吻合器痔上黏膜环切术与传统外剥内扎术治疗痔的疗效和安全性对比

目的:对比分析吻合器痔上黏膜环切术(PPH)与传统外剥内扎术(MMH)治疗Ⅲ期和Ⅳ期混合痔的疗效和安全性。方法:采用病例对照研究将我科2016年6月～2018年6月期间符合收治条件的Ⅲ期和Ⅳ期混合痔的患者共94例,随机分为PPH组48例和MMH组46例,比较两组手术的治疗效果和近远期疗效。结果:PPH组总体治疗有效率为97.9%(47/48),MMH组总体治疗有效率为93.5%(43/46);与MMH组相比,PPH组患者的手术时间、术中出血量、术后住院时间、术后疼痛持续时间和术后VAS疼痛评分等均减少,差异有统计学意义(P<0.01);术后出现肛门坠胀的发生率较低,差异有统计学意义(P<0.05),而两组患者术后出现出血需再次手术止血、尿潴留、肛缘水肿、肛门狭窄、便秘、里急后重感和排便异常的发生率无明显差异(P>0.05)。结论:PPH治疗Ⅲ期和Ⅳ期混合痔临床疗效确切,操作简便,手术安全性高,术后并发症少,值得基层医院推广使用。     

吻合器痔上黏膜环切术与外剥内扎术治疗重度痔的疗效观察

目的：比较吻合器痔上黏膜环切术（PPH）与外剥内扎术（MMH）治疗Ⅲ、Ⅳ期痔的疗效。方法回顾性分析60例重度痔手术患者的临床资料,根据不同手术方式分为MMH组（30例）和PPH组（30例）,对两组患者手术时间、术后VAS评分、注射止痛药次数、术后并发症、住院时间及住院费用进行比较。结果手术后两组患者的临床症状均得到缓解,尽管PPH组患者住院费用高于MMH组患者,差异有统计学意义（P＜0．05）,但PPH组患者在手术时间、术后疼痛的VAS评分、需用止痛药次数、术后并发症（肛缘水肿）发生率及住院时间等方面均明显优于MMH组,差异有统计学意义（P＜0．05）。结论 PPH治疗重度痔与MMH一样安全、有效,且近期疗效优于MMH。     

PPH术与Milligan术治疗重度痔疮疗效比较分析

目的:比较分析吻合器痔上粘膜环形切除术(procedureforprolapseandhemorrhoids,PPH)与传统Milligan手术治疗重度痔疮(Ⅲ、Ⅳ期)的疗效。方法:57例Ⅲ、Ⅳ期痔疮患者,随机分成两组,35例经PPH治疗(PPH组),22例经传统手术治疗(Milligan组)。结果:两组手术时间、住院时间、术后使用止痛药次数、肛门狭窄及肛门失禁均有显著差异。结论:PPH治疗重度痔疮具有手术时间短、术后疼痛轻、恢复快、并发症少等优点,将成为今后重度痔疮的首选治疗方法。     

吻合器痔上黏膜环形切除术与肛门紧缩术治疗重度痔疮疗效比较

目的比较分析吻合器痔上黏膜环形切除术（procedure for prolapse and hemorrhoids,PPH）与肛门紧缩术治疗重度痔疮（Ⅲ、Ⅳ期）的疗效。方法 57例Ⅲ、Ⅳ期痔疮患者,随机分成二组,35例经PPH治疗（PPH组,治疗组）,22例经直肠黏膜柱状缝合,硬化剂注射加肛门紧缩术治疗（肛门紧缩术组,对照组）。结果二组手术时间、住院时间、术后出血,术后使用止痛药次数、肛门狭窄及肛门失禁均有差异,患者满意度,复发率方面差异无统计学意义。结论 PPH治疗重度痔疮具有手术时间短、术后疼痛轻、恢复快、并发症少等优点,为今后重度痔疮的首选治疗方法。     

吻合器痔上黏膜环切术联合外剥内扎术治疗Ⅲ~Ⅳ度环状混合痔患者的效果

目的:观察吻合器痔上黏膜环切术(PPH)联合外剥内扎术(MMH)治疗Ⅲ~Ⅳ度环状混合痔患者的效果。方法:回顾性分析2019年12月至2021年6月该院收治的200例Ⅲ~Ⅳ度环状混合痔患者的临床资料,根据治疗方法不同分为对照组和观察组各100例。对照组给予MMH治疗,观察组在对照组基础上联合PPH治疗,比较两组临床疗效、治疗前后肛门功能指标(肛管最大收缩压、肛管静息压、直肠静息压、直肠肛门抑制反射阳性率、肛管高压带长度)水平、手术相关指标(住院时间、术后疼痛时间、切口愈合时间、手术时间)水平和术后并发症发生率。结果:观察组治疗总有效率为91.00%(91/100),高于对照组的76.00%(76/100),差异有统计学意义(P<0.05);治疗3个月后,两组肛管最大收缩压和直肠静息压均高于治疗前,但组间比较,差异均无统计学意义(P>0.05);两组肛管静息压、肛管高压带长度和直肠肛门抑制反射阳性率均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组住院时间、术后疼痛时间、切口愈合时间和手术时间均短于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.00%(5/100),低于对照组的18.00%(18/100),差异有统计学意义(P<0.05)。结论:PPH联合MMH治疗Ⅲ~Ⅳ度环状混合痔患者可提高治疗总有效率,改善肛门功能指标水平,减轻术后疼痛程度,加快切口愈合,缩短手术时间和住院时间,以及降低并发症发生率,效果优于单纯MMH治疗。     

