随着生活方式的改变,痔疮患者的数量也越来越多.很多人认为痔疮只是小问题,只要熬一熬,过段时间就会自愈.但如果不及时进行正确的护理和治疗,小痔疮也会引起大问题,为患者带来更多的困扰.那么,痔疮是怎么形成的?得了痔疮以后应该怎么护理才能控制病情发展呢?

目的 研究成人重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠呼吸暂停低通气指数(AHI)与硬腭高度、宽度、鼻腔高度、硬腭高度与鼻腔高度占比的相关性.方法 选取2020年1月～2022年10月解放军总医院京东医疗区耳鼻咽喉头颈外科资料完整的重度OSAHS成年患者40例,分别测量第一前磨牙、第一磨牙区硬腭高度及宽度以及对应位置鼻腔高度,并计算出硬腭高度与鼻腔高度占比,将AHI与第一前磨牙、第一磨牙区硬腭高度及宽度、鼻腔高度、硬腭高度与鼻腔高度占比进行比较,评价其相关性.结果 40例重度OSAHS患者AHI为(53.74±18.22)次/h,与第1前磨牙对应硬腭高度为(7.82±2.97)mm、硬腭宽度为(31.15±3.44)mm、鼻中隔高度为(48.65±4.45)mm、硬腭高度与鼻中隔比例为16.09%±6.06%进行比较,差异有统计学意义(P均＜0.05);与第1磨牙对应硬腭高度为(12.99±2.95)mm、硬腭宽度为(38.18±4.13)mm、鼻中隔高度为(45.75±3.53)mm、硬腭高度与鼻中隔比例为28.99%±7.32%进行比较,差异有统计学意义(P均＜0.05).结论 成人重度OSAHS患者常伴有硬腭高拱和鼻腔结构的改变.

目的 探讨两种不同手术方法治疗舌咽平面狭窄导致的重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的疗效.方法 选取2010年1月～2019年12月解放军总医院京东医疗区资料完整的OSAHS患者,按照不同手术径路分为颈外径路组和口内舌根部分切除联合悬雍垂腭咽成形术(UPPP)组(简称口内切除组),每组各36例,分析两组患者手术前后参数的变化.结果 颈外径路组术后半年睡眠呼吸暂停低通气指数(AHI)由(69.2±25.1)次/h降至(16.0±19.7)次/h;最低血氧饱和度(lowest oxygen saturation,LSaO2)由0.673±0.095提高至0.814±0.080,差异有统计学意义(P＜0.01);治愈14例(38.9％),显效14例(38.9％),有效5例(13.9％),无效3例(8.3％).口内切除组术后半年AHI由(54.8±22.2)次/h降低至(17.9±15.2)次/h;LSaO2由0.688±0.111提高至0.816±0.080,差异有统计学意义(P＜0.01);治愈9例(25％),显效12例(33.3％),有效11例(30.6％),无效4例(11.1％).结论 经颈外径路和口内舌根部分切除联合悬雍垂腭咽成形术治疗因舌咽平面狭窄导致的重度OSAHS患者疗效明显、安全性高.

目的 了解北京城市副中心变应性鼻炎(AR)患者变应原分布特点,为该地区预防治疗AR提供科学依据.方法 回顾性分析355例确诊AR患者血清IgE结果.分析性别、发病年龄和病程与变应原的关系.结果 355例患者变应原阳性率最高的前三位分别为户尘螨209例次(58.9％)、树138例次(38.9％)、杂草49例次(13.8％).树变应原女性(42.6％)高于男性(30.4％),发病年龄30岁以下者(45.4％)高于30岁以上者(29.8％).杂草变应原男性(21.4％)高于女性(9.9％),发病年龄20岁以上及50岁以下者偏高.结论 北京城市副中心AR的变应原主要是户尘螨,其次是树、杂草,前者是宣教、预防治疗的重点,后者与性别的关系与以往研究有所不同,需进一步探讨.

目的 探讨肛周应用硝酸甘油软膏与肛周皮下组织注射复方亚甲蓝注射液联合情况下的肛肠疾病手术后镇痛的临床效果.方法 选取2019年5月 ～2020年2月在首都医科大学附属北京潞河医院住院行手术治疗的肛肠疾病患者60例,随机数表法将研究对象分成对照组和观察组各30例,对照组患者仅应用复方亚甲蓝注射液于肛周伤口周围皮下封闭注射;观察组肛周皮下组织注射复方亚甲蓝注射液同时联合肛周外用硝酸甘油软膏.观察两组患者术后第1天、第3天、第5天疼痛评分情况及术后恢复过程中的排便和排尿情况.结果 观察组在术后监测3d的疼痛评分和术后排便困难比例和尿潴留发生比例各方面指标均低于对照组,差异有统计学意义(P<0.01).结论 复方亚甲蓝注射液和硝酸甘油软膏联合应用在肛肠疾病术后镇痛的临床效果更加明显,是一种安全可行的肛肠疾病术后镇痛方法.

