Efficacy of polyglycosides of Tripterygium wilfordii in preventing postoperative recurrence of Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To observe the efficacy of polyglycoside of Tripterygium wilfordii(GTW) in preventing postoperative recurrence of Crohn disease(CD).</p><p><b>METHODS</b>Thirty-nine post-operative CD patients in whom all of the diseased gut had been removed from January 2005 to December 2006 were enrolled in a randomized, placebo-controlled trial. The patients took GTW(21 cases) or SASP(18 cases) in two weeks after operation. Crohn disease activity index(CDAI), ESR and CRP were collected at week 0, 13, 26, 52 or at the onset of symptoms. Ileocolonoscopy was performed at the end of the trial or at the onset of symptoms.</p><p><b>RESULTS</b>One patient in GTW group and 2 patients in SASP group were lost and 2 patients in GTW were excluded from the trial for non-compliance. Clinical recurrence was ascertained in one patient (5.6%) received GTW and in four (25.0%) received SASP. Four of eighteen patients in GTW(22.2%) had endoscopic recurrence compared with nine of sixteen(56.2%) in SASP. There were significant differences between the two groups(P<0.05).</p><p><b>CONCLUSION</b>Tripterygium wilfordii showed good efficacy in preventing recurrence of postoperative CD which can maintain remission and prevent recurrence.</p>

Enteral nutrition support in 21 patients after opening abdomen / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of enteral nutrition (EN) in patients underwent open-abdomen managements.</p><p><b>METHODS</b>Twenty-one patients who received at least 3 days of EN after opening the peritoneal cavity between January 2003 and November 2006 were included in this study. Energy expenditure and actual caloric and protein intake were determined in some patients. The levels of serum protein and nitrogen balance before and after the EN were analyzed. Other related complications were also evaluated.</p><p><b>RESULTS</b>Average daily total caloric intake was 93% - 95% of estimated needs. The EN support was administered (8.8 +/- 5.5) d after opening the abdominal cavity and lasted for (51.5 +/- 33.6) d. Initial serum protein levels were low and below normal but increased in all of the patients after the EN. The average nitrogen balance was (-28.6 +/- 5.4) g/d. Diarrhea, gastric reflux, vomiting and abdominal distention occurred in 67%, 23%, 9.5% and 23% of the patients, respectively. All the complications were managed well.</p><p><b>CONCLUSIONS</b>EN support could be effectively and safely given in patients requiring opening peritoneal cavity management.</p>

Computer tomography appearances of the enterocutaneous fistula classification / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To discuss the computer tomography(CT) appearances of the enterocutaneous fistula classification.</p><p><b>METHODS</b>CT scan was performed on 754 patients with enterocutaneous fistula, which were divided into tube fistula and labiate fistula according to clinic classification, and the appearances of CT scan were analyzed respectively.</p><p><b>RESULTS</b>Five hundreds and eighteen patients (68.6%) were diagnosed as tube fistula, and CT appearance of which was a duct formed between internal hole and external hole. Two hundreds and thirty-six patients (31.4%) were diagnosed as labiate fistula,and CT appearance of which was a large external hole like labium.The basic appearance of intestine and celiac cavity in enterocutaneous fistula was inflammatory focus. The incidence of abscesses in tube fistula was higher than that in labiate fistula (P<0.01). The intestinal inflammation was more common in labiate fistula than that in tube fistula (P<0.01).</p><p><b>CONCLUSION</b>There are characteristic CT appearances in enterocutaneous fistula and CT scan is useful for classification of enterocutaneous fistula.</p>

Surgical management of chronic radiation enteritis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the surgical methods and the clinical results of chronic radiation enteritis.</p><p><b>METHODS</b>Treatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases.</p><p><b>RESULTS</b>Forty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died.</p><p><b>CONCLUSIONS</b>Surgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.</p>

Diagnosis and management of Crohn disease complicated with gastrointestinal fistulae / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of patients with Crohn disease (CD) complicated with gastrointestinal fistulae.</p><p><b>METHODS</b>Clinical data of sixty-two cases with CD complicated with gastrointestinal fistula e from 1978 to 2004 were analyzed.</p><p><b>RESULTS</b>These were 68 external fistulae in 6 2 patients including recurrent fistulae in 6 cases, internal fistulae in 8 cases . Twenty- seven fistulae were located in the terminal ileum and 21 fistulae wer e located in ileocolic anastomosis site. The main surgery included 14 ileocecal resections with primary anastomosis and 26 resections of original ileocolic anastomosis with fistula and re-anastomosis. The incidence of recurrence was lower (15.4% ) in patients with postoperative medication including sulfasalazine and immunomodulator than that (34.8% ) in patients without postoperative immunomodulator,but the recurrence time was longer [(40+/- 17) months] in patients with postoperative medication than that [(8+/- 3)months] in the patients without postoperative specific medication.</p><p><b>CONCLUSIONS</b>Most CD fistulae are external fistulae,most of the external fistulae are treated by resection of the fistula and anastomosis. Specific medication including sulfasalazine,mesalamine and immunomodulators should be used to prevent postoperative complications and CD recurrence.</p>