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題名 | Anorectal Injury Induced by Glycerin Ball Enema--An Animal Experiment=甘油球灌腸導致的肛門直腸傷害: 動物實驗 |
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作者姓名(中文) | 邱仁輝; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 18:4 1985.12[民74.12] |
頁次 | 頁367-373 |
分類號 | 416.245 |
關鍵詞 | 甘油球灌腸; 肛門直腸傷害; |
語文 | 英文(English) |
中文摘要 | 甘油球灌腸常常被用於治療便祕或直腸鏡檢的準備步驟。一般而言,甘油球灌腸不會產生任何問題。但是部分病人尤其是長期臥床或行動不便的病人,灌腸需假借他人之手,程度不一的肛門直腸傷害並不罕見。此種傷害往往在灌腸后,病人覺得肛門周圍不適或有血便現象。肛門直直腸在可發現直腸潰瘍伴有周圍組織壞死。因甘油球尖端造成的傷害應不致有如此嚴重的組織壞死。是否甘油球的內容物會引起如此嚴重的變化?由甘油球灌腸液的成分分析及進一步的動物質驗結果顯示高張鹽水可引起組織變性及壞死。甘油本身對直腸組織傷害並不明顯。在正常情況下,直腸黏膜具有保護作用。如果因甘油球使用不當,例如假借他人或外行人之手灌腸,性急的病人自行灌腸等,造成直腸黏膜傷害,再注入高張灌腸液引起組織燒死,甚至合併大量出血或直腸膿瘍。因此我們建議:1.以軟質尖端代替目前使用的硬質尖端;2.以甘抽取代高張鹽水;3.自有經驗的人員指導灌腸,方可避免此類的肛門直腸傷害。 |
英文摘要 | Glycerin ball enema is commonly used to relieve constipation or prepare for proctosigmoidoscopy. It rarely causes complications unless forcibly used or attempted by an inexperienced person. However, recent awareness of severe anorectal injury induced by glycerin ball enema stimulated an analysis of the content of the commercial glycerin ball and further experimental study. Twenty rats were divided into four groups depending on the solutions injected into the rectal submucosa via the anus. The solutions were normal saline, hypertonic saline (15% NaCl), 10% glycerin and E. coli suspension. The rats were sacrificed at intervals and specimens, taken from the rectum were compared grossly and microscopically. Two rats injected with hypertonic saline (Gr. II) had gross necrotic change and severe polymorphonuclear (PMN) infiltration microscopically. Two rats injected with 10% glycerin (Gr. III) had minimal change grossly and mild PMN infiltration. Only moderate to severe PMN infiltration without cell degeneration or necrosis were noted in rats injected with E. coli suspension (Gr. IV). The pathogenesis of anorectal injury induced by glycerin ball enema was suspected to be from initial traumatization of the rectal mucosa by the hard tip of glycerin ball, followed by bolus injection of hypertonic saline which caused tissue degeneration or necrosis. Superimposed bacterial infection resulted in anorectal abscess. It was concluded that rectal mucosa trauma was the initial event, induced by a rough glycerin ball enema. The major pathogen, of the commercial glycerin ball was hypertonic saline, not glycerin. The pathogenesis of anorectal abscess induced by glycerin ball enema differed from that of anorectal abscess resulting from cryptoglandular infection. Enema with a soft tip glycerin ball and supervised by experienced personnel is advised to prevent anorectal injury induced by glycerin ball enema. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。