功能性出口梗阻型便秘患者肛管直肠功能与血胃动素的相关性研究

目的 研究血胃动素及肛管直肠功能改变在功能性出口梗阻型便秘发病中的作用，探讨胃动素及其受体激动剂可否用于治疗出口梗阻型便秘。方法 根据结肠运输时间和运输指数选择出口梗阻型便秘患者，设健康对照组，行肛管直肠测压检查，测定血胃动素并分析其与肛管直肠测压指标值的相关性。结果 出口梗阻型便秘患者的肛管静息压升高，模拟排便时直肠肛管压差显著降低，引起直肠肛管抑制反射的最小松弛容积及直肠感觉阈值均高于健康人。患者血胃动素无明显变化，胃动素水平与肛管静息压、最大缩榨压及模拟排便时肛管压力成正相关，与模拟排便时直肠肛管压差成负相关。结论 出口梗阻型便秘发病基础是肛门括约肌舒张失调，排便时直肠肛管不协调，直肠敏感性低；血胃动素正常便秘惠者可能有更多出口梗阻问题，出口梗阻型便秘患者不宜采用胃动素或其受体激动剂治疗。     

肛肠治疗仪术后联合应用MEBO的疗效观察

目的：总结MEBO在肛肠治疗仪门诊肛肠手术中的应用方法及疗效。方法：对900例门诊肛肠手术后创面使用MEBO治疗。结果：900例肛肠手术患者手术创面愈合良好。结论：MEBO在肛肠科使用HCPT疗法进行的门诊肛肠手术创面恢复中,临床效果理想、实用性强、值得推广。     

MRI对先天性肛门直肠畸形的诊断价值

目的探讨MR I对先天性肛门直肠畸形手术前后的诊断价值。方法对5例正常对照组,14例先天性肛门直肠畸形病例均行盆腔、骶尾部MR检查。观察肛门内、外括约肌、耻骨直肠肌形态,肛门直肠本身发育缺陷以及骶椎、泌尿生殖系统等畸形。结果本组MR显示耻骨直肠肌、括约肌群发育好13例,发育较好3例,发育差3例,T1W I不抑脂序列为显示肛周肌群较好的序列。7例合并骶尾椎畸形,5例合并泌尿系统畸形。结论MR I对先天性肛门直肠畸形具有重要诊断价值,可从形态上了解盆底肌的发育,并能明确骶骨、椎管、泌尿系统等畸形,在确定手术方式及评价手术疗效方面具有重要意义。     

Anorectal sepsis

Anorectal sepsis is a common cause of hospital admission, presenting with abscess or fistula formation. This article discusses the aetiology of acute anorectal sepsis and its management.     

功能性便秘肛门直肠动力学和敏感性研究

目的：探讨功能性便秘（FC）患者肛门直肠动力学和直肠感觉特征。方法：采用肛门直肠测压方法检测44例FC患者的肛门直肠静息压、缩榨压、直肠初始感觉阈值、排便感觉阈值、窘迫感觉阈值和最大耐受容量指标,并与14例健康人做对照。结果：FC患者肛门静息压、最大缩榨压均较对照组明显降低,差异有显著性（P〈0.05）;但FC患者的初始感觉阈值、排便阈值、窘迫阈值和最大耐受容量均高于对照组（P〈0.05）。模拟排便时,FC组31.82%的患者在直肠收缩时伴有肛管括约肌的矛盾收缩。结论：功能性便秘患者存在肛门直肠动力和感觉异常,可能与FC发病相关。     

肛肠外科预住院对提高床位利用率的影响

探讨肛肠外科实施预住院制度对提高床位利用率的影响。2013年11月起,肛肠外科病房实施预住院制度,比较预住院前后各1个月的床位利用率、小肛肠病人的住院收治率及患者满意度。肛肠外科实施预住院制度后,床位利用率从97．5％提升至115％,小肛肠病人住院收治率从55．3％提升至93．5％,患者满意度从92．8％提升至98．5％。     

男性婴幼儿肛瘘和肛周脓肿的特点及外科治疗

目的：研究婴幼儿肛瘘和肛周脓肿的特点及外科治疗方法。方法：对41 例2岁以上婴幼儿肛瘘和肛周脓肿患儿的临床资料及治疗方法进行了回顾性分析。结果：41例婴幼儿肛瘘和肛周脓肿均为男性，其中35例（85．4％）肛周脓肿感染源为相对应的肛隐窝。另外在19例（46．4％）发现肛隐窝发育异常（包括肛隐窝过深、壁厚、融合等）。全部患儿均为单纯性瘘管，均经外科手术治疗，术后未见复发。结论：婴幼儿肛瘘和肛周脓肿的临床特点与成人有很大不同，了解这些特点对婴幼儿肛瘘和肛周脓肿的治疗有很大帮助。仔细寻找并切除肛瘘和肛周脓肿的感染源对降低术后复发有很大益处。     

