目的总结陈旧性会阴肛管缺损肛门不全失禁临床处理经验。方法回顾性分析我院1994年1月至2000年1月收治的7例陈旧性会阴肛管缺损肛门不全失禁患者的临床资料。结果7例患者均行手术治疗，术后全部随访，无一例复发。结论对于陈旧性会阴肛管缺损肛门不全失禁患者，明确找到断裂的外括约肌断端是手术成败的关键。
ObjectiveTo investigate the influence of surgical treatment on early postoperative anal function in left colon cancer patients with acute complete obstruction. MethodsThe clinical data of left colon cancer patients with acute complete obstruction were retrospectively chosen from January 2017 to June 2020 in Yibin Second People’s Hospital. The patients were grouped according to the treatment plan including emergency operation group (54 cases), stent+operation group (46 cases) and stent+neoadjuvant chemotherapy (NAC)+operation group (44 cases). The anal function was evaluated at 4 weeks, 1 month and 6 months after operation, and quality of life was evaluated at 12 months after operation. Unconditional logistic regression model was used to explore the factors influencing early postoperative anal function injury. Results The proportion of open surgery in the emergency operation group was statistically higher than the stent+operation group and stent+NAC+operation group (P<0.05). The low anterior rectum resection syndrome (LARS) score at 4 weeks after operation of the emergency operation group was statistically higher than those of the stent+operation group and stent+NAC+operation group (P<0.05). However there was no statistical difference in LARS score at 1 month and 6 months after operation among the three groups (P>0.05). The score of social function in the emergency operation group at 12 months after operation was statistically lower than those of the stent+operation group and stent+NAC+operation group (P<0.05). Multivariate logistic regression analysis showed that body mass index (BMI) ≥24 kg/m2, emergency operation, and Eastern Collaborative Oncology Group (ECOG) score were the risk factors for early postoperative anal dysfunction in the left colon cancer patients with acute complete obstruction (P<0.05). ConclusionsLeft colon cancer patients complicated with acute complete obstruction who only received emergency surgery, BMI≥24 kg/m2, or one score of ECOG are more likely to have functional impairment, and the quality of life of those patients underwent emergency surgery alone is decreased. In addition, the stent placement at the obstruction site should be helpful to avoid the above problems.
目的：总结吻合器痔上黏膜环切术（PPH）治疗痔病的经验。探讨该术式的有关问题，以便提高疗效。方法：回顾性分析了2001～2006年8月收治痔病541例，其中PPH术42例的临床资料。本组均为Ⅲ度或Ⅳ度痔。局部合并症共22例次：血栓外痔愈合后遗留皮赘14例，肛裂2例。有关全身合并症：前列腺增生7例，慢性泌尿系统感染1例。结果:42例中，35例术后2～5天出院，6例自愿留院到7天，1例慢性尿路感染者术后2～7天多次便血，再次手术后28日痊愈出院。随访13～24个月：32例恢复满意，10例有肛门包块感及包块排粪时轻度脱出，其中3例经进一步处理缓解，另7例观察治疗。结论:(1)PPH手术简单易行，疼痛轻，住院时间短，效果好。(2)为了提高效果术中应注意：①禁忌症为单个痔块脱出和肛管皮肤不平滑并纤维化的Ⅳ度病变者外。我们还发现慢性泌尿系统感染未彻底治愈者也应视为相对禁忌。明显前列腺增生者也应慎重。②术中按经典PPH手术的要求进行操作，扩肛器插入前后，不宜扩肛和下牵痔块。③个别巨大痔块及皮赘性痔块（tag）宜先行切除，再行本术。④重度脱出者，黏膜切除应宽大，必要时切除部分肛垫。
ObjectiveTo investigate effect of preoperative three-dimensional anorectal endosonography (3D-AREUS) in anal fistula surgery.MethodsA total of 100 patients with anal fistula who were admitted to the Chaoyang Central Hospital from December 2017 to December 2018 were included prospectively, then were randomly divided into ultrasound group and control group with 50 cases in each group. The preoperative examination was performed by 3D-AREUS in the ultrasound group, and preoperative routine examination, finger examination or probe exploration were performed in the control group. The postoperative recurrence and anal functions were compared between the two groups.ResultsThere were no statistically significant differences in the gender, age, body mass index, anal surgery history, preoperative anal function, etc. between the two groups (P>0.05). The detection rate of branch fistulas in the ultrasound group was significantly higher than that in the control group (P=0.025). For the patients with complex anal fistula, compared with the control group, the location accuracy rate of internal opening was higher (P=0.014), the change value of preoperative and postoperative fecal incontinence score was lower (P=0.039), anorectal pressure status (resting pressure of anal canal, anal systolic pressure, and length of anal high pressure zone) were lower (P<0.05) in the ultrasound group; For the patients with simple anal fistula, which had no significant differences between the ultrasound group and control group (P>0.05). There were 4 cases of recurrence in each group.ConclusionsFor complex anal fistula, preoperative 3D-AREUS could clarify position of internal opening, presence of branching fistula, and the relationship between fistula and sphincter, so as to make accurate surgical plans, reduce secondary injuries, and retain postoperative anal function of patients.
