浅谈医疗设备的供水问题

长期以来医疗设备的供水问题一直没有得到人们的重视,使一些医疗设备由于供水水质的关系提早进入维修期和报废阶段,给医院增加了开支.有些治疗设备由于水质的关系甚至影响到治疗的效果,对医疗设备的供水水质应该引起高度重视,做好医疗设备的供水工作.     

浅谈新生儿溶血病

由于与其他新生儿常见病相比致死率较高,且容易造成新生儿终身与疾病相伴,所以新生儿溶血病一直以来都受到妇儿医疗学界的重视,而近年来随着医学技术的发展,新生儿溶血病的检测和临床治疗手段有了很大的进步,其痊愈率也在不断上升,关于对新生儿溶血病的认识和分析,本文将从发病机理、临床表现及检查、治疗这三个方面为切入点进行.     

关于痔术后平整度的问题

肛管附近皮肤,粘膜及皮下粘膜下组织由于某些原因造成突起所形成的各类痔核,均是肛门形态学的改变。痔核手术的目的就在于用各种手段消除这些突起,以此消除因这些突起而引发的有关症状,使肛门恢复原来的形态和平整度。如果经过治疗后,没有恢复原来的平整度,则遗留突起和一些相关症状,既使是遗留没有症状的突起,也会给便后清洁处理增加困难。个别会造成病人的心理负担,实际上就是手术的不彻底,治疗上的欠缺,由此可见痔术后平整度的问题是衡量手术成败和优     

PPH及传统手术治疗严重内痔73例临床疗效评价

痔是直肠下端称之为肛垫的唇状肉赘,当合并有出血、痔块脱出、疼痛等症状时,形成痔病。PPH(痔上粘膜环切术)是国内近两年来开展的一种治疗重度痔的新手术。我院自2001年8月至2004年10月应用PPH技术治疗26例内痔患者,同期采用传统手术方法治疗47例。现将PPH和传统手术的临床数据     

开环式微创肛肠吻合器痔切闭术治疗脱垂性痔病的临床研究

目的 研究开环式微创肛肠吻合器痔切闭术治疗脱垂性痔病的临床疗效。方法 回顾分析2016年5月~2017年10月在我院诊治的130例脱垂性痔病患者,随机分为对照组和观察组,每组65例。对照组采用吻合器痔上黏膜环切术（PPH）治疗,观察组采用开环式微创肛肠吻合器痔切闭术（TST）治疗,对比两组临床治疗疗效、手术时间、术中出血、住院时间、术后疼痛评分以及并发症发生率。结果 观察组临床治疗有效率与对照组相比,差异无统计学意义（P＞0.05）。观察组手术时间、术后出血率、住院时间及术后疼痛评分均低于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为12.30%,低于对照组的38.46%,差异有统计学意义（P＜0.05）。结论 采用TST术治疗脱垂性痔病与PPH术治疗疗效相同,但TST术手术时间短,术后出血发生率低、疼痛轻,且肛门水肿、排尿困难等并发症发生率低,值得临床推广和应用。     

吻合器痔病环状切除术近期和远期经验

目的　对吻合器痔病环切术治疗痔病的近期疗效 ,并发症和远期随污进行前瞻性临床研究。方法　 5 6例症状患者施行择期手术 ,其中男性 33例 ,平均年龄 4 6岁。病程 3～ 10 8个月 (平均两年 ) ,二度痔 13例(2 3% ) ,三度痔 (5 9% ) ,四度痔 10例 (18% )。全部患者均采用吻合器痔病环状切除术 ,术后 1周、 2周和 4周随访 ,5～ 12 0个月通过电话方式对出血、狭窄、溢粪以及肛门节制功能进行远期随访研究。结果　全部手术均成功实施 ,手术时间 <15 m in,无大出血和吻合口破裂发生 ,6例 (13% ) ,腰麻和硬膜外麻醉患者出现尿潴留 ,1例 (1.7% )血小…     

