ObjectiveTo summarize the causes, clinical manifestations, diagnosis and treatment methods for the intestinoseminal vesicle fistula. MethodLiteratures about intestinoseminal vesicle fistula at home and abroad were retrieved, the causes, clinical manifestations, diagnosis and treatment methods were analyzed. ResultsThe clinical reports of 19 patients with intestinoseminal vesicle fistula were searched.The intestinoseminal vesicle fistula occurred after the rectal low anterior resection with stomal leak, sigmoid diverticulum, inflammatory bowel disease, prostatectomy or radiotherapy.The main clinical symptoms were pneumaturia, fecaluria, fever, scrotal swelling and pain, orchitis, epididymitis and so on.Imaging methods such as enhanced CT or CT with rectal contrast and so on could confirm the diagnosis.The conservative treatment such as indwelling catheter, antibiotics, parenteral nutrition, and the operation methods such as sinus incision and drainage, mucosa/skeletal muscle flap repairment, urine/stool bypass could cure majority of cases. ConclusionsThe intestinoseminal vesicle fistula is a rare and independent disease.Through the discussion of the intestinoseminal vesicle fistula, it could improve the knowledge, and avoid misdiagnosis and mistreatment of the intestinoseminal vesicle fistula.
ObjectiveThe low anterior resection syndrome (LARS) score is a simple and visual instrument assessing sphincter preserving surgery for low rectal cancer. The purpose of this study is to analyze the feasibility of using LARS score to assess the function after intersphincteric resection for low rectal cancer. MethodsBetween March 2013 and June 2015, 76 patients underwent sphincter preserving surgery for low rectal cancer, 23 cases underwent intersphincteric resection set as ISR group, the other 53 cases received low anterior resection set as LAR group. LARS score, Saito function questionnaire, Wexner score, and European organization for research and treatment of cancer (EORTC) quality of life questionnaire core 30 (QLQ-C30), questionnaire module for colorectal cancer (QLQ-CR29) were compared for the two groups. ResultsThere were 63.2 percent patients (48/76) appeared major LARS, 27.6 percent (21/76) minor LARS and 9.2 percent (7/76) no LARS, there were no statistically difference between the ISR and LAR groups (P=0.727), but the item of incontinence due to liquid stools appeared more obvious in ISR group (P=0.009). The items of faecel incontinence and sore skin for EORTC QLQ-CR29 were serious in ISR group (P < 0.05), the other item of EORTC QLQ-CR29 and EORTC QLQ-C30, Saito function questionnaire, Wexner score were similar between the two groups (all P > 0.05). ConclusionThe anal function after intersphincteric resection is non-inferior to the low anterior resection for low rectal cancer, but both can appear serious low anterior resection syndrome.
ObjectiveTo compare anal function and quality of life between partial longitudinal resection of the anorectum and sphincter (PLRAS) and intersphincteric resection (ISR) for rectal cancer. MethodsNinety-nine cases of very low rectal cancer were classified as PLRAS group (n=23) and ISR group (n=76) according to different surgical method. Anal function was assessed by Saito function questionnaire and the Wexner scale in 6, 12, and 24 months after operation. At the same time, quality of life was assessed by European Organization for research and treatment of cancer quality of life questionnaire CR29 (EORTC-QLQ-CR29). Results①Anastomosis stenosis:compared with ISR group, the situation on anastomosis stenosis was worse in 6 months (P < 0.001) and 12 months (P=0.003) after operation, but didn't significantly differed in 24 months after operation (P=0.230).②Results of the Saito function questionnaire:compared with ISR group, there were higher incidence on stool fragmentation (P=0.016), dyschesia (P=0.008), and feces-flatus discrimination (P < 0.001) in PLRAS group in 6 months after operation, and the incidence of feces-flatus discrimination was still higher in 12 months (P=0.017), but there was no any significant difference in 24 months after operation (P > 0.05).③Results of Wexner scale:there were no statistical difference between the 2 groups at all recorded times (P > 0.05).④Results of EORTC-QLQ-CR29 questionnaire:in 6 months after operation, the scores of flatulence (P=0.003), faecal incontinence (P=0.043), and sexual interest in women (P=0.023) of PLARS group were lower than ISR group but higher in buttock pain (P=0.031) and dyspareunia (P=0.006). In 12 months after operation, the scores of flatulence (P=0.012) and sexual interest in women (P=0.017) were both lower than ISR group, but score of dyspareunia was higher (P=0.012). In 24 months after operation, there was no any significant difference (P > 0.05). ConclusionsPLRAS surgery have worse situation of anastomosis stenosis and sexual function in women than ISR surgery before 12 months after operation, but have analogous effect in 24 months after operation.