ObjectiveTo investigate the curative effect of C-shaped mucosal resection and anastomosis above the dentate line in the treatment of mixed hemorrhoids and its effect on anal function. MethodsA total of 78 patients with degree Ⅳ mixed hemorrhoids treated in Nanjing Liuhe District People’s Hospital from June 2015 to February 2018 were retrospectively collected. The patients were divided into control group (n=39) and observation group (n=39) according to treatment methods. Patients of the control group received traditional procedure for prolapse and hemorrhoids operation, while patients of the observation group received C-shaped mucosal resection and anastomosis above the dentate line. The perioperative indexes (operation time, intraoperative blood loss, hospital stay, etc.), subjective function evaluation indexes (Wexner constipation score, Kirwan grade, etc.), clinical efficacy and recurrence rate were compared between the two groups. The random walking model was used to evaluate the clinical curative effect. ResultsThe intraoperative blood loss [(27.9±3.4) mL vs. (43.2±5.2) mL, P<0.001], 24 h visual analogue scale score [(4.2±1.5) points vs. (5.6±1.5) points, P<0.001], duration of first defecation pain [(22.1±3.2) min vs. (34.2±5.0) min, P<0.001], the time of carrying blood [(4.1±0.4) d vs. (5.7±0.6) d, P<0.001], and the time of edema [(3.2±0.6) d vs. (4.7±0.9) d, P<0.001] in the observation group were shorter (lower) than those in the control group. The difference between pre-and post-operation of Wexner constipation score [(13.2±2.4) points vs. (11.7±2.1) points, P=0.004], resting pressure [(23.1±4.9) mmHg vs. (17.8±3.4) mmHg, P<0.001] and maximum squeeze pressure [(33.5±7.3) mmHg vs. (23.1±5.6) mmHg, P<0.001] in the observation group were significantly higher than those in the control group. There was a long-term correlation between changes in random fluctuating power rate values of Wexner constipation score, Kirwan grade, rectoanal inhibitory reflex positive rate, resting pressure, maximum squeeze pressure and the surgical procedure received by the patient of the two groups. The total effective rate [97.4% (38/39) vs. 66.7% (26/39)] and non-recurrence rate [92.3% (36/39) vs. 76.9% (29/39)] in the observation group were higher than those in the control group, while there was no significant difference in the incidence of total complications between the two groups [5.1% (2/39) vs. 12.8% (5/39), P=0.235)]. ConclusionCompared with PPH, C-shaped mucosal resection and anastomosis above the dentate line for the treatment of degree Ⅳ mixed hemorrhoids can improve the therapeutic effect, reduce postoperative recurrence, maintain anal function and facilitate the recovery of patients.
