复方丹参注射液在肛门病术后应用的临床研究

目的探讨复方丹参注射液在肛门病术后应用的止痛促愈作用和机制。方法收集2008年12月至2010年1月我科收治肛门疾病手术患者120例,随机分为治疗组和对照组,治疗组手术创面局部注射加静脉点滴复方丹参注射液,对照组不应用复方丹参注射液,手术方式及余治疗方式与治疗组相同,术后评价创面疼痛、水肿积分及创面愈合情况;同时于术后24h、48h分别采集患者的外周静脉血,应用放免法检测患者血清TXB2、6-Keto-PGF1a的水平。结果治疗组术后疼痛及水肿积分明显低于对照组;与对照组相比较,治疗组局部创面愈合时间缩短;治疗组患者血清中TXB2、6-Keto-PGF1a水平降低。结论肛门病术后应用复方丹参注射液,具有止痛促愈的作用,其作用可能和调节TXA2与PGI2水平有关。     

保肛术联合放、化疗治疗低位中晚期直肠癌的临床观察

目的探讨保肛术联合放、化疗对低位或超低位中晚期直肠癌的临床疗效。方法 2006年8月至2010年12月在我院行保肛术的低位或超低位直肠癌患者56例(保肛手术组),以及同期行Miles手术的直肠癌患者64例(Miles手术组),比较两组患者术中、术后一般情况以及随访两年复发和死亡情况。结果保肛手术组手术时间、术中出血量和住院时间均显著低于Miles手术组,差异具有统计学意义(P<0.05);而两组间术后排气时间及术后留置导尿管时间差异无统计学意义(P>0.05)。保肛手术组2年后复发率为14.3%,死亡率为23.2%,Miles手术组复发率为14.1%,死亡率为23.4%,两组相比,差异无统计学意义(P>0.05)。结论保肛手术联合放、化疗可以显著提高低位或超低位中晚期直肠癌患者的生活质量,并且近期疗效和远期疗效与miles手术并无差异。     

Angiogenesis, proliferation, and apoptosis in anal high-grade squamous intraepithelial lesions

PURPOSE: Management of anal high-grade squamous intraepithelial lesions is controversial. Anal and cervical high-grade squamous intraepithelial lesions are similar in that they occur in transitional squamous epithelium, are associated with human papilloma virus infection, and have increased incidence in the immunocompromised population. Ablation of cervical high-grade squamous intraepithelial lesions is preferred, but similar ablation or excision of anal high-grade squamous intraepithelial lesions may compromise bowel control; thus, there is a need to define the malignant potential of anal high-grade squamous intraepithelial lesions. METHODS: We analyzed 50 paraffin sections of normal anoderm, anal low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and anal squamous-cell carcinoma. Microvessels were detected immunohistochemically with von Willebrand factor and counted manually along the epithelial-stromal junction. Proliferation and apoptosis were determined in the epithelial cells with MIB-1 antibody immunostaining and the terminal deoxynucleotidyl transferase-mediated digoxigenin-11-dUTP nick end labeling, respectively. RESULTS: Microvascular density was significantly greater in anal high-grade squamous intraepithelial lesions (mean, 0.50 vessels/cm)vs. normal anoderm (mean, 0.21 vessels/cm;P=0.0017, Mann-WhitneyU test). The proliferative percentages were greater in low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and squamous-cell carcinoma (mean, 20.4, 21.8, and 23.6 percent)vs. normal anoderm (mean, 14.4 percent), although not significantly (P=0.06, Kruskal-Wallis statistic). Although the mean proliferative proportions were similar in low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions, the apoptotic proportion was lower for high-grade squamous intraepithelial lesions than low-grade squamous intraepithelial lesions (10.13vs. 19.96 percent, respectively;P=NS, Mann-WhitneyU test). CONCLUSIONS: Angiogenesis, increased proliferation, and decreased apoptosis occur in anal high-grade squamous intraepithelial lesions as they do in the cervix before the development of malignancy. These biologic markers support the importance of anal high-grade squamous intraepithelial lesions as a potential premalignant lesion warranting surgical intervention.Supported by a grant from the National Institutes of Health (DDDN, NIDDK KO8 DK 02507-03).Podium presentation at The American Society of Colon And Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

Transrectal ultrasonography: relationship with anorectal manometry, electromyography and sensitivity tests in irritable bowel syndrome

Irritable bowel syndrome is the most frequently diagnosed disorder in gastroenterology. It has been demonstrated with specialized motility studies that these patients compared to healthy subjects show changes in rectoanal electrical and mechanical activity and in rectoanal sensitivity. However, until now no report has been published on morphological alterations in the rectum or the internal anal sphincter. Twenty-five consecutive patients with irritable bowel syndrome (mean age 32, range 17–47 years; 24 females) were evaluated prospectively by transrectal ultrasonography, rectal sensitivity studies, and recordings of both electrical and mechanical activity of the distal rectum and internal anal sphincter during a 2-h interdigestive period. Ten healthy volunteers (mean age 34.5, range 19–50 years) served as a control group. Paired and non-paired Student's two-tailed t test and linear regression analysis were used. It was shown that muscle thickness of the rectum during rest (4.7±0.1 mm) was correlated neither with its rectal spike amplitude (0.73±0.1 mV) nor with rectal spike frequency (17.06±3.6 spike/2 h). In addition, the diameter of the internal anal sphincter (1.2±0.1 mm) was correlated neither with its resting pressure, nor with frequency (17.1±3.2/2 h), duration (14.9±1.5 s), or amplitude (14.1 ±1.9 mmHg), of inhibition of the spontaneous rectoanal inhibitory reflex. No correlation was found between ultrasonographic parameters and rectal distension variables (r=0.03). This study demonstrates for the first time morphological anorectal changes in patients with irritable bowel syndrome compared to healthy subjects, in addition to showing that morphological changes are independent of physiological ones. Therefore both transrectal ultrasonography to determine anorectal morphology and electromanometry to assess anorectal function are important measures in the evaluation of patients with irritable bowel syndrome. Accepted: 21 November 1997     

