Effects of an anal fistula plug on anal function after surgery for treatment of a trans-sphincteric anal fistula.

PURPOSE: The aim of this study was to evaluate the anal function in patients with trans-sphincteric anal fistulas who underwent an anal fistula plug procedure, and analyze risk factors that might affect post-operative anal function. METHODS: This was an observational, retrospective study of patients diagnosed with trans-sphincteric anal fistulas and initially underwent anal fistula plug procedures between August 2008 and September 2012 at our institute. The analysis includes clinical characteristics, anal fistula healing, and the Wexner score for pre- and post-operative anal function (0 = no incontinence to 20 = complete incontinence). RESULTS: A total of 123 patients who had an adequate follow-up in the end were included. The median duration of follow-up was 8 years (range 72-121 months). The overall healing rate was 56% (69/123), and 33 (26.8%) patients had decreased anal function after surgery. The post-operative Wexner score on anal function was significantly higher than that before the operation (p < 0.001), as well as scores of gas, liquid stool, solid stool incontinence, and alteration in lifestyle (p < 0.05). Based on multiple logistic regression analysis, a high body mass index (p < 0.001) and long distance between the external opening and anal verge (p = 0.003) were significantly associated with a decline in post-operative anal function. CONCLUSIONS: As a sphincter-preserving technique for the treatment of anal fistulas, the anal fistula plug procedure might impair the anal function. Especially for patients with obesity or long distance between the external opening of anal fistula and anal verge, the reduced anal function is more likely to occur after treatment with anal fistula plug therapy.

Long-Term Clinical Results of Use of an Anal Fistula Plug for Treatment of Low Trans-Sphincteric Anal Fistulas.

BACKGROUND An anal fistula plug is a sphincter-sparing procedure that uses biological substances to close an anorectal fistula. This study aimed to evaluate the long-term therapeutic effect of an anal fistula plug procedure in patients with trans-sphincteric fistula-in-ano and to determine the risk factors affecting fistula healing. MATERIAL AND METHODS A single-center retrospective study was performed assessing long-term treatment outcomes of patients with low trans-sphincteric anal fistulas who initially underwent anal fistula plug procedures between August 2008 and September 2012. Risk factors affecting fistula healing were identified using univariate and multivariate analyses. RESULTS A total of 135 patients who had low trans-sphincteric anal fistulas and underwent anal fistula plug procedures were analysed. The overall healing rate was 56% (75/135) with a median follow-up time of 8 years (range, 72-121 months). The primary reasons for treatment failure were plug extrusion (n=12, 20%) and surgical site infection (n=9, 15%), occurring within 30 days after surgery. Multiple logistic regression analysis showed that the duration of anal fistula ≥6 months was significantly associated with treatment failure using an anal fistula plug (OR=3.187, 95% CI: 1.361-7.466, P=0.008). Of the patients who failed initial treatment with an anal fistula plug, 6 (9%) had anal fistulas that healed spontaneously after 2-3 years without additional treatment. CONCLUSIONS As a sphincter-preserving procedure, the anal fistula plug can effectively promote healing of low trans-sphincteric anal fistulas. The long-term efficacy is good and the procedure warrants wider use in clinical practice.

Essential oil of Cinnamon exerts anti-cancer activity against head and neck squamous cell carcinoma via attenuating epidermal growth factor receptor - tyrosine kinase.