目的 探讨老年低位直肠癌经肛门局部切除后加放、化疗的临床意义。方法 对18例年龄≥65岁，肿瘤距肛缘≤6 cm且经病理证实但拒绝Miles术的直肠癌患者行经肛门局部切除； 于术后1个月给予放疗（总剂量50 Gy）； 化疗： 亚叶酸钙200 mg、5-FU 400 mg/m2，第1次于术后第1~5 d，每3~4周重复1次，共3~6次。结果 全部病例无手术死亡，术后均有良好的肛门功能。16例获随访，随访5年，其中3例局部复发，拒绝再次手术，给予放、化疗。死亡12例，其中2例死于远处转移，10例死于其他因素。本组患者1年生存率为77.8%（14/18），5年生存率为38.9%（7/18）。结论 对老年低位直肠癌拒绝Miles术的患者行经肛门局部切除加放、化疗，疗效确切，可提高患者生活质量，延长生存期。
ObjectiveTo explore the effects of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviation: PPH+sphincterotomy) on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids.MethodsEighty-five patients with severe mixed hemorrhoids admitted to this hospital from February 2017 to February 2018 were selected as the study subjects, then they were divided into a PPH group (n=42) and PPH+sphincterotomy group (n=43) according to the different treatment methods. The patient in the PPH group was treated with the PPH, while in the PPH+sphincterotomy group was treated with the partial internal anal sphincterotomy on the basis of the PPH group. The clinical efficacy, degree of pain, edema of wound margin, anal function, and the recurrence rate of symptoms were observed in two groups.Results① There were no significant differences in the baseline data such as the gender, age, course of disease, grading of internal hemorrhoids, and symptoms between the two groups (P>0.05). ② The total effective rate of the PPH+sphincterotomy group was significantly higher than that of the PPH group [100% (43/43) versus 90.48% (38/42), χ2=4.297, P=0.038]. ③ The VAS score of the PPH+sphincterotomy group was significantly lower than that of the PPH group on the 3rd and 7th day after the treatment (P<0.05), the VAS score of each group at the 3rd or 7th day after the treatment was significantly lower than that before the treatment (P<0.05), and it was significantly lower on the 7th day than that on the 3rd day after the treatment (P<0.05). ④ The postoperative wound margin edema in the PPH group was more serious than that in PPH+sphincterotomy group (χ2=20.237, P<0.001), and the score in the PPH group was significantly higher than that in the PPH+sphincterotomy group (t=13.514, P<0.001). ⑤ The resting pressure of anal canal after the treatment was significantly lower than that before treatment (P<0.05), and the diastolic pressure of anal canal after the treatment was significantly higher than that before the treatment (P<0.05) in the two groups. The resting pressure of anal canal in the PPH+sphincterotomy group was significantly lower than that in the PPH group and the diastolic pressure of anal canal was significantly higher than that in the PPH group (P<0.05) after the treatment. ⑥ In addition, the total recurrence rate of symptoms at 1 year in the PPH+sphincterotomy group was significantly lower than that of the PPH group [6.98% (3/43) versus 23.81% (10/42), χ2=4.647, P=0.031].ConclusionPPH+sphincterotomy could effectively relieve symptoms of severe mixed hemorrhoids, improve clinical efficacy, and reduce recurrence rate.
Objective To summarize the assessment methods of anal function after low/ultralow rectal anastomosis in patients with rectal cancer. Methods Domestic and international publications on the study of evaluation of anal function after low/ultralow rectal anastomosis in patients with rectal cancer were collected and reviewed. Results Anal function of patients with rectal cancer was usually evaluated by feeling of discharge, continence, perceptual function of rectum, defecate frequency, and defecation time, anal manometry and three-dimensional vector manometry were used as well. Recovery of anal function in patients with rectal cancer after low/ultralow rectal anastomosis depended on the integrity of anal canal, length of remaining rectum, level of anastomosis, and integrity of mucosa. Conclusions Subjective assessment methods and auxiliary measuring instruments are the common means to evaluate the rectal-anal function. Subjective assessment method is simple and direct, but its accuracy is low; Auxiliary measuring instruments have high accuracy, while their examination costs are high and that of costs are not popular, the new assessment methods are needed for further research.
Objective To investigate the application of gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia. Methods Between December 2002 and November 2010, 25 patients with fecal incontinence were treated with gluteus maximus transplantation, which was caused by surgery of high anal atresia. There were 11 malesand 14 females with an average age of 10.2 years (range, 3-22 years). Preoperative radiography, anorectal manometer, and electromyogram showed abnormality or deficiency of anal sphincter function. Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and Self-rated Health Measurement Scale Version 1.0 (SRHMS) score were used to evaluate l ife qual ity of the patients. The anorectal manometer, intra-rectal ultrasound examination, and defecation radiography were performed. Results Healing of incision by first intention was achieved in 23 cases and rectal-wound fistula occurred in 2 cases. The follow-up time was 1 to 9 years (mean, 6.3 years). Defecation frequency was decreased from more than 10 times to 4-6 times every day. Wexner score and SRHMS were significantly improved at 1 or 2 years after surgery when compared with preoperative socres (P lt; 0.05). FIQL was also significantly improved after 2 years (P lt; 0.05). At 2 years after surgery, the anal maximum systol ic pressure, contraction duration, and maximum systol ic volume were improved, showing significant differences when compared with those at preoperation and 1 year after surgery (P lt; 0.05). Conclusion Gluteus maximus transplantation can improve defecation controls in the patients with fecal incontinence after surgery of high anal atresia.