The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study / 中华外科杂志

Objective: To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. Methods: Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (M(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the χ2 analysis, and a paired χ2 test was used to compare diagnostic validity. Results: Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received in vivo puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% vs. 60%, χ2=17.500, P<0.01) and accuracy (88.5% vs. 74.4%, χ2=5.125, P=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (χ2=4.026, P=0.045). The accuracy of the in vivo puncture was 94.4%, which was 83.3% of the in vitro puncture (χ2=1.382, P=0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (χ2=7.112, P=0.029). Conclusion: TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.

Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease

Purpose@#Increasing evidence has shown an association of surgical technique, particularly anastomotic configuration, with postoperative recurrence of CD. This pilot study aimed to evaluate short-term outcomes of isoperistaltic side-to-side anastomosis (ISSA) employed on Crohn disease (CD) patients. @*Methods@#Data were retrieved from a prospectively maintained database. Postoperatively, all patients were followed up with close endoscopic (ileocolonoscopy) surveillance. @*Results@#From January 2017 to May 2021, 30 patients diagnosed with CD who underwent ISSA were compared with 45 CD patients who underwent antiperistaltic side-to-side anastomosis (ASSA). The 2 groups were comparable in baseline demographics and clinical characteristics. No significant differences were observed between groups regarding postoperative safety issues, including anastomotic leak, abdominal/pelvic abscess, length of hospital stay, readmission rate within 30 days, etc. At postoperative 24th month, reduced endoscopic recurrence was observed in the ISSA group compared with that in the ASSA group (18 of 24, 75.0%, vs. 36 of 38, 94.7%; P = 0.024). Regarding surgical recurrence, there was 0% in the ISSA group vs. 4.4% (2 of 45) in the ASSA group (P = 0.510). @*Conclusion@#In this study, we aimed to explore the influence of ISSA on postoperative recurrence in CD patients, and the preliminary results show that ISSA was technically safe and feasible, and appears to be effective in reducing postoperative recurrence in CD patients. However, our conclusion was underpowered due to small sample size and inadequate followup. We proposed ISSA be considered as another alternative option in the toolbox of inflammatory bowel disease surgeons when performing anastomosis on CD patients.

Sexual function, urinary function and quality of life in patients after total proctocolectomy and ileal pouch anal anastomosis / 中华普通外科杂志

Objective@#To investigate the sexual function, urinary function and quality of life in patients of ulcerative colitis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA).@*Methods@#The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed , postoperative sexual function, urinary function, and long-term quality of life were assessed.@*Results@#There were 45 patients with median age of 35 years , median follow-up time of 31 months. 18 were UC, 27 were FAP, 5 did 1-stage surgery, 37 did 2-stage surgery, 3 for 3-stage surgery, 13 underwent open surgery, and 32 underwent laparoscopic surgery. 7 patients suffered sexual dysfunction after IPAA, and there was no statistical difference between male and female (P=0.992), UC and FAP (P=0.153), 1-stage , 2-stage , and 3-stage surgery (P=0.363) , with statistically significant difference between the open group and the laparoscopic group (P=0.025). 6 patients complicated with urinary dysfunction after IPAA , and there was no statistical difference between male and female (P=0.562), UC and FAP (P=0.325), 1-stage, 2-stage, and 3-stage surgery (P=0.286) , with statistically significant difference between the open group and the laparoscopic group (P=0.007). The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696±0.085. There were no statistical difference on CGQL scores in males and females (P=0.635), UC and FAP (P=0.664), 1-stage, 2-stage, and 3-stage (P>0.05), open group and laparoscopic group (P=0.205), postoperative long-term QOL was significantly associated only with age at the time of surgery (P=0.001).@*Conclusions@#Compared with open surgery, laparoscopic TPC-IPAA patients had better postoperative sexual function and urination function.

