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1.
Ann R Coll Surg Engl ; 102(1): 28-35, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31232611

RESUMEN

INTRODUCTION: Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. MATERIALS AND METHODS: A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. RESULTS: A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. DISCUSSION: Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.


Asunto(s)
Analgesia/métodos , Enfermedades del Colon/cirugía , Laparoscopía/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedades del Recto/cirugía , Anciano , Analgesia/estadística & datos numéricos , Analgesia Controlada por el Paciente/estadística & datos numéricos , Analgésicos Opioides/uso terapéutico , Conversión a Cirugía Abierta/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/estadística & datos numéricos , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Resultado del Tratamiento
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1131-1136, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31874528

RESUMEN

Objective: To explore the effectiveness of KeyPort access in transanal endoscopic mircrosurgery (TEM). Methods: A descriptive case series study was performed. Clinicopathological data of 20 patients undergoing KeyPort access TEM in Beijing Chaoyang Hospital of Capital Medical University from December 2016 to April 2018 were collected and analyzed retrospectively. Procedure of KeyPort access TEM: general anesthesia or combined spinal epidural anesthesia (CSEA); lithotomy or prone jack-knife position; anal dilation; placement of the KeyPortaccess; connection of TEM pneumoperitoneum device, light source and imaging equipment; placement of 5 mm dedicated endoscope; insufflation of CO2 with pressure of 1.6-2.0 kPa (12-15 mmHg); after rinsing the intestinal lumen, circular resection marginlabeled by the needle-shaped electrocautery;electric coagulation or ultrasonic knife used to perform a full-thickness resection with a 0.5 cm-1 cm margin along the marking line. Indications of KeyPort access TEM: (1) benign large sessile polyps which were difficult to resect under colonoscopy; (2) submucosal lesions with diameter <2 cm; (3) Tis and T1 stage rectal carcinoma without lymph node metastasis; (4) palliative resection of T2 stage rectal carcinoma without lymph node metastasis. Contraindications: (1) accompanying serious diseases without the tolerance of anesthesia and operation; (2) distance from lesion to anal verge >20 cm. Results: There were 10 males and 10 females with age of (63±15) years old and BMI of (24.5±3.3) kg/m(2). The diameter of the lesions was (2.0±1.3) cm, and the distance from lesion to anal verge was (6.2±2.2) cm. One patient had 3 lesions at different positions in rectum with diameters of 0.5 cm, 0.5 cm, and 1 cm, respectively. All operations were accomplished through the KeyPort access TEM and no case was transferred to other methods. The duration of surgery was 75 (30-220) minutes; intraoperative blood loss was 10 (0-30) ml. Two patients with rectal anterior wall lesions underwent full-thickness resection of the intestine wall reaching the peritoneal reflex with penetration into the peritonealcavity, and received suture closure immediately. For the patient with 3 rectal lesions, the 1.0 cm lesion received a full-thickness resection and the other 2 lesions received submucosal resection. No postoperative complication occurred. Postoperative pathology showed that there were 1 case of chronic inflammatory lesion, 4 cases of benign tumor, 3 cases of carcinoma in situ, 4 cases of neuroendocrine tumor, 6 cases of pT1 rectal cancer, 2 cases of pT2 rectal cancer (both invading the superficial muscle layer). The median hospital stay was 6 (3-7) days. The postoperative follow-up was (7.2±3.8) months. No postoperative complication or recurrence was observed. Conclusion: TEM with KeyPort access is safe, rapid and effective in the treatment of rectal tumors.


Asunto(s)
Neoplasias del Recto/cirugía , Microcirugía Endoscópica Transanal/instrumentación , Microcirugía Endoscópica Transanal/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Recto/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
4.
Lakartidningen ; 1162019 Nov 26.
Artículo en Sueco | MEDLINE | ID: mdl-31769859

RESUMEN

Solitary rectal ulcer syndrome (SRUS) is a rare disorder likely to be caused by a traumatic and ischemic mucosal injury related to latent or overt rectal prolapse. Mucosal damage can vary between erythema and up to intractable ulceration. The typical symptoms of SRUS may resemble those of inflammatory bowel disease (IBD)-related proctitis or rectal malignancy with mucus- and blood-mixed defecation with urgency and sometimes transient incontinence. The purpose of this paper is to raise awareness of this rare, quality-of-life impacting and difficult-to-treat disease and the not so well-known argon plasma coagulation (APC) treatment that can provide very good and long lasting symptom relief.


