保留括约肌虚挂线法治疗高位肛周脓肿

目的探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。方法 2009年10月-2010年10月采用随机对照试验,对52例高位肛周脓肿患者施行手术治疗,其中保留括约肌虚挂线法(治疗组)26例,切开挂线引流法(对照组)26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分(VAS)和术后6个月痊愈患者肛门功能后遗症发生率进行比较。结果术后6个月,治疗组和对照组肛瘘发生率分别为4.0%和3.8%,差异无统计学意义(P>0.05)。术后7～15 d治疗组VAS评分均低于对照组,差异有统计学意义(P<0.05)。两组切口愈合时间分别为(19.05±6.71)d和(21.42±8.40)d,差异有统计学意义(P<0.05)。术后6个月治疗组痊愈患者肛门功能全部正常,对照组后遗症发生率为12.0%,两组比较差异有统计学意义(P<0.05)。结论保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗,是一种治疗高位肛周脓肿较为理想的方法。     

一次性根治肛周脓肿的临床观察

目的探讨肛周脓肿患者一次性根治的治疗方法。方法采用一次性根治术治疗肛周脓肿60例。其中肛周皮下脓肿及低位肛门周围脓肿患者（12例）行脓肿一次性切开根治术;坐骨直肠脓肿及高位肌间脓肿患者（48例）行脓肿一次性切开＋肛瘘挂线术。结果 60例患者住院时间5～8 d,经过手术治疗后一次性治愈59例,一次性治愈率为98.3%。肛周皮下及低位肌间脓肿的患者切口愈合时间为12～20 d;坐骨直肠脓肿及高位肌间脓肿的患者切口愈合时间为25～40 d,其中1例患者术后因自行拔除橡皮筋而复发,经二次手术后未再复发。所有患者均随访3个月无复发,未出现肛门失禁、肛门狭窄、肛门畸形等并发症,肛门功能均正常。结论肛周脓肿患者采用合理的手术方法均能获得较好疗效,避免了分期手术疗程长、痛苦大、费用高的缺点。     

复方角菜酸酯乳膏应用于肛瘘肛周脓肿术后的疗效观察

目的探讨复方角菜酸酯乳膏应用于肛瘘肛周脓肿术后的临床疗效。方法选取本院收治的肛瘘肛周脓肿患者78例,随机分为2组,各39例。2组患者均根据自身肛瘘肛周脓肿病情,采取相应的手术治疗,对照组于术后使用生肌玉红膏治疗,治疗组于术后使用复方角菜酸酯乳膏治疗。比较2组术后肛周创面的疼痛情况以及术后创面愈合的时间。结果治疗组术后Ⅲ级疼痛的比例显著低于对照组,差异有统计学意义（P〈0.01）。治疗组术后用药后创面在14 d、21 d内愈合的比例明显大于对照组,差异有统计学意义（P〈0.05）。结论复方角菜酸酯乳膏对肛瘘肛周脓肿术后减轻创面疼痛和促进创面的修复具有确切的临床疗效,值得临床推广。     

高频彩超诊断肛周脓肿和肛瘘的临床应用价值

目的探讨高频彩超检查肛周脓肿、肛瘘的声像图特点及术前定位的临床应用价值。方法对临床拟诊肛周脓肿或肛瘘的73例患者,应用高频探头进行肛门周围探测,观察声像图特征及血流分布情况,并进行术前定位。结果超声检查73例患者,共检出病灶79个,其中肛周脓肿38例、单纯性肛瘘29例、复杂性肛瘘4例、漏诊2例。肛周脓肿声像图表现为圆形、椭圆形或不规则低回声、无回声或混合回声区;肛瘘声像图表现为管道样低回声,病灶边缘区见丰富彩色血流信号。超声术前定位与手术结果一致。结论高频彩超能区分肛周脓肿及瘘管与周围组织的关系,为确定病灶部位、数目及瘘口位置提供更多的可靠信息,为临床治疗提供更确切的依据。     

经肛括约肌间切开术合拖线引流术治疗肛周脓肿的临床研究

目的：观察经肛括约肌间切开术合拖线引流术治疗肛周脓肿的临床疗效。方法：将40例括约肌间马蹄形肛周脓肿患者随机分为治疗组、对照组,每组20例。对照组采用肛周脓肿切开挂线术治疗,治疗组采用经肛括约肌间切开术合拖线引流术治疗。观察临床疗效、术后肛门功能评分、并发症评分、创面愈合时间和术后复发率。结果：治疗组有效率为95%优于对照组90%,但是差异无统计学意义（P>0.05）;治疗组在术后肛门功能、肛门疼痛、创面渗出物、创面愈合时间、复发率方面显著优于对照组（P<0.05）。结论：经肛括约肌间切开术合拖线引流术治疗低位括约肌间脓肿疗效满意,具有具有疼痛轻、渗出少、恢复快、损伤小、复发率低等优点,值得临床推广应用。     

