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Objective To study the surgical treatment of the pilonidal disease.Methods The clinical data of 33 cases of the pilonidal disease were retrospectively analyzed from Jul 2007 to Feb 2014.18 cases were treated with Excision and Marsupialization,and 15 cases were treated with Rhomboid excision and Limberg flap.Results All 18 cases in the excision and marsupialization group,were cured by surgery.all 15 cases in the rhomboid excision and Limberg flap group were cured,five of these cases were delayed healing dehiscence or necrosis,all this cases were healed after dressing drainage.The average healing time of the Limberg flap group was shorter than that of the Marsupialization group[(19 ±7) d vs.(37 ± 12) d,t =6.556,P ＜ 0.01].Postoperative recurrence of the Marsupialization group was 1 case,the recurrence rate was 5.6％,and there was no recurrence after Limberg flap transfer.The recurrence rate of the 2 groups was statistically insignificant (P ＞ 0.05).Conclusion The excision and marsupialization and the rhomboid excision and Limberg flap are effective in the treatment of the pilonidal disease,and the Limberg flap transfer is recommended in complicated and recurrence cases.
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Objective To investigate the application value of magnetic resonance imaging (MRI) examination in the efficacy evaluation of infliximab combined with seton placement for perianal fistulizing Crohn's disease (PFCD) and influencing factors of deep remission.Methods The retrospective case-control study was conducted.The clinicopathological data of 57 patients with PFCD who were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2010 to October 2017 were collected.There were 39 males and 18 females,aged (24±9)years,with a range of 14-58 years.Patients underwent MRI examination preoperatively and postoperatively.Observation indicators:(1) follow-up situations;(2) influencing factors analysis of deep remission of PFCD.Follow-up using outpatient and inpatient reexamination was performed to detect clinical recovery of patients up to October 2017.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage.The univariate analysis was performed using the chi-square test.The multivariate analysis was done using the logistic regression model,using P＜0.15 as an inclusion criteria in the univariate analysis.Results (1) Follow-up situations:57 patients with PFCD undergoing inflixmab combined with seton placement were followed up for (40±24)months.During the follow-up,24 of 57 patients had clinical response,33 had long-term clinical healing.The fistulas of 24 patients with clinical response presented as high signal on T2 weighted image (T2WI) of postoperative MRI.Of 33 patients with long-term clinical healing,the fistulas of 16 patients with deep remission presented loss of high signal and replacement of fibrosis tissue on T2WI of postoperative MRI,the fistulas of 17 patients without deep remission presented as high signal on T2WI of postoperative MRI.(2) Influencing factors analysis of deep remission of PFCD:results of univariate analysis showed that extent of fistula was related factors affecting deep remission of PFCD (x2 =4.312,P＜0.05).Results of multivariate analysis showed that a single fistula complicated with branches and times of infliximab maintenance treatment ≤3 were independent risk factors affecting deep remission of PFCD (odds ratio=4.377,4.296,95％ confidence interval:1.124-17.043,1.158-15.940,P＜0.05) and fistula under levator ani muscle was an independent protective factor affecting deep remission of PFCD (odds ratio =0.182,95％ confidence interval:0.041-0.815,P＜ 0.05).Conclusions Partial patients with long-term clinical healing can achieve deep remission after Infliximab combined with seton placement for perianal fistulizing Crohn's disease,requiring MRI examination to further evaluate recovery situations.A single fistula complicated with branches and times of infliximab maintenance treatment ≤ 3 are independent risk factors affecting deep remission of PFCD and fistula under levator ani muscle is an independent protective factor affecting deep remission of PFCD.