PURPOSE: Impressed by the exceptional anticancer activity of cinnamon, the present study was conducted to elucidate the anticancer potential of essential oil of Cinnamon (EOC). METHODS: EOC was tested against various cell lines (FaDu, Detroit-562 and SCC-25) of head and neck squamous cell carcinoma (HNSCC) using MTT assay. The Hep-2 cell xenograft model was used to assess the positive bio-activity of EOC. EGFR-TK inhibitory assay was also carried out to explain the possible mechanism of action of EOC. Moreover, to rationalise the key contacts responsible for attenuating EGFR, the major component of EOC, i.e., trans-cinnamaldehyde, as identified by GC-MS analysis, was subjected to molecular docking experiments with the catalytic domain of EGFR protein model. RESULTS: EOC exhibited significant anticancer activity with percent inhibition 66.12, 87.32, and 99.34%, against FaDu, Detroit-562 and SCC-25, respectively. Moreover, EOC reduced the tumor burden to 43.5% in Hep-2 cell xenograft model along with 89% inhibition of EGFR-TK activity in the EGFR-TK inhibitory assay. Docking experiments showed that trans-cinnamaldehyde was proficiently fitted into the inner grove of the active site of EGFR by making close inter-atomic contacts with the key catalytic residues Val702, Ala719, Lys721, Leu764, Thr766 and Leu820 and with inhibition constant Ki = 775.93 µM. CONCLUSION: EOC exhibits significant anticancer activity against HNSCC cells in vitro. The mechanism underlying its anticancer action was attributed to the suppression of EGFR-TK. It also significantly suppressed the tumor growth in Hep-2 cell xenograft model.

[A multi-center, randomized, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure].

OBJECTIVE: To evaluate the clinical efficacy and safety of glyceryl trinitrate (GTN) ointment in the treatment of anal fissure. METHODS: In this multi-center, randomized, double-blind and placebo-controlled trial, 240 chronic anal fissure patients from 7 clinical centers were randomized to receive eight-week treatment with GTN ointment (treatment group) or vaseline ointment (control group) respectively. Healing rate, visual analogue score (VAS), maximum anal resting pressure (MARP) and adverse reactions were recorded and compared. RESULTS: A total of 221 patients (92.1%) finished the trial, including 114 patients in treatment group (95.0%, 114/120) and 107 in control group (89.2%, 107/120). At the endpoint of treatment (56 d), 90 patients in treatment group (78.9%, 90/114) healed completely compared to 31 patients in control group (29.0%, 31/107), and decrease rates of VAS in the two groups were (94.8±15.7)% and (61.2±35.7)% respectively, both differences were statistically significant (P<0.01). MARP after first administration was (20.2±18.5) mm Hg in treatment group (n=12) and (7.1±14.7) mm Hg in control group (n=6), which was not significantly different (P=0.152). Adverse reaction incidence was higher in treatment group (42.1% vs. 9.3%, P<0.05), while these adverse reactions were mainly headache and fullness in head, which were self-limiting. CONCLUSION: GTN ointment can effectively promote healing and relieve pain in anal fissure with safety and tolerance.

[Ligation of the intersphincteric fistula tract plus bioprosthetic anal fistula plug (LIFT-plug) in the treatment of transsphincteric perianal fistula].

OBJECTIVE: To assess the treatment outcome of ligation of the intersphincteric fistula tract plus bioprosthetic anal fistula plug(LIFT-plug) for transsphincteric perianal fistulas. METHODS: Clinical data of 36 patients with transsphincteric perianal fiftula who were managed by the LIFT-plug technique between November 2010 and February 2012 were analyzed retrospectively. RESULTS: Clinical healing of the fistula, defined as the absence of drainage with no evidence of residual fistula tract, occurred in 34(94.4%) patients. The operative time ranged from 12 to 35 minutes(mean, 17 minutes). The median postoperative length of stay was 5 days. The median healing time was 18 days. No complications requiring intervention occurred. The postoperative follow up was at least 3 months and two patients had recurrence(5.6%). CONCLUSIONS: LIFT-plug procedure for the management of transsphincteric perianal fistulas is simple with high healing rate, minimal invasiveness, quick healing, and without disturbance to anal function. LIFT-plug is an ideal procedure for intrasphinteric fistula.

[Study of healing mechanism of acellular dermal matrix in the treatment of anal fistula].

