Extramammary Paget’s Disease Manifested by Intraepithelial Adenocarcinoma of the Vulva and Anus Combined with Invasive Adenocarcinoma of the Ampullary Part of the Rectum

The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.

度伐利尤单抗联合PP化疗方案治疗Ⅲ期非小细胞肺癌患者的效果

目的:观察度伐利尤单抗联合PP化疗方案治疗Ⅲ期非小细胞肺癌(NSCLC)患者的效果。方法:回顾性分析2021年5月至2023年5月该院收治的66例Ⅲ期NSCLC患者临床资料,按治疗方案不同将其分为观察组和对照组各33例。对照组采用PP化疗方案治疗,观察组在对照组基础上联合度伐利尤单抗注射液治疗,比较两组疾病缓解率、KPS评分、癌症治疗功能评价系统-肺癌模块(FACT-L)评分、血清生化因子[Ⅳ型胶原蛋白α3(COL4A3)、G蛋白偶联受体相关分选蛋白1(GASP-1)]水平和不良反应发生率。结果:观察组疾病缓解率为60.61%,明显高于对照组的36.36%,差异有统计学意义(P<0.05);治疗后,两组KPS评分高于治疗前,且观察组高于对照组,两组FACT-L评分和血清COL4A3、GASP-1水平低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05);治疗期间,两组腹泻、脱发、骨髓抑制、恶心等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:度伐利尤单抗联合PP化疗方案治疗Ⅲ期NSCLC患者可提高疾病缓解率和KPS评分,降低FACT-L评分及血清COL4A3、GASP-1水平,效果优于单纯PP化疗方案治疗。

Perianal disease in inflammatory bowel disease:Broadening treatment and surveillance strategies for anal cancer

The perianal disease affects up to one-third of individuals with Crohn's disease(CD),causing disabling symptoms and significant impairment in quality of life,particularly for those with perianal fistulising CD(PFCD).The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing.Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents,endoscopic procedures and surgical techniques that show promising results.Among these,mesenchymal stem cells injection is a particularly hopeful therapy.In addition to the burden of fistulas,individuals with perianal CD may face an increased risk of developing anal cancer.This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes.Currently,there is no established formal anal screening programme.In this review,we provide an overview of the current state of the art in managing PFCD,including novel medical,endoscopic and surgical approaches.The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD,intending to propose a risk-based surveillance algorithm.The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.

Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn’s disease

BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease(CD).Anti-tumor necrotic factor(TNF)therapy combined with drainage procedure is effective as well.However,previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula closure.AIM This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula(CPF)closure rates after stem cell transplantation with and without anti-TNF therapy,and to identify the factors affecting CPF closure and recurrence.METHODS The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were enrolled.Clinical data were compared according to anti-TNF therapy and CPF closure.RESULTS A total of 65 patients were included.The median age of females was 26 years(range:21-31)and that of males was 29(44.6%).The mean follow-up duration was 65.88±32.65 months,and complete closure was observed in 50(76.9%)patients.The closure rates were similar after stem cell transplantation with and without anti-TNF therapy(66.7%vs 81.6%at 3 year,P=0.098).The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture(P=0.027,0.002,and 0.008,respectively).Clinical factors such as complexity,number of fistulas,presence of concurrent abscess,and medication were not significant for closure.The cumulative 1-,2-,and 3-year closure rates were 66.2%,73.8%,and 75.4%,respectively.CONCLUSION Anti-TNF therapy does not increase CPF closure rates in patients with stem cell transplantation.However,both refractory and non-refractory CPF have similar closure rates after additional anti-TNF therapy.Fistulous tract length,proctitis,and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.