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Objective To analyze the time of removing setons by observing 30 cases of the infliximab (IFX)combined drainage setons therapy in the treatment of perianal fistulising Crohn's disease.Methods Thirty patients of perianal fistulising Crohn's disease of Department of Colorectal Surgery,Jiangsu Prorince Hospital of TCM in Aug.2015 to Jul.2017 were treated with drainage setons followed by intravenous IFX injections according to the standard,and setons were removed after the third injection of IFX.The method of repeated measurement were adopted to record.Clinical symptoms,perianal manifestations,laboratory indexes,healing rate and general linear model and nonparametric test of SPSS 23.0 software were used for statistical analysis.Results The differences of WBC,CRP,ESR,HB,PLT,BMI,CDAI and PDAI between post treatment and pretreatment were statistically significant (P ＜ 0.05).WBC,CRP and ESR will rerise at some time after removing the rubber band (sixth week).The closure rate of fistular at the 14th week was 53.3％,and after the follow-up in the ward at 22th week and 30th week,the clinical efficacy of fistular was not statistically significant (P ＞0.05) at the 14th week,22th week and 30th week.Conclusion IFX combined drainage setons which was removed when the induction therapy finished can induce Crohn's disease remission,improve laboratory index and promote fistula closure.the clinical efficacy in short time was stable.
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Objective To evaluate the efficacy of infliximab combined with sphincter-sparing surgery in treatment of perianal Crohn's disease.Methods Clinical data of 49 patients with perianal Crohn's disease (3 cases with nonfistulizing perianal Crohn's disease and 46 cases with fistulizing perianal Crohn's disease) receiving infliximab combined with sphincter-sparing surgery in Jiangsu Province Hospital of TCM from May 2010 to June 2014 were analyzed retrospectively.The situation of fistula closure was assessed.C-reactive protein and perianal disease activity index were estimated by Wilcoxon method.Results No patient was failed to respond to primary treatment.patients (26/46) had a complete response to treatment,28.3％ patients (13/46) had a partial response and 15.2％ patients (7/46) had lost response to treatment;2 cases of anal ulcer healing;No other perianal lesion occurred in 1 case of verrucous skin.At final follow-up,CRP was decreased to [4.5 (1.5,15.9)] mg/Lfrom [16.9(6.6,35.6)] mg/L(Z=-3.994,P=0.00);PDAI was decreased to[1(0,4.5)]from [7(4.5,10.5)] (Z=-6.100,P=0.00).Conclusion Infliximab combined with sphincter-sparing surgery is effective for perianal Crohn's disease.
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Objective To evaluate the efficacy of infliximab combined with sphincter-sparing surgery in treatment of perianal Crohn's disease.Methods Clinical data of 49 patients with perianal Crohn's disease (3 cases with nonfistulizing perianal Crohn's disease and 46 cases with fistulizing perianal Crohn's disease) receiving infliximab combined with sphincter-sparing surgery in Jiangsu Province Hospital of TCM from May 2010 to June 2014 were analyzed retrospectively.The situation of fistula closure was assessed.C-reactive protein and perianal disease activity index were estimated by Wilcoxon method.Results No patient was failed to respond to primary treatment.patients (26/46) had a complete response to treatment,28.3％ patients (13/46) had a partial response and 15.2％ patients (7/46) had lost response to treatment;2 cases of anal ulcer healing;No other perianal lesion occurred in 1 case of verrucous skin.At final follow-up,CRP was decreased to [4.5 (1.5,15.9)] mg/Lfrom [16.9(6.6,35.6)] mg/L(Z=-3.994,P=0.00);PDAI was decreased to[1(0,4.5)]from [7(4.5,10.5)] (Z=-6.100,P=0.00).Conclusion Infliximab combined with sphincter-sparing surgery is effective for perianal Crohn's disease.
