Intrabolus pressure on high‐resolution manometry distinguishes fibrostenotic and inflammatory phenotypes of eosinophilic esophagitis

The aim of this investigation was to determine the motility patterns of inflammatory and fibrostenotic phenotypes of eosinophilic esophagitis (EoE) utilizing high‐resolution manometry (HRM). Twenty‐nine patients with a confirmed diagnosis of EoE according to clinicopathological criteria currently being managed at the Joy McCann Culverhouse Swallowing Center at the University of South Florida were included in the retrospective analysis. Only patients who completed HRM studies were included in the analysis. Patients were classified into inflammatory or fibrostenotic subtypes based on baseline endoscopic evidence. Their baseline HRM studies prior to therapy were analyzed. Manometric data including distal contractile integral, integrated relaxation pressure, and intrabolus pressure (IBP) values were recorded. HRM results were interpreted according to the Chicago Classification system. Statistical analysis was performed with SPSS software (Version 22, IBM Co., Armonk, NY, USA). Data were compared utilizing Student's t‐test, χ² test, Pearson correlation, and Spearman correlation tests. Statistical significance was set at P < 0.05. A total of 29 patients with EoE were included into the retrospective analysis. The overall average age among patients was 40 years. Male patients comprised 62% of the overall population. Both groups were similar in age, gender, and overall clinical presentation. Seventeen patients (58%) had fibrostenotic disease, and 12 (42%) displayed inflammatory disease. The average IBP for the fibrostenotic and inflammatory groups were 18.6 ± 6.0 mmHg and 12.6 ± 3.5 mmHg, respectively (P < 0.05). Strictures were only seen in the fibrostenotic group. Of the fibrostenotic group, 6 (35%) demonstrated proximal esophageal strictures, 7 (41%) had distal strictures, 3 (18%) had mid‐esophageal strictures, and 1 (6%) patient had pan‐esophageal strictures. There was no statistically significant correlation between the level of esophageal stricture and degree of IBP. Integrated relaxation pressure, distal contractile integral, and other HRM metrics did not demonstrate statistical significance between the two subtypes. There also appeared no statistically significant correlation between patient demographics and esophageal metrics. Patients with the fibrostenotic phenotype of EoE demonstrated an IBP that was significantly higher than that of the inflammatory group.     

经肛管腔内超声过氧化氢增强造影诊断肛瘘的价值

目的：探讨经肛管腔内超声过氧化氢增强造影技术（HPUS）在肛瘘诊断中的临床价值。方法：对36例专科体检初步诊断为直肠肛门瘘的患者术前先常规进行传统经肛管腔内超声（TAUS）检查后,再将3％过氧化氢通过导管注入肛瘘外口,观察瘘管走向和内口开位置,然后将专科检查,TAUS和HPUS检查结果与手术中所见进行比较分析,结果：HPUS与UAUS对兼管分类的超声诊断准确率分别为91％（33／36）和63％（23／26）,对内口位置的判断准确率分别为72％（26／36）和44％（16／36）,HPUS检出的内口数目为44例,符合率为93％（44／47）,TAUS检出内口数目的符合率为59％（28／47）,结论：HPUS对肛瘘的诊断有较高的可视性和准确率。     

肛瘘的超声诊断及其临床价值探讨

目的探讨高频超声对肛瘘的诊断价值。方法采用5-17MHz高频线阵超声与5～9MHz直肠腔内超声相结合的方法,对经超声诊断的108例肛瘘患者的声像图进行回顾性分析,并与手术及病理相对照。结果声像图表现分4种类型,超声对肛瘘诊断的定位准确率为88．9％（96／108）。结论超声能清晰显示肛瘘内口的位置,便于判断瘘管的走向,对临床的诊断和治疗有很高实用价值,是一种很好的诊断工具。     

糖尿病患者胃肠测压的护理

糖尿病患者伴有胃肠运动功能障碍,被称为糖尿病性胃轻瘫。胃十二指肠测压是诊断糖尿病胃轻瘫的一种新方法,本文通过对５１例糖尿病患者和１５例正常人胃十二指肠测压的护理,体会为：检测前做好病人的护理心理,缓解紧情绪是检测成功的关键。     

