Organization of the cavernous structures of the human rectum

By means of complex histological and injection methods, including roentgenovasography and morphometry, 140 preparations of the human rectum have been studied during the late and middle fetal period, as well as during all periods of the postnatal ontogenesis. On the lateral walls of the columnar zone of the anal canal, places where the internal haemorrhagic nodes occur especially often, peculiar incapsulated and nonincapsulated microglomal cavernous bodies have been revealed. A large vascular peduncle connects them with the superior rectal artery and vein (according to 2-4 and 8-10 o'clock on the clock face) as complexes consisting of 2-3 penicilli and glomeruli. They are connected with the portocaval anastomoses of the initial multicanal anal-columnar sources of the superior and inferior rectal veins. The latter have various obturative mechanisms represented as microvalves, subintimal muscular toruli and arteriol-venular shunts of the obturative glomal and combined type.     

介入栓塞治疗内脏动脉瘤的临床研究

目的:探讨介入血管腔内栓塞治疗内脏动脉瘤的方法、疗效及安全性。方法:选择内脏动脉瘤患者23例,包括脾动脉瘤13例,肝动脉瘤2例,胃十二指肠动脉瘤3例,肠系膜上动脉瘤4例,肾动脉瘤1例。其中,9例行远近端动脉栓塞术,4例采用支架辅助弹簧圈瘤体内填塞,3例采用弹簧圈瘤体内填塞加瘤体内注胶栓塞术,4例行弹簧圈瘤体内栓塞术,2例行分支动脉颗粒栓塞术,1例行单纯注胶栓塞术。术后1月、3月、6月行超声、CTA或血管造影复查,以后每年复查一次。结果:本组均成功行介入血管腔内栓塞治疗内脏动脉瘤,栓塞治疗后造影示动脉瘤体和/或载瘤动脉闭塞,动脉瘤体内无明显对比剂显影,脾动脉瘤栓塞患者有3例出现发热,脾区疼痛等脾梗塞症状,未见栓塞术相关严重并发症发生。4例消化道出血患者出血均停止。术后随访3~48个月,未见动脉瘤破裂出血、动脉瘤复发或增大,支架置入者,支架内及分支动脉血流均保持通畅。结论:介入血管腔内栓塞是一种治疗内脏动脉瘤的简便、微创、安全有效的方法。     

CT血管造影联合CT尿路成像在重度闭合性肾损伤患者中的临床应用价值分析

摘要 目的：探讨CT血管造影（CTA）联合CT尿路成像（CTU）检查在重度闭合性肾损伤患者临床处理中应用价值。方法：收集并分析2017年1月-2019年12月我院收治的9例诊断重度闭合性肾损伤患者的临床资料,入院时先行急诊CT平扫检查了解肾挫伤情况,确定重度肾损伤再进一步行CTA联合CTU检查,根据检查结果选择合适的治疗方案（保守治疗、选择性肾动脉介入栓塞治疗、手术治疗）。结果：9例患者均成功救治。保守治疗4例,肾动脉介入栓塞治疗5例（其中有2例行肾动脉介入栓塞后再行手术治疗）。随访3-8个月,患者恢复良好,无明显并发症。结论：肾动脉CTA联合CTU检查,能全面提供肾血管及肾盂、输尿管、邻近脏器等的解剖信息,明确损伤程度,为介入和手术治疗提供良好的术前指导,尤其是结合肾动脉选择性栓塞,能最大限度保留肾脏功能,提高抢救率,具有重要的临床应用价值。     

痔治疗的临床进展研究

痔是肛肠外科最常见的疾病之一,其治疗方式多种多样,尚无统一治疗标准。虽然,痔在临床上以保守治疗为主,但是对于II度以上有症状的痔,手术仍是目前最主要的治疗方式。关于有症状痔最佳治疗方式的争论仍在继续,无论是非手术治疗、传统的痔切除术还是痔的微创手术,都处于不断的改进和探索之中。临床医生总希望能够找到一项理想的具有复发率低、安全可靠、可早期恢复正常活动、术后疼痛轻微甚至无痛的手术方式。随着手术方式的改进和医疗技术的进步,痔的治疗效果也取得了很大的进步。本文就痔的非手术治疗、有创手术治疗以及微创手术治疗作一综述,为痔的临床治疗提供一定的理论依据。     

