肛周子宫内膜异位症1例

患者女,44岁。因肛周肿痛、流脓水3个月以“肛瘘”收入我院。3个月前患者肛周出现一包块,肿胀疼痛,在当地卫生院诊断为“肛周脓肿”予以切开排脓,术后切口缩小,但不愈合,时常流脓性分泌物。入院时见肛旁11点位距肛缘3cm处有一切口,未愈合,触之有硬索条通向肛内11点位肛窦区。行肛瘘瘘管切除术,术中见瘘道内残留有白色浑浊物,故取部分瘘管壁行活组织检查。病理报告示肛周子宫内膜异位症,患者转往外地医院治疗。     

肛周子宫内膜异位症1例

子宫内膜异位症(内异症)是育龄妇女的常见病。子宫内膜异位症多发生在盆腔脏器,也可发生在宫颈,阴道,会阴和腹部手术切口。与剖宫产手术相关的腹壁子宫内膜异位症是较常见的盆腔外内膜异位症,而肛周子宫内膜异位症临床并不多见。我院于2006年2月收治1例肛周子宫内膜异位症患者,报告如下。患者,女,31岁,因“肛旁肿痛伴流血水反复发作4月余”由门诊拟“肛旁肿物”收治入院。患者于4个月前因肛旁肿痛,曾在当地医院就诊,诊断为“肛瘘”,给予手术治疗(切开旷置),切除组织未做病理切片检查。术后切口未愈合,伴少量血性分泌物自切口外溢,月经期切口…     

糖尿病人内痔注射术后继发肛周巨大脓肿1例

糖尿病人内痔注射术,一般视为禁忌,但由于基层医院行内痔注射术前询问病史不仔细,导致术后继发肛周感染,仅采取简单的对症处理,而未严格控制血糖水平,感染进一步扩大,形成肛周、尾骶部、腰骶部、髂腰部巨大脓肿,给进一步的治疗带来很大的麻烦和困难。１９９９年１１月２０日我科收治１例糖尿病人内痔注射术后继发肛周巨大脓肿,报告如下。患者女,３３岁．因“内痔注射术后肛周、尾骶部、腰骶部肿痛,流脓伴发热半月”于１１月２０日入院。患者半月前因“痔疮伴出血”在某医院行“内痔注射术”,术后肛门周围、尾骶部肿痛,并逐日加…     

去顶开窗手术治疗肛周化脓性汗腺炎疗效分析（附12例报告）

目的探讨去顶开窗术治疗肛周化脓性汗腺炎的疗效。方法对12例肛周化脓性汗腺炎患者采用去顶开窗手术治疗的临床资料作回顾性分析。结果2例患者术后平均6个月复发,再次手术后痊愈。10例患者术后平均随访33个月,治疗部位无复发。结论去顶开窗手术是一种有效、简单、微创、保留组织的外科治疗技术,适用于肛周化脓性汗腺炎的治疗。     

胰十二指肠切除术后胰肠吻合口假性囊肿自发性破裂1例报道

<正>病例资料患者,男,67岁,因"胰腺癌术后18个月"入院。患者于18个月前诊断为胰腺癌,行胰十二指肠切除术,术后恢复顺利,于术后2周出院,术后行放疗。术后12个月因腹腔系膜多发转移及腹壁切口转移行吉西他滨、奥沙利铂化疗3个周期。病程中患者多次并发肠梗阻,第3次化疗结束后2 d,患者夜间出现中上腹持续性疼痛,程度剧烈,并伴有呕吐,给予禁食、胃肠减压、抗感染等对症治疗后无缓     

急性环状嵌顿痔术后复方丹参注射液肛周注射临床疗效观察

目的探讨复方丹参注射液肛周注射在急性环状嵌顿痔术后的临床应用效果。方法对同期收治的急性环状嵌顿痔患者随机分成治疗组和对照组各100例,分别采用和不采用复方丹参注射液肛周注射治疗,对临床疗效进行对比观察。结果治疗组术后疼痛程度、水肿程度、切口瘢痕形成率均低于对照组;切口愈合时间短于对照组。结论急性环状嵌顿痔术后应用复方丹参注射液肛周注射能有效地缩短切口愈合时间,减轻术后疼痛、水肿及切口瘢痕形成。     