局部冷冻预防痔上黏膜环切术出血的疗效观察

目的探讨直肠肛门内局部冷冻法预防痔上黏膜环切术（PPH）术中术后出血的效果。方法在PPH术前术中用局部冷冻法（n=63例）和对照组（n=73例）治疗Ⅲ度、Ⅳ度混合痔，分析比较两种方法术中、术后出血及术后24h疼痛程度。结果加用局部冷冻治疗组术中黏膜下血肿发生率显著低于对照组（P〈0．05），两组术中吻合口渗血发生率差异无统计学意义（P〉0．05）。局部冷冻组术后早期出血及疼痛发生率明显低于传统治疗组（P〈0．05）。结论手术前、后肛门内冰块冷冻法对减少PPH术中及术后早期出血及减轻术后疼痛具有一定作用。     

吻合器痔上黏膜环切术与外剥内扎术对重度痔疮的治疗效果

目的 探讨吻合器痔上黏膜环切术与外剥内扎术对重度痔疮的治疗效果。方法 前瞻性研究2019年3月至2020年3月在我科手术治疗的106例重度痔疮患者,采用随机数字表法分为两组,每组各53例。对照组使用外剥内扎术,观察组使用吻合器痔上黏膜环切术,比较两组的各项围术期指标、并发症发生率、血清疼痛应激指标、肛肠动力学指标。结果 观察组手术时间、术中出血量、术后3 d VAS疼痛评分、止痛药使用次数、创面愈合时间、住院时间均明显少于对照组(P0.05);观察组肛缘水肿、肛门狭窄、肛门失禁、尿潴留等并发症发生率明显低于对照组(P0.05);观察组术后3 d的SP、NPY、IL-6、NGF、PGE2水平明显低于对照组(P0.05);观察组术后1个月的MSP、MTV明显高于对照组,而RRP、AIRT明显低于对照组(P0.05)。结论 吻合器痔上黏膜环切术对重度痔疮的治疗效果更好,创伤小,术后疼痛应激反应轻,对肛肠动力影响小,恢复快,并发症发生率低,具有积极的临床意义。     

经吻合器痔上黏膜环切术治疗重度痔的临床疗效观察

【目的】探讨吻合器痔上黏膜环切术治疗重度痔的临床疗效。【方法】将2011年5月至2013年6月期间本院收治的Ⅲ度以上痔患者随机分成两组,对照组和观察组各120例。对照组采用外剥内扎术治疗,观察组则采用经吻合器痔上黏膜环切术治疗。比较两组间疗效及手术时间、住院时间、并发症发生率差异,采用视觉模拟评分法（VAS）对术后6 h、24 h及一周后排便的疼痛情况进行评分,比较组间差异。【结果】观察组痊愈率63．33％（76/120）和总有效率94．17％（113/120）显著高于对照组61．67％（62/120）和80．03％（97/120）,且两组相比较差异均有显著性（P ＜0．05）。观察组手术时间、住院时间显著短于对照组（P ＜0．05）;观察组术后出血发生率显著低于对照组（P ＜0．05）,观察组肛门狭窄、肛周红肿、尿潴留等其余并发症发生率低于对照组（P ＞0．05）。观察组术后6h、24h肛门疼痛评分及一周后排便疼痛评分显著低于对照组（P ＜0．05）。【结论】采用吻合器痔上黏膜环切术治疗重度痔疮疗效确切,术后恢复快,患者疼痛轻且并发症发生率低。     

双波混合激光消融术联合围扎悬吊治疗Ⅱ～Ⅲ度内痔

目的观察双波混合激光消融术联合围扎悬吊法治疗Ⅱ~Ⅲ度内痔的临床疗效。方法将60例Ⅱ~Ⅲ度内痔患者,随机分为观察组和对照组,各30例。观察组采用双波混合激光消融术联合围扎悬吊法治疗,对照组采用传统的内痔结扎术治疗,比较2组临床有效性及安全性。结果观察组在术后第1~3天VAS评分均低于对照组(P0.05);术后第4~5天2组VAS评分无明显的差异(P0.05);观察组术后尿潴留、肛门水肿、肛门出血的发生率低于对照组(P0.05);观察组及对照组临床有效率分别为96.67%、93.33%(P0.05)。结论双波混合激光消融术联合围扎悬吊法治疗Ⅱ~Ⅲ度内痔的临床疗效与传统的内痔结扎术疗效相当,但前者具有术后疼痛小、并发症少、恢复速度快的优势。     

PPH手术治疗重度痔的临床观察

[目的]总结吻合器痔上黏膜环切术（PPH）治疗重度痔的临床经验。[方法]115例以肿物脱出及便血为症状的Ⅲ、Ⅳ度痔患者分为PPH组45例和传统手术组（Milligan-Morgan组）70例．分别进行手术,对比分析手术时间、住院时间、恢复工作时间、术后疼痛、出血、肛门狭窄等并发症。[结果]两组相比较,PPH组的住院时间及恢复工作时间短．术后疼痛轻．肛门狭窄少。[结论]PPH治疗重度痔疗效确切．并发症少．术后恢复抉。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…