Laparoscopic Abdomino-Paracoccygeal Resection of Anorectal Cystic Teratoma

Sacrococcygeal teratoma rarely presents in adulthood (reported incidence of 1:87 000). It is more common in females. Adult anorectal teratoma is a rare variant of sacrococcygeal teratoma. The majority of tumors spare the sacrococcygeal bone. The size and location of the tumor within the pelvis dictates whether it is approached surgically through a transabdominal, posterior, or a combined approach. We present in this article the case of a young woman with a large cystic anorectal teratoma treated successfully with a combined laparoscopic abdomino-paracoccygeal resection.     

陆金根治疗肛肠疾病术后并发症经验

结合验案介绍陆金根教授治疗肛肠疾病术后并发症的临床经验。二便不调、水肿疼痛及创面愈合缓慢为肛肠疾病最常见的并发症,治疗以益气、祛瘀、健脾为主。     

会阴超声诊断直肠肛管病变的意义

目的 探讨经会阴超声诊断直肠肛管病变的意义.方法 回顾性分析23例经手术病理或随访证实的直肠肛管病例.结果 23例中,经会阴超声发现直肠肛管病变21例,漏诊2例,诊断符合率91％.结论 会阴超声由于其无创、使用方便及无变形失真而成为直肠肛管病变诊断的首选方法之一.     

基于数据挖掘的灌肠剂临床使用规律分析

目的:通过对临床上使用的灌肠剂的使用规律进行分析,包括灌肠剂的使用温度、体积、疗程等,为以后灌肠剂的使用提供依据和参考。方法:以中国知网收录含临床使用灌肠剂经验方为资料来源,使用Excel 2013、SPSS Modeler 14.1统计软件为工具,对纳入标准的灌肠剂的温度、体积、疗程及使用中药进行统计处理和关联规则分析。结果:根据分析结果,在临床使用灌肠剂中,温度30~38℃,灌肠体积100~200 mL,使用疗程14~21 d。在灌肠剂治疗肛肠疾病的过程中,关联规则分析中发现治疗肛肠病类关联强度最高的药对组合7种。结论:通过对灌肠剂的临床使用进行分析,反映出灌肠剂用于不同疾病时的用药规律和配伍特点,为"异病同治"提供理论支持,数理统计法是中医用药规律分析的重要工具,为指导临床用药提供现代化研究方向,为规范临床使用灌肠剂提供了可能。     

主动护理干预对患者肛肠术后恢复的影响

目的研究主动护理干预对肛肠术患者术后恢复的影响。方法选择混合痔、肛裂等肛肠术患者共426例,分为对照组和实验组,对照组为传统的护理方式,对实验组患者采取主动护理干预,包括心理干预及实际操作干预。统计两组内尿滞留及便秘率,进行统计学分析。结果实验组的尿滞留率及便秘率分别为5.8%和11.3%,对照组该两项指标分别为29.2%和31.7%。组间统计学分析,P﹤0.01。结论主动护理干预可显著降低患者肛肠术后并发症的发生率,对患者的快速恢复具有积极的作用。     

肛门直肠及畸形发育胚胎学的研究

[目的]通过采用乙烯硫脲(ETU)诱导孕鼠胎仔肛门直肠畸形,研究胚胎发育过程中肛门内括约肌间神经节细胞及神经丛的数目及形态。[方法]采用Wastar孕鼠16只,随机分为空白对照组及模型组,每组8只,在妊娠的d7、d9、d11.5及d13.5、d14.5、d15、d16由胃管注入125mg/kg的乙烯硫脲(ETU),空白对照组8只Wastar大鼠于d11.5、d13.5、d14、d16,模型组4只Wastar大鼠于11.5d、13.5d、14d、15d、16d进行取材,取胎仔行正中矢状面进行连续切片,取材标本进行HE及PAS染色,观察直肠肛管发育情况及肛门内括约肌肌间神经节细胞及神经丛数的数目。[结果]11d、13d模型组产生的肛门直肠畸形的发生率为75.00%(6/8),模型组肛门直肠畸形胎仔每个视野下肛门内括约肌肌间神经节的细胞数为(1.341±0.024),神经丛数为(0.406±0.029),空白对照组胎仔为(3.156±0.074)、(1.375±0.053),两者比较差异有统计学意义(P﹤0.05);其中模型组中正常胎仔的数值分别为(3.087±0.059)、(1.324±0.031),与空白对照组比较差异无统计学意义(P﹥0.05)。[结论]乙烯硫脲是良好的诱导肛门直肠畸形的致畸剂,肛门内括约肌肌间神经节细胞数及神经丛数的减少是肛门直肠畸形的病理学改变的重要影响因素。     

