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.     

大网膜人工窦道预防胆管引流管拔出后胆漏的动物实验研究

目的探讨采用带蒂大网膜在胆管引流管周围做成人工窦道的方法及效果。方法建立实验兔胆管引流动物模型。100只新西兰大白兔随机分为2组,即实验组及对照组。每组再随机分成5个亚组,每亚组10只,在手术后3、6、9、12、15d分别剖腹了解5亚组中一亚组胆管引流管窦道形成情况,并取部分窦道壁送病理检查。结果实验组在不同时间点,窦道完全形成动物数分别为:3d8只,6d10只,9d10只,12d10只,15d10只;对照组分别为:3d1只,6d1只,9d2只,12d3只,15d4只。两组比较差异有统计学意义(P<0.01)。结论采用带蒂大网膜在胆管引流管周围形成人工窦道的方法简单、实用,不仅可缩短留置T管的时间,而且可有效防止拔T管后胆漏的发生,值得临床推广使用。     

女性尿瘘的治疗体会(附13例报告)

目的　探讨女性尿瘘的诊治,对巨大复杂的膀胱尿道阴道瘘的手术修补法进行探讨。方法　经阴道修补膀胱阴道瘘4例, 尿道阴道瘘3例,膀胱尿道阴道瘘2例,经腹阴道联合途径修补复杂性女性尿瘘4例,其中输尿管阴道瘘1例。结果　一次性修 复痊愈率(甲级)达84.6%、有效率(乙级)达92.3%。结论　术前仔细检查及评估手术方案是缩短手术时间、减少术中创伤的重 要环节,精细的外科手术技巧是确保手术成功的关键,经腹阴道联合手术途径修补术是治疗巨大复杂女性尿瘘的有效方法。     

经未显影的岩下窦途径栓塞海绵窦区硬脑膜动静脉瘘

目的探讨经未显影的岩下窦途径栓塞海绵窦区硬脑膜动静脉瘘(CSDAF)的治疗方法。方法回顾性分析7例CSDAF病人的临床资料,均经未显影的岩下窦插管,以微弹簧圈栓塞海绵窦和瘘口。结果5例插管成功并达到完全致密栓塞;2例导管虽插入海绵窦,但海绵窦分隔致导管位置与瘘口不相通,而改行面静脉-眼静脉途径插管行栓塞治疗。7例病人均治愈,随访5～20个月,均无复发。结论经岩下窦途径栓塞是CSDAF最常用的治疗方法,即使岩下窦未显影,也有相当部分病人可插管和治疗成功。     

血液透析动静脉瘘的建立及并发症的处理

目的 通过对238例内瘘患者的总结，探讨更好的血透患者的内瘘手术方法及并发症的治疗。方法 总结我院从1998年至今实行的内瘘手术238例，分别采用钛轮钉和显微外科血管吻合术建立动静脉瘘。手术部位多位于前臂桡侧腕横纹上3～5cm或鼻烟窝处将头静脉与桡动脉作端端或端侧吻合，前臂尺侧腕横纹上贵要静脉与尺动脉端侧吻合。比较各种类型的内瘘的成功率和并发症发生率。结果 显微外科血管吻合术制作的内瘘成功率高，并发症少，6年的内瘘通畅率达90％以上。结论采用动静脉直接吻合制作内瘘是建立血透患者血管通路的良好方法。     

Sentinel Bleeding After Pancreaticoduodenectomy: A Disregarded Sign

Introduction Delayed massive hemorrhage induced by pancreatic fistula after pancreaticoduodenectomy is a rare but life-threatening complication. The purpose of this study was to analyze the clinical course of patients with late hemorrhage, with or without sentinel bleeding, to better define treatment options in the future. Material and Methods From April 1998 to December 2006, 189 pancreaticoduodenectomies were performed. Eleven patients, including two patients referred from other hospitals, were treated with delayed massive hemorrhage occurring 5 days or more after pancreaticoduodenectomy. Sentinel bleeding was defined as minor blood loss via surgical drains or the gastrointestinal tract with an asymptomatic interval until development of hemorrhagic shock. The clinical data of patients with bleeding episodes were analyzed retrospectively. Results Eight of the 11 patients had sentinel bleeding, and seven of them had it at least 6 h before acute deterioration. Seven out of 11 patients died, five out of eight with sentinel bleeding. No differences could be detected between patients with or without sentinel bleeding before delayed massive hemorrhage. The only difference found was that non-surviving patients were significantly older than surviving patients. Delayed massive hemorrhage is a common cause of death after pancreaticoduodenostomy complicated by pancreatic fistula formation. The observation of sentinel bleeding should lead to emergency angiography and dependent from the result to emergency relaparotomy to increase the likelihood of survival.     

创伤性肾动静脉瘘的介入治疗

目的 评价用介入技术治疗创伤性肾动静脉瘘(RAVFs)的安全性和疗效。方法 对8例不适宜做外科治疗的RAVFs患者进行了介入治疗，其中外伤性损伤4例，医源性损伤4例。6例行经导管超选择性肾动脉内钢丝圈栓塞术，2例行被覆膜支架置入患侧肾动脉内封闭瘘口。结果 血管造影显示肾内型动静脉瘘4例，累及肾动脉段-亚段级分支；主干(肾外)型动静脉瘘4例。治疗均获成功，治疗结束时复查血管造影显示瘘口被封闭。轻微并发症1例。医源性RAVFs患者术后失血症状迅速改善，肉眼血尿消失；4例术前存在心脏负荷过度症状患者，闭塞动静脉瘘后症状迅速改善，血管杂音消失。术后肾功能测定均属正常范围，其中2例肾动脉被覆膜支架置入患者，同位素肾扫描显示患侧肾脏形态、功能正常。术后随访10～42个月，2例分别于术后10，18个月死于与RAVFs无关的疾病。6例仍然生存，一般情况良好，未再针对RAVFs进行外科或介入治疗。结论 介入技术，包括经导管超选择性肾动脉内栓塞术和被覆膜支架置入术，是治疗创伤性、复杂型RAVFs的安全、有效的方法。     

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。     

体部表面线圈磁共振成像对肛瘘的术前诊断价值

目的:探讨体部表面线圈MRI对肛瘘的术前诊断价值。材料和方法:回顾性分析42例肛瘘患者,均于术前进行非增强MRI检查,将MRI结果与手术结果对照。结果:MRI诊断结果与手术结果一致,其中23例为括约肌间型,5例经括约肌型,5例括约肌上型,9例括约肌外型,所有病例中有12例可见肛周脓肿形成。结论:MRI作为一种安全、准确的肛瘘检查方法,对于肛瘘的术前诊断具有非常重要的价值。