肛周化脓性汗腺炎13例临床分析

目的总结肛周化脓性汗腺炎的临床特点、诊断及治疗方法。方法回顾性分析我院肛肠外科2013年1月至2015年12月期间收治的13例肛周化脓性汗腺炎患者的临床资料。结果全部病例均行外科手术治疗,术中切开所有瘘管,彻底清除瘘管壁,术后给予抗炎、换药等治疗。手术时间(50±6)min,住院时间平均16.3 d,伤口愈合时间平均45.6 d。随访半年,1例患者4个月后局部复发再次入院,以同样手术方式治疗后治愈。其余患者均治愈,未复发,无失禁,愈合后肛周切口形成瘢痕,无感染。结论肛周化脓性汗腺炎诊断主要依据临床表现及病理学检查,误诊率高,治疗以手术为主。早期诊断,及时治疗,手术彻底,是治愈肛周化脓性汗腺炎、降低复发的关键。     

Gant-Miwa联合肛门环缩及消痔灵注射术治疗16例直肠全层脱垂的临床观察

目的 评价Gant-Miwa联合肛门环缩及消痔灵注射术治疗直肠全层脱垂的疗效.方法 回顾性分析2011年2月-2014年11月在沈阳军区总医院接受Gant-Miwa联合肛门环缩及消痔灵注射术的16例直肠全层脱垂患者的临床资料.结果 16例患者均手术顺利,术后脱垂症状消失,3例出现尿潴留,2例出现肛周术区感染而复发,1例肛周切口延迟愈合,2例出现直肠狭窄致便秘,无大出血、肛周脓肿、肛瘘等并发症,无围手术期死亡病例.术后13例患者接受了平均2.2年的随访,2例直肠脱垂复发.结论 Gant-Miwa联合肛门环缩及消痔灵注射术治疗直肠全层脱垂手术创伤小、术后并发症少、复发率较低,经创新及改良后更值得广泛开展.     

内括约肌侧切联合肛周皮瓣移植术治疗32例Ⅲ期肛裂的临床效果观察

目的探讨内括约肌侧切联合肛周皮瓣移植术治疗Ⅲ期肛裂的临床疗效。方法将2015年3月至2017年3月广东省中医院珠海医院肛肠科收治的32例符合条件的III期肛裂患者纳入研究,所有患者均行内括约肌侧切联合肛周皮瓣移植术,记录手术时间、住院时间、创面愈合时间、切口感染及术后复发情况。结果 32例患者平均手术时间(38.41±4.41)min,平均住院时间(8.19±1.26)d,平均愈合时间(11.03±1.09)d,无切口感染发生,术后随访3~12个月未见复发病例。结论内括约肌侧切联合肛周皮瓣移植术治疗Ⅲ期肛裂疗效确切,创面愈合时间短,术后复发率低。     

肛周坏死性筋膜炎的外科处理

目的总结结肠造口在肛周坏死性筋膜炎外科处理中的意义。方法4例肛周坏死性筋膜炎患者中，2例行乙状结肠造口；2例行肛周扩创引流术及抗炎、对症治疗。结果行乙状结肠造口的2例患者术后均恢复良好。行肛周扩创引流术的2例中，1例术后第3天出现上消化道出血，低血容量性休克和感染性休克，入院后第5天死亡：1例术后感染症状仍不能快速控制，患者全身情况继续恶化并放弃治疗。结论肛周坏死性筋膜炎在肛周感染无法迅速阻断时，实施结肠造口术有效。     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7–, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20–, MUC2–). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

Oddi括约肌肌电活动实验模型的建立

目的建立研究Oddi括约肌肌电活动的动物模型和实验方法。方法将双极金属钩状电极通过浆膜层置入Oddi括约肌，记录不同条件干预下家兔的Oddi括约肌肌电活动信号，调整电生理实验参数并经放大、滤波及计算机处理后，对其大小、波形、幅度进行分析。结果不同条件干预下的家兔Oddi括约肌的肌电活动在波形、频率、幅度等方面均有明显的不同，具有明显的规律性。重复实验可得到相似的结果。结论使用双极金属钩状电极配以合理的电生理实验参数调整可以稳定地采集到在体的家兔Oddi括约肌肌电活动信号。这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。