目的 探讨罗伊适应模式(RAM)对行肠造口术的结直肠癌患者临床症状、自我护理能力及生活质量的影响.方法 依据随机数字表法将212例行肠造口术的结直肠癌患者分为两组,每组106例.对照组患者予以常规护理,观察组患者予以RAM护理,比较护理前后两组患者的临床症状、自我护理能力及生活质量,比较两组患者的护理满意度.结果 护理后,两组患者的躯体症状、心理症状、社会适应性评分均较本组护理前降低,且观察组患者的上述评分均低于对照组,差异均有统计学意义(P﹤0.05).护理后,两组患者的自我护理技能、健康知识水平、自我概念、自我责任感评分及总评分均高于本组护理前,且观察组患者的上述评分均高于对照组,差异均有统计学意义(P﹤0.05).护理后,两组患者的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均高于本组护理前,且观察组患者的上述评分均高于对照组,差异均有统计学意义(P﹤0.05).观察组患者的护理满意度为96.23％(102/106),明显高于对照组的81.13％(86/106),差异有统计学意义(P﹤0.01).结论 将RAM应用于结直肠癌造口术后患者的护理工作中,可减轻患者的临床症状,提高患者的生活质量、自我护理能力及护理满意度.

Objective To investigate the change of expression of phosphorylated mechanistic target protein (p-MTOR) in colon cancer tissues and its influence on prognosis. Method 110 cases of colon cancer tissue samples and 110 cases of corresponding adjacent tissues were collected,and then were detected for the expression of p-MTOR protein by immunohistochemical staining,the relationship between p-MTOR protein expression and clinicopathological features and long-term prognosis was analyzed.Result The positive expression rate of p-MTOR protein in colorectal carcinoma was 54.55%,and was significantly higher than that in adjacent tissue at 10.00%,the difference was statistically significant (P<0.01);p-MTOR protein expression was significantly correlated with TNM stage,depth of invasion and lymph node metastasis(P<0.01);the 3-year survival rate of patients with positive expression of p-MTOR protein(28.33%)was signif-icantly lower than that in patients with negative p-MTOR protein expression(55.00%)(χ2=8.364,P=0.004);higher TNM staging,presence of lymph node metastasis,muscular invasion and positive expression of p-MTOR protein were indepen-dent risk factors for poor prognosis in patients with colon cancer(P<0.05).Conclusion The expression of p-MTOR pro-tein is up-regulated in colon cancer tissues,and is correlated with TNM stage,lymph node metastasis and depth of inva-sion,indicating that it is an independent risk factor for poor prognosis.

Objective To summarize the treatment experience of pulmonary tuberculosis complicated with spontaneous pneumothorax.Methods Clinical data of 116 in-patients with pulmonary tuberculosis complicated with spontaneous pneumothorax from June 2005 to June 2015 were retrospective analyzed.Results Of these 116 patients,the relapse rate of pneumothorax more than two times was 8.5％,the relapse rate in patients treated with closed drainage was 21.6％,the relapse rate of patients treated with operation was 2.2％.The total cure rate was 94.7％.Conclusion Individualization should be emphasized for the treatment of pulmonary tuberculosis complicated with spontaneous pneumothorax.Pneumothorax is difficult to be cured with conservative treatment only for the existence of tuberculosis focus,the therapeutic effect of active surgery is certain and reliable.VATS should be the first choice for less trauma and quick recovery.Pulmonary repair and bullectomy should be the major surgical approach.Favorable results can be achieved by using auto pleura flap and intensive suture to avoid pulmonary air leakage.

Objective To compare the clinical efficacy of two surgical methods for the treatment of anal fissures in elderly patients.Methods A total of 138 elderly patients with anal fissures treated at our hospital from January to December 2016 were randomly divided into the conventional method group(69 cases) and the modified method group (69 cases).Patients in the conventional method group were treated with lateral sphincterotomy,while patients in the modified method group were treated with modified longitudinal sphincterotomy with transverse suture.Outcomes of treatment,VAS scores,incision wound infection rates,postoperative voiding dysfunction rates and recurrence rates were compared.Results There was no significant difference in overall effectiveness between the modified method group (98.6％)and the conventional method group(94.2％) (x2=1.8677,P=0.1717).The rates of incision wound infection,moderate postoperative urinary retention and recurrence in the conventional method group(8.7％,42.0％ and 10.1 ％,respectively)were significantly higher than those in the modified methods group(0.0 ％,15.9 ％ and 0.0％,respectively) (x2 =4.3561,11.4061 and 5.4177,respectively,P =0.0369,0.0007 and 0.0199,respectively).At 12 hours after operation,favorable VAS scores and incision healing times were observed in the modified method group,compared with the conventional method group,and the differences were statistically significant(each P＜0.05).Conclusions Modified longitudinal sphincterotomy with transverse suture produces about the same overall effectiveness as does lateral sphincterotomy in the treatment of elderly patients with anal fissures,but it is superior in reducing incision wound infection,moderate postoperative voiding dysfunction,recurrence and pain intensity,and in promoting incision healing.

