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anorectal functional outcome after repeated transanal endoscopic microsurgery

World Journal of Gastroenterology 2012年第40期18卷 5807-5811页

作者： Hong-Wei Zhang Xiao-Dong Han Yu Wang Pin Zhang Zhi-Ming Jin Department of General Surgery the Sixth Peo-ple's Hospital Affiliated to Shanghai Jiao Tong UniversityShanghai 200233China

AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large （〉 1 cm） polyps in the remaining rectum （range： 6-20 cm from the anal edge）. All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. anorectal manometry and a question- naire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maxi- mum squeeze pressure, maximum tolerable volume （MTV） and rectoanal inhibitory reflexes （RAIR） were recorded. The integrity and thickness of the internal anal sphincter （IAS） and external anal sphincter （EAS） were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life （QoL）. RESULTS： All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38±5 mmHg to 19±3 mmHg （38±5 mmHg vs 19±3 mmHg, P = 0.000） and MTV from 165± 19mLto60± 11mL（165± 19mLvs60± 11 mL, P = 0.000） at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg （38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057） and 159 ± 19 mL （165 ± 19 mL vs 159 ± 19 mL, P = 0.071）, respectively, at month 6 after TEM. Maximal squeeze pressure de- creased from 171 ± 19 mmHg to 62 ± 12 mmHg （171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000） at week 2 after operation, and returned to normal values by postoperative month 3 （171 ± 19 vs 166 ± 18, P = 0.051）. RAIR were absent in 4 patients preoperatively and in 12 （χ2 = 4.947, P = 0.026） patients at month 3 after surgery. PAIR was absent only in 5 patients

关键词： Familial adenomatous polyposis Repeatedtransanal endoscopic microsurgery anorectal function anorectal manometry Subtotal colectomy

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Sphincter preservation for distal rectal cancer - a goal worth achieving at all costs?

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World Journal of Gastroenterology 2011年第7期17卷 855-861页

作者： Jürgen Mulsow Des C Winter Institute for Clinical Outcomes Research and Education St. Vincent’s University Hospital

To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.

关键词： Rectal cancer Survival Local recurrence Morbidity anorectal function Quality of life Patient preference

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Diverting colostomy is an effective and reversible option for severe hemorrhagic radiation proctopathy

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World Journal of Gastroenterology 2020年第8期26卷 850-864页

作者： Zi-Xu Yuan Qi-Yuan Qin Miao-Miao Zhu Qing-Hua Zhong Alessandro Fichera Hui Wang Huai-Ming Wang Xiao-Yan Huang Wu-Teng Cao Ye-Biao Zhao Lei Wang Teng-Hui Ma Department of Colorectal Surgery The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655Guangdong ProvinceChina Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases Guangdong Institute of GastroenterologyThe Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655Guangdong ProvinceChina Department of Surgery University of North CarolinaChapel HillNC 27514United States Department of Radiology The Sixth Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510655Guangdong ProvinceChina

BACKGROUND Severe chronic radiation proctopathy(CRP) is difficult to *** To evaluate the efficacy of colostomy and stoma reversal for *** To assess the efficacy of colostomy in CRP,patients with severe hemorrhagic CRP who underwent colostomy or conservative treatment were *** with tumor recurrence,rectal-vaginal fistula or other types of rectal fistulas,or who were lost to follow-up were *** bleeding,hemoglobin(Hb),endoscopic features,endo-ultrasound,rectal manometry,and magnetic resonance imaging findings were *** of life before stoma and after closure reversal was scored with *** functions were assessed using the CRP symptom scale,which contains the following items:Watery stool,urgency,perianal pain,tenesmus,rectal bleeding,and fecal/gas *** A total of 738 continual CRP patients were *** exclusion,14 patients in the colostomy group and 25 in the conservative group were included in the final *** Hb was only 63 g/L ± 17.8 g/L in the colostomy group compared to 88.2 g/L ± 19.3 g/L(P functions and quality of life were significantly improved after stoma reversal,when compared to those before stoma *** Diverting colostomy is a very effec

关键词： Chronic radiation proctitis Hemorrhage Colostomy anorectal function Quality of life

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anorectal dysfunction in patients with mid-low rectal cancer after surgery: A pilot study with three-dimensional high-resolution manometry

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World Journal of Clinical Cases 2022年第12期10卷 3754-3763页

作者： Yan-Na Pi Yi Xiao Zhi-Feng Wang Guo-Le Lin Hui-Zhong Qiu Xiu-Cai Fang Department of Gastroenterology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of General Surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

BACKGROUND The quality of life in patients who develop low anterior resection syndrome(LARS)after surgery for mid-low rectal cancer is seriously *** underlying pathophysiological mechanism of LARS has not been fully *** To assess anorectal function of mid-low rectal cancer patients developing LARS *** Patients diagnosed with mid-low rectal cancer were *** LARS score was used to evaluate defecation symptoms 3 and 6 mo after anterior resection or a stoma reversal *** functions were assessed by threedimensional high resolution anorectal manometry preoperatively and 3-6 mo after *** The study population consisted of 24 *** total LARS score was decreased at 6 mo compared with 3 mo after surgery(Panorectal dysfunctions, especially focal pressure defects of the anal canal and spasticperistaltic contractions from the new rectum to anus postoperatively, might be the majorpathophysiological mechanisms of LARS.