浅谈新生儿溶血病

由于与其他新生儿常见病相比致死率较高,且容易造成新生儿终身与疾病相伴,所以新生儿溶血病一直以来都受到妇儿医疗学界的重视,而近年来随着医学技术的发展,新生儿溶血病的检测和临床治疗手段有了很大的进步,其痊愈率也在不断上升,关于对新生儿溶血病的认识和分析,本文将从发病机理、临床表现及检查、治疗这三个方面为切入点进行。     

做自己的师音乐治疗师

古希腊神话中,光明之神阿波罗掌管音乐和医药,被誉为人类的保护神.这从一个侧面反映出来,古时候人们认为音乐和治愈疾病是分不开的. 欧阳修"弹琴解忧"的故事 我国北宋文学家欧阳修在《送杨寘序》中写道,他曾经由于过度的忧伤和劳累得了病,"退下来"后过上了悠闲的日子,却一直没有医治好.后来向朋友孙道滋学习如何弹琴,学会了弹奏各...     

神经干细胞的研究进展

长期以来,人们一直认为,成年哺乳动物脑内神经细胞不具备更新能力,一旦受损及至死亡,不能再生,这种观点使Parkinson病、多发性硬化及脑脊髓损伤的治疗受到了很大的限制。近年来科学家对神经干细胞的研究是脑科学领域的重要成果之一,它突破了以往一直认为成年动物神经细胞不能分裂再生的观念,为研究神经细胞的发育分化过程,也为神经系统疾病的治疗开辟了一条全新的途径。     

浅析围绝经期综合征的中医病位

关于围绝经期综合征的病位问题一直存在争议,现代医家观点不一:"肾虚"说,"肝虚"说,"心之虚实"说,"脾胃阴火"说等.笔者对围绝经期综合征的主要临床表现进行了仔细分析,认为本病的病位在冲任二脉,治疗也应该侧重从调理冲任入手.     

Submucosal electrocoagulation for prolapsed hemorrhoids:a new operative approach to hemorrhoidal varices

The results of submucosal electrocoagulation (SEC), a new radical operation for prolapsed hemorrhoids, in 403 patients with third- or fourth-degree hemorrhoids are reported. After resecting the anal skin tags that coexisted with prolapsed hemorrhoids, the hemorrhoidal varices could be resected and electrically coagulated through the wound without cutting the anal canal epithelium by using a fine needle-type electric knife. The results of this series indicated that SEC could dramatically reduce the incidence of the postoperative complications that sometimes occur after conventional hemorrhoidectomy, such as severe anal pain, massive anal bleeding and anal stenosis. Moreover, SEC could ensure that operated patients make an early return to social activities and have a satisfactory quality of life. Relapse of prolapsed hemorrhoids after SEC was rare.     

Benign fibrous histiocytoma presenting as anal canal polyp: first case report

Nonepithelial and nonmelanocytic anal neoplasms are uncommon. The majority are mesenchymal tumors, most of which are malignant sarcomas, particularly leiomyosarcomas and gastrointestinal stromal tumors. Benign mesenchymal anal neoplasms are even rarer. The most common reported cases were anal leiomyomas, granular cell tumors, fibroadenomas, and xanthogranulomas. Benign fibrous histiocytomas (BFHs) or dermatofibromas are common mesenchymal cutaneous tumors that occur in different sites and at any age. Review of the literature did not show previous reports of BFH arising in the anal canal region. We report the first case of a solitary BFH, an unexpected occurrence of a common tumor type presenting as a polyp in an unusual site such as the anus. This rare occurrence can present diagnostic challenges for the surgeons and pathologists. Clinically, it can be confused with the usual anal tags, fibroepithelial polyps, or hemorrhoids. Benign fibrous histiocytoma is a neoplasm with a potential of local recurrence and, therefore, carries certain clinical implications for the patients' management and follow-up when compared with the common nonneoplastic causes of anal polyps such as the anal tags of anal fissures, hemorrhoids, or fibroepithelial papilla. Histologically, it should be differentiated from other histiocytic lesions. This can be resolved by the application of certain histologic features with the appropriate immunohistochemical markers taken within the correct clinical context.     