OBJECTIVE: To evaluate the efficacy of acellular dermal matrix(ADM) in the closure of anal fistula in an experimental porcine model, and to explore its healing mechanism. METHODS: The fistula-in-ano model was created and treated with ADM in the porcine model (n=14). Fistula specimens were obtained at hour 12, 24 and day 3, 7, 14, 28, 60 respectively with 2 pigs in each time point. Hematoxylin and eosin staining and immunohistochemical staining for the alpha smooth muscle actin (α-SMA) were performed. RESULTS: At 12 hours after implantation, neutrophils and scattered cells with a fibroblastic appearance were present at the interface and began to infiltrate into the ADM. The cell density increased from hour 12 (218.2±58.2) to day 7(998.7±128.0) (P<0.01), and decreased from day 7 to day 28. Mature vessels and myofibroblasts stained with α-SMA were identified at the edge of ADM at day 7. The density of vessels (11.2±3.3 vs. 30.5±5.2, P<0.01) and myofibroblasts (3.8±0.8 vs. 6.8±0.4, P<0.01) increased from day 7 to day 14. Partially organized bundles of muscle were found at day 60. CONCLUSIONS: ADM is a reasonable new option for the closure of anal fistula. The ability of ADM to become vascularized and remodeled by autologous cells may be advantageous for anal fistula healing and other chronic septic wound.

Long-term outcomes of human acellular dermal matrix plug in closure of complex anal fistulas with a single tract.

BACKGROUND: Bioprosthetic plugs represent a promising technique for the treatment of anal fistula simple because they allow simple and repeatable application, preservation of sphincter integrity, minimal patient discomfort, and subsequent surgical options if needed. However, success rates vary widely. OBJECTIVE: The aim of this study was to assess long-term outcome in patients treated with an acellular dermal matrix plug for closure of complex single-tract anal fistulas. DESIGN: This was a retrospective analysis of a prospective database. SETTING: The study was conducted at a university hospital in Beijing, People's Republic of China. PATIENTS: The study population comprised 114 patients treated between January 2007 and May 2010 for complex high transsphincteric anal fistula with a single tract. INTERVENTION: Fistulas were treated with an acellular dermal matrix plug derived from donated human skin. MAIN OUTCOME MEASURES: The main outcome measures were fistula closure rate and postoperative incontinence (Wexner scores). RESULTS: No mortality or major complications were observed. The overall success rate was 54.4% (62/114), with a median follow-up of 19.5 (range, 11-46) months. Of the 52 patients with plug failure, 11 (21%) had plug extrusion and 9 (17%) had sepsis. Most plug failures occurred within 30 days, with only 1 plug failure occurring 6 months after surgery. On multiple logistic regression analysis, smoking (P < .001), long distance between external opening (P < .001), and performance of the operation by a nonexpert surgeon (P = .018) were significantly associated with plug failure. Of 40 patients who underwent cutting seton placement after plug failure, 33 (82.5%) reported a successful outcome. However, the rate of incontinence 6 months after seton placement was 75% (30/40), whereas the rate in the overall study population 6 months after insertion of the ADM plug was 1.75% (2/114; P < .001). LIMITATIONS: This study was limited by its retrospective nature. CONCLUSIONS: Given the low morbidity and relative simplicity of the procedure, we suggest that an acellular dermal matrix plug is a reasonable option for closure of complex anal fistulas with a single tract.

Histologic analysis of acellular dermal matrix in the treatment of anal fistula in an animal model.

