肛管良性疾病外科治疗的现状与展望

肛管良性疾病包括痔、肛裂、肛瘘、直肠脱垂、排便障碍型便秘等。随着生活水平的逐步提高，对肛管良性疾病的研究越来越重视，其理论水平和外科技术都获得明显提高。痔的发病机制研究和外科治疗、排便障碍型便秘的机制研究等是我国结直肠肛门外科的热点问题。     

结直肠肛门良性疾病的诊疗进展

正结直肠肛门良性疾病是临床的常见病和多发病,包括痔病、肛瘘、肛裂、直肠脱垂、直肠阴道瘘等。随着国人生活水平和健康意识的提高,因结直肠肛门良性疾病就诊和住院治疗的患者不断增加,越来越多的综合性医院相继成立肛肠外科或结直肠外科以满足患者的就医需求;同时,我国结直     

对直肠肛管良性疾病的认识及其发展

直肠肛管良性疾病主要包括痔、直肠肛管周围脓肿、肛瘘、肛裂、直肠脱垂、肛门失禁、直肠肛管狭窄和肛门周围的一些皮肤病等,具有发病率高、症状反复、对人体影响较小、容易忽视等特点。随着人民生活水平的提高,直肠肛管良性疾病越来越受到重视,现拟对最为常见的痔、脓肿和肛瘘、肛裂在诊治发展中一些值得关注的问题进行概述。一、痔痔是肛门部最为常见和多发的疾病,人们对痔的认识已有4000余年的历史,但对痔的概念、分期及有关治疗仍然存在争议。1.痔的传统概念及新认识:长期以来都认为,如果存在于直肠下端或肛管的丰富静脉丛,一处或数处发…     

重视肛管直肠良性疾病的诊断与治疗

重视肛管直肠良性疾病的诊断与治疗第二军医大学长海医院肛肠诊治中心（２００４３３）喻德洪肛管、直肠良性疾病包括内外痔、肛周感染、肛瘘、肛裂、直肠脱垂、肛管乳头肥大、直肠息肉、肛管直肠良性肿瘤、出口处梗阻型便秘及肛门失禁等疾病。其中以肛管疾病最多。肛管直...     

重视肛周疾病的诊治

重视肛周疾病的诊治喻德洪肛周疾病包括肛门周围、肛管及直肠下端的疾病，其特点是：（１）病种多：包括内外痔、肛周感染、肛瘘、肛裂、直肠脱垂、肛管乳头肥大、直肠下端息肉、肛管及直肠下端良性及恶性肿瘤、出口梗阻型便秘、肛周皮肤病及肛门失禁等病，其中以肛管疾病...     

2009年全国结直肠肛门外科新技术新进展（良性疾病）研讨会征文及会议通知

由《中华胃肠外科杂志》、中华中医药学会肛肠专业委员会和湖南省肛肠外科学组主办,湖南省人民医院承办的（2009年全国结直肠肛门外科新技术新进展（良性疾病）研讨会（国家级医学继续教育项目[2009-04-01-099（国）]）》。定于2009年8月28日～31日在湖南省长沙市举办。本次研讨会主要就结直肠肛门实用解剖、结直肠肛门良性肿瘤、直肠脱垂、肛周脓肿、痔、肛瘘、慢性便秘等常见问题、疑难病诊治方面的新技术、     

2009年全国结直肠肛门外科新技术新进展（良性疾病）研讨会征文及会议通知

由《中华胃肠外科杂志》、中华中医药学会肛肠专业委员会和湖南省肛肠外科学组主办，湖南省人民医院承办的《2009年全国结直肠肛门外科新技术新进展（良性疾病）研讨会（国家级医学继续教育项目【2009—04—01—099（国）】）。定于2009年8月28～31日在湖南省长沙市举办。本次研讨会主要就结直肠肛门实用解剖、结直肠肛门良性肿瘤、直肠脱垂、肛周脓肿、痔、肛瘘、慢性便秘等常见病、疑难病诊治方面的新技术、新进展进行研讨。     

经肛门切除治疗乙状结肠直肠外科疾病的研究进展

直肠和乙状结肠外科疾病不论是在成人还是儿童都有相应的病种和人群，其中儿童以良性疾病为多，但往往影响小儿的生长发育，而成人的乙状结肠、直肠外科疾病可为良性、潜在恶性和恶性疾病。传统的肛门直肠外科疾病如肛瘘、肛裂、痔、低位直肠息肉和部分直肠脱垂等经肛门手术均取得满意疗效，而对一些直肠潜在恶性和恶性疾病则多需经腹、腹会阴、骶会阴或经肛门括约肌途径切除，不仅手术创伤大，特别是部分直肠癌患者术后永久的人工肛门护理困难，严重影响患者的生活质量。     

重视肛门良性疾病手术治疗中的功能保护

肛门良性疾病临床常见,其中痔、肛瘘和肛裂占据结直肠外科手术前3位,术后排粪失禁或污粪尚未得到足够重视。本文从临床现状、功能评估流程和方法、功能保护策略以及治疗方法等方面做了论述。重视肛门良性疾病手术治疗中的功能保护,需要专科医生以患者为中心,关注治疗的核心目的不仅从疾病本身出发,更应重视提高患者的生活质量。     

直肠肛管良性疾病的诊治现状

直肠肛管良性疾病主要包括痔、肛瘘、肛裂、慢性非特异性便秘和直肠脱垂等,现对其诊治现状作一分析。一、痔的诊治现状近年来认为,痔是肛垫发生病理性肥大和移位所致。肛垫是位于直肠末端的组织垫,为平滑肌纤维、结缔组织及血管丛构成的复合体,其功能是协助肛门括约肌完善肛门的闭锁。对肛垫的全新认识使我们对控便机制有了更深入的理解,更重要的是,直接导致产生了有关痔起源的肛垫下移学说和痔治疗方式的改变。根据现代痔的概念,痔的治疗原则是治疗痔的症状而不是根治痔本身。目前认为,痔无症状不需要治疗,只有合并脱垂、出血、嵌顿和血栓…     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.