Extranodal natural killer/T-cell lymphoma(nasal type) presenting as a perianal abscess: A case report

BACKGROUND Extranodal natural killer(NK) T-cell lymphoma(ENKTL), nasal type is a rare subtype of extranodal non-Hodgkin lymphoma characterized by vascular damage and necrosis. The lesions usually present in the nasal cavity and adjacent tissues, however, the disease originates from the gastrointestinal or genitourinary tract in 25% of cases. Since rectal involvement in ENKTL is rare, rectal symptoms in the course of ENKTL are often misdiagnosed and considered to be related to benign diseases such as rectal fistula or perianal abscess.CASE SUMMARY We report the case of a 24-year-old Han Chinese female who initially presented with a perianal abscess that was subsequently diagnosed as nasal type ENKTL.Due to typical perianal pain, perianal abscess was diagnosed and surgical incision and drainage were performed. After recurrent, severe anal hemorrhages leading to hypovolemic shock and multiple surgeries, a diagnosis of ENKTL was made. The patient's condition gradually deteriorated, and she died shortly after initiation of chemotherapy.CONCLUSION Systemic and neoplastic diseases should be included in the differential diagnosis of any potentially benign perianal abscess complicated with recurrent hemorrhages.     

肛管和肛周疾病的MRI诊断

肛管是消化道的重要组成部分,具有复杂的解剖结构。近年来发生于肛管和肛周的疾病呈上升趋势,常见疾病包括肛瘘、肛周脓肿、痔、肛裂等,少见病包括肛管肿瘤、骶尾部藏毛窦及性疾病等,这些疾病严重影响患者的生活质量。MRI具有较高的软组织分辨率,能够全方位、多平面成像,作者着重探讨肛管和肛周疾病的MRI检查技术和表现,旨在提高对肛管和肛周疾病的诊断水平。     

改良药纱联合微波在肛周脓肿术后治疗中的作用

目的探讨改良药纱(康复新液+高渗葡萄糖)联合局部微波理疗在肛周脓肿术后创面修复治疗中的作用。方法随机将因肛周脓肿行手术治疗的患者80例分为两组。对照组40例术后行常规方法换药,改良组40例使用改良药纱换药联合局部微波理疗。比较两组术后切口疼痛、水肿、肛坠等症状消失时间,创面恢复情况和住院时间。结果改良组在术后切口疼痛、水肿、肛坠等症状消失时间短于对照组,创面渗液、肉芽组织、愈合时间和住院时间上均优于对照组(P0.05)。结论使用改良药纱(康复新液+高渗葡萄糖)换药联合局部微波理疗,能明显改善肛周脓肿患者术后不适症状,改善创面愈合,有效地缩短了创面愈合时间。     

肛管直肠周围肌组织感染的MRI表现及术后随访

目的  分析肛管直肠周围肌组织脓肿长期被临床忽视的原因,并总结术后患者肛门功能的恢复情况。方法  回顾性分析39例肛门外括约肌和/或耻骨直肠肌、肛提肌脓肿患者的MRI表现,并随访术后患者控便及排便能力。结果  18例为单一肌组织脓肿,21例并发两组以上肌组织脓肿,其中存在肛门外括约肌深部脓肿28例,浅部脓肿26例,耻骨直肠肌脓肿9例,肛提肌脓肿4例,肛门外括约肌皮下部脓肿1例;感染肌组织肿胀增粗,基本保持解剖形态,其中外括约肌深部呈典型“U”形,肛提肌呈对称“蝴蝶翅膀样”表现;肛周脂肪间隙清晰34例,脂肪间隙结构不清5例,术中触及内口26例。35例未累及肛提肌患者术后控便和排便良好,3例肛提肌脓肿患者存在不同程度控便不良及排便无力,另1例失联。结论  肛门外括约肌和/或耻骨直肠肌、肛提肌有时不能阻挡肛周感染的传播,甚至肌组织内部形成脓肿,肛门外括约肌及耻骨直肠肌脓肿术后患者肛门控便及排便功能很可能不受影响,肛提肌脓肿术后患者可能会出现肛门控便及排便功能不同程度降低。     

经会阴部超声检查肛管周围感染性疾病

目的：评价经会阴部超声检查法对肛周感染性病变的诊断意义。方法：通过对54例肛周肿物患者与10例正常组的对照检查，显示肛周括约肌及肛周病变，并与手术结果对照。患者取膀胱截石位，选用3-6MHz凸阵探头和5-10MHz线阵探头进行检查。结果：所有受检者均能清晰显示肛管内外括约肌。异常组发现肛周脓肿23例，肛周脓肿合并肛瘘或窦道形成31例，除未发现合并复合高位脓肿及肛瘘各1例外，其他均与手术结果相吻合。结论：经会阴部超声法检查肛管周围感染性疾病是一种简便、易行的方法，值得临床推广。     

Abdominal manifestations of fishbone perforation: a pictorial essay

Purpose

The present article provides an overview of the spectrum of abdominal presentations of fishbone (FB) ingestion and its complications.

