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Objective@#To explore the efficacy of closed negative pressure irrigation and suction device (Patent number: Z200780013509.8) in the treatment of high perianal abscess.@*Methods@#From January 2015 to December 2016, ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled. Exclusion criteria: (1) recurrent perianal abscess; (2) complicated with anal fistula formation; (3) preoperative, intraoperative or postoperative physical therapy, and curettage treatment, negative pressure irrigation; (4) Crohn′s disease-related perianal abscess; (5) with immunosuppressive status, such as transplant recipients; (6) co-existence of malignant tumors, such as leukemia; (7) with diabetes; (8) those who could not receive long-term follow-up and were not suitable to participate in this study. According to the random number table method, the patients were randomly divided into negative pressure irrigation and suction group and routine drainage group. All patients were clearly diagnosed and the location and size of the perianal abscess were marked before surgery. These two groups were treated as follows: (1) Negative pressure irrigation and suction group: the skin was incised at a diameter of 1-2 cm at the site where the abscess fluctuated most obviously. After the abscess was removed, a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed. Generally, the irrigation was stopped 5 days later or when the drainage was clear. The closed vacuum suction was maintained for 2 additional days, before the wound was sutured. (2) Conventional drainage group: conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing. Dressing was changed regularly until the wound healed. The efficacy, operative time, intraoperative bleeding, incision length, frequency of dressing change, pain index (visual analogue score, VAS score), postoperative healing time, complications, recurrence rate of perianal abscess, anal fistula formation rate were observed. The t test and χ2 test were used for comparison between the 2 groups.@*Results@#There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group. There were 28 males and 12 females in negative pressure irrigation and suction group with a mean age of (38.3±12.0) years and mean disease course of (6.6±2.1) days. The abscess in pelvic-rectal space accounted for 50.0% (20/40) and the mean diameter of abscess was (8.0±3.7) cm. There were 26 males and 14 females in the conventional drainage group with a mean age of (37.1±11.8) years and mean disease course of (6.4±2.5) days. The abscess in pelvic-rectal space accounted for 55.0% (22/40) and the diameter of abscess was (8.2±3.5) cm. The differences in baseline data between two groups were not statistically significant (all P>0.05). Both groups successfully completed the operation. There was no significant difference in operative time between two groups (P>0.05). As compared to conventional drainage group, intraoperative blood loss in negative pressure irrigation and suction group was less [(12.1±5.5) ml vs. (18.3±4.4) ml, t=5.606, P<0.001], incision length was shorter [(2.3±0.8) cm vs. (7.6±1.7) cm, t=17.741, P<0.001], postoperative VAS pain scores at 1-, 3-, 7-, and 14-day after operation were lower [3.7±1.4 vs. 7.6±1.8, t=10.816, P<0.001; 3.0±1.3 vs. 6.8±1.6, t=11.657, P<0.001; 2.7±0.9 vs. 5.1±1.1, t=10.679, P<0.001; 1.2±0.3 vs. 1.6±0.4, t=5.060, P=0.019], the dressing change within 7 days after operation was less (3.5±1.2 vs. 12.6±2.7, t=19.478, P<0.001), postoperative healing time was shorter [(10.4±3.0) d vs. (13.5±3.8) d, t=4.049, P<0.001] and postoperative complication rate was lower [17.5% (7/40) vs. 2.5% (1/40), χ2=5.000, P=0.025]. During follow-up of 12 to 36 (24±5) months, the recurrence rate of perianal abscess within 1 year after operation and anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ2=4.114, P=0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ2=5.000, P=0.025, respectirely]. The one-time cure rate of negative pressure irrigation and suction group and conventional drainage group was 92.5% (37/40) and 62.5%(25/40), respectirely (χ2=10.323, P=0.001).@*Conclusions@#The application of the negative pressure irrigation and suction device in the treatment of high perianal abscess can improve the efficiency of one-time cure, reduce postoperative pain, accelerate healing time, decrease the morbidity of postoperative complication and the rates of abscess recurrence and anal fistula formation, indicating an improvement of the treatment.