Asunto(s)
Coagulación con Plasma de Argón , Enfermedades del Recto/cirugía , Úlcera/cirugía , Adulto , Vías Clínicas , Endoscopía , Femenino , Humanos , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/etiología , Enfermedades del Recto/patología , Síndrome , Úlcera/diagnóstico , Úlcera/etiología , Úlcera/patología
5.
Artículo en Inglés | MEDLINE | ID: mdl-31738869

RESUMEN

Aim: To describe the epidemiology of lymphogranuloma venereum (LGV) in New South Wales (NSW) from 2006 to 2015. Methods: LGV notification data between 2006 and 2015 from New South Wales were analysed to describe time trends in counts and rates by gender, age group and area of residence, as well as anatomical sites of infection. A positivity ratio was calculated using the number of LGV notifications per 100 anorectal chlamydia notifications per year. Data linkage was used to ascertain the proportion of LGV cases that were co-infected with HIV. Results: There were 208 notifications of LGV in NSW from 2006 to 2015; all were among men, with a median age of 42 years, and half were residents of inner-city Sydney. Annual notifications peaked at 57 (1.6 per 100,000 males) in 2010, declined to 16 (0.4 per 100,000 males) in 2014, and then increased to 34 (0.9 per 100,000 males) in 2015. Just under half (47.4%) of LGV cases were determined to be co-infected with HIV. Conclusion: The number of LGV notifications each year has not returned to the low levels seen prior to the peak in 2010. Continued public health surveillance is important for the management and control of LGV.


Asunto(s)
Chlamydia trachomatis/aislamiento & purificación , Monitoreo Epidemiológico , Linfogranuloma Venéreo/epidemiología , Adolescente , Adulto , Anciano , Notificación de Enfermedades , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/microbiología , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Enfermedades del Recto , Minorías Sexuales y de Género , Adulto Joven
6.
Surg Clin North Am ; 99(6): 1151-1162, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31676054

RESUMEN

Medical treatment remains the mainstay of perianal disease management for CD; however, aggressive surgical management should be considered for severe or recurrent disease. In all cases of perianal CD, medical and surgical treatments should be used in tandem by a multidisciplinary team. Significant development has been made in the treatment of Crohn's-related fistulas, particularly minimally invasive options with recent clinical trials showing success with mesenchymal stem cell applications. Inevitably, some patients with severe refractory disease may require fecal diversion or proctectomy. When considering reversal of a diverting or end ileostomy, cessation of proctitis is the most important factor.


Asunto(s)
Enfermedad de Crohn/terapia , Fístula Intestinal/cirugía , Enfermedades del Recto/terapia , Terapia Combinada , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Femenino , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/fisiopatología , Masculino , Proctectomía/efectos adversos , Proctectomía/métodos , Pronóstico , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/etiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
9.
BJOG ; 126(13): 1600-1608, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31407476

RESUMEN

OBJECTIVE: To determine whether ileocaecal endometriosis (ICE) is a marker for low rectal endometriosis (LRE) severity. DESIGN: Retrospective cohort study. SETTING: France. POPULATION AND SAMPLE: Analysis of 375 colorectal resections performed in women undergoing complete surgery for LRE from January 1995 to December 2015 in a university centre for endometriosis. METHODS: Univariate and multivariate analysis of anatomical, postoperative clinical, and long-term outcomes according to presence of ICE. MAIN OUTCOMES AND MEASURES: Mean number and type of deep infiltrating endometriosis (DIE) lesions, the existence of an associated endometrioma, and mean total American Society for Reproductive Medicine (ASRM) score. RESULTS: The prevalence of ICE was 25.6%. Primary end-point data showed that women with ICE had a significantly higher adjusted number of DIE lesions (OR = 1.43, 95% CI 1.02-3.03; P = 0.048), higher prevalence of endometriomas (OR = 1.91, 95% CI 1.04-3.51; P = 0.044), more associated DIE sigmoid lesions (OR = 2.12, 95% CI 1.07-3.91; P = 0.025), and a higher mean total ASRM score (OR = 2.07, 95% CI 1.12-4.14; P = 0.025). Women with ICE resected during the surgical procedure for LRE did not have more adverse postoperative clinical outcomes than ICE-negative patients. CONCLUSION: Ileocaecal endometriosis was significantly associated with greater LRE severity. In a complete surgical resection strategy, combining resection of ICE and LRE did not appear to increase postoperative rates of complications, morbidity or recurrence, nor did it seem to impair long-term clinical outcomes. TWEETABLE ABSTRACT: In women with low rectal endometriosis, 25% have an associated ileocaecal location that is a marker for severity.


