目的探讨袋形缝合术联合中药外敷治疗骶尾部藏毛窦的临床疗效。 方法应用袋形缝合术联合中药外敷治疗骶尾部藏毛窦13例。 结果13例患者全部治愈，随访1年，未见明显复发及并发症。 结论袋形缝合术联合中药外敷治疗骶尾部藏毛窦手术操作简单，治疗彻底，缩小了手术创面，愈合时间相对缩短，复发少，患者痛苦少，长期效果优良，治疗骶尾部藏毛窦安全、有效，值得临床推广应用。
目的总结直肠神经内分泌肿瘤（RNEN）的临床诊断和治疗方法。 方法回顾性分析2009年1月至2013年12月期间南京中医药大学附属医院（江苏省中医院）收治的16例RNEN患者的临床资料。 结果16例患者均顺利完成手术，手术时间30～120 min，平均50 min；术中出血量10～80 mL，平均55 mL；均无手术死亡，术中均未见严重并发症发生。术后住院时间10～35 d，平均17 d。手术创面均一期愈合，均顺利出院。术后所有患者均获访，随访时间为2个月～5年，中位随访时间为20个月。随访期间所有患者均未见复发或转移，无死亡病例。 结论RNEN发病隐匿，具有恶性潜能，且常无特异性临床表现，故应加深对该病的认识，及时对就诊患者进行全面检查，做到早发现、早诊断及早治疗，且治疗后应对患者进行严密随访。
ObjectiveTo compare the clinical therapeutic efficacy of the pilonidal sinus with four kinds of surgical procedures. MethodsThe clinical data of 43 patients with sacrococcygeal pilonidal sinus treated from January 2008 to March 2013 were analyzed retrospectively. All of them were received surgery, in who 4 patients underwent pilonidal sinus resection alone(incision open group), 7 patients underwent incision and direct suturing after pilonidal sinus resection (incision and direct suturing group), 19 patients underwent marsupialization after pilonidal sinus resection(marsupialization group), and 13 patients underwent Limberg flap transposition after pilonidal sinus resection(rhombus flap transposition group). Results①There were not statistically significant differences regarding demographics among four groups (P > 0.05). 2 The hospital stay was(16.70±8.69) d, (16.43±10.68) d, (15.84±11.29) d, and(14.69±4.01) d in the incision open group, incision and direct suturing group, marsupialization group, and flap transposition group, respectively, and the healing time of incision was(64.75±6.50) d, (34.57±19.15) d, (35.16±15.49) d, and(17.92±4.29)d among the same four groups, respectively. The difference of the hospital stay was not statistically significant among four groups(P > 0.05). The healing time of incision in the flap transposition group was less than that in the other three groups(P < 0.05), which in the incision and direct suturing group and marsupialization group were shorter than those in the incision open group(P < 0.05), and which had no significant difference between the incision and direct suturing group and marsupialization group(P > 0.05).③The partial wound dehiscence occured in two patients and the wound was partially broken because of infection in two patients in the incision and direct suturing group. One patient was performed drainage because of emhysis and the wound tension blisters occurred in one patient in the flap transposition group. There was no complications in the other two groups. There was no recurrence after the wound healing of follow-up six months. ConclusionsAccording to this limited preliminary data, the selection of wound closure method depends on the incision tension. Direct suturing can be the choice for incision with lower tension. The marsupialization can be the choice for incision with higher tension. The Limberg flap transposition can be the choice for incision with extensive disease or postoperative recurrence.
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 evaluate the value of magnetic resonanace imaging (MRI) on the diagnosis of complex anal fistula. Methods The preoperative digital examination and MRI with the phased-array coil were implemented for 22 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results. Results Eighteen patients were diagnosed as complex anal fistula, 1 case of presacral cyst and 3 cases of chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI, while the patients with presacral cyst and perinaal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients suffered from transsphincteric fistula, 11 cases of supra-sphincteric and 5 cases of extra-sphincteric fistula. The diagnosis rates of the internal opening with digital examination and MRI were 33.3% and 72.2%, the rates of the primary tract were 83.3% and 100%, and the rates of the secondary extensions were 16.7% and 88.9%, respectively. The differences in detection of internal opening and secondary extensions between MRI and digital examination were significant (P=0.019, P=0.000), the difference in detection of primary tract was no significant (P=0.072). Conclusion MRI with the phased-array coil can develope the high accuracy in the diagnosis of complex anal fistulas, and reveal the relationship between anorectal sphincters and the complex fistula.
ObjectiveTo summarize the recent development of surgical treatment for chronic anal fissure. MethodsThe related literatures on various operation treatment of anal fissure at home and abroad in recent years were collected and reviewed. ResultsThere are many operation treatment methods of anal fissure, includes the closed or open lateral internal sphincterotomy, excision of anal fissure, skin flap plasty, and other operation modes.The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications and the recurrence risk. ConclusionFor what kind of operation method is the most suitable for the treatment of chronic anal fissure is no fixed conclusion.
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.
Objective To explore the clinical characteristics of Crohn’s disease (CD) with perianal fistula by analyzing the clinical data of them. Methods A total of 139 cases of CD with perianal fistula who got treatment from January 2010 to January 2017 in The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were analyzed retrospectively. Results The proportion of males and females in 139 patients was about 3.3∶1.0, the age was (28±8) years, and 47.5% of patients had perianal fistula before CD diagnosis. The percents of patients with perianal surgery history and medication history were 64.7% and 74.1%, respectively. The ratio of L3 type (diseased position) was 49.6%. The ratios of inflammatory type (B1 type) and stenotic type (B2 type) of the disease were 51.8% and 41.0%, respectively. The complex perianal fistula accounted for 90.6%, and 31.7% of patients combined analrectal stricture. Symptoms of diarrhea were found in 46.0% of patients and perianal lesions alone in 29.5% of patients; 54.0% of patients combined with abnormal BMI; 64.7% of patients were in the active stage of Crohn’s disease activity index (CDAI) and 94.2 % of patients were in the active period of perianal disease activity index (PDAI). The patients with erythrocyte sedimentation rate (ESR) higher than normal were 53.2%. The results of logistic showed that, age and degree of CDAI were influencing factors for CD with stenosis of perianal fistula. Conclusions Characteristics of patients with CD combined with perianal fistula include: young, men predominant, high prevalence of ileocolic position involvement, as well as inflammation and stenosis disease behavior. Fistula symptoms often preced the intestinal symptoms and diarrhea is the most common intestinal performance. History of perianal abscess and fistula operation are common. The anorectal stricture are complicated usually. Intestinal inflammation is active. Some patients show abnormal laboratory indicators of inflammation. This suggests that patients with perianal fistula with these clinical features should be alert to the possibility of CD, so as toavoid the consequences of blind surgery. The higher CDAI score and the older the diagnosis age, the higher the risk ofrectal stenosis.