太宁栓治疗肛裂疼痛的临床观察

目的：探讨肛裂疼痛的治疗效果及安全性。方法：将80例患者分为两组，治疗组采用黏膜保护剂太宁栓，对照组选用马应龙麝香痔疮膏。结果：治疗后太宁栓组疼痛、出血、瘙痒、水肿糜烂的减轻程度明显优于对照组（P〈0.05）。结论：太宁栓具有良好的止痛作用，临床效果明显，安全性高。     

MEBO在血栓性外痔和陈旧性肛裂术后治疗中的疗效观察

目的：观察美宝湿润烧伤膏在血栓性外痔和陈旧性肛裂切除术后治疗中的疗效。方法：术毕用MEBO纱布条填塞伤口,术后24小时取出纱布条,以后用MEBO涂于伤口内,每日2次,直至痊愈。结果：48例患者无术后伤口疼痛、出血、感染及肛门狭窄。伤口愈合时间短,治愈率高。结论：美宝湿润烧伤膏是血栓性外痔、陈旧性肛裂切除术后良好的局部治疗药物。     

腹泻型、便秘型肠易激综合征和功能性便秘患者的直肠肛管测压比较

目的研究腹泻型、便秘型IBS和功能性便秘患者直肠肛管测压参数的不同，并评价性别和年龄对各项参数的影响，方法腹泻型IBS(n=18)、便秘型IBS(n=14)、功能性便秘(n=30)和健康对照组(n=18)，通过定点牵拉法进行直肠肛管测压。结果腹泻型IBS、便秘型IBS、功能性便秘以及健康对照组直肠肛管测压各项压力参数基本无差异，但三组患者的诱发RAIR所需的最小气体容量均显著高于健康对照组，便秘型IBS和功能性便秘模拟排便时发生矛盾运动的百分比显著高于腹泻型IBS和健康对照组；便秘型IBS和功能性便秘组中，肛管上部和下部最大紧缩压力，以及模拟排便发生矛盾运动的百分比男性均高于女性；腹泻型IBS组内男性模拟排便发生矛盾运动的百分比高于女性；健康对照组内男性肛管下部静息压力和最大紧缩压力高于女性；各组20-50岁人群和50-80岁人群的各项压力参数无显著性差异，但功能性便秘组青年组诱发RAIR所需的最小气体容量低于老年组。结论腹泻型IBS、便秘型IBS和功能性便秘患者的直肠肛管测压各项压力参数无助于这三型功能性肠病的鉴别诊断。男性的直肠肛管测压的多项压力参数显著高于女性，男性更易出现模拟排便矛盾运动，年龄对直肠肛管测压各项参数无明显影响。     

Early experience with laparoscopic abdominoperineal resection

Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic abdominoperineal resection at Washington University Medical Center. Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center. Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel disease (two patients), and anal melanoma (one patient). Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2% SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients (29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%). There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization or complication rates. Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis patients. Received: 23 April 1996/Accepted: 8 July 1996     

ART技术封闭恒牙的3年临床效果观察

目的 :评价非创伤性充填 (ART)技术对恒牙窝沟封闭后 ,封闭剂保留及新生龋病发生情况。方法 :1996年在四川省德阳市 4所中学选取 12～ 13岁儿童 14 0名作 191个ART封闭。采用WHO的ART标准器械 ,德国ESPE公司生产的高强度玻璃离子材料 ,对选择的牙面窝沟进行封闭 ;操作者为经中等口腔专业训练的医生。试验 3年后对ART封闭及牙龋病情况进行评价。结果 :封闭后 1、2、3年的封闭成功率分别为 89.6% ,78.8% ,71.9%。试验后 1年没有新生龋齿的发生 ,试验后 2、3年 ,龋患率较低 ,分别为 1.6% ,2 .8%。结论 :ART封闭试验 3年的保存率较高 ,新生龋发生率低 ;作为恒牙龋病防治的措施是适合和可接受的 ;是一种适合于在学校、社区开展的有效、实用的龋病预防方法。     