ObjectiveTo analyze the safety and feasibility of laparoscopic intersphincteric resection with stapled colo-anal anastomosis under direct vision for low rectal cancer. MethodsFrom January 2001 to March 2012, 138 patients were underwent intersphincteric resection for low rectal cancer, 45 cases of whom were received laparoscopic surgery and stapled colo-anal anastomosis (SCAA group), and the other 93 cases (55 open and 38 laparoscopic) of whom were received hand-sewn colo-anal anastomosis (HCAA group). The morbidity comparison only involed the data of relevant to the anastomosis. The anus functional outcomes, including those from the Saito function questionnaire and Wexner score, were compared and only involved the data of relevant to the laparoscope. Results①The anastomotic complications rates were similar for the fistula, bleeding, and rectal mucosal prolapse (P > 0.05); the rate of anastomosis leakage and the degree of anastomotic stricture in the SCAA group were significantly lower (or milder) than those in the HCAA group (P=0.001 and P=0.022, respectively).②As for the functional results, the incidence of dyschesia in the SCAA group was significantly lower than that in the HCAA group (P=0.016), and the other 7 items of Saito function questionnaire and Wexner score were similar between these two groups (P > 0.05). ConclusionsCompared with traditional intersphincteric resection for low rectal cancer, laparoscopic surgery with stapled colo-anal anastomosis could reduce the morbidity and the anus function is non-inferior to the former.
ObjectiveTo systematically evaluate the stress response of laparoscopic surgery (LS) and conventional open surgery (OS) in patients with colorectal cancer. MethodsThe literatures about the immune stress response of LS and OS for colorectal cancer were collected from PubMed, Springer, OVID, Cochrane library, CNKI, VIP Database, and Wanfang Database from May 2001 to September 2014. RevMan 5.3 software was used for data analysis. ResultsFifteen randomized controlled trials including 881 patients were brought into this Meta analysis, of 881 patients, 424 patients were treated with LS and 457 patients were treated with OS. The results of Meta-analysis showed that:①At 24, 72, and 120 hours after surgery, the levels of interleukin (IL-6) in LS group were all lower than those of OS group at same time point[24 h (WMD=-27.78, 95% CI:-43.24--12.32, P < 0.01), 72 h (WMD=-13.23, 95% CI:-19.89--6.57, P < 0.01), 120 h (WMD=-16.51, 95% CI:-30.13--2.89, P=0.02)]. ②At 24, 72, and 120 hours after surgery, the levels of C reactive protein (CRP) in LS group were all lower than those of OS group at same time point[24 h (WMD=-31.11, 95% CI:-47.49--14.73, P < 0.01), 72 h (WMD=-29.81, 95% CI:-49.99--9.64, P < 0.01), 120 h (WMD=-32.03, 95% CI:-45.34--18.71, P < 0.01)]. ③There was no significant difference between the 2 groups in WBC level at 24 hours after surgery (WMD=-0.63, 95% CI:-1.80-0.54, P=0.29), but the WBC levels of LS group at 72 hours and 120 hours after surgery were lower than those of OS group[72 h (WMD=-0.21, 95% CI:-0.41--0.01, P=0.04), 120 h (WMD=-0.86, 95% CI:-1.66--0.06, P=0.03). ④There was no significant difference between the 2 groups in cortisol level at 24 hours and 72 hours after surgery[24 h (WMD=-60.19, 95% CI:-194.77-74.39, P=0.38), 72 h (WMD=-13.83, 95% CI:-43.94-16.28, P=0.37). ⑤There was no significant difference between the 2 groups in blood glucose level at 24 hours and 72 hours after surgery[24 h (WMD=-0.95, 95% CI:-2.74-0.84, P=0.30), 72 h (WMD=-0.69, 95% CI:-2.05-0.66, P=0.32)]. ⑥There was no significant difference between the 2 groups in insulin level (WMD=-0.52, 95% CI:-1.87-0.82, P=0.45) at 24 hours after surgery. ⑦There was no significant difference between the 2 groups in tumor necrosis factor (TNF) level at 24 hours after surgery (WMD=-4.18, 95% CI:-9.39-1.04, P=0.12). ConclusionCompared with open radical surgery, laparoscopic radical surgery for colorectal cancer causes less stress and less effect on the immune function, it also can reduce postoperative complications and can be propitious to faster body recovery.