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Curative Effect of PPH Combining with Shaobei Injection on Moderate and Severe Degree Rectocele

目的評價痔上黏膜環切術（PPH)加芍倍注射術治療中重度（排糞造影檢查提示突出深度大于16 mm）直腸前突的療效。方法回顧性分析我院2006年12月至2010年9月期間應用PPH加芍倍注射術治療的45例中重度直腸前突患者的臨床資料，分析其手術時間、住院時間及復發和并發癥發生情況。結果本組患者手術時間為(18.8±2.2) min （15～25 min），住院時間為(7.2±0.6) d (6～8 d)。術后隨訪(12.3±6.6)個月(6～30個月)。34例(75.6%)排便費力、肛門堵塞、下墜等不適癥狀完全緩解; 10例(22.2%)癥狀明顯緩解，有輕度肛門下墜感，可忍受; 1例(2.2%)術后排便困難癥狀緩解，但肛門下墜感明顯，6個月后緩解。1例(2.2%)于術后25個月再次出現排便費力癥狀，排糞造影檢查提示直腸前突深度為17 mm(術前34 mm)。45例患者術中及術后均未發生大出血、直腸狹窄、直腸陰道瘺等并發癥。結論PPH加芍倍注射術治療中重度直腸前突具有創傷小、術后恢復快、療效顯著、并發癥少等優點，但是患者術后養成良好的排便習慣很重要。

Significance of Laboratory Examination in The Diagnosis of Ulcerative Colitis

ObjectiveTo summarize the significance of laboratory examinations in diagnosis of ulcerative colitis (UC). MethodsLiteratures at home and abroad were searched to review the clinical significance of laboratory examinations indexes in diagnosis of UC. ResultsAnti-neutrophilcytoplasmicantibodies (ANCA) had some value in diagnosis of UC, but it was limited in evaluation of UC in active patients. The positive rate of anti-intestinal goblet cell antibody (GAB) in patients with UC was higher than that of patients with Crohn's disease (CD), so it could be used as identification indexes of the two diseases, but it could not reflect the severity of the disease. Anti-saccharomyces cerevisiae antibodies (ASCA) and anti-pancreatic antibody (PAB) were mainly used in the differential diagnosis of UC and CD, but they had no significant advantages in diagnosis of UC. Fecal calprotectin (FCP) played a positive role in evaluation of recurrence and activity in UC. Although lactoferrin, M2-pyruvate kinase (M2-PK), and S100A12 were not as effective as FCP, but if combined with related indicators, they were also important. ConclusionsOf the relevant indexes of laboratory examination in the diagnosis of UC, FCP plays an importent role in the evaluation of recurrence and activity of UC.

Value of Fecal Calprotectin in Activity Evaluation of Ulcerative Colitis

Objective　To explore the value of fecal calprotectin （FCP） in the activity evaluation for ulcerative colitis （UC）. Methods　Sixty three patients with UC （UC group） and 30 patients with gastrointestinal symptoms but without abnormal results of colonoscopy （control group）， who were treated in The Forth Affiliated Hospital of China Medical University between Sep. 2007 to Dec. 2009 were enrolled to examine the FCP， C-creative protein （CRP）， and erythrocyte sedimentation rate （ESR）. Then comparison between UC group and control group was performed. Results　Levels of FCP and CRP in active gradeⅠ，Ⅱ， and Ⅲ group were all significantly higher than those of control group and inactive UC group （P＜0.05）， with the increase of active grade of UC， the level of FCP gradually increased （P＜0.05）. The levels of CRP in active grade Ⅱ and Ⅲ group were all significantly higher than those of gradeⅠgroup （P＜0.05）， but didn’t differed between active grade Ⅱ and Ⅲ group （P＞0.05）. There were no significant difference among 5 groups on ESR （P＞0.05）. Levels of FCP （rs=0.807， P＜0.01）， CRP（rs=0.651， P＜0.01）， and ESR （rs=0.371， P＜0.05） in active grade group were significantly related to histological grade under colonoscopy. Conclusion　FCP examination is simple， inexpensive， repeatable， and noninvasive， and FCP can be used as an marker of activity evaluation in UC.

Diagnosis and Treatment Experience of 84 Patients with Sacrococcygeal Pilonidal Sinus

Objective　To summarize the methods of diagnosis and treatment for sacrococcygeal pilonidal sinus. Methods　The processes of diagnosis and treatment for 84 patients with sacrococcygeal pilonidal sinus were analyzed retrospectively. The incision and primary suture with mattress-suture and exterminated dead space was performed in 36 patients （without recurrence and the length of fistulous tract was less than 5 cm）. The sinus resection and incision open surgery with excision of fully pathology tissue and regional treatment with Kangfuxin liquid was performed in 48 patients （with recurrence and the length of fistulous tract was more than 5cm）. Results　Two cases were recurrent after half a year and cured with sinus resection and incision open surgery and regional treatment with Kangfuxin liquid in the incision and primary suture group. The others were disposable healing. The healing time in the incision and primary suture group was from 14 to 35d， the mean time was 26d， which in the other group was from 30 to 45d， the mean time was 37d. Follow-up for more than one year， none of recurrence happened. Conclusion　Perfecting inspection before surgery， clarifying a diagnosis， choosing a suitable surgical treatment， and perioperative care could cure the disease and extremelyreduce recurrence.

