Observation on effect characteristics of electroacupuncture for different types of functional constipation / 中国针灸

<p><b>OBJECTIVE</b>To explore the differences of electroacupuncture (EA) on onset time and symptom improvement for treatment of different types of functional constipation.</p><p><b>METHODS</b>Thirty-eight cases of constipation were selected, including 9 cases of constipation-predominant irritable bowel syndrome (IBS-C), 10 cases of slow transit constipation (STC), 10 cases of pelvic floor dyssynergia (PFD) and 9 cases of inadequate defecatory propulsion (IDP). The electroacupuncture was applied at Tianshu (ST 25), Fujie (SP 14), Shenshu (BL 23), Dachangshu (BL 25) and so on in abdominal and lumbosacral area, 5 times per week, 10 times as a treatment course. The onset time, score of clinical symptoms of constipation and improvement of every symptom in each group were compared.</p><p><b>RESULTS</b>(1) The onset time was (1.78 +/- 0.83) days in IBS-C type, (3.11 +/- 1.90) days in IDP type, (4.10 +/- 1.85) days in STC type and (4.30 +/- 2.00) days in PFD type, indicating statistical differences between IBS-C type and STC type, IBS-C type and PFD type (both P < 0.05). (2) Compared before the treatment, the total scores of symptoms on the onset day in each group were all improved (P < 0.05, P < 0.01), and score of IBS-C type was superior to the rest 3 types (P < 0.05, P < 0.01). (3) EA improved desire to defecate or frequency of defecation in each type (P < 0.05, P < 0.01), in which both were improved in STC type and PFD type, and the improvement of defecation frequency was more significant in STC type (P < 0.01). EA relieved unsmooth defecation or pendant-expansion feeling in each type (all P < 0.05), in which both were improved in IBS-C type (both P < 0.05). EA relieved abdominal distension and pain in IBS-C type, STC type and PFD type (all P < 0.05), while its effects were not obvious on defecation difficulty, defecation time and defecation texture (all P > 0.05).</p><p><b>CONCLUSION</b>The electroacupuncture for treatment of 4 types of constipation is characterized by rapid onset; the improved symptoms are not identical in the electroacupuncture treatment plan for each type of defecation; the main improvement of symptoms are lied on desire to defecate and frequency of defecation, unsmooth defecation or pendant-expansion feeling and abdominal distension and pain. Meanwhile the improvements of defecation texture, defecation difficulty and defecation time were not signi-ficant.</p>

Dynamic three-dimensional ultrasound study on levator ani muscle fissures for female pelvic floor relaxation syndrome / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the value of dynamic three-dimensional ultrasound in detecting the levator ani muscle fissures morphological changes of female pelvic floor relaxation syndrome after biofeedback and acupuncture treatments.</p><p><b>METHODS</b>Forty female constipation patients with pelvic floor relaxation syndrome were screened from the Constipation Designed Disease Clinic in our hospital between October 2011 and September 2012. Cleveland Constipation Score (CCS) scale was used. Anteroposterior and transverse diameters of the levator ani muscle fissures were measured by dynamic three-dimensional ultrasound in Valsalva maneuver. After a course (10 days) of biofeedback and acupuncture treatments, CCS scale was filled, and dynamic three-dimensional ultrasound was performed in Valsalva maneuver as well. Associated data before and after treatment were compared.</p><p><b>RESULTS</b>Twenty-five patients completed the trial. As compared to pre-treatment, the longitudinal axes of levator ani muscle fissure [(4.89±0.89) cm vs. (5.13±0.82) cm, P<0.01], the horizontal axes of the levator ani muscle fissure [(4.62±0.75) cm vs. (4.86±0.74) cm, P<0.01], and the area of the levator ani muscle fissure [(18.16±6.42) cm(2) vs. (19.92±6.33) cm(2), P<0.01] decreased significantly after treatment, while CCS scale (9.52±2.50 vs. 15.80±3.42, P<0.01) declined significantly as well.</p><p><b>CONCLUSIONS</b>The dynamic three-dimensional ultrasound is an effective, simple and non-invasive method for the determination of levator ani muscle fissure in female patients with pelvic floor relaxation syndrome.</p>

Study on the measurement and locating of Baliao points (eight sacral foramina) / 中国针灸