Asunto(s)
Endometriosis/patología , Intestino Delgado/patología , Enfermedades del Recto/patología , Adulto , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Humanos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
11.
Pediatr Surg Int ; 35(10): 1137-1141, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31420742

RESUMEN

PURPOSE: The aim of this study was to investigate risk factors for recurrence in the perineal canal (PC). METHODS: Patients with PC who underwent operations were enrolled in this study and were divided into recurrence and non-recurrence groups. Preoperative infection, the age at the operation, the presence of colostomy and the treatment procedure for fistula were retrospectively investigated. Regarding the treatment procedure for fistula, either closure of the rectal wall with stitches or ligation of fistula in the rectum was performed. These factors were compared between the two groups. RESULTS: Six of 17 patients with PC who underwent surgical treatment had recurrence. There were no significant differences in the incidence of preoperative infection, age at operation or presence of colostomy (p = 0.60, 0.38, 1.00, respectively). In the recurrence group, all patients were treated by closure of the rectal wall. In the non-recurrence group, five were treated by the closure of the rectal wall with stitches and six by ligation of the fistula. There was a significant association between recurrence and the treatment procedure for fistula (p = 0.04). CONCLUSION: Closure of the rectal wall with stitches is a risk factor for the recurrence of PC.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Fístula/cirugía , Perineo/anomalías , Enfermedades del Recto/cirugía , Recto/anomalías , Femenino , Fístula/diagnóstico , Humanos , Lactante , Masculino , Perineo/cirugía , Enfermedades del Recto/diagnóstico , Recto/cirugía , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
12.
Zentralbl Chir ; 144(4): 340, 2019 08.
Artículo en Alemán | MEDLINE | ID: mdl-31412414
13.
S Afr J Surg ; 57(3): 50-53, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31392865

RESUMEN

BACKGROUND: Colorectal surgery has developed into an established surgical subspecialty in South Africa, however there is a paucity of data regarding the epidemiology and surgical outcomes of patients with colorectal disease in this country. The objective is to present the findings of a one-year audit of the Wits Donald Gordon Medical Centre (WDGMC) Colorectal Unit with specific reference to indications, surgical procedures and patient outcomes. METHOD: Patient files from December 2016 to November 2017 were included in a retrospective analysis. The Mann-Whitney U test was used to analyse continuous variables and the Chi-squared test was used to compare categorical variables. RESULTS: During the audit period, 1264 patients were admitted to the Colorectal Unit and a further 564 outpatient endoscopic procedures were performed. There were 306 emergency admissions. 139 elective colorectal resections took place, with a 16% major complication rate, a 12% anastomotic leak rate and no deaths. Rectal resections constituted 66% of the operations and 34% were colonic resections. The median length of stay for all patients undergoing resection was 9 days and there was no statistically significant difference in length of stay between open and laparoscopic cases. CONCLUSION: The WDGMC Colorectal Unit manages a high volume of patients presenting with the full spectrum of colorectal disease.


Asunto(s)
Colectomía/estadística & datos numéricos , Enfermedades del Colon/cirugía , Complicaciones Posoperatorias/etiología , Proctectomía/estadística & datos numéricos , Enfermedades del Recto/cirugía , Centros Médicos Académicos/estadística & datos numéricos , Fuga Anastomótica/etiología , Colectomía/efectos adversos , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/estadística & datos numéricos , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación , Auditoría Médica , Readmisión del Paciente/estadística & datos numéricos , Proctectomía/efectos adversos , Estudios Retrospectivos
14.
J Laparoendosc Adv Surg Tech A ; 29(9): 1122-1127, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31343375

