ObjectiveTo compare clinical efficacy of 4 kinds of surgical treatment for high transsphincter fistula. MethodsThe clinical data of 116 patients with high transsphincter fistula in Jiangsu Province Hospital of TCM from January 2012 to December 2014 were analyzed retrospectively.These patients were divided into 4 groups according to surgical treatments,including cut seton group (n=30),loose seton group (n=34),ligation of intersphincteric fistula tract group (LIFT,n=41),mucosa advancement flap group (MAF,n=11).The length of stay,incision healing time,postoperative pain score on the second day,Wexner score when healed,postoperative complications,curative status,and recurrence were observed. Results① The length of stay in the loose seton group was significantly longer than that in the LIFT group (P<0.01),cut seton group (P<0.05) or MAF group (P<0.05),but which had no differences among the other groups (P>0.05).② The incision healing time in the loose seton group was significantly longer than that in the LIFT group (P<0.01) or the MAF group (P<0.05),but which had no differences among the other groups (P>0.05).③ The postoperative pain score on the second day in the cut seton group was significantly higher than that in the other three groups (P<0.01),which in the MAF group was lower than that in the LIFT group (P<0.05),but which had no difference between the other groups (P>0.05).④The Wexner score when healed in the cut seton group was significantly higher than that in the other three groups (P<0.01),bwt which had no differences among the other groups (P>0.05).⑤ The rate of postoperative complica-tion in the LIFT group was significantly higher than that in the loose seton group (P<0.05),but which had no differences among the other groups (P>0.05).⑥ The curative rate and recurrence rate had no statistically differences among the 4 groups (P>0.05). ConclusionsCurative rate and recurrence rate in loose seton,LIFT,and MAF group are similar with cut seton group,meanwhile they could protect anal function better and relieve pain.The length of stay and the incision healing time are longer in the loose seton group.The postoperative complications in LIFT group is increased as compared with loose seton group.The postoperative pain of MAF group is slighter than that in LIFT group.Comprehensive evaluation,MAF has more advantages,but the technique is more complex.The decision should be made individually according to patients and surgeons.
Objective To investigate the application of magnetic resonance imaging (MRI) in preoperative assessment of rectal cancer. Methods Combined with the literatures, the MRI features and measurements of rectal tumor staging, extramural vascular invasion, circumferential margin involvement, and the distance between distal margin of the tumor from the anorectal ring and the anal margin were described. Results On T2-weighted images (T2WI), T1 staging-tumors were those in which the normal submucosa was replaced by the iso-intensity of tumor tissue without invasion of muscularis propria; T2 staging-tumors were those with extension into the muscularis propria, but not invaded the high-intensity of mesorectal fat; T3 staging-tumors manifested as the rectal tumor penetrated into the muscularis propria and invaded the high-intensity of mesorectal fat; T4 staging-tumors manifested as the tumor invaded adjacent structures or organs. The metastatic lymph nodes were showed with irregular boundaries and mixed signals on T2WI. The tumor signals could be found in the extramural vascular on T1-weighted images (T1WI), accompanied by irregular distortion and expansion of the blood vessels. On T2WI, metastatic lymph nodes, extramural vascular invasion, and the distance between the residual tumor and the low-signal of mesorectal fascia was within 1 mm, indicated the positive circumferential margin. On T2WI, the distal margin of the tumor was located at the junction of hyperintense submucosa and iso-signal of tumor, the tip of the iso-signal puborectal muscle was the apex of the anorectal ring, and the lowest point of the iso-signal external sphincter was the anal margin. Conclusion MRI can provide reliable imaging information for preoperative staging, height measurement, and prognosis of rectal cancer, and it is helpful for early diagnosis and treatment of rectal cancer.
ObjectiveTo summarize the latest research progress of intersphincteric fistula ligation in the treatment of anal fistula. MethodsThrough the retrieval of CNKI and PubMed literature database, the principle, clinical application and related improvement of LIFT were reviewed. ResultsLigation of intersphincteric fistula tract is a sphincter preserving surgery in recent years. Because it has the advantage of ensuring the integrity of the sphincter, less damage to the anal function after operation, the wound healing quickly and so on, it has been accepted by domestic and foreign scholars. ConclusionLIFT to cure anal fistula while ensuring the anal function integrity, is the development trend of anal fistula surgery, is worthy to be popularized.
Objective To investigate the clinical efficacy of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids. Methods Seventy patients with Ⅲ-Ⅳ internal henmorrhoids and mixed hemorrhoids who were admitted into Jiangsu Provincial Hospital of Traditional Chinese Medicine form June 2015 to June 2016 were enrolled. The patients were randomly divided into two groups: the combined operativ group and control group. The combined operativ group in which 35 cases were treated by pouched suture plus external dissection and internal ligation, and the control group in which 35 cases were treated by external dissection and internal ligation. The wound healing time, clinical curative effect, hospital stay, the operative time and postoperative complications (postoperative pain, edema, postoperative bleeding volume, urination difficulties, residual skin tag, anorectal stenosis) between two groups were compared. Results No significant difference were found in the clinical curative effect, the operative time and anorectal stenosis in two groups (P>0.05). The visual analogue scale (VAS) scores and the edema scores of the combined operativ group on the first day, the third day, and the fifth day after operation were lower than those of control group, the difference was statistically significant (P<0.05), while there were no statistically significant on the seventh day after operation in two groups (P>0.05) . The wound healing time, hospital stay, postoperative bleeding volume, urination difficulties, and residual skin tag in the combined operativ group were significantly shorter or lower than those in the control group (P<0.05). Conclusion Pouched suture plus external dissection and internal ligation has the advantages of less pain, fewer complications and quicker recovery, it also meets the modern concept of minimally invasive, so it is worthy of popularization and application.
ObjectiveTo investigate long-term efficacy of infliximab (IFX) combined with seton placement in treatment of perianal fistulizing Crohn disease (CD) and to analyze factors affecting its clinical healing and recurrence.MethodsThe patients with perianal fistulizing CD underwent the IFX combined with seton placement therapy from July 2010 to January 2017 were collected from the HIS database of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The healing and recurrence of perianal fistulizing CD were counted and their influencing factors were analyzed.ResultsA total of 103 patients with perianal fistulizing CD were included in the study. After a median follow-up of 36 months, 64 patients (62.1%) had a complete fistula healing, 34 patients (33.0%) relapsed. The cumulative recurrence rates of fistula in the 1, 3, and 5 years was 21.8%, 32.6%, and 37.4%, respectively. The multivariate analysis showed that the Montreal classification B1 ［HR=3.987, 95% CI (1.640, 9.694), P=0.023］ and without abscess ［HR=2.724, 95% CI (1.101, 6.740), P=0.030］ were positively associated with the long-term healing of fistula, and the IFX maintenance treatment >3 times ［HR=5.497, 95% CI (1.197, 25.251), P=0.028］ was a risk factor for the recurrence of the fistula.ConclusionsLong-term healing rate of fistula by IFX combined with seton placement therapy is higher. Montreal classification B1, without abscess, and IFX maintenance treatment less than 3 times are expected to have a better long-term efficacy.