基于数据挖掘分析中医治疗老年肛周会阴部坏死性筋膜炎术后用药规律

目的 基于数据挖掘分析中医治疗老年肛周会阴部坏死性筋膜炎术后的用药规律,指导临床用药.方法 检索中文文献库,纳入相关文献.根据分层聚类、关联规则的数据挖掘方法,对高频用药及组方规律进行分析.结果 纳入文献中,有31篇涉及口服方剂,24篇涉及外洗方剂,总共涉及处方107份.高频口服药19味,药对18对,聚类方4则;高频外...     

造口袋负压吸引用于危重病人大便失禁肛周皮肤护理的效果观察

目的探讨造口负压吸引装置在合并大便失禁的危重病人肛周皮肤护理中的效果.方法对于大便失禁的危重病人,通过对肛门使用造口袋连接2根一次性引流管,将1根连接中心负压吸引装置进行间断或者持续负压吸引为吸引管,压力-20~-40 kPa,另1根定期用灌食空针抽取温开水或生理盐水清洗为冲洗管,冲洗结束后用橡皮筋捆扎.结果25例发生大便失禁危重病人中,造口袋连接负压吸引装置使用最长15.6 d,最短3.3 d,平均6.7 d;除1例Ⅲ度肛周皮肤损伤病人死亡外,肛周皮肤损伤Ⅰ度和Ⅱ度共16例病人停用造口袋连接负压吸引装置时,皮肤均愈合、潮红消退;肛周皮肤完好8例病人无出现皮肤损伤.结论造口袋负压吸引装置能够避免大便对肛周皮肤的刺激,保护肛周皮肤;加强危重病人观察,保证危重病人的安全,降低护理成本,有效减少护士的工作量,可以在ICU推广使用.     

藻酸钙敷料联合消炎坐浴洗剂治疗糖尿病肛周脓肿的疗效观察和护理

目的探讨藻酸钙敷料联合消炎坐浴洗剂治疗糖尿病肛周脓肿的临床疗效。方法将34例糖尿病肛周脓肿患者随机均分为观察组(藻酸钙敷料联合消炎坐浴洗剂)与对照组(传统方法),比较2组治疗有效率及平均治愈时间。结果观察组治疗有效率明显高于对照组(P<0.05),平均愈合时间明显短于对照组(P<0.01)。结论使用藻酸钙敷料联合消炎坐浴洗剂治疗糖尿病肛周脓肿明显优于传统治疗方法,具有治愈率高、伤口愈合快等优点。     

Efficacy of combined anti-TNF-alpha and surgical therapy in perianal and enterocutaneous fistulizing Crohn’s disease – clinical observations from a tertiary Eastern European center

Abstract

Background and aims. Recently, anti-TNF-alpha therapy has increasingly been used in the treatment of perianal Crohn’s disease (PCD), but there is only limited data regarding its short- and long-term efficacy. Material and methods. The medical records of 68 patients treated with anti-TNF-alpha for PCD were assessed retrospectively. Rate of complex fistulas was 75%. Every patient received induction therapy, but in 20 cases the treatment was discontinued before week 52 due to funding regulations, an allergic reaction, or compliance problems. On week 12, the luminal activity decreased in more than 80% of the cases and the complete remission (CR) rate was about 60%; by the end of the first year, this ratio did not change substantially. Complete fistula closure was achieved in 26 cases (38.3%) and 53 patients (51.5%) showed a partial response during the 1-year period. Regarding both perianal and luminal activities, CR rate was achieved in 23 cases (33.8%). However, after the biological therapy was discontinued, recurrence of fistulas could be detected in every second patient. Additional surgical intervention was performed in 45% of patients during the 1-year period (seton drainage of fistulas and abscess drainage). Conclusion. The anti-TNF-alpha therapy combined with surgery is an effective treatment of PCD. Approximately every third patient revealed complete fistula closure, while half of the other cases showed a partial response. Due to the high rate of fistula recurrence after stopping the biological therapy, more than 1 year of anti-TNF-α treatment may be beneficial.     

Perianal anatomy in non-abused preschool children

The purpose of this study was to describe the normal variation in perianal anatomy in preschool children, selected for non-abuse, and to compare the findings in two examination positions. A letter of invitation was sent to 3773 children, after which 305 children (103 boys and 202 girls) were recruited. Inclusion in the study was based on self-selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. The mean age of the children was 5.63 y (range: 5.13-6.75). An anal examination was performed in the left lateral position (LLP) and the prone knee-chest position (KCP), for approximately 30 s each. A colposcope and a camera were used. All data were systematically analysed for gender differences, and a paired sample test was used to compare findings in LLP and KCP. Venous congestion in LLP and external anal dilatation in both positions were significantly more common in girls, while midline depressions and smooth areas (both positions) were significantly more common in boys. External and total anal dilatation, midline smooth areas and depressions and the occurrence of a prominent anal verge were significantly more common in the KCP. The finding of total anal dilatation was rare. CONCLUSION: We observed several gender and position differences in perianal anatomy, and most of these findings seem to be related to structure and tone in the anal muscles.     