<p><b>OBJECTIVE</b>To seek the problems of position, measuring and locating methods of Baliao points (posterior sacral foramina) in modern researches.</p><p><b>METHODS</b>Using Baliao (eight sacral foramina), Shangliao(BL 31), Ciliao(BL 32), Zhongliao(BL 33), Xialiao(BL 34), Dihoukong (posterior sacral foramina), Dikong (sacral foramina) and Digu(sacrum) as the key words, literature in the database of the CNKI from 1957 to 2012 were re trieved and analyzed.</p><p><b>RESULTS</b>Problems were found in the past researches including limited numbers of relative literature, disunity of the measurement targets, complicated terms of indices, disunity of the starting and ending point of measurement, unclear weight of indices, deviation of results, lacking of combination with clinical practice and variety of locating methods.</p><p><b>CONCLUSION</b>Position of Baliao points (eight sacral foramina) are clear. However, the locating methods are blurred and vary a lot. Study on living body has more significance for measurement and researches. Factors of gender, body weight, height and childbearing should also be taken into consideration. Therefore, it is necessary to find a more accurate and easier way of locating.</p>

Dynamic three-dimensional ultrasound in the diagnosis of pelvic floor dyssynergia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of dynamic three-dimensional ultrasound measurement in the diagnosis of pelvic floor dyssynergia(PFD).</p><p><b>METHODS</b>Thirty female patients with PFD received dynamic three-dimensional ultrasound. The differences in angle α measured by transperineal three-dimensional ultrasound, and angle β, angle γ, and H line as measured by transanorectal three-dimensional ultrasound were compared between resting state and Valsalva maneuver. In addition, the detective rate of PFD by different parameters was analyzed.</p><p><b>RESULTS</b>In 30 patients, rectocele was found in 13 cases(43.3%), rectal internal mucous intussusception in 14 cases(46.7%), uterine prolapse in 11 cases(36.7%), and bladder prolapse in 1 case(3.3%). Compared with the resting state, α, β and H decreased obviously, but γ increased apparently in Valsalva maneuver, and differences of these parameters were statistically significant(all P<0.01). Detective rates of PFD for parameters of α, β, γ and H were 93.3%(28/30), 96.7%(29/30), 96.7%(29/30) and 86.7%(26/30), respectively.</p><p><b>CONCLUSION</b>Measurements of α, β, γ and H can provide feasible indicators for clinical diagnosis of PFD.</p>

A multi-center, randomized, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy and safety of glyceryl trinitrate (GTN) ointment in the treatment of anal fissure.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>GTN ointment can effectively promote healing and relieve pain in anal fissure with safety and tolerance.</p>

Strategies on perianal abscess and fistula-in-ano: interpretation of the guidelines from USA and German / 中华胃肠外科杂志

The Practice Parameters for the Management of Perianal Abscess and Fistula-in-ano from USA(2011) and German guidelines for anal abscess (2012) are based on the evidence and specialists consensus from colorectal field. Standardization of the anal abscess management may simplify the anal fistula treatment. This review is to concepts from other countries and guide the treatment in China.

Clinical study on acupuncture for treatment of chronic functional constipation / 中国针灸

<p><b>OBJECTIVE</b>To discuss the effect of acupuncture for treatment of chronic functional constipation (CFC).</p><p><b>METHODS</b>Ninety cases were treated with acupuncture. The following two groups of acupoints were used alternatively once every other day. The acupoints in the first group were Tianshu (ST 25), Qihai (CV 6), Shangjuxu (ST 37) etc., and Zhongliao (BL 33), Xialiao (BL 34), Dachangshu (BL 25) etc. in the second group, electroacupuncture was used at Zhongliao (BL 33), Xialiao (BL 34), Tianshu (ST 25) and Shangjuxu (ST 37), once a day, 10 times constituting one course. The defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality and awareness of defecation were observed and the Patient Assessment of Constipation Quality of Life (PAC-QOL) was evaluated by constipation patients' diaries.</p><p><b>RESULTS</b>The scores of defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality, awareness of defecation and PAC-QOL were obviously improved after treatment (all P < 0.01). The total effective rate was 67.7% (61/90). The effect of acupuncture for chronic functional constipation in different dynamic mechanism was different. The effect of slow transit constipation (STC) was better than that of spastic pelvic floor syndrome (SPFS) (P < 0.05), and the effect of constipation caused by irritable bowel syndrome (IBS-C) was better than that of SPFS and relaxant pelvic floor syndrome (RPFS) (both P < 0.05). Fifty-two cases were effectively followed up. Three cases were cured, 6 cases were remarkably effective, 23 cases were effective and 20 cases were ineffective after 1 month of treatment. Three cases were cured, 5 cases were remarkably effective, 16 cases were effective and 28 cases were ineffective after 3 months.</p><p><b>CONCLUSION</b>The effect of acupuncture for CFC with exact etiology, disease location and classification diagnosis is definite, but different dynamic mechanism has different effect. The treatment programs for SPFS and RPFS need to be optimized to improve the therapeutic effect.</p>

