胃切除手術知多點 [上]

胃切除手術最常用於治療惡性腫瘤，手術切除依然是最有效的方法，讓病人有機會痊癒或長期存活。現在良性的胃部疾病很少需要用胃部切除手術治療。此外，姑息性切除手術（如可進行的話）能夠有效地舒緩若干症狀，例如梗阻、出血及穿孔。

胃切除手術分類

1. 胃部分切除（partial gastrectomy）

切除範圍是根據病變的位置及範圍大小而來決定。

2. 胃全摘（total gastrectomy）

胃全部切除。

手術過程

 

可能治癒胃癌的切除手術之原則為：

1. 腫瘤邊緣有足夠的切割空間
2. 就此，可切除四分之三的胃部或整個胃部，這視乎腫瘤的位置而定
3. 清除與胃部癌症有關整個區域的淋巴結
4. 安全而操作良好的重建

(續)

資料來源：psclinic.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。

Anal fissure

Anal fissure is caused by anal injuries. The major cause of anal fissure is constipation. When patients force hard stool out of the anus, the extreme pressure will tear the epithelium of the anus. Symptoms of anal fissure include fresh blood on stool and sharp pain during defecation. Besides, recurrent anal fissure will lead to ulceration around the anus, forming hypertrophic polyps and skin thickening, eventually leading to stenosis of the anal sphincter. This is a vicious cycle that makes defecation even more difficult.


 



 




Treatment of anal fissure

The treatment is targeting on the fundamental problem - constipation. Patients are encouraged to do more exercises and maintain a healthy diet, as well as using prescribed medications to soften the stools.

If the above methods failed, doctors may consider sphincterotomy, which dilates the anus and allow the wound to heal itself. Over 90% of patients recovered in 6 weeks.

Another method is called chemical sphincterotomy, in which a muscle relaxant (e.g. Botox) will be injected to the diseased area. 96% of patients recovered in 8 weeks.

 

 Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Haemorrhoid treatment (2)

Traditional surgery – Hemorrhoidectomy

The principle of the surgery is to decrease the blood flow to anorectal ring, which is followed by the removal of redundant hemorrhoidal tissue.
 

Indications

• Grade II, III and IV hemorrhoids
• Failure of non-operative treatment of 2nd degree pile
• Thrombosed hemorrhoid
• Interoexternal pile when the external pile is well defined

 
Types

• Excision of hemorrhoids with (closed hemorrhoidectomy) or without (open hemorrhoidectomy) suturing
• Excision by using different energies
• Diathermy
• Harmonic scalpel
• Bipolar scissors

Stapled hemorrhoidopexy / Procedure for prolapsed and hemorrhoids (PPH)
Based on the concept of interruption of the superior and middle hemorrhoidal vessels, and the upward lifting of the prolapsed anorectal mucosa, followed by repositioning of the vascular cushions back into the anal canal, causing atrophy of hemorrhoidal tissue

• For Grade 3 and 4 hemorrhoids
• No incisions are made in the somatically innervated, highly sensitive anoderm, which cause significantly less postoperative pain
• Side effects include rectal perforation, sphincter dysfunction and sepsis
• Advantages:
  1. Simple and quick procedure
  2. Less postoperative pain, shorter hospital stay and earlier return to normal activity
  3. Similar complication rate as conventional procedure

	Staple hemorrhoidopexy	Traditional hemorrhoidectomy
Operative time	Quick, around 30 minutes	40-60 minutes
Postoperative pain	Much less	Painful wound, subsided days to weeks later
Recovery time	Fast, can resume normal activity on next day, avoid strenuous exercise	Slow, requires days to week to resume normal duty
Wound care	Not needed if not infected	Daily wound dressing, for one to two weeks

Hemorrhoidal artery ligation (HAL) and Transanal hemorrhoid dearterialization (TAH)
Video Demonstration


These are for treatment of bleeding and Grade 2 to 3 prolapsed hemorrhoids. Dearterialization is to apply Doppler-USG for identification and selective ligation of the branches of rectal artery, thereby correcting the arterial hyperinflux, which is the main cause of bleeding and swelling of the haemorrhoidal plexus. Mucopexy or rectoanal repair is the reposition of the cushions in their anatomical site by folding the muco-hemorrhoidal prolapsed
 

Benefits

• Minimally invasive and atraumatic
• Marginal post-operative pain
• No grave complications