脾动脉栓塞术后出现严重粘连的脾切除手术体会

目的:探讨脾动脉栓塞术后严重脾粘连脾切除手术技巧,为临床实践提供可借鉴的方法。方法:收集我院2005年4月-2013年6月收治的18例脾动脉栓塞术后严重脾粘连行脾切除术的患者临床资料,分析手术时间、术中出血、术中特殊处理及术后恢复情况等。结果:18例患者均顺利恢复出院,无围手术期死亡,开腹后到脾切除完成平均耗时55 min、出血550 mL。术后并发症为腹水(8例)、肺部感染(1例)、胰瘘(1例)及腹腔内出血(1例)。结论:脾动脉栓塞术后出现严重脾粘连行脾切除术,手术风险较大,手术时间、术中出血较常规脾切除术明显延长、增多。规范手术操作,细致分离脾周粘连,合理处理脾蒂,是安全、有效完成此类脾切除术的关键。     

Uterine artery embolization for the treatment of uterine fibroids

Uterine artery embolization can be regarded as a less invasive procedure for the treatment of fibroids compared with myomectomy, hysterectomy, and laparoscopic myolysis. The aim of this study was the evaluation of safety and efficacy of uterine artery embolization and of womens' opinion about this treatment. After gynecological examination sixty-nine premenopausal women underwent uterine artery embolization. All procedures but four were technically successful; three women underwent unilateral embolization because of vascular malformation and one of them had an allergic reaction to contrast medium. Of the 69 patients: 58 went home the day after embolization, and 11 within first week. The follow-up examinations after 3, 6 and 12 month showed a significant reduction of uterine and fibroid volume with significant improvement of bleeding. Therefore, according to this report, uterine artery embolization is a successful, minimal invasive treatment of myoma that preserves the uterus and requires shorter hospitalization and recovery times than surgery.     

Cryosurgical hemorrhoidectomy: How to prevent the postoperative swelling and prolapse

Cryosurgical hemorrhoidectomy was performed on 171 patients with excellent results achieved in the great majority. The key to successful results is based on the prevention of prolapse of the edematous tissue after freezing. To prevent the edema, it is important to pull out the hemorrhoid as much as possible during the freezing, to freeze only on the rectal side of the anal verge, to carefully avoid freezing the anal verge, and to freeze the hemorrhoids in two or three stages when they are large. Less than satisfactory results were achieved in 11.7% of the patients. The anal discomfort and discharge in these patients were related to prolapse of the frozen tissue. Cryosurgery is an effective method of treatment for hemorrhoids if care is taken to use the proper technique.     

混合痔手术治疗技术新进展

：痔(Haemorrhoids)是直肠末端黏膜、肛管皮肤下痔静脉丛屈曲或扩张而形成的柔软静脉团,是外科常见的疾病。尽管保守治 疗适用于大部分患者人群,但是手术治疗却适用于大部分严重病人,比如外剥内扎术就被视为治疗IV 度痔的金标准。痔的手术 治疗有传统手术和微创手术,为了减轻患者的痛苦、加速恢复、减少并发症的发生,PPH 和TST 等新型手术方式也逐渐被应用于 III痔的治疗中,这些手术方法的目的是纠正痔疮的病因及病理生理基础,具有微创、痛苦小的特点,但往往复发率较高。随着手术 方式的改进以及操作技术的成熟,痔的外科治疗效果也取得了长足的进步。本文对混合痔的外科手术技术作一综述,为临床治疗 提供理论依据。     

Histologic investigation of vascular malformations of the face after transarterial embolization with ethibloc and other agents

Twenty-one vascular malformations located in the facial area, 11 high-flow arteriovenous malformations and 10 slow-flow malformations, underwent combined treatment by embolization and later surgery. Embolization was performed simultaneously with superselective angiography of the branches of the external carotid artery. The new biodegradable fibrosing agent Ethibloc was used in 16 cases. Histologic examination of the surgical specimens confirmed the good target orientation by the transarterial injection of Ethibloc. Limitations of this technique are discussed. The agent proved to have thrombogenic and fibrogenic properties. Some of the vascular walls degenerated and ruptured following the embolization, but there were no instances of necrosis of interstitial tissue or skin. Embolization treatment of vascular malformations of the face was not curative, but it facilitated subsequent surgery in all examined cases.     