Study on thirty patients with slow-transmission constipation treated by acupuncture and moxibustion / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To assess the therapeutic effects and acting specialty of acupuncture and moxibustion for treatment of slow-transmission constipation (STC).</p><p><b>METHODS</b>A clinical pathway was created and Patient-Reported Outcomes (PROs) method was taken for efficacy evaluation dominantly. Acupuncture and moxibustion were applied to 30 STC patients on two groups of acupoints in alternation, with acupoints of Tianshu (ST25), Daheng (SP15), Fujie (SP14), Qihai (RN6), Guanyuan (RN4), Zusanli (ST36), and Shangjuxu (ST37) as group 1; Dachangshu (BL25), Shenshu (BL23), Baliao (BL31, BL32, BL33, BL34), and Sishencong (Ex-HN1) as group 2. Deep needling was applied on acupoints of abdominal and back region and moxibustion was put on Sishencong, 20 times as one course. The therapeutic effect was assessed based on the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) method by comparing the Bristol scoring on quality of stool, awareness and frequency of defecation, degree of abdominal fullness sensation, and patients' quality of life (QOL) at different time points, i.e., pre-treatment, after 1, 2 and 3 weeks of treatment.</p><p><b>RESULTS</b>Compared with the condition of pre-treatment, after 1, 2 and 3 weeks of treatment, cases using irritant laxative or glycerin enema reduced, with quality of stool normalized, scores for awareness and frequency of defecation increased, and abdominal fullness sensation lessened (all P < 0.01); both the total score and scores on the 4 domains of QOL (malaise, psychosocial complaint, anxiety and interest related to constipation, and satisfaction) were obviously reduced. No adverse event occurred during the treatment course. Therapeutic effectiveness assessment at the end of treatment showed that 13 patients were cured, 9 improved and 8 treated in vain; the corresponding cases assessed at 1 month after treatment were 10, 7, 13; and those at 3 months after were 7, 8, 15, respectively.</p><p><b>CONCLUSION</b>Establishing a clinical pathway is helpful to patients in their continuous diagnosis and treatment. Using PROs method to evaluate the therapeutic effect could clearly reveal the superiority of acupuncture and moxibustion in improving symptoms and QOL in patients of STC.</p>

Application of magnetic resonance imaging in the diagnosis of complex anal fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of magnetic resonance imaging (MRI) in the diagnosis of complex anal fistula.</p><p><b>METHODS</b>The preoperative digital examination and MRI with the phased-array coil were implemented for 28 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results.</p><p><b>RESULTS</b>Twenty-five patients were diagnosed as complex anal fistula, 1 presacral cyst and 2 chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI,while the patients with presacral cyst and perianal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients were suffered from trans-sphincteric fistula, 10 intersphincteric, 5 supra- sphincteric and 7 extra-sphincteric. The diagnosis rates of the internal opening with digital examination and MRI were 48% and 84%, the rates of the primary tract were 76% and 100%, and the rates of the secondary extensions were 57.9% and 94.7% respectively. The differences in detection of internal opening, primary tract and secondary extensions between MRI and digital examination were significant (P<0.01).</p><p><b>CONCLUSION</b>MRI with the phased-array coil can correctly orient the internal opening and direction of the complex anal fistula, and find the relationship between anorectal sphincters and the complex fistula.</p>

Study of germline mutation of hMSH2, hMSH6 and hMLH1 and methylation of hMLH1 in microsatellite instability colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the characteristics of germline mutations of hMLH1, hMSH2 and hMSH6 and promoter methylation status of MLH1 in patients with MSI colorectal cancer.</p><p><b>METHODS</b>Sequence analysis of germline mutation and promoter methylation of MLH1 in 34 prospective collected patients with MSI colorectal cancer were performed.</p><p><b>RESULTS</b>Nineteen out of 34 patients with MSI colorectal cancer were detected with hypermethylation of MLH1,which accounted for 55.9%. 73.7% MSI-H colorectal cancer cases and 33.3% MSI-L colorectal cancer cases were detected with hypermethylation of MLH1 and the difference was significant. Eight germline mutations were found, including 3 MSH6 mutations and 5 MSH2 mutations.</p><p><b>CONCLUSION</b>There are some different characteristics of the germline mutations of hMLH1, hMSH2 and hMSH6 and promoter methylation of MLH1 in Chinese MSI colorectal patients.</p>

