目的 探讨中药熏洗剂联合针刺穴位治疗肛门瘙痒症患者的临床疗效.方法 将2020年9月—2021年2月在临汾市人民医院中医肛肠科门诊就诊的72例肛门瘙痒患者按照随机数字表法分成2组,2组均予自拟中药熏洗方进行熏洗治疗,治疗组在此基础上联合针刺董氏奇穴进行治疗,2组疗程均为10 d.记录2组患者治疗前后瘙痒程度、皮损状况、潮湿评分,统计2组患者治疗效果及治疗后1个月、3个月的复发率.结果 治疗后2组瘙痒程度、皮损状况、潮湿评分均明显降低(P均<0.05),且观察组明显低于对照组(P均<0.05);治疗后观察组总有效率为88.9％(32/36),对照组为63.9％(23/36),观察组总有效率明显高于对照组(P均<0.05);观察组治疗后1个月复发率为6.2％(2/32)、3个月复发率为18.8％(6/32),对照组治疗后1个月复发率为21.7％(5/23)、3个月复发率为47.8％(11/23),观察组治疗后1个月、3个月复发率均明显低于对照组(P均<0.05).结论 自拟中药熏洗剂联合针刺董氏奇穴能明显改善肛门瘙痒症患者的临床症状,不仅近期疗效满意,还可降低复发率.

Abstract Introduction/Objective Primary malignant melanoma of vagina (PMMV) has a very high rate of recurrence and poor long-term survival. Less than 250 cases are reported in English literature to date, optimal treatments, risk factors, and prognostic predictors for PMMV are still subjects of debate. This study sought to evaluate the clinicopathologic features, initial management, and survival of 6 patients over 7 years follow-up in one institution. Methods/Case Report In this study, the clinical and pathologic features of 6 PMMV occurring in patients age 49 to 83 years were evaluated retrospectively. The mean age of the patients was 68.2 years, and all patients were postmenopausal women. At the time of diagnosis, all tumors were limited to the vagina. Results (if a Case Study enter NA) Vaginal bleeding, discharge and a tumor mass were the chief complaints. These patients were treated by pelvic exenteration, radical surgery and postoperative chemotherapy and/or radiotherapy. Follow-up was available in all patients ranging from 1 to 7 years. Two patients had metastases in other organs died at 16 and 34 months respectively. Two patients had distant recurrence at 1 to 2 years and are still alive. The other 2 patients have no evidence of disease over 2 years follow-up. Grossly, the tumors were mostly polypoid and ranged from 0.25 to 9.5 cm (mean, 5 cm) in maximum dimension. The depth of invasion ranged from 2.2 to 11 mm. A vertical growth phase was present in all tumors. S-100, HMB-45 and Melan-A were positive in 100% of cases tested. Depth of invasion, mitotic index of tumor cells, tumor size, age, menopausal status, pelvic lymph node metastasis and lymphocytic infiltration show no tendency towards progression-free survival. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins. And adjuvant therapy was associated with progression-free survival. Conclusion In conclusion, PMMV is a rare disease, predominantly seen in women of postmenopausal age, and is associated with a poor prognosis. This study confirms S-100, HMB-45and Melan-A remains the most sensitive marker. Conventional predictors were of no prognostic value. Positive margin and adjuvant therapy were associated with progression-free survival. This report can facilitate the expansion of the phenotypic spectrum of gynecologic melanomas, and contribute to the prevention of misdiagnosis and inadequate treatment of PMMV.

目的 探讨肛管直肠黑色素瘤患者的临床病理特征及预后分析.方法 收集16例肛管直肠黑色素瘤患者的临床病理资料,所有标本均采用HE及免疫组化染色.结果 16例送检标本中均带肛门肠管1段.溃疡性肿块11例,息肉样肿块、带蒂5例,呈灰褐色,直径5-7cm;镜检:恶性黑色素瘤在肠粘膜下呈现出浸润性生长,排列出弥漫片形状,多数由类圆形的细胞组成,核浆比升高,细胞核变大,能看见核分裂;免疫组化:肛管直肠恶性黑色素瘤其肿瘤细胞S-100、HMB45、Vimentin、MelanA强阳性,CK、EMA以及LCA为阴性.结论 肛管直肠恶性黑色素瘤是比较少见的恶性肿瘤,其预后极差.

