PPH术治疗急性嵌顿性环状混合痔的临床研究

目的探讨PPH术治疗急性环状嵌顿性混合痔的临床疗效。方法将80例急性嵌顿性环状混合痔分成两组,治疗组(40例)行PPH手术治疗,对照组(40例)行Milligan-Morgan术,比较两组手术时间、创面愈合时间、住院时间及其临床疗效、肛门功能、术后并发症发生情况。结果 PPH组与Milligan-Morgan术组相比,临床疗效差异无统计学意义,手术时间、创面愈合时间、住院时间及其术后疼痛、肛门功能治疗组均优于对照组,差异有统计学意义(P<0.05)。治疗组术后恢复良好,未出现严重并发症。结论 PPH手术治疗急性嵌顿性环状混合痔安全有效,手术时间短、住院时间短、恢复快、并发症少。     

PPH术与改良分段结扎术治疗环状混合痔的疗效分析

目的 探讨PPH与改良分段结扎术治疗Ⅲ、Ⅳ度痔合并肛裂、肛乳头肥大、肛周皮赘、肛门狭窄的临床疗效.方法 将108例具有肛门合并症的Ⅲ、Ⅳ度痔患者在知情同意后,随机分为PPH组54例,改良分段结扎组54例,比较两组术后疼痛、肛门水肿、手术费用、愈合时间、手术满意度、术后1个月、6个月肛门镜检结果,术后6个月、12个月随访结果.结果 (1)术后8 h视觉模拟疼痛(VAS)评分PPH组3.3(2～5),改良分段结扎组5.6(4～7),P<0.05,术后24 h肛门静息时VAS评分,两组无差异,P>0.05,无统计学意义,术后24 h排便疼痛(VAS)评分PPH组优于改良分段结扎组.(2)肛门水肿PPH组0例,改良分段结扎组4例,P<0.05.(3)愈合时间PPH组10～18 d,改良分段结扎组15～25 d,P<0.05.(4)手术费用PPH组(6120±238)元,改良分段结扎组(2830±180)元,P<0.05.(5)1个月、6个月两次肛镜检查PPH组在吻合口近或远侧有隆起增生的肛垫组织6例,改良分段结扎组1例,两组均无症状与不适.(6)满意度调查PPH组95%,改良分段结扎组92%,P>0.05.结论 PPH术与改良分段结扎术两者均为有效治疗有肛门合并症的环状混合痔.术后疼痛、肛门水肿、愈合时间3个方面PPH术优于改良分段结扎术,手术费用少、远期并发症少、肛门外观平整是改良分段结扎术的优点.根据随访结果,PPH术后有明显改善便秘的症状,因此,对于内痔为主伴有便秘和肥胖的患者PPH术较好;外痔多于内痔、有陈旧性肛裂、肛门狭窄、肛乳头肥大等良性合并症的患者,改良分段结扎术较好.     

PPH联合痔切除术治疗环状混合痔的疗效观察

目的：比较PPH联合痔切除术治疗环状混合痔的临床效果。方法选择368例环状混合痔患者,随机分为治疗组（190例）和对照组（178例）,分别采用PPH联合痔切除术和单纯痔切除术治疗,比较两组患者手术疗效和术后并发症情况。结果治疗组术后住院时间、创面愈合时间均明显优于对照组,而手术时间则无明显差别。其术后并发症中术后疼痛、肛门水肿、复发率明显低于单纯痔切除术组,而术后出血、肛门狭窄程度差别不大。结论 PPH联合痔切除术治疗环状混合痔,具有出血少、疼痛水肿轻微、恢复快、复发率低等优点,值得推广。     

PPH结合痔切除与Milligan-Morgan手术治疗重度痔的对比研究

目的:比较PPH结合痔切除手术与传统Milligan-Morgan手术治疗重度混合痔的临床效果.方法:对收治的100例重度混合痔分为实验组和对照组,分别进行PPH结合痔切除手术及Milligan-Morgan手术治疗.并分别对手术时间、术后疼痛指数、注射止痛剂次数、住院时间、恢复工作时间、术后并发症、患者满意度等进行比较分析.结果:在患者症状改善满意度、术后并发症及恢复工作时间方面,PPH结合痔切除手术明显优于对照组(P＜0.01);而在手术时间、术后疼痛指数、注射止痛剂次数方面实验组亦优于对照组(P＜0.05);住院时间上两者差异不显著.结论:对合并有明显外痔的重度混合痔仍可采用PPH手术,其疗效优于传统的外剥内扎术.     

改良PPH术对Ⅲ～Ⅳ期混合痔的疗效

探讨改良痔上黏膜环形切除钉合术(PPH)对Ⅲ-Ⅳ期混合痔的治疗效果。将120例Ⅲ-Ⅳ期混合痔患者随机分为两组,分别行国产吻合器改良PPH术(改良PPH组)和Milligan-Morgan术(MMH组),比较两组的手术疗效、手术时间、术后住院时间、术后疼痛、出血情况等指标;术前3天和术后1周采用肛管直肠测压法测定两组患者手术前、后肛管静息压(ARP)、肛管最大收缩压(AMSP)及直肠排便收缩压(ASP),评估两组患者肛门排便功能。结果显示,改良PPH组切除标本上下径为(2.5±0.90)cm,吻合口距齿状线位置为(2.1±1.13)cm。改良PPH组和MMH组的显愈率分别为96.7%和91.7%。与MMH组相比,改良PPH组的手术时间和术后住院时间显著缩短(P0.01),疼痛和出血等并发症的发生率显著降低(P0.01)。改良PPH组和MMH组的术后ARP较术前均显著降低(P0.05);MMH组术后AMSP较术前显著降低(P0.05),并显著高于改良PPH组的术后AMSP,但改良PPH组的术前、术后AMSP未发生明显改变。结果表明,改良PPH术治疗Ⅲ-Ⅳ期混合痔既能保证手术悬吊肛垫效果,又能有效减少术后并发症发生并保护肛垫精细排便功能。     

