[Objectives] To evaluate the effectiveness of the incisional skin-bridge procedure in the treatment of posterior horseshoe perianal abscess based on finite element model. [Methods] A cohort of 120 patients with posterior horseshoe perianal abscess who underwent the incisional skin-bridge procedure in the Department of Anorectal Surgery, Affiliated People’s Hospital of Fujian Traditional Chinese Medicine University (Fujian People’s Hospital) from September 2020 to December 2022 were included. These patients were randomly assigned into either standard skin-bridge group or the wide skin-bridge group (60 patients each) using random number table. Three-dimensional finite element model for both the standard skin-bridge (model A) and wide skin-bridge (model B) were constructed. Stress and displacement metrics at various skin-bridge nodes during surgery were quantified and incorporated into their respective models. Six pivotal nodes were selected for model validation, followed by comparisons of displacement disparities between the two models and an evaluation of anal pressure three months post-surgery. [Results] Displacements measured surgically at 174 nodes in the standard skin-bridge group and 173 nodes in the wide skin-bridge group significantly deviated from the model prediction (P<0.05), whereas other nodes displacements measured surgically aligned with the model (P>0.05). Compared to model B, nodes 89, 173, and 257 located on model A’s inner skin-bridge edge showed markedly less displacements (P<0.05), while nodes 90 and 258 on the outer edge exhibited increased greater displacements (P<0.05). Inner edge displacements were substantially greater than those at the outer edge in both models (P<0.05). Postoperative three-month anal pressure revealed that the anal resting pressure and maximal contraction pressure of the standard skin-bridge group surpassed those of the wide skin-bridge group (P<0.001). [Conclusion] The finite element method efficaciously mirrors the biomechanical dynamics of incision and skin-bridge procedures for perianal abscesses. During surgery, the skin-bridge nodes endure varied tensile forces. Tailoring the skin-bridge design might be crucial in preserving postoperative anal integrity and functionality following perianal abscess surgery.

《伤寒论》中有关便血的诊治对理解经典与指导临床实践有着重要意义.本文对《伤寒论》中关于便血的部分条文进行归纳总结,探讨太阳、阳明瘀热互结之蓄血证,少阴寒化证,厥阴阳复太过的便血成因,同时归纳总结其证治规律,并与现代疾病的病因病机相联系,以期为便血的内科治疗提供一定的基础理论与临床用药指导.

With the rapid development of biomedical and intelligent systems, more and more surgical modalities can be created and improved with computers. The finite element method is widely used in orthopaedics and can also simulate biomechanical changes in perianal soft tissues. This study created surgical models of perianal abscesses with different working conditions in SUPER-SAP finite element software by giving different tissue mechanical properties through MR image mapping and axial pulling tests. The results suggest that perianal abscess surgery with an incisional indwelling skin bridge may reduce displacement deformation at key anal nodes, revealing that the skin bridge may be one of the potential factors in preserving the functional reconstruction of the anus. This study may provide a basis for further exploration of perianal biomechanical mechanisms.

本文总结托法在肛周脓肿的现代理论、临床应用、作用机制的相关研究成果,同时分析现存不足并提出建议.通过总结名老中医经验、临床研究、实验研究、药理学研究成果,发现托法在肛周脓肿中的应用广泛,效果显著,主要运用于初期和溃脓期,且不局限于内服中药治疗.托法具有控制炎症反应、调节免疫、加速创面愈合等作用,但目前研究其现代作用机制的高质量文献甚少,建议今后在动物实验研究、生物分子水平等方面深入探究托法的现代作用机制.

