RESUMEN
In order to understand the status quo of ethical review of clinical research on the defecation function of patients with rectal cancer after sphincter-preserving surgery, analyze its causes and put forward corresponding suggestions, to arouse researchers’ attention to ethical review in subsequent relevant clinical studies. The ethical review of literatures related to the defecation function of patients with rectal cancer after sphincter-preserving surgery published on CNKI in recent 10 years was sorted out and summarized. The results showed that the ethical review of clinical research papers on defecation function of patients with rectal cancer after sphincter-preserving surgery was not optimistic. We should strengthen the ethical training of researchers, improve the ethical awareness of researchers, strictly implement the ethical norms of paper publication, strengthen the ethical requirements of manuscript contracts, perfect the ethical review system, and pay attention to the examination and supervision of informed consent, so as to promote the construction of ethical examination and approval norms of clinical research documents.
RESUMEN
Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.
Asunto(s)
Humanos , Canal Anal/cirugía , Anastomosis Quirúrgica/efectos adversos , Defecación , Incontinencia Fecal/etiología , Complicaciones Posoperatorias/epidemiología , Neoplasias del Recto/cirugíaRESUMEN
Objective:To compare the effects of modified incision drainage combined with thread-drawing and precise minimally invasive surgery in the treatment of anal fistula on anal defecation function and complications.Methods:A total of 105 patients with anal fistula who were diagnosed and treated in Xin′an International Hospital from December 2018 to December 2020 were collected. The patients were divided into the observation group (58 cases) and the control group (47 cases) according to surgical methods. The observation group received modified incision drainage combined with thread-drawing surgery. The control group received precise minimally invasive anal fistula surgery. The treatment outcome, anal defecation function and complications were compared between the two groups.Results:The operation time, intraoperative blood loss, first defecation time after operation, normal eating time after operation in the two groups had no significant differences ( P>0.05). The hospital stay in the observation group was significantly longer than that in the control group: (5.29 ± 1.53) d vs. (4.02 ± 1.16) d, there was statistical differences ( P<0.05). After operation, the resting pressure of the anal canal, resting rectal pressure, length of the tube high pressure belt, the maximum systolic pressure of the anal canal between the two groups had no significant differences ( P>0.05). The excellent and good rate of anal defecation function and complication rate between the two groups had no significant differences ( P>0.05). Conclusions:Modified incision drainage combined with thread-hanging surgery in the treatment of anal fistula is equivalent with precision minimally invasive surgery. Both can effectively improve the anal defecation function. The postoperative safety is good and there is no recurrence. However, the hospital stay of patients with precision minimally invasive surgery for anal fistula is relatively shorter.
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Objective: To investigate the changes of rectal smooth muscle structure after spinal cord injury in rats. Methods: Twenty adult female Sprague-Dawley rats were randomly divided into two groups,i.e.,spinal cord injury group and control group. In the spinal cord injury group,the spinal cord was completely disconnected between L5 and L6,and control group was not surgically treated. After 3 months,gastric instillation was used to measure the intestinal transit time with the administration of activated carbon suspension and the mass of fecal pellets within 24 h was recorded. Then the rectal tissue was taken at about 1 cm proximal to the anus. The changes of rat rectal smooth muscle were detected by hematoxylin-eosin (H-E) staining,Masson staining and immunohistochemistry staining. Results: Gastric instillation showed that compared with control group,the intestinal transit time of spinal cord injury group significantly prolonged,and the mass of fecal pellets within 24 h significantly reduced. H-E staining showed that the arrangement of rat rectal smooth muscle cells was disordered after spinal cord injury. Masson staining showed fibrotic changes in the rectal smooth muscle layer of rats after spinal cord injury. Immunohistochemistry staining showed that the expression of α smooth muscle actin (α-SMA) in rat rectal smooth muscle decreased after spinal cord injury. Conclusion: After spinal cord injury,rats present defecation dysfunction. The structure of rectal smooth muscle also changes significantly,mainly including smooth muscle atrophy,fibrosis and decreased α-SMA expression.
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After lower rectal anterior resection, patients often experience defecation disorders such as increased stool frequency and fecal incontinence. Researches have shown that these disorders may be resulted from pathophysiological consequences such as impaired neorectal compliance, decreased internal anal sphincter function, direct damage or injury of the nervous supply and the loss of rectal sensation.
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Objective: To investigate the effects of acupuncture on constipation in rats. Method:Compound diphenoxylate was used to set up rat model of constipation. After needling Heguand Housanli, the time to first bowel movement, and stool grains quantity and weight in 12 rats were observed. Results: The time to first bowel movement was delayed, and the stool grains quantity and weight were reduced in the model rats. Acupuncture could significantly shorten the time to first bowel movement, and increase stool grains quantity and weight.Conclusion: Acupuncture can improve the defecating abilities in rats model of constipation.