Application of 4% formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis / 世界急诊医学杂志（英文）

BACKGROUND@#To investigate the effectiveness of topical application of 4% formaldehyde as a minimally invasive treatment of rectal bleeding due to chronic radiation proctitis (CRP) under direct vision of electronic colonoscope.@*METHODS@#The clinical data of 13 CRP patients complicated with ≥ grade II bleeding admitted to our hospital between January 2003 and December 2018 were retrospectively analyzed. Under the guidance of electronic colonoscope, 4% formaldehyde combined with 5-aminosalicylic acid (5-ASA) suppositories was topically applied. Patients were followed up for two months after treatment, and the therapeutic effectiveness was observed and analyzed.@*RESULTS@#The rectal bleeding due to CRP was markedly reduced after topical application of 4% formaldehyde under colonoscope in all 13 patients. The bleeding stopped after one treatment session in 11 patients and after the second session in 2 patients. 5-ASA was also applied along with the use of 4% formaldehyde. The therapeutic effectiveness was satisfactory during the 1- and 2-month follow-up period.@*CONCLUSION@#Topical application of 4% formaldehyde under the direct vision of colonoscope as a minimally invasive treatment for CRB-induced bleeding is a simple, effective, affordable, and repeatable technique without obvious complications, which deserves further exploration and promotion.

Adult sacrococcygeal teratoma: a retrospective study over eight years at a single institution / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#To determine the clinical, imaging, and histological features, and surgical resection modalities and outcomes of adult sacrococcygeal teratoma (SCT).@*METHODS@#Adult patients with histopathologically diagnosed SCT were enrolled in our hospital between August 2010 and August 2018. Each patient's characteristics and clinical information were reviewed.@*RESULTS@#There were 8 patients in the study (2 males, 6 females) with a median age of 34 years (range, 18-67 years). The time to clinical symptoms was 14 d to 35 years, with a median time of 4 years. Six patients presented with symptoms of sacrococcygeal pain, and four with signs of sacrococcygeal mass and ulceration in the sacrococcygeal region. Six patients were evaluated using a combination of computed tomography (CT) and magnetic resonance imaging (MRI). All patients showed a presacral tumor with heterogeneous intensity on CT images. All patients underwent surgical treatment, including 6 parasacral, 1 transabdominal, and 1 combined anterior-posterior surgery cases. Seven patients were histopathologically diagnosed with benign mature SCT, and have shown no recurrence. One patient had malignant SCT, with recurrence at 84 months after surgery. After a second surgery, the patient had no recurrence within 6 months follow-up after re-resection.@*CONCLUSIONS@#Our retrospective study demonstrated: (1) adult SCT is difficult to diagnose because of a lack of typical clinical symptoms and signs; (2) a combination of CT and MRI examination is beneficial for preoperative diagnosis; (3) the choice of surgical approach and surgical resection modality depends on the size, location, and components of the tumor, which can be defined from preoperative CT and MRI evaluation; (4) most adult SCTs are benign; the surgical outcome for the malignant SCT patient was good after complete resection. Even for the patient with recurrent malignant SCT, the surgical outcome was good after re-resection.

Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches

PURPOSE: To demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers. METHODS: Patients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate. RESULTS: In total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate. CONCLUSION: The results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers.

Cutaneous metastasis: a rare phenomenon of colorectal cancer

Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary tumor. Although this phenomenon is uncommon, it is very important and often indicates a poor prognosis. We present a case of a 76-year-old female patient with multiple cutaneous metastatic nodules on the back, just 1 month after resection of rectal cancer. Unfortunately, the patient gave up the follow-up treatment due to her age and poor physical condition; she died 3 months later. In view of its rarity of occurrence and lack of experience in treatment, we reviewed the literature and report as follows.

A cross -sectional study on the prevalence of anorectal disease and its influencing factors among rural residents / 预防医学

Objective To know the prevalence of anorectal disease and its influencing factors among rural residents in Lanxi city.Methods A cluster sampling method was performed,a total of 2 287 residents aged 1 8 years and over were selected. A questionnaire interview and physical examination were carried out.Results The prevalence of anorectal diseases was 64.1 5% totally,with female 73.02% and male 52.66%,respectively.Multivariate analysis showed that gender,age, marriage status,working intensity,defecation habit,family history of anorectal disease and body mass index were the influencing factors (P <0.01 ).Conclusion The prevalence of anorectal diseases was relatively high among rural residents in Lanxi city.The colonoscopy should be recommended and health education should be taken in general physical examination.