Sexual function, urinary function and quality of life in patients after total proctocolectomy and ileal pouch anal anastomosis / 中华普通外科杂志

Objective To investigate the sexual function,urinary function and quality of life in patients of ulcerative cohtis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA).Methods The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed,postoperative sexual function,urinary function,and long-term quality of life were assessed.Results There were 45 patients with median age of 35 years,median follow-up time of 31 months.18 were UC,27 were FAP,5 did 1-stage surgery,37 did 2-stage surgery,3 for 3-stage surgery,13 underwent open surgery,and 32 underwent laparoscopic surgery.7 patients suffered sexual dysfunction after IPAA,and there was no statistical difference between male and female (P =0.992),UC and FAP (P =0.153),1-stage,2-stage,and 3-stage surgery (P =0.363),with statistically significant difference between the open group and the laparoscopic group (P =0.025).6 patients complicated with urinary dysfunction after IPAA,and there was no statistical difference between male and female (P =0.562),UC and FAP (P =0.325),1-stage,2-stage,and 3-stage surgery (P =0.286),with statistically significant difference between the open group and the laparoscopic group (P =0.007).The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696 ± 0.085.There were no statistical difference on CGQL scores in males and females (P =0.635),UC and FAP (P =0.664),1-stage,2-stage,and 3-stage (P ＞ 0.05),open group and laparoscopic group (P =0.205),postoperative long-term QOL was significantly associated only with age at the time of surgery (P =0.001).Conclusions Compared with open surgery,laparoscopic TPC-IPAA patiems had better postoperative sexual function and urination function.

Preliminary report on prospective, multicenter, open research of selective surgery after expandable stent combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon cancer / 中华胃肠外科杂志

OBJECTIVE@#To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer.@*METHODS@#This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541).@*INCLUSION CRITERIA@#(1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent.@*EXCLUSION CRITERIA@#(1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon.@*RESULTS@#The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P0.05).@*CONCLUSION@#Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.

Thrombus removal of external hemorrhoid combined with procedure for prolapse and hemorrhoidsin the treatment of incarcerated circumferential mixed hemorrhoids / 重庆医学

Objective To observe the clinical effect of thrombus removal of external hemorrhoid combined with procedure for prolapse and hemorrhoids(PPH) in the treatment of circumferential mixed hemorrhoid with incarceration.Methods A total of 118 cases of circumferential mixed hemorrhoid with incarceration were divided into two groups:experimental group of 60 cases was treated by thrombus removal combined with PPH;control group of 58 cases was treated by Milligan-Morgan.We observed the differences of postoperative visual analogue scale (VAS)score,edema,bleeding,residual skin tag,wound healing time,anal stenosis,fecal incontinence,anorectal manometry and satisfaction in the two groups.Results There was significant difference between the experimental group and the control group in postoperative edema,bleeding and residual skin tag(χ2=6.63,4.19,6.64,P0.05).Postoperative VAS score,wound healing time,satisfaction,anal resting and anal maximal squeeze pressure between the two groups were all statistically different(P<0.01).Conclusion The operation of thrombus removal of external hemorrhoid combined with PPH can effectively reduce the postoperative complications and promote recovery.