Methods

In image data from 9 patients, FB perforations were found in different levels of the gastrointestinal tract (GIT), including duodenal, jejunal, and sigmoid perforations; in 4 asymptomatic patients, FBs were observed in the mesentery, falciform ligament, and intestinal bowel.

Results

The main imaging features of FB perforation were focal gastric or intestinal wall thickening, fat stranding, bowel obstruction, ascites, localized pneumoperitoneum, intra-abdominal abscess, liver abscess, and a linear hyperdense structure in the abdominal cavity in the GIT or within a parenchymal organ often surrounded by inflammatory changes. Free pneumoperitoneum was rare.

Conclusion

Although in most cases, a FB does not cause any serious complications, an inflammatory process and complications may occur when it perforates the stomach or bowel loops. Radiologists need to be aware of the possibility of FB perforation, especially in high-risk patients, because it is not always considered in the differential diagnosis by referring physicians and can mimic other inflammatory conditions and tumoral lesions.

     

MRI增强扫描在肛周脓肿术前诊断中的价值

目的探讨MRI不同方位及序列成像,尤其是冠状位及轴位T1WI压脂增强序列在肛周脓肿的术前诊断中的价值。方法经手术证实的30例脓肿患者全部进行增强MRI扫描。以手术结果为对照标准,统计分析MRI扫描三种序列组合对各种类型肛周脓肿及内口的检出率,并与直肠指诊进行对照分析。结果 30例患者手术证实52个脓肿,30个内口。直肠指诊肛周脓肿43个,检出率为82.69%,其中括约肌间脓肿15个,坐骨肛管间隙脓肿23个,肛提肌上方脓肿5个,正确的内口22个,检出率为73.33%。MRI轴位联合冠状位T1WI压脂增强序列检出肛周脓肿52个,检出率最高为100%,其中括约肌间脓肿18个,坐骨肛管间隙脓肿23个,肛提肌上方脓肿11个,正确的内口29个,检出率为96.67%。两组比较,对于肛提肌上方脓肿和内口的检出有统计学意义(P值分别为0.017和0.030)。结论肛周脓肿术前MRI增强扫描,能发现更多的肛提肌上方脓肿及明确的内口,为外科手术方式的选择提供更可信的影像资料。     

Endoanal sonography in the assessment of perianal endometriosis with external anal sphincter involvement

Endoanal sonography can be used in the assessment of benign and malignant anal conditions and to evaluate the anatomy of the anal sphincters. We used endoanal sonography with a 10-MHz rotating endocavitary probe to evaluate a 45-year-old woman with a perianal mass, fecal incontinence, and menses-associated perianal pain. She had had 2 vaginal deliveries requiring episiotomies. Biopsy of the mass showed endometrial tissue. The ultrasound examination showed a perianal mass and an external anal sphincter injury. A wide excision and sphincteroplasty were performed, with improvement of fecal continence and pain. Histopathologic examination of the mass confirmed perianal endometrioma in an episiotomy scar.     

肛周脓肿患者术后疼痛管理方案内容框架的构建

目的构建肛周脓肿患者术后疼痛管理方案内容框架,为科学的疼痛管理提供依据。方法2018年7月—2019年5月,以曼彻斯特疼痛管理模式、跨文化护理理论为理论指导,通过提取循证证据结合质性访谈凝练肛周脓肿患者术后疼痛管理需求,形成方案初稿。采用目的抽样法选取上海市15名长期从事疼痛管理的医学及护理专家,运用德尔菲(Delphi)法对方案初稿进行修订,建立肛周脓肿患者术后疼痛管理方案内容框架。结果经过2轮专家咨询,形成包含5个一级指标、23个二级指标、67个三级指标的疼痛管理方案内容框架。专家咨询权威系数为0.90,专家协调系数检验P<0.01。结论肛周脓肿患者术后疼痛管理方案内容框架构建的过程科学、可靠,内容结合了患者疼痛管理的循证证据、患者需求,具有实用性,对实施肛周脓肿术后疼痛管理具有指导作用。     

High‐Resolution Sonography Is Effective in Detection of Soft Tissue Foreign Bodies