The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study / 대한외과학회지

PURPOSE: To compare and assess the efficacy, safety and utility of hand-assisted laparoscopic surgery (HALS) with open surgery (OS) in total colectomy with ileorectal for colonic inertia. METHODS: From January 2001 to February 2012, 56 patients diagnosed with colonic inertia who failed to respond to medical treatments underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Another 68 patients underwent laparotomy. Main parameters such as clinical manifestations, conversion to open procedure, operative time, incision length, pain score, intraoperative blood loss, time to first flatus and hospitalization, early postoperative complications and hospitalization cost were retrospectively analyzed. Postoperative defecating frequencies were followed up in both groups. RESULTS: All patients received successful operation, no surgical mortality happened and none of the patients required conversion to an exploratory laparotomy in HALS group. The clinical features, the estimated blood loss, incision length, pain score, first passing flatus time, and postoperative hospitalization time were superior in HALS group (P < 0.05). The early postoperative complications and frequency of defecation were similar. However, the mean operative time was longer and hospitalization cost was higher in HALS group than those in OS group (P < 0.05). CONCLUSION: HALS total colectomy can be a safe and efficient technique in the treatment of colonic inertia. HALS can result in a better cosmetic result and a quicker postoperative recovery, but requires higher direct cost.

Efficacy and safety of domestic biofragmentable anastomotic ring in the intestinal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of the domestic biofragmentable anastomotic ring (BAR) from Hangzhou in the intestinal anastomosis.</p><p><b>METHODS</b>A total of 134 patients who underwent intestinal anastomosis from February 2010 to April 2011 in the First Municipal People's Hospital of Guangzhou and the First Affiliated Hospital of Zhejiang University were randomized into two groups. The Valtrac BAR from USA was employed in the control group while the experimental group used domestic BAR. The operative performance of the BARs, as well as the patients vital signs and bowel function, complications, fragmentation status of the rings were compared between two groups.</p><p><b>RESULTS</b>No significant difference was found between two groups in the operative performance, the fragmentation status of the BARs, the temperature, blood pressure, heart rate, and bowel function (P>0.05).</p><p><b>CONCLUSION</b>The domestic BAR possesses similar safety and efficacy with the Valtrac BAR in intestinal anastomosis.</p>

Hand-assisted laparoscopic surgery in radical resection of rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the application experience and clinical effects of hand-assisted laparoscopic radical resection for rectal cancer.</p><p><b>METHODS</b>The clinical data of 156 patients with rectal cancer treated with hand-assisted laparoscopic surgery between August 2009 and April 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>The operative procedures of 156 patients were completed successfully and 1 case was converted to laparotomy (0.6%). The mean operation time was (125 ± 35) minutes; the mean intraoperative blood loss was (118 ± 60) ml; the mean time of bowel function recovery was (60 ± 8) hours; the median postoperative hospital stay was (9.5 ± 2.2) days. The mean number of lymph nodes dissection was (14 ± 5). Five patients (3.2%) had postoperative complications. All the patients were followed up. There had been no local recurrence or trocar site implantation metastasis.</p><p><b>CONCLUSION</b>Hand-assisted laparoscopic surgery approach for the curative resection of rectal cancer is safe and effective and has broad prospects in clinical application.</p>

Clinical study of hand-assisted laparoscopic total colectomy for colonic inertia / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the efficacy of hand-assisted laparoscopic surgery (HALS) with that of open surgery (OS) in total colectomy, and to evaluate the feasibility of hand-assisted laparoscopic total colectomy for colonic inertia.</p><p><b>METHODS</b>A total of 42 patients of colonic inertia received total colectomy from January 2001 to June 2006 were randomly allocated to OS group (n = 22) and HALS group (n = 20). Data as clinical manifestation, perioperative features including operative time, intraoperative blood loss and incision length, postoperative features including first flatus-passing time, first fluid-feeding time, hospitalization time, early postoperative complications, and hospitalizing expense were recorded and compared in the two groups. Postoperative defecating frequency was followed up in both groups.</p><p><b>RESULTS</b>All patients underwent total colectomy successfully and no death of operation occurred. The clinical features, operative time and blood loss were similar for the two groups. Incision length, first flatus-passing time, first fluids-feeding time, hospitalization time were better in HALS group than those in OS group. But mean hospitalizing expense in HALS group was higher than that in OS group. One case of incision infection and one intestinal obstruction occurred in OS group. No complication occurred in HALS group. Patients were followed up for 2 - 14 months, in the meantime the average defecating frequency was 3.55 +/- 1.80/d.</p><p><b>CONCLUSIONS</b>HALS and open total colectomy are safe, rapid and effective surgical procedures for colonic inertia. HALS can result in a better cosmetic effect and a quicker postoperative recovery.</p>