目的 探讨地奥司明片联合马应龙痔疮栓治疗混合痔术后并发症临床情况.方法 我院2013年5月至2015年5月肛肠科行混合痔手术患者80例按入院顺序分组,对应随机数字为偶数者为实验组,奇数者为对照组,每组40例.给予实验组患者地奥司明片口服联合马应龙痔疮栓外用联合治疗,对照组患者仅给予马应龙痔疮栓外用治疗.观察并比较两组患者术后疼痛、心理状态、水肿及出血情况.结果 治疗后实验组治疗有效率为95％,明显高于对照组有效率为80％(P ＜0.05).治疗前两组患者症状评分无明显差异(P＞0.05),治疗后实验组与对照组症状评分均明显降低(P＜0.05),但实验组评分降低程度明显优于对照组(P＜0.05).两组患者治疗前SAS评分无明显差异(P＞0.05),治疗后实验组患者SAS评分明显低于对照组(P＜0.05).治疗后4d,7d实验组出血、水肿、疼痛评分均明显低于对照组(P＜0.05),有统计学意义.结论 地奥司明片联合马应龙痔疮栓较单独使用能更好改善混合痔术后心理状态和水肿、疼痛、出血等并发症的发生,疗效确切.

Objective to study the value of hs‐CRP and IL‐6 expression on prognosis of Radical operation for sec‐ondary Abscess with anal fissure .Methods A total of 124 consecutives from Octomber 2010 to Octomber 2014 were a‐dopted operation of anal fissure excision ,internal sphincter cutting ,abscess seton and incision‐drainage;then to compare levels of hs‐CRP and IL‐6 expression .Results there were up to 68 cases(54 .8% ) recovery had one time operation as the A group ,32 cases(25 .8% )recovery had more than one times as the B group ,and other 24 cases(19 .4% )had bad complications as the C group .the levels of hs‐CRP and IL‐6 before operation in C group were both significantly higher than the other two groups(P<0 .05);What’more ,they in A and B group after operation were significantly lower than before(P<0 .05);but there were no lower in C group(P>0 .05) .Conclusion hs‐CRP and IL‐6 expression has a cer‐tain value on prognosis of Radical operation for secondary Abscess with anal fissure .

Objective To summarize the treatment experience of emergency operation for pulmonary tuberculosis complicated with massive hemoptysis.Methods Clinical data about 45 inpatients with pulmonary tuberculosis complicated with massive hemoptysis received emergency operation in our hospital from June 2005 to December 2015 were retrospectively analyzed.There were 39 male and 6 female patients with average age of 47.5 years old.Their operation methods included lobectomy and total pneumonectomy.Results Of the 45 patients,one patient died during the operation,one patient died at seven days after surgery because of severe pulmonary infection,and one patient gave up treatment at 13 days after surgery for the respiratory insufficiency and extubation failure.Bronchopleural fistula occurred in two patients during the early stage after surgery,and it turned to be chronic empyema after thoracic rinsing and drainage.The patients survived and discharged with drainage tube.Hemothorax occurred in two patients after operation,then they received surgical hemostasis and recovered.Other 38 patients recovered.Conclusion For patients with pulmonary tuberculosis complicated with massive hemoptysis,immediate pulmonary resection is the key for the success of surgery.Lobectomy is the first choice.Precise management after surgery can effectively prevent complications.

目的:观察高位虚挂线法加内口套扎术治疗高位肛瘘临床效果.方法:前瞻性设计高位虚挂线加内口套扎术治疗的 28 例高位肛瘘患者的临床资料.结果:28例全部治愈,随访1年,无延期愈合,无肛门畸形后遗症,无肛门失禁发生.结论:高位虚挂线法加内口套扎术疗效确切,创伤小,并发症少,保护了肛门括约肌功能,顺应外科微创理念,值得临床推广.

