高位虚挂线法与实挂线法治疗高位肛瘘的临床对比研究

为探讨高位虚挂线法治疗高位肛瘘在肛门功能保护及术后并发症方面的优势,将高位肛瘘80例患者随机分为治疗组和对照组,每组40例。术中分别以实挂线法和虚挂线法治疗,比较两组术后创面愈合时间、肛管静息压及最大收缩压的变化、术后肛管锁眼畸形、肛门漏气漏液、复发情况。结果显示,术后治疗组创面愈合时间较对照组短（P〈0．05）,肛管锁眼畸形发生率较对照组低（P〈0．05）;肛管静息压和最大收缩压方面,治疗组术后无明显变化（P〉0．05）,对照组术后较术前降低（P〈0．05）;治疗组未见术后肛门漏气漏液,对照组为20例（P〈0．05）;两组各有1例复发。结果表明,高位虚挂线法治疗高位肛瘘在创面愈合时间、术后并发症及减轻患者疼痛方面优于传统的实挂线法。     

截断切开挂线加隧道引流术治疗高位肛瘘的临床观察

通过两种术式对比研究,探索截断切开挂线加隧道引流术在治疗高位肛瘘方面的临床应用价值。将240例高位肛瘘患者分别采用截断切开挂线加隧道引流术（试验组120例）和低位切开高位挂线术（对照组120例）治疗,观察并记录两组患者的创面愈合时间、术后疼痛、术前术后的最大肛管静息压和最大收缩压、随访6个月复发情况。结果显示,试验组创面愈合时间较对照组明显缩短（P〈0.05）,术后疼痛明显减轻（P〈0.05）;两组间术前术后最大肛管静息压和最大收缩压、随访6个月复发情况差异无统计学意义（P〉0.05）。结果表明,截断切开挂线加隧道引流术不仅可以有效的治疗高位肛瘘,防止肛瘘复发,很好地保护肛门功能,并且可以缩短创口愈合时间、减轻疼痛。     

复方硝苯地平软膏在肛门部手术后的临床应用研究

为研究复方硝苯地平软膏在肛门部手术后的临床应用效果，将166例肛门部手术后患者按随机数字表法分为3组，即治疗组（56例）、对照组（59例）和空白组（51例），分别给予复方硝苯地平软膏、消炎祛腐生肌膏、凡士林软膏换药，观察3组患者术后平均疼痛指数、排便疼痛指数、创面愈合时间、创面出血、创面水肿、肛门控便能力、心血管副作用、肛管动力学变化、肛门肌电图、住院时间等指标。结果显示，治疗组平均疼痛指数、排便疼痛指数低于对照组和空白组（P〈0．05），3组患者出血症状、肛门控便能力、住院时间差异无统计学意义（P〉0．05）。空白组创面水肿发生率高于治疗组和对照组（P〈0．05）。治疗组创面愈合时间短于对照组和空白组（P〈0．05）。肛管动力学变化：治疗组术后肛管静息压低于对照组和空白组（P〈0．05）；3组患者肛管收缩压差异无统计学意义（P〉0．05）。肛门肌电图检测：3组患者术后检测静息相及缩肛相的运动单位电位（MUP）分析显示，治疗组静息相MUP波幅（Am）、面积／波幅（Ar／Am）与对照组和空白组差异有统计学意义（P〈0．05），3组患者缩肛相MUPAm、面积（Ar）、Ar／Am、频率（Freq）的差异无统计学意义（P〉0．05）。心血管副作用：治疗组有5例（8．9％）出现头晕或头痛、面色潮红等反应，未予干预处理，其中4例为复杂性肛瘘患者，术后创面较大。空白组没有发现心血管相关反应。结果表明，复方硝苯地平软膏能有效减轻肛门部手术后疼痛，加快创面愈合，不良反应少，但在较大创口中应用，不良反应可能增加。     

生物蛋白胶封堵术治疗高位肛瘘的临床应用(附7例临床报告)

目的探讨生物蛋白胶封堵术治疗高位肛瘘的临床应用效果。方法回顾分析我科2006年2月至2007年9月，采用生物蛋白胶封堵术治疗高位肛瘘7例临床病例。结果术后随访半年，7例均无复发。结论生物蛋白胶封堵术治疗高位肛瘘有较好的效果，能缩短伤口愈合时间，减轻术后换药疼痛，为高位肛瘘的治疗开辟了一条新的途径。     

