肛瘘切开半深缝合的研究

[目的]研究肛瘘切开半深缝合术的疗效。[方法]把106例单发肛瘘患者随机分为3组,A组36例采用切开半深缝合术;B组(对照1组)32例采用切开术,C组(对照2组)38例采用切除1期缝合术;通过6~18月的跟踪随访,在治疗时间、费用、创面瘢痕宽度和术后并发症方面进行判断分析,比较优劣。[结果]A、B、C组全部治愈。A组平均愈合时间短、费用少,与B、C组比较有显著差异,而在创面瘢痕宽度上A、C组比B组明显缩小;术后并发症方面,B、C组为多;A组未出现肛门功能损伤患者;B组3例、C组1例有肛门凹陷畸形。[结论]肛瘘切开半深缝合组治愈时间短、费用低、创面瘢痕小、并发症少、术后痛苦轻且处理简单,为治疗肛瘘的首选方式。     

外伤性盆底肛管直肠损伤的救治体会

肛管直肠因其特定的解剖位置，外伤的发生率较低，其占创伤很少一部分．而且其临床表现隐蔽往往无法反应患者的真实病情，多不引起临床医生的重视。笔者总结了本院2000年1月至2007年8月收治的28例外伤性盆底肛管直肠损伤的救治经过，分析探讨外伤性盆底肛管直肠损伤救治的基本原则及注意事项。     

Fournier综合征伴糖尿病二例诊治分析

Fournier综合征是一种混合感染的肛周、阴囊及会阴坏死性筋膜炎,是一种极严重、罕见的感染性疾病,其起病急,发展迅速,病死率高,若诊断不及时,处理不当,会危及患者生命.笔者2006年共收治Fournier综合征伴糖尿病2例,现总结这2例患者的诊治经过,结合复习相关文献,对Fournier综合征的相关问题进行系统分析.     

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.     

经肛内外括约肌间切除术治疗超低位直肠癌的保肛效果观察

目的 探讨经肛内外括约肌间切除术(ISR)联合经腹全直肠系膜切除术(TME)及经肛结肠肛管吻合术治疗超低位直肠癌的保肛效果.方法 经肛ISR联合经腹TME及经肛结肛吻合术治疗34例无肛门外括约肌受侵的超低位直肠癌患者,术后进行肛门功能训练及功能评价.结果 34例患者远切缘距肿瘤下缘的中位距离为2.3 cm.病理类型为腺癌28例(其中高分化11例,中分化17例),乳头状癌1例,绒毛状腺瘤癌变5例.病理TNM分期Ⅰ期28例,Ⅱ a期1例,Ⅲa期4例,Ⅲb期1例.术后吻合口狭窄3例,吻合口裂开2例,直肠阴道瘘2例.术后早期肛门控便能力明显下降,术后6～12个月肛门功能逐渐恢复.术后5个月吻合口复发1例,术后40个月肝转移1例.结论 在严格掌握适应证的前提下,经肛ISR联合经腹TME及经肛结肠肛管吻合术符合肿瘤根治性原则,并保留了肛门功能,是一种超低位直肠癌保肛的有效手术方法.     

姊妹同患甲状腺乳头状腺癌二例

姊妹同患甲状腺乳头状腺癌二例宋华羽例１７４岁，右颈部肿块２５年，缓慢增大，声嘶１个月，于１９９４年６月１８日入院。查体：右颈肿块约７ｃｍ×７ｃｍ，质硬，无压痛，表面粗糙，肿块随吞咽活动。颈淋巴结不肿大。心肺未见异常。喉镜检查见右声带麻痹。ｘ线片示右颈...     

45例老年急性弥漫性腹膜炎临床分析

我院１９８６年～２０００年间共收治急性弥漫性腹膜炎２１８例 ,其中６０岁以上４５例 ,占２０．６%。现通过对老年病例的分析 ,就其病因病理、临床特点、治疗措施作一初步探讨。１临床资料１．１一般资料本组４５例 ,男３６例 ,女９例 ,年龄６０～８９岁 ,平均 (６７．３±１．５)岁 ,从发生腹痛到首次就诊平均时间为１８．２小时 ,首次误诊９例 ,占２０ % ,发生腹痛到接受急诊剖腹手术平均时间为３８．５小时（３～１２２小时）。导致急性弥漫性腹膜炎的原发疾病有 :由急性感染所致者８例 ,其中重症急性胰腺炎３例 ,坏疽性阑尾炎２例 ,坏…