PURPOSE: A randomized trial was undertaken to evaluate and compare stapled hemorrhoidopexy with excisional hemorrhoidectomy in which the Harmonic Scalpel(TM) was used. METHODS: Patients with Grade III hemorrhoids who ...PURPOSE: A randomized trial was undertaken to evaluate and compare stapled hemorrhoidopexy with excisional hemorrhoidectomy in which the Harmonic Scalpel(TM) was used. METHODS: Patients with Grade III hemorrhoids who were employed during the trial period were recruited and randomized into two groups:(1) Harmonic Scalpel(TM) hemorrhoidectomy, and (2) stapled hemorrhoidopexy. All operations were performed by a single surgeon. In the stapled group, the doughnut obtained was sent for histopatho-logic examination to determine whether smooth muscles were included in the specimen. Operative data and complications were recorded, and patients were followed up through a structured pro forma protocol. An independent assessor was assigned to obtain postoperative pain scores and satisfaction scores at six-month follow-up. Patients were also administered a simple questionnaire at follow-up to assess continence functions. RESULTS: Over a 20-month period, 88 patients were recruited. The two groups were matched for age and gender distribution. No significant difference was identified between the two groups in terms of operation time, blood loss, day of first bowel movement after surgery, and complication rates. Despite a similar parenteral and oral analgesic requirement, the stapled group had a significantly better pain score (P = 0.002); these patients also had a significantly shorter length of stay (P = 0.02), and on average resumed work nine days earlier than the group treated with the Harmonic Scalpel(TM) (6.7 vs. 15.6, P = 0.002). Although 88 percent of doughnuts obtained in the stapled group contained some smooth muscle fibers, no association was found between smooth muscle incorporation and postoperative continence function, and as a whole the continence outcomes of the stapled group were similar to those after Harmonic Sca-lpel(TM) hemorrhoidectomy. Finally, at sixmonth follow-up, patients who underwent the stapled procedure had significantly better satisfaction scores (P = 0.001). CONCLUSION: Stapled hemorrhoidopexy is a展开更多
We describe a case of a cutaneous perivascular myoma with features overlapping between the myofibromatosis and the myo pericytoma type. The patient is a 58 year-old woman with a painless plaque-like and multinodular...We describe a case of a cutaneous perivascular myoma with features overlapping between the myofibromatosis and the myo pericytoma type. The patient is a 58 year-old woman with a painless plaque-like and multinodular lesion in the pretibial dermis and subcutaneous tissue. She had repeated trauma to this site, first in her early youth that left an area of hyperpigmentation, and then again at age 40. The biopsy showed a biphasic pattern with a myofibromatosis-type component composed of spindle cell myoid nodules and more cellular round cell areas. The myopericytoma-like areas appeared to be infiltrating along vessels. These areas contained aggregates of immatureappearing cells arranged concentrically around vascular lumina in a manner reminiscent of pericytes. Immunohistochemical stains showed focal positivity for smooth muscle actin. Immunohistochemical and ultrastructural studies have showed these pericyte-like cells to be of a myoid origin. The reason for the neoplastic proliferation of perivascular myoid cells is presently unknown. The association of trauma and neoplastic transformation of the skin is rare. We report the first case of a cutaneous perivascular myoma arising in a chronic scar.展开更多
