目的 探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。 方法 2009年10月－2010年10月采用随机对照试验，对52例高位肛周脓肿患者施行手术治疗，其中保留括约肌虚挂线法（治疗组）26例，切开挂线引流法（对照组）26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分（VAS）和术后6个月痊愈患者肛门功能后遗症发生率进行比较。 结果 术后6个月，治疗组和对照组肛瘘发生率分别为4.0%和3.8%，差异无统计学意义（P＞0.05）。术后7～15 d治疗组VAS评分均低于对照组，差异有统计学意义（P＜0.05）。两组切口愈合时间分别为（19.05 ± 6.71）d和（21.42 ± 8.40）d，差异有统计学意义（P＜0.05）。术后6个月治疗组痊愈患者肛门功能全部正常，对照组后遗症发生率为12.0%，两组比较差异有统计学意义（P＜0.05）。 结论 保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗，是一种治疗高位肛周脓肿较为理想的方法。
目的探讨经腹正中线入路2孔法腹腔镜胆囊切除术的可行性。 方法对笔者所在医院2009年5月至2013年3月期间收治的220例胆囊结石、胆囊炎患者行经腹正中线入路2孔法腹腔镜胆囊切除术，观察其手术时间、术后疼痛、并发症发生情况及恢复时间。 结果220例中成功施行经腹正中线入路2孔法腹腔镜胆囊切除术215例，成功率为97.73%，手术时间30～110 min，平均45 min。另5例因炎症严重、操作困难而改为3孔法完成腹腔镜胆囊切除术，并行腹腔引流。本组患者无中转开腹者，术后均未用镇痛剂，也无并发症发生；术后住院时间3～5 d，平均4 d。 结论经腹正中线入路2孔法腹腔镜胆囊切除术，具有切口更少、创伤更小、疼痛轻、康复快、美容效果更好、不增加设备投入等优点。
Objective To summarize and evaluate the significance of tumor necrosis factor (TNF) tolerance, and to understand the general characteristics and known molecular mechanisms of different forms of tolerance, including the roles of transcription factors, signaling systems and receptors. Method The relevant literatures at home and abroad in recent years were collected and readed, and the content related to TNF tolerance was summarized. ResultsTNF tolerance could be produced after TNF pretreatment, and be divided into absolute tolerance and induced tolerance. TNF tolerance was related to a variety of interrelated and interdependent intracellular signal transduction. There was cross tolerance between TNF and lipopolysaccharide. Conclusions TNF tolerance may represent a protective mechanism, participating in the termination of inflammation and preventing excessive or persistent inflammation. TNF tolerance may also trigger immune paralysis, leading to severe inflammatory diseases, such as sepsis. The understanding of TNF tolerance can promote the diagnosis of inflammation related diseases or the implementation of treatment methods, so as to achieve more accurate evaluation and treatment.
With the aging of the Chinese population, the incidence of vascular diseases is increasing year by year. Currently, venous diseases account for a large proportion of vascular surgical diseases. With the rapid development of venous imaging, the rapid progress of endovascular technology and the innovation of vene-related instruments, the diagnosis and treatment of venous diseases are constantly updated. As the development source and foundation of vascular surgeons, venous diseases should be paid attention to by every vascular surgeon. This paper will discuss the current research hotspots of venous surgery.
ObjectiveTo summarize the changes and mechanism of related genes induced by stem cell therapy in acute-on-chronic liver failure (ACLF) in recent years, and in order to guide the clinical value of ACLF and curative effect evaluation. MethodsThrough searching Wanfang med, CNKI, Pubmed database and so on in recent years, the differentially expressed genes induced by stem cell therapy for ACLF in recent years was retrieved and the changes of related genes induced during the treatment process were discussed. ResultsBoth at home and abroad had reported that stem cell therapy in the process of ACLF caused mir-27b, TRAIL, and Tg737 genetic changes, some genetic changes had an fixed change trend. ConclusionsStem cells in the treatment of ACLF, cause mir-27b, TRAIL, Tg737 genetic changes, which can provides a new way and method for monitoring stem cell therapy ACLF.
Objective To summarize present situation and development of non-biological artificial liver. Method The related literatures about artificial liver treatment in recent years were reviewed. Results The current artificial liver which applied to clinic mainly are non-biological artificial liver, including plasma exchange, hemodialysis, hemofiltration, bilirubin adsorption, hemoperfusion, molecular adsorption recycling, etc. Because of the individual clinical cases, the individualized requirements for treatment are put forward. Single treatment of non-biological artificial liver is often unable to satisfy the individualized requirements, combined the advantages of each treatment so as to maximum therapeutic effect for patients has become a trend. Conclusion Combined treatment of non-biological artificial liver is superior to single treatment, individual treatment concept should be carried out in whole process of treatment.
Objective To investigate the clinical curative effect of divided excision and plastic combined with procedure for prolapse and hemorrhoids (PPH) in treatment for circular mixed hemorrhoids. Methods Clinical observation on 120 patients with circular mixed hemorrhoids between May 2007 and May 2008 treated by divided excision and plastic combined with PPH was carried out. Results The mean hospital stay after operation was 7.6 d. The wound healing average time was 11.9 d. The incidence rate of postoperative urinary retention was 5.8% (7/120). Average scores of pain in 3 d after operation: 5.3 points (1-8 points) on day 1, 3.6 points （2-9 points） on day 2, 2.2 points （1-8 points） on day 3. All patients were followed up for 12 months, there were 3 cases of hematochezia， 1 case of prolapse, and 1 case of remained abnormal outgrowth skin; the anus function was normal in all cases without anal stricture or tightening feeling. Conclusions Divided excision and plastic combined with PPH can better treat circular mixed hemorrhoids. This operation can not only completely clear the lesions, but also repair and reconstruct the anus and anal canal, protect its size and function. It is an ideal operation for treatment for circular mixed hemorrhoids.