Efficacy of Altemeier procedure in the treatment of rectal prolapse / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the perineal rectosigmoidectomy (Altemeier procedure) in the treatment of full thickness rectal prolapse.</p><p><b>METHODS</b>Clinical and follow-up data of 52 patients with full thickness rectal prolapse undergoing Altemeier procedure in 9 hospitals from September 2010 to July 2016 were analyzed retrospectively. Of which 38 cases were from Zhongnan Hospital of Wuhan University, 1 case from Suizhou Central Hospital of Hubei province, 1 case from Jingzhou Second People's Hospital of Hubei province, 3 cases from Wuxue First People's Hospital of Hubei province, 1 case from Jingmen First People's Hospital of Hubei province, 1 case from Tuanfeng County Hospital of Hubei province, 4 cases from Jingzhou Central Hospital of Hubei province, 2 from PLA Rocket Army General Hospital, 1 case from the Affiliated Hospital of Xuzhou Medical University in Jiangsu province. Altemeier operation steps: The line shaped teeth, the prolapsed rectum is first exposed to the anus. In the dentate line proximal 1-3 cm with ultrasonic knife or Ligasure ring outer rectal incision, using electric knife to mark pre resection line in rectal mucosa. Open down in front of the pelvic peritoneum. Incision of the outer intestine and the reduction of the internal rectum and part of sigmoid colon. To free and remove excess pelvic retroperitoneal, pelvic peritoneum and be at the top of the colon or rectum anterior pelvic reconstruction suture. The rear of the levator ani muscle forming rectum. Pull gently to the anus and rectum and sigmoid, in the absence of tension, 2-3 cm outside the anus was selected as the proximal inner bowel pre resection line, along the line of pre transection of proximal bowel resection, again the broken end of intestine full-thickness end-to-end anastomosis. Postoperative complication and recurrence were summarized. Gastrointestinal quality of life index (GIQLI), Wexner constipation score and Wexner fecal incontinence score were used to evaluate the efficacy.</p><p><b>RESULTS</b>All the 52 patients were beyond moderate full thickness rectal prolapse. Thirty-one were male and 21 were female with age ranging from 22 to 83 (average 53) years. The length of prolapsed rectum was 6 to 20 (average 9) cm and course of disease was 0.5 to 46(average 19.5) years. No perioperative death. Five patients (9.6%) had postoperative complications, including 2 anastomotic bleeding, 1 wall portion dehiscence of anastomosis, 1 anastomotic stenosis, and 1 malnutrition. Recurrence rate was 9.6%(5/52) within the long-term follow-up of 5 to 71 (median 40) years. Compared with the preoperative results, Wexner constipation score and Wexner fecal incontinence score decreased obviously (2.1±1.4 vs. 4.6±3.4, 4.8±4.1 vs. 6.8±4.1), and GIQLI significantly increased from 99.6±8.0 to 103.0±9.1 (all P<0.05) at 6-month after operation. Above 3 scores were sustained and continuously improved at 12-, 24-, and 36-month during the follow-up (all P<0.05).</p><p><b>CONCLUSION</b>Altemeier procedure possesses good efficacy with low morbidity of complication and recurrence in the treatment of full thickness rectal prolapse.</p>

Meta analysis of choice of laparoscopic operation time for acute cholecystitis / 临床外科杂志

Objective To assess the operation time of laparoscopic operation for acute cholecystitis by Meta analysis.Methods The methods of computer literature retrieval and manual search were used to collect the research on the timing of laparoscopic surgery for acute cholecystitis in recent years,and the random effects model was used to conduct the Meta analyze.The quality of the literature was evaluated,and then the RevMan5.0.21 software was used to calculate the RR value and 95%CI of the operation time,bleeding volume and postoperative complications.Results A total of 13 articles were included in the Meta analysis,9 in Chinese,4 in English,2535 for a total number of cases,1401 in the early operation group,1134 in the delayed operation group,and 10 papers for low risk of bias,3 papers for bias risk.Meta analysis of the random effects model showed that the operation time of the early operation group was significantly shorter than that of the delayed operation group(P=0.00,RR=-20.25,95%CI=-24.97~15.33),and the intraoperative blood loss was also significantly reduced(P=0.00,RR=-12.58,95%CI=-29.36~5.78),then the postoperative complications were also significantly reduced(P=0.00,RR=0.63,95%CI=0.47~0.84).Conclusion The use of laparoscopic operation in the treatment of acute cholecystitis in patients with 72h could not only shorten the operation time and reduce the amount of bleeding,but also had a significant effect on reducing postoperative complications.

