选择性痔上黏膜切除钉合术治疗Ⅱ～Ⅲ度痔的临床应用

目的：探讨选择性痔上黏膜切除钉合术（ TST）治疗Ⅱ~Ⅲ度痔的临床疗效。方法将我院自2012年9月以来收治的120例Ⅱ~Ⅲ度痔患者随机分为试验组（ TST组）和对照组（痔上黏膜环切钉合术，PPH组）各60例，对比其手术疗效和术后并发症。结果两组平均手术时间、平均住院时间及总体满意度TST组优于PPH组。两组术后疼痛、吻合口狭窄比较差异无统计学意义（P﹥0.05）；术后出血、尿潴留、肛缘水肿、肛门坠胀比较差异有统计学意义（P﹤0.05）。结论TST作为痔治疗的一种新手术，手术疗效确切，手术创伤小，术后恢复快，符合现代外科微创发展要求，值得临床推广应用。

选择性痔上黏膜切除吻合术与外切内扎术治疗Ⅱ、Ⅲ期混合痔患者的效果比较

目的:比较选择性痔上黏膜切除吻合术(TST)与外切内扎术治疗Ⅱ、Ⅲ期混合痔患者的效果。方法:选取200例Ⅱ、Ⅲ期混合痔患者为研究对象,按随机数字表法将其分为观察组与对照组各100例。观察组采用TST治疗,对照组采用外切内扎术治疗,比较两组治疗效果、治疗前后肛肠动力学指标[肛管最大收缩压(MSP)、肛管静息压(ARP)]水平、术后疼痛程度[视觉模拟评分法(VAS)]评分、手术时间、术中出血量和术后并发症发生率。结果:两组治疗总有效率比较,差异无统计学意义(P>0.05);术后,两组MSP、ARP水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组术后VAS评分为(1.35±0.52)分,低于对照组的(2.09±0.71)分,差异有统计学意义(P<0.05);观察组术后并发症发生率为6.00%(6/100),低于对照组的17.00%(17/100),差异有统计学意义(P<0.05)。结论:TST治疗Ⅱ、Ⅲ期混合痔患者可提高肛肠动力学指标水平,降低VAS评分和术后并发症发生率,效果优于外切内扎术治疗。

多普勒超生引导下痔动脉结扎术与外剥内扎痔切除术在治疗Ⅱ～Ⅲ度混合痔中的临床对比

观察多普勒超生引导下痔动脉结扎术与外剥内扎痔切除术在混合痔治疗中的临床对比。方法回顾我院肛肠科从2009至2011年收入院的182例混合痔患者的手术治疗效果，182例混合痔均为Ⅱ～Ⅲ度混合痔，随机分成两组，A组患者（n=92）行多普勒超生引导下痔动脉结扎术（DoPPle—guidedhemorrhoidartervliqatoion，DG—HAL），B组患者（n=90）行传统的外剥内扎痔切除术（MiIIigan—MorganHemorrhoidectomv），比较两组患者术后平均住院时间、恢复工作时间、并发症及痔的复发率。结果在手术时间无明显差别及术中麻醉药物用量基本相同的情况下，A组患者术后平均住院及恢复工作时间比B组明显缩短，差异有统计学意义（P〈0．05），A组患者术后的疼痛、出血、肛门便急感及肛门狭窄等并发症及痔复发率比B组明显降低，差异有统计学意义（P〈0．05）。结论多普勒超生引导下痔动脉结扎术与传统的外剥内扎痔切除术比较具有缩短患者住院及恢复工作时间、减少术后并发症等优点，满足了临床上痔治疗的微创外科要求。

The effect of alphastatin peptide suppressing the hypoxia-induced vasculogenic mimicry formation of glioma

Objective:To investigate the vasculogenic mimicry formation induced by hypoxia in Ⅱ-Ⅲ human glioma cell and the effect of alphastatin peptide suppressing the hypoxia-induced vasculogenic mimicry formation and the mechanism.Methods:MTT,Transwell and three-dimentional culture were used to detect the proliferation,migration and tubule formation of SHG44.The expression of vascular endothelial growth factor-α(VEGF-α),erythropoietin-producing hepatocellular carcinoma-A2 (EphA2) and matrix metalloproteinases 2 (MMP2) was detected by RT-PCR and Western blotting analysis.Results:The OD 490 in hypoxia group was 0.60±0.06 and in control group was 0.46±0.05.The number of cell migration was 178.71±18.81 in hypoxia group and 85.86±17.92 in control group.The tubule formation was 56.80±12.21 in hypoxia group and 4.20±2.62 in control group.The proliferation,migration and tubule formation in hypoxia group were significantly higher than that in control group.The expression of VEGF-α,EphA2 and MMP2 was upregulated in hypoxia.When various concentrations of alphastatin (100,1 000,10 000 nmol/L) were added to hypoxia group,the numbers of cell migration were 142.57±12.12,92.71±17.68,30.00±7.72 and the tubule formation were 47.71±10.58,18.86±8.40,8.43±5.62.The cell migration and tubule formation were significantly suppressed by alphastatin in a dose-dependent manner.In alphastatin group,the phosphorylation of EphA2 protein (P=0.037,F=4.629) and activation of MMP2 protein (P=0.005,F=9.331) were significantly suppressed but there was no change in VEGF-α protein.Conclusion:Ⅱ-Ⅲ human glioma cell is able to form vasculogenic mimicry induced by hypoxia and alphastatin peptide can suppress the hypoxia-induced vasculogenic mimicry.VEGF-α induced EphA2 phospharilation and MMP2 activation maybe the key pathway to form vasculogenic mimicry.

交错内痔套扎联合外痔切除治疗Ⅲ~Ⅳ期混合痔临床效果

目的:研究交错内痔套扎联合外痔切除与传统内扎外剥治疗Ⅲ~Ⅳ期混合痔的临床效果。方法:2020年4月至2021年2月在我科住院,明确诊断为Ⅲ~Ⅳ期混合痔,无特殊基础疾病且行手术治疗的患者90例,随机分为观察组和对照组两组。观察组采用交错内痔套扎联合外痔切除手术,对照组予以传统外剥内扎手术,观察对比两组患者术后治疗效果、疼痛不适程度、伤口愈合时间及并发症发生率。结果:观察组在术后治疗效果、术后疼痛不适程度、伤口愈合时间及并发症发生率明显低于对照组(P<0.05)。结论:治疗Ⅲ~Ⅳ期混合痔,交错内痔套扎联合外痔切除的临床效果比传统内扎外剥的方法更优。