个性化心理护理在高位复杂性肛瘘围手术期患者中的应用

为探讨个性化心理护理对高位复杂性肛瘘围手术期患者焦虑、抑郁、疼痛及术后恢复的影响,将57例高位复杂性肛瘘围手术期患者随机分为观察组（28例）和对照组（29例）。对照组采用传统心理护理方式干预,观察组采用个性化心理护理方式干预,对比两组患者围手术期焦虑、抑郁及疼痛情况,以及住院时间、住院费用、创面愈合时间、患者生活质量。结果显示,观察组手术当日及术后第7天焦虑、抑郁、疼痛评分均明显低于对照组,P〈0．05;观察组住院时间、住院费用明显少于对照组,P〈0．05;两组术后创面愈合时间差异无统计学意义,P〉0．05;两组患者治疗后生活质量评分较治疗前均显著提高,P〈0．05,但组间比较差异无统计学意义,P〉0．05。结果表明,个性化心理护理可缓解高位复杂性肛瘘手术患者围手术期焦虑、抑郁等不良心理反应,减轻疼痛,有助于患者术后恢复。     

婴幼儿肛周脓肿3种手术方法疗效比较

为探讨婴幼儿肛周脓肿的最佳治疗方法．将63例肛周脓肿婴幼儿分成3组,分别采取脓肿局部切开引流、脓肿扩大切开引流和脓肿切开挂线治疗,对治疗后的肛瘘发生率、创口愈合时间及直肠肛管测压结果进行比较。结果显示,脓肿扩大切开组、切开挂线组的肛瘘发生率明显低于局部切开组（P〈0．05）。3组创口愈合时间、手术前和手术后1个月的肛管静息压差异无统计学意义（P〉0．05）。术后3d肛管静息压,局部切开组、切开挂线组明显低于扩大切开组（P〈0．05）。结果表明,一次性行扩大切开引流术或切开挂线引流术是治疗婴幼儿肛周脓肿最适宜的方法。     

低位肛瘘术后中医辨证分期换药的疗效观察

为探讨低位肛瘘术后中医辨证分期换药的临床疗效,回顾接受手术治疗的113例低位肛瘘患者资料,其中55例患者术后根据不同时期采用大黄油纱、生肌玉红膏油纱换药（治疗组）,58例患者采用凡士林油纱换药（对照组）。对比两组患者术后第4、8、14、21天肛门疼痛及肉芽组织生长情况．以及创面愈合时间。结果显示,治疗组术后第4、8、14、21天肛门疼痛评分均日月娩低于对照组,P〈0．05;两组术后第4天肉芽组织生长情况评分差异无统计学意义,P〉0．05,但治疗组术后第8、14、21天肉芽组织生长情况评分均叫显高于对照组,P〈0．05;治疗组创面愈合时间明显短于对照组,P〈0．05。结果表明,根据低位肛瘘术后中医辨证分期采用大黄油纱、生肌玉红膏油纱换药可明显减轻患者肛门疼痛,缩短创面愈合时间,值得临床推广应用。     

主管切开挂线支管引流术治疗高位复杂性肛瘘的临床疗效

为探讨主管切开挂线支管引流术治疗高位复杂性肛瘘的临床疗效,回顾采用主管切开挂线支管引流术（306例,治疗组）与传统切开挂线术（304例,对照组）治疗的高位复杂性肛瘘患者疗效,并进行对比分析。结果显示,两组治愈率比较差异无统计学意义,P〉0．05;但治疗组创面愈合时间明显短于对照组,P〈0．05;术后肛门功能情况明显优于对照组,P〈0．05。结果表明,主管切开挂线支管引流术治疗高位复杂性肛瘘治愈率高,创面愈合快,对肛门功能影响小,值得临床推广应用。     

低位微创切口高位虚挂线术在高位肛瘘的临床应用

目的探讨低位微创切口高位虚挂线术治疗高位肛瘘的临床疗效。方法回顾性分析2008年01月至2011年12月江西省全南县人民医院收治的96例接受手术治疗的高位肛瘘患者的临床资料,其中行低位微创切口高位虚挂线手术58例（治疗组）,传统低位切开高位挂线术38例（对照组）。结果治疗组患者手术时间、术后创面愈合时间及住院时间较对照组明显缩短（P〈0．05）;治疗组患者中出血量比对照组少（P〈0．05）;治疗组患者术后肛门疼痛较对照组明显减轻（P〈0．05）;术后1个月和6个月治疗组Wexner评分分别为（1．80±0．77）和（1．00±0．64）,与对照组的（2．50±0．62）和（1．60±0．77）相比,差异有统计学意义（P〈0．05）。结论低位微创切口高位虚挂线治疗高位肛瘘更有效,患者术后恢复更快。     

