经直肠耻骨直肌部分切断、纵切横缝术治疗耻骨直肠肌综合征的临床疗效评价

目的:探讨耻骨直肠肌综合征的外科治疗.方法:将36例耻骨直肠肌综合征患者随机分为两组,治疗组(18例)采用经直肠耻直肌部分切断、纵切横缝术;对照组(18例)采用后位耻直肌部分切断术.对两组患者的术后疗效、愈合时间、术后并发症等进行观察分析.结果:治疗组与对照组在术后并发症,愈合时间等方面比较有统计学意义.结论:经直肠耻直肌部分切断、纵切横缝术治疗耻骨直肠肌综合征疗效确切,术后并发症少.     

耻骨直肠肌全束部分切断+自体闭孔内肌移植术治疗盆底痉挛综合征的临床效果评价(附42例分析)

目的探讨耻骨直肠肌全束部分切断+自体闭孔内肌移植术治疗盆底痉挛综合征的疗效及安全性。方法 42例盆底痉挛综合征患者采用耻骨直肠肌全束部分切断+自体闭孔内肌移植术治疗。结果平均手术时间50分钟(39~100分钟),平均术后住院时间9.6天(7~19天),随访12个月,手术前后肛管静息压分别为(55.95±5.57)mmHg、(43.19±5.16)mmHg,差异有统计学意义(P0.05);手术前后肛管收缩压分别为(164.21±11.02)mmHg、(137.40±7.61)mmHg,差异有统计学意义(P0.05);手术前后肛管力排压分别为(128.31±16.93)mmHg、(81.33±8.37)mmHg,差异有统计学意义(P0.05)。手术前后出口梗阻型便秘症状(ODS)评分分别为(15.83±4.52)分、(5.90±3.69)分,差异有统计学意义(P0.05);手术前后Wexner评分分别为0分、(0.71±0.81)分,差异有统计学意义(P0.05),但术后Wexner评分均≤3分,未出现严重肛门失禁。手术前后便秘患者生存质量量表(PAC-QOL)评分(不满意)分别为(44.21±5.12)分、(14.36±2.92)分,差异有统计学意义(P0.05),手术前后PAC-QOL评分(满意)分别为0分、(10.02±2.67)分,差异有统计学意义(P0.05)。结论耻骨直肠肌全束部分切断+自体闭孔内肌移植术术式操作简单、治愈率高、效果确切,并发症少。     

挂线快速松解术治疗耻骨直肠肌综合征37例

目的:观察挂线疗法治疗耻骨直肠肌综合征的疗效。方法:对37例患者采用耻骨直肠肌挂线快速松解治疗。结果:术后挂线橡皮筋2~4d脱落,创口愈合时间12~27d。术后随访0.5~2年,总有效率94.6%。结论:挂线快速松解术治疗耻骨直肠肌综合征,操作简便、安全,并发症少,疗效满意。     

挂线治疗出口梗阻型便秘30例临床观察

为探讨挂线疗法治疗出口梗姐型便秘的疗效．将55例因耻骨直肠肌痉挛引起的出口梗阻型便秘的病人分为两组。采用挂线30例（治疗组）,采用部分耻骨直肠肌切断术25例（对照组）。结果显示,治疗组30例均恢复排便顺应性,肛门指诊肛管直肠弹性良好,肛门自制功能正常,术后疼痛径,往院时间、创面愈合时间均短,无术后感染,复发率低．明显优于对照组（P〈0.01）。结果表明,挂线术治疗出口梗阻型便秘,具有术式简单、术后疼痛轻、住院时间短、复发率低等优点。     

经肛门耻骨直肠肌部分切断术治疗耻骨直肠肌肥厚型便秘28例

2000年3月-2004年4月,我们采用经肛门耻骨直肠肌部分切断术治疗耻骨直肠肌肥厚型便秘28例,疗效满意,现报告如下.     