BACKGROUND: Human acellular dermal matrix (ADM) has been used successfully for the treatment of severe burns, ureter support, and abdominal wall reconstruction. This study was designed to evaluate the mechanism of ADM in the closure of anal fistula in an experimental porcine model. STUDY DESIGN: The fistula-in-ano model was created in the porcine model and treated with ADM in 14 animals. Fistula specimens were obtained at hours 12 and 24 and on days 3, 7, 14, 28, 60. Hematoxylin and eosin staining, Masson trichrome staining, and immunohistochemical staining for alpha smooth muscle actin and matrix metalloproteinase 9 were performed. RESULTS: The cell density increased from hour 12 to day 7 and decreased from day 7 to day 28 (p < 0.001). Mature vessels stained with alpha smooth muscle actin were identified at day 7. Alpha smooth muscle actin-positive myofibroblasts were found in clusters at the edge of the ADM at day 7. The density of vessels (p < 0.001) and myofibroblasts (p < 0.001) increased from day 7 to day 14. The density of matrix metalloproteinase 9 increased from hour 12 to day 7 and decreased from day 14 to day 60 (p < 0.001). Partially organized bundles of muscle were found by day 60. CONCLUSIONS: We suggest that ADM is a reasonable new option for closure of anal fistulas. Anal fistulas begin to heal as early as 12 hours, and day 7 may be an important time point to judge whether the fistula healed preliminarily or not. The ability of ADM to become vascularized and remodeled by autologous cells may be advantageous for anal fistula healing.

[Efficacy of cellulose on functional constipation].

OBJECTIVE: To assess the clinical efficacy and safety of cellulose on functional constipation. METHODS: A prospective, self-controlled, multicenter clinical trial of cellulose was conducted for 2 weeks in 240 patients with functional constipation according to the Rome III( criteria. Symptoms and characters of feces before and after the treatment were observed and evaluated according to a score scheme. RESULTS: In the 240 patients, the frequencies of defecation increased and the characters of feces was improved significantly after 2-week treatment. There were no adverse reactions observed throughout the clinical trial. The total efficacy was 82.1% at day 7 and 90.7% at day 14. The satisfactory rate of doctors was 83.8% and of patients was 83.8%. CONCLUSION: Cellulose is effective and safe in the treatment of chronic functional constipation.

[Application of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome].

OBJECTIVE: To evaluate the sensitivity and feasibility of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome. METHODS: One hundred and nine female with pelvic floor disorders, such as difficult defecation, fecal incontinence or urinary incontinence, pelvic pain, were treated from July 2007 to March 2009. Pelvic floor dynamic MRI and defecography with homemade high conformable sacculus was performed in the patients to evaluate pelvic floor anatomy. RESULTS: Fifty-four cases (49.6%) of cystocele and 11 cases (10.1%) of rectouterine pouch hernia, 29 cases (26.6%) of perineum prolapse and 71 cases (65.2%) of rectocele were found by dynamic MRI. The dynamic MRI also revealed 19 cases (18.2%) of external sphincter trophy and 32 cases (29.4%) of spastic pelvic floor syndrome. Compared with defecography, dynamic MRI was more positive in diagnosing enterocele. Defecography Of the patients, sacrum-rectal separate was found in 33 cases (30.3%) and rectal mucosal prolapse or internal rectal intussusceptions in 41 cases (37.7%) by defecography, while dynamic MRI found none. CONCLUSIONS: As a new noninvasive imaging technique to evaluate the pelvic floor function, dynamic MRI is more sensitive, especially for patients with complicated multi-organs prolapse, and its deficiency could be remedied by defecography.

An anorectal fistula treatment with acellular extracellular matrix: a new technique.

AIM: To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix (AEM). METHODS: Thirty patients with anorectal fistula were treated with AEM. All fistula tracts and primary openings were identified using conventional fistula probe. All tracts were curetted with curet and irrigated with hydrogen peroxide and metronidazole. The AEM was pulled into the fistula tract from secondary to primary opening. The material was secured at the level of the primary opening. The excess AEM was trimmed at skin level at the secondary opening. RESULTS: All of the 30 patients had successful closure of their fistula after a 7-14 d follow-up. The healing rate of anal fistula in treatment group was 100%. The ache time, healing time and anal deformation of treatment group were obviously superior to traditional surgical methods. CONCLUSION: Using AEM anal fistula plug in treatment that causes the anorectal fistula is safe and successful in 100% of patients. It can reduce pain, shorten disease course and protect anal function.