吻合器痔上黏膜环形切除术对环状混合痔患者肛门功能及生活质量的影响

目的:比较吻合器痔上黏膜环形切除术(PPH)和外剥内扎手术(MMH)治疗环状混合痔的疗效及对患者肛门功能恢复、生活质量的影响,为临床治疗环状混合痔的术式选择提供依据。方法:选取2016年8月-2018年1月我院收治的84例环状混合痔患者作为研究对象。采用随机数字表法将患者分为PPH组(n=42)和MMH组(n=42)。比较两组患者的疗效、手术及术后恢复情况。随访3个月,观察两组患者的并发症发生情况,并采用生活质量综合评定问卷(GQOL-74)评价两组患者的生活质量变化情况。术后6个月对所有患者进行直肠肛门测压,记录并比较两组测量结果。结果:PPH组患者治疗总有效率为97.62%,高于MMH组的83.33%(P0.05)。两组患者手术时间、创面愈合时间、住院时间及恢复工作时间比较,PPH组均明显短于MMH组(P0.05)。PPH组总并发症发生率为14.29%,低于MMH组的40.48%(P0.05)。术后3个月,两组患者GQOL-74各维度评分均高于术前,且PPH组患者GQOL-74各维度评分均高于MMH组患者(P0.05)。术后6个月,PPH组患者肛管静息压、肛管高压带长度、直肠肛门抑制反射阳性率均明显高于MMH组(P0.05),但两组肛管最大收缩压和直肠静息压比较无统计学差异(P0.05)。结论:PPH治疗环状混合痔疗效确切且兼具较高的安全性,可促进患者的术后恢复,明显改善患者肛门功能和生活质量。     

COMMON ANORECTAL COMPLICATIONS IN PREGNANCY—Methods of Management

The hormonal, anatomic and pelvic vascular changes of pregnancy have a profound effect on the anorectum, making hemorrhoidal disease the most common anorectal complication of pregnancy. Anal infections such as fissures, abscesses and fistulas are relatively infrequent.Physiologic engorgement of the hemorrhoidal vessels during pregnancy is quite common, transitory and requires only simple palliation. True symptomatic hemorrhoidal disease, however, is less common, more permanent and will usually need corrective treatment to prevent immediate complications and future aggravation. Serious rectal and colonic diagnostic problems demand endoscopic investigation regardless of the pregnancy.Clinical experience and studies seem to indicate that extreme conservatism in the treatment of severe complicated hemorrhoidal disease during pregnancy appears to be unwarranted. After consultation and agreement, surgical treatment of severe, disabling, symptomatic hemorrhoids that are not responsive to palliation can be safely accomplished during the second trimester of pregnancy. Once true hemorrhoidal disease develops, correction should be done before a subsequent pregnancy to avoid later increased aggravation and morbidity.     

Haemangiomas of the orbit

The authors describe their experience with systemic therapy of cavernous haemangiomas making use of interferon alpha. They have successfully used the method in treating two female patients with cavernous haemangiomas in the orbit. In the first patient, the IFN therapy was followed by surgical removal of the tumour. In the second patient, surgical operation was not suitable. After the IFN therapy, the patient's state improved both subjectively and objectively. Decreased level of bFGF in urine prove to be the criterion for successful treatment by IFN. The authors also stress the risk of complications in sucklings. When choosing the method of treatment, they emphasize the necessity of interdisciplinary cooperation.     