改良探针挂线结合过氧化氢灌洗治疗高位肛瘘的疗效观察

为探讨治疗高位肛瘘较为有效的手术方式,采用改良探针挂线结合过氧化氢灌洗治疗高位肛瘘46例,并与传统挂线手术治疗的32例进行对比分析。结果显示,传统挂线组与改良组术后均获近期治愈,改良组创面愈合时间为（20．3±0．3）d,对照组为（28．4±0．5）d（P〈0．05）;对照组肛瘘复发2例,改良组无复发（P〈0．05）。结果表明,改良探针挂线结合过氧化氢灌洗治疗高位肛瘘的疗效优于传统挂线手术。     

Seton or glue for trans‐sphincteric anal fistulae: a prospective randomized crossover clinical trial

Objective Fibrin glue treatment of anal fistulae has been proposed to minimize the risk of faecal incontinence but its acceptance by coloproctologists is still poor because the published data is controversial. Therefore, we carried out a prospective randomized crossover trial comparing treatment with a commercial fibrin glue to classical seton treatment, with healing rate, hospital stay, healing time, faecal incontinence and postoperative pain as study outcomes. Method Sixty‐four homogeneous patients with trans‐sphincteric anal fistulae referred to seven colorectal units were randomized to undergo fibrin glue (39 patients) or seton (25 patients) treatment. Patients failing to heal after treatment with fibrin glue were re‐randomized to undergo a second injection with glue or seton treatment. Results Sixty‐two of the 64 patients completed the minimum 1‐year follow‐up period. Twenty‐one of 24 patients healed in the seton group compared with 15/38 in the fibrin glue group (P = 0.0007). The 23 failures after glue treatment were re‐randomized to have a second glue injection (eight patients) or a seton treatment (15 patients). Four of the eight (50%) patients treated with a second injection of glue, and nine out of the 15 (60%) patients in the seton group, healed. Patients treated with fibrin glue reported less postoperative pain and had a shorter hospital stay than patients treated with a seton; furthermore, faecal continence and anal manometry significantly worsened after seton treatment. Conclusion Seton treatment has a significantly higher probability of success compared with fibrin glue treatment but poses a higher risk of faecal incontinence. Fibrin glue could be considered as a first line of treatment for patients at risk of faecal incontinence or other comorbidities.     

超声引导下置管引流术治疗高位肛周脓肿对照临床观察研究

目的：观察超声引导置管引流术治疗高位肛周脓肿的疗效。方法：将 120 例高位肛周脓肿患者按照随机数字表法分为治疗组和对照组各 60 例,治疗组采用超声引导下置管引流术治疗,对照组采用常规置管引流术治疗,比较两组术后第 3、7、1 天肛门疼痛和脓腔渗液情况,出现出血（大于 20 mL）、尿潴留、发热（>38.5 ℃）等并发症的情况,术后 1 个月总有效率、创面愈合时间,随访 6 个月的脓肿复发率及成瘘率。结果：治疗组创面完全愈合时间明显少于对照组（P<0.01）;两组间术后第 3 天疼痛评分和渗液评分差异无显著性统计学意义（P>0.05）,术后第 7、14 天疼痛评分和渗液评分有显著性差异（P<0.05）;两组术后出现出血、尿潴留的发生率无显著差异（P>0.05）,治疗组出现发热的发生率（3.33%）明显优于对照组（13.33%）（P<0.05）。术后 1 个月总有效率,治疗组明显优于对照组（P<0.05）;随访半年,两组复发形成肛瘘病例,治疗组（13.33%）明显少于对照组（30%）（P<0.05）。结论：超声介入高位肛周脓肿置管引流术的术前、术中、术后,安全可行,疗效显著。     