PKR and PP1C Polymorphisms in Alzheimer’s Disease Risk

Alzheimer’s disease (AD) is a neurodegenerative disease characterized by senile plaques and neurofibrillary tangles. Senile plaques are deposits of amyloid ?-peptide (A?) produced by the cleavage of a transmembrane protein termed Amyloid Precursor Protein (APP). The amyloidogenic cleavage of APP is performed by γ-secretase complex and ?-site APP cleaving enzyme 1 (BACE1), a key enzyme in AD that can be activated by different noxious stimuli. Interestingly, some viruses could activate double-stranded RNA-activated protein kinase (PKR), which phosphorylates Eukaryotic Initiation Factor 2 alpha (eIF2α). This phosphorylation stops global translation to avoid any synthesis of viral infective proteins, but paradoxically up-regulates BACE1 translation. One of the viral mechanisms to circumvent eIF2α phosphorylation is the recruitment of protein phosphatase 1 (PP1), to fully dephosphorylate eIF2α and allow viral protein synthesis. Due to the functional relationship between BACE1, PKR, PP1 and AD we have performed a large (1122 cases and 1191 control individuals) case-control genetic analysis using two biallelic polymorphisms rs2254958 and rs7480390, located within the genes coding for PKR and the catalytic unit A of PP1, respectively. Although a trend to association of the rs2254958 TT genotype with AD risk was found, our results show that neither rs7480390 nor rs2254958 are associated with AD susceptibility.

马立克氏病毒pp38基因的克隆测序和B细胞抗原表位预测

对Ⅰ型马立克氏病毒的pp38基N进行了扩增、克隆及序列测定。采用DNAStar Protean软件对pp38蛋白的二级结构、亲水性和抗原性指数等参数进行分析，并预测其B细胞表位分布。结果表明，pp38基N长873bp，包含完整的开放阅读框架，编码290个氨基酸。蛋白的B细胞表位可能位于第1～11，18～162，180-217和274-290位等氨基酸区域内或附近。本试验为pp38蛋白的表达和抗体制备奠定了理论基础。

Transcutaneous perianal sonography:A sensitive method for the detection of perianal inflammatory lesions in Crohn's disease

AIM:Pelvic magnetic resonance imaging(MRI)and endoanal ultrasound which are established imaging methods for perianal inflammatory lesions in patients with Crohn's disease require expensive specialized equipments and expertise.We investigated the feasibility and sensitivity of transcutaneous perianal ultrasound(PAUS)using regular ultrasound probes in the imaging of perianal inflammatory lesions.The sonographic findings were correlated to pelvic MR]-scans. METHODS:We performed PAUS in 25 patients with Crohn's disease and clinical signs of perianal inflammatory disease. Wibhin a median of 10 d(range 0-75)these patients underwent MRI of the pelvis.Regular convex and linear high resolution probes were used for PAUS.The sonographic findings were correlated to the MRI findings by blinded investigators. RESULTS:The sonographic investigations were well tolerated by all patients.Fistulae typically presented as hypoechoic tracks.Twenty-nine fistulae were detected in 22 patients.Abscesses were detected in 7 patients and presented as hypo-or anechoic formations.Twenty-six of 29 fistulae and 6 of 7 abscesses could be confirmed by MRI.Kappa statistics showed an excellent agreement (kappa>0.83)between the two imaging methods. CONCLUSION:PAUS is a simple,painless,feasible,real- time method that can be performed without specific patient preparation which is comparable in its sensitivity to pelvic MRI in the detection of perianal fistulae and/or abscesses. PAUS can especially be recommended as a screening tool in acute perianal disorders such as perianal abscess and for follow-up studies of perianal inflammatory disease.

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

To evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission.METHODSAll patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses.RESULTSForty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission.CONCLUSIONDeep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

Exogenous brain-derived neurotrophic factor attenuates cognitive impairment induced by okadaic acid in a rat model of Alzheimer's disease

Decreased expression of brain-derived neurotrophic factor（BDNF） plays an important role in the pathogenesis of Alzheimer＇s disease, and a typical pathological change in Alzheimer＇s disease is neurofibrillary tangles caused by hyperphosphorylation of tau. An in vivo model of Alzheimer＇s disease was developed by injecting okadaic acid（2 μL） and exogenous BDNF（2 μL） into the hippocampi of adult male Wister rats. Spatial learning and memory abilities were assessed using the Morris water maze. The expression levels of protein phosphatase 2 A（PP2 A）, PP2 Ac-Yp307, p-tau（Thr231）, and p-tau（Ser396/404） were detected by western blot assay. The expression levels of BDNF, TrkB, and synaptophysin mRNA were measured by quantitative real-time polymerase chain reaction. Our results indicated that BDNF expression was suppressed in the hippocampus of OA-treated rats, which resulted in learning and memory deficits. Intra-hippocampal injection of BDNF attenuated this OA-induced cognitive impairment. Finally, our findings indicated an involvement of the PI3 K/GSK-3β/AKT pathway in the mechanism of BDNF in regulating cognitive function. These results indicate that BDNF has beneficial effect on Alzheimer＇s disease, and highlight the potential of BDNF as a drug target for treatment of Alzheimer＇s disease.

