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保留括約肌掛線引流術聯合英夫利昔單抗治療肛周瘺管型克羅恩病的短期臨床療效

目的 總結保留括約肌掛線引流術聯合英夫利昔單抗（infliximab，IFX）治療肛周瘺管型克羅恩病（Crohn disease，CD）的短期臨床療效。 方法 回顧性分析江蘇省中醫院肛腸科于 2010 年 3 月至 2011 年 6 月期間收治的接受保留括約肌掛線引流術聯合 IFX 治療的 20 例肛周瘺管型 CD 患者的臨床資料，治療方案為降階梯治療。在第 0、2 及 6 周分別給予 5 mg/kg IFX 靜脈注射誘導治療，隨后給予每 8 周 1 次、共 3 次的 IFX 維持治療（5 mg/kg），共計 6 次。于治療前和第 0、6 及 30 周治療后評估克羅恩病活動指數（CDAI）、肛周克羅恩病活動指數（PCDAI）、治療效果及瘺管閉合情況，并開展實驗室檢測。 結果 ① CDAI 和 PCDAI：與治療前比較，第 0、6 及 30 周的 CDAI 和 PCDAI 均較低（P<0.05）。② 瘺管閉合：第 0 周時，18 例瘺管部分閉合，2 例無效；第6 周時，16 例瘺管完全閉合，4 例部分閉合；第 30 周時，16 例瘺管完全閉合，1 例部分閉合，3 例復發。③ 實驗室檢查：與治療前比較，第 0、6 及 30 周的 C-反應蛋白（CRP）水平、紅細胞沉降率（ESR）、血小板計數、中性粒細胞百分比及白細胞計數均較低（P<0.05），第 6 周和第 30 周的血紅蛋白水平較高（P<0.05）。④ 不良反應：治療過程中 3 例次發生不良反應。 結論 保留括約肌掛線引流術聯合 IFX 降階梯治療對肛周瘺管型 CD 有效。

肛周壞死性筋膜炎12例診治體會

目的總結肛周壞死性筋膜炎（PNF）的臨床診治體會。 方法對2008年11月至2015年3月期間我院診治的12例PNF患者的臨床資料進行回顧性分析。 結果本組12例患者平均住院時間35.6 d，經手術治療后均痊愈，隨訪3個月均無復發。 結論早期診斷、及時有效的清創手術及合理使用抗生素是治愈PNF的關鍵。

微波干擾素結合中藥熏洗治療肛周尖銳濕疣療效觀察

摘要:目的:觀察采用微波、干擾素結合自擬消疣湯熏洗中西醫結合方法治療肛周尖銳濕疣的療效。方法:采用微波、干擾素結合自擬消疣湯(板藍根、大青葉、紫草、蒲公英、野菊花、馬齒莧、黃柏、土茯苓、苦參、薏苡仁、赤芍)熏洗的中西醫結合方法治療本病30例,并設對照組進行對照。結果: 治療組復發率為10%,治愈率為90%,創面感染率為0,對照組復發率為37.9%,治愈率為62.1%,并有2例并發感染。結論:本治療方法對肛周尖銳濕疣有提高治愈率,降低復發率并能有效地防止繼發感染之功效。

146 例肛周膿腫膿液培養及藥敏試驗結果分析

目的 總結肛周膿腫相關致病菌的分布以及藥敏特點，為其臨床抗生素的應用提供依據。 方法 回顧性分析 2012 年 4 月至 2016 年 7 月期間于蘇州高新區人民醫院肛腸科行手術治療的 146 例肛周膿腫患者的膿液細菌培養結果和藥敏結果。 結果 146 例標本中檢出病原菌 156 株，其中革蘭陰性菌 137 株，占 87.8%；革蘭陽性菌 19 株，占 12.2%。數量在前 3 位的細菌依次為大腸埃希菌 109 株（69.9%）、肺炎克雷伯菌 18 株（11.5%）和金黃色葡萄球菌 9 株（5.8%）。156 株細菌中檢出產超廣譜 β-內酰胺酶（ESBLs）細菌 34 株，占 21.8%，除 1 株為肺炎克雷伯菌外，其余均為大腸埃希菌。對革蘭陰性菌，前 3 種敏感抗菌藥物分別為阿米卡星、哌拉西林他唑巴坦及頭孢西丁，前 3 位耐藥的抗菌藥物為哌拉西林、四環素及磺胺甲噁唑/甲氧芐啶；對革蘭陽性菌，前 3 種敏感抗菌藥物分別為左氧氟沙星、亞胺培南和慶大霉素；前 3 位耐藥的抗菌藥物為青霉素/氨芐西林舒巴坦（并列）、環丙沙星及四環素/阿莫西林/氨芐西林（并列）。 結論 肛周膿腫的病原菌以大腸埃希菌為主，且產 ESBLs 細菌主要為大腸埃希菌。

副腫瘤性天皰瘡伴Castleman瘤患者肛周膿腫護理一例

CURATIVE EFFECTS OF BASIC FIBROBLAST GROWTH FACTOR ON ANUS WOUND HEALING

OBJECTIVE: To observe the curative effects of basic fibroblast growth factor (bFGF) on anus wound healing. METHODS: From April 1996 to December 2000, out of 109 patients with anus trauma, hemorrhoidectomy or fistula resection, 68 were treated with bFGF as the experimental group, while 41 were treated routinely as the control group. The healing of the wound, the general and local reaction were observed. RESULTS: The healing time of the experimental group was(17.00 +/- 1.54) days while that of the control group was(20.00 +/- 1.16) days (P lt; 0.01). Three weeks after operation, the healing rates of the experimental and control groups were 97.1% and 87.8%, respectively (P lt; 0.01). No general or local detrimental reactions were found in two groups. CONCLUSION: Local application of bFGF can accelerate the healing of anus wound, and the patients have little pain.