经括约肌间瘘管结扎术治疗高位单纯性肛瘘的前瞻性临床对比研究

目的探索经括约肌间瘘管结扎术治疗高位单纯性肛瘘的临床疗效及安全性。方法前瞻性收集2015年3月至2017年12月期间笔者所在医院科室收治的72例确诊为高位单纯性肛瘘的患者,按随机数字表法并结合患者意愿分为经括约肌间瘘管结扎术组(试验组,32例)和高位肛瘘低切高挂术组(对照组,40例),比较2组患者的手术效果和术后6个月时的括约肌生理功能。结果与对照组相比,试验组患者的术后疼痛持续时间短,术后创面愈合时间短,治愈率高,复发率低,初始感觉阈值低,肛管静息压高,肛管高压带长度长,差异均有统计学意义(P<0.05);但2组患者的手术时间、肛管最大收缩压和直肠静息压比较差异均无统计学意义(P>0.05),表明试验组的肛门生理功能恢复较好。结论经括约肌间瘘管结扎术治疗高位单纯性肛瘘的效果明显,术式安全可靠,可在临床中推广应用。     

术后早期腹腔化疗下联合应用生长激素和生物蛋白胶对结肠吻合口愈合的影响

目的研究联合应用生长激素(GH)和生物蛋白胶(FS)对术后早期腹腔化疗条件下结肠吻合口愈合的影响。方法Wister大鼠48只,随机分为4组：对照组,单纯行肠切除吻合；腹腔化疗组(5-FU组),术后连续3 d腹腔内注射氟尿嘧啶(5-FU)(20 mg·kg~(-1)·d~(-1))；FS组,术中应用FS、术后给予早期腹腔化疗；GH联合FS组,术中应用FS、术后给予GH(1 mg·kg~(-1)·d~(-1))及早期腹腔化疗。术后8 d处死各组大鼠,剖腹切取吻合口进行评分(评分越高提示吻合口与周围组织的粘连越重)和测量吻合口破裂压力及进行吻合口组织学评分。结果GH联合FS组的吻合口评分2．00,低于FS组(2．13)和对照组(2．38),但P＞0．05,差异无统计学意义；GH联合FS组显著低于5-FU组的2．75,P＜0．05；差异有统计学意义。GH联合FS组的吻合口破裂压力229．9475,高于对照组(199．7525)和FS组(199．4338),P＜0．05；显著高于5-FU组(171．7938),P＜0．01。GH联合FS组的吻合口组织学评分2．9,高于FS组(2．3)和对照组(2．1)及5-FU组(1．7),P＜0．05。结论联合应用GH和FS能提高吻合口愈合强度,促进术后早期腹腔化疗条件下结肠吻合口的愈合。     

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??Application of negative pressure ball drainage on the perianal abscess in deep parapharyngeal space : a study of curative effect PAN You-zhen, ZHEN Jin-xia, ZHENG Zhen-lin. Department of Proctology Surgery, Gongli Hospital of Pudong New Area, Shanghai 200135, China. Corresponding author: ZHEN Jin-xia, E-mail: zhenjinxia8@163.com Abstract Objective To study the clinical effect of the negative pressure ball drainage in the application of postoperative perianal abscess in deep parapharyngeal space. Methods The 60 patients with perianal abscess in deep parapharyngeal space admitted between January 2007 and August 2008 at Gongli Hospital of Pudong New Area of Shanghai City were randomly divided into negative pressure ball group (treatment group n=30) and vaseline gauze group (control group n=30). Occurrence of pain, postoperative analgesic, postoperative drainage and wound healing time were compared respectively. Follow-up was performed in 3 months, 6 months and 12 months after the operation in order to observe the occurrence of secondary anal fistula. Results Occurrence of pain, postoperative analgesic, postoperative drainage and wound healing time of treatment group was lower than those of the control group (P <0.01). Incidence of secondary anal fistula of treatment group was lower than that of the control group (P <0.01). Conclusion Negative pressure ball is very suitable for postoperative drainage of perianal abscess in deep parapharyngeal space.     

Open tension-free Lichtenstein repair of inguinal hernia: use of fibrin glue versus sutures for mesh fixation

Purpose

To investigate pain and other complications following inguinal hernioplasty performed by the Lichtenstein technique with mesh fixation by fibrin glue or sutures.

Methods

Five hundred and twenty patients were enrolled in this 12-month observational multicenter study and received either sutures or fibrin glue (Tissucol^?/Tisseel^?) based on the preference of the surgeon. Pain, numbness, discomfort, recurrence, and other complications were assessed postoperatively and at 1, 3, 6, and 12?months. Pain intensity was assessed by a visual analog scale (VAS; 0 [no pain] to 10 [worst pain]).

