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Objective:To observe the clinical effect of Sanhuang Qingre Fuming and Washing Decoction combined with Chinese medical excision in the treatment of horseshoe-shaped perianal abscess after high position and to explore its mechanism of action.Methods:Randomized controlled trial. Sixty surgical patients in our hospital from April 2020 to February 2021 were selected as observation objects. The patients were divided into two groups according to the random number table, with 30 patients in each group. Both groups were treated with Traditional Chinese Medicine drainage. On the second day after operation, the control group was treated with potassium permanganate sitz bath fumigation and washing, and the observation group was treated with Sanhuang Qingre Fuming and Washing Decoction. The wound healing time was observed in the two groups, serum TNF-α, IL-1β, IL-6, VEGF, bFGF, and EGF levels were detected by ELISA on the 1st and 7th d after operation, respectively. Serum SOD level was detected by the chemiluminescence method, and serum MDA level was detected by thiobarbituric acid method.Results:The wound healing time in the observation group was shorter than that in the control group ( t=3.37, P<0.01). The recovery rate was 93.3% (28/30) in the observation group and 76.7% (23/30) in the control group. The difference was statistically significant between the two groups ( χ2=4.32, P=0.038). Seven days after surgery, the levels of serum TNF-α, IL-1β and IL-6 in the observation group were significantly lower than those in the control group ( t values were 2.01, 2.05 and 4.88, respectively, P<0.05 or P<0.01), the level of SOD was significantly higher than that of the control group ( t=-2.13, P=0.038), the level of MDA water was significantly lower than that of the control group ( t=3.26, P=0.002), and the levels of VEGF, bFGF and EGF were significantly higher than those in the control group ( t values were -2.02, -3.33, -3.77, respectively, P<0.05). Conclusion