Expressions and clinical significance of SDF-1 and CXCR4 in local tissues of perianal abscess

ObjectiveTo investigate the expressions of stromal cell-derived factor-1 (SDF-1) and chemokine receptor-4 (CXCR4) in local tissues of perianal abscess and their relationships with clinicopathological features and prognosis of patients.MethodsA total of 47 patients with perianal abscess (perianal abscess group) and 58 patients with mixed hemorrhoids (mixed hemorrhoids group) were selected for the study. The tissues were collected during the operation. Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expressions of SDF-1 mRNA and CXCR4 mRNA in local tissues of the two groups, the positive expressions of SDF-1 protein and CXCR4 protein in local tissues were detected by immunohistochemistry, and the relationships between the expressions of SDF-1 and CXCR4 protein and the clinical characteristics, prognosis of patients were analyzed.ResultsThe expression levels of SDF-1 mRNA and CXCR4 mRNA in the perianal abscess group were higher than those in the mixed hemorrhoids group, and the positive rates of SDF-1 protein and CXCR4 protein in the perianal abscess group were higher than those in the mixed hemorrhoids group too (P<0.05). The expressions of SDF-1 protein and CXCR4 protein in perianal abscess tissues were both not related to sex, age, location of abscess, and course of disease (P>0.05), but was related to abscess diameter, healing time, and anal fistula (P<0.05). The non-recurrence rates of SDF-1 protein-negative group and CXCR4 protein-negative group were lower than those of SDF-1 protein-positive group and CXCR4 protein-positive group respectively (P<0.05).ConclusionSDF-1 and CXCR4 molecular are up-regulated in the local tissues of perianal abscess, which are related to the size of abscess, healing time, anal fistula, and recurrence of patients.

Clinical Efficacy of Sphincter-retaining and Loose-seton Therapy in Treating Patients with High Perianal Abscess

目的　探討保留括約肌虛掛線法治療高位肛周膿腫的臨床療效。 方法　2009年10月－2010年10月采用隨機對照試驗，對52例高位肛周膿腫患者施行手術治療，其中保留括約肌虛掛線法（治療組）26例，切開掛線引流法（對照組）26例。對兩組患者術后6個月肛瘺發生率、切口愈合時間、術后1～15 d每晚疼痛視覺模擬評分（VAS）和術后6個月痊愈患者肛門功能后遺癥發生率進行比較。 結果　術后6個月，治療組和對照組肛瘺發生率分別為4.0%和3.8%，差異無統計學意義（P＞0.05）。術后7～15 d治療組VAS評分均低于對照組，差異有統計學意義（P＜0.05）。兩組切口愈合時間分別為（19.05 ± 6.71）d和（21.42 ± 8.40）d，差異有統計學意義（P＜0.05）。術后6個月治療組痊愈患者肛門功能全部正常，對照組后遺癥發生率為12.0%，兩組比較差異有統計學意義（P＜0.05）。 結論　保留括約肌虛掛線治療在術后疼痛、切口愈合時間和保護肛門功能等方面明顯優于切開掛線引流治療，是一種治療高位肛周膿腫較為理想的方法。

Clinical Application of AQUACEL-Ag? HydrofiberTM Dressing in Wound Healing Following Anorectal Abscess Operation

目的　觀察AQUACEL-Ag?親水性纖維敷料對肛周膿腫患者術后創面愈合的作用。方法　將49例肛周膿腫術后患者按隨機數字表法隨機分為試驗組（25例）和對照組（24例），分別予AQUACEL-Ag?親水性纖維敷料換藥（1 次/3d）和無菌凡士林紗布換藥（1次/d），并觀察2組患者的換藥時創面疼痛程度、創面愈合時間、創面換藥次數、創面愈合率及換藥時創面分泌物培養結果。結果　試驗組在創面疼痛、愈合時間、創面換藥次數及換藥時分泌物培養轉陰時間方面均優于對照組（P＜0.05）；動態監測創面愈合率：第3d時2組間比較差異無統計學意義（P＞0.05），第9、15、21d時試驗組創面愈合率明顯高于對照組（P＜0.05）。結論　從本組有限的數據看，AQUACEL-Ag?親水性纖維敷料對肛周膿腫患者術后創面愈合有重要作用。

The clinical effect of VSD technology in the treatment of high perianal abscess

Objective To evaluate the clinical effect of vacuum sealing drainage (VSD) technology in the treatment of high perianal abscess. Methods A total of 38 cases of high perianal abscess who underwent surgery in our hospital from May. 2014 to Feb. 2016 were randomly divided into 2 groups: the VSD group (n=19) and the control group (n=19). The cases of VSD group were performed with closure of internal orifice+VSD technique, and the cases of control group were treated with radical operation of perianal abscess (low incision combined with high thread operation). The following indexes of cases in 2 groups were compared and analyzed, including postoperative pain score, wound healing time, postoperative anal function score, and prognosis. Results There were significant differences in pain score (3.53±0.70vs. 5.11±0.74), postoperative anal function score (0vs. 1), and wound healing time〔(27.58±4.95) dvs. (44.68±6.53) d〕between VSD group and control group,P<0.05. Compared with the control group, the pain score and anal function score of the VSD group were both lower, and the wound healing time was shorter. However, there was no statistically significant difference in incidence of fistula between the two groups〔5.3% (1/19)vs. 15.8% (3/19),P=0.60〕. Conclusion In the treatment of high perianal abscess, VSD technology can relieve pain in patients, shorten the wound healing time, protect the anal function, and the prognosis is as well as low incision combined with high thread operation, so VSD is a better treatment method for high perianal abscess.