自拟疏肝利胆汤对胆囊切除术后综合征患者胆总管、奥狄氏括约肌测压水平的影响

目的:探讨自拟疏肝利胆汤对胆囊切除术后综合征( PCS)患者胆总管、奥狄氏括约肌( SO)测压水平的影响。方法:选取 2020年 3月—2021年 4月本院收治的 48例 PCS患者,采用随机单双编号法将患者分为观察组和对照组,每组 24例。对照组采用常规西医治疗,观察组在对照组的基础上添加自拟疏肝利胆汤,两组均持续治疗 2周。观察两组患者的临床疗效,分别于治疗前后评估两组患者的中医证候积分;采用内镜检测胆总管压力及 SO基础压、蠕动频率以及逆向蠕动波;抽取患者清晨空腹静脉血,检测患者的肝功能 [谷丙转氨酶(ALT)、谷草转氨酶(AST)]和相关炎性因子 [白细胞介素 -4(IL-6)、肿瘤因子 -α(TNF-α)]水平;记录两组患者治疗期间的不良反应发生情况。结果:观察组总有效率为 87.50%,高于对照组的 62.50%,差异有统计学意义( P<0.05);治疗后,观察组食欲减退、腹痛腹胀、腹泻、恶心嗳气证候积分均明显低于对照组( P<0.05);观察组的胆总管内压、 SO基础压、蠕动频率、逆向蠕动波明显低于对照组( P<0.05);观察组的 ALT、 AST、IL-6、TNF-α水平明显低于对照组( P<0.05)。两组患者均无明显头晕、皮疹、胸闷等不良反应发生。结论:自拟疏肝利胆汤方辅助临床西医治疗 PCS患者可明显降低胆管及 SO压力,改善肝功能,降低炎症反应程度,提高临床疗效。     

Esfinteroplastia anatómica mediante reconstrucción combinada del esfínter anal interno y externo en el tratamiento quirúrgico de la incontinencia anal

Several groups studying the results of the classic sphincteroplasty show improvement of 75% of patients treated in a short-term follow-up, with a worsening of this data in the long-term follow-up down to an improvement of 50% of the patients. Some other groups published more optimistic results, showing an 80% success rate without any deterioration of the technique over time after introducing a separate repair of the internal and external muscles. We think that the introduction of some modifications in the classic technique, named “anatomic sphincteroplasty with combined reconstruction of external and internal anal sphincter muscles” may obtain very good clinical and anorectal manometric results both in a short and mid-term follow-up. In addition, increasing the pressive length in the anal canal may contribute to maintain more stable results over time.     

Design and evaluation of puborectalis-like artificial anal sphincter that replicates rectal perception

While fecal incontinence (FI) is not fatal, it can dramatically decrease the patient’s quality of life. An artificial anal sphincter (AAS) is an implantable device that treats FI by replacing a diseased or damaged anal sphincter, thus allowing the patient’s continence to be maintained. Here, we report a novel implantable puborectalis-like artificial anal sphincter (PAAS) that replicates rectal perception and has a low risk of ischemia necrosis. Using the pressure sensors embedded in the PAAS, the relationship between the mass of feces and the pressure was determined, and a feces mass estimation model was developed based on in vitro studies. Rectal perception is provided through the real-time monitoring of rectal feces, and the feeling of defecation is quantified based on a comparison between the feces mass and a preset threshold mass. In vivo studies were performed for validation, and the accuracy of the model was determined to be as high as 90%. The performance of the PAAS in the real-time monitoring of rectal feces and its in vivo biocompatibility were also evaluated. The device should further the functionality of existing AAS systems while improving their biosafety and thus expand the applicability of implantable AAS systems in the treatment of FI.     

改良内括约肌侧切术与后切术治疗陈旧性肛裂疗效比较

目的比较分析改良内括约肌侧切术与后切术治疗陈旧性肛裂的疗效。方法选择100例陈旧性肛裂患者,其中60例患者采用改良内括约肌侧切术（侧切组）,40例患者采用传统后正中位内括约肌切断术（对照组）。观察两组患者的术后住院时间、创面愈合时间、术后疼痛程度和术后并发症情况,并进行临床疗效比较。结果两组患者手术均成功,侧切组患者术后住院时间、创面愈合时间和术后24 h疼痛程度均明显少于对照组（t＝2．13、2．19、2．17,均P＜0．05）,侧切组患者的临床总有效率（98．3％）明显优于对照组（85.0％）（χ2＝4．67,P＜0．05）,侧切组患者术后并发症发生率（13．3％）明显低于对照组（35．0％）（χ2＝6.57,P＜0．05）。结论改良内括约肌侧切术治疗陈旧性肛裂较传统后正中位内括约肌切断术治疗具有术后疗效佳、术后住院时间短、创面愈合快、术后疼痛少和术后并发症少等优点。