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。     

cetuximab联合5-FU对直肠癌放射治疗敏感度影响的实验研究

目的 研究西妥昔单抗(cetuximab)联合氟尿嘧啶对结直肠癌细胞术前放射治疗效果的影响。方法 对结肠癌细胞系RKO给予4种不同方式干预,2Gy放疗.氟尿嘧啶联合2Gy放疗.西妥昔单抗联合2Gy放疗.氟尿嘧啶及西妥昔单抗联合2Gy放疗,对各组细胞行CCK8检测不同干预后的细胞增殖情况,采用流式细胞术检测干预48h后各组细胞凋亡率.细胞周期比例,统计分析不同干预方式对RKO结直肠癌细胞系增殖的影响,利用RKO行裸鼠成瘤,对成瘤裸鼠同样给予4种不同方式干预并评估干预结果。结果 西妥昔单抗及氟尿嘧啶各自单独联合放疗均提高了放射治疗对肿瘤细胞生长抑制作用,差异有统计学意义(P＜0.05),但氟尿嘧啶联合西妥昔单抗与各自单用比较对提高放射治疗效果不明显,抑制率比较差异无统计学意义(P＞0.05)。西妥昔单抗与2Gy放疗联合明显降低了G₁/G₀期肿瘤细胞的比例(P＜0.05),而氟尿嘧啶与2Gy放疗联合则导致细胞周期检测出现一个明显的凋亡峰。裸鼠成瘤实验显示2Gy+氟尿嘧啶组,2Gy+西妥昔单抗组瘤体重量均明显低于对照组,差异有统计学意义(P＜0.05),结果还显示2Gy+氟尿嘧啶组瘤体重量明显低于2Gy+西妥昔单抗组,差异有统计学意义(P＜0.05)。结论 西妥昔单抗提高放疗敏感度主要通过改变细胞周期,减少引起对放疗损伤逃逸的G₁/G₀期细胞的比例,而氟尿嘧啶提高放疗敏感度主要通过增加细胞凋亡,氟尿嘧啶与西妥昔单抗比较增加放疗敏感度更加显著。氟尿嘧啶.西妥昔单抗各自单药均明显增加了2Gy放疗对裸鼠移植瘤的生长抑制作用,但西妥昔单抗联合氟尿嘧啶没有提高氟尿嘧啶单药对放疗敏感度的增加。     

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.     

蚊式钳辅助改良混合痔外剥内扎术的临床应用

Ⅲ、Ⅳ度混合痔是不可恢复的病理性肛垫,保守治疗常难以解除其症状。混合痔外剥内扎术是传统并继续延用的治疗混合痔的基本术式。笔者在十多年的临床手术探索中发现蚊式钳在混合痔外剥内扎术辅助应用能明显简化手术操作,缩短手术时间,     

直肠癌HIF-1α和COX-2的表达与新辅助放化疗敏感性的相关性

目的：探讨直肠癌组织中HIF-1α和下游调控基因COX-2的表达与新辅助放化疗敏感性的相关性。方法：收集2008年4月至2013年3月行新辅助放化疗后行手术治疗的直肠癌患者45例,应用免疫组织化学方法检测新辅助放化疗前活检组织标本中HIF-1α和COX-2蛋白的表达,用改良Wheeler直肠癌消退分级（mRCRG）体系和T分期降期来评估新辅助放化疗的效果。结果：活检组织中HIF-1α低表达组有50.0%患者在放化疗后肿瘤消退达到mRCRGI级,高表达组仅有16.0%,两者差异有统计学意义（P＜0.05）。活检组织中HIF-1α低表达组在放化疗后T分期降期率为70.0%,高表达组为32.0%,两者相比差异有统计学意义（P＜0.05）。COX-2表达水平与mRCRG肿瘤消退等级及T分期降期无关（均P＞0.05）。直肠癌组织中HIF-1α与COX-2表达呈低度正相关（r=0.36,P＜0.05）。结论：直肠癌组织中HIF-1α表达水平与直肠癌新辅助放化疗疗效密切相关,可作为预测直肠癌新辅助放化疗的敏感性指标之一。     

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…     

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.