肺栓塞是由于肺动脉或其分支被栓子堵塞而引发的严重疾患,急性肺栓塞是普通外科手术后患者死亡的重要原因之一.本研究探讨腹腔镜直肠癌术后肺栓塞并发症的相关危险因素,以期为减少术后肺栓塞并发症的发生提供研究思路.

Objective To investigate the clinical effect of adjuvant chemotherapy on colon cancer surgery.Methods A total of 120 colon cancer patients who underwent surgery in Linfen People's Hospital from December 2016 to December 2017 were enrolled.The patients were divided into observation group and control group according to whether or not adjuvant chemotherapy was given,with 60 cases in each group.Surgical treatment was given to both groups of patients.On this basis,the observation group was given adjuvant chemotherapy after surgery.The therapeutic effects of the two groups were observed.Results The effective rate of treatment in the observation group was 71.67％,and the effective rate in the control group was 53.33％.The effective rate of the observation group was significantly higher than that of the control group,and the difference was significant (P ＜ 0.05).The scores of WHOQOL-BREF in the two groups were significantly higher than those before treatment (P ＜ 0.05).The improvement in the observation group was more significant than that in the control group (P ＜ 0.05).After treatment,the CEA of the observation group decreased significantly,and the decrease of the observation group was more obvious (P ＜ 0.05).After three years of follow-up,the recurrence rate of the observation group was 26.67％,and the disease-free survival time was (17.64 ± 4.43) months.The recurrence rate of the control group was 45.00％,and the disease-free survival time was (14.64 ± 3.64) months.The recurrence rate of the observation group was lower than that of the control group,and the disease-free survival time was longer than that of the control group (P ＞0.05).Conclusions Postoperative adjuvant chemotherapy for colon cancer is beneficial to improve the effect of surgical treatment and reduce the recurrence rate.It is worthy of promotion in clinical practice.

直肠癌在我国发病率呈逐年上升趋势,其中中低位直肠癌比例高达50％,目前以直肠癌全直肠系膜切除术(TME)为原则的直肠癌前切除(AR)作为一种标准的保肛术式已被外科医生所认可,并在世界范围内普及采用[1].吻合口瘘(AL)是直肠癌术后严重并发症之一,文献报道结直肠手术后吻合口瘘发生率为1％-30％,其中以结肠-直肠吻合或结肠-肛管吻合最高.除了围手术期死亡和永久性造口的短期风险外,吻合口瘘还被认为与远期局部复发有关,严重影响直肠癌患者术后恢复及预后,因此对直肠癌切除术后吻合口瘘相关因素的探究、诊治及其重要性的认识尤为重要.本文通过检索国内外文献,对直肠癌保肛术后吻合口瘘的影响因素、临床表现、防治现状进行评述.

目的：本次主要对腹腔镜探查在胃肠外科急诊中的应用价值进行探讨，为临床治疗提供重要依据，确保患者早日康复。方法：选取2014年10月～2015年10月在我院进行腹腔镜探查的患者80例，根据所有患者入院的编号平均分为实验组和对照组各40例，实验组采用腹腔镜探查治疗，对照组采用传统的开腹治疗。结果：实验组在临床各项指标方面明显优于对照组，并发症发生情况对比，实验组有2例患者出现结肠破裂的现象，之后转为开腹手术进行治疗，对照组患者有2例出现肺部感染的情况，5例出现切口感染的情况，有1例患者在手术之后出现麻痹性肠梗阻，P＜0．05。结论：临床上对于胃肠外科急诊的患者，采用腹腔镜探查的方法有利于降低患者手术过程中的出血量，降低对患者的创伤，加快患者下床的时间，同时有利于减少患者并发症的发生率，因此该方法值得在临床上大力推广运用。

随着人们对身体保健重视程度的提高,饮食养生得到了极大的关注。而随着社区医疗范围的扩大化,饮食养生也成为了社区保健中的重要内容之一,成为了人们治病防病、延年益寿的最优选择。

目的探讨肝损伤患者的诊断和治疗。方法选择我院2010年6月—2012年6月收治的43例创伤性肝损伤患者,对其临床资料、治疗方法和结果进行回顾性分析。结果本组43例患者经采取不同治疗方法后均痊愈。结论对于不同程度的肝损伤患者,应当分别给予保守治疗和手术治疗。