肛门直肠测压在先天性巨结肠及巨结肠同源病中的应用进展CSCD

Anorectal manometry (ARM) is a non-invasive clinical tool of detecting anorectal rectal motion reflexes with a pressure detection device. It has been widely employed for diagnosing and treating Hirschsprung’s disease and allied disorders due to the advantages of mini-invasiveness, non-radioactivity, rapidness and convenience. However, its diagnostic value has remained controversial. This review summarized the application of ARM in recent years and discussed its shortcomings to help better diagnose the diseases, evaluate the prognosis, improve patient quality-of-life and provide new rationales for in-depth ARM researches. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

分段切除伴肛门整形术治疗环状外痔为主混合痔的远期疗效观察

目的 评价分段切除伴肛门整形术治疗环状外痔为主混合痔的远期疗效.方法 采用多中心随机对照试验,将符合环状外痔为主混合痔的300例患者随机分为试验组和对照组,每组各150例,试验组采用分段切除伴肛门整形术,对照组采用混合痔外剥内扎术.术后1年及18个月随访,观察两组术后肛门狭窄、肛门功能、旺门平整度及满意度情况.结果 两组患者在肛门功能、肛门平整度和满意度上,差异有统计学意义(P＜0.05).结论 分段切除伴肛门整形术治疗环状外痔为主混合痔,远期疗效确切,术后随访并发症少,患者满意度高.     

产程中阴道检查代替肛门检查的临床观察

目的 探讨在产程的观察过程中使用碘伏消毒行阴道检查替代肛门检查的临产观察.方法 在产程观察过程中使用使用-山东利尔康碘伏消毒液,其有效碘含量在4.5~5.5/15%的碘伏消毒会阴部行阴道检查(以下用5%的碘伏或碘伏表示).结果 310例产妇无一人感染,可靠率100%.结论 在产程观察过程中,使用5%的碘伏消毒会阴部行阴道检查替代肛门检查在临产上是可以使用的.     

Chemoradiotherapy for Squamous Cell Cancer of the Anal Canal: A Systematic Review

Squamous cell cancer of the anal canal is a rare tumour for which there remains uncertainty regarding optimal therapy. A systematic review was conducted to summarise the evidence examining concurrent chemotherapy and radiotherapy or different chemotherapy regimens in combination with radiotherapy. MEDLINE, EMBASE and conference proceedings were searched for relevant randomised controlled trials. Outcomes of interest were colostomy rate, local failure, overall survival, disease-free survival, adverse effects and quality of life. Six randomised controlled trials were identified. Two trials reported lower colostomy and local failure rates for concurrent 5-fluorouracil (5-FU) plus mitomycin C (MMC) and radiotherapy compared with radiotherapy alone. The omission of MMC from this regimen resulted in higher colostomy and local failure rates and lower disease-free survival. Induction chemotherapy followed by concurrent 5-FU plus cisplatin and radiotherapy resulted in a higher colostomy rate than concurrent 5-FU plus MMC and radiotherapy. Haematological toxicity rates were lower in patients who received radiotherapy with 5-FU alone or 5-FU plus cisplatin compared with 5-FU plus MMC. No benefit was seen for the addition of induction or maintenance chemotherapy to concurrent chemoradiotherapy. The available evidence continues to support the use of radiotherapy with concurrent 5-FU and MMC as standard treatment for cancer of the anal canal to decrease colostomy and local failure rates.     

Malignant melanoma of the anus

The authors present a report of 12 patients with anal melanoma (AM) and review 255 cases reported since 1947. Combining these patients with those from the literature, the authors analyze several aspects of AM that are controversial or have not been studied in a systematic manner. The mean clinical tumor size was 4.1 cm. Seventy per cent were grossly pigmented, 63 per cent were polypoid, and 44 per cent were prolapsed. Two-thirds of AM were located in the proximal pecten, at or near the level of the anal valves. Microscopically, the most useful diagnostic criteria were melanin production, junctional change, and a nesting growth pattern. In four of the authors’ cases, atypical junctional change extended laterally from the overt invasive neoplasm for distances up to 1 cm. Approximately 60 per cent of patients had metastases at the time of diagnosis. There was no statistical difference in determinate survivals of patients treated for cure by local excision and abdominoperineal resection. Neither tumor size nor configuration affected survival. The choice of therapy was not influenced by tumor size. Read in part at the annual meeting of the International Academy of Pathology, Boston, Massachusetts, March 2, 1982. Dr. Mills is an American Cancer Society Junior Faculty Clinical Fellow.