Clinical application of biofragmentable anastomosis ring for intestinal anastomosis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare the efficacy of the biofragmentable anastomotic ring (BAR) with conventional hand-sutured and stapling techniques,and to evaluate the safety and applicability of the BAR in intestinal anastomosis.</p><p><b>METHODS</b>The totol of 498 patients performed intestinal anastomosis from January 2000 to November 2005 were allocated to BAR group (n=186), hand-sutured group (n=177) and linear cutter group (n=135). The operative time, postoperative convalescence and corresponding complication were recorded. Postoperative anastomotic inflammation and anastomotic stenosis were observed during half or one year follow-up of 436 patients.</p><p><b>RESULT</b>The operative time was (102 +/- 16) min in the BAR group, (121 +/- 15) min in the hand-sutured group, and (105 +/- 18 ) min in the linear cutter group. The difference was significant statistically (P <0.05). The operative time in BAR group and linear cutter group was shorter than hand-sutured group. One case of anastomotic leakage was noted in the BAR group, one case in the hand-sutured group, and none in the linear cutter group. They were cured by conservative methods. One case of anastomotic obstruction happened in the BAR group, one case in the hand-sutured group. Two of them were cured by conservative methods. Two cases of anastomotic obstruction happened in the hand-sutured group. However, one of them required reoperation to remove the obstruction. In the BAR, hand-sutured and the linear cutter group, the postoperative first flatus time was (67.2+/- 4.6) h, (70.2 +/- 5.8) h and (69.2 +/- 6.2)h, respectively. No significant differences were observed among three groups(P > 0.05). The rate of postoperative anastomotic inflammation was 3.0 % (5/164) in the BAR group, 47.8 % (76/159) in hand-sutured group and 7.1 % (8/113) in the linear cutter group. The difference was significant statistically (P <0.05). The rate of postoperative anastomotic inflammation in the BAR group and in the linear cutter group was less than that in hand-sutured group.</p><p><b>CONCLUSION</b>BAR is one of rapid,safe and effective methods in intestinal anastomosis. It has less anastomotic inflammatory reaction than hand-sutured technique. It should be considered equal to manual and stapler methods.</p>

Minilaparotomy approach for curative resection of colorectal cancer / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of a minilaparotomy approach for curative resection of colorectal cancer in comparison with the conventional laparotomy.</p><p><b>METHODS</b>Seventy-eight patients underwent radical resection for rectal cancer with minilaparotomy during April 2001 to December 2002. The minilaparotomy involved complete resection and a skin incision 2 cm above the link line of left anterior superior iliac spine to pubic symphysis and was about 7-10 cm in length. Another 86 patients who served as control group underwent a similar resection with a conventional laparotomy during the same period.</p><p><b>RESULT</b>The minilaparotomy approach was successful in all 78 patients. The general status of patients, operative types and histopathological features of tumor were similar in the two groups (P>0.05). Operative blood loss in control group was greater (P<0.001), whereas incision length in minilaparotomy group was significantly shorter than that in conventional laparotomy (9.38 cm compared with 17.32 cm). The operative time, analgesia requirement, first passing flatus,first oral fluids and postoperative hospital stay were significantly shorter in the minilaparotomy group (P<0. 001). In an average 25.4-month follow-up, there were no tumor recurrences in the minilaparotomy group.</p><p><b>CONCLUSION</b>A minilaparotomy approach for curative resection of rectal cancer may be an ideal alternative approach to conventional laparotomy.</p>

The prognosis of the total proctocolectomy and ileal-pouch anal anastomosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognosis of the total proctocolectomy and ileal-pouch anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP).</p><p><b>METHODS</b>Sixty-one patients with ulcer colitis or familial adenomatous polyposis were performed total proctocolectomy and ileal pouches-anal anastomosis during 1985 to 2002. There are S type pouch 25 cases, S-J type pouch 13 cases, J type pouch 17 cases and W type pouch 6 cases. The complication and function after the IPAA were also discussed.</p><p><b>RESULTS</b>No patient died after operation. The total morbidity is 16% (10/61), the morbidity of group UC (6/25) is higher than FAP's (4/34). The W type pouch's morbidity is higher than other three types', the operation with stapled technique is associated with fewer complication than hand-sewn IPAA (2/20 vs 8/41), however, there is also no significant difference between them. The number of stools per 24 hours is 4.2, the percent of the normal continence of daytime and nighttime is 84% (43/51) and 75% (38/51) respectively. There's only about 6% (3/51) patient with fecal incontinence. The most patients are satisfied with IPAA.</p><p><b>CONCLUSION</b>The proctocolectomy ileal pouch-anal anastomosis for FAP and UC has few complication with accepted frequency and preserve a good anal function, it is an ideal alternative approach.</p>