目的 探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。 方法 2009年10月－2010年10月采用随机对照试验，对52例高位肛周脓肿患者施行手术治疗，其中保留括约肌虚挂线法（治疗组）26例，切开挂线引流法（对照组）26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分（VAS）和术后6个月痊愈患者肛门功能后遗症发生率进行比较。 结果 术后6个月，治疗组和对照组肛瘘发生率分别为4.0%和3.8%，差异无统计学意义（P＞0.05）。术后7～15 d治疗组VAS评分均低于对照组，差异有统计学意义（P＜0.05）。两组切口愈合时间分别为（19.05 ± 6.71）d和（21.42 ± 8.40）d，差异有统计学意义（P＜0.05）。术后6个月治疗组痊愈患者肛门功能全部正常，对照组后遗症发生率为12.0%，两组比较差异有统计学意义（P＜0.05）。 结论 保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗，是一种治疗高位肛周脓肿较为理想的方法。
ObjectiveTo investigate the effect of external dissection and internal ligation, plus partial internal sphincterotomy in the treatment of mixed hemorrhoids. MethodsDuring January 2010 to January 2012, 364 patients with mixed hemorrhoids selected for surgery were divided into two groups based on whether the patients should accept the treatment of partial internal sphincterotomy. We observed the curative effect of the two groups, including anal pain, bleeding, edema, average healing days and the anorectal stenosis after operation. ResultsThere were statistical differences between the two groups in terms of anal pain, complication rate and hospital stay (P<0.01). The curative effect of the group treated with partial internal sphincterotomy was better than that of the other group. ConclustionExternal dissection and internal ligation, plus partial internal sphincterotomy is a better choice in the treatment of mixed hemorrhoids, which can relieve postoperative symptoms, reduce complications and shorten treatment course.
Objective To explore the mechanism of Liuhedan in promoting wound healing through applying Liuhedan to the infective wounds of New Zealand white rabbits. Methods A total of forty New Zealand white rabbit models of infective wounds were established after anesthesia. Five circular infective incisions were generated on the back of each rabbit, with a diameter of 2 cm. Five wounds of each rabbit were assigned respectively to the control group, model group, traditional Chinese medicine (TCM) group (Oleum Lithospermum), Western medicine group (calcium alginat), and treatment group (Liuhedan). Wound dressings were performed every day since postoperative day 1. Ten rabbits were selected randomly to be euthanized on postoperative day 3, 7, 14 and 21, respectively. Each specimen was divided into two parts. One was used for detecting interleukin-1β (IL-1β) by enzyme-linked immunosorbent assay, and the other was used for detecting tumor necrosis factor-α (TNF-α) by immunocytochemistry. Results On postoperative day 3 and 7, groups with the expression of IL-1β from low to high were respectively the control group, the treatment group, the Western medicine group, the TCM group, and the model group [postoperative day 3: (680.81±185.53), (1 028.67±205.57), (1 278.67±251.15), (1 449.86±230.74), (1 544.62±371.77) pg/mL; postoperative day 7: (1 024.43±239.94), (1 333.57±257.31), (1 635.14±222.40), (1 784.71±323.85), (1 953.29±324.78) pg/mL], and all the differences among the groups were significant (P<0.05); On postoperative day 14, groups with the expression of IL-1β from low to high were respectively the treatment group, the control group, the Western medicine group, the TCM group, and the model group [(908.71±108.61), (978.57±161.75), (1 120.43±265.39), (1 129.71±298.06), (1 191.14±234.92) pg/mL], and all the differences among groups were significant (P<0.05) except the difference between the Western medicine group and the TCM group (P>0.05); On postoperative day 21, the expression of IL-1β in the control group, the model group, the TCM group, and the Western medicine group was (487.19±121.80), (496.35±102.15), (500.31±139.34), (499.08±120.67) pg/mL, respectively, with no significant differences among the groups (P>0.05), which were all higher than that in the treatment group [(398.62±102.93) pg/mL] with significant difference (P<0.05). The expression of TNF-α in the model group was significantly greater than those in the other groups. The expression of TNF-α in the treatment group and Western medicine group was significantly lower compared with the model group. The expression of TNF-α in the TCM group was stronger compared with those in the treatment group and the Western medicine group. Conclusion Liuhedan can specifically suppress the expressions of IL-1β and TNF-α in the treatment of infective wounds, decrease the release of inflammatory factor and promote the healing.
