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。
Objective To explore the mechanism of Liuhedan in promoting wound healing through applying Liuhedan to the infective wounds of New Zealand white rabbits. Methods A total of forty New Zealand white rabbit models of infective wounds were established after anesthesia. Five circular infective incisions were generated on the back of each rabbit, with a diameter of 2 cm. Five wounds of each rabbit were assigned respectively to the control group, model group, traditional Chinese medicine (TCM) group (Oleum Lithospermum), Western medicine group (calcium alginat), and treatment group (Liuhedan). Wound dressings were performed every day since postoperative day 1. Ten rabbits were selected randomly to be euthanized on postoperative day 3, 7, 14 and 21, respectively. Each specimen was divided into two parts. One was used for detecting interleukin-1β (IL-1β) by enzyme-linked immunosorbent assay, and the other was used for detecting tumor necrosis factor-α (TNF-α) by immunocytochemistry. Results On postoperative day 3 and 7, groups with the expression of IL-1β from low to high were respectively the control group, the treatment group, the Western medicine group, the TCM group, and the model group [postoperative day 3: (680.81±185.53), (1 028.67±205.57), (1 278.67±251.15), (1 449.86±230.74), (1 544.62±371.77) pg/mL; postoperative day 7: (1 024.43±239.94), (1 333.57±257.31), (1 635.14±222.40), (1 784.71±323.85), (1 953.29±324.78) pg/mL], and all the differences among the groups were significant (P<0.05); On postoperative day 14, groups with the expression of IL-1β from low to high were respectively the treatment group, the control group, the Western medicine group, the TCM group, and the model group [(908.71±108.61), (978.57±161.75), (1 120.43±265.39), (1 129.71±298.06), (1 191.14±234.92) pg/mL], and all the differences among groups were significant (P<0.05) except the difference between the Western medicine group and the TCM group (P>0.05); On postoperative day 21, the expression of IL-1β in the control group, the model group, the TCM group, and the Western medicine group was (487.19±121.80), (496.35±102.15), (500.31±139.34), (499.08±120.67) pg/mL, respectively, with no significant differences among the groups (P>0.05), which were all higher than that in the treatment group [(398.62±102.93) pg/mL] with significant difference (P<0.05). The expression of TNF-α in the model group was significantly greater than those in the other groups. The expression of TNF-α in the treatment group and Western medicine group was significantly lower compared with the model group. The expression of TNF-α in the TCM group was stronger compared with those in the treatment group and the Western medicine group. Conclusion Liuhedan can specifically suppress the expressions of IL-1β and TNF-α in the treatment of infective wounds, decrease the release of inflammatory factor and promote the healing.
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.
Objective To explore the effectiveness of expanded curettage in the treatment of chondroblastoma. Methods The clinical data of 37 patients with chondroblastoma who were treated with expanded curettage between January 2011 and May 2016 were retrospectively analyzed. There were 24 males and 13 females, with a median age of 17 years (range, 12-30 years). There were 32 primary patients and 5 recurrent patients. Local pain was the first symptom in all patients. The average disease duration was 4.9 months (range, 2-8 months). The lesions were located in the distal femur in 10 cases, the proximal femur in 7 cases, the proximal tibia in 9 cases, the proximal humerus in 5 cases, the patella in 2 cases, the talus in 1 case, the calcaneus in 1 case, and pelvis in 2 cases. According to the Enneking staging of benign bone tumors, all tumors were rated as the 3rd stage. The length of the lesion ranged from 1.2 to 6.9 cm (mean, 3.2 cm). The lesions involved the epiphyseal plate in 19 cases. Results All incisions healed by first intention, and no complications occurred. All patients were followed up 12-76 months, with an average of 40.5 months. At last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 27.5±1.4, and the difference was significant when compared with pre-operative value (18.5±1.9) (t=23.462, P=0.000). The chondroblastoma recurred in 1 case (2.7%) after 5 months. X-ray film showed that bone resorption was found in 6 cases, but there was no obvious collapse in the articular surface of bone graft. The limb shortening deformity occurred in 3 cases who were epiphyseal plate involvement patients and lesions located around the knee joint. But there was no varus deformity, and knee joint activity was not affected. Conclusion Expanded curettage has advantages of low incidence of recurrence and skeletal deformity, good limb function, and it is one of the ideal options for chondroblastoma.