Results

One hundred and seventy-one patients received sutures and 349 received fibrin glue. During the early postoperative phase, 87.4% of patients in the fibrin glue group and 76.6% of patients in the sutures group were complication-free (P?=?0.001). Patients who received fibrin glue were also less likely to experience hematoma/ecchymosis than those in the suture group (both P?=?0.001). The mean pain score was significantly lower in the fibrin group than the sutures group (2.5 vs. 3.2, P?<?0.001). At 1?month, significantly fewer patients in the fibrin glue group reported pain, numbness, and discomfort compared with patients in the sutures group (all P?<?0.05). Fibrin glue patients also experienced less intense pain (0.6 vs. 1.2; P?=?0.001). By 3?months, the between-group differences had disappeared, except for numbness, which was more prevalent in the sutures group. By 12?months, very few patients reported complications.

Conclusions

Tissucol fibrin glue for mesh fixation in the Lichtenstein repair of inguinal hernia shows advantages over sutures, including lower incidence of complications such as pain, numbness, and discomfort, and should be considered as a first-line option for mesh fixation in hernioplasty.     

乳晕切口负压引流治疗乳腺脓肿的疗效分析

目的 观察分析经乳晕切口负压引流治疗乳腺脓肿的临床效果,总结其临床价值。方法 选取我院2008年12月至2011年12月46例乳腺脓肿的患者,分为观察组和对照组,各23例,观察组采取经乳晕切口负压引流治疗,对照组采取脓肿切开行开放引流治疗,观察比较两组治疗效果,进行统计学分析。结果 两组手术时间、伤口愈合时间比较存在明显差异（P＜0.05）,具有统计学意义;两组乳房变形率、切口瘢痕形成率及术后并发症发生率比较存在显著差异（P＜0.05）,具有统计学意义。结论 经乳晕切口负压引流治疗乳腺脓肿的临床效果优于传统切开引流,并发症少,对乳房组织损伤小,痛苦小,安全可靠,值得在临床上合理推广。     

Effect of 5-Fluorouracil plus Interferon on the Integrity of Colonic Anastomoses Covering with Fibrin Glue

Background It has been well established that the immediate postoperative intraperitoneal administration of chemotherapeutic agents such as 5-fluorouracil (5-FU) after curative colon resection for colon cancer destroys disseminated cancer cells and inhibits micrometastases but also inhibits anastomotic healing. On the other hand, the application of fibrin glue constitutes a physical barrier around the anastomosis and may prevent anastomotic leakage. The purpose of this experimental study was to determine the effect of 5-FU plus interferon (IFN)-α-2a on the integrity of colonic anastomoses covered with fibrin glue when injected intraperitoneally immediately after colon resection. Materials and Methods Sixty rats were randomized to one of four groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. Rats of the control and the fibrin glue groups were injected with 6 ml of 0.9% sodium chloride (NaCl) solution intraperitoneally. Rats in the 5-FU + IFN and the 5-FU + IFN + fibrin glue groups received 5-FU plus IFN intraperitoneally. The colonic anastomoses of the rats in the fibrin glue and in the 5-FU + IFN + fibrin glue groups were covered with fibrin glue. All rats were sacrificed on the 8th postoperative day, and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded, and the anastomoses were graded histologically. Results Only the 5-FU + IFN group had anastomoses rupture, and the rupture rate (33%) in this group was significantly greater than in the other groups, where there were no ruptures (P = 0.015). The adhesion formations score was, on average, significantly higher in rats of the 5-FU + IFN group compared with the control group (P = 0.006) and the 5-FU + IFN + fibrin glue group (P = 0.010). Bursting pressures were significantly lower in the control group when compared to the fibrin glue and 5-FU + IFN + fibrin glue group (P < 0.001). Rats in the 5-FU + IFN + fibrin glue group developed significantly more marked neoangiogenesis than rats in the other groups. Inflammatory cell infiltration, collagen deposition, and fibroblast activity did not differ significantly among the four groups (P = 0.856, P = 0.192 and P = 0.243, respectively). Conclusion The immediate postoperative intraperitoneal administration of 5-FU plus IFN impairs colonic healing. However, when the colonic anastomoses were covered with fibrin glue, the injection of 5-FU plus IFN had no adverse effects on the integrity of the anastomoses.