经肛内括约肌切除术联合经腹全系膜切除术对超低位直肠肿瘤保肛的应用探讨

Objective To study the combination of trans-anal intersphincteric resection and trans- abdominal total mesorectal excision for anus-retained ultra-low rectal tumors. Methods Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed Results The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2. 1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with canceration and 3 giant villous adenoma. For pathological stages, there were 18 eases at stage pTNM Ⅰ , 5 at Ⅱ A, 1 at Ⅱ B, 4 at ⅢA, 1 at ⅢB and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months. Conclusion The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.     

经肛内括约肌切除术联合经腹全系膜切除术对超低位直肠肿瘤保肛的应用探讨

Objective To study the combination of trans-anal intersphincteric resection and trans- abdominal total mesorectal excision for anus-retained ultra-low rectal tumors. Methods Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed Results The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2. 1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with canceration and 3 giant villous adenoma. For pathological stages, there were 18 eases at stage pTNM Ⅰ , 5 at Ⅱ A, 1 at Ⅱ B, 4 at ⅢA, 1 at ⅢB and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months. Conclusion The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.     

中西医结合Ⅰ期根治术治疗肛门直肠周围脓肿96例

肛门直肠周围脓肿简称肛周脓肿,一般是指肛腺感染后炎症向肛管直肠周围间隙组织蔓延而发生的化脓性疾病。本病属中医学肛痈、脏毒等范畴。其特点是自溃或切开排脓后常形成肛瘘,特别是切开排脓后形成的肛瘘,一般需再次手术,给患者增加痛苦和负担。肛周脓肿是肛肠科的常见病,传统     

吻合器痔上黏膜环切术106例术后并发症分析

目的:探讨吻合器痔上黏膜环切术(PPH)并发症的可能原因及防治对策.方法:回顾性分析本院自2003年1月至2006年12月间用PPH治疗的106例痔病患者术后并发症的发生情况.结果:尿潴留54例,出血25例,肛痛52例,其中剧烈肛痛6例,肛门坠胀感17例,下腹坠痛8例,外痔血栓形成4例,直肠吻合口狭窄2例,排便困难6例,急便感2例,性交痛2例,复发3例.结论:PPH存在多种并发症,注意手术操作可减少其发生.     

综合治疗出口梗阻型便秘68例临床分析

[目的]探讨出口梗阻型便秘综合治疗的必要性、适应症以及有效性。[方法]运用手术结合中医药内服治疗已经确诊的出口梗阻型便秘68例,并对远期疗效随访。[结果]痊愈52例,好转14例,无效2例。[结论]对出口梗阻型便秘采用手术结合中医药内服治疗的疗效确切,但是要掌握严格的手术指针,同时要排除一些手术禁忌症。     

肾动脉狭窄合并高血压及肾功能不全患者行血运重建的中期疗效评价

目的评价经皮肾动脉血运重建术(percutaneous transluminal renal artery revascularization,PTRAR)治疗对肾动脉狭窄合并高血压及肾功能不全患者的临床疗效。方法对2011年1月至2015年6月因肾动脉狭窄合并高血压在华中科技大学同济医学院附属同济医院心内科行肾动脉血运重建术的62例患者进行回顾性研究,并对其中18例肾功能不全的患者进行随访观察。结果62例患者共76条肾动脉严重狭窄或闭塞,均成功开通,14条肾动脉仅行球囊扩张,62条肾动脉行支架置入。住院期间未出现任何手术相关并发症;术后24 h血压也有明显的下降[收缩压:(150.8±16.4)mmHg比(132.0±12.8)mmHg;舒张压:(88.6±12.7)mmHg比(80.1±11.1)mmHg,P均0.05]。术后24 h肾功能不全的18例患者平均血压降至(135.7±16.0)/(83.8±11.4)mmHg。针对18例肾功能不全的患者,术后平均随访26个月,结果发现,与术前相比血压明显下降[收缩压:(138.4±11.8)mmHg比(148.7±9.1)mmHg;舒张压:(88.1±10.7)mmHg比(93.5±9.5)mm·Hg,P均0.05]。所有62例患者术后服药种数明显减少。18例肾功能不全者中6例(33.3%)治愈,7例(38.9%)改善,5例(27.8%)无变化;术后血清肌酐水平的监测发现9例患者的肾功能好转,6例患者的肾功能未受明显影响,3例患者的肾功能恶化。结论肾动脉血运重建术对肾动脉狭窄合并高血压患者的血压带来明显的获益,但对肾功能的改善效果有待进一步研究。     

经肛内括约肌切除术联合经腹全系膜切除术对超低位直肠肿瘤保肛的应用探讨

Objective To study the combination of trans-anal intersphincteric resection and trans- abdominal total mesorectal excision for anus-retained ultra-low rectal tumors. Methods Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed Results The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2. 1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with canceration and 3 giant villous adenoma. For pathological stages, there were 18 eases at stage pTNM Ⅰ , 5 at Ⅱ A, 1 at Ⅱ B, 4 at ⅢA, 1 at ⅢB and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months. Conclusion The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.     

阵发性室上性心动过速合并肌钙蛋白升高患者临床分析

目的：探讨阵发性室上性心动过速(paroxysmal supraventricular tachycardia, PSVT)发作时合并肌钙蛋白升高对冠心病的诊断意义。方法：对以突发心悸作为首发症状并通过体表心电图、食道调搏或心内电生理检查诊断为PSVT的患者,在起病24小时内进行血清肌钙蛋白的检测,并在住院期间进行冠脉造影检查,对这些患者的肌钙蛋白水平、冠脉造影结果进行分析。共入选21例PVST患者,其中肌钙蛋白正常组5例（血清肌钙蛋白水平< 0.0262 ng/ml）,肌钙蛋白显著升高组（血清肌钙蛋白水平 > 0.3 ng/ml）5例,肌钙蛋白临界组（0.0262 ng/ml ＜血清肌钙蛋白水平＜0.3 ng/ml）组11例。结果：冠脉造影结果提示冠心病例数：肌钙蛋白正常及临界组0例,肌钙蛋白显著升高组中3例。肌钙蛋白正常组与临界组冠心病发生率相比无统计学意义,肌钙蛋白显著升高组较临界组有统计学意义,P<0.05。结论：PSVT患者发作时可导致肌钙蛋白水平升高,当肌钙蛋白显著升高时（> 0.3ng/ml）,需警惕合并冠心病可能。     

Ⅲ度AVB患者发生起搏器介导性心动过速1例报告

临床资料患者男性,72 岁。因反复心悸、胸闷、气促 3 年,加重 4月,于2004年5月26日入院。既往有高血压病史约 10 年,未正规治疗。入院时,BP190/100 mmHg,颈静脉怒张,双下肺少许细湿罗音,心界向左扩大, HR48 bpm,律齐,可闻及大炮音,肝右肋下4cm,双下肢轻度凹陷性水肿,心电图示:Ⅲ度房室传导阻滞,QRS波宽大畸形见图 1 1,心脏彩超示:全心扩大(左房 39 mm,左室 56 mm,右房 47 mm,右室 43mm),左心收缩功能减低(EF 43%)。临床诊断:①冠心病,心功能不全,心功能Ⅳ级,Ⅲ度房室传导阻滞;②高血压病 3级。于2004年6月2日植入DDD型永久起搏器,上限…