用PP袋+肿腿蜂等防治松材线虫病技术试验

用PP袋能有效地阻断松墨天牛传播松材线虫病。把病死松木放入PP袋 ,次年只有 2 98%松墨天牛成虫能咬破PP袋而逃逸 ;PP袋 +PEM农药 ,对松墨天牛成虫的阻断率达到 10 0 % ;PP袋 +肿腿蜂对松墨天牛的阻断率也达到 10 0 % ,同时 。

Inhibition of Flavonoids from Scutellaria baicalensis Stems and Leaves against Abnormal Formation of PHF and Regulation of PP in OA Induced Brain Injury in Rats

[Objectives] To explore the inhibitory effects of flavonoids from Scutellaria baicalensis Georgi stems and leaves against abnormal formation of PHF and regulation mechanism of protein phosphatase(PP) in okadaic acid(OA) induced brain injury in rats.[Methods]Male Sprague-Dawley rats were treated with OA(200 ng/kg) in the lateral ventricle to establish a memory impairment model,and Morris water maze was used to screen the memory impairment model.Rats were intragastrically administered with 25,50 and 100 mg/kg SSF daily for 36 d.The protein expressions of PHF,PP1,PP2A-Cα,PP2A-Cβ,PP2 CA and PP2 CB in rat cortex and hippocampus were determined by Western blot.Ginkgo biloba leaf flavonoids were used as positive control drugs.[Results]Compared with the sham-operated rats,the expression of PHF protein in the cortex and hippocampus of the model group was significantly increased(P < 0.01);protein expression of PP2A-Cα and PP2A-Cβin the cortex and hippocampus,and PP2 CB in the hippocampus were significantly decreased(P < 0.05);protein expression of PP2 CA and PP2 CB in the cortex was significantly increased(P < 0.01);protein expression of PP1 in the cortex was significantly decreased(P < 0.01).Compared with the model rats,25,50 and 100 mg/kg SSF 36 d reversed the protein expression of PHF,PP2A-Cα and PP2ACβ in rat cortex and hippocampus and expression of PP1 in rat cortex induced by OA,but had no significant effect on the protein expression of PP2 CA and PP2 CB,G.biloba flavonoids also showed similar results to SSF.[Conclusions] SSF can significantly inhibit the abnormal formation of PHF in rat brain induced by OA.The inhibitory effect may be related to the regulation of PP1,PP2A-Cα and PP2A-Cβ protein expression in cerebral cortex and hippocampus by SSF,but less related to the regulation of PP2 CA and PP2 CB.

二苯乙烯苷对APP/PS1/Tau三转基因小鼠痴呆模型CK1、HSP90、 PP5的影响

目的观察二苯乙烯苷(TSG)对淀粉样前体蛋白/早老蛋白-1/tau蛋白(APP/PS1/Tau)三转基因小鼠痴呆模型脑组织中酪蛋白激酶(CK)1、磷酸丝氨酰/磷酸苏氨酰蛋白磷酸酶(PP)5、热休克蛋白(HSP)90的表达影响。方法8月龄APP/PS1/Tau三转基因小鼠45只,随机分为模型组、阳性药对照组(石杉碱甲0.15 mg/kg)、TSG低、中、高剂量组(TSG 0.033、0.100、0.300 g/kg),另取同龄C5B7L/6J小鼠9只为正常对照组。各组灌胃60 d相应药物后,采用Morris水迷宫观察各组小鼠空间认知能力;逆转录-聚合酶链反应(qRT-PCR)法检测CK1、PP5和HSP90 mRNA表达情况;Western印迹法检测CK1、PP5和HSP90蛋白表达情况。结果与模型组相比,TSG能够提高小鼠空间认知能力;降低CK1、HSP90及提高PP5的mRNA表达水平(P<0.05,P<0.01);降低CK1和HSP90和提高PP5的蛋白表达水平(P<0.05,P<0.01)。结论TSG治疗阿尔茨海默病的机制可能与降低CK1和HSP90的表达水平与蛋白表达水平,提高PP5的表达水平与蛋白表达水平等机制有关。

