肛门后正中切开术治疗后高位蹄铁型肛周脓肿及肛瘘50例

为探寻治疗后位高位蹄铁型肛周脓肿和肛瘘的有效手术方法,减少并发症,对38例后位高位蹄铁型肛周脓肿及12例后高位蹄铁型肛瘘患者采用肛门后正中切开手术治疗。结果显示,38例肛周脓肿和12例高位肛瘘全部治愈,术后肛门外观平整,无畸形,肛门功能良好。结果表明,肛门后正中位切开手术治疗高位蹄铁型肛周脓肿和肛瘘,手术操作简单,手术时间短,术中寻找内口容易,患者痛苦小,愈合后瘢痕小,肛门功能好,疗效可靠。     

克罗恩病合并肛瘘的综合治疗

目的 探讨克罗恩病合并肛瘘的合理治疗方法.方法 回顾性分析2007年6月至2011年4月中山大学附属第六医院收治的33例克罗恩病合并肛瘘或肛周脓肿患者的临床资料.根据克罗恩病合并肛瘘的活动程度及病变范围,本研究采用外科治疗、内科治疗以及外科联合内科治疗.外科治疗方式包括肛瘘挂线术、肛瘘切除术、肛周脓肿切开引流术以及肠造口术.针对克罗恩病患者肠道病变选用5-氨基水杨酸类药物、免疫抑制剂、糖皮质激素治疗、TNF单克隆抗体等药物进行内科治疗.治疗后采用门诊治疗和电话方式随访至2012年8月.术前及术后克罗恩病活动指数(CDAI)、肛周克罗恩病活动指数(PDAI)采用独立样本t检验比较.结果 33例患者中,22例行外科联合内科治疗,7例行单纯外科治疗,4例行单纯内科治疗.首次治疗后18例患者肛瘘瘘口愈合(其中3例行单纯内科治疗),愈合时间为(3.2±2.6)个月(1 ～12个月),其中8例瘘管减少、症状改善;4例瘘口持续未闭;6例出现肛瘘复发或再发,复发或再发时间为首次治疗后(35±56)个月(5～ 148个月).33例患者术前CDAI和PDAI评分分别为(166±100)分(7～ 361分)和(9.2±2.6)分(5～16)分,经治疗后(包括手术及药物治疗)CDAI和PDAI评分分别为(83±53)分(0 ～212分)和(2.7±3.1)分(0～11分),患者治疗前后CDAI和PDAI评分比较,差异有统计学意义(t=4.20,8.92,P＜0.05).12例首次治疗肛瘘未愈合患者再次治疗后,3例愈合,9例未愈合.6例患者出现复发或再发,其中5例接受再次手术治疗(4例愈合、1例症状改善),1例仅接受内科治疗瘘口未愈合.直至随访结束,30例患者中20例肛瘘愈合,10例肛瘘未愈合.结论 目前尚无统一的克罗恩病合并肛瘘治疗标准,外科联合内科治疗克罗恩病合并肛瘘疗效较好,手术方式需根据患者具体情况慎重选择.     

Increased Body Mass Index Associated with Increased Risky Sexual Behaviors

Study ObjectiveThe increasing prevalence of adolescent obesity has led to consideration of the potential effect of obesity on risky sexual behaviors. In the current study we examined whether body mass index (BMI) was related to age at sexual debut, type of sexual behavior, partner number, and condom use in a population of adolescent women at high risk for obesity and risky sexual behaviors.Design, Setting, and ParticipantsCross-sectional examination of 860 sexually active, predominantly minority, adolescent women who received medical care at an urban health center from 2007 through 2013.Intervention and Main Outcome MeasuresSelf-reported age at sexual debut, types of sexual intercourse, number of partners and condom use was compared with clinically assessed BMI.ResultsBMI was positively associated with number of sexual partners (P = .001) and history of attempted anal intercourse (P = .002). An inverse association was observed with age at first anal intercourse (P = .040).ConclusionIn this sample of adolescent women, increased BMI was associated with riskier sexual practices at a younger age. Results of this study suggest that overweight and obese adolescents are a vulnerable population who might need targeted sexual health counseling.     

