简易负压封闭引流在低位蹄铁型肛周脓肿治疗中的应用

为观察采用简易负压封闭引流治疗低位蹄铁型肛周脓肿的疗效,将100例肛周脓肿患者随机分为治疗组和对照组,每组50例,治疗组采用简易负压封闭引流治疗,对照组采用单纯切开排脓术治疗,并对两组疗效进行比较。结果显示,治疗组创面愈合时间明显短于对照组（P〈0．01）;术后各时点疼痛评分治疗组低于对照组（P〈0．05,P〈0．01）;在肛门水肿方面,治疗组患者在术后第3、7、15天的评分均明显低于对照组（P〈0．05）。结果表明,简易负压封闭引流用于治疗低位蹄铁型肛周脓肿,可减轻患者术后肛门疼痛、水肿,缩短创面愈合时间。     

浮挂引流药线对高位蹄铁型肛周脓肿的作用

目的:研究浮挂引流药线对高位蹄铁型肛周脓肿煨脓祛腐的作用。方法:65例患者分为3组,均采用肛周脓肿一次性根治术。A组为浮挂引流药线组,B组为浮挂引流线组,C组为不挂浮线组。分别从术后创面疼痛程度、分泌物程度、创面愈合时间以及一次手术治愈率等方面比较疗效。结果:浮挂引流药线组在术后创面疼痛程度、分泌物程度、创面愈合时间方面均优于其他两组。结论:浮挂引流药线对高位蹄铁型肛周脓肿有煨脓祛腐的作用。     

蹄铁型肛瘘两种手术方式的疗效比较

目的:观察和评价两种手术方法治疗蹄铁型肛瘘的临床疗效。方法:将76例蹄铁型肛瘘患者随机分成试验组(多切口浮线引流术)和对照组(切缝内口引流术)各38例。观察两组病例术后疼痛、尿潴留、创面愈合时间、术后疤痕大小、肛门变形和随访1年内的复发情况。结果:两组在术后疼痛、尿潴留、疤痕大小、肛门形态与功能受损及复发率等方面有显著差异(P<0.05),对照组创面愈合时间短于试验组(P<0.05),治愈率方面无显著差异(P>0.05),试验组优于对照组。结论:多切口浮线引流术治疗蹄铁型肛瘘具有较好的效果,并能有效减少术后并发症及后遗症。     

旷置手术治疗高位蹄铁型肛周脓肿的临床分析

为探讨高位蹄铁型肛周脓肿一期根治术的临床疗效,我们分别采用旷置手术（52例,治疗组）和主管切开支管多切口引流术（53例,对照组）治疗高位蹄铁型肛周脓肿,并进行对比观察。结果显示,两组患者在一期根治疗效、手术复发情况、创口愈合时间方面均无明显差异（P〉0．05）;而在减少肛门括约肌的损伤及对肛门外观的影响方面,治疗组明显优于对照组。结果表明,旷置手术治疗高位蹄铁型肛周脓肿疗效优于主管切开支管多切口引流术。     

主脓腔低切高挂加支脓腔开窗留桥对口引流术治疗蹄铁型肛周脓肿的疗效观察

为探讨主脓腔低切高挂、支脓腔开窗留桥对口引流术治疗蹄铁型肛周脓肿的疗效,本研究将60例蹄铁型肛周脓肿患者随机分为两组,分别采用主脓腔低切高挂、支脓腔开窗留桥对口引流术（治疗组）和一期切开根治术（对照组）治疗,对比分析两组治愈率、住院时间、创面愈合时间、术后肛门功能、复发等情况。结果显示,两组患者均一次性治愈,但治疗组住院时间、创面愈合时间、术后肛门功能方面明显优于对照组,P〈0．05。结果表明,两种手术方法均能根治肛周脓肿,但主脓腔低切高挂、支脓腔开窗留桥对口引流术较肛周脓肿一期切开根治术效果更好,具有创面小、创面愈合快、疗程短、术后肛门功能损伤小等优点。     

隧道成型术治疗蹄铁型肛瘘的临床观察

分别采用隧道成型术与瘘道切开术治疗蹄铁型肛瘘,术后观察其临床效果,评估隧道成型术的优劣。将蹄铁型肛瘘患者86例随机分为两组,治疗组43例采用隧道成型术治疗,对照组43例采用瘘道切开术治疗。观察术后疼痛程度、创面愈合时间及术后肛门相关功能恢复等情况。结果显示,86例肛瘘患者全部治愈,治愈率100％。在术后疼痛程度、创面愈合时间及术后肛门功能评估等方面,治疗组优于对照组（P〈0．05）。结果表明,隧道成型术治疗蹄铁型肛瘘具有术后疼痛轻、愈合快、肛门功能恢复好等优点。     

