AN UNUSUAL CAUSE OF RECTOVAGINAL FISTULA

An unusual case of rectovaginal fistula is reported. An 81 year old woman presented to the geriatric team with a request to review her faecal incontinence. It was discovered that she had a predilection for placing foreign objects in her vagina. In this instance a carbonated drink top had formed a rectovaginal fistula.     

Vesicocutaneous fistula: An unusual complication of inguinoscrotal hernia

Involvement of the urinary bladder in an inguinal hernia is common, but massive bladder hernia is rare. Most urinary bladder herniations are discovered and repaired during surgery. We report a case of large incarcerated inguino-scrotal hernia, which was reduced only to present as a scrotal abscess and vesicocutaneous fistula; an unusual complication. The patient was managed conservatively due to underlying comorbidities.     

次侧切术治疗期肛裂前后肛门直肠压力对比分析

目的 :探讨次侧切开内括约肌治疗肛裂术前、术后肛门直肌压力的变化。方法 :采用自行设计的次侧方内括约肌切开加双缘结扎术治疗 期肛裂 6 0例 ,测定手术前后肛门直肠压力 ,并与 6 0例正常人肛压比较 ,评价新术式治疗 期肛裂的临床疗效及其对肛门功能的影响。结果 :显示术后患者肛管静息压显著降低 ,与术前比较有显著性差异 (P <0 .0 1) ,与正常人比较无显著性差异 (P>0 .0 5 ) ;肛管最大收缩压与术前及正常人比较无显著性差异 (P>0 .0 5 )。结论 :次侧方内括约肌切开加双缘结扎术能有效地解除内括约肌痉挛 ,从根本上消除高肛压 ,从而彻底治愈肛裂 ,而且不影响肛门功能。     

Off-pump resection of a coronary arterial fistula using the Harmonic Scalpel

Off-pump surgery was performed in a patient with post-infarction angina complicated with aneurysmal coronary-pulmonary arterial fistula. Epicardial echocardiography localized the artery feeding the fistula in the myocardium, which had not been revealed by visual inspection, palpation, or transesophageal echocardiography. The patient underwent off-pump coronary artery bypass grafting concomitant with aneurysmectomy. The feeding arteries were dissected easily using a Harmonic Scalpel and ligated. The flow in the aneurysm disappeared immediately and aneurysmectomy was performed without bleeding.     

重组人表皮生长因子应用于肛裂手术的临床研究

目的：研究外源性表皮生长因子对于肛裂手术后的手术创面愈合情况的影响。方法：肛裂手术后，治疗组患者每日用重组人表皮生长因子敷于肛管创面，对照组患者采用常规的方式换药。比较两组患者术后伤口疼痛、出血情况，以及伤口肉芽生长愈合情况。结果：治疗组在减轻术后伤口疼痛、伤口水肿和出血等方面均显著优于对照组，其平均住院时间和伤口愈合时间也显著短于对照组。结论：外源性表皮生长因子有助于肛裂术后创面的快速修复，减轻患者的痛苦。     

肛门病手术应用低浓度小剂量利多卡因局麻的效果

目的观察低浓度小剂量利多卡因在肛门病手术中的应用效果。方法选择接受肛门病手术者100例,手术时用0．25％盐酸利多卡因5-20ml,根据病情和手术需要作局部浸润麻醉。结果通过100例的肛门手术观察,结果显示麻醉满意顺利83例,麻醉良好17例,无1例麻醉无效失败。总有效率100％。此法麻醉效果确切,未发现严重不良反应。结论此法具有易于掌握,效果好而安全的优越性,适于临床应用和推广。     

带膜金属支架治疗食管癌术后胸内吻合口瘘的临床研究

目的探讨镍钛记忆合金带膜内支架在治疗食管癌术后胸内吻合口瘘中的应用价值。方法在X线电视透视下对22例食管癌术后胸内吻合口瘘患者进行镍钛记忆合金带膜内支架植入治疗。结果19例一次植入成功，成功率86％，恢复正常饮食；不完全封堵瘘口3例（14％）；16例术后出现轻度的胸骨后疼痛不适或胃液反流的症状；1例出现上消化道大出血。22例病人均治愈出院，治愈率100％。结论镍钛记忆合金带膜内支架植入治疗食管癌术后胸内吻合口瘘成功率高，治愈率高，操作简单，安全，见效快，并发症少，有效解除患者痛苦，宜在临床上推广使用。     

Treatment of iatrogenic biliary obstruction by balloon dilatation of a biliary jejunal fistula

Biliary obstruction and multiple hepatic abscesses occurred in a patient after ligation of a segmental branch of the right hepatic duct. The patient was successfully managed by transhepatic biliary drainage and balloon dilatation of an internal fistula that developed between the ligated duct and a Roux limb of jejunum. Internal biliary fistulas may be dilated using interventioanl radiologic techniques to permit nonobstructed bile flow. Implications for the nonsurgical treatment' of biliary strictures are discussed.     

克罗恩病并发肠瘘的诊断与治疗

目的探讨克罗恩病(CD)并发肠瘘的诊断与治疗方法。方法对1978至2004年收治的62例CD并发肠瘘患者的临床资料进行分析。结果本组肠外瘘68例次,其中多发瘘6例次;肠内瘘8例次。肠瘘以末端回肠瘘(27例次)和回结肠吻合口瘘(21例次)为主。手术方式主要为回结肠吻合口拆除重建(26例次)和回盲部切除回结肠吻合(14例次)。首次肠瘘、术后服用免疫药物者复发率15.4%,明显低于未服药患者(34.8%);复发时间为(40±17)个月,明显长于不服药组的(8±3)个月;两组比较,P<0.01。结论CD合并的肠瘘以肠外瘘为主。主要手术方法为瘘口切除与肠吻合术。术后应用免疫抑制药物可降低CD合并肠瘘的复发率。     

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。