Cornel iridoid glycoside inhibits PP2Ac demethylation by regulationg PME-1

OBJECTIVE PP2Ac demethyl⁃ation is regulated by LCMT(a specific leucine carboxyl methyltransferase catalyzing methyla⁃tion of PP2A)and PME(a specific methylester⁃ase catalyzing demethylation of PP2A.This study was to investigate the mechanism of Cor⁃nel iridoid glycoside(CIG)on PP2A catalytic sub⁃unit C(PP2Ac).METHODS Recombined lentivi⁃rus vector was used to deliver PME-1 genetic materials into N2a cells or transfected LCMT-1 siRNA into N2a cells to block the expression of LCMT-1.Twenty-four hours later,cells were rinsed twice with cold PBS(pH 7.4)and CIG at different concentrations(50,100 and 200 g·L^(-1),respectively)were added for 24 h.Western blotting was used to PP2Ac,demethylaion/methylation PP2Ac,LCMT-1 and PME-1.The ac⁃tivity of PP2A was detected by a biochemical as⁃say.RESULTS①Lentivirus transferred PME-1 was expressed at high level in the N2a cells after transduction.Correspondingly,the demethylation of PP2Ac was increasing and PP2A activity was decreasing after transduction.Treatment with CIG for 24 h reversed the increase of PME-1 and demethylation of PP2Ac without influencing LCMT-1 expression.PP2A activity was also sig⁃nificantly enhanced in CIG treatment group,compared with the cells after PME-1 transduc⁃tion.②LCMT-1 siRNA significantly decreased LCMT-1 expression.CIG did not affect LCMT-1expression.however,demethylation of PP2Ac is increased in siRNA-transfected cells and CIG could reversed the high demethylation of PP2Ac and PP2A activity.CONLUSION CIG increases methylation of PP2A subunit C by inhibiting PME-1.

基于改进YOLOv8的轻量化小麦病害检测方法

为提高小麦病害检测精度,实现将模型方便快速部署到移动端,该研究提出了一种基于改进YOLOv8的轻量化小麦病害检测方法。首先,使用PP-LCNet模型替换YOLOv8网络结构的骨干网络,并在骨干网络层引入深度可分离卷积(depthwise separable convolution, DepthSepConv)结构,减少模型参数量,提升模型检测性能;其次,在颈部网络部分添加全局注意力机制(global attention mechanism, GAM)模块,强化特征中语义信息和位置信息,提高模型特征融合能力;然后,引入轻量级通用上采样内容感知重组(content-aware reassembly of features,CARAFE)模块,提高模型对重要特征的提取能力;最后,使用Wise-IoU(weighted interpolation of sequential evidence for intersection over union)边界损失函数代替原损失函数,提升网络边界框回归性能和对小目标病害的检测效果。试验结果表明,对于大田环境下所采集的小麦病害数据集,改进后模型的参数量及模型大小相比原YOLOv8n基线模型分别降低了12.5%和11.3%,同时精确度(precision)及平均精度均值(mean average precision,m AP)相较于原模型分别提高了4.5和1.9个百分点,优于其他对比目标检测算法,可为小麦病害检测无人机等移动端检测装备的部署和应用提供参考。

杨巍运用“魄门亦为五脏使”理论治疗肛肠疾病经验介绍

介绍杨巍教授运用“魄门亦为五脏使”理论治疗肛肠病的临床经验。杨巍教授认为,魄门的合理启闭与肝、心、脾、肺、肾五脏功能的正常发挥密不可分。杨巍教授根据不同类型肛肠病与五脏之间的关系进行诊治。如治疗便秘,重视肺脏宣发肃降作用,常加用宣肺通气之品;治疗功能性肛门直肠痛,以疏肝养心、调理冲任为治法,并创拟肛痛方;治疗器质性肛肠疾病伴焦虑悲伤情绪者,从肝论治,辨证加用安神疏肝解郁之药;治疗溃疡性结肠炎,无论便秘与泄泻,均重视脾胃之升降功能;治疗炎症性肠病、习惯性便秘等慢性病,常从肾论治,注重培元固本,脾肾兼补。