Biological immunomodulators improve the healing rate in surgically treated perianal Crohn’s fistulas

Aim The role of biological therapy in perianal fistulas associated with Crohn’s disease (CD) is uncertain as available data are confused and conflicting. In order to provide some clarity to the issue we have examined a large cohort of patients with perianal fistulas and CD and stratified them according to use of biological agents. Method Patients with perianal Crohn’s fistulas treated between June 1999 and June 2009 were stratified according to use of biological agents and outcome was examined. Healing was defined as absence of fistula or drainage. Prior to surgery perianal sepsis was eradicated with drains or setons. Endpoints were defined as either complete healing, improvement (minimal symptoms and drainage) or unhealed, as noted at subsequent outpatient follow‐up. Variables assessed were age, body mass index, smoking, perineal involvement with Crohn’s granuloma and type of procedure. Fisher’s exact test and χ² test were used for analysis. Results Two hundred and eighteen patients had anal fistulas and CD. Mean follow‐up was 3.2 ± 3 years with mean age 38.8 ± 12.2 years and body mass index of 25.3 ± 6. One hundred and seventeen patients (53.7%) underwent surgery alone (Group A) and 101 patients (46.3%) underwent surgery and biological immunomodulator treatments (Group B). Demographic data and CD history were similar between groups. Surgeries included seton drainge (n = 90), fistulotomy (n = 22), rectal advancement flap (n = 39), fistulotomy plus seton (n = 47) and others (n = 20). Overall improvement in Group A was in 42 patients (35.9%) vs 72 patients (71.3%) in Group B (P = 0.001). There was no significant difference in other studied variables between both groups. Conclusions There is a definite role for biological therapy as an adjuvant to surgery in patients with perianal fistulas and CD.     

MRI不同序列成像在肛周脓肿的诊断和分型中的应用

目的探讨MRI轴位、冠状位及矢状位T1WI压脂(FS)增强序列在肛周脓肿诊断和分型中的应用价值。方法经手术证实的30例脓肿患者全部进行T1WI-FS增强MRI扫描,以手术结果为对照标准,统计分析增强MRI扫描序列组合对各种类型肛周脓肿及内口的检出率。结果 30例病人MRI显示肛周脓肿52个,轴位和冠状位T1WI-FS增强序列,对于坐骨肛管间隙脓肿显示率均为100%。前者对于诊断位于肛提肌下方的脓肿和内口准确率高,均为100%。后者对于诊断肛提肌上方的脓肿准确率高,均为100%。结论理想的肛周脓肿的检查方法是轴位联合冠状位FS-T1WI增强序列,可为外科手术方式的选择提供可信的影像资料。     

电灼术联合干扰素封闭治疗肛周尖锐湿疣的疗效评价

目的：评价电灼术联合干扰素封闭治疗肛周尖锐湿疣的疗效。方法采用电灼术联合局部干扰素封闭治疗肛周尖锐湿疣51例（观察组）,单纯应用电灼术治疗肛周湿疣51例（对照组）,比较一次性痊愈率和12周复发情况。结果观察组比对照组治愈率高（P〈0.05）,观察组12周复发明显少于对照组（P〈0.05）。结论电灼术联合干扰素封闭治疗肛周尖锐湿疣治愈率高,复发率低,能明显减轻患者的痛苦,患者易于接受。     

Perianal ulceration: a case of tuberculosis cutis orificialis

BACKGROUND: Tuberculosis cutis orificialis is an extremely rare variant of cutaneous tuberculosis. Perianal location is a possible site of presentation. METHODS: We describe the management of a young male with a painless non-specific perianal ulcer, who presented an asymptomatic disseminate pulmonary and intestinal tuberculosis. He had a history of pulmonary sarcoidosis and long-term corticosteroid therapy. RESULTS: Healing of the ulcer was achieved after three-drug antituberculous therapy, with an improvement of the radiographic pulmonary alterations. CONCLUSIONS: Tuberculous origin should be considered in persistent perianal ulcers to avoid delays in the treatment of this rare form of tuberculosis.