切挂对口橡皮引流术治疗高位后马蹄型肛瘘临床观察

目的 :探讨治疗高位后马蹄型肛瘘的手术效果。方法 :采用随机单盲法分为观察组切挂对口橡皮引流术治疗 2 5例和对照组多切口引流术治疗 2 5例对比观察。结果 :观察组痊愈 2 4例 ,未愈 1例 ,随访 2年无复发 ,术后瘢痕残留 1例 ,平均疗程(2 1.31± 2 .76 ) d;对照组痊愈 2 0例 ,未愈 5例 ,随访 2年复发 3例 ,术后瘢痕残留 4例 ,平均疗程 (2 7.82± 3.89) d。结论 :观察组明显优于对照组 (P<0 .0 1) ,切挂对口橡皮引流术治疗高位后马蹄型肛瘘具有损伤小 ,疗程短、痛苦小、复发率低 ,术式简便等优点。     

医用高分子材料的应用研究及发展

本文介绍了医用高分子材料的应用状况,着重介绍了硅橡胶、聚氨酯、天然胶乳、聚乳酸的应用及其产业化情况.     

Anatomic specificity in the diagnosis and treatment of internal rectal prolapse

Distal bowel evacuation was studied by cinedefecography in 85 women with obstinate constipation, tenesmus, and incomplete evacuation in whom a diagnosis of internal rectal intussusception was clinically suspect. Sixty-five patients showed radiographic evidence of intussusception—mostly of the distal rectum, without rectosacral separation. Patients with distal intussusception who did not respond to nonoperative measures were treated by Delorme's transrectal excision with excellent results. Internal rectal intussusception is a real and demonstrable entity which may be symptomatically disabling and whose documentation may be integral to effective and anatomically specific treatment. The syndromes of perineal descent, solitary rectal ulcer, levator syndrome and so-called recurrent hemorrhoids may be diagnostic intermediaries in the evolution of internal rectal intussusception. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 6 to 10, 1985.     

Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids

PURPOSE: Rubber band ligation therapy for symptomatic hemorrhoidal disease has been used for many years and is a well-accepted treatment modality, but information on long-term outcome is limited. Our goals were to determine safety and long-term efficacy of this treatment.METHODS: A retrospective chart review of patients undergoing rubber band ligatures for symptomatic internal hemorrhoids in a single practice was conducted. Information on presenting symptoms, number of bands applied, response to therapy, complications encountered, length of follow-up, interval to recurrent symptoms when applicable, and subsequent therapy were documented. Supplemental information was obtained from telephone follow-up. Outcome was categorized as success or failure, in which success was defined as: permanent relief of symptoms for follow-up period; marked improvement in symptomatology with rare manifestation of bleeding (1/month); symptom relief for a limited period of time (100 days), and failure was defined as: modest improvement (decreased but not relief of symptoms); or no improvement in symptoms.RESULTS: A total of 805 patients underwent 2,114 rubber band ligatures. Most common presenting symptoms were bleeding in 731 patients (90.8 percent) and prolapsing in 382 patients (47.5 percent). The median number of bands placed was two (range, 1–17). The median time between bandings was 4.7 (range, 1.1–35.6) weeks. Median follow-up time was 1,204 (range, 14–9,571) days. Excluding 104 patients lost to follow-up (never returned after initial treatment), success was obtained in 70.5 percent (494/701) and failure in 29.5 percent (207/701) of patients. Success rates were similar for all degrees of hemorrhoids. Hemorrhoidal disease requiring the placement of four or more bands was associated with a trend in higher failure rates and greater need for subsequent hemorrhoidectomy. Complications per treatment series included bleeding (2.8 percent), thrombosed external hemorrhoids (1.5 percent), and bacteremia (0.09 percent). Higher bleeding rates were encountered with the use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin. Time to recurrence was less with subsequent treatment courses. Treatment of recurrent symptoms with rubber band ligation resulted in success rates of 73.6, 61.4, and 65 percent for first, second, and third recurrences respectively. This resulted in a cumulative success rate of 80.2 percent for this method of treatment.CONCLUSIONS: Rubber band ligatures are safe and effective therapy for symptomatic internal hemorrhoids. It can be used to treat all degrees of hemorrhoids with similar effectiveness. The likelihood of success is lower if more than four bands are needed to eliminate symptoms. The use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin is associated with higher bleeding rates. Rubber band ligatures for recurrence of symptoms is effective; however, time to recurrence is less with subsequent treatments.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

