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患者,女,45岁。3d前肛周肿痛,无发热,用抗生素治疗疼痛不减,于1998年2月25日急诊入院。局部检查胸膝位:肛门外形不整,左侧臀部见一10cm×9cm大小肿块,表皮无红肿,明显高于右侧,肛缘皮肤无红肿凸起。指诊:左侧臀部皮温略高于右侧,触痛(±),弹性硬,食指探肛左位距肛缘5~6cm处可触及粘膜隆起,触痛(+),波动感(±),因疼痛未行肛镜检查。诊断:肛周脓肿。立即于当日下午行手术治疗。手术经过:骶麻成功后,患者取截石位,肛门外形不整,左侧臀部距肛缘5cm处见一10cm×9cm大小肿块,表皮无红肿,且见肿块中央有搏动。指诊:左侧臀部皮温略高于右侧,弹性硬,食指探肛左位距肛缘5~6cm处可触及粘膜明显隆起,波动感(±),肛镜:左位齿线上粘膜红肿。于左侧距肛缘1.5cm处行长约4cm弧形切口,止血钳沿肛内方向钝性分离肌肉组织,未见有脓汁溢出。遂用无菌注射器于切口处穿刺,亦未抽出脓汁,于肿块中央穿刺抽吸出鲜红血液15ml,故暂停手术,立即缝合切口,术毕。B超示:疑为血管瘤。第6天间断拆线,于3月2日转至中国医科大学附属二院外科治疗。经彩超示:左臀部血管瘤。左髂内、外血管造影术,诊断为左侧臀部内外动脉多发血管瘤。经完善检查,明确诊断后,于3月19日在全麻下行腹膜外左髂内动脉阻断、结扎,左臀部血管瘤切除术。术中经过顺利,无
Patient, female, 45 years old. Three days before the perianal swelling and pain, no fever, the use of antibiotics to treat pain unabated, in February 25, 1998 emergency admission. Partial examination of the chest and knee position: the anus is not well-shaped, the left hip see a lump of 10cm × 9cm in size, the epidermis is not red and swollen, was significantly higher than the right side, anal skin without swelling swelling. DRE: The left buttock skin temperature is slightly higher than the right side, tenderness (±), elasticity, the index finger anal left to the anal margin 5 to 6cm can touch the mucous membrane uplift, tenderness (+), volatility (± ) Anal examination was not performed because of pain. Diagnosis: Perianal abscess. Immediately on the same day after the surgery. After the operation: After the ramie was successful, the patient took a stone litter and the shape of the anus was not perfect. A lump of 10cm x 9cm in size was seen at the left hip from the anal verge of 5cm. The epidermis did not have redness, and there was a beating in the center of the mass. DRE: The left buttock skin temperature is slightly higher than that of the right side, elasticity is hard, the index finger can be touched by the anal canal in the left and right position 5~6cm, and the mucosal uplift is noticeable (±). The anal lens: the left dentition mucosa Redness. A curved incision of approximately 4 cm in length was made at 1.5 cm from the anal margin on the left side. Hemostatic forceps were bluntly separated along the anal direction and there was no pus overflow. A sterile syringe was used to puncture the incision and no pus was withdrawn. In the center of the mass, 15 ml of bright red blood was punctured, so the operation was suspended and the incision was immediately closed. B ultrasound shows: suspected hemangiomas. On the 6th day of the discontinued suture removal, he was transferred to the Second Affiliated Hospital of China Medical University for surgical treatment on March 2. Color Doppler ultrasonography shows: left hepatic hemangioma. Left iliac internal and external angiography, diagnosis of multiple hemangioma of the left hip external and internal arteries. After thorough examination and diagnosis, on March 19, the extraperitoneal left internal iliac artery was blocked and ligated under general anesthesia, and the left hip hemangioma was removed. After the surgery went well, no