Clinical efficacy of partial resection of puborectalis combined with mutilation of internal anal sphincter in the treatment of puborectalis syndrome with high anal pressure / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the efficacy of partial resection of puborectalis combined with mutilation of internal anal sphincter(IAS) in the treatment of puborectalis syndrome with high anal pressure.</p><p><b>METHODS</b>Twenty-five cases of puborectalis syndrome with high anal resting pressure in the preoperative examination received the operation of partial resection of puborectalis combined with mutilation of IAS in Zhongnan Hospital of Wuhan University between January 2013 and May 2015. The position of puborectalis was confirmed by touching with the exposure under the transfixion device, and a transverse incision was made by electrotome between 3 and 5 o'clock direction of puborectalis, then partial puborectalis was lifted by vessel clamp at 5 o'clock direction, and about 0.5 cm of muscular tissue was resected. Between 8 to 10 o'clock direction of anal tube, about 1 cm length of transverse incision was made by electrotome, then partial IAS was lifted by vessel clamp and cut off. Preoperative and postoperative 3-month anorectal manometry and defecography were carried out. Wexner constipation score and Cleveland Clinic incontinence score were implemented before surgery and 3, 6, 12 months after operation. This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ORB-16007695).</p><p><b>RESULTS</b>Of the 25 cases, 18 were male and 7 were female, the average age was 55 years old and the average course of disease was 9 years. Compared with pre-operation, the postoperative 3-month anal resting pressure and maximal squeeze pressure were significantly decreased [(53.56±9.05) mmHg vs. (92.44±7.06) mmHg, (142.80±20.35) mmHg vs. (210.88±20.56) mmHg, respectively, both P=0.000]; anorectal angulation at resting state and forced defecation state increased significantly [(102.32±4.96)degree vs. (95.88±4.01)degree, (117.88±5.95)degree vs. (89.52±3.25)degree, respectively, both P=0.000]. Wexner constipation score of postoperative 3-month, 6-month, 12-month (8.28±3.91, 7.40±3.64 and 8.04±4.74) was significantly lower than the preoperative score (16.00±3.69, all P<0.05), while the score was not significantly different among 3 time points after operation (P>0.05). Cleveland Clinic incontinence score was 0 at postoperative 6 and 12 months, and revealed 20 cases were effective among all the surgical patients(80%).</p><p><b>CONCLUSION</b>Partial resection of puborectalis combined with mutilation of internal anal sphincter can effectively reduce anal pressure and improve symptoms of outlet obstruction, which is an effective method in the treatment of puborectalis syndrome with high anal pressure.</p>

Application of Lactulose Oral Solution in the patients after operation of PPH with constipation / 实用医学杂志

Objective To observe the Lactulose Oral Solution's influence in PPH postoperative complications and patients′ satisfactory rate for constipation and to find more intervention measures for reducing the complications. Methods A hundred and twenty cases of hemorrhoids with constipation were randomly divided into the two groups: the experimental group, the control group in 60 cases in each group. All patients’ postoperative bleeding, anal edema, stool impaction and satisfaction were observed and compared within 30 days. Results In the control group, the postoperative bleeding’ cases were of 23, anal edema’s were of 20 and stool impaction‘s were of 8. The incidence was 38.3%, 33.3% and 13.3% severally. The satisfactory patients were of 49 and the degree of satisfaction was of 81.7%. In the experimental group, the postoperative bleeding’ cases were of 12, anal edema’s were of 8 and stool impaction's was of 1. The incidence was 20%, 13.3% and 1.7% respectively. The cases who were satisfactory were of 58 and the degree of satisfaction was 96.7%. The postoperative bleeding , anal edema , stool impaction and satisfaction were different statistically in the two groups above (P < 0.05). Conclusion It can reduce PPH postoperative complications and increase patients′satisfaction by using Lactulose Oral Solution in patients with constipation and it will have a certain clinical value if these patients take this oral solution routinely.

Application of ileal D-pouch anal anastomosis in the treatment of ulcerative colitis and familial adenomatous polyposis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of ileal D-pouch anal anastomosis in the treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP).</p><p><b>METHODS</b>Clinical and follow-up data of 6 UC patients and 5 FAP patients undergoing proctocolectomy and D-ileum pouch anal anastomosis between October 2014 and March 2015 were retrospectively analyzed. End-to-side anastomosis was firstly performed in ileal cutting end and ileum, then side-to-side anastomosis was operated in closing amphi-loop to construct the D-ileum pouch.</p><p><b>RESULTS</b>The mean age of the patients was 42 years (range 18 to 61 years), 5 patients were female. The duration of surgery was (225±23) min, the operation time to D-ileum pouch was (18±4) min, the volume of D-ileum pouch was (175±15) ml, the blood loss was (110±30) ml. There was no procedure-related death, however rectum perforation occurred in 1 male UC patient during operation. The postoperative hospital stay was 8 to 11 days (mean 8.5 days). The follow-up period was 2 to 7 months (median 3 months). One female FAP patient suffered from anal anastomosis vagina fistula 21 days after operation. No pouch-related fistula, anastomosis or input loop stricture fecal incontinence, and severe pouchitis were recorded. The defecation frequency was 4 to 6 times per day (UC) and 3 to 5 times per day (FAP) 6 months after operation. No night-time fecal leakage was complained in those patients. Wexner incontinence score was 3±2 and GQLI was 114±11 one month after operation. Clinical outcome in the first month was excellent in 10 patients and good in 1 patient.</p><p><b>CONCLUSIONS</b>After total colorectal resection for UC and FAP patients, application of D-ileum pouch can clear ileal stump of pouch and avoid the pouch-associated complications effectively.</p>