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Objective To investigate the efficacy of adhesive negative pressure suction apparatus in treatment of wound infection after colorectal surgery.Methods From January 2010 to November 2011,consecutive patients with wound infection after colorectal surgery were randomized to the experimental group (n =24 ) and the control group (n =24).The patients in experimental group were treated with the adhesive negative pressure suction apparatus.The patients in the control group were treated with traditional wound therapy.The results of treatment were evaluated.Results Time from debriding the wound infection to secondary suture was significantly shorter in patients of the experimental group ( P ＜ 0.05 ).The total number of dressing changes was very significantly less in patients of the experimental group ( P ＜ 0.01 ).The total cost of dressing in experimental group was significantly less than the control group (P ＜ 0.05 ).Conclusions The application of adhesive negative pressure suction apparatus in treatment of the wound infection after colorectal surgery can shorten the wound processing time,reduce the number of dressing changes and the total cost of dressing,thus has a high clinical value.
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Objective To evaluate the efficacy,safety and the possible mechanism of shenfu injection (SFI)in the treatment of severe acute pancreatitis(SAP).Methods A total of fifty-eiSht patients with SAP admitted to Research Institute of General Surgery of Nanjing Military Command from June 2006 to September 2008 were randomized into the conventional group(n=28)and SFI group(n=30).Patients in SFI group were treated by plus SFI(50 ml per day for 7 days)on routine treatment.The time to pain ease,bowel sound recovery times,body temperature recovery time were observed;APACHE Ⅱ score,Binder point was calculated;serum amylase,TNF-α and IL-1β were measured.The complication rate,operation rate,mortality were analyzed.Results The duration of abdominal pain,recovery of bowel sound,body temperature,and mean hospital stay days in SFI group were 95.3±2.8)d,(5.1±1.7)d,(7.1±2.4)d and(32.4±6.4)d;7 days later the APACHE Ⅱ score,Binder point was 8.63±1.33 and 6.50±1.66.respectively;the serum levels of amylase,TNF-α,and IL-1β were(1152±576)U/L,(48.7±16.4)ns/na and(199.3±53.3)ng/ml,respectively.12 episodes of severe complication occurred,operation rate was 3.33%(4/30)and the mortality rate was 0%.All the parameters were statistically significantly lower than those in the conventional group(P＜0.05 or P＜0.01).There was no adverse event related to SFI.Conclusions SFI was safe and effective for SAP,and the mechanism may be related to inhibit over-release of inflammatory medium and cytokines,and improve microcirculation.
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Objective: According to heparanase’s gene sequence of gene bank, to construct heparanase gene-targeted small interfering RNA (siRNA)and its expression vector and to observe its interfering effect on the expression of heparanase gene in human malignant breast cancer MDA-MB-231 cells. Methods: Heparanase gene-targeted hairpin siRNA was designed, two complementary oligonucleotide strand was synthesized and inserted into pGPU6/GFP/Neo vector,which was identified by sequence identify. Human malignant breast cancer MDA-MB-231 cells were transfected with the constructed vector with lipofectamine method. Western blot was per-formed to evaluate the expression of heparanase protein. Results: Four kinds of heparanase gene-targeted hairpin siRNA were designed, and were inserted into pGPU6/GFP/Neo vector after annealing. The vector containing siRNA was proved to be right by sequencing. The result of Western blot indicated that the expression of heparanase could be degraded by siRNA. Conclusion: The expression of heparanase can be degraded by siRNA method, and HPSE-A and HPSE-B showed the best results.
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Objective: To search for the differentially expressed genes between gastric adenocarcinoma and normal gastric mucosa using cDNA microarray. Methods: The PCR products of 12 800 human genes were spotted on a chemical material coated glass plate in array. DNAs were fixed onto the glass plate after series of treatments. The total RNAs were isolated from the tissues, and were purified to mRNAs by Oligotex. Both mRNAs from the gastric adenocarcinoma and normal gastric mucosa were reversely transcribed to the cDNAs with the incorporation of fluorescent dUTP to prepare the hybridization probes. The mixed probes were hybridized to the cDNA microarray. After high stringent washing, the cDNA microarray was scanned for the fluorescent signals and showed differences between 2 tissues. Results: Among the 12 800 target genes, 27 genes differentially expressed in all 5 samples were identified, 11 were up regulated (0.086%) and 16 down regulated (0.125%). There were 2 novel genes among the down regulated group. Conclusion: cDNA microarray technique is effective in screening the differentially expressed genes between gastric adenocarcinoma and normal gastric mucosa. [