超低位直肠癌经括约肌间切除术后的肛门功能评价

目的分别应用问卷调查和直肠肛管向量测压技术来评价超低位直肠癌经括约肌间切除术后的肛门功能。方法对25例经括约肌间切除术后的患者进行Vaizey和Wexner评分以及直肠肛管向量测压，分别选择同期25例直肠癌低住前切除术及25例肛门功能正常的患者作为对照研究。结果经括约肌间切除术后的Vaizey和Wexner评分在术后1个月均高于低住前切除术，但在术后1年差异却没有显著性，而两者直肠肛管向量测压的结果在术后1年却仍有差异。与正常对照组差异一直有显著性。结论经括约肌间切除术的肛门功能短期内不如低住前切除术，虽然长期的结果可以接受，但仍达不到正常水平。     

Anal size in children: the influence of age, constipation, rectal examination and defaecation

With the increase in the number of reported cases of child abuse it is important that medical practitioners should know the normal values for the size of the anus. Children aged 3 months to 15 years, attending a paediatric gastroenterology clinic for a routine examination, had a photographic record made of the anus 30 seconds after exposure of the anus as part of a standardised examination protocol. Anorectal disease, including Crohn's disease was present in eight children. Analysis of the 54 children without anorectal disease indicated that the anteroposterior diameter of the anus was less than 10.0 mm and the transverse diameter was less than or equal to 2.0 mm. Age, sex of the child, digital rectal examination, time since last defaecation and the capacity and contents of the rectum were unrelated to the size of the anus. In view of the difficulties which arise in suspected child abuse, medical practitioners should gain experience of the normal appearance and size of the anus. This can best be validated within a medicolegal framework if some form of standardised examination protocol is used. The key element of such an examination is not the position in which the child is examined but the time taken to observe the anus, to allow any dynamic changes to occur. An inspection time of 30 seconds in a cooperating conscious child is recommended.     

Hepatic abscesses

Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instituted. They are prevalent all over the globe and pyogenic abscesses are predominant over amoebic. With better control of intra abdominal and systemic infections by a spectrum of antibiotics, aetiology of pyogenic abscesses are secondary to interventions and diseases in the biliary tree to a large extent today. The common organisms isolated are the Gram negative group. Amoebic abscesses continue to plague some regions of the world where hygiene and sanitation are questionable.     

Iliopsoas abscesses

Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed.     

Retroperitoneal abscesses

Abscesses developing within the retroperitoneal spaces are complicated serious surgical infections marked by an insidious, occult process lead to considerable mortality and morbidity. In a retrospective review of 39 retroperitoneal abscesses in our hospital. Attention is directed to clinical presentation, diagnosis and treatment. On average, 19.2 days was required to establish the diagnosis and overall mortality is 7.7%. Two patients suffered from complications of discharged sinus and recurrent abscess respectively. Computed tomography (CT) is thought to be the best diagnostic modality of retroperitoneal abscesses. Only 2 patients (5.3%) shows bilateral lesions. Detailed anatomic reviews detailing the pathogenesis of bilateral retroperitoneal abscess are also discussed.     

Hepatic abscesses

Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instituted. They are prevalent all over the globe and pyogenic abscesses are predominant over amoebic. With better control of intra abdominal and systemic infections by a spectrum of antibiotics, aetiology of pyogenic abscesses are secondary to interventions and diseases in the biliary tree to a large extent today. The common organisms isolated are the Gram negative group. Amoebic abscesses continue to plague some regions of the world where hygiene and sanitation are questionable.Over the years, diagnosis, treatment and prognosis have evolved remarkably. Imaging modalities like ultrasonography and CT scan have become the cornerstone of diagnosis. The absence of ionizing radiation makes MRI an attractive alternative in patients who require multiple follow up scans. Serological testing in amoebic abscesses has become more reliable. Though antibiotics have remained the principal modality of management, percutaneous drainage of abscesses have vastly improved the chances of cure and bring down the morbidity drastically in pyogenic abscesses. Amoebic abscesses respond well to medical treatment with nitroimidazoles, and minimally invasive surgical drainage is an option in cases where open surgery is indicated.     

25例膀胱瘘诊断和治疗的临床分析

目的：探讨膀胱瘘的病因、临床特点及治疗方法。方法回顾性分析北京协和医院1986-2010年住院诊治的膀胱瘘患者的临床资料。结果膀胱瘘25例,主要病因是手术损伤（12例,48%）、恶性肿瘤（6例,24%）和慢性感染/炎症（5例,20%）,表现为粪尿（9例,36%）、气尿（5例,20%）、尿路刺激症（11例,44%）、腹部包块（7例,28%）、排水样大便（9例,36%）等。对膀胱瘘阳性发现率较高的检查是膀胱镜（73%,11/15）,膀胱造影（73%,8/11）和 CT （67%,8/12）。18例（72%）患者接受手术,术后发生切口感染6例、吻合口漏3例、瘘复发2例;死亡5例（27.8%）。7例（28%）给予非手术治疗,5例瘘口愈合。结论膀胱瘘的病因主要是手术损伤、恶性肿瘤和慢性感染/炎症。 CT、膀胱镜和结肠镜是诊断膀胱瘘及寻找病因的首选方法。手术是其主要治疗方法,保守治疗可尝试用于某些患者。     

内括约肌切开加皮瓣成形术治疗肛门狭窄的初步评价

目的:总结内括约肌切开加皮瓣成形术治疗肛门狭窄的初步临床经验。方法:对1 998年9月～2 0 0 4年7月,采用内括约肌切开加皮瓣成形术治疗肛门狭窄3 8例进行回顾分析。结果:所有3 8例手术均获得成功,2 0例采用Y -V皮瓣,8例采用V -Y皮瓣,6例采用菱形皮瓣,4例采用房形皮瓣,术后所有病例均不同程度缓解,有效率89%。结果::内括约肌切开加皮瓣成形术治疗肛门狭窄,保证了手术成功率和治疗的彻底性,值得进一步推广和研究