A prospective multicenter clinical trial of extralevator abdominoperineal excision for locally advanced low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.</p><p><b>METHODS</b>A prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.</p><p><b>RESULTS</b>All patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).</p><p><b>CONCLUSIONS</b>ELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.</p>

Current role of surgery for the treatment of fulminant Clostridium difficile colitis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>This review discusses the current status and progress in studies on fulminant Clostridium difficile colitis (FCDC), including the definition, risk factor, diagnostic role of CT, surgical treatment, postoperative mortality, and new therapeutic strategy.</p><p><b>DATA SOURCES</b>A literature search was conducted mainly in Medline and PubMed published in English between January 2000 and May 2011. The search terms were "ulminant Clostridium difficile colitis" "reatment", "urgery" and "ortality"</p><p><b>RESULTS</b>Recent studies show that the overall mortality rate for FCDC remains high despite early surgical intervention. It has been difficult to identify the real value for surgical intervention in patients with FCDC due to the absence of prospective, randomized studies. Early recognition of patients with FCDC will help a clinician decide the need for treatment in an intensive care setting, multi-disciplinary consultation, and appropriate therapeutic selection. Some studies emphasize the importance of early recognition and emergent surgery at a less severe stage. Monoclonal antibody therapy and intravenous immunoglobulin treatment may be useful for the treatment of FCDC.</p><p><b>CONCLUSIONS</b>Present studies do not provide strong evidence for guiding the surgical treatment of FCDC; hence, creation of collaborative research networks is crucial in order to undertake large prospective multi-center studies for improvement in overall survival.</p>

Total colonic exclusion plus side to side ileorectal antiperistaltic anastomosis in the treatment for elderly patients with slow transit constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of total colonic exclusion plus side to side antiperistaltic ileorectal anastomosis in the treatment for elderly patients with slow transit constipation (STC).</p><p><b>METHODS</b>Clinical data of 13 patients with severe idiopathic STC undergoing the above novel procedure in Zhongnan Hospital of Wuhan University between May 2009 and September 2012 were retrospectively analyzed. The Wexner constipation score and gastrointestinal quality of life index (GIQLI) before and 6 months after operation were compared.</p><p><b>RESULTS</b>There were 8 female and 5 male patients, with a mean age of 74 years (range 63-82 years). No procedure-related deaths or any serious complication occurred. The length of follow-up ranged from 6 to 29 months (median,12 months). The duration of surgery was (55±4) min. Blood loss was (30±2) ml. The postoperative hospital stay ranged 10 to 16 days (mean 11.4 days). The first bowel movement occurred in the 4th day (range 2nd-8th day) after operation. There was no intestinal occlusion and anastomotic leakage that required surgery in all the patients. No fecal incontinence or constipation recurrence was found. One patient developed blind loop syndrome 14 months after operation. Postoperative complications included incision fat liquefaction in 2 cases, anorectal bearing-down while bowel movement in 2 cases, and minor defecate difficulty needed glycerin enema in 1 case. Wexner scores was significantly improved from 22.8±3.3 before operation to 5.4±2.1 six months after operation (P<0.05). GQLI was significantly increased from 93.6±20.5 before operation to 120.8±13.0 six months after operation (P<0.05). At 6 months after operation, the outcome was excellent in 11 patients and good in 2 patients.</p><p><b>CONCLUSION</b>Total colonic exclusion plus side to side antiperistaltic ileorectal anastomosis is easy, safe and effective in the treatment for selected elderly patients with STC.</p>