关键词： Low anterior resection syndrome anorectal function Three-dimensional high-resolution manometry Rectal cancer

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Sensory threshold for defecation and its correlation with pelvic organ prolapse:An exploration of related factors

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Gynecology and Obstetrics Clinical Medicine 2023年第3期3卷 149-153页

作者： Yanhua Liu Man Tan Cheng Tan Xin Yang Department of Obstetrics and Gynecology Peking University People's HospitalBeijingChina Department of Gynecological Pelvic Floor and Oncology Chongqing Health Center for Women and ChildrenChongqingChina

Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall *** A total of 214 patients with pelvic organ prolapse were recruited between October 2019 to January *** patients underwent a defecation sensory threshold examination,physical examination,and pelvic floor ultrasound *** related to the defecation sensory threshold were ***(1)Among the participants,57 patients(26.6%)had a defecation sensory threshold of more than 90*** with a threshold>90ml showed higher scores of defecation dysfunction in the Constipation Scoring System(CSS)score(p=0.003)and higher scores of constipation in the Colorectal-anal Distress Inventory 8(CRADI-8)score(p=0.002).(2)The defecation sensation threshold positively correlated with the Ap point(r=0.448,p<0.001),the Bp point(r=0.345,p=0.009),the area of the levator-ani hiatus measured by transvaginal ultrasound(r=0.403,p=0.002),and parity(r=0.355,p=0.007).Conclusions Patients diagnosed with pelvic organ prolapse commonly experience an increased threshold of defecation *** thresholds were associated with more frequent constipation ***,the severity of posterior pelvic prolapse positively correlated with the defecation sensory threshold.

关键词： anorectal function Defecation sensory threshold Pelvic organ prolapse

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Evaluation of pelvic visceral functions after modified nerve-sparing radical hysterectomy

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Chinese Medical Journal 2014年第4期127卷 696-701页

作者： Wang Wenwen Li Bin Zuo Jing Zhang Gongyi Yang Yeduo Zeng Hongmei Li Xiaoguang Department of Gynecologic Oncology Cancer Hospital Peking Union Medical College Chinese Academy of Medical SciencesBeijing 100021 China National Office for Cancer Prevention and Control Cancer Hospital Peking Union Medical College Chinese Academy of Medical SciencesBeijing 100021 China

Background Nerve-sparing radical hysterectomy （NSRH） was developed in an attempt to minimize complications after radical *** 2008,a modified NSRH-nerve plane-sparing radical hysterectomy （NPSRH） has been developed at the Cancer Hospital,Chinese Academy of Medical *** aim of this study was to investigate the role of NPSRH in improving postoperative pelvic visceral *** Eighty-three patients with International Federation of Gynecology and Obstetrics （FIGO） stage IB1-IIA2 cervical cancer received NPSRH （the study group） from January 2008 to October *** hundred and sixty-six patients who underwent conventional radical hysterectomy （CRH） were randomly selected as the control ***,pathological type and stage were matched between the two *** safety of surgery was assessed by duration of operation and blood transfusion *** short-term bladder function was analyzed by duration of ***-term bladder,anorectal and sexual function were evaluated with *** Seventy-eight patients （94.0%） in the NPSRH group and one hundred and sixty patients （96.4%） in the CRH group completed the *** follow-up time was 31.9 months and 31.0 months respectively （P=0.708）.There was no significant difference between the two groups in terms of age,body mass index,FIGO stage,pathologic type,preoperative and postoperative therapy （P 〉0.05）.The blood transfusion rate shared no difference between two groups （P=0.364）.The operation time in the NPSRH group was significantly longer than CRH group （P 〈0.01）.But the duration of catheterization and hospitalization in the NPSRH group was significantly reduced compared with CRH group （P 〈0.01）.In addition,the incidence of long-term urinary frequency,urinary incontinence,urinary retention,straining to void,constipation and diarrhea was significantly lower in the NPSRH group （P 〈0.05）.However,there was no significant difference regarding sexual function （

关键词： cervical neoplasm nerve-sparing radical hysterectomy modification bladder function anorectal function sexual function

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Observation on Curative Effect of Self-made Wubeizi Decoction Combined with rhaFGF in Promoting Postoperative Wound Healing in Patients with Anal Fistula

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Medicinal Plant 2023年第3期14卷 74-77,81页

作者： Yingnan YANG Dan GAN Zhiqiang YUAN Dongqin WANG Yu CHEN TCM anorectal Department Luodian Hospital in Baoshan DistrictShanghai 201908China Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University Shanghai 200437China

[Objectives]To explore the curative effect of Self-made Wubeizi Decoction combined with recombinant human acidic fibroblast growth factor(rhaFGF)in promoting postoperative wound healing in patients with anal fistula.[Methods]A total of 82 patients with anal fistula who underwent anal fistula resection+use of setons in Luodian Hospital during January and March of 2020 were randomly divided into observation group and control group with 41 cases in each *** control group was given rhaFGF external application regimen,and the observation group was treated with Self-made Wubeizi Decoction on the basis of the control *** 3 weeks of treatment,the differences in curative effects of TCM syndromes were compared between the two ***,the changes in TCM symptom scores,inflammatory mediators[interleukin-12(IL-12),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ)],anorectal functions[anal resting pressure(ARP),maximal systolic pressure(MSP)and maximum tolerated volume(MTV)of the anal canal],quality of life[GQOLI-74 scores]were compared.[Results]After 3 weeks of treatment,the total effective rate of the observation group was significantly higher than that of the control group(Panorectal function and improve the quality of life,thus has high clinical application value.

关键词： Self-made Wubeizi Decoction Recombinant human acidic fibroblast growth factor(rhaFGF) Anal fistula Anal fistula resection Wound healing Inflammatory mediators anorectal function Quality of life

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