<正>结直肠癌是常见恶性肿瘤病的一种,近年来呈多发态势,根治术后5年生存率保持在60%～70%。公开资料显示,自上世纪80年代腹腔镜胆囊切除术在临床上取得成功以来,腹腔镜技术就已广泛应用于结直肠手术上。手术范围无论是结肠造口术,还是结肠段大部切除术都获得了成功。并且腹腔镜结直肠手术创伤小、

目的:对于腹腔镜上消化道溃疡穿孔修补术处理方法及其效果进行探讨。方法:对于采用腹腔镜上消化道溃疡穿孔修补术的45例患者进行分析。结果:45例均是良性溃疡穿孔,均在腹腔镜下完成溃疡穿孔修补术。结论:作为简单快捷的方法,腹腔镜上消化道溃疡穿孔修补术,对避免术后切口感染和开裂、发生肠粘连、肠梗阻,减轻术后疼痛,有着积极作用。

目的对于左半结肠癌并发肠梗阻手术的处理方法及其效果探讨。方法对于采用何种方法对左半结肠癌并发肠梗阻的45例患者手术进行分析。结果左半结肠癌并发肠梗阻35例患者都痊愈出院。结论分期手术与I期手术各有优缺点,应当根据实际情况采用。

目的:观察腹部手术后功能性胃排空障碍患者非手术治疗胃动力恢复情况。方法:选取我院近3年收治的18例腹部手术后功能性胃排空障碍患者,采用非手术进行治疗。结果:患者经非手术治疗治愈,出现FDGE后3d-18d恢复了胃动力,痊愈出院。结论:腹部手术后明确诊断为FDGE的情况下,应坚持非手术治疗,多数于3周内症状可缓解,一般不宜手术治疗。

目的探讨HIF-1和COX-2在高原重症急性胰腺炎（SAP）中的作用以及二者之间的关系,初步探讨高原SAP的发病机制,为更好的诊治SAP提供理论基础。方法将72只SPF级健康雄性Wistar大鼠随机根据海拔不同分为3个大组（每组24只）,再将每个大组随机分成4个小组（每组6只）。采用向胰胆管逆行注射5%牛磺胆酸钠的方法建立SAP动物模型。SAP组（p组）在造模后的第6、12、24 h分批处死大鼠,假手术组（n组）在造模后6 h处死大鼠,分别测定血清淀粉酶（AMY）、胰腺组织缺氧诱导因子（HIF-1）和环加氧酶-2（COX-2）含量,观察胰腺组织病理变化并评分。结果p组各时点的胰腺病理评分及AMY、COX-2、HIF-1均较n组显著增高（P＜0.05）。三个海拔的p组相比,胰腺病理评分及HIF-1、COX-2的表达具有显著性差异（P＜0.05）。HIF-1、COX-2、HE评分呈正相关（P＜0.05）。结论①HIF-1、COX-2在SAP的早期即被激活,被激活因子可能在SAP的始发阶段起重要作用;②HIF-1与COX-2密切关联;③HIF-1、COX-2在高原SAP的发生发展中起重要作用。

<正>乳腺增生症在妇女中发病率较高,占80%以上,可以发生癌变,国内对乳腺增生症的治疗多采用中药治疗,疗效不理想[1],因而越来越引起临床医师的重视。笔者自2004—

贲门癌发病率有增高的趋势,但对贲门癌根治术的手术径路仍有分歧,经胸或经腹各有优缺点,经腹膈肌切开径路可综合经胸经腹的优点,弥补二者的缺点,值得推广.

患者女,36岁.2005年5月来我院口腔科就诊,口腔内黏膜有小泡,有蠕动感、麻木感,后患者自己用手指拽出一条白色细线小虫.既往否认肝炎、结核、寄生虫病史,否认食物、药物、过敏、家族史,无遗传疾病记载.查体:胸部透视正常,肝脾未及,心电图正常.实验室检查:肝功能正常,血常规:血红蛋白120 g/L,白细胞6×109/L嗜酸细胞0.08.尿常规正常,便常规正常(未见到虫卵).将小虫放置玻璃片上,加盖玻片,在显微镜下观察,分别用100、400倍镜头观察:此虫细长如线状,乳白色,略透明,体表有明显横纹,体前端表皮有明显纵行排列,大小不等,形状各异,数目不同的花缘状表皮奥、背、腹、面各有四行,口位于头顶正中,虫长20 mm左右,尾部有膜状尾翼,经鉴定属寄生虫"美丽筒线虫"(Threadworms).