邻苯二甲酸二丁酯致雄性仔鼠肛门直肠畸形与相关基因表达的研究

目的 邻苯二甲酸二丁酯(di-n-butyl phthalate,DBP)孕晚期染毒诱导子代雄性大鼠发生肛门直肠畸形(anorectal malformations,ARMs),探讨形态学变化及相关基因的表达.方法 孕鼠20只,随机分为两组,在怀孕天数第12～18天,每日分别给予DBP及大豆油850mg/kg灌胃.出生后(PND)1d统计雄性仔鼠肛门闭锁发生率,测量雄性仔鼠体重和肛门生殖器距离(AGD),观察肛门闭锁雄性仔鼠末端直肠及肛周病理学改变.Real-time PCR法检测雄性仔鼠末端直肠组织中Shh、Gli2、Gli3、Bmp4、Wnt5a、Hoxa13、Hoxd13、Fgf10、Fgfr2基因mRNA的表达水平.结果 与对照组相比,DBP染毒组母鼠孕期体重增量减少,孕期延长,仔鼠产量降低(P＜0.05),PND 1d肛门闭锁雄性仔鼠体重及AGD较对照组明显降低(P＜0.05).染毒组雄性仔鼠肛门闭锁发生率大约为39.5％.肛门闭锁雄性仔鼠PND1末端直肠及肛周组织病理显示典型的ARMs.与对照组相比,肛门闭锁雄性仔鼠PND1末端直肠中Shh、Gli2、Gli3、Bmp4、Wnt5a、Hoxa13、Hoxd13、Fgf10、Fgfr2的mRNA表达水平较对照组也明显降低(P＜0.05).结论 DBP孕晚期染毒能明显诱导雄性仔鼠ARMs发生,并对其生长发育具有不良影响,其末端直肠组织中与肛门直肠分化发育相关的基因Shh、Gli2、Gli3、Bmp4、Wnt5a、Hoxa13、Hoxd13、Fgf10、Fgfr2的mRNA的表达水平降低可能促进ARMs的发生.     

柏硝祛毒洗剂熏洗在肛裂术后应用的疗效观察

目的:观察柏硝祛毒洗剂对肛裂术后疼痛、水肿、出血、伤口愈合指标的影响,证实其临床疗效。方法:选择120例肛裂术后患者随机分为治疗组60例(应用柏硝祛毒洗剂)和对照组60例(应用1∶5000高锰酸钾溶液),2组均熏洗20 min/次,2次/d,疗程为9 d,分别对2组术后3、6、9 d的疼痛、水肿、出血、伤口愈合指标进行观察和检测。结果:治疗组的总有效率93.33%,优于对照组的总有效率76.67%,差异有统计学意义(P0.05);组内比较,2组术后第3、6、9日疼痛、水肿、出血、伤口愈合积分均较治疗前明显降低,(P0.05或P0.01);组间比较,术后第3、6、9 d治疗组积分均明显低于对照组,治疗组疗效优于对照组,差异显著(P0.05或P0.01)。结论:柏硝祛毒洗剂用于肛裂术后,可明显减轻疼痛、水肿、出血症状,促进伤口愈合。     

Anal canal carcinoma: experience from a single Korean institution

PURPOSE: The clinical features, treatment modality approaches in clinical practice, and prognostic factors for anal canal carcinoma patients were retrospectively analyzed. MATERIALS AND METHODS: Between October 1994 and December 2005, 50 patients with anal canal cancer were treated at Samsung Medical Center, Seoul, Korea. RESULTS: After a median follow up of 37.8 months (range, 6.6-136.1 months), the 5-year and 10-year survival rates for the 38 patients with early and locally advanced squamous and cloacogenic carcinoma (squamous cell carcinoma and cloacogenic carcinoma) were 74.8% and 66.5%, respectively. The 5-year survival and disease-free survival rates (DFS) of the 31 patients who received chemoradiation therapy (CRT) were 83.6% and 74.3%, respectively. The overall and DFS could not be determined for the adenocarcinoma group due to the small number of cases (n=8). Univariate analysis showed that tumor size (p=0.04) and inguinal node status (p=0.04) significantly influenced patient survival in patients with squamous cell and cloacogenic carcinomas. Furthermore, univariate analysis also showed that, inguinal node status influenced patient survival in the adenocarcinoma group. Multivariate analysis showed that inguinal node metastasis is a single independent prognostic variable for survival (p=0.04) in patients with squamous cell and cloacogenic carcinomas. CONCLUSION: Combined CRT has been adopted as standard treatment with outcomes that are comparable to those reported in randomized clinical trials. Due to the rarity and complexity of anal canal carcinoma, interdepartmental cooperation is required for disease treatment. Thus, proper treatment of patients should incorporate a team-approach and should be available to as many patients as possible.     

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.     

手术后温水足浴促肛门排气时间提前的临床观察

根据足部反射区理论，对８９例妇产科三类手术后病人进行温水足浴，肛门排气时间较８１例对照组病人明显提前，有显著性差异。此法操作简单，不受条件限制，既促进了手术后病人康复，又密切了护患关系，也提高了病人对护理工作的满意度