Experimental study of acellular dermal matrix biological patch enriched with bone marrow mesenchymal cells for the treatment of external anal sphincter injury / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of bone marrow mesenchymal stem cells(MSC)with the acellular dermal matrix(ADM) biological patch for the treatment of external anal sphincter injury on the animal models.</p><p><b>METHODS</b>Thirty Wistar rats with sphincter injury were randomly divided into three groups. Group A underwent end to end sphincteric repair directly, group B underwent end to end repair and then covered by ADM patch, and group C underwent end to end repair and then covered by ADM which was previously seeded with MSC. After six weeks, the whole ring specimens including anal canal and lower rectum were removed. The hematoxylin and eosin stain and Masson trichrome stain were performed to observe the change of histomorphology.</p><p><b>RESULTS</b>Two weeks later, the majority of rat models presented with moist anus and crissum with loose stools, which indicated that the model was established successfully. Six weeks after repair, in group A and B, the suffusion of fibrous connective tissue and the infiltration of inflammatory cells were observed at the repair site of sphincter. And lots of collagen fiber which was stained into blue deposited dispersedly at the site of repair with no obvious proliferation of capillaries. However, in group C, the blue collagenous fiber which deposited at the sphincter injury site was less than that in groups A and B. Muscle fibers were observed to be stained into red distributed dispersedly at the repair site of sphincter in group C.</p><p><b>CONCLUSIONS</b>Transplantation of ADM biological patch rich in bone MSC can partly improve the regeneration of rat injured anal sphincter and lessen the formation of cicatrix.</p>

Use of antiperistaltic cecoproctostomy in colorectal reconstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and functional outcome of antiperistaltic cecoproctostomy in colorectal reconstruction.</p><p><b>METHODS</b>Fifty-six patients who underwent antiperistaltic cecoproctostomy were retrospectively studied. Indications for antiperistaltic cecoproctostomy included slow transit constipation(n=44), synchronous colon cancer or colonic polyps(n=5), acute obstructing left colon carcinoma(n=4), and adult megacolon(n=3).</p><p><b>RESULTS</b>Short-term postoperative complications included wound infections(n=5), 3 lymphatic leakages(n=3), and inflammatory small bowel obstruction(n=1). One month after antiperistaltic cecoproctostomy, the median frequency of daily bowel movement was 4.0(range, 2-6). After a median follow-up of 4 years(range, 1 month to 7 years), the median daily bowel frequency was 2.5(range, 0.5-4.0). Five patients suffered from long-term postoperative complications including small bowel obstruction(n=3), incision hernia(n=1), and mild cecal dilatation(n=1). The mean Wexner incontinence score was 4.2±1.1.</p><p><b>CONCLUSION</b>Antiperistaltic cecoproctostomy is safe and effective for colorectal reconstruction.</p>

Hydroxyapatite nanoparticles intratumoral injection for treatment of liver VX2 tumor in rabbits / 中华肝胆外科杂志

Objective To study the inhibitory effects of hydroxyapatite nanoparticles on liver VX2 tumor in rabbits after intratumoral injection. Methods 40 rabbits with implantation of liver VX2 tumors were randomly divided into 4 groups and intratumorally injected with different preparations.Group A: (control group), 1 ml nomal saline containing 0.2% CMC-Na; Group B: ( 5-Fu group),20 mg/ml 5-Fu 1 ml; Group C: (Nano HAP), 20 mg/ml Nano HAP 1 ml; Group D: (5-Fu+Nano HAP), 20 mg/ml 5-Fu 1 ml and 20 mg/ml Nano HAP 1 ml. Ultrasonography was performed to measure liver tumor volume 7, 14, 21 d after treatment. Survival durations of the animals were recorded. Tumor tissues and liver tissues close to tumor were obtained and examined histologically.Results The average tumor volumes 7, 14 and 21 d after treatment were (4.93 ±0.76)cm3,(15. 67±2.75)cm3 and (52. 36±10. 57)cm3 in group A, (4. 16±0. 33)cm3 , (10. 26± 1.60)cm3 and (18. 89±4.65)cm3 in group B, (1.43±0.13)cm3 , (3.69±0.77)cm3 and (9.51±2.09)cm3 in group C, (2. 80±0.46)cm3 , (3. 77±0. 91)cm3 and (8. 46±0.95)cm3 in group D respectively. The average tumor volumes of groups B, C and D were significantly smaller than that of group A in the same time phases after treatment. The life span of group C was longer than that of other three groups, and there was no statistically significant difference between group B and group D, although the two groups were significantly longer than group A. Blood flow was not detected by color Doppler or power Doppler in group C and group D. Pathological examination showed that there was obvious intratumoral necrosis in group C and D. Tumor in group B exhibited thoroughgoing necrosis. Conclusion Hydroxyapatite nanoparticles intratumoral injection is safe and feasible for treatment of liver tumor. Hydroxyapatite nanoparticles can exert a significant inhibitory effect on liver VX2 tumor growth in rabbits without liver toxicity.