RESUMEN

Background: Since introduced in 2010, the transanal minimally invasive surgery (TAMIS) has been gaining popularity worldwide for local excision of benign and early-stage malignant rectal lesions of the proximal and mid-rectum. The aim of this study was to review our experience with the procedure, including mid-term oncological outcomes. Materials and Methods: This is a retrospective descriptive study. The data collected include all patients who underwent TAMIS procedure in a single tertiary institute. Results: Forty TAMIS procedures were performed on 38 patients, 78% men and 22% women, with a median age of 67 years. The indications were 24 benign lesions, 14 adenocarcinoma, and 1 neuroendocrine tumor. The average lesion size was 43.2 mm and the average distance from the anal verge was 8 cm (range 5-12). We had no intraoperative complications and overall the 30-day morbidity rate was 20%, of which only one was major complication. No perioperative mortality was encountered. After a mean follow-up time of 26 months we had 3 cases of local recurrence (21.4%) of which 2 cases had high-risk features on the primary TAMIS pathology and refused our advice for completion proctectomy. Hence, they were both treated eventually with adjuvant radiotherapy. The distant recurrence rate was 14.2%. Conclusions: The TAMIS procedure is an acceptable option for local excision of rectal lesions for carefully selected patients. It has overt benefits of lower morbidity and easier recovery compared with radical surgery. When it is utilized for early-stage rectal cancers, high-risk pathological features should prompt a completion proctectomy.


Asunto(s)
Canal Anal/cirugía , Enfermedades del Recto/cirugía , Cirugía Endoscópica Transanal/métodos , Anciano , Canal Anal/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Israel/epidemiología , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Enfermedades del Recto/diagnóstico , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
15.
Pediatr Surg Int ; 35(9): 989-997, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31278480

RESUMEN

PURPOSE: Fetal extraperitoneal rectal perforation (FERP) is an extremely rare entity. The objective of this report is to review the available literature on this condition and to add our experience with four additional cases managed at our institution. METHODS: A literature search was performed for journal articles addressing this condition. Management strategies and outcomes were then analysed, together with additional information provided from retrospective record review of four cases managed at our institution. RESULTS: A total of 18 patients were identified and included, 14 from the literature and 4 from our records. Initial investigations varied between authors with contrast enema being the most frequently performed study (7/18). All patients were treated with faecal diversion via colostomy formation. Exploratory laparotomy was performed in 6 cases, perineal debridement and washout in 9 cases while drains were left in situ in 14 cases. At 3-6 months of age, a distal contrast study was performed before closure of colostomy. CONCLUSION: Although FERP is a rarely encountered clinical condition, timely recognition and appropriate management can result in good outcomes. Diagnosis can be achieved based on clinical and abdominal X-ray features alone. General management principles involve a diverting colostomy and extended drainage with closure of the colostomy 3-6 months later.


Asunto(s)
Perforación Intestinal/cirugía , Enfermedades del Recto/cirugía , Recto/cirugía , Adulto , Colostomía/métodos , Desbridamiento , Drenaje , Femenino , Humanos , Recién Nacido , Laparotomía , Masculino , Embarazo , Radiografía Abdominal , Estudios Retrospectivos
16.
Minerva Chir ; 74(4): 279-288, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31271276

RESUMEN

BACKGROUND: The interest and adoption of transanal total mesorectal excision (TaTME) is growing worldwide, but evidence on nationwide implementation and short-term outcomes is scarce. This study aims to evaluate national results for this relatively new technique in the UK. METHODS: All TaTME procedures performed in the UK and recorded on the international TaTME registry between January 2013 and January 2018 were analyzed. Surgeons who received training on TaTME in the UK were sent a survey regarding their experience with implementation of TaTME in their unit. Primary endpoint was a composite for "optimal pathology" (free resection margin (R0) and TME specimen with no major defects and no rectal wall perforations). Secondary outcomes included 30-day clinical course and survey outcomes. RESULTS: Forty-two hospitals entered 513 cases over a 5-year period; 28 of 42 hospitals (66.7%) performed ten cases or less. The indication for surgery was cancer in 364 (71.0%) cases. Optimal pathology was achieved in 295 (92.8%), with an involved resection margin (R1) rate of 13 of 513 (4.1%). A Clavien-Dindo ≥III within 30 days was 13.4% (N.=45) and 6.8% (N.=10) in the cancer and benign groups, respectively. Based on the survey (response rate 68 of 86; 79%), 76.1% of the surgeons implemented TaTME in their unit after receiving training, all of whom experienced difficulties with performing TaTME. CONCLUSIONS: This study reports acceptable nationwide short-term outcomes of TaTME. However, adoption occurred in a rapid and non-standardized manner. A structured TaTME training program is therefore recommended.