目的 探讨不同类型肛周脓肿中医证素分布特点和差异性,为不同类型肛周脓肿的防治提供依据.方法 收集2021年10月—2023年2月因肛周脓肿在福建中医药大学附属人民医院肛肠科手术的住院患者210例,根据肛周脓肿分类标准将其分为肛门括约肌间脓肿组77例、肛门周围脓肿组38例、坐骨直肠间隙脓肿组33例、直肠后间隙脓肿组32例和骨盆直肠间隙脓肿组30例,采用证素辨证方法,比较5 组病位、病性证素分布特点和差异性.结果 肛周脓肿病位证素主要为脾、大肠、肝、小肠、心神,病性证素主要为气滞、湿、热、痰、血瘀、气虚、阴虚.骨盆直肠间隙脓肿组热、气滞、气虚的证素积分均高于其余4组(P＜0.05),湿的证素积分高于肛门括约肌间脓肿组(P＜0.05);骨盆直肠间隙脓肿组大肠、肝的证素积分均高于肛门括约肌间脓肿组、肛门周围脓肿组(P＜0.05).结论 骨盆直肠间隙脓肿气滞、热、气虚的病变程度较其余4个分型更严重,湿的病变程度较肛门括约肌间脓肿更严重,肝、大肠的病变程度较肛门括约肌间脓肿组、肛门周围脓肿组更严重,故治疗骨盆直肠间隙脓肿应注重清化大肠、疏肝行气、清热利湿,且祛邪应不忘益气固本.

目的 观察全国名中医陈民藩教授经验方清草饮在肛周脓肿热毒炽盛证术后应用的临床疗效.方法 选取86例肛周脓肿热毒炽盛证术后住院患者,采用随机数字表法分为对照组与观察组各43例.对照组术后采用常规抗生素口服治疗,观察组在对照组治疗基础上联合中药清草饮内服,2组疗程均为5d.观察2组治疗前后白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)等炎症指标和视觉模拟评分(VAS)变化情况,并比较其创面愈合时间和疗效.结果 与治疗前比较,2组术后5 d后炎症指标WBC、CRP、PCT均明显降低(P<0.05);与对照组比较,观察组创面平均愈合时间明显缩短(P<0.05),术后3 d、5 d的VAS评分均明显降低(P<0.05);术后25天观察组有效率(42/43,97.67％)优于对照组(38/43,88.37％)(P<0.05).结论 清草饮联合抗生素可促进肛周脓肿热毒炽盛证术后创面愈合,减少患者术后疼痛.

目的 分析低位切开留皮桥高位挂线术治疗高位复杂性肛瘘的临床疗效.方法 回顾性分析2017年1月至2019年1月福建中医药大学附属人民医院收治的120例高位复杂性肛瘘患者的临床资料,患者均接受低位切开留皮桥高位挂线术及术后随访,记录疗效、复发、术后并发症(肛门变形、肛门失禁)发生情况,创面愈合时间,术前以及术后3个月的肛管直肠压力(肛管最大收缩压、肛管静息压、直肠静息压).结果 中位随访时间为1.2年,治愈111例、好转1例、未愈2例,复发6例,其中4例复发患者接受二次低位切开留皮桥高位挂线术后治愈,另2例复发患者为克罗恩病肛瘘、带瘘生存.所有患者均未出现肛门失禁、肛门变形.术后创面愈合时间为32～73 d,平均愈合时间为(49.4±15.2)d.术后3个月的肛管最大收缩压与术前比较差异无统计学意义(P＞0.05);术后3个月,直肠静息压、肛管静息压均较术前下降,差异有统计学意义(均P＜0.05).结论 低位切开留皮桥高位挂线术治疗高位复杂性肛瘘疗效良好,治愈率较高,对肛门功能影响较小.