Non-invasive measurement of pan-colonic pressure over a whole digestive cycle: clinical applications of a capsule-style manometric system.

AIM: To study the prolonged colonic motility under normal conditions with a novel capsule-style micro-system and to assess its clinical significance. METHODS: A single use telemetry capsule (10 mm in diameter, 20 mm in length) embedded with a pressure sensor was ingested by the subjects. The sensor is capable of transmitting colonic pressure wirelessly for more than 130 h. The time of capsule entering the segmental colon was detected by ultrasound. The ultrasonic electrodes were mounted on the surface of the ileocecum and navel and at the junction of the left and rectosigmoid colon of the subjects in sequence, which were identified by abdominal X-rays with radiopaque markers. To verify the accuracy and reliability of ultrasonic detection of telemetry capsules at key points of colon, the segmental colonic transit time was simultaneously recorded by using radiopaque markers. RESULTS: The signal lamp showed that all recorders could receive the radio signal transmitted by the telemetry capsule. The X-rays showed that all telemetry capsules were detected successfully when they were passing through the key points of colon. There was a significant correlation between the transit results obtained by ultrasonic detection or by radiopaque markers. Colorectal recording was obtained from 20 healthy subjects during 613 h (411 h during waking, 202 h during sleep). Compared to waking, the number of pressure contractions and the area under pressure contractions were significantly (P < 0.05) decreased during sleep (21 +/- 5 h(-1) vs 15 +/- 4 h(-1), 463 +/- 54 mmHg x s/min vs 342 +/- 45 mmHg x s/min). The colonic motility exhibited significant regional variations both in the circadian behavior and in response to waking and meal. CONCLUSION: The capsule-style micro-system is reliable and noninvasive, and may represent a useful tool for the study of physiology and pathology of colonic motor disorders.

[The pathological characters and its clinical significance of internal hemorrhoids].

OBJECTIVE: To investigate the pathological characters and the corresponding clinical significance of internal hemorrhoids tissues. METHODS: Normal anal cushion and internal haemorrhoids tissue samples were obtained after stapled haemorrhoidectomy procedure from 24 grade III hemorrhoidal patients. The macroscopically normal cushions served as own controls and the normal cushions from a patient without a history of haemorrhoids as quality control. Routine Hematoxylin-Eosin and orcein were performed for elastic fibers. RESULTS: Compared with the corresponding normal anal cushions, the subepithelial vessels especially the cavernous vessels of the hemorrhoidal tissues showed obvious structural impair, retrograde changes, and the internal elastic lamina were ruptured and discontinuous. In addition, thrombosis and subsequent ischemic changes were observed. The Trietz's muscle and the fibro-elastic tissues showed hypertrophy, distortion, rupture and tortility. Obvious mucosal injury was observed in the mucous of hemorrhoidal tissues. Venous dilatation was infrequent in the hemorrhoidal tissues. CONCLUSIONS: The anal cushions of hemorrhoids disease patients show significant pathological changes. The pathological changes include structural impair, retrograde changes of the cavernous vessels and the hypertrophy, distortion, rupture and tortility of the Trietz's muscle and the fibroelastic tissues, and mucosal injury of the mucous membranes. These pathological changes are the basis of pathogenesis and development of hemorrhoids.

[Efficacy of intersphincteric resection in the sphincter-preserving operation for ultra-lower rectal cancer].

