吻合器在痔手术中的应用

目的探讨吻合器在痔手术中的适应证及术后并发症的处理。方法应用吻合器行痔手术,切除齿状线上直肠黏膜约2cm,部分阻断直肠黏膜血运,使痔核逐渐萎缩、消失。患者共10例,其中3～4度痔8例,混合痔伴部分直肠黏膜脱垂2例。结果所有患者术后便血及直肠黏膜脱垂症状消失,2例术后出现短时间间断性腹痛,经对症治疗后症状消失。结论吻合器痔手术是临床上治疗直肠黏膜脱垂及重度痔方法之一,较传统方法具有明显优点,应在临床实践中普及与推广。     

PPH治疗重度痔的临床应用

目的探讨PPH手术治疗重度痔的临床效果、并发症及防治措施。方法回顾分析我科2012年10月~2013年9月应用PPH手术治疗64例重度痔患者(主要为III-IV度内痔及脱垂混合痔)的临床资料。结果全组病例均一次性治愈,经术后3~6个月随访,症状完全消失。59例外脱痔核完全回缩(1例术后吻合口出血),5例外脱痔核回缩不全,有肛门轻度狭窄2例,无肛门失禁、切口感染及直肠阴道瘘等并发症,无复发病例。结论 PPH手术创伤小,疼痛轻,复发率低,并发症相对少,是治疗重度痔的重要手术方式,值得临床推广应用。     

吻合器痔上黏膜环切术后并发症的观察和处理

目的观察吻合器痔上黏膜环切术治疗Ⅲ度、Ⅳ度痔疮的术后并发症的情况,并探讨术后并发症的处理方法。方法回顾性分析68例行PPH术患者的术后并发症发生情况处理方法及效果。结果68例患者手术均获成功,切除的直肠黏膜环完整,完成随访6～12个月;术后发生肛门疼痛9例,术后一周内出血9例,术后一周后出血3例,肛门坠胀不适10例,痔核回缩不良6例,有2例随访12个月后复发;其中因术后早期出血再次手术患者3例,有3例患者随访12个月仍有肛门坠胀感,其余并发症患者经处理后临床症状消失;复发病例经痔核切除术治愈。结论吻合器痔上黏膜环切术是治疗Ⅲ度和Ⅳ度痔疮的有效方法。但其术后并发症需引起足够重视,细致、耐心和标准的手术操作是预防术后并发症的根本,及时正确的处理是治愈术后并发症的关键。     

PPH术治疗环形混合痔并发直肠黏膜脱垂的护理

痔是临床上十分常见的疾病,且复发率高,一般以手术根治为主.而传统的手术治疗并发症较多,近年来,我院应用吻合器痔上黏膜环切术( PPH)的方法治疗此病,与传统手术相比,该手术方式减轻了术后疼痛及出血,缩短手术时间,使手术并发症及复发率降至极低水平[1].2010-02 ～2011 -05我院行PPH的患者47例,术后均取得了显著的效果,报告如下.1资料与方法1.1一般资料本组患者47例,男19例,女28例,年龄24 ～ 68岁,平均26岁.均为Ⅲ期或Ⅳ期痔病以及直肠脱垂的患者.临床表现为在自然状况下或排便时脱出肛外,需用手帮助还纳以及脱出不能还纳嵌顿.诊断标准参照《外科学》第7版教材[2].     

PPH联合RPH治疗直肠前突合并直肠黏膜内脱垂疗效观察

【摘要】 目的 观察痔上黏膜环切术(PPH) 联合弹力线套扎术(RPH) 治疗直肠前突合并直肠黏膜内脱垂的临床疗效。方法 选取2017 年2 月至2020 年2 月湖北中医药大学附属襄阳市中医医院收治的100 例直肠前突合并直肠黏膜内脱垂女性患者作为研究对象, 并按照随机数表法将其随机分为治疗组50 例和对照组50 例, 治疗组患者行PPH 联合RPH 治疗, 对照组患者行单纯PPH 治疗, 对比两组患者临床疗效以及排便?疼痛及生活质量评分变化情况。结果 术后1 个月, 治疗组患者中痊愈15 例?显效20 例?有效14 例?无效1 例, 明显优于对照组患者的痊愈7 例?显效17 例?有效19 例?无效7 例(Z=-2.700,P=0.007); 术后1?3?6 个月, 治疗组患者Longo 出口梗阻型便秘(Longo ODS) 评分表评分?视觉模拟评分法(VAS) 评分及便秘患者生活质量量表(PAC-QOL) 评分均明显低于对照组(Longo ODS评分:t=13.53?20.280?22.380,P均<0.001;VAS评分:t=18.84?24.27?25.10,P均<0.001;PAC-QOL评分:t=8.796?21.70?23.95,P均<0.001)。结论 PPH 联合RPH 治疗直肠前突合并直肠黏膜内脱垂能够显著提高患者临床疗效, 减轻患者疼痛程度, 改善患者生活质量, 值得临床推广应用。     

