Choice of surgical procedure and management of postoperative incision for anal fistula / 中华胃肠外科杂志

Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

Features of anorectal manometry in patients with rectocele / 中华消化杂志

Objective To assess the anal and pelvic floor function in patients with rectocele (RC),and to afford the evidence for the treatments of RC.Methods Patients with functional constipation (FC) and healthy controls were consecutively enrolled,and all the subjects underwent defecography and anorectal manometry.According to defecography,the subjects were divided into four groups as no RC,mild RC,moderate RC and severe RC.The t-test,analysis of variance,rank sum test and Chi-square test were performed to compare the results of anorectal manometry between different RC groups in FC patients,and the results of anorectal manometry between moderate RC group in FC patients and control group with moderate RC were also compared.Results A total of 54 FC patients and 17 healthy controls were enrolled.No RC was found in all of male subjects.Of 48 female patients with FC,nine cases (18.8％) had no RC,seven (14.6％) had mild RC,18(37.5％) had moderate RC,and 14(29.2％) had severe RC.Three of the 12 female controls had no RC,one had mild RC,and eight had severe RC.Among all female patients with FC,the defecation rectal pressure in severe RC group ((34.4 ± 14.2) mmHg,1 mmHg=0.133 kPa) was significantly higher than of no RC group ((20.8 ± 13.1) mmHg,t=3.663,P=0.001),mild RC group ((19.1± 15.1) mmHg,t=3.719,P＜0.01) and moderateRC group ((25.6±16.3) mmHg,t=2.525,P=0.010).The left rectal pressure after defecation in mild RC group ((55.1 ± 19.7) mmHg) was significantly higher than that of moderate RC group ((43.3±17.6) mmHg,t=2.507,P=0.019) and severe RC group ((40.0±20.9) mmHg,t=2.619,P=0.006).The anal relax ratio in mild RC group (3.0％,0.5％ to 25.5％) was significantly lower than that of moderate RC group (19.5％,10.0％ to 29.0％,Z=-2.583,P=0.010) and severe RC group (22.0％,7.3％ to 54.5％,Z=-2.830,P=0.005).There were no significant differences in rectal and anal resting pressure,anal squeezing pressure,rectal sensory threshold and constituent ratio of manometry among four groups (all P＞0.05).The left rectal pressure after defecation in FC patients with moderate RC ((43.3 ± 17.6) mmHg) was significantly higher than that of controls with moderate RC ((26.3±20.8) mmHg,t=2.997,P＜0.01),and anal relax ratio was significantly lower than that of controls with moderateRC ((23.4±20.2)％ vs (55.2±16.3)％,t=-5.266,P=0.008).Conclusions RC is found in female and also found in individuals with normal defecation.FC patients with mild RC lack enough anal relax during defecation.However,defecation is relatively coordinate in FC patients with severe RC,which indicates that severe RC may be part of manifestation of pelvic floor relaxation.

Correlation analysis of acute pancreatitis with hyperlipemia and C reactive protein / 中国基层医药

Objective To analyze the correlation of acute pancreatitis with hyperlipemia and C reactive pro-tein. Methods 42 patients with acute pancreatitis with hyperlipemia were divided into two groups of SAP group and MAP group under the diagnostic code. The blood fat and CRP were compared between the two groups, also the scores of APACHE Ⅱ , Ranson and CT were measured. Results The CRP and TG in group SAP compared with those in group MAP had significant difference(P<0.01),but the CHOL has no-difference;the scores of APACHEⅡ , Ranson and CT after control lipid in 42 patients were significantly' different( P < 0.05). Conclusion Hyperlipe-mia is one risk factors of the AP;combined with the CRP, it can be one evaluating index of the severity.

Effect of partial internal sphincterotomy on the pain after cutting seton treatment / 中国微创外科杂志

Objective To study the influence of partial internal sphincterotomy on the postoperative pain after cutting seton treatment in patients with perianal infection. Methods A controlled study was carried out on 40 cases of cutting seton insertion with (Group A) or without (Group B) partial internal sphincterotomy. The subjects reported their postoperative pain at defecation and at rest respectively using a visual analogue scale (VAS). The intensity of pain between the two groups was compared. Results All the 40 patients were cured, without recurrence or fecal incontinence. During the period of cutting seton treatment, the pain scores at defecation and at rest were lower in the Group A than in the Group B ( P 0.05). Conclusions Internal sphincterotomy can significantly relieve anal pain after cutting seton treatment, being an effective method.