目的 观察两种不同切口的低位切开留皮桥高位挂线术式治疗肛周脓肿的疗效.方法 选取我院肛肠科收治的80例深部肛周脓肿住院患者,按随机数字表法分为:A组40例采用原发灶脓腔放射状切口、继发性脓腔弧形切口的方式进行手术,B组40例采用原发灶脓腔和继发性脓腔均放射状切口的方式进行手术.比较2组术后24 h疼痛评分、创面愈合时间、肛门功能(漏气、漏液、漏便情况);随访1年,观察术后3个月、术后1年的肛门压力测定及术后1年复发情况.结果 与B组比较,A组术后24 h疼痛评分较低(P＜0.01),创面愈合时间缩短(P＜0.05),肛门功能(漏气、漏液、漏便情况)及术后1年的复发率无明显差异(P＞0.05);术后3个月,A组肛管静息压、肛管最大收缩压显著高于B组(P＜0.05);术后1年,A组肛管静息压、直肠静息压、肛管最大收缩压均高于B组(P＜0.05).结论 低位切开留皮桥高位挂线术式采用原发灶脓腔放射状切口、继发性脓腔弧形切口治疗深部肛周脓肿较原发灶脓腔和继发性脓腔均采用放射状切口方式,具有减轻术后疼痛、缩短疗程、保护肛门功能的优势.

Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme's procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme's procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 (P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

目的:分析研究术前MRI定位技术对于复杂性肛瘘手术的临床效果.方法:选取80例2017年2月-2018年5月笔者所在医院收治的复杂性肛瘘患者,随机分为对照组和研究组,两组均40例.对照组采用亚甲蓝染色技术进行手术,研究组采用MRI定位技术确定瘘管相关情况,然后根据瘘管走向和内口进行手术,比较分析两组术中发现内口数量、手术次数、愈合时间和治疗效果.结果:研究组发现的内口数量显著多于对照组,手术次数显著少于对照组,且差异均有统计学意义(P<0.05);虽然研究组的愈合时间较对照组短,但两组比较差异无统计学意义(P>0.05).研究组的治疗率高达92.50％,显著高于对照组的72.50％,差异有统计学意义(P<0.05).结论:术前MRI定位技术应用于复杂性肛瘘手术的临床效果显著,值得推广.

Background: Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to update and expand our previous work to compare the safety and efficacy of the procedure for prolapse and hemorrhoids (PPH), Milligan-Morgan hemorrhoidectomy (MMH) and tissue-selecting therapy stapler (TST) in the treatment of grade III and IV internal hemorrhoids. Methods: We performed a network meta-analysis. We searched the Cochrane library, Embase, PubMed, Medline, Web of Science, CNKI, Wangfang, and VIP databases up to May 20, 2019. All randomized controlled trials (RCTs) comparing PPH, MMH and TST in the treatment of grade III and IV internal hemorrhoids were included. We performed a Bayesian network meta-analysis to integrate the adverse events of all treatments. This work is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. This study was registered with PROSPERO, number CRD42019137270. Result: Twenty-two RCTs that recruited 3511 patients were identified. Among these patients, 1379 patients underwent PPH, 805 patients underwent TST, and 1327 patients underwent MMH. In terms of adverse events, TST presented the lowest urinary retention rates and fecal incontinence rates. TST exhibited fewer incidences of anal stenosis than PPH and MMH. Importantly, PPH showed the weakest effects on reducing recurrence rates in hemorrhoid patients. Conclusions: The current study indicated that TST showed optimal potential superior clinical effects for grade III and IV hemorrhoids compared to PPH and MMH. However, high-quality large sample RCTs are still expected.

目前临床上以手术治疗肛瘘为原则。随着近年来新技术、新材料的应用已经产生了许多新的微创术式，这些微创术式都以肛门功能的损伤最小化为目标，但目前肛瘘的治疗仍面临着疗效与功能难以兼顾、术式与规范难以统一的问题。因此，本文根据循证医学、指南及临床研究的证据，对肛瘘微创术式的疗效与安全性做一综述，以期提高对肛瘘术式的正确认识，为今后肛瘘的术式提供参考。目前，像瘘管激光闭合术、肛瘘栓、视频辅助治疗肛瘘等微创术式是另一种治疗选择，但是要根据患者的肛瘘分型、内口位置、瘘管走向等情况选择最合适的手术方案，权衡括约肌损伤程度与疗效、肛门功能之间的利弊，以高治愈率、低复发率、高质量生活为远期目标。

