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.

目的 对比填充式无张力与平片无张力疝修补术在腹股沟疝气治疗中的疗效.方法 选择2018年1月～2020年1月期间于我院接受治疗的98例腹股沟疝气患者作为本次研究的一般对象,按照随机数列表分组法,将其分为对照组与观察组,各49例,对照组实施填充式无张力疝修补术,观察组实施平片无张力疝修复术,对比两组临床效果.结果 两组手术时间、术中出血量、术后恢复时间、术后并发症等围术期指标对比差异不显著(P>0.05),观察组手术费用低于对照组(P<0.05);术后1 d两组VAS评分对比差异无统计学意义(P>0.05);术后1月、3月,观察组VAS评分低于对照组(p<0.05).结论 两种疝修补术的临床疗效相当,平片无张力疝修补术患者术后疼痛和异物感少,且费用较低,适合在基层医院推广.

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.

目的 探析诱发腹腔镜下根治性远端胃切除术治疗的胃癌患者术后发生胃瘫高危因素.方法 选取顺利完成手术且术后无发生胃瘫患者40例设为对照组,另取手术完成后发生胃瘫并发症患者15例为观察组.对两组患者临床数据以回顾性方式进行分析并归纳诱发腹腔镜下根治性远端胃切除术后胃瘫高危因素.结果 对两组纳入对象的计量数据、计数数据对比后提示体重指数、术前血红蛋白、白蛋白、术前幽门梗阻以及腹腔并发症数据存在统计学意义(P<0.05);多因素Logistic分析后提示白蛋白、腹腔并发症是诱发术后胃瘫的独立高危因素(P<0.05).结论 对拟腹腔镜下根治性远端胃切除术方案治疗的胃癌患者在术前应该积极纠正低蛋白血症并采取有效措施防止腹腔并发症出现,对于降低术后发生胃瘫概率有重要意义,值得重视.

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.