选择性痔上黏膜切除术、痔上黏膜环切术与外剥内扎术治疗中重度混合痔的效果比较

目的比较吻合器痔上黏膜环切术（PPH）、外剥内扎术（M-M）与选择性痔上黏膜切除术（TST）治疗中重度混合痔的临床效果。 方法回顾性分析2015年1月至2018年12月克拉玛依市独山子人民医院收治的675例中重度混合痔患者资料，按手术方式分为M-M组（238例）、PPH组（185例）、TST组（252例）。比较三组患者一般手术情况，术后疼痛、肛缘水肿、创面出血或渗血等并发症发生率，排便及创面愈合情况，术后1个月时肛门功能、术后6个月时肛门外观平整度及随访期内肛门失禁、肛门漏气漏液发生率。 结果PPH组、TST组术中出血量、住院时间及住院费用、术后疼痛程度、创面愈合时间、恢复正常活动时间以及肛门水肿Ⅱ~Ⅳ度比例、部分失禁发生率、坠胀/排便感发生率均显著低于M-M组（P<0.05），TST组术中出血量、住院时间显著低于PPH组（P<0.05）。首次排便时间、大便情况分度Ⅲ度及肛门外观平整度Ⅲ度比例为TST组2=0.771，P=0.680）。 结论TST治疗中重度混合痔的治愈率与M-M、PPH相当，但在术中出血量、住院时间、术后排便、肛门外观平整度等方面优势更显著，值得临床推广。     

PPH联合痔切除缝合术治疗混合痔149例疗效观察

为观察PPH联合痔切除缝合术治疗混合痔的临床疗效,将混合痔患者298例随机分为两组,每组149例,观察组行PPH联合痔切除缝合术治疗,对照组行传统外剥内扎术治疗,从治愈率、肛门疼痛、创面愈合时间等方面进行疗效观察。结果显示,两组在治愈率方面疗效相当（P〉O．05）,但在肛门疼痛、创面愈合时间方面观察组优于对照组（P〈0.05）。结果表明,PPH联合痔切除缝合术治疗混合痔,具有术后疼痛轻、创面愈合时间短等优点。     

PPH与Milligan-Morgan手术治疗重度痔的疗效比较

目的：比较PPH与Milligan-Morgan手术治疗重度痔的疗效。方法：将130例重度痔患者半随机分为治疗组（PPH）和对照组（Milligan-Morgan术）,分别采用相应的方法治疗,对比观察两组的手术时间、住院时间、住院费用、创面愈合时间、治疗有效率和术后近期及6～24个月后并发症、肛门功能等指标。结果：两组手术有效率无统计学差异（P〉0.05）,治疗组手术时间、平均住院日、创面愈合时间明显低于对照组（P〈0.01）;术后并发症发生率（疼痛、肛缘水肿、出血等）低于对照组（P〈0.01）,肛门功能恢复优于对照组（P〈0.05）,住院费用、术后肛门坠胀、下腹疼痛发生率高于对照组（P〈0.01）。术后6～24个月肛门狭窄、瘙痒和残留皮赘发生率两组差异均无统计学意义（P〉0.05）。结论：PPH治疗重度脱垂痔的近期疗效明显优于Milligan—Morgan手术,但费用较大,远期疗效尚需进一步追踪随访。     

吻合器痔上黏膜环切钉合术治疗Ⅲ～Ⅳ度内痔效果观察

目的观察吻合器痔上黏膜环切钉合术(PPH)治疗Ⅲ~Ⅳ度内痔的效果。方法随机将104例Ⅲ~Ⅳ度内痔患者分为2组,各52例。对照组行外剥内扎术,观察组行PPH。比较2组疗效。结果观察组术中出血量、手术时间、切口愈合时间、住院时间及并发症发生率等指标,均优于对照组,差异有统计学意义(P<0.05)。结论 PPH治疗Ⅲ~Ⅳ度内痔,创伤小、疼痛轻、手术时间短、患者恢复快,是一种理想的术式。     

外剥内缝扎术悬吊联合皮桥整形在环状混合痔中的应用体会

目的探讨外剥内缝扎悬吊术联合皮桥成形在环状混合痔中的应用价值。方法将650例环状混合痔患者随机分为治疗组(332例)和对照组(328例),治疗组行外剥内缝扎悬吊术联合皮桥成形,对照组行外剥内扎术,对比观察两组疗效、术后并发症、术后肛门功能、平均住院时间及创面愈合时间。结果两组治愈率、好转率、术后大出血、术后疼痛对比无统计学差异(P0.05);治疗组在术后肛门功能、肛门狭窄、水肿、赘皮残留、平均住院时间及创面愈合时间均优于对照组,有统计学差异(P0.05)。结论外剥内缝扎悬吊术联合皮桥成形治疗环状混合痔在保护肛门功能、减少术后并发症及缩短治疗周期等方面优于传统的外剥内扎术,值得推广应用。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.