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<p><b>OBJECTIVE</b>To discuss the clinical features of perianal Crohn disease (PCD).</p><p><b>METHODS</b>Clinical data of 52 PCD patients who were treated at the Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine from June 2011 to October 2014 were analyzed retrospectively. Montreal classification, clinical symptoms, the subtype of perianal lesions, history of perianal surgery and medical treatment, disease active indexes, serum inflammation markers and nutritional indexes were included.</p><p><b>RESULTS</b>Among 52 patients, there were 40 males and 12 females with a mean age of (27.9±9.1) years. According to Montreal classification, 51.9%(27/52) of patients had ileocolic involvement and 75.0%(39/52) had inflammatory disease behavior. Thirteen (25.0%) and 15(28.8%) patients had abdominal pain and diarrhea respectively at admission. With respect to the subtype of perianal lesions, there were 32(61.5%) cases of anal fistula and 16(30.8%) cases of perianal abscess. Thirty-nine(75.0%) and 33(63.5%) patients had a history of perianal surgery and medical treatment before admission resepectively. Laboratory findings revealed high C-reaction protein level in 63.5%(33/52), high erythrocyte sedimentation rate in 61.5%(32/52), elevated platelet in 32.7%(17/52), low body weight in 44.2%(23/52), low albumin in 26.9%(14/52) and anemia in 42.3%(22/52) of patients.</p><p><b>CONCLUSIONS</b>The clinical features of PCD patients include male predominant, early onset disease, high prevalence of ileocolic involvement and inflammation disease behavior. Features prompting underlying PCD diagnosis include characteristic gastrointestinal symptoms, requiring multiple perianal surgery, and abnormality of inflammation markers and nutritional indexes.</p>
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Objective To investigate the clinical characteristics of perianal Crohn's disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation.Methods The retrospective cohort study was conducted.The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected.Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and non-proctitis group.All the 52 patients underwent surgery combined with infliximab therapy.Observation indicators included:(1) clinical characteristics:gender,age,body mass index (BMI),lesion location,disease behavior,type of perianal lesions,history of perianal surgeries,CD activity index (CDAI),perianal disease activity index (PDAI),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC),platelet (PLT) and albumin (Alb),(2) treatment and follow-up.Follow-up using outpatient examination was performed to evaluate the perianal lesions up to December 2015.Measurement data with normal distribution were described as-x ± s and comparison between groups was analyzed by the t test.Count data were described as the percentage,and comparison between groups was analyzed by the chi-square test and Fisher's exact probability.Results (1)Clinical characteristics:number of patients with BMI ＜ 18.5 kg/m2 and with normal BMI were respectively 17,13 in the proctitis group and 6,16 in the non-proctitis group.Lesions located at ileum,colon and ileocolon were respectively detected in 3,9,18 patients in the proctitis group and 9,4,9 patients in the non-proctitis group.CDAI≥ 150 and ＜ 150,CRP≥8 mg/L and ＜ 8 mg/L,ESR ＞ normal level and =normal level,Alb ＜ 35 g/L and between 35 g/L and 50 g/L were respectively detected in 23,7,25,5,24,6,12,18 patients in the proctitis group and 8,14,8,14,8,14,2,20 in the non-proctitis group,with statistically significant differences between the 2 groups (x2 =4.446,6.855,8.563,12.076,10.211,6.163,P ＜ 0.05).(2) Treatment and follow-up:all the 52 patients underwent more than 3 times infliximab therapies and perianal surgeries within 1 week after infliximab therapy.All the patients were followed up for a median time of 28 months (range,8-52 months).Thirty-four patients still underwent maintenance therapy of immunosuppressive agents and 18 didn't undergo maintenance therapy up to the end of follow-up.Twenty-two patients in the proctitis group and 12 patients in the non-proctitis group underwent maintenance therapy,with no statistically significant difference between the 2 groups (x2 =1.979,P ＞ 0.05).The total healed rate,improvement rate and unhealed rate of perianal lesion were 55.8％ (29/52),34.6％ (18/52) and 9.6％ (5/52),respectively.The number of patients with healed,improved and unhealed perianal lesions were 16,11,3 in the proctitis group and 13,7,2 in the non-proctitis group,respectively,showing no significant difference in treatment effects between the 2 groups (x2 =O.173,P ＞ 0.05).Conclusions Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis.However,there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis.Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of complex fistula-in-ano.</p><p><b>METHODS</b>Clinical data of 24 patients with complex fistula-in-ano who treated with LIFT in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2009 to February 2012 were analyzed retrospectively. The operative efficacy and postoperative continence were evaluated.