Antiacute Rejection Effect of Pachymic Acid in Heart Transplantation Rats

Abstract: Objective To study the antiacute rejection effect of Pachymic acid (PA) in heart transplantation rats, in order to select a new antirejection medicine with low side effect from traditional Chinese medicine. Methods We established the model by transplanting Wistar rats (32,donor) heart allografts into the abdomen of SD rats (32,receptor). The homologous hearttransplanted rats were then randomly divided into 4 groups with 16 rats in each group. Olive oil solution with PA 1 mg/(kg·d), PA 10 mg/(kg·d), Cyclosporine (CsA) 5 mg/(kg·d) and olive oil solution 0.5 ml/(kg·d) were respectively given intragastrically to lowdosage PA group, highdosage PA group, CsA group and the control group till the end of observation. Survival time of heart allografts, heart beating and the histological changes of allografts were examined and serum level of interleukin2 (IL-2) and interferon-γ (IFN-γ) were determined by enzymelinked immunosorbent assay (ELISA). Results Survival time in the highdosage PA group, the lowdosage PA group and the CsA group were 24.90±0.99 d, 15.50±1.60 d and 26.80±0.88 d respectively, which is much better than the control group (6.10±1.10 d, q=22.363, P=0.000; q=44.793, P=0.000; q=49.272,P=0.000). IL-2 serum level in the highdosage PA group, the lowdosage PA group and the CsA group were all lower than that in the control group (q=14.483, P=0.000; q=3.705, P=0.000; =21.418,P=0.000), whileIL-2 serum level in the highdosage group was lower than that in the lowdosage group (q=10.778,P=0.000). Similarly, IFN-γ serum level in the first three groups were all lower than that in the control group (q=16.508,P=0000; q=4.281, P=0.000;q=19.621, P=0.000) and IFNγ serum level in the highdosage group was also lower than that in the lowdosage group (q=14.975, P=0.000). Pathological examination 7 days after the surgery showed that pathologic lesion was much more relieved in the two PA groups and the CsA group than the control group. Conclusion Acute rejection of heart transplantation can be effectively suppressed by PA.

The Diagnosis and Treatment of McKittrick-Wheelock Syndrome

Comparison of the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids combined with Block operation in treatment of obstructed defecation syndrome

Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.

Effectiveness of PPH in Treatment for Constipation Caused by Rectocele in 104 Cases

目的　觀察吻合器痔上黏膜環形切除釘合術（PPH）治療直腸前突所致便秘的臨床療效。方法　回顧性分析我科2008年1月至2012年1月期間經PPH治療的104例女性直腸前突致便秘患者的手術經過及術后療效。結果　本組104例均手術順利，手術時間13～35min，平均21min；住院時間3～7d，平均4.5d；無直腸陰道瘺、肛周膿腫、肛門狹窄等并發癥發生。術后2周均常規行肛門指檢，3例局部輕度炎癥，給予抗炎對癥治療后癥狀消失。5例吻合口局部吻合釘未完全脫落，給予取出后不適癥狀消失。術后隨訪1～5年（平均3年），隨訪率為97.12%（101/104），臨床癥狀完全消失99例，治愈率為95.19%；癥狀好轉5例，該5例行排糞造影檢查，直腸前突均明顯減輕，且便秘癥狀明顯緩解。結論　PPH治療女性直腸前突所致便秘安全、有效，便秘癥狀緩解明顯，是一種適合臨床應用的手術方式。

肛周化膿性汗腺炎13例臨床分析

目的總結肛周化膿性汗腺炎的臨床特點、診斷及治療方法。 方法回顧性分析我院肛腸外科2013年1月至2015年12月期間收治的13例肛周化膿性汗腺炎患者的臨床資料。 結果全部病例均行外科手術治療，術中切開所有瘺管，徹底清除瘺管壁，術后給予抗炎、換藥等治療。手術時間（50±6）min，住院時間平均16.3 d，傷口愈合時間平均45.6 d。隨訪半年，1例患者4個月后局部復發再次入院，以同樣手術方式治療后治愈。其余患者均治愈，未復發，無失禁，愈合后肛周切口形成瘢痕，無感染。 結論肛周化膿性汗腺炎診斷主要依據臨床表現及病理學檢查，誤診率高，治療以手術為主。早期診斷，及時治療，手術徹底，是治愈肛周化膿性汗腺炎、降低復發的關鍵。

吻合器痔上黏膜環形切除術輔助剪口結扎治療357例混合痔患者的長期療效評價

目的研究吻合器痔上黏膜環形切除術（PPH）輔助剪口結扎治療357例混合痔的長期療效。 方法回顧性分析2007年1月至2009年1月期間在中國醫科大學附屬第四醫院肛腸外科行PPH輔助剪口結扎治療的369例混合痔患者的臨床資料。觀察混合痔患者術后的排便疼痛、出血、肛門瘙癢等癥狀，隨訪至少5年并記錄痔復發、肛門狹窄、吻合口狹窄、肛門控便能力等情況。 結果最終完成隨訪患者有357例，所有患者均未發生陰道直腸瘺、陰道尿道瘺、排便失禁、吻合口大出血及吻合口感染并發癥，患者術后疼痛、出血、肛門瘙癢癥狀人數早期（術后6個月）與術前比較有明顯減少（P＜0.05），中長期（術后5年與術后1年）比較差異無統計學意義（P＞0.05），其5年隨訪改善率分別為94.9%、96.1%、96.6%。隨訪5年內痔復發患者12例（3.4%），外痔復發11例（3.1%），吻合口狹窄2例（0.6%），無肛門狹窄患者，無排便失禁患者。 結論PPH輔助剪口結扎治療混合痔安全、有效，長期復發率低。