目的 探讨一期后位切开挂线左右侧切开引流手术治疗高位马蹄型肛周脓肿的临床效果。方法 前瞻性纳入2008年10月至2010年10月期间庆阳市人民医院收治的60例高位马蹄型肛周脓肿患者，将其随机分成2组，其中观察组30例，行一期后位切开挂线左右侧切开引流术；对照组30例，行一期切开挂线术。比较2组患者的临床疗效。结果 临床疗效观察组为优11例（36.67%），良17例（56.66%），差2例（6.67%），优良率为93.33%（28/30）；对照组为优5例（16.67%），良16例（53.33%），差9例（30.00%），优良率为70.00%（21/30）。观察组的临床疗效优于对照组（P＜0.05）。观察组患者术后肛缘水肿、肛门前移和肛门内陷的发生率以及创面愈合时间均低于或短于对照组（P＜0.05）。2组患者术后均获访1年，均无复发，肛门功能均正常，无畸形。结论 一期后位切开挂线左右侧切开引流术治疗高位马蹄型肛周脓肿的临床疗效确切，患者术后恢复良好，值得临床推广应用。
ObjectiveTo investigate the protective effect of mangiferin on acute spinal cord injury (SCI) in rats and its mechanism. MethodsNinety Sprague Dawley rats were randomly divided into 5 groups, 18 rats in each group. SCI was induced by using the Allen's method (60 g/cm) at T9 level in the rats of groups B, C, D, and E; laminectomy was performed at T8-10 in group A. The rats were injected intraperitoneally with saline in groups A and B, and with mangiferin in groups C (10 mg/kg), D (25 mg/kg), and E (50 mg/kg) every day for 30 days. The survival condition of rats was observed after operation; at 24, 48, and 72 hours after operation, the motor function of the hind limb was evaluated by the Basso, Beattie, Bresnahan (BBB) scores. The spinal cord edema was assessed by measuring the water content in spinal cord tissues at 72 hours. Meanwhile, malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH) were detected by ELISA; nuclear factor κB (NF-κB), tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 were measured via ELISA at the same time. Caspase-3 and Caspase-9 were also detected by ELISA after mangiferin treatment for 30 days. The expressions of Bax and Bcl-2 proteins were detected by Western blot. Pathological changes of the spinal cord was observed by HE staining. And Caspase-3 protein expression was detected by immunohistochemical staining. ResultsAll rats survived to the end of experiment. BBB scores of groups B, C, D, and E were significantly less than that of group A (P < 0.05), and it showed an increase trend from groups B to E (P < 0.05). The content of water of groups B, C, D, and E were significantly greater than that of group A (P < 0.05), and it showed a decrease trend from groups B to E (P < 0.05). ELISA showed that the activities of MDA, NF-κB, TNF-α, IL-1β, IL-6, Caspase-3, and Caspase-9 in groups B, C, D, and E were significantly greater than that in group A (P < 0.05), and they showed decrease trends from groups B to E (P < 0.05). Meanwhile, the activities of CAT, SOD, and GSH in groups B, C, D, and E were significantly less than that in group A (P < 0.05), and they showed increase trends from groups B to E (P < 0.05). Western blot showed that the relative expression of Bax protein in groups B, C, D, and E were significantly greater than that in group A (P < 0.05), and it showed a decrease trend from groups B to E (P < 0.05). Meanwhile, the relative expression of Bcl-2 protein in groups B, C, D, and E were significantly less than that in group A (P < 0.05), and it showed an increase trend from groups B to E (P < 0.05). Histological observation showed that the pathological changes in group B were accord with that in SCI, and the degree of necrosis in groups C, D, and E were significantly improved when compared with that in group B, and the effect was better in group E than group D, and group D than group C. Immunohistochemical staining showed that the absorbance (A) value of Caspase-3 in groups B, C, D, and E were significantly greater than that in group A (P < 0.05), and it showed a decrease trend from groups B to E (P < 0.05). ConclusionMangiferin has neuroprotective effects on acute SCI in rats by alleviating edema of spinal cord, inhibiting oxidative stress and inflammation response, and regulating the Bcl-2 and Bax pathway.
ObjectiveTo investigate the indications and clinical effect of pancreatoduodenectomy with extended lymphadenectomy for pancreatic head carcinoma. MethodsThe clinical data of 21 patients with pancreatic head carcinoma that performed pancreatoduodenectomy with extended lymphadenectomy between June 2010 to June 2011 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were retrospective analyzed. The 21 patients included 15 men and 6 women with an age range of 36-57 years and an average age of 47.8 years. ResultsThere were 3 cases(14.3%), 9 cases(42.9%), 8 cases(38.1%), and 1 case(4.8%) in stageⅠ, ⅡA, ⅡB, andⅢ, respectively. Eighteen cases had a R0 resection(85.7%) and 3 cases had a R1 resection. The total number of resected lymph nodes were 14-43 with an average of 27.4. Lymph node invasion occurred in 10 cases(47.6%). The average operative time was 6.8 h(5-8.5 h) and the average amount of blood transfusion was 5.6 U(3-8 U). There was no death in this group and 5 cases(23.8%) had postoperative complications. Tree cases(14.3%) developed pancreatic fistula, 1 case(4.8%) developed bile leakage, 1 case(4.8%) developed abdominal hemorrhage, 1 case(4.8%) developed gastrointestinal bleeding, and 2 cases(9.5%) developed intractable diarrhea. Postoperative pathological results in high, medium, and low differentiated adenocarcinoma was 6 cases(28.6%), 10 cases(47.6%), and 5 cases(23.8%), respec-tively. Twenty one cases were followed-up, the follow-up time ranged from 5 to 40 months with a median time of 19 months. 1-, 2-, and 3-year cumulative survival rates was 66.7%, 38.1%, and 19%, respectively. ConclusionSelective application of pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head carcinoma is conducive to increase the proportion of the radical resection and improve the prognosis, but the postoperative complications is higher.