Anorectal malignancies and dysplasia in HIV-positive men who have sex with men

Since the HIV epidemic, the incidence ofanorectal (pre)malignancies in men who have sex with men (MSM) is increasing. The incidence is likely to increase further in the coming years, given that HIV-positive MSM are living longer thanks to powerful antiretroviral treatment. Persistent human papillomavirus (HPV) infection is a major risk factor for the development of anal (pre)malignancies. Less is known about the natural history of anal intraepithelial neoplasia (AIN). Screening in HIV-positive and HIV-negative MSM for anorectal malignancies or dysplasia is cost-effective if the incidence is sufficiently high. Treatment options range from watchful waiting for asymptomatic grade-1 AIN to excision or radio(chemo)therapy for anorectal carcinoma. HPV vaccines are in development. Especially in HIV-positive MSM with anorectal complaints or genital warts in their medical history, one should consider these malignancies.     

Gastrointestinal surgery and gastroenterology. IX. Obstipation: etiology and diagnosis

Constipation and disordered defaecation are symptoms, not disease entities. Usually these symptoms are not caused by organic abnormalities, but by disordered motility of the colon and pelvic floor. Both decreased colonic motility (inertia coli) and increased frequency and amplitude of haustrating colonic contractions in the context of an irritable bowel syndrome may lead to constipation. A third important functional cause of constipation is by paradoxical straining of the pelvic floor muscles during (attempts to) defaecate: anismus. In the diagnosis of constipation the primary aim usually is the exclusion of organic disorders. A plain abdominal X-ray and measurement of colonic transit with radiopaque particles will provide information about the severity of the constipation. Defaecography is indicated primarily if disordered faecal expulsion exists. Anorectal manometry is relevant when Hirschsprung's disease is suspected.     

先天性肛门直肠畸形患儿父母生活质量和社会支持研究进展

先天性肛门直肠畸形是一种常见的消化道畸形。手术治疗虽然挽救了患儿生命,但是术后肛门失禁、狭窄和便秘等并发症给患儿的身心健康带来严重影响。父母作为主要照顾者,既承担照顾患儿的繁重任务,又面临着沉重的经济和精神负担,成为亟待关注的群体。本文就先天性肛门直肠畸形患儿父母生活质量和社会支持的研究进展进行综述,以期为改善该人群生活质量提供参考依据。     

括约肌间瘘管结扎术在单纯肛瘘患者中的应用研究

目的 探究及观察括约肌间瘘管结扎术在单纯肛瘘患者中的疗效及对肛门功能的影响.方法 选取2019年1月—2021年1月的80例单纯肛瘘患者为研究对象,将其按照治疗方法分为对照组(切开挂线组)和观察组(括约肌间瘘管结扎术组),每组各40例.比较两组的临床疗效(总有效率)、手术前后的VAS评分、Wexner评分结果及肛肠动力...     

Maternal exposure to tobacco smoke, alcohol and caffeine, and risk of anorectal atresia: National Birth Defects Prevention Study 1997–2003

Anorectal atresia is a congenital anomaly with mostly unknown risk factors. Studies have provided evidence of teratogenic effects of alcohol and tobacco, and animal studies have suggested that caffeine may potentiate their teratogenicity. However, it is unclear how these factors affect the risk of anorectal atresia. We analysed data from maternal telephone interviews in a multistate case-control study with 464 infants with anorectal atresia and 4940 infants with no major birth defects. We used unconditional logistic regression to determine the association of exposure to smoking, environmental tobacco smoke (ETS), alcohol or caffeine with anorectal atresia. Effect modification by caffeine intake was assessed on additive and multiplicative scales.
There was no association with alcohol intake in this analysis. However, there was some evidence of an association between anorectal atresia and maternal exposure to tobacco smoke and caffeine. Compared with non-smokers not exposed to ETS, the crude odds ratio (OR) and 95% confidence interval [CI] for cigarette smoking was 1.2 [95% CI 1.0, 1.5]. The association with anorectal atresia for non-smokers exposed to ETS at home and work was OR = 2.3 [95% CI 1.2, 4.1]. Compared with the lowest level of caffeine intake (<10 mg/day), the association for the highest caffeine intake (≥300 mg/day) was OR = 1.5 [95% CI 1.0, 2.2]. Results did not change after adjustment for covariates. This study found evidence of associations between anorectal atresia and caffeine intake, cigarette smoking and exposure to ETS. Because there are currently few additional data to support these results, further study is needed.     

Hazards associated with anal erotic activity

The recent liberalization of attitudes towards sexuality has brought with it the desire by some individuals to seek alternate methods of sexual stimulation and gratification, among them an exploration of anal eroticism. Various practices associated with anal sexuality carry with them the potential for medical complications. In this paper some of the hazards associated with anal eroticism are outlined and potential complications are discussed. Topics discussed include anal masturbation, enemas, sexually related anorectal disease, and the hazards of foreign objects introduced into the rectum. The intent of this paper is to provide concerned professionals dealing with various aspects of human sexuality with information relevant to anal eroticism.     