OBJECTIVE: To evaluate the clinical efficacy of intersphincteric resection in the sphincter- preserving operation for ultra-lower rectum cancer. METHODS: Thirty-one rectal cancer patients with the distal edge of the tumour less than 2 cm from the dentate line were evaluated. Eighteen advanced rectal cancer patients received preoperative chemo-radiation. Total mesorectal excision (TME) was performed with the rectum immobilized down, and the puborectal ligament and partial levator cut to the level of the dentate line. In some well-exposed patients, it was possible to further immobilize the rectum between the external sphincter ring and the rectum inner sphincter wall. In anal approach,good exposure was attained and the cut-line was made vertically to the anal canal 2 cm below the lower edge of the tumor, and further intersphincteric immobilization was made upright. Colon or colon pouch were anastomosed to the distal anal wall. RESULTS: There was no peri-operative death. Thirty patients had good fecal control. Twenty-nine patients showed no evidence of recurrence or metastasis after follow-up for 12 months. Recurrence occurred in one case 1 year after operation. Another one had higher CEA 19.9 level, but without evidence of metastasis. CONCLUSION: Radical resection can be attained and anal sphincter preserved by intersphincter resection which is an alternative sphincter-preserving operation.

[Comparison of the efficacy and safety of compound carraghenates cream and compound carraghenates suppository in the treatment of mixed hemorrhoids].

OBJECTIVE: To evaluate and compare the efficacy and safety of titanoreine cream with compound carraghenates suppository in the treatment of mixed hemorrhoids. METHODS: Two hundred and fifty-two patients with mixed hemorrhoids were enrolled in this randomized,open, multicentral trial. Patients applied titanoreine cream (study group, n=133) or compound carraghenates suppository (control group, n=119). The symptomatic relief including pain,bleeding and edema was evaluated by scoring system at 30 minutes, 3 hours, 6 hours, 1 day, 2 days, 3 days, 4 days, 6 days after administration. RESULTS: Symptoms were significantly improved in both groups (87.3%, 94.8%, respectively) excepting symptom of pain relief, but there was no significant difference between two groups (P > 0.05). The pain scores were lower at every observing point in the study group than those in the control group (P< 0.05). The proportions of the patients with pain relief and all symptoms relief were both higher in the study group than that in the control group at 30 min, 3 h after drug used (both P< 0.01). No side effect was found during the triad. CONCLUSION: Titanoreine cream has predominance of relieving pain and response time compared with compound carraghenates suppository, but other effects on mixed hemorrhoid are similar between the two groups.

[Treatment and mechanism of compound carraghenates suppository to rat acute rectal mucous injury].

OBJECTIVE: To investigate the treatment and mechanism of compound carraghenates suppository to rat acute rectal mucous injury. METHODS: The model of rat acute rectal mucous injury was established by 3% acetic acid. Two hundred and forty rats were divided equally into control and experimental group. The rats of experimental group were administrated with 20 mg carraghenates suppository via rectum twice a day, but rats of control group were not administrated with carraghenates suppository. Thirty rats in both groups were executed at different time points. The pathologic changes were observed and the rectal mucous injury was scored. Immunohistochemical staining was used to evaluate the effect of carraghenates suppository on expression of VEGF, iNOS, IL-8, MMP9, HIF-1 alpha and PCNA in the two groups. RESULTS: The scores of rectal mucous injury was lower, the pathologic changes such as hyperaemia, edema, destroy of glands were less severe, and tissue repair time was shorter in experimental group compared with those in the control group at 24 h, 78 h and 120 h after administration of carraghenates suppository. No obvious cicatrisation was observed in experimental group. Expression of VEGF and MMP9 was significantly lower in experimental group compared with those in the control group at 24 h after administration. Expression of VEGF, iNOS, IL-8, MMP9, HIF-1alpha and PCNA were statistically decreased in experimental group than those in the control group at 72 h, 120 h after administration. MVD in experimental group was statistically decreased than that in the control group. CONCLUSION: The compound carraghenates suppository can reduce the rectal mucous injury from 3% acetic acid, and accelerate the wound healing without obvious cicatrisation. The compound carraghenates suppository can reduce the expression of MMP9, VEGF, IL-8, PCNA, iNOS and HIF-1 alpha, which may play a role in its protective mechanism.

[Pathologic change of elastic fibers with difference of microvessel density and expression of angiogenesis-related proteins in internal hemorrhoid tissues].

