ABSTRACT
Objective Although intersphinctoric resection is the standard method for clinical treatment of local low rectal cancer, it is lack of control for the occurrence and development of postoperative incontinence symptoms. Therefore, the effects of different ISR on postoperative stool function were analyzed retrospectively to provide guidance for judging the degree of fecal incontinence. Methods A total of 73 cases of ISR patients with low rectal adenocarcinoma treated in the oncology ward, and the outpatient department of our department from January 2014 to November 2017 were retrospectively studied. According to the distance of the tumor from the anal margin and different ISR procedures, 73 cases were divided into three group:group ISR (37 cases), subtotal ISR group (28 cases) and complete ISR group (8 cases). The anus dynamic index, Wexner subjective score of incontinence and multiple regression analysis were used to compare the severity of fecal incontinence in each group before and after operation to determine the function of stool control. Results There was no significant difference in the maximum resting pressure of anal canal, HPZ, the maximum systolic pressure of the anal canal and the Wexner in the three groups. Multiple variable ROC model regression analysis was used to analyze the influencing degree on the function of the stool, and the results showed that the Wexner score, HPZ, the maximum resting pressure of the anal canal, and the maximum systolic pressure had an obvious effect on the ability to control the stool, in which the HPZ correlated most predominately (P<0.01, HR=1.74, 95％CI 1.49- 2.03), and the age and sex factors were not selected in the equation. Conclusions Inter sphincter resection combined with new adjuvant therapy can effectively improve the anal fecal control ability of patients with low rectal cancer. The change of HPZ is of significance for prejudging the severity of fecal incontinence, which is worthy of further study.
ABSTRACT
Objective To observe the clinical effect of small endoscopic sphincterectomy (SES) combined with endoscopic papillary balloon dilation (EPBD) in the treatment of large common bile duct stones.Methods The patients were randomly divided into 3 groups:normal endoscopic sphincterotomy(EST),EPBD,SES combined with EPBD.The incidence of pancreatitis at 1 week after operation and the recurrence rate of inner duct stone within 15 months after operation were statistically analyzed.Results At 1 week after treatment,the incidence of pancreatitis was lower in group EST and group SES combind with EPBD than in group EPBD [3.3％ (1/30),3.3％ (1/30) vs.20.0％ (6/30),both P＜0.05].After 15 months of treatment,the recurrence rate of inner duct stone were lower in group B and group C than in group A 3.3％ (1/30),3.3％ (1/30) vs.23.3％(7/30),both P＜0.05).Conclusions In the treatment of large common bile duct stones,SES combined with EPBD can reduce the incidence of postoperative acute pancreatitis and the longterm recurrence rate of common bile duct stones.
ABSTRACT
BACKGROUND/AIMS: Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track. METHODS: A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group. RESULTS: The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614). CONCLUSIONS: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.