中西医结合治疗80例肛门直肠周围脓肿临床疗效分析

目的分析并评价采用中西医结合方法治疗肛门直肠周围脓肿的临床疗效。方法我院自2009年12月至2010年12月期间运用中西医结合的方法共治疗80例肛门直肠周围脓肿病人。结果本组80例病人全部治愈出院,实施一次切开手术者的治愈时间平均为7～15日;实施低位切开高位挂线手术者的治愈时间平均为19～35日。全部病人术后进行随访半年～2年,未见后遗症病例,无复发病例。结论中西医结合方法在肛门直肠周围脓肿的治疗方面疗效理想,该方法的优点是简单安全、见效迅速、不易复发、无后遗症、疼痛较小等,值得临床推广应用。     

综合护理干预在肛肠疾病术后尿潴留中的应用及效果探讨

目的对于肛肠疾病术后患者,避免发生尿潴留或通过规范化护理措施解除尿潴留。方法将120例肛肠疾病术后患者依随机数字法分为两组,各60例。实验组实施综合护理干预方案,对照组为常规护理。比较两组患者术后的尿潴留发生率及导尿率。结果对照组60例,发生尿潴留23例,经常规护理后9例自行排尿,14例行导尿术(2例感染);实验组60例,发生尿潴留者6例,4例自行排尿,行导尿术者2例。结论应用自我调节理论对肛肠疾病术后患者进行综合护理干预,可以有效预防及降低肛肠疾病术后尿潴留的发生,降低导尿率,减轻患者痛苦,促进疾病的康复。     

Endorectal balloon reduces anorectal doses in post-prostatectomy intensity-modulated radiotherapy

Background and purpose

To investigate the effect of an endorectal balloon (ERB) on anal wall (Awall) and rectal wall (Rwall) doses in high-dose post-prostatectomy intensity-modulated radiotherapy (IMRT).

Materials and methods

For 20 patients, referred for salvage IMRT after prostatectomy for prostate cancer, two planning CT-scans were performed: one with and one without an air-filled ERB. A planning target volume (PTV) was defined, using international guidelines. Furthermore, the Awall and Rwall were delineated. In both the scans, IMRT plans were generated with a prescribed dose of 70 Gy. The mean dose (D_mean), maximum dose, minimum dose, and volumes exposed to doses ranging from ?20 to ?70 Gy (V₂₀-V₇₀) to the Awall and Rwall were calculated. Finally, inner Rwall surface areas exposed to doses ranging from ?20 to ?70 Gy (A₂₀-A₇₀) were calculated. Dose-parameters were compared between plans with and without ERB.

Results

All Awall parameters, except V₇₀, were significantly reduced by the ERB with an overall D_mean reduction of 6 Gy. Absolute reductions in dose-volume parameters varied from 5% to 11%. Significantly reduced Rwall V₃₀, V₄₀, and A₄₀ were observed with ERB, irrespective of the target volume size.

Conclusion

ERB application significantly reduces Awall and to a lesser degree Rwall doses in high-dose post-prostatectomy IMRT.     

PET-CT fusion in radiation management of patients with anorectal tumors

PURPOSE: To compare computed tomography (CT) with positron emission tomography-CT (PET-CT) scans with respect to anorectal tumor volumes, correlation in overlap, and influence on radiation treatment fields and patient care. PATIENTS AND METHODS: From March to November 2003, 20 patients with rectal cancer and 3 patients with anal cancer were treated with preoperative or definitive chemoradiation, respectively. Computed tomography simulation data generated a CT gross tumor volume (CT-GTV) and CT planning target volume (CT-PTV) and (18)F-fluoro-2-deoxy-glucose PET (FDG-PET) created a PET-GTV and PET-PTV. The PET-CT and CT images were fused using manual coregistration. Patients were treated with three-dimensional conformal therapy to traditional doses. The PET, CT, and overlap volumes (OVs) were measured in cubic centimeters. RESULTS: Mean PET-GTV was smaller than the mean CT-GTV (91.7 vs. 99.6 cm(3)). The mean OV was 46.7%. As tumor volume increased, PET and CT OV correlated significantly (p < 0.001). In 17% of patients PET-CT altered the PTV, and in 26% it changed the radiation treatment plan. For 25% of patients with rectal cancer, PET detected distant metastases and changed overall management. Ten rectal cancer patients underwent surgery. When the pretreatment PET standardized uptake value was >10 and the posttreatment PET standardized uptake value was <6, 100% achieved pathologic downstaging (p = 0.047). CONCLUSIONS: Variation in volume was significant, with 17% and 26% of patients requiring a change in treatment fields and patient management, respectively. Positron emission tomography can change the management for anorectal tumors by early detection of metastatic disease or disease outside standard radiation fields.