腹部皮肤横切口在前列腺切除术中的应用研究

目的:探讨腹部皮肤横切口在耻骨上前列腺切除术中的优势。方法:于2001年2月至2004年9月期间,将41名因BPH行耻骨上前列腺切除术的患者随机分为纵切口组20例及横切口组21例。并对两组的结果进行比较和统计分析。结果:横切口在术中及术后出血量、切口长度以及术后肛门恢复排气时间上均优于纵切口,差异有统计学意义(P<0.05)。结论:与腹部皮肤纵切口耻骨上前列腺切除术相比,皮肤横切口术式具有暴露好、术中及术后出血少、手术时间短、术后肠道功能恢复较快、切口愈合好且较美观等优点,值得临床推广应用。     

手术治疗耻骨直肠肌综合征12例体会（摘要）

本文报告了手术治疗12例耻骨直肠肌综合征的疗效和经验。均行耻骨直肠肌后方部分切除,冶愈10例(10/12)、好转2例(2/12)。好转2例系同时存在会阴下降及直肠粘膜内套叠。术后无切口感染及大便失禁。我们认为 耻骨直肠肌后方部分切除术是治疗耻骨直肠肌综台征最有效的方法:若同时存在其它引起便秘的原因。治疗效果将不同程度受到影响,故应一并处理。     

耻骨直肠肌部分松解术治疗耻骨直肠肌综合征62例

为探讨耻骨直肠肌部分松解术治疗耻骨直肠肌综合征所致便秘的临床疗效,对62例经症状、体征及相关检查确诊为耻骨直肠肌综合征所致便秘患者采用耻骨直肠肌部分松解术治疗,观察治疗后临床疗效及随访3个月疗效。结果显示,62例患者治疗后总有效率为96．7％,随访3个月疗效为95．2％。结果表明,耻骨直肠肌部分松解术治疗耻骨直肠肌综合征所致便秘安全有效。     

腹腔镜低位直肠癌经肛门拖出切除吻合术近期疗效分析(附11例报告)

目的:评价腹腔镜低位直肠癌经肛门拖出切除吻合技术的近期疗效。方法:回顾分析11例腹腔镜直肠全系膜切除、经肛门拖出切除、结-直肠吻合、预防性末端回肠造瘘手术的临床资料。结果:11例均在腹腔镜下完成手术,无一例中转开腹,无辅助切口,保肛率100%。手术时间平均(162.3±31.01)min,术中出血量平均(31.82±14.88)ml,术后平均(2.00±0.63)d恢复胃肠功能并进流质饮食,平均住院(12.27±1.56)d。术后1例发生吻合口漏。结论:腹腔镜直肠全系膜切除、经肛门拖出切除吻合技术治疗低位直肠癌创伤小、安全、可行,近期疗效满意。     

耻骨直肠肌后位切断术治疗耻骨直肠肌综合征25例

耻骨直肠肌综合征（puborectal muscle syndrome,PRMS）是以耻骨直肠肌痉挛性肥大、盆底出口梗阻为特征的排便障碍性疾病,是紧张型出口梗阻型便秘的主要原因之一。我科采用耻骨直肠肌后位切断术治疗25例因耻骨直肠肌综合征而致便秘的患者,取得了良好的效果,现报告如下。     

闭合式侧切术治疗耻骨直肠肌综合征的临床应用

为探讨闭合式侧切术治疗耻骨直肠肌综合征的临床疗效，将60例耻骨直肠肌综合征患者随机分为治疗组和对照组，每组各30例，分别采取闭合式侧切术与经骶尾人路改良耻骨直肠肌松解术治疗。结果显示，治疗后两组进行疗效比较，在排便困难、排便不尽感、创口愈合时间、术中出血、术后疼痛方面治疗组优于对照组（P〈O．05）。随访6个月，远期疗效治疗组优于对照组。结果表明，闭合式侧切术治疗耻骨直肠肌综合征优于经骶尾入路改良耻骨直肠肌松解术。     

Puborectalis syndrome: a cause of obstinate constipation

Two patients with severe chronic constipation caused by spasmodic hypertrophy of puborectalis underwent partial resection of the muscle. Pre-operative anorectal manometry showed increased length of the anal canal. Concentric electromyography showed that the puborectalis muscle failed to relax during attempted defecation and patients were unable to expel a water-filled balloon from the rectum. After surgery they have a regular defecation without difficulty. We consider that partial resection of the puborectalis muscle is a useful procedure for the puborectalis syndrome.     