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Haemorrhoid treatment (1)

• Varies from simple reassurance to surgery
• Treat symptomatic disease only
• Depends on grading

It is divided into four categories:

1. Dietary and lifestyle modification to prevent hemorrhoids formation
2. Medications to relieve symptoms
3. Outpatient hemorrhoid treatment
4. Operation

Treatment is according to severity of hemorrhoids

	Dietary and lifestyle modifications	Medications	Outpatient procedures	Operations
Grade 1	✓	✓	+/-	x
Grade 2	✓	✓	✓	+/-
Grade 3	x	x	✓	✓
Grade 4	x	x	x	✓

 

Dietary and lifestyle modification

The goal is to minimize straining at stool by minimizing constipation. Increase fluid intake which acts as stool softeners is encouraged in diet. Moreover, regular defecatory habits should be developed.
 


 Medications

There are two kinds of medications, local and oral medications. This helps to:

• arrest bleeding
• relieve pain, irritation, and inflammation
• guard against infection

 

Outpatient hemorrhoid treatment

• Rubber band ligation, endoscopic ligation
• Sclerotherapy
• Infrared coagulation
• Bicap electrocoagulation
• Cryotherapy
• Laser treatment

 

Banding / Ligation of hemorrhoids

It is carried out for Grade 2 and 3 internal hemorrhoids. The principle of it is to cause ischemic necrosis by banding, which will slough off within a few days. 60-70% successful response rate is found when cured with a single treatment session

Video Demonstration

 

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

 

傳統甲狀腺切除手術與微創甲狀腺切除手術之分別

 

 

 

傳統甲狀腺切除手術

在病人頸部開出創口, 再將之切除。手術後，頸前會有一個約2-3cm長的傷口。傷口疤痕或增生、紅腫，甚至成為仿如「蜈蚣」形狀的疤痕。

 

 

微創甲狀腺切除手術

在隱蔽部位如鎖骨對下、乳暈及腋下位置，開出小創口。以內視鏡監定位技術，將有問題的副甲狀腺組織切除。好處有:

• 傷口面積1至2公分長
• 傷口位置不顯眼，術後亦可被遮蓋於衣服內
• 微創手術需時一個半小時至兩小時半不等 

資料來源：psclinic.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。

副甲狀腺功能亢進 - 副甲狀腺治療方法

副甲狀腺位於甲狀腺左右兩葉的裹側，每邊兩粒，體積像米粒一般。副甲狀腺賀爾蒙 (PTH) 的功能是幫助身體維持鈣和磷質在體內的平衡。它可促使骨骼釋放出鈣，增加小腸對鈣的吸收和調節尿鈣的排泄，來維持血鈣的平衡。



副甲狀腺功能亢進

當副甲狀腺荷爾蒙分泌過盛，會造成高鈣血症和低磷血症。主要病徵包括骨質疏鬆、病理性骨折、腎結石、磷酸鈣在腎臟的沈積、虛弱、疲勞、抑鬱、肌肉酸 痛。 隨著病情加劇，患者會食慾減退、噁心、嘔吐、便祕、迷妄、無法思考、記憶力減退、口渴及多尿等。 副甲狀腺功能亢進的病人，也較容易發生高血壓、消化性潰瘍和胰臟炎。


治療方法

原發性副甲狀腺功能亢進可以透過外科手術徹底治癒。手術可分為傳統副甲狀腺切除術及微創副甲狀腺切除手術。




資料來源：psclinic.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。
 

痔瘡槍 (痔瘡環狀切割手術 (PPH)

痔瘡環的原理是切斷流到上及中層痔瘡血管的血液供應，拉起突出的肛門組織，再把血管墊重新放回肛門內，令組織收縮。

 

主治:

• 第三、四級的痔瘡
• 與傳統治療的副作用相若

 

好處:

1. 簡單、快捷
2. 減少痛楚、住院時間、能及早回復日常生活
3. 無需在敏感的肛門開任何切口，大大減低手術引起的痛楚

	痔瘡槍	傳統痔瘡切除術
手術時間	快, 大約30分鐘	40-60分鐘
術後痛楚	極少	傷口疼痛會於數日/數星期後逐漸消除
康復時間	快, 翌日出院, 避免劇烈運動	慢, 數要數日/星期時間才可回復正常活動
傷口護理	如無感染，無需治理	手術後一至兩星期內每日洗傷口

資料來源：psclinic.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。