内痔注射后套扎联合外痔切除术治疗环状混合痔的疗效

目的 观察内痔消痔灵注射后套扎联合外痔切除治疗环状混合痔的临床疗效。方法 选取我院2017年10月~2018年6月收治的106例环状混合痔患者,按照手术方式分为对照组与观察组,各53例。对照组采用内痔套扎联合外痔切除治疗,观察组在内痔消痔灵注射后套扎联合外痔切除治疗。比较两组治愈率、术中出血量、术后疼痛、脱线时间、脱线后出血、创面愈合时间、肛门狭窄及复发率等情况。结果 对照组治愈率为92.45%,高于观察组的84.91%,但差异无统计学意义（P＞0.05）;两组术中出血量、术后疼痛、创面愈合时间、肛门狭窄等情况比较,差异无统计学意义（P＞0.05）;观察组患者脱线时间为（8.13±1.97）d,少于对照组的（11.03±1.58）d,差异有统计学意义（P＜0.05）;观察组脱线时出血发生率、复发率均为1.89%,少于对照组的13.21%、9.43%,差异均有统计学意义（P＜0.05）。结论 内痔消痔灵注射后套扎联合外痔切除治疗环状混合痔可以减少内痔脱线时间与脱线期出血,有效降低复发率。     

金梦贤-华佗消痔灵之方证分析

华佗消痔灵是天津市名老中医金梦贤教授根据多年临床经验,自拟的治疗多种中医肛肠疾病常用方剂之一。尤其对肛门肿痛,痔疮便血,大便秘结,脱肛不收等临床症状的治疗效果显著。本文就金梦贤-华佗消痔灵的组方、方解及临床效果进行逐一探讨。     

对Ⅲ度痔两种手术方式治疗效果的评价

目的 比较吻合器痔上黏膜环切术与传统外剥内扎切除术两种手术方式治疗Ⅲ度痔的疗效。方法 回顾性收集2014年6月~2015年6月在南方医科大学附属小榄医院行痔疮手术的128例患者临床资料,按手术方法分为两组,吻合器痔上黏膜环切术组78例,传统外剥内扎切除术组50例,采用倾向得分匹配法均衡组间混杂因素影响,对匹配后的两组患者进行术后复发率及并发症的分析。结果 经倾向得分匹配法后,共计43对患者匹配成功,吻合器痔上黏膜环切术组的术后2年复发率46.51%,高于传统外剥内扎切除术组18.61%,差异有统计学意义（P＜0.05）;吻合器痔上黏膜环切术组（23.25%）比传统外剥内扎术组（4.65%）有更多患者有里急后重感（P＜0.05）;术后出血、尿潴留、尿失禁、肛门狭窄、肛裂、大便失禁、直肠阴道瘘方面,差异无统计学意义（P＞0.05）;传统外剥内扎切除术组患者在术后第1天、第3天、术后2周疼痛程度均比吻合器痔上黏膜环切术组强烈,差异有统计学意义（P＜0.05）;吻合器痔上黏膜环切术组的总住院费用,高于传统外剥内扎切除术组,差异有统计学意义（P<0.05）。结论 吻合器痔上黏膜环切术术后短期2周内疼痛更轻微,但术后里急后重感发生率和术后2年复发率更高。     

Results of Surgical Treatment on Benign Anal Diseases in Korean HIV-Positive Patients

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/µL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients.     