吻合器痔上粘膜环切术对肛肠动力学影响的临床研究

目的：比较吻合器痔上粘膜环切术（PPH手术）与传统痔外剥内扎术对肛门直肠动力学影响的差异。方法：采用瑞典生产的肛肠测压仪测量PPH术和传统常规手术术前及术后3月患者的肛管静息压（RASP）、肛管收缩压（MASP）、直肠感知阈值（RSTV）、直肠最大容量阈值（RMTV）的变化，切除标本送病理检查，观察有无肌肉组织和痔组织。结果：PPH术后肛管RASP较术前明显降低（P〈0．01），肛管MASP、直肠RSTV、直肠RMTV较术前有轻微降低但无显著性差异（P〉0．05），肛管RASP在PPH手术组恢复至正常水平，而在传统手术组肛管MASP、直肠RSTV、直肠RMTV较术前和正常值均有显著性降低。病理检查切除标本中无肌肉组织，仅含少量痔组织。结论：PPH手术使重度痔患者的肛管高压明显改变，使肛垫得到保护，而对直肠功能影响较小，使直肠功能得到最大保护。     

Anorectal lymphogranuloma venereum in a Melbourne man

We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in Australia in the setting of the recent emergence of LGV among MSM in Europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in Europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for Chlamydia trachomatis; investigation for other STIs including HIV were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from Europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.     

Current concepts in anorectal physiology

Anorectal physiology is primarily the study of anal sphincter and pelvic floor muscle function. Coincident with a developing interest in pelvic floor disorders has evolved a need for greater understanding of the normal physiological mechanisms, particularly in regard to faecal incontinence, and for increasingly sophisticated techniques whereby such function may be studied.     

Recent concepts in fecal incontinence

Fecal incontinence is an inability to defer release of gas or stool from the anus and rectum by mechanisms of voluntary control. It is an important medical disorder affecting the quality of life of more than 2% of the US population. The most common contributing factors include previous vaginal deliveries, pelvic or perineal trauma, previous anorectal surgery, and rectal prolapse. Many physicians lack experience and knowledge related to pelvic floor incontinence disorders, but advancing technology has improved this knowledge. Increased experience with endoanal ultrasound and endoanal magnetic resonance imaging have given us better understanding of the anatomy of the anal canal, and new techniques with muscle translocation and artificial neosphincters and neuromodulation have expanded our armamentarium of options for restoring continence.     

Imperforate hymen and vaginal atresia and their associated anomalies

The presenting features and associated abnormalities of imperforate hymen and vaginal atresia were studied in 24 girls under the age of 16 years. Hydrocolpos or hydrometrocolpos occurred in 8 infants, 13 older girls developed haematocolpos, but 3 of the girls had no distension of the genital tract. Seven of the older girls were diagnosed as having appendicitis. Anorectal anomalies were present in 9 of the children. Intravenous pyelography was performed on 16 girls and was normal in only one. Urinary tract investigations are indicated in all girls with vaginal outlet obstruction, and the vaginal orifice should be inspected in all girls with anorectal abnormalities.     

阿是穴按摩联合生物反馈疗法治疗功能性肛门直肠痛的机制探讨

功能性肛门直肠痛的治疗方法很多,有中医疗法,西医疗法,物理疗法,心理疗法等.笔者通过临床观察发现,阿是穴联合生物反馈疗法治疗功能性肛门直肠痛效果显著.因此,通过查阅文献,对阿是穴和生物反馈疗法对治疗功能性肛门直肠痛的机制进行探讨和研究,以期为本治疗方法提供更有利的理论支持,从而将此方法推广开来.     

TST联合外剥内扎术治疗混合痔的效果及对肛肠动力学指标的影响

目的探讨选择性痔上黏膜切除吻合术(TST)联合外剥内扎术治疗混合痔的效果以及对肛肠动力学指标的影响。方法选择2017年5月至2019年5月我院收治的混合痔患者72例,随机分为两组各36例。对照组采用外剥内扎术治疗,研究组采用TST联合外剥内扎术治疗。比较两组的手术指标、肛肠动力学指标及并发症。结果研究组的创面愈合时间短于对照组,VAS评分低于对照组(P<0.05)。研究组的术后肛管高压区长度、肛管静息压、肛管收缩压均高于对照组(P<0.05)。研究组的并发症总发生率为11.11%,低于对照组的30.56%(P<0.05)。结论TST联合外剥内扎术治疗混合痔的效果显著,可有效减轻患者的术后疼痛,促进术后恢复,改善肛肠动力学,减少术后并发症。