吻合器痔上黏膜环切术联合外剥内扎手术治疗Ⅲ-Ⅳ度环状混合痔的疗效及对患者肛门功能的影响

目的:研究吻合器痔上黏膜环切术(PPH)联合外剥内扎手术(MMH)治疗Ⅲ-Ⅳ度环状混合痔的疗效及对患者肛门功能的影响。方法:选择2016年3月~2018年3月我院收治的III-IV度环状混合痔患者128例为研究对象,将入选患者按照随机数字表法分为MMH组(n=58,采用MMH治疗)和联合组(n=70,采用PPH联合MMH治疗),比较两组手术指标及术后恢复情况,术后对两组患者进行为期3个月的随访,随访结束后,比较两组治疗疗效、肛门功能以及并发症的发生情况。结果:与MMH组比较,联合组手术出血量明显更少,住院时间、伤口愈合时间明显更短,各时间点的疼痛评分明显降低(P0.05)。与MMH组比较,联合组治疗总有效率升高,差异有统计学意义(P0.05)。与MMH组比较,联合组患者肛管静息压、肛管高压带长度、直肠肛门抑制反射阳性率均升高,肛管最大收缩压降低(P0.05),但两组直肠静息压比较差异无统计学意义(P0.05)。联合组并发症发生率为10.00%(7/70),低于MMH组的34.48%(20/58),差异有统计学意义(P0.05)。结论:较传统的MMH单独治疗,PPH联合MMH治疗Ⅲ-Ⅳ度环状混合痔具有更好的效果,可以缩短术后恢复时间,改善术后疼痛程度及肛门功能,且安全性较高。     

PPH与Milligan-Morgan术式治疗环状混合痔的临床效果观察

目的:比较PPH与Milligan-Morgan术式治疗Ⅲ～Ⅳ期环状痔的临床效果,探讨治疗Ⅲ～Ⅳ期环状痔的最佳术式。方法:选择Ⅲ～Ⅳ期环状痔患者130例,随机均分为PPH组和Milligan-Morgan组,两组患者分别采用PPH术式和Milligan-Morgan术式治疗,比较两组患者手术时间、术中出血量、术后疼痛评分、住院时间、住院费用和术后并发症情况。结果:PPH组优于Milligan-Morgan组,两组患者手术时间、术中出血量、术后疼痛评分、住院时间、住院费用及术后发生急性尿潴留、肛门水肿和吻合口感染病例比较,差异具有统计学意义(P<0.05)。结论:应首选PPH术式治疗Ⅲ～Ⅳ期环状痔患者,可显著减轻术后疼痛,加快患者术后恢复,减少术后并发症。     

Use of cephalosporins for the prevention of mixed infection during surgical treatment of rectal cancer

Cephalosporin antibiotics such as cephaloridine, cephazolin and cephalothin++ were used during operations for rectum cancer. The antibiotics were administered intravenously and immediately into the superior rectal artery. It provided high levels of the antibiotics in blood and discharge of the small pelvis cavity and prevented development of infectious complications during the postoperative period.     

血清VEGF，IGF-1和CA125水平与子宫动脉栓塞术(UAE)治疗子宫腺肌症的相关性

目的:探讨血清血管内皮生长因子(VEGF)、胰岛素样生长因子-1(IGF-1)和CA125水平和子宫动脉栓塞术(UAE)治疗子宫腺肌症的之间的相关性。方法:选择接受子宫动脉栓塞术治疗的39例子宫腺肌症患者作为患者组,取同时期参加健康体检的30名健康者作为健康对照组。用ELISA法检测子宫腺肌症患者子宫动脉栓塞术前和术后不同时点血清VEGF、IGF-1、CA125的水平,评估子宫动脉栓塞术后的患者的疗效。结果:34例痛经患者术后1个月开始改善,最终29例完全缓解,有效率85.2%。患者组治疗前血清VEGF、IGF-1、CA125水平均显著高于健康对照组(P0.05)。子宫动脉栓塞术治疗后,患者组血清IGF-1、VEGF和CA125的水平与治疗前相比均显著降低,术后6月,恢复正常水平。结论:血清IGF-1、VEGF、CA125的变化可能在子宫动脉栓塞术治疗子宫腺肌症中作为疗效和预后评估指标。     

手术切除与介入栓塞治疗肝癌术后复发患者的临床对比研究

目的:比较手术切除与介入栓塞治疗肝癌术后复发患者的临床疗效。方法:选择2010年6月到2011年6月本院收治的92例肝癌手术切除术后复发患者,按随机数字表法分为手术切除组和介入栓塞组,各46例。手术切除组患者给予再次切除治疗,介入栓塞组患者给予介入栓塞治疗。记录并比较两组患者治疗后1年、3年及5年的生存率。检测并比较两组患者治疗前后血清肝纤维化指标,包括血清透明质酸(HA)、层黏蛋白(LN)、人Ⅲ型前胶原(HPC-Ⅲ)及IV型胶原(IV-C)水平。检测并比较两组患者治疗前后血清白细胞(WBC)、甲胎蛋白(AFP)及癌胚抗原(CEA)水平。结果:手术切除组患者治疗后1年、3年、5年的生存率均明显高于介入栓塞组,差异均具有统计学意义(P0.05)。治疗后,介入栓塞组血清HA、LN、HPC-Ⅲ及IV-C明显高于治疗前,且均明显高于手术切除组,差异均具有统计学意义(P0.05)。两组患者治疗后血清WBC、AFP及CEA水平均明显低于治疗前,且手术切除组患者血清WBC明显高于介入栓塞组,而血清AFP、CEA水平明显低于介入栓塞组,差异均具有统计学意义(P0.05)。结论:手术切除治疗肝癌术后复发能够明显提高患者生存率,降低肝纤维化程度,改善血清AFP及CEA水平,值得在临床上推广应用。     