一、奥迪括约肌的生理解剖奥迪括约肌(sphincter of oddi,SO)位于十二指肠中部或稍下的后内侧壁,为胆总管的第4段(十二指肠壁内段),长4~6 mm。SO通常指围绕在胆总管末端、胰管末端、壶腹和乳头部的平滑肌纤维。胆总管末端括约肌长,将其...一、奥迪括约肌的生理解剖奥迪括约肌(sphincter of oddi,SO)位于十二指肠中部或稍下的后内侧壁,为胆总管的第4段(十二指肠壁内段),长4~6 mm。SO通常指围绕在胆总管末端、胰管末端、壶腹和乳头部的平滑肌纤维。胆总管末端括约肌长,将其细分为胆总管上括约肌、胆总管下括约肌;胰管末端括约肌短;壶腹和乳头部括约肌相对较厚也是功能最强的部分,还有位于胰胆管间隔的纵行肌。胆管和胰管末端汇合后在十二指肠壁内括约肌膨大部称为Vater壶腹。括约肌壶腹和乳头作为一个整体,斜向穿过肠壁,当十二指肠内压增高、肠腔扩大时,使乳头及壶腹更加处于壁内斜位,更具有防止肠内容物逆流入胆、胰管的作用。十二指肠乳头开放时开口部直径为2~3 mm。SO受神经体液调节。具有维持胆、胰管内压,控制胆汁和胰液的排出,防止十二脂肠液反流入胆管的重要生理功能。展开更多
文摘PURPOSE: A randomized trial was undertaken to evaluate and compare stapled hemorrhoidopexy with excisional hemorrhoidectomy in which the Harmonic Scalpel(TM) was used. METHODS: Patients with Grade III hemorrhoids who were employed during the trial period were recruited and randomized into two groups:(1) Harmonic Scalpel(TM) hemorrhoidectomy, and (2) stapled hemorrhoidopexy. All operations were performed by a single surgeon. In the stapled group, the doughnut obtained was sent for histopatho-logic examination to determine whether smooth muscles were included in the specimen. Operative data and complications were recorded, and patients were followed up through a structured pro forma protocol. An independent assessor was assigned to obtain postoperative pain scores and satisfaction scores at six-month follow-up. Patients were also administered a simple questionnaire at follow-up to assess continence functions. RESULTS: Over a 20-month period, 88 patients were recruited. The two groups were matched for age and gender distribution. No significant difference was identified between the two groups in terms of operation time, blood loss, day of first bowel movement after surgery, and complication rates. Despite a similar parenteral and oral analgesic requirement, the stapled group had a significantly better pain score (P = 0.002); these patients also had a significantly shorter length of stay (P = 0.02), and on average resumed work nine days earlier than the group treated with the Harmonic Scalpel(TM) (6.7 vs. 15.6, P = 0.002). Although 88 percent of doughnuts obtained in the stapled group contained some smooth muscle fibers, no association was found between smooth muscle incorporation and postoperative continence function, and as a whole the continence outcomes of the stapled group were similar to those after Harmonic Sca-lpel(TM) hemorrhoidectomy. Finally, at sixmonth follow-up, patients who underwent the stapled procedure had significantly better satisfaction scores (P = 0.001). CONCLUSION: Stapled hemorrhoidopexy is a
文摘We describe a case of a cutaneous perivascular myoma with features overlapping between the myofibromatosis and the myo pericytoma type. The patient is a 58 year-old woman with a painless plaque-like and multinodular lesion in the pretibial dermis and subcutaneous tissue. She had repeated trauma to this site, first in her early youth that left an area of hyperpigmentation, and then again at age 40. The biopsy showed a biphasic pattern with a myofibromatosis-type component composed of spindle cell myoid nodules and more cellular round cell areas. The myopericytoma-like areas appeared to be infiltrating along vessels. These areas contained aggregates of immatureappearing cells arranged concentrically around vascular lumina in a manner reminiscent of pericytes. Immunohistochemical stains showed focal positivity for smooth muscle actin. Immunohistochemical and ultrastructural studies have showed these pericyte-like cells to be of a myoid origin. The reason for the neoplastic proliferation of perivascular myoid cells is presently unknown. The association of trauma and neoplastic transformation of the skin is rare. We report the first case of a cutaneous perivascular myoma arising in a chronic scar.
文摘一、奥迪括约肌的生理解剖奥迪括约肌(sphincter of oddi,SO)位于十二指肠中部或稍下的后内侧壁,为胆总管的第4段(十二指肠壁内段),长4~6 mm。SO通常指围绕在胆总管末端、胰管末端、壶腹和乳头部的平滑肌纤维。胆总管末端括约肌长,将其细分为胆总管上括约肌、胆总管下括约肌;胰管末端括约肌短;壶腹和乳头部括约肌相对较厚也是功能最强的部分,还有位于胰胆管间隔的纵行肌。胆管和胰管末端汇合后在十二指肠壁内括约肌膨大部称为Vater壶腹。括约肌壶腹和乳头作为一个整体,斜向穿过肠壁,当十二指肠内压增高、肠腔扩大时,使乳头及壶腹更加处于壁内斜位,更具有防止肠内容物逆流入胆、胰管的作用。十二指肠乳头开放时开口部直径为2~3 mm。SO受神经体液调节。具有维持胆、胰管内压,控制胆汁和胰液的排出,防止十二脂肠液反流入胆管的重要生理功能。