</p><p><b>RESULTS</b>The prime success rate of fistula healing was 66.7% (16/24) after the LIFT procedure. Two patients presented with intersphincteric incision infection which was successfully treated with topical of silver nitrate. Four patients had intersphincteric fistula with infection and managed with the complete laying open approach. The total clinical healing rate was 91.7% (22/24). Another 2 patients had persistent external opening with discharge. During follow-up of 6 to 44 (median 16) months, The Cleveland Clinic Florida Fecal Incontinence score revealed that no patient developed decreased continence.</p><p><b>CONCLUSION</b>LIFT is a safe and effective sphincter-preserve procedure for complex fistula-in-ano.</p>
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Humans , Anus Diseases , General Surgery , Fecal Incontinence , Ligation , Rectal Fistula , General Surgery , Retrospective Studies , Wound HealingABSTRACT
Objective To establish a stable orthotopic model with high green fluorescent protein (GFP) expression in nude mice and observe its biological features.Methods Human HCT116 colon cancer cells transfected with GFP pLPCX retroviral plasmid were used to build a subcutaneous tumor model in nude mice.Fifteen BALB/C nude mice were selected to underwent orthotopic transplantation of colon when the GFP-labeled tumor grew to 10 mm × 10 mm as observed by in vivo fluorescent microscopy.The growth and metastasis of orthotopically implanted colon cancer cells were observed with fluorescent imaging system at different time points.The differences of the tumor size measured by peripheral vernier caliper and fluorescent imaging system were analyzed using the t test,and the differences in different groups were analyzed using the analysis of variance.Results GFP-labeled colon cancer models were successfully established in all the 15 nude mice,and there was no surgery-related complications or death.Tumors marked by GFP were observed under fluoroscope in week 3.The size of the tumors progressively increased with time.The volumes of the orthotopically transplanted tumors obtained from global measurement using fluorescent imaging system were greater than those measured by peripheral vernier calipers at postoperative week 3,4,5,6,7,while no statistically significant difference was observed (t =-1.280,-1.115,-0.718,-0.199,-0.386,P ＞0.05).There was a significant difference in the interation of measure method and different time points (F =29.546,P ＜ 0.05).Eight nude mice survived at the end of the experiment,and tumor metastasis was observed in 6 mice.Conclusions It is technically feasible to construct GFP-labeled colon cancer orthotopic transplantation model.The mice model could be used for real-time,in vivo,non-invasive and dynamic observation and analysis of the growth and metastasis of tumor cells.
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Objective To study the effect of baicalin on the apoptosis and cell cycle of colorectal cancer cells in orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.Methods Sixty orthotopic transplantation mice models of human colorectal cancer cell line HCT1 16 expressing green fluorescent protein (GFP) were established,and were randomly divided into the control group and the 50,100,200 mg/kg baicalin groups according to the random number table.Mice in the 50,100,200 mg/kg baicalin groups received intragastric infusion of baicalin at the corresponding dosages twice a day,while mice in the control group received intragastric infusion of 5％ NaHCO3.Cell cycles and apoptotic rates of the HCT116-GFP cells were detected by flow cytometry and TUNEL method respectively.Differences between the 2 groups were analyzed using the analysis of variance or chi-square test,and differences within each group were analyzed using the LSD-t test.Results The orthotopic transplantation mice models of human colorecta] cancer were successfully constructed,and there was no significant difference in the body weight of the mice and tumor size among the 4 groups (F =0.343,0.107,P ＞0.05).The proportion of HCT116-GFP cells in the G2/M phase in the 50,100,200 mg/kg baicalin groups were 22％±6％,18％±7％ and 19％±6％,which were significantly higher than 7％ ±5％ of the control group (t =5.421,3.483,3.575,P ＜0.05).There were no significant differences in the proportion of HCT116-GFP cells in the G2/M phase among the 50,100,200 mg/kg baicalin groups (F =1.291,P ＞ 0.05).The apoptotic rates of HCT116-GFP cells in the 50,100,200 mg/kg baicalin groups were significantly higher than the control group (t =7.163,3.703,2.688,P ＜0.05).The apoptotic rate of the 50 mg/kg baicalin group was significantly higher than that of the 200 mg/kg baicalin group (t =2.259,P ＜ 0.05).Conclusions Baicalin significantly inhibits tumor growth in the orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.After treated with baicalin,the cell cycle is arrested at the G2/M phase,thus the tumor growth is inhibited.