Muscle layers of the stomach

The arrangement of the gastric muscles of men, dogs and cats was studied from the aspect of functional anatomy. The stomach is divided into 8 segments on the basis of its vascularisation, musculature, structure and function. The muscular structures of the walls of the different segments are different. It was found that the sphincter of the pylorus is formed by the outer longitudinal muscle. The internal oblique muscle separates the sac and the tube system, while the circular musculature contributes mainly to the transport of nutrition.     

Isokinetic Muscle Performance Test Can Predict the Status of Rotator Cuff Muscle

Background  

The isokinetic muscle performance test (IMPT) is a validated and objective method used to evaluate muscle function but it is unknown whether it correlates with severity of rotator cuff tears.     

Muscle

Two important types of muscle are skeletal and smooth muscle. Their similarities and differences are described with regard to general morphology and ultrastructure (arrangement of filaments and T tubules), linking structure to physiological functions. The sliding-filament theory of muscle contraction is explained. Finally, the processes by which nerves excite muscle contraction (excitation–contraction coupling) are outlined, again relating variations in these processes in the two types of muscle to differences between them in their role in the body.     

Myositis Ossificans of the Temporalis Muscle

Traumatic myositis ossificans (TMO) is a rare ossifying disease that occurs in the muscle or soft tissues. A case of TMO isolated in the temporalis muscle is reported. In the case described, calcification in the temporalis muscle was confirmed after computed tomography. Surgery, physiotherapy, and histopathological analysis were performed. One year after treatment, further ossification was present but without interference in function. The most accepted treatment for TMO in the maxillofacial region is excision followed by physiotherapy. The high rate of non-recurrence may be concealed due to the short follow-up period. TMO is a lesion that may frequently recur and long-term follow-up must be provided.     

Muscle transfers involving the shoulder

Muscle transfer provides a viable treatment option for several difficult problems involving the shoulder. Muscle transfer is often the only alternative to a salvage procedure such as shoulder fusion, and whereas salvage procedures provide pain relief at the cost of function, muscle transfer can provide pain relief while retaining acceptable function. The five most commonly encountered shoulder problems for which muscle transfer can be utilized are subscapularis rupture, irreparable rotator cuff tear, deltoid injury and dysfunction, trapezial paralysis, and serratus anterior scapular winging. Although numerous muscle transfer procedures have been described, the following procedures have proven the most reliable and are the focus of this article: 1) transfer of the pectoralis major for subscapularis rupture, 2) transfer of the latissimus dorsi for irreparable rotator cuff tears, 3) latissimus dorsi transfer for deltoid injury or dysfunction, 4) modified Eden-Lange procedure for trapezial paralysis, and 5) modified Marmor-Bechtol pectoralis major transfer for serratus anterior scapular winging.     

Three Intermittent Sessions of Cryotherapy Reduce the Secondary Muscle Injury in Skeletal Muscle of Rat

Although cryotherapy associated to compression is recommended as immediate treatment after muscle injury, the effect of intermittent sessions of these procedures in the area of secondary muscle injury is not established. This study examined the effect of three sessions of cryotherapy (30 min of ice pack each 2h) and muscle compression (sand pack) in the muscle-injured area. Twenty-four Wistar rats (312 ± 20g) were evaluated. In three groups, the middle belly of tibialis anterior (TA) muscle was injured by a frozen iron bar and received one of the following treatments: a) three sessions of cryotherapy; b) three sessions of compression; c) not treated. An uninjured group received sessions of cryotherapy. Frozen muscles were cross- sectioned (10 µm) and stained for the measurement of injured and uninjured muscle area. Injured muscles submitted to cryotherapy showed the smallest injured area (29.83 ± 6.6%), compared to compressed (39.2 ± 2.8%, p= 0.003) and untreated muscles (41.74 ± 4.0%, p = 0.0008). No difference was found between injured compressed and injured untreated muscles. In conclusion, three intermittent sessions of cryotherapy applied immediately after muscle damage was able to reduce the secondary muscle injury, while only the muscle compression did not provide the same effectiveness.

Key Points

• Three sessions of cryotherapy (30 min each 2 hours) applied immediately after muscle damage reduce the secondary muscle injury.
• Sessions of compression applied after muscle damage are not able to reduce the secondary muscle injury.

Key words: Tibialis anterior, hypothermia, damage