Asunto(s)
Enfermedades del Recto/cirugía , Neoplasias del Recto/cirugía , Recto/cirugía , Adulto , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Reino Unido
17.
Curr Gastroenterol Rep ; 21(7): 33, 2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31281951

RESUMEN

PURPOSE OF REVIEW: Systemic sclerosis is a chronic autoimmune disorder commonly involving the gastrointestinal tract, including the colon and anorectum. In this review, we summarize major clinical manifestations and highlight recent developments in physiology, diagnostics, and treatment. RECENT FINDINGS: The exact pathophysiology of systemic sclerosis is unclear and likely multifactorial. The role of the microbiome on gastrointestinal manifestations has led to a better understanding of potential pathogenic gut flora. Carbohydrate malabsorption is common. Evaluation using fecal calprotectin and high-resolution anorectal manometry may broaden our understanding of the etiologies of diarrhea and fecal incontinence and help with early recognition of pathology. Prucalopride, a high-affinity 5HT4 agonist, and pyridostigmine, an acetylcholinesterase inhibitor, may help improve colonic transit in patients with constipation. Intravenous immunoglobulins have been used to target muscarinic receptor antibodies that are believed to contribute to gastrointestinal dysmotility. Colonic and anorectal manifestations of systemic sclerosis include constipation, diarrhea, and fecal incontinence, and can diminish quality of life for these patients. Recent studies regarding pathophysiology as well as diagnostic and treatment options are promising. Further targeted studies to facilitate early intervention and better management of refractory symptoms are still needed.


Asunto(s)
Enfermedades del Colon/etiología , Enfermedades del Recto/etiología , Esclerodermia Sistémica/complicaciones , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/terapia , Humanos , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/terapia
18.
Zhongguo Zhen Jiu ; 39(7): 709-12, 2019 Jul 12.
Artículo en Chino | MEDLINE | ID: mdl-31286731

RESUMEN

OBJECTIVE: To observe the efficacy differences between acupuncture combined with grain-moxibustion and acupuncture on acute urinary retention after epidural anaesthesia for anorectal diseases. METHODS: A total of 60 patients were randomized into an acupuncture combined with grain-moxibustion group and an acupuncture group, 31 cases in each one. In the acupuncture group, acupuncture was applied at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6), Shuidao (ST 28), Pangguangshu (BL 28), Sanyinjiao (SP 6) and Yinlingquan (SP 9). In the acupuncture combined with grain-moxibustion group, grain-moxibustion was given at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6) and Shuidao (ST 28) on the basis of acupuncture. Those who failed to urinate 60 min after the first treatment received the second treatment. 30 min after the second treatment, the lower abdominal symptom scores before and after treatment as well as the bladder residual urine volume after the first urination after treatment were compared between the two groups. In addition, the clinical efficacy and security were evaluated. RESULTS: Compared before treatment, the symptom scores after treatment were reduced in the two groups (P<0.05), and the score in the acupuncture combined with grain-moxibustion group was lower than that in the acupuncture group after treatment (P<0.05). The bladder residual urine volume in the acupuncture combined with grain-moxibustion group was (26.71±17.01) mL, which was lower than (35.32±20.76) mL in the acupuncture group (P<0.05). The total effective rate was 93.5% (29/31) in the acupuncture combined with grain-moxibustion group, which was superior to 71.0% (22/31) in the acupuncture group (P<0.05). CONCLUSION: The efficacy of acupuncture combined with grain-moxibustion is superior to simple acupuncture on acute urinary retention after epidural anaesthesia for anorectal diseases, which is safe and reliable.