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ObjectiveTo study the clinical value of minimally invasive treatment of the doppler-guided hemorrhoid artery ligation with lauromacrogal sclerosis injection in treatment of hemorrhoids.MethodsA retrospective analysis was made on treatment of 32 cases with hemorrhoids using doppler-guided hemorrhoid artery ligation combined with lauromacrogal sclerosis injection.ResultsAccording to the branch of the Chinese Medical Association by the Surgery the clinical diagnosis and Treatment Guidelines of Hemorrhoids (draft),the Ⅰ degree hemorrhoid was found in 1 case,Ⅱ degree hemorrhoids in 18 cases,Ⅲ degree hemorrhoids in 13 cases.Recovery was found in 32 cases.The longest follow-up time was 30 weeks.No relapse was found. ConclusionsDoppler-guided hemorrhoid artery ligation combined with lauromacrogal case sclerosis injection is a low aggressive minimally invasive method to treat hemorrhoid and has small trauma,definite effect,less pain,fewer complications,and short course and other advantages,but the longterm outcome needs further observation.
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Objective To explore the effect of transabdominal posterior rectopexy with resection of the partial rectosigmoid colon on adult rectal prolapse.Methods During the 2006 to 2011,transabdominal posterior rectopexy with resection of the partial rectosigmoid colon was performed on 6 selected adult patients with complete rectal prolapse.Results All patients were cured,the median length of hospital stay was 13.7 days.Followed up for 3-61 months,there was no recurrent case.Conclusions The operation offers a safe and effective alternative to other more complex procedures for the treatment of adult rectal prolapse.The procedure can not only treat the rectosigmoid disease,but also improve the rectosigmoid disease,improve the function of bowel and reduce the recurrence rate.
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Rectal prolapse is a rare disease, has been attracting many surgeons to study it.Surgical treatment of rectal prolapse is currently more than 50 kinds, most of which are modifications of several basic modes treatment, depending on the doctor' s grasp on the patient anatomy.Currently comprehensive treatment of a variety of therapies is a more ideal way for the treatment of rectal prolapse.
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Objective Extrapolate the relationships between the width of circumferential rectal mucosa re-sected and the method of either performing single purse-string or performing double purse-string during per-forming the procedure for prolapse and hemorrhoids (PPH), and to assess the impact of both the level of sta-ple line and the width of rectal mucosa resected on clinical outcomes after stapled hemorrhoidpexy. Meth-ods Twenty-eight adult patients with Ⅲ-Ⅳ hemorrhoids were assigned to two groups: 15 patients using sin-gle pursestring and the remaining 13 patients using double purse-string. The mucosal width of doughtnuts of both groups were measured and the data recorded. The doughtnuts resected were sent to pathology examina-tion after stapled hemorrhoids pexy to identify whether or not the specimens involved the smoth muscles. The demographic complications (bleeding, postoperative pain, urinary retention, fecal urgency) were compared and statistically analysed between the two groups, respectively. Results There were no statistical differ-ences between the two groups in terms of postoperative short-term results and complication rates, as well as the proportion of involving smooth muscle in specimens(P >0.05). However, when compared the width of doughtnuts resected in single-pursestring group was smaller than that in double-parse-string group (P < 0. 01). Conclusion The single or double-purse-string suture in PPH can control the width of resected rectal mucosa.
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Abstract: The high recurrent rate and insufficient protection of anal function in treatment of anal fistula were reviewed in this article. To solve the problems in the treatment of complex fistula-in-ano including ignorance of preoperative assessment and lack of consciousness of preserving anal function, the authors raised the countermeasures to carry out the "gold standard" of preoperative assessment and the system of medical delivery, form the new principle of incision of anal sphincters, collect the high-level evidence-based medicine proof, improve the healing rate and significantly reduce the postoperative continence disturbance, so as to develop a new guideline for the treatment of fistula-in-ano.