OBJECTIVE: To investigate the pathological variations in internal hemorrhoid and evaluate the expression of nitric- oxide synthase(NOS),vascular endothelial growth factor(VEGF),matrix metalloproteinase- 2(MMP2) and MMP9. METHODS: Normal anal cushion and internal hemorrhoids tissue samples were obtained from 24 patients with iii degree hemorrhoids after procedure for prolapse and hemorrhoids(PPH) procedure. The expression of NOS, VEGF, MMP2, MMP9 and CD34 were detected by immunohistochemical staining; the microvessel density (MVD) was counted by anti- CD34 antibody; the elastic fibers were detected by orcein staining. RESULTS: There were statistically significant differences in the expression of MVD, VEGF, MMP9 between internal hemorrhoid tissue and normal anal cushions(P< 0.05). iNOS was significantly increased in hemorrhoid tissue, but no significant difference between normal anal cushions and hemorrhoid tissue. Morphological abnormalities such as breaking, distortion, mortality, hyaline degeneration were found in elastic fibers of internal hemorrhoid tissue, but not in normal anal cushions. CONCLUSION: Angiogenesis is evident in hemorrhoid tissue, suggesting the possible mechanism in the pathogenesis of hemorrhoids. The direct degeneration effect of MMP9 on supporting structure elastic fibers in anal cushion is another important mechanism. The high expression of iNOS suggests the inflammatory factors involve in the pathogenesis of hemorrhoids, and NO may be involve in pathological effect on hemorrhoids.

[Laparoscopy assisted total mesorectal excision for rectal cancer].

OBJECTIVE: To evaluate the feasibility of laparoscopy assisted total mesorectal excision (TME) for rectal cancer. METHOD: From March 2000 to November 2003,67 patients with rectal cancer received laparoscopy assisted TME,in whom 45 cases received anterior resection (AR),and 22 cases received abdominal perineal resection (APR). RESULTS: The operation was performed according to the rules of TME. The operative bleeding volume ranged from 10 to 50 ml. The operative time ranged from 2.5 to 5 hours without operative related death. Gastrointestinal decompression time ranged from 8 to 24 hours after operation. The time of intaking fluid food ranged from 24 to 48 hours after operation; the time of taking general activity ranged from 1 to 3 days after operation,and the defecating time ranged from 1 to 5 days after operation. The time of the hospital stay ranged from 7 to 10 days. All patients were followed up from 3 to 43 months except 3 patients. Two patients had local recurrence, including 1 patient died of local recurrence; 2 patients had liver metastases including 1 patient died of tumor metastasis but another was still alive. No metastasis and recurrence was found in 19 patients within follow - up time of one year. CONCLUSION: The laparoscopy assisted TME is a feasible approach for rectal cancer if surgeons have experience in open operation of laparoscopy assisted TME and good managing skills.

[Long-term follow-up of autogenous fat injection for unilateral vocal cord paralysis].

OBJECTIVE: To study the long-term results of autogenous fat injection for unilateral vocal cord paralysis. METHODS: Twenty cases with unilateral vocal cord paralysis were treated by autogenous fat injection into the thyroarytenoid muscle to achieve medialization. The patients were divided into 3 groups by hoarse degree before operation, all of them were followed more than 12 months with serial video laryngoscope and voice evaluation. The ratio between paralyzed vocal cord upper surface and that of the normal vocal cord were adopted as the measurement for the vocal cord volume changes before and after operation. RESULTS: 1. The volume of paralyzed vocal cord was increased. The degree of hoarse and normalized noise energy (NNE) were evaluated by objective methods after operation. 2. The hoarse symptom was less severe after operation than that before operation. The cure cases 3 to 6 months and over 12 months after operation were nearly the same. 3. NNE of over 12 months and 3 to 6 months after operation were not significantly different, but the postoperative NNE were different with that before operation. CONCLUSIONS: Autologous fat injection was an effective method for treating unilateral vocal cord paralysis, and the long term effects were reliable.