老年环状痔与并发病灶的手术治疗分析

目的探讨手术治疗老年环状痔、残留痔体及并发病灶的疗效。方法回顾性分析我科对49例老年患者环状痔行吻合器痔上黏膜环切术(PPH),同时对残留痔体及合并的肛乳头肥大、息肉、肛瘘进行手术治疗的临床资料。结果全部病例术后肛门平整,形态恢复满意,合并病灶同时得到治疗,消除了残留及合并病灶的术后症状。无肛门失禁、肛门狭窄。结论对PPH治疗老年环状痔的残留痔体和合并病灶一次性手术治疗,可彻底消除病灶和术后症状,提高疗效。     

痔上黏膜环切吻合术治疗妊娠中晚期重度痔18例

目的总结痔上黏膜环切吻合术（PPH）治疗妊娠中晚期孕妇重度痔的临床疗效。方法分析18例妊娠中晚期孕妇重度痔患者的临床资料,对手术疗效、术后并发症、特别是晚期流产或早产等进行统计。结果18例均一次吻合成功,手术时间平均18min,术后住院4—7d;术后尿潴留5例（28％）,经对症治疗后症状好转。随访至分娩及产褥期结束,无一例晚期流产或早产;产褥期无内痔出血及混合痔脱出等。随访1年无肛门狭窄、大便失禁发生,效果良好。结论PPH治疗妊娠中晚期孕妇重度痔具有安全、有效等优点。     

开环式分段黏膜切除吻合术治疗脱垂性痔病的临床应用研究

目的探讨开环式分段黏膜切除吻合术、PPH手术和传统Milligan—Morgan术3种术式治疗脱垂性痔病的临床疗效。方法选取2013年1~4月间在我院住院治疗的环状混合痔患者90例,随机分为治疗组（TsT组）、对照A组（PPH组）和对照B组（Milligan—Morgan术组）,每组各30例。观察3组间患者围手术期的一般情况及术后并发症。结果治疗组在手术时间上明显少于对照A组及对照B组,有显著性差异（P〈0．05）;治疗组在术后第2、4、6天疼痛及水肿积分上均少于对照A组及对照B组,有显著性差异（P〈0．05）;治疗组在术后7天内出现尿潴留、急便感的情况例数均少于对照A组及对照B组。有显著性差异（P〈0．05）。结论开环式分段黏膜切除吻合术治疗脱垂性痔病比PPH手术和传统Milligan—Morgan术更具优势。     

环状混合痔两种手术方式的疗效比较

 目的 比较吻合器痔上黏膜环形切除术(procedure for prolapsed and hemorrhoids, PPH)与外剥内扎术(Milligan-Morgan hemorrhodcotomy,MMH)治疗环状混合痔的临床效果.方法 将60例环状混合痔患者随机分为PPH组和MMH组各30例,分别进行吻合器痔上黏膜环切术和外剥内扎术.比较两组手术时间、创面愈合时间、住院时间及其术后疼痛指数、肛门功能、术后并发症发生情况及患者满意度.结果 两组患者术后原有症状均得到有效控制.PPH组在缩短手术时间、创面愈合时间、住院时间,以及术后疼痛指数、肛门功能及术后满意度均优于MMH组(P＜0.01).肛管压力测定PPH组手术前后无变化,MMH组术后明显降低.结论 与MMH术相比,PPH术安全、有效、手术时间短、住院时问短、恢复快、并发症少.     

齿状荷包缝合法在PPH术治疗重度痔68例中的临床观察

目的探讨应用齿状荷包缝合法在吻合器痔上黏膜环切术(PPH)治疗重度痔临床疗效。方法回顾分析我科2008年6月—2010年6月应用PPH术,术中采用齿状荷包缝合法治疗以肿块脱出及便血为主要症状的68例Ⅲ、Ⅳ期痔患者的临床资料和随访结果。结果改良PPH术创伤小、疼痛轻、恢复快。且对控制出血、防止脱垂以及减少并发症的作用显著,患者满意度达97.3%,随访l～3个月,一次性治愈90%,无大便失禁、肛周感染、脓肿、吻合口狭窄等并发症。结论齿状荷包缝合法在PPH术治疗重度痔临床疗效明显。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.