Objective To investigate the clinical curative effect of divided excision and plastic combined with procedure for prolapse and hemorrhoids (PPH) in treatment for circular mixed hemorrhoids. Methods Clinical observation on 120 patients with circular mixed hemorrhoids between May 2007 and May 2008 treated by divided excision and plastic combined with PPH was carried out. Results The mean hospital stay after operation was 7.6 d. The wound healing average time was 11.9 d. The incidence rate of postoperative urinary retention was 5.8% (7/120). Average scores of pain in 3 d after operation: 5.3 points (1-8 points) on day 1, 3.6 points （2-9 points） on day 2, 2.2 points （1-8 points） on day 3. All patients were followed up for 12 months, there were 3 cases of hematochezia， 1 case of prolapse, and 1 case of remained abnormal outgrowth skin; the anus function was normal in all cases without anal stricture or tightening feeling. Conclusions Divided excision and plastic combined with PPH can better treat circular mixed hemorrhoids. This operation can not only completely clear the lesions, but also repair and reconstruct the anus and anal canal, protect its size and function. It is an ideal operation for treatment for circular mixed hemorrhoids.
【摘要】目的 探讨分段整形提缩注射术治疗脱肛痔的临床疗效。方法 175例重度环状痔, 沿肛缘弧形切除结缔组织外痔以整形肛门, 再于结扎痔核基底及其上端黏膜下层注射消痔灵注射液,并进行疗效观察。结果 术后肛周水肿(72 h)、疼痛(24及72 h)明显减少； 术后4周临床治愈145例,好转23例,总有效率为96.0%； 所有患者均随访3~6个月，未见复发。结论 选择分段整形提缩注射术既比较彻底地去除了痔核使之不易复发，又整形了肛门，保护其大小和功能, 该术式可成为治疗脱肛痔的较理想术式。
Objective To explore the effectiveness of expanded curettage in the treatment of chondroblastoma. Methods The clinical data of 37 patients with chondroblastoma who were treated with expanded curettage between January 2011 and May 2016 were retrospectively analyzed. There were 24 males and 13 females, with a median age of 17 years (range, 12-30 years). There were 32 primary patients and 5 recurrent patients. Local pain was the first symptom in all patients. The average disease duration was 4.9 months (range, 2-8 months). The lesions were located in the distal femur in 10 cases, the proximal femur in 7 cases, the proximal tibia in 9 cases, the proximal humerus in 5 cases, the patella in 2 cases, the talus in 1 case, the calcaneus in 1 case, and pelvis in 2 cases. According to the Enneking staging of benign bone tumors, all tumors were rated as the 3rd stage. The length of the lesion ranged from 1.2 to 6.9 cm (mean, 3.2 cm). The lesions involved the epiphyseal plate in 19 cases. Results All incisions healed by first intention, and no complications occurred. All patients were followed up 12-76 months, with an average of 40.5 months. At last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 27.5±1.4, and the difference was significant when compared with pre-operative value (18.5±1.9) (t=23.462, P=0.000). The chondroblastoma recurred in 1 case (2.7%) after 5 months. X-ray film showed that bone resorption was found in 6 cases, but there was no obvious collapse in the articular surface of bone graft. The limb shortening deformity occurred in 3 cases who were epiphyseal plate involvement patients and lesions located around the knee joint. But there was no varus deformity, and knee joint activity was not affected. Conclusion Expanded curettage has advantages of low incidence of recurrence and skeletal deformity, good limb function, and it is one of the ideal options for chondroblastoma.