泻心效灵汤治疗环状混合痔术后肛门肿痛的临床疗效

目的 观察泻心效灵汤治疗环状混合痔术后肛门肿痛的临床疗效。方法 选取2017年1月~2018年12月我院收治的环状混合痔拟行经典的外剥内扎术患者128例,随机分为观察组和对照组,每组64例。对照组直接在换药时行吲哚美辛呋喃唑酮栓纳肛,观察组给予中药泻心效灵汤水煎薰洗坐浴治疗,然后再行创面换药处理,两组均于术后第2天开始,连续使用至术后第5天。对比两组患者首次治疗前后及术后第6天疼痛评分、术后第6天肛门水肿发生率和不良反应情况。结果 两组首次治疗后疼痛评分均低于首次治疗前,且观察组术后第6天疼痛评分低于对照组[（2.67±1.64）分 vs （4.55±1.96）分],差异有统计学意义（P＜0.05）;两组首次治疗后疼痛评分比较,差异无统计学意义（P＞0.05）。观察组术后第6天肛门水肿发生率低于对照组（15.63% vs 29.69%）,差异有统计学意义（P＜0.05）。观察组未见明显不良反应,对照组有5例患者出现胃痛、胃烧灼感、恶心反酸症状。结论 泻心效灵汤治疗环状混合痔术后肛门肿痛,可减轻术后疼痛,降低肛门水肿发生率,安全性较高。     

Inflammatory cloacogenic polyp: relationship to solitary rectal ulcer syndrome/mucosal prolapse and other bowel disorders

The clinicopathologic features of nine patients with inflammatory polyps of the anorectal transition zone (inflammatory cloacogenic polyp, ICP) were reviewed. All polyps were characterized histologically by crypt hyperplasia and a thickened muscularis mucosa arising beneath a surface epithelium consisting of variable proportions of squamous, columnar, and often transitional epithelium. Tubulovillous architecture was characteristic. Sialomucin predominated over sulfomucin in eight of nine cases. One polyp displayed focal dysplasia and condylomatous features, while two others had associated hemorrhoids. Three cases had been previously diagnosed as adenomas. Seven patients were women, and two were men; their median age was 54 years (range, 17 to 85). Clinical presentation was most commonly intermittent rectal bleeding, and the clinical diagnosis was anal polyp or hemorrhoids in all cases. Six patients had the solitary rectal ulcer syndrome (SRUS) and/or evidence of mucosal prolapse. Papillomavirus was demonstrated by histochemical and immunohistochemical methods in one case in which multiple foci of dysplasia were also noted. Two patients had Crohn's disease, and the remaining patient had a coexistent adenocarcinoma located several centimeters proximal to his ICP. The pathologist and clinician must be aware that although ICP is often associated with SRUS/mucosal prolapse, it may occur in other clinical settings.     