生物材料免疫抑制效应评价的方法初探

本文介绍了选择环磷酰胺作为免疫抑制剂,建立评价生物材料免疫抑制作用的实验模型。通过观察实验动物外周血淋巴细胞总数及血清TNF－α浓度变化．探讨医用热硫化硅橡胶对免疫系统的毒性反应,结果显示该材料未见明显的免疫抑制作用。该研究为生物材料的免疫毒性评价提供一种有效的检测方法。     

胶筋挂线法治疗直肠黏膜下瘘71例临床分析

目的探讨简便、有效的治疗直肠黏膜下瘘的方法。方法用胶筋挂线法治疗直肠黏膜下肛瘘71例,治愈率达100%。随访3个月～2年,未见复发。结论该方法具有操作简便、并发症少、费用低、安全可靠等优点,是治疗直肠黏膜下瘘的有效方法。     

快速多环食管静脉结扎术并早期再发大出血

目的总结食管静脉曲张多环快速结扎的疗效及早期再发出血的原因。方法６３例门脉高压食管静脉曲张出血的患者，进行了择期内镜下结扎治疗。本组全部采用Ｗｉｌｓｏｎ－Ｃｏｏｋ或Ｍｉ－ｃｒｏｖａｓｉｖｅ多环结扎器，结扎次数每例为１～４次，平均１．９次，每次结扎橡皮圈４～１２个，每例共扎５～２１个圈，平均１０．２个圈。结果食管静脉曲张消失和基本消失４１例，占６５％，并发早期再发大出血８例，占１２．６％，分别发生于术中、术后１５小时、３６小时、３至９天。出血死亡３例，肝衰死亡１例。结论多环快速静脉结扎是一有效的治疗方法，但早期再发出血值得重视，并对早期再出血的可能原因及预防措施提出粗浅的见解。     

亚硝胺暴露剂量、时间与肺癌效应关系和致癌多阶段模型的探讨

目的分析该橡胶工人队列中亚硝胺暴露及与其有关的时间变量的肺癌危险度。方法应用Ｐｏｉｓｏｎ相乘模型和致癌多阶段理论。结果肺癌危险度随亚硝胺暴露年数增加而稳定升高,从暴露开始后经过一个潜隐期（大约２０～３０年）,肺癌危险度达到最高峰,然后迅速下降。结论本资料中亚硝胺暴露对肺癌危险度所显示的行为符合晚期阶段致癌原的特性     

Decreased erythrocyte glutathione s-transferase activity in rubber workers

Summary Decreased erythrocyte glutathione s-transferase activity was found in workers exposed to hot rubber fumes in two-roll mill and calender departments (6.6±0.9 and 6.8±0.8 mol/min × mg haemoglobin, respectively vs 8.4±0.5 in controls). This trend was also noted in the general category of all rubber exposed workers without stratification according to their task (7.6±0.5,n=30). This result was contrary to that expected, as the cases with the lowest values had the greatest urinary thioether excretion. The thioethers are the end-products of the enzyme-catalyzed glutathione conjugation reaction aimed at the inactivation of potentially toxic chemicals. Thus, it appears that the assay of erythrocyte glutathione s-transferase activity is not very informative about exposure, although the enzyme assay might disclose other, so far unknown, biological effects of reactive rubber chemicals.