Detection of microsatellite instability in colorectal cancer by fluorescence multiplex polymerase chain reaction and its clinical value / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To detect microsatellite instability(MSI) in colorectal cancer by fluorescence multiplex polymerase chain reaction(FM-PCR) and explore its clinical value.</p><p><b>METHODS</b>MSI of 110 colorectal cancer patients undergone surgical resection in our department from 2004 to 2005 were examined by FM-PCR, and the pathological characteristics were compared between MSI and microsatellite stable (MSS) colorectal cancer patients.</p><p><b>RESULTS</b>Among 110 cases, the male were 66 and the female were 44. Mean age was 60.8 (26-94) yrs. All 5 microsatellite markers were amplified. Out of them, 10 cases (8.1%) were MSI-H, 13 cases (11.8%) were MSI-L and 87 cases (79.1%) were MSS. Instability of BAT-26 was found in 9 cases (8.2%), BAT-25 was in 11 cases (10.0%), D2S123 was in 11 cases (10.0%), D5S346 was in 6 cases (8.2%) and D17S250 was in 8 cases (7.3%). Age between MSI and MSS colorectal cancer patients was significant and other pathological characteristics were not significant.</p><p><b>CONCLUSIONS</b>FM-PCR is a clinically stable method for MSI detection in colorectal cancer patients. There are no significant differences between MSI and MSS pathological characteristics of colorectal cancer patients.</p>

Diagnosis and treatment of pediatric anismus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the diagnosis and treatment methods of pediatric anismus.</p><p><b>METHODS</b>Twenty-nine patients with idiopathic chronic constipation, diagnosed with anismus by colon barium contrast and anorectal manometry from Nov. 2001 to Nov. 2004 in our hospital, were investigated retrospectively.</p><p><b>RESULTS</b>This group consisted of 13 men and 16 women whose mean age was (6.7+/-4.0) years. Hirschsprung diseases were excluded from the patients by colon barium contrast and rectoanal inhibitory reflex (RAIR) examination. Normal RAIR (5-10 ml elicited) was showed on 21 cases while weakened RAIR (15-30 ml elicited) was showed on 8 cases. After the diagnosis, the patients were treated by toilet training, diet regulation and laxative for 1-2 months. 4 cases were recovered, 5 cases were improved and 20 cases were relied on glycerin suppository. Four cases, relied on glycerin suppository, underwent Lynn procedure and had good results after 5-24 months follow-up. Two cases were re-examined by anorectal manometry 3 and 6 months after surgery, the resting pressure and the high pressure zone (HPZ) decreased, but the simulation defecation reflex was still abnormal.</p><p><b>CONCLUSIONS</b>The diagnosis of pediatric anismus relies on history of constipation, combined with anorectal manometry and colon barium contrast. Lynn procedure could be chosen for the patients unsatisfied in toilet training and other non-operative treatment.</p>

Diagnosis and surgical management of adult Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and surgical treatment of adult Hirschsprung disease (AHD).</p><p><b>METHODS</b>Clinical data of 10 patients with AHD undergoing operation from May 1985 to May 2005 were analyzed retrospectively.</p><p><b>RESULTS</b>There were 7 males and 3 females with an age ranged from 14 to 40 years. All the cases had constipation, and were diagnosed by barium enema. Aganglionosis was located in distal sigmoid and rectum in 2 cases, in rectum in 7 cases, unknown in one case. Colostomy was performed in one, Ikeda s operation in 6, Rehbein operation in two,modified Swenson operation in one. After radical operation,7 patients had excellent continence function, one had good function, one had poor function.</p><p><b>CONCLUSIONS</b>The diagnosis of adult HD mainly depends on the history of constipation, barium enema and manometry examination. The pull-through procedures are effective surgical treatments for adult HD. The operation type should be selected individually.</p>

Effect of modified Sinisan on anorectal manometry of the constipation predominant type of irritable bowel syndrome / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (SNS).</p><p><b>METHODS</b>Forty-seven IBS patients with the constipation predominant type were randomly divided into the treated group (n = 24) and the control group (n = 23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other.</p><p><b>RESULTS</b>Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment (P < 0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups (P < 0.05), and the improvement of the treated group was more significant than that of the control group (P < 0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>SNS has good effect on IBS of the constipation predominant type.</p>