例（3．1％）,对照组为10例（15．6％）（P〈O．01）。结果表明,侧切法治疗陈旧性肛裂能缩短疗程,减轻患者痛苦,愈后无并发症和后遗症,并可减少术后复发。     

A Comparison of the Effects of Diltiazem and Glyceryl Trinitrate Ointment in the Treatment of Chronic Anal Fissure: A Randomized Clinical Trial

Purpose Anal fissure is a common problem affecting all age groups with an equal incidence in both sexes. Traditional surgical treatments, like manual anal dilatation or a sphincterotomy, effectively heal most fissures within a few weeks but such procedures may result in anal incontinence. In recent years, various medical therapies have been used for the treatment of chronic anal fissure without fear of incontinence. Methods Ninety patients with a symptomatic anal fissure were randomly divided into three groups. Group I was treated with 2% diltiazem ointment, Group II was treated with 0.2% glyceryl trinitrate (GTN) ointment, and Group III was kept as the control group. The improvement in the signs and symptoms, the time taken for healing, and side effects were recorded in each group. The patients were followed up monthly and then every 3 months for any recurrence of fissure. Comparative evaluations of the three groups regarding an improvement in symptoms, progress in healing, appearance of side effects, and recurrence were made using the Tukey HSD test. Results Diltiazem ointment was found to be superior regarding pain relief, fewer side effects, and late recurrence as compared with GTN ointment. Conclusion Diltiazem ointment (2%) and GTN ointment (0.2%) are both effective treatment modalities for chronic anal fissure, with diltiazem giving better patient outcome.     

疼痛评分和动脉血氧分压作为筛选指标在肋骨内固定手术中的应用

目的探讨疼痛评分和动脉血氧分压（PaO2）作为肋骨内固定手术指征筛选指标的可行性。方法回顾性分析2010年9月至2013年2月上海市浦东医院收治48例肋骨骨折患者的临床资料。采用视觉模拟评分法,选取其中3d后疼痛评分≥6分、PaO2〈60mmHg患者共24例作为试验组[男16例,女8例;年龄（49．294-15．73）岁];另选取3d后疼痛评分≤5分、PaO,≥60mmHg患者共24例作为对照组[男19例,女5例;年龄（48．634-13．49）岁]。两组患者均采用爪形钢板行肋骨内固定术。术后3d、1周观察疼痛评分和PaO2。结果试验组术后3d疼痛评分小于术前[（4．09±0．93）分VS．（8-21±1．18）分,尸〈0．05],术后1周疼痛评分小于术前[（3,204-0．98）分VS．（8．214±1．18）分,P〈0．05];对照组术后3d疼痛评分与术前比较差异无统计学意义（P〉0．05）,术后l周疼痛评分小于术前（P〉0．05）。试验组术后3dPa02大于术前[（61．004±3．47）mmHgVS．（53．004-3．97）mmHg,P〈0．05];对照组术后3dPaO：大于术前[（66．714-5．15）mmHgVS．（66．004-5．00）mmHg,P〉0．05]。术后3d试验组发生肺炎4例,对照组2例（X2=0．762,P〉0．05）。术后3d疼痛评分下降值试验组高于对照组[（4．134-1．45）分VS．（0．004±0．42）分,P〈0．05],术后1周疼痛评分下降值试验组高于对照组[（5．044-1．23）分VS．（0．08±0．28）分,P〈0．05],术后3dPaO2升高值试验组高于对照组[（7．424-3．59）mmHgVS．（0．214±0．98）mmHg,P〈0．05]。结论将肋骨骨折后3d疼痛评分≥6分、PaO2〈60mmHg作为肋骨内固定手术的筛选指标具有合理性和可行性。