磁共振成像在深部肛周脓肿诊断中的应用

目的 探讨MRI检查在深部肛周脓肿诊断中的应用价值.方法 回顾性分析2006年1月至2007年12月南京中医药大学附属医院收治的21例临床疑诊为深部肛周脓肿患者的临床资料.术前进行MRI体表相控阵列线圈检查;以手术结果为标准,比较MRI检查和术前肛门指诊在深部肛周脓肿的分型和内口检查结果.采用X2检验分析检测数据.结果 19例患者诊断为深部脓肿,1例诊断为骶前囊肿伴感染,1例诊断为骶前占位性病变(病理检查证实为黏液腺癌).19例患者共发现25个脓腔,其中坐骨直肠间隙脓腔14个,骨盆直肠间隙脓腔5个,高位括约肌间脓腔6个.单间隙脓肿13例,多间隙脓肿6例.MRI检查与术前肛门指诊的内口诊断符合率分别为12/19和13/19,两种检查方法比较差异无统计学意义(χ2=0.116,P>0.05);深部肛周脓肿分类准确率分别为25/25和16/25,两种检查方法比较差异有统计学意义(χ2=10.970,P<0.05);手术探查发现13例患者为单间隙脓肿,6例为多间隙脓肿,而MRI检查与术前肛门指诊多间隙脓肿准确率分别为19/19和13/19,两种检查方法比较差异有统计学意义(χ2=7.125,P<0.05).结论 MRI检查能确诊并定位深部肛周脓肿病变范围及其与肛管直肠周围括约肌之间的复杂关系;对指导手术排除肛管直肠周围潜伏病变具有确切意义.     

磁共振成像在深部肛周脓肿诊断中的应用

Objective To evaluate magnetic resonance imaging (MRI) in the diagnosis of deep anorectal abscess. Methods Twenty-one patients who were suspected of having deep anorectal abscess were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2006 to December 2007, and their clinical data were retrospectively analyzed. Phased-array coil MRI was applied to all patients before the operation. We compared the efficacy of MRI and rectal digital examination in the classification of deep anorectal abscess and the diagnosis rate of internal opening according to the postoperative results. All data were analyzed using the chi-square test. Results Nineteen patients were diagnosed with deep anorectal abscess, one patient had presacral cyst combined with infection and one patient had perianal mucinous adenocarcinoma. A total of 25 lesions were identified, including 14 ischiorectal abscesses, five pelvirectal abscesses, and six high intersphincteric abscesses. Thirteen patients had single space abscesses and six had multiple space abscesses. There were no significant differences in the diagnosis rate between MRI (12/19) and rectal digital examination for internal opening (13/19) (χ2 =0. 116, P>0.05). The accuracy rate was significantly different between MRI (25/25) and rectal digital examination (16/25) in the classification of deep anorectal abscess (χ2 = 10.970, P <0.05). Operative exploration revealed that there were 13 patients with single space abscesses and six with multiple space abscesses. The accuracy rate was significantly different between MRI (19/19) and the rectal digital examination (13/19) for detecting multiple space abscesses (χ2 =7. 125, P <0. 05). Conclusions MRI with a phased-array coil can accurately detect the extent of deep anorectal abscess and its relationship with anorectal sphincters. MRI examination is helpful in excluding potential lesions in the anorectal region.     

也谈产后虚实补泻

关于产后是虚是实及产后病宜补宜泻,历代医家多有论述,争论不一.仲景有"产后阴气独盛"之说,故今人有倡导以温补为宜者.徐灵胎则反对产后唯补之说,指出"世之庸医,误信产后宜温之说,不论病证,皆以辛热之药,烁其阴而益其火,无不立毙".于氏引用这一论述,结合     

中医治疗产后尿潴留近况

产后尿潴留是临床常见的妇科病证,有时经多法治疗仍顽固不愈,故为医家所重视。本病属中医“癃闭”范畴,中医以其方法多样、简便易行、不良反应小,深受病家欢迎。近年来的文献报道很多,现综述     

结肠肝曲癌21例临床分析

1991～1995年收治大肠癌612例，其中肝曲癌21例，占3．4％。本文就结肠肝曲癌的临床病理特点、诊断和治疗进行分析。     

黄蜀葵花乌梅复方提取物对TNBS诱导克罗恩病小鼠的治疗作用及其机制研究

目的:探讨黄蜀葵花乌梅复方提取物对三硝基苯磺酸(TNBS)诱导的克罗恩病(CD)实验小鼠的治疗作用及肿瘤坏死因子-α(TNF-α)和干扰素-γ(IFN-γ)等炎症因子的影响。方法:BABL/c小鼠随机分为正常对照组、模型组、柳氮磺吡啶组和黄葵乌梅复方组,后3组应用TNBS诱导建立小鼠CD模型。造模开始时,柳氮磺吡啶组和黄葵乌梅复方组分别给予0.5g/kg柳氮磺吡啶和6g/kg黄蜀葵花乌梅复方提取物灌胃,每日1次,连续28d。实验终点时分析实验动物的存活率、结肠长度/重量比值、结肠组织病理,以及结肠组织中炎症因子TNF-α和IFN-γ含量。结果:与模型组相比,黄蜀葵花复方组小鼠存活率明显增高,结肠重量/长度比值明显降低,结肠组织炎症和隐窝损害明显减轻,结肠病理评分和结肠组织TNF-α、IFN-γ含量明显降低。结论:黄蜀葵花和乌梅复方提取物可用于CD的治疗,其作用机制可能与显著降低炎症因子TNF-α和IFN-γ含量有关。     

浅挂线法治疗高位肛周脓肿的临床研究

目的:研究适当降低挂线高度的浅挂线法治疗高位肛周脓肿的可行性和临床价值。方法:将60例高位肛周脓肿随机分成治疗组和对照组,观察疗效。结果:两组治愈率相当,但治疗组手术时间缩短,术后疼痛减轻,住院时间缩短,且无肛门功能障碍,两组差异具有统计学意义(P<0.05)。结论:浅挂线法在保持高治愈率基础上,降低了手术操作难度,减轻了病人痛苦,缩短了住院时间,最大限度地保护了肛门功能。     

便秘、便血验案

<正>南京中医药大学附属医院朱秉宜主任中医师是江苏省名中医,全国首批师承指导老师,业医六十余载,积累了丰富的临床经验。现整理其治疗便秘、便血案数则,以窥其辨治肛肠疾病之一斑。1便秘案1男,68岁,2003年8月13日初诊。大便秘结10余年,近年来逐步发展到几无便意,多用泻剂以通便,口干喜饮、纳尚可,寐安。口腔有散在溃     

溃疡性结肠炎的肠外皮肤表现

溃疡性结肠炎(UC)的发病率呈逐年上升趋势,其发病机制尚未完全明确。UC肠外表现(EIM)多样,可涉及骨关节、皮肤、肝胆、眼等全身多个器官系统,一种EIM的出现增加了其他EIM的发生风险。皮肤表现是UC重要的EIM,可分为反应性皮肤表现、免疫相关性皮肤表现、营养不良和治疗导致的皮肤表现。本文就UC肠外皮肤表现的临床症状、诊断、治疗等作一综述。