两种术式治疗后半蹄铁型肛瘘的疗效对比分析

为探讨治疗后半蹄铁型肛瘘的手术方式及疗效,我们采用隧道式瘘管剔除对口引流术治疗后半蹄铁型肛瘘38例（A组）,隧道式拖线术治疗34例（B组）,并对两组疗效进行对比分析。结果显示,两组治愈率均为100％,其中B组4例经二次扩创后治愈,随访3年无复发。两组均无肛门畸形、肛门失禁等并发症。A组平均疗程为（26．2±3．4）d,B组平均疗程为（28．3±3．1）d。术后2级以上疼痛A组为89．5％（34／38）,平均持续时间（7．3±3．2）d;B组为94．1％（32／34）,平均持续时间（12．8±3．8）d。结果表明,隧道式瘘管剔除对口引流术治疗后半蹄铁型肛瘘疗效显著。     

中药坐浴联合银黄解毒促愈汤对促进肛周脓肿术后创面愈合的效果观察

目的：观察中药坐浴联合银黄解毒促愈汤对促进肛周脓肿术后创面愈合的效果。方法：将90例肛周脓肿术后患者随机分为对照组和观察组,每组45例。对照组患者采用中药坐浴治疗,观察组患者采用中药坐浴联合银黄解毒促愈汤治疗,治疗3周后比较2组患者创面分泌物评分、创面肉芽组织生长评分以及创面愈合时间。结果：观察组患者术后14d、21d创面分泌物评分、创面肉芽组织生长评分均低于对照组（P <0.05）;观察组患者创面愈合时间短于对照组（P <0.05）。结论：对肛周脓肿术后患者应用中药坐浴联合银黄解毒促愈汤治疗,可减少术后创面分泌物,促进肉芽组织生长,缩短创面愈合时间。     

促愈外用方熏洗对热毒炽盛型肛周脓肿术后创面愈合的疗效

目的：观察促愈外用方熏洗对热毒炽盛型肛周脓肿术后创面愈合的临床疗效。方法：采用随机数字表法将90例肛周脓肿患者随机分为对照组和治疗组各45例。两组患者均行脓肿切开引流术（低位肛周脓肿行单纯脓肿切开引流术，高位肛周脓肿行脓肿切开置管引流术）。对照组术后予以高锰酸钾溶液熏洗坐浴，治疗组予以促愈外用方熏洗坐浴。分别检测两组患者术前及术后第3天的白细胞（WBC）、C反应蛋白（CRP）、中性粒细胞与淋巴细胞比率（NLR）；比较患者术后第1、7、14天肛门疼痛、创面渗出、肉芽组织评分；在术后第21天评价两组疗效，记录创面愈合时间及不良事件；随访1年，比较两组成瘘率。结果：治疗组的炎症指标（术后第3天）、肛门疼痛（术后第7、14天）、创面渗出（术后第14天）、肉芽组织情况（术后第7、14天）、临床疗效和创面愈合时间均优于对照组（P <0.05）。治疗组成瘘率有低于对照组的趋势，但差异无统计学意义（P> 0.05）。结论：促愈外用方熏洗坐浴可有效降低肛周脓肿的炎症指标，减轻术后肛门疼痛，减轻创面渗出，改善肉芽组织，缩短愈合时间，减少术后肛瘘形成，安全有效，值得临床推广。     

保留括约肌微创改良术一期根治蹄铁型肛周脓肿的疗效分析

目的评价保留括约肌微创改良术一期根治蹄铁型肛周脓肿的临床疗效。方法采用前瞻性随机、单盲、平行对照的设计方法对2013年1月至2015年2月期间成都医学院第一附属医院及四川省第二中医医院肛肠科收治的符合纳入标准的120例蹄铁型肛周脓肿住院患者进行分析,采用随机数字表法将其随机分为保留括约肌微创改良一期根治术组(观察组)和传统放射状多切口挂线引流术组(对照组)。比较2组患者的一期愈合率、术后9 d内疼痛评分、住院时间、切口愈合时间、愈合后瘢痕面积、术后肛门功能评分、围手术期并发症、远期术后并发症及复发率。结果 2组患者手术过程均顺利。除观察组中2例、对照组中1例一期手术切口未愈经二期手术后痊愈外,2组其余患者均一期愈合。2组患者术后第1 d疼痛评分2组间比较差异无统计学意义(P0.05),术后第2~4 d及术后第7~9 d的疼痛评分观察组明显低于对照组,差异有统计学意义(P0.05)。2组患者的住院时间及愈合后瘢痕面积比较差异均无统计学意义(P0.05),但观察组的切口愈合时间和术后肛门功能评分均明显低于对照组(P0.05)。2组患者均无切口感染及大出血发生,尿潴留、肝肾功能异常发生率及血白细胞总数10.0×10~9/L2组间比较差异均无统计学意义(P0.05)。术后随访6个月,2组均未出现远期复发、肛门狭窄及肛门失禁。结论从本组的研究结果初步得出,保留括约肌微创改良术一期根治蹄铁型肛周脓肿的临床疗效确切,愈合快、术后并发症少。     

Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial

The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a gallium-aluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS?=?6 hands and bilateral CTS?=?106 hands) completed the study. Both groups I and II had n?=?56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group (p?<?0.05). LLLT therapy, as an alternative for a conservative treatment, is effective for treating mild to moderate CTS patients. It can improve hand grip strength and electroneurophysiological parameter with a carry-over effect up to 3 months after treatment for grip strength of the affected hands.     

Incisional corporoplasty for the correction of congenital penile curvature: a review of two suturing techniques

This retrospective study was designed to evaluate the surgical outcome of correction of congenital penile curvature, via multiple vertical incisions in the tunica albuginea using two different types of suture material, simple inverted 2-0 PDS sutures versus Proline 2-0 suture followed by closure with 3-0 vicryl. The study included 45 men with congenital penile curvature and surgeries were performed in four general hospitals. Patients were divided into two groups; Group A (n=24) included patients undergoing penile curvature correction using 2-0 PDS sutures; and Group B (n=21) patients undergoing the same procedure by placing an inverted Proline 2-0 suture in the middle of the suture line and completing the closure of the incision line with 3-0 vicryl. The procedures straightened the penile shaft in all cases but a degree of curvature recurred in three cases (all Group A). No operative or postoperative complications occurred and no reoperations were needed. Four patients complained of penile shortening (all Group A). No recurrence was observed in the proline group (difference not statistically significant). Horizontal plication after vertical corporal incisions is safe and effective in the treatment for congenital penile curvature without hypospadias. We advise avoiding overcorrection to prevent penile shortening.     

The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions

Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.     

Distal nerve blocks at the wrist for outpatient carpal tunnel surgery offer intraoperative cardiovascular stability and reduce discharge time

Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique. IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge.     

氟西汀治疗早泄的效果观察

目的 :评价氟西汀对早泄的治疗效果及停药后效果维持状况。方法 :将 6 8例早泄患者随机分为A组 :2 4例 ,每天口服氟西汀 2 0mg至研究结束 ;B组 :2 4例 ,每天口服氟西汀 2 0mg至 12周 ,然后改口服安慰剂至研究结束 ;C组 :2 0例 ,每天口服安慰剂至研究结束。分别测定治疗前 4周、治疗后 1周、12周、14～ 16周平均射精潜伏时间。结果 :3组治疗前平均射精潜伏时间差异无统计学意义 (P >0 .0 5 )。A组与B组平均射精潜伏时间经氟西汀治疗前后比较及与C组比较均有明显延长 ,差异有统计学意义 (P <0 .0 1) ;但B组在改服安慰剂后14～ 16周的平均射精潜伏时间与治疗前及对照组相比无统计学意义 (P >0 .0 5 )。结论 :氟西汀能显著延长射精潜伏时间 ,但停药后其疗效并不能维持。     

银离子藻酸盐敷料在不同类型手术切口中的应用效果分析

目的:探讨银离子藻酸盐敷料在不同类型手术切口中的应用效果.方法:选取本院进行腹部手术病例321例,术后切口使用普通无菌医用敷料的患者160例(对照组),其中Ⅰ类切口(清洁伤口)35例,Ⅱ类切口(相对清洁伤口)75例,Ⅲ类切口(清洁-污染伤口)50例.术后切口部位用银离子藻酸盐湿性敷料的患者161例(观察组),其中Ⅰ类切口32例,Ⅱ类切口76例,Ⅲ类切口53例.比较两组各类切口感染情况和切口愈合时间,视觉模拟评分法(VAS评分)观察换药时疼痛情况.结果:Ⅰ类切口两组感染率均为0,组间无差异(P＞0.05);Ⅱ类、Ⅲ类切口对照组感染率明显高于观察组(P＜0.05);Ⅰ类、Ⅱ类、Ⅲ类切口观察组VAS评分均低于对照组(P＜0.05);Ⅰ类切口两组愈合时间差异不显著(P＞0.05):Ⅱ类、Ⅲ类切口对照组愈合时间明显长于观察组(P＜0.05).结论:腹部手术切口使用银离子藻酸盐湿性敷料效果显著,特别是在Ⅱ类、Ⅲ类切口中使用,不仅减轻疼痛,还能降低切口感染率,缩短切口愈合时间.     

Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: its technique and clinical results

The traditional method of thoracoabdominal retroperitoneal approach requires dissection of diaphragm which bears potential complications such as postoperatively weakened abdominal breathing and dysfunction of diaphragm. Mini-open anterior instrumentation with diaphragm sparing is designed to minimize the damage to diaphragm and improve cosmesis. This study compared the traditional anterior instrumentation and mini-open anterior instrumentation under the hypothesis that both results in similar surgical outcomes in treating thoracolumbar scoliosis. In Group A, 38 patients with an average age of 16.5 years underwent mini-open anterior instrumentation with diaphragm sparing. The average standing coronal Cobb angle was 56.4° in Group A. Thirty-eight patients with average age of 16.7 years in Group B received traditional open approach. The preoperative average Cobb angle was 55.8° in Group B. The average correction rate of coronal curve was 78% in group A while 75% in group B. No statistical difference between the two groups in terms of coronal curve correction, sagittal profile restoration and estimated blood loss was observed. The operation time was significantly higher in Group A than that in Group B. All patients in the two groups had good healing of incisions without neurological and instrumental complications during minimal 2 year follow-up. In Groups A and B, two patients suffered from pleural effusion, respectively. The wedging of the vertebral discs distal to the lowest fused level occurred in three and four patients in Group A and B, respectively. One case in group B was found to be suspicious pseudoarthrosis without loss of correction. Mini-open anterior instrumentation with diaphragm sparing could minimize the surgical invasion as well as achieve similar clinical outcomes compared with classical anterior approach.     

左半结肠恶性梗阻行自扩张内支架的治疗

目的探讨金属内支架治疗左半结肠恶性狭窄的临床疗效。方法左半结肠恶性狭窄病例38例分成两组。A组24例,B组14例。A组以介入方法植入永久性结肠内支架;B组暂时植入结肠内支架解除梗阻并充分肠道准备后行外科手术。结果A组24例中23例顺利植入结肠支架,其中1例因导丝不能通过植入失败,3例植入2枚支架。B组14例均成功植入支架并顺利接受外科手术。结论自扩张式金属内支架能有效解除左半结肠梗阻,为晚期肿瘤患者提供安全有效的姑息性治疗方法并为临床手术切除创造条件。     

Ultrastructural comparison of medial collateral ligament repair after single or multiple applications of GaAlAs laser in rats

BACKGROUND AND OBJECTIVES: To examine single versus multiple applications of a gallium aluminum arsenide (GaAlAs) laser on the ultrastructural morphology of surgically injured medial collateral ligaments (MCLs) in rats. STUDY DESIGN/MATERIALS AND METHODS: Sixteen rats were studied with 12 receiving right MCL transection and 4 receiving sham injury. Group 1 (n = 4) received one session of laser (31.6 J/cm(2)) immediately after injury. Group 2 (n = 4) received 9 doses of transcutaneous laser (3.5 J/cm(2)). The controls (Group 3, n = 4) received one session of placebo laser, while the sham Group 4 (n = 4) received no treatment. Ultrastructural analyses were done with electron microscopy at 3 weeks. RESULTS: The mass-averaged diameters of collagen fibril in the core and periphery of MCLs treated with multiple laser were larger than the control and those with single laser treatment (P < 0.05). However, the sham injured group had larger fibrils than all other groups (P < 0.05). CONCLUSIONS: The repairing MCLs had smaller collagen fibrils than the sham injured ligaments. Multiple laser treatments enhanced the collagen growth in the repairing MCLs at 3 weeks after injury, which are superior to a single treatment with similar dosage.     

Prophylactic antibiotics in vascular surgery. Topical, systemic, or both?

A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to one of four groups with respect to prophylactic antibiotics. Group I received no antibiotic. Group II had topical cephradine instilled in their incisions prior to closure. Group III received a 24-hour perioperative course of intravenous cephradine, and Group IV received both topical and intravenous cephradine. Groin and abdominal incisional infections were significantly reduced (p < 0.01) among patients who received prophylactic antibiotics by either the topical, systemic, or combined routes of administration. No significant differences were noted among the three antibiotic groups. Profundoplasty, femoral embolectomy, and femoral aneurysm repair were each associated with an increased incidence of infection (p < 0.01). Other risk factors were only important in patients not receiving antibiotics. Either intraoperative topical antibiotics or perioperative systemic antibiotics prevent infection in peripheral vascular surgery, but antibiotic administration by both routes is unnecessary.