Association of vascular endothelial growth factor 936C/T polymorphism and the susceptibility to colorectal adenoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the association between polymorphism of vascular endothelial growth factor(VEGF)1498 C/T,936 C/T and colorectal adenoma genetic susceptibility.</p><p><b>METHODS</b>A case-control study of 224 colorectal adenomas and 200 controls was conducted and VEGF genotypes were determined based on TaqMan-probe assay. The epidemiological factors were collected through questionnaire. Accordingly, the clinicopathological data of each sample were also investigated.</p><p><b>RESULTS</b>The carriage of 936 CT and CT+TT genotypes had significantly higher risk of colorectal adenoma (CT vs. CC, OR=2.00, 95% CI: 1.23-3.25, P=0.006; CT+TT vs. CC, OR=2.04, 95% CI:1.28-3.26, P=0.003). 936-T allele carriage had increased risk of colorectal adenoma (OR=1.91, 95% CI:1.25-2.91, P=0.003). The genotypes of 1498 C/T and the frequency of C/T allele showed no differences between healthy persons and patients (P>0.05). In patients with 936 CT+TT and 936-T allele implied a tendency of villous adenoma category (CT+TT vs. CC, OR=2.54, 95% CI:1.12-5.75, P=0.040; T allele vs. C allele, OR=3.08, 95% CI, 1.64-5.80, P=0.001).</p><p><b>CONCLUSION</b>VEGF 936 C/T polymorphism can influence susceptibility to colorectal adenoma.</p>

Comparison of subtotal colectomy with antiperistaltic cecoproctostomy and total colectomy with ileoproctostomy in treating slow transit constipation / 中华外科杂志

<p><b>OBJECTIVE</b>To compare clinical outcome and quality of life of subtotal colectomy with antiperistaltic cecoproctostomy and total colectomy with ileorectal anastomosis (TAC-IRA) in patients with severe slow transit constipation (STC).</p><p><b>METHODS</b>Of the 56 patients enrolled in this study from January 1999 to June 2008, 32 cases underwent subtotal colectomy with antiperistaltic cecoproctostomy, and 20 patients underwent TAC-IRA. The patients' clinical characteristics, operative data, postoperative outcome, functional result and gastrointestinal quality of life index (GIQLI) survey were compared between the two groups.</p><p><b>RESULTS</b>All patients were followed up for 1-7 years (median, 4 years). The basic clinical characteristics between the two groups was comparable. During the follow-up period, the number of daily bowel movements in the subtotal colectomy group was significantly fewer than that in TAC-IRA group (2.5+/-0.8 vs. 3.4+/-0.8; P=0.000). The Wexner continence score was significantly lower in subtotal colectomy group (4.4+/-1.6 vs. 5.8+/-1.9; P=0.011), and the GIQLI score in subtotal colectomy group was significantly higher than that in the TAC-IRA group (120.7+/-7.5 vs. 111.1+/-12.0; P=0.005).</p><p><b>CONCLUSION</b>Subtotal colectomy with antiperistaltic cecoproctostomy appeared to be the superior treatment than the TAC-IRA for selected patients with slow transit constipation for improved functional outcomes and quality of life.</p>

Efficacy of cellulose on functional constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the clinical efficacy and safety of cellulose on functional constipation.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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%.</p><p><b>CONCLUSION</b>Cellulose is effective and safe in the treatment of chronic functional constipation.</p>