Objective. Patients with penetrating trauma or field injuries are commonly encountered by emergency physicians. Clinical examination by inspection or palpation can detect superficial foreign bodies (FBs), and radiographs can detect radiopaque FBs. However, soft tissue FBs can be easily missed. The aim of our series was to evaluate the role of high‐resolution sonography in detection of soft tissue FBs. Methods. All patients referred to our center for sonographic evaluation of suspected soft tissue FBs from 1999 to 2008 were included in this analysis. Patients were scanned with an ultrasound machine using a 7.5‐MHz transducer. The suspected area was scanned in both axial and sagittal planes. The nature of the FB, length, and depth from the surface were recorded and reported. The presence of an FB was confirmed by surgical excision. Results. During the study period, 123 patients underwent sonography for a suspected FB, of which 12 were lost to follow‐up and excluded from the analysis. The study group included 73.8% male patients; the mean age was 36.2 years. Wood fragments and wooden thorns were the most frequently observed FBs, at 46.2% and 36.2%, respectively. The surgeon was satisfied with the reported depth of the FB from the surface in most cases (89%). The overall sensitivity and specificity of sonography were 94.5% and 53.8%. Conclusions. High‐resolution sonography is a very sensitive tool in diagnosis of soft tissue FBs. It also helps the surgeon with accurate localization, permitting easy removal.     

Perianal tuberculosis: A case report and review of the literature

Tuberculosis(TB) is still a major health problem worldwide. We present a rare case of an immunocompetent patient with perianal TB. A 38-year-old man visited a clinic with pain, swelling, and redness in the perineum. He had been persistently coughing for the past 6 mo. The abscess had formed a fistula to the perianal region, indicating perianal abscess. Mycobacterium tuberculosis was found in sputum and perianal abscess. Surgical drainage was performed, and oral anti-tuberculous drugs were administered for 6 mo. The patient's clinical course was favorable. On review of the literature on 58 cases of perianal TB, we found that the duration of persistent perianal lesion was much longer in patients without active pulmonary TB(APTB) than in those with APTB(66.4 mo vs 8.3 mo; confidence interval, 0.0760-0.9620, P = 0.0380). Thus, in cases of non-healing or recurrent perianal lesions, TB should be considered.     

Unusual perianal tumours masquerading as abscesses

Tumours of the perianal region and anal canal are uncommon and can present in a variety of ways. Acute anorectal sepsis is a common condition that usually presents as a painful lump close to the anal margin. Tumours in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. We report three patients who presented to our department with symptoms and signs suggestive of perianal abscess but which on further investigation were discovered to be due to unusual perianal tumours. Only one of the tumours was found to be malignant--a primary perianal mucinous adenocarcinoma; the other two were benign, a leiomyoma and an aggressive angiomyxoma. A high index of clinical suspicion is required to the diagnosis of perianal tumours when assessing patients with painful perianal lumps, particularly those with a long history and those of ethnic origin. Every effort should be made to establish a preoperative diagnosis so that correct treatment can be delivered.     

一次性根治高位复杂肛周脓肿术式探讨

目的探讨一次性根治高位复杂肛周脓肿的手术方法。方法对本院2003年1月~2007年5月期间收治的200例患者采用低位切开、高位引流的手术方法治疗高位肛周脓肿,观察手术效果。结果 200例患者均治愈出院,住院5~17d,平均11.5 d。术后无伤口出血、肛门失禁及肛管瘢痕狭窄等并发症。结论该手术方法避免了分期手术造成的患者病程的延长,手术效果好,值得临床推广。     

长效抗菌膜用于肛周脓肿切开术后的临床效果观察

目的观察长效抗菌膜喷洒创面促进肛周脓肿术后创面愈合的临床疗效。方法将52例肛周脓肿术后患者随机分为试验组和对照组各26例,试验组术后换药消毒后采用长效抗菌膜喷洒,对照组则常规消毒换药。观察两组肛周脓肿术后创面疼痛程度,创面渗液量及创面愈合时间。结果试验组术后创面疼痛轻,渗液量少,愈合时间短,与对照组相比均具有统计学差异（P〈0.05）。结论长效抗菌膜能有效减轻肛周脓肿术后创面疼痛,减少渗液、缩短创面愈合时间。     

经直肠高频彩超对肛周脓肿的诊断价值

目的探讨经直肠高频彩超对肛周脓肿的诊断价值。方法应用高频双平面探头,对57例肛周脓肿患者进行经直肠彩色多普勒超声检查,分析肛周脓肿的声像特征。结果肛周脓肿的声像图与周围正常组织存在明显差异,脓肿表现为无回声区或低回声与混合回声区;脓腔内无血流信号,周边可见彩色血流信号,合并瘘管则表现为条索状无回声或低回声区。57例患者均经手术及病理证实为肛周脓肿。结论经直肠高频彩超对肛周脓肿进行诊断可作为首选方法。