Human VIP-α: an emerging biologic response modifier to treat primary pulmonary hypertension

Primary pulmonary hypertension (PPH) is a rare life-threatening disorder of unknown etiology manifested by chronic elevation of pulmonary arterial pressure. Given that pulmonary vasoconstriction, endothelial and vascular smooth muscle cell proliferation and in situ thrombosis contribute appreciably to the evolution of PPH, treatment with vasodilators, antiproliferative drugs and anticoagulants, alone or in combination, constitute the pharmacologic standard of care. To this end, long-term administration of oral calcium channel blockers, prostacyclin analogs by various routes and oral endothelin-1 receptor antagonists, alone or in combination, is efficacious in treating patients with PPH. Unfortunately, efficacy is hampered by poor stability, delivery and bioavailability, and by systemic toxicity. Hence, there is an ongoing need to develop and test new drugs to treat patients with PPH. To address this issue, a novel, targeted, long-acting, biocompatible and safe sterically stabilized liposomal and micellar formulation of human vasoactive intestinal peptide (VIP) was developed and tested for human use: the 28-amino acid pleiotropic biologic response modifier, human VIP-α. The long-lasting salutary effects of phospholipid-associated VIP on vasomotor tone and arterial pressure were expressed at low concentrations solely in diseased animals and were independent of its route of administration. Thus, the author proposes that human VIP-α could be developed as a safe long-acting drug to treat patients with PPH.     

吻合器痔上黏膜环切术(PPH)治疗重度痔术后并发症分析(附384例报告)

目的探讨PPH术后并发症的原因及防治体会。方法回顾性分析2011-01—2013-12间实施PPH术治疗的384例重度痔患者术后并发症的情况。结果尿潴留81例(21.1%),肛门疼痛需用止痛剂165例(42.9%),术后原发性出血4例(1.1%),术后继发性出血7例(1.8%),肛门残留皮赘或仍有轻度痔核脱垂18例(4.7%),肛门狭窄2例(0.5%),直肠阴道瘘1例。随访10~30个月,有2例再次入院行痔切除术。结论 PPH术虽具有操作简便,创伤小、恢复快等优点,但仍需进一步规范手术操作及围手术期处理,减少并发症发生。     

Stapled Mucosectomy for Rectocele Repair: A Preliminary Report

There is no optimum surgical method of repair for rectoceles; however, recent interest in the use of the circular hemorrhoidal stapler gun to treat rectoceles has stirred interest. We describe our early results using the circular hemorrhoidal stapler gun for repair of rectoceles. Seven patients (median age, 45 (range, 31–62) years; all females) have been treated. All seven patients presented with incomplete or difficult defecation, four patients required digital vaginal manipulation, and all patients had tried a variety of aperients to aid defecation. The procedure involved two pursestrings and one firing of the circular hemorrhoidal stapler gun. No perioperative complications were encountered. At a median of six (range, 1– 10) months follow-up, all patients were able to defecate without difficulty or manipulation. None of the patients required any medication to aid bowel evacuation after surgery. These promising early results support the use of stapled mucosectomy for the repair of rectoceles.     

PPH加Block术与单纯Block术治疗直肠前突的临床比较研究

目的 探讨吻合器痔上黏膜环切术（PPH 术）加直肠闭式修补术（Block 术）治疗直肠前突的临床疗效。方法 近9年来对女性直肠前突患者先后采用Block 术（36 例）和PPH+Block 术（41 例）治疗,分析两组患者的临床资料,观察并比较其术后第1 天出血量、术后并发症的发生率及疗效。结果 两组患者术后第1 天出血量及术后并发症发生率的差异均无统计学意义（均P＞0.05）。术后3、6、12个月PPH+Block 术组与Block 术组的痊愈率分别为85.4%、82.9%、82.9%和58.3%、52.8%、52.8%,差异均有统计学意义（均P＜0.05）。结论 PPH+Block 术治疗直肠前突较单纯Block 术疗效更好,值得推广应用。     

Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis

ObjectivesThe influence of preoperative biliary drainage (PBD) for obstructive jaundiced patients before pancreaticoduodenectomy is debated in the past decades. The aim of this study is to assess the impact of preoperative biliary drainage on intraoperative and postoperative outcomes in patients with severely obstructive jaundice.MethodsData were collected retrospectively from severely obstructive jaundiced patients with serum total bilirubin level exceeding 250 μmol/L and undergoing pancreaticoduodenectomy from January 2012 to December 2017. The univariate and multivariate analyses were performed to assess independent risk factors for overall postoperative complications. A propensity score-matched (PSM) analysis was performed to adjust baseline characteristics between PBD and direct surgery (DS) groups. After PSM, intraoperative data and postoperative complications were compared between the two groups.ResultsA total of 200 patients were included. The rate of overall postoperative complication occurred in 119 (59.5%) patients, with prealbumin <150 mg/L (OR = 3.03; 95%CI = [1.63–5.62]; p < 0.001), ASA (American Society of Anesthesiology score) classification II-III (OR = 2.27; 95%CI = [1.21–4.27]; p = 0.011), and direct surgery (OR = 3.88; 95%CI = [1.67–8.99]; p = 0.002) identified as independent risk factors in multivariate analysis. After PSM, there was similar operative time and intraoperative transfusion between PBD and DS group. However, DS group had a higher incidence of overall postoperative complication (p = 0.005), grades B and C of post-pancreatectomy hemorrhage (PPH) (p = 0.032), and grades B and C of postoperative pancreatic fistula (POPF) (p = 0.045) compared to PBD group.ConclusionsIn this retrospective study, in order to reduce overall postoperative complications, PBD should be performed routinely for those patients with serum total bilirubin level exceeding 250 μmol/L and undergoing pancreaticoduodenectomy.     