改良外剥内扎术配合中药熏洗治疗环状混合痔临床研究

目的探索改良外剥内扎术配合术后中药熏洗治疗环状混合痔的临床效果。方法纳入2021年1月至2023年12月在漳州市龙海区紫泥卫生院就诊的120例环状混合痔疮患者,按治疗手段的不同,分为研究组与对照组,研究组采取改良外剥内扎术配合术后中药熏洗,对照组采取传统内扎外剥术,每组各60例。比较两组患者手术相关指标及住院时间,术后临床症状评分,临床疗效及并发症。结果研究组术中出血量及住院时间均显著少于对照组(P<0.001),但研究组手术时间长于对照组(P<0.001)。术后,研究组创面疼痛、便时出血、肛门坠胀、肛缘水肿评分均低于对照组(P<0.001)。术后1个月,研究组临床有效率为95.00%,显著高于对照组的81.67%(P<0.05),差异有统计学意义。术后1年,研究组并发症发生率为1.67%,与对照组的5.00%相比,差异无统计学意义(P>0.05)。结论改良外剥内扎术配合术后中药熏洗可减少环状混合痔术中出血量,改善术后创面疼痛、便时出血、肛门坠胀及肛缘水肿程度,提高了临床疗效。

Hailey-Hailey disease with lichenoid lesions around the anus

To the Editor: Hailey-Hailey disease (HHD), first discovered by the brothers Howard and Hugh Hailey,[1]is a genodermatosis at intertriginous sites. Mutation of ATP2C1 on chromosome 3q21-2 coding a calciumdependent ATPase gives rise to calcium dysfunction within keratinocytes, resulting in acantholysis due to a signal transduction disorder.[2] It has been suggested that this gene mutation combined with irritation such as frequent friction, cold, and ultraviolet exposure leads to the development of HHD.[3]

经肛门改良Soave手术治疗小儿先天性巨结肠

目的探讨经肛门后正中切开直肠肌鞘改良Soave巨结肠根治术治疗先天性巨结肠的临床疗效。方法收集2003年1月至2014年2月我们经肛门后正中切开肌鞘行改良Soave术治疗的72例先天性巨结肠患儿临床资料。对手术时间、术中出血量、术后并发症、肛门排便功能进行分析。结果 72例中,除3例并发肠炎(经保守治疗后痊愈)外,其他均效果良好。结论经肛门后正中切开改良Soave术是治疗小儿先天性巨结肠的有效方法。主要用于短段型和常见型。具有创伤小、恢复快、美观、术后并发症少等优点。

经肛门Soave Ⅰ期脱出根治术治疗婴幼儿长段型先天性巨结肠

目的回顾分析用经肛门Soave Ⅰ期脱出根治术治疗长段型先天性巨结肠的手术过程、疗效及随访,探讨长段型先天性巨结肠经肛门脱出非开腹治疗的可行性和安全性.方法自2001年2月至2005年2月应用经肛门Soave Ⅰ期脱出根治术治疗长段型先天性巨结肠患儿39例.年龄6个月至3岁,平均年龄1.92岁,均经钡剂灌肠、直肠测压和病理证实为先天性巨结肠.随访手术时间、出血量和并发症.结果经肛门直接脱出38例,由于痉挛段位于结肠肝区腹腔镜辅助下脱出1例;直接拖出痉挛段最长60 cm,至横结肠;平均切除结肠58 cm,最长75 cm;平均手术时间107 min;均于术后2～4 d进食,术后平均住院时间9.3 d,患儿术后1个月随访时排便2～4次/d,半年时排便1～3次/d,无粪污,无吻合口狭窄.结论对于长段型先天性巨结肠特别是痉挛段位于脾区及脾区以远的,非开腹根治术是可行的和安全的.术前充分的肠道准备,特别是洗肠是长段型先天性巨结肠非开腹根治术的基础,而彻底切除痉挛段是手术成功的关键.

经肛门Ⅰ期手术治疗先天性巨结肠

目的探讨经肛门Ⅰ期巨结肠根治术的微创手术治疗方法。方法采用不开腹经肛门斜形切断直肠(前高后低),拖出式处理直肠、结肠系膜和达正常神经节细胞的结肠并予切除病变肠管,行结直肠Ⅰ期“斜形”吻合的方法,治疗短段型及普通型巨结肠共40例。结果40例患儿经肛门完成手术,无需扩肛,随诊6￣24个月,每日排便2、3次,无吻合口瘘、吻合口狭窄、骶前感染和污粪。半年后可排成形便,无不良并发症。结论经肛门Ⅰ期斜形切断直肠拖出式治疗婴幼儿巨结肠,是一种微创的手术路径,手术创伤小、操作简单、近期疗效良好和安全有效。