2005年1月至2010年12月,我科采用病窦切开敞开引流术治疗肛窦炎20例,取得满意疗效,现总结报道如下. 临床资料:本组20例患者中,男7例,女13例;年龄28～66岁,平均43.3岁;病程13个月至16年.19例患者为1个病窦,1例患者为2个病窦.病灶部位:截石位6点15例,3点2例,9点3例.

Objective To explore the clinical effect of four drug combination in the treatment of senile constipation.Methods Sixty cases with constipation patients were randomly divided into treatment group of 30 cases and control group of 30 cases by medical order.The treatment group was given four drug combination,control group was given Maren capsule,the period of treatment were 4 weeks,cured+effective=total effective,the total effective rate of the two groups were compared by the χ2 test.Results The cure in 17 cases,effective in 11 cases,invalid in 2 cases,the total effective rate was 93.33% in the treatment group;10 cases were cured,effective in 9 cases,invalid in 11 cases,the total effective rate was 63.33% in the control group;The total effective rate in treatment group was better than that of the control group,the difference was statistically significant(P 0.05).Conclusion Four drug combination is significant effective at healing senile constipation.

为探讨直肠脱垂更佳手术方式,回顾分析1999年10月至2011年12月手术治疗的30例直肠脱垂患者资料,按手术方式分组进行疗效比较.结果显示,(1)消痔灵直肠黏膜下点状注射加消痔灵直肠周围注射加肛门紧缩术治疗3例,其中1例有效,2例无效,总有效率为33.3％.(2)消痔灵直肠周围注射加直肠黏膜柱状缝扎加肛门紧缩术治疗5例,其中2例痊愈,1例有效,2例无效,总有效率为60.0％.(3)消痔灵直肠周围注射加直肠黏膜柱状缝扎加肛门外括约肌折叠术治疗9例,其中4例痊愈,2例有效,3例无效,总有效率为66.6％.(4)直肠黏膜剥除缝合加消痔灵直肠周围注射术治疗13例,其中10例痊愈,有效2例,无效1例,总有效率为92.3％.经统计学分析,直肠黏膜剥除缝合加消痔灵直肠周围注射术总有效率明显高于其他三种术式,P ＜0.05.结果表明,直肠黏膜剥除缝合加消痔灵直肠周围注射术治疗直肠脱垂效果优于其他三种术式,是一种较理想的术式.

为观察哨兵痔修剪倒V形皮瓣移位缝合术治疗Ⅲ期肛裂的疗效,将230例Ⅲ期肛裂患者按就诊先后顺序随机分为治疗组100例与对照组130例；治疗组采用哨兵痔修剪倒V形皮瓣移位缝合术治疗,对照组采用常规侧位内括约肌切断术治疗.结果显示,治疗组治愈90例,显效9例,无效1例,总有效率为99％；对照组治愈97例,显效20例,无效13例,总有效率为90％;治疗组疗效高于对照组(P＜0.05).结果表明,哨兵痔修剪倒V形皮瓣移位缝合术治疗Ⅲ期肛裂疗效显著.

<正>痔上黏膜环切钉合术(Procedure for prolapse and hemorrhoids,PPH)自1998年首次应用报道以来,成为治疗痔病的新方法,具有手术方法简单、符合病理生理、手术时间短、术后痛苦小、恢复快等优点,在国内得到迅速普及。但在治疗一些混合痔尤其是外痔较重患者时,往往存在外痔残留,痔回缩不全等不足。我院自引进PPH技术以来,尝试在PPH基础上联合应用外痔剥除、外痔切除缝合

患者男，41岁。肾移植术后9年余，发热2周。查体：双肺呼吸音粗，左下胸部叩诊呈实音。胸部增强CT(图1)：右上肺尖后段、左上肺尖段见斑点状、条索状高密度影；左下肺脊柱旁分叶状团块影，密度欠均匀、边界清，约7.0 cm×5.7 cm×8.5 cm，增强后见不均匀强化，未见明显肿大淋巴结。连续3次痰涂片查抗酸杆菌均为阴性，经抗炎对症治疗后体温、血沉控制正常。2010年7月全麻下行左肺下叶切除、左肺上叶楔形切除术和淋巴结清扫术。病理诊断：左下肺高分化腺癌，左肺上叶结核，隆凸下淋巴结结核。术后出现高热，加强抗感染、抗结核治疗，治愈后出院。

吻合器痔上黏膜环切术(PPH)治疗痔病方法简单,手术时间短,术后痛苦小,恢复快,但也存在一定的术中、术后并发症,直接影响手术治疗效果,甚至危及患者生命,如血肿形成、下腹胀痛、钉合切割不全、出血、尿潴留、疼痛、吻合口狭窄、感染、直肠阴道瘘、痔回缩不全、肛门坠胀不适等.现将儿种常见并发症的预防措施总结如下.