Impact of Less Invasive Treatments Including Sclerotherapy With a New Agent and Hemorrhoidopexy for Prolapsing Internal Hemorrhoids

Conventional hemorrhoidectomy is applied for the treatment of prolapsing internal hemorrhoids. Recently, less-invasive treatments such as sclerotherapy using aluminum potassium sulphate/tannic acid (ALTA) and a procedure for prolapse and hemorrhoids (PPH) have been introduced. We compared the results of sclerotherapy with ALTA and an improved type of PPH03 with those of hemorrhoidectomy. Between January 2006 and March 2009, we performed hemorrhoidectomy in 464 patients, ALTA in 940 patients, and PPH in 148 patients with second- and third-degree internal hemorrhoids according to the Goligher''s classification. The volume of ALTA injected into a hemorrhoid was 7.3 ± 2.2 (mean ± SD) mL. The duration of the operation was significantly shorter in ALTA (13 ± 2 minutes) than in hemorrhoidectomy (43 ± 5 minutes) or PPH (32 ± 12 minutes). Postoperative pain, requiring intravenous pain medications, occurred in 65 cases (14%) in hemorrhoidectomy, in 16 cases (1.7%) in ALTA, and in 1 case (0.7%) in PPH. The disappearance rates of prolapse were 100% in hemorrhoidectomy, 96% in ALTA, and 98.6% in PPH. ALTA can be performed on an outpatient basis without any severe pain or complication, and PPH is a useful alternative treatment with less pain. Less-invasive treatments are beneficial when performed with care to avoid complications.     

PPH治疗内痔发生术后大出血的危险因素分析及对策

目的探讨PPH治疗内痔发生术后大出血的危险因素,指导术中、术后采取干预措施以减少其发生。方法将2003年1月至2013年6月佛山市第二人民医院普外三科收治的38例内痔患者采用PPH术后大出血病例作为研究对象;按性别、年龄(相差不超过5岁)及混合痔分度进行1:2匹配,选取同期76例PPH术后无大出血病例为对照。采用单因素及多因素条件Logistic回归分析以明确PPH术后大出血的危险因素。结果单因素分析显示,切除痔上黏膜完整性(P=0.047)、切除痔上黏膜厚度(P=0.005)、吻合口距齿线的距离(P=0.034)、吻合口缝扎止血(P=0.034)、术后便秘(P=0.002)与PPH术后大出血相关。Logistic多因素回归分析显示,切除痔上黏膜厚度、吻合口距齿线的距离、吻合口缝扎止血处数及术后便秘是PPH术后大出血危险因素(均P0.05)。结论 PPH术后大出血的独立危险因素是切除痔上黏膜厚度、吻合口距齿线的距离、吻合口缝扎止血处数及术后便秘。荷包缝合仍是PPH术的核心技术,术中注重荷包缝合的质量和术后加强通便是消除PPH术后大出血的重要对策。     

改良PPH结合梭形小切口治疗静脉曲张性混合痔的疗效观察

为探讨改良PPH结合梭形小切口治疗静脉曲张性混合痔的临床疗效,回顾性分析应用改良PPH结合梭形小切口冶疗100例静脉曲张性混合痔的临床资料。结果显示,手术时间为25～35min,平均30min;术后住院时间4～7d,平均5d。随访0．5～2年,均无复发,无肛门失禁、直肠吻合VI狭窄及直肠阴道瘘等后遗症,肛门外观平整。结果表明,该手术治疗静脉曲张性混合痔具有患者住院时间短,疼痛轻,并发症少等优点。     

PPH加消痔灵注射配合电凝切术治疗混合痔的临床观察

为探讨PPH加消痔灵注射配合电凝切术治疗混合痔的临床疗效,回顾性分析10年来对560例混合痔患者施行PPH加消痔灵注射配合电凝切术治疗的资料,观察其疗效。结果显示,560例患者中,治愈500例（89．3％）,显效53例（9．5％）,有效7例（1．2％）,总有效率i00％。住院时间7～14d,平均（10±1）d。术后随访3个月至10年,吻合口出血3例,均经过再次缝扎止血后治愈;吻合口狭窄4例,予以局麻下行电凝切狭窄松解术后治愈。结果表明,PPH加消痔灵注射配合电凝切术治疗混合痔,术后患者痛苦小,恢复快,并发症少,肛门功能正常,肛门外观平整,近、远期未见复发,疗效确切。     

RPH联合外痔切除术治疗混合痔的疗效探讨

为探讨自动痔疮套扎术（RPH）联合外痔切除术治疗混合痔的临床疗效,回顾分析85例混合痔手术患者资料,其中采用RPH联合外痔切除术治疗52例（观察组）,采用PPH联合外痔切除术治疗33例（对照组）。对比两组患者的疗效。结果显示,两组患者总体疗效、患者满意度、住院时间比较差异均无统计学意义,P〉0.05;但观察组在术后首次排便时疼痛、肛门坠胀感、尿潴留、短暂性肛门失禁、住院费用方面明显优于对照组,P〈0．05或P〈0.01。结果表明,RPH联合外痔切除术治疗混合痔疗效可靠、经济安全、患者恢复快,术后无肛门狭窄、肛门失禁等并发症。