Asunto(s)
Terapia por Acupuntura , Moxibustión , Enfermedades del Recto , Retención Urinaria , Humanos , Enfermedades del Recto/terapia
19.
Rev Gastroenterol Peru ; 39(2): 136-140, 2019.
Artículo en Español | MEDLINE | ID: mdl-31333230

RESUMEN

OBJECTIVE: To describe the anorectal manometry results in the pediatric population with chronic constipation and acquired anorectal disease. MATERIALS AND METHODS: We reviewed the records of children who were referred to the Motility and Pelvic Floor Laboratory of the Hospital San Jose Tecnologico de Monterrey between 2004-2016 for further evaluation with anorectal manometry and who presented acquired anorectal disease. RESULTS: We reviewed 170 records. The mean age was 7.18 ± 4.51 years old. The prevalence of anorectal disease was 73%. The symptoms more frequently presented were difficult evacuation (78%), painful defecation (67%), large and hard stool (50%) and fecal soiling (49%). 44% of patients with hypotonic external anal sphincter (EAS) presented with soiling and 74% of those had diminished critical volume. Significant manometric values (p<0.05) were EAS resting pressure, maximal squeeze pressure, and critical volume. 97.7% of those who underwent abdomino pelvic coordination evaluation had pelvic floor dyssynergia (anismus). CONCLUSIONS: Contrary to adult population, the manometric values in children with acquire anorectal pathology were within normal values except for the EAS resting pressure and critical volume that were diminished. This could suggest a different mechanism in the pediatric population. Pelvic floor dyssynergia could explain chronic constipation in these patients.


Asunto(s)
Canal Anal/fisiopatología , Estreñimiento/fisiopatología , Enfermedades del Recto/fisiopatología , Recto/fisiopatología , Niño , Preescolar , Enfermedad Crónica , Estreñimiento/complicaciones , Estudios Transversales , Femenino , Humanos , Masculino , Manometría , Enfermedades del Recto/complicaciones , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/epidemiología
20.
Zhongguo Zhen Jiu ; 39(6): 605-8, 2019 Jun 12.
Artículo en Chino | MEDLINE | ID: mdl-31190496

RESUMEN

OBJECTIVE: To explore and quantify the intervention effect of auricular point sticking on perioperative psychological stress in patients with anorectal diseases. METHODS: Eighty patients who underwent anorectal surgery were randomly divided into an observation group (40 cases) and a control group (40 cases). The routine preoperative guidance, preoperative visits, and informed of the postoperative condition were received in the control group. On the basis of the treatment in the control group, auricular point sticking was immediately applied at Shenmen (TF4), Shen (CO10), Wei (CO4), Gan (CO12), Pi (CO13), Pizhixia (AT4), E (AT1), Nie (AT2) and Zhen (AT3) in the observation group.The patients were pressed by themselves, 3 to 5 min per point each time, 5 times a day, and the contralateral auricular points were replaced every 2 or 3 days until 1 week after surgery. The Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), and Pittsburgh sleep quality index (PSQI) scores were compared between the two groups before and 7 days after surgery. RESULTS: There was no significant difference in the total HAMA scores between after and before surgery in the observation group (P>0.05). The total HAMA score in the control group was higher than that before surgery (P<0.05). The total HAMA score in the observation group after surgery was lower than that in the control group (P<0.05). There was no significant difference in the total HAMD scores between the two groups before and after surgery (P<0.05). There was no significant difference in the total HAMD scores between the two groups after the surgery (P>0.05). The scores of somatic anxiety factor in the two groups were higher than those before surgery (P<0.05). The scores of somatic anxiety factor in the observation group were lower than those in the control group (P<0.05). The scores of psychotic anxiety factors in the two groups were lower than those before surgery (P<0.05). There was no significant difference in the score of psychotic anxiety factors between the two groups (P>0.05). The total score of PSQI in the two groups was lower than that before surgery (P<0.05), and the total score of PSQI in the observation group was lower than that in the control group (P<0.05). CONCLUSION: Auricular point sticking can effectively improve some psychological stress problems during perioperative period in patients with anorectal diseases.


Asunto(s)
Acupuntura Auricular , Trastornos de Ansiedad , Enfermedades del Recto , Puntos de Acupuntura , Trastornos de Ansiedad/terapia , Humanos , Enfermedades del Recto/cirugía , Estrés Psicológico
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