目的:探讨2型糖尿病病人颈动脉内膜中层厚度与三酰甘油-葡萄糖指数的相关性.方法:选取符合纳入标准的2型糖尿病病人79例,检测病人颈动脉内膜中层厚度、三酰甘油、空腹葡萄糖等实验室检测指标,计算三酰甘油-葡萄糖指数,探讨2型糖尿病病人颈动脉内膜中层厚度与三酰甘油-葡萄糖指数等的相关性.结果:①2型糖尿病病人颈动脉内膜中层厚度与三酰甘油-葡萄糖指数、三酰甘油、血肌酐、中性粒细胞计数、尿蛋白呈正相关(P<0.05),也与年龄、收缩压、缺血性脑血管病、糖尿病肾病呈正相关(P<0.01),与血小板计数(P<0.05)、内生肌酐清除率(P<0.01)呈负相关.②年龄、舒张压、血肌酐和内生肌酐清除率是颈动脉内膜中层厚度增厚的独立危险因素.结论:2型糖尿病病人颈动脉内膜中层厚度与三酰甘油-葡萄糖指数相关,有望为2型糖尿病大血管病变的监测提供一定的参考依据.

Background and aim: Fournier's gangrene (FG) is a fulminant infection in the external genital region and perineum. The present study explored the clinical features of FG originating from the anorectal region, from primary conditions such as anal fistulas and abscesses. Methods: A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals-the Sixth Affiliated Hospital of Sun Yat-sen University and People's Hospital Affiliated to Fujian University of Traditional Chinese-over the period from May 2013 to April 2017. Results: Sixty FG patients were included in this study. The common causative microorganisms cultured were Escherichia coli species. Genital and perirectal regional involvement was evident in 52 and 59 cases, respectively, although the perineum was unaffected in 7 cases (12%), as confirmed by imaging examination and surgical exploration. Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality (1.7%). Ten patients underwent protective colostomy. No patient underwent an orchidectomy and required urinary diversion. Conclusions: FG originating from the anorectal region can be rapidly progressive and life-threatening. Infection can spread superiorly to the genital region without the involvement in perineal tissue. An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.

目的:观察痛泻要方加减治疗混合痔术后肝木乘脾型腹泻的临床疗效.方法:选取混合痔术后肝木乘脾型腹泻患者86例,随机分为2组各43例,治疗组采用痛泻要方加味治疗,对照组采用双歧杆菌乳杆菌三联活菌片治疗.观察2组症状积分及综合疗效.结果:总有效率治疗为90.70％,对照组为76.74％,2组比较,差异有统计学意义(P＜0.05);2组症状总积分治疗前后组内比较及治疗后组间比较,差异均有统计学意义(P＜0.05);2组各项症状积分治疗后比较,差异均有统计学意义(P＜0.05).结论:痛泻要方加味治疗混合痔术后肝木乘脾型腹泻疗效优于双歧杆菌乳杆菌三联活菌片.

目的:观察柴胡桂枝汤治疗肛门直肠手术术后汗证的临床效果.方法:30例用柴胡桂枝汤口服汤剂治疗肛门直肠手术术后汗证.结果:总有效率为93.3%.结论:柴胡桂枝汤治疗肛门直肠手术术后汗证效果较好.

目的 观察紫芨洗剂在促进低位单纯性肛瘘术后创面愈合的作用. 方法 将80例肛瘘患者按随机数字表法分为治疗组和对照组各40例,由同一术者在局麻下行肛瘘切开术.治疗组术后采用紫芨洗剂创面坐浴,对照组采用1∶5000高锰酸钾溶液坐浴,比较2组创面疼痛、便血、创面肉芽、创缘水肿症状体征积分情况及创面愈合时间. 结果 治疗组创面疼痛、便血、创面肉芽症状体征积分均低于对照组(P＜0.05),治疗组平均创面愈合时间为(23.51±5.32)d,较对照组(28.83±4.53)d明显缩短(P＜0.05). 结论 低位单纯性肛瘘术后创面应用紫芨洗剂坐浴能够减缓疼痛,减少出血,促进肉芽生长,缩短创面愈合时间.