Anal Canal Cancer

PURPOSE: This study was designed to obtain an updated population-based perspective on anal canal cancer incidence rates, demographics, and outcomes using a nationwide database. Eight-five percent of all carcinomas of the anus are anal canal cancers, and previous studies suggest that incidence rates may be rising. Although the most successful treatment for anal canal cancer has been chemoradiation, little information at the population-level exists regarding demographics, treatment, and survival. METHODS: All patients diagnosed with anal canal cancer from 1973 to 1998 in the Surveillance Epidemiology and End Results cancer registry were analyzed. Data regarding demographics, cancer characteristics, treatment, and survival were assessed. Univariate and multivariate survival analyses were performed. RESULTS: A total of 4,841 patients were studied (mean age was 61 years; 62 percent female). Female patients were significantly older than male patients (65 vs. 58 years; P < 0.0001). There was a yearly increase in incidence of anal canal cancers (from 1973–1998). Disease prevalence by stage was localized (53 percent), regional (38 percent), and distant (9 percent). Racial/stage differences were seen, because black patients had less localized disease than white patients (46 vs. 53 percent; P < 0.01). Overall five-year survival for the entire cohort was 53 percent, and cancer-specific survival was 84 percent. Survival improved per decade (based on year of diagnosis). Significant survival differences in race were noted, but were less when the receipt of treatment was considered. CONCLUSION: Although most anal canal cancer reviews are single institutional series, this study was performed with population-based data. The incidence of anal canal cancer is increasing, and overall survival rates are improving. Important disparities in care were identified, which need to be addressed.     

线锯穿过眶下裂行额颞眶颧开颅技术

目的额颞眶颧开颅应用广泛且有诸多变异。其中，由颧结节指向眶下裂方向的这一重要而必不可少切割已引起神经外科医师的关注。许多学者对颧面孔在精确定位眶下裂方面的实用价值也有若干评价，最近其可靠性又受到质疑。本研究的目的即是对用线锯代替摆锯完成切割这一新的技术要点的可行性进行评价。方法颅骨标本19个（38侧）用以模拟术中线锯从眶内经眶下裂穿出，并沿眶下裂-颧上颌缝方向切割的技术动作，而后将这一简捷有效的操作技术用于5例患者。其中三叉神经鞘瘤1例，同时累及前中颅底的（蝶骨嵴）脑膜瘤3例，累及左侧蝶骨大小翼、蝶骨体和翼突的骨纤维结构不良1例。结果临床实践证实，眶下裂可以在眶内充分暴露，而眶筋膜可基本完整或轻度撕裂仅需缝合数针；线锯穿过眶下裂基本无困难，切割效果满意。三叉神经鞘瘤、骨纤维结构不良和3例中的2例脑膜瘤予以全切除，另1例脑膜瘤予以近全切除。结论用线锯完成颧结节与眶下裂之间的切割过程是眶颧开颅中一种非常简捷实用的技术改良。     

Keratin and vimentin distribution patterns in the epithelial structures of the cannie anal region

The intermediate filament labeling pattern of the epithelial structures of the canine anal region was studied with different polypeptide specific keratin monoclonal antibodies (MoAbs) and with a monoclonal and polyclonal vimentin antibody. The epithelial structures in this region could be discriminated and characterized by differences in their keratin staining pattern. The basal cells in the different epithelial structures showed a similar staining pattern characterized by reactivity with MoAbs staining keratins 5, 8, 14, and 17. Columnar epithelial cells showed a completely different phenotype mostly characterized by reactivity with MoAbs staining keratins 7, 5, 8, 18, and 19. A restricted number of differentiated perianal gland cells showed perinuclear vimentin staining. Myoepithelial cells did not stain for vimentin, but, as other basal cells, were positive for MoAbs staining keratins 5, 8, 14, and 17.© Willey-Liss, Inc.     

Professor Ahmed Shafik (1933–2007)

Most cases of anal abscess are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. Treatment consists of excision of the abscess and, in case of fistula, fistulectomy. Primary anorectal and perianal forms of actinomycosis are very rare and caused by actinomyces, as ubiquitous anaerobics bacterium. We report a case of perianal actinomycosis. The patient had a short history of painless perineal induration without fever and leukocytosis with normal results at routine blood examination. After excision, sulfur granules drained from the cavity and pathological investigations indicated perianal actinomycosis. Appropriate surgery and antibiotic treatment healed the perianal infection. After exclusion of possible diagnoses such as Crohn’s disease, tuberculosis and malignant growths, the rare case of perianal actinomycosis should be considered in the differential diagnosis of painless perianal masses.     

龙血竭散在肛瘘术后的临床应用

目的：探讨龙血竭散在肛瘘术后促进创面愈合的疗效和机理。方法：选用50例肛瘘手术病人，分为治疗组（用龙血竭散）和对照组（用雷夫奴尔纱条）各25例，分别观察术后创面换药疼痛和愈合时间。结果：治疗组在减轻创面疼痛，促进肉芽组织生长，加速创面愈合等方面明显优于对照组（P〈0．01）。结论：龙血竭散可明显缩短创面愈合时间，且无瘢痕过度生长，具有临床应用价值。