Résumé
Anal fistula is a common disease, surgical treatment is the best option. There are many kinds of surgical treatments for anal fistula, traditional surgical methods, such as fistulotomy and fistulectomy are more thorough in treating internal opening, infection and fistula tract, but the injury to the sphincter is also greater. In recent years, surgery is becoming refined, many scholars pay more and more attention to the protection of anal sphincter, which has derived a series of minimally invasive surgeries, such as Endorectal advancement flap procedure, Ligation of intersphincteric fistula tract, Fistula laser closure procedure, Video-assisted anal fistula treatment, Over-the-scope clip, Endofistular polyurethane-sponge vacuum therapy and biological sphincter preservating procedures. This paper describes the application status and progress of sphincter preserving surgeries by reviewing relevant literature, in order to provide relevant reference for clinical workers, optimize the treatment plan and improve the cure rate.
Résumé
Objective To evaluate sacral nerve stimulation (SNS) in the treatment of spastic pelvic floor syndrome (SPFS).Method In this study,36 patients of spastic pelvic floor syndrome who received SNS treatment from 2011.3 to 2011.12,were reviewed in terms of clinical curative effect,changes of anal pressure and defecography.Result After a course of SNS treatment,patients were followed up for 3 months,12 cases were cured,22 cases improved and 2 cases were ineffective,the total effective rate was 94.4％.The symptoms such as endless defecate feeling,difficulty in defecation,anal pain and anal obstruction feeling improved significantly (P ＜0.01 ).After the therapy,rectal anal reflex( RAR)threshold value volume rose,anal maximum contraction pressure (AMCP),anal rest perssure (ARP) decreased (P ＜ 0.01 ).While the anal longest contraction time (ALCT)and rectal rest pressure (RRP) did not change significantly (P ＞ 0.05 ).After treatment,when patient defecate the anorectal angle (ARA) increases,the puborectal muscle spasm notch (PMSN)attenuates (P ＜ 0.01 ).Conclusions SNS is effective and minimally invasive in treating spastic pelvic floor syndrome.
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Objective To study the efficacy of external dissection & internal ligation for beating mixed hemorrhoids, and compare with Milligan-Morgan. Methods One hundred and twenty-six patients with mixed hemorrhoids were divided into two groups: treatment group(66 cases)and controlled group(60cases).In treatment group used external dissection & internal ligation for treating mixed hemorrhoids, but in eontrolled group used Milligan-Morgan. Then the differences between both groups in healing time of wound surface, as well in the statuses of bleeding, pain, edema, anus stenosis, and anus overflow liquid were observed. Results Averaged healing time in treatment group was significantly shorter than that in controlled group, (8.2±2.6)days vs (17.4±3.8)days, P＜0.01.The anus stenosis and anus overflow liquid were significantly less in treatment group than those in controlled group, P＜0.01.Conclusion External dissection & internal ligation of hemorrhoids for treating mixed hemorrhoids decreases anal transitional zone(ATZ)disorganization, shorten healing time, and significantly decreases crissum scar,protectes anus function effectively.