切开旷置挂线配合中药坐浴治疗高位复杂性肛瘘疗效分析

为提高高位复杂性肛瘘的手术效果,减少并发症和后遗症,保持肛门的正常功能和形态,对60例高位复杂性肛瘘患者采用主管切开挂线引流,支管对口挂浮线或旷置引流,术后配合中药坐浴,60例均一次性治愈,肛门功能良好,肛门外观美观,疗程21—58天,平均29．5天。术后随访2～3年未见复发。提示切开旷置挂线配合中药坐浴治疗高位复杂性肛痿根治彻底,保持了肛门的正常功能和形态。     

肛瘘肛周脓肿术后应用复方角菜酸脂乳膏的效果分析

目的:观察复方角菜酸脂乳膏对肛瘘和肛周脓肿术后治疗的效果,寻找一种安全有效的术后换药药物.方法:将188例后位单纯性肛瘘或肛周脓肿一次性根治术后患者,分为复方角菜酸脂乳膏治疗组和中药换药对照组,对其愈合时间和并发症进行对比观察.结果:复方角菜酸脂乳膏在肛瘘或肛周脓肿术后伤口的促进愈合和减低并发症发生等方面优于传统中药换药(P＜0.01).结论:复方角菜酸脂乳膏是一种安全、有效的肛瘘和肛周脓肿术后换药药物,尤其在纤维增殖期(中期)、上皮覆盖期(后期)作用明显,具有明显的镇痛、促进愈合作用,并有效防止湿疹的出现.     

腹部无切口腹腔镜低位直肠癌前切除经肛门取出标本的临床分析

目的探讨腹部无辅助切口腹腔镜低位直肠癌前切除经肛门自然腔道取出标本的临床应用价值。方法选取2013年1月至2015年6月接受腹腔镜直肠癌手术的94例患者进行回顾性分析,其中27例患者采用经肛门自然腔道取出标本的无腹部切口腹腔镜低位前切除术治疗(无切口组)、67例采用腹腔镜辅助直肠前切除术治疗(常规组),数据分析采用SAS10.0软件处理,围手术期指标、疼痛程度评分采用均数±标准差(x珋±s)表示,组间比较采用t检验;手术并发症发生率采用百分率进行统计描述,比较采用χ2检验;P值0.05表示差异有统计学意义。结果无切口组患者的手术时间、手术出血量、胃肠道功能恢复时间、住院时间、住院费用均显著的低于常规组患者;术后12、24、48 h,无切口组患者的疼痛程度评分均显著的低于常规组患者,差异均具有统计学意义(P0.05);清扫淋巴结数目和手术并发症,两组差异不具有统计学意义(P0.05)。结论经肛门自然腔道标本取出的无切口腹腔镜低位前切除术治疗低位直肠癌效果可靠,手术创伤小、术后患者恢复快。     

左布比卡因和罗哌卡因与亚甲蓝的配比液对肛周术后镇痛效果的比较研究

为比较左布比卡因和罗哌卡因与亚甲蓝的配比液在肛周手术后的镇痛效果,探讨肛周手术后最佳的镇痛方式,将196例肛门手术病人随机分为A组和B组各98例,按照3：2的等效比率,A组使用0．75％罗哌卡因5ml加1％亚甲蓝2ml的配比液,B组使用0．5％左布比卡因5ml加1％亚甲蓝2ml的配比液,组成长效镇痛剂进行肛周皮下局部注射。在术后1～7d采用疼痛视觉评分系统（VAS）对病人疼痛程度进行评分。结果显示,术后1～3dA组与B组VAS评分无显著性差异（P〉0．05）,术后4～7dB组VAS评分低于A组（P〈0．05）。结果表明,用左布比卡因与亚甲蓝的配比液能够更好地进行肛周术后的镇痛。     

内括约肌侧方切开术治疗肛裂30例疗效观察

为探讨白内向外内括约肌侧方切开术治疗肛裂的疗效,将60例肛裂患者随机分为两组即观察组和对照组,每组各30例。观察组采用自内向外内括约肌侧方切开术治疗,对照组采用开放式内括约肌后方切开术治疗,比较两组患者手术时间、创口愈合时间、住院时间及术后疼痛评分情况,并进行统计分析。结果显示,观察组在手术时间、创口愈合时间、住院时间及术后疼痛评分方面均优于对照组（P〈0．05或P〈0．01）。结果表明,自内向外内括约肌侧方切开术治疗肛裂安全有效,术后疼痛轻,并发症少,恢复快。