Ultrasound characteristics of uterine myoma before and after uterine artery embolization

The diagnosis and treatment of uterine leiomyoma are topical problems of modern gynecology and radiodiagnosis. Organ-saving treatments for uterine myoma, one of which is uterine artery embolization, are gaining wide acceptance now. The objective of the study was to increase the informative value of ultrasound study to predict the uterine myoma after uterine artery embolization. One hundred uterine myoma patients aged 20 to 52 years were examined. Small pelvic Doppler ultrasonography was carried out in all the patients. The reduction of myomatous nodules was estimated after uterine artery embolization. The decrease in uterine myoma sizes was found to be due to the reduction in their vascularization and the occurrence of ischemia with degeneration in the myoma. Ultrasonography was found to be most accessible and informative in the prognostic and postoperative evaluation of the efficiency of X-ray endovascular treatment for uterine myoma.     

子宫动脉栓塞术后并发血栓的临床病例分析和诊治探讨

目的:探讨剖宫产瘢痕妊娠(CSP)患者经子宫动脉栓塞术(UAE)后并发下肢深静脉血栓(DVT)的临床病例的诊断治疗要点。方法:回顾性分析2014年-2016年我院收治的剖宫产瘢痕妊娠患者经子宫动脉栓塞术后并发下肢深静脉血栓(DVT)5例患者的临床特点及诊断、治疗方法。结果:2014年-2016年,我院CSP患者经UAE治疗后发生DVT的发病率为1.63%,患者平均年龄35.2岁。DVT临床症状出现于UAE术后3-6天,多表现为下肢的疼痛及酸胀,深静脉血栓均出现在介入穿刺处肢体。用彩色多普勒血流显像诊断深静脉血栓安全可靠。采用低分子肝素皮下注射抗凝治疗均取得较好效果。结论:剖宫产瘢痕妊娠患者经子宫动脉栓塞术治疗后有发生下肢深静脉血栓风险,DVT发生与穿刺处肢体制动,血管受压,血液回流障碍有关。手术前后应采取预防措施,低分子肝素钠抗凝对DVT治疗有效。     

DynaCT对肝转移瘤介入治疗具有指导意义

为了探讨锥形束CT (DynaCT)在肝癌患者实施经导管肝动脉化疗栓塞(TACE)手术治疗中的指导作用、栓塞效果评估中的价值,本研究选取了2012年3月至2015年5月在本院实施TACE手术治疗的102例原发性肝癌或转移性肝癌患者进行研究。通过对102例患者病灶进行手术前螺旋CT检测、术中数字减影血管造影(DSA)及DynaCT检测,并对比DSA与DynaCT对肝癌病灶、供血动脉、术后栓塞效果的检测结果。本研究发现术前普通螺旋CT共计检出病灶105个,术中DSA检出病灶数目176个,DynaCT术中检出肿瘤病灶285个;DynaCT和DSA的平均检出病灶数目均显著的高于普通螺旋CT (p<0.05),DynaCT平均检出病灶数目均显著的高于DSA (p<0.05);DynaCT的病灶供血动脉检出率为86.67%,显著地高于DSA (55.68%)(p<0.05);DynaCT检出的285个病灶对栓塞效果评估结果与实际栓塞效果一致的有271个病灶(95.09%),DSA评估结果与实际结果一致的有138个病灶(78.41%),DynaCT对于TACE术后效果评估的一致性高于DSA (p<0.05)。本研究表明,DynaCT在肝癌患者实施TACE手术治疗中能够更有效的发现病灶,指导栓塞操作。