On the etiology of anal squamous carcinoma

The thesis is based on 13 publications in English and a review of the literature. The underlying work was done with the overall aim to describe incidence patterns for anal squamous carcinoma (anal SC) and to contribute new insight into the causes of this neoplasm. The work, supported by the Danish Cancer Society, was carried out in the period 1991-2000 while I was employed at 1) the Danish Cancer Registry, 2) Statens Serum Institute, Department of Epidemiology Research, and 3) the National Cancer Institute, Viral Epidemiology Branch, Maryland. Study designs employed include a ) population-based incidence studies in Denmark and the United States, b) register-based case-control studies and cohort studies for the scrutiny of multiple cancer patterns among patients with anal SC and for the study of anal SC risk among individuals with certain non-malignant diseases of the anal region as well as among persons with the acquired immuno-deficiency syndrome (AIDS), c) a nationwide interview-based case-control study of risk factors for anal SC and in Denmark and Sweden, and d) a combined molecular biological and histological analysis examining the association of human papillomavirus (HPV) status with histopathological and anatomical characteristics in anal SC tissues. The epidemiology of anal SC has changed remarkably during the second half of the 20th century. In Denmark, age-adjusted incidence rates per 100,000 person-years increased during the period 1943-1997 from around 0.2 among both men an women to 0.5 among men and 1.0 among women. Where systematically studied, incidence rates of anal SC have also been found to increase in a few other countries (Sweden and the United States). Register-based multiple cancer studies have shown an excess of previous and subsequent genital cancers of squamous histology among women with anal SC. This is likely to reflect common susceptibility toward infection with cancer-associated HPV types shared by all anogenital organs covered by squamous epithelium. A study based on data from the United States supports the possible role of anogenital SC-associated HPV types in the development of some tonsillar cancers. Observations in other register-based investigations and in the Danish-Swedish case-control study challenge the long held belief that benign anal lesions (e.g. hemorrhoids) and anal inflammation (e.g. in association with Crohn's disease) are linked to an increased risk of anal SC. The work documents strong links between a variety of sexual behavior measures and the risk of anal SC. The previously observed excess of anal SC among homosexual men is confirmed. Unlike in previous studies, an increased risk of anal SC associated with promiscuous heterosexual activity is also documented among both men and women. Measures of sexual extroversion, rather than sexual preference, are linked to the risk of anal SC presumably by means of higher rates of anal HPV infection in people with such behaviors. A new hypothesis is proposed to explain how smoking, the only consistently observed non-sexual risk factor in previous studies, might be associated with anal SC risk. A study of the short-term cancer profile among 309.365 AIDS patients in the United States provided no evidence to support immunosuppression as a major risk factor for anal SC in the first two years after the AIDS diagnosis. With the introduction around 1996 of highly active anti-retroviral therapy regimens, however, the future may hold a para-doxical increase in the incidence of anal SC along with the increased life expectancy in this population. Examination of tumor tissues from patients in Denmark and Sweden by the polymerase chain reaction techique showed a high proportion of anal SCs to be positive for types of HPV that are associated with high risk of cervical cancer (90%, 100%, and 58% among women, homosexual men, and heterosexual men, respectively). Tumor tissues from control subjects with adenocarcinoma of the rectum were consistently HPV-negative. A combined molecular biological and histological analysis showed that anal SCs with likely origin in the anal canal are 7.5 times more likely to be HPV-positive than anal SCs with likely origin in the perianal skin. Additionally, cancer of the anal canal are more likely than those of the perianal skin to be characterized histologically by small or medium-sized tumor cells, basaloid features, and little or no keratinization. Epidemiological studies from the past two decades have contributed imprtantly to our current understanding of anal SC and its causes. Most cases of this neoplasm can now be considered as a consequence of sexually or otherwise acquired infection in the anal mucosa with types of HPV already known to be involved in cancers of the uterine cervix. Expectedly, the upward trend in the incidence of anal SC seen over the past half century will continue in many years to come. However, there is currently widespread, yet cautious, optimism regarding the prospects for a prophylactic HPV vaccine. It this optimism is justified, the future may bring drastic reductions in the incidence of HPV-associated morbidities, including SC.     

痔上黏膜C环切除术治疗痔的临床效果

目的 观察痔上黏膜C环切除术治疗混合痔的临床疗效。方法 取2016年12月~2018年5月我院收治的210例痔病患者为研究对象,随机分成观察组和对照组,每组105例。观察组予痔上黏膜C环切除术治疗,对照组采用黏膜环切钉合术（PPH）治疗。比较两组临床疗效、手术时间、住院时间及吻合口狭窄、肛门疼痛、出血发生率。结果 观察组治愈率为81.90%,手术总有效率为100.00%,对照组治愈率78.10%,手术总有效率100.00%,组间比较,差异无统计学意义（P＞0.05）;观察组吻合口狭窄发生率低于对照组,差异有统计学意义（P＜0.05）;观察组肛门疼痛程度轻于对照组,差异有统计学意义（P＜0.05）;两组出血情况比较,差异无统计学意义（P＞0.05）;两组手术时间及住院时间比较,差异无统计学意义（P＞0.05）。结论 痔上黏膜C环切除手术可以有效降低PPH术后吻合口狭窄的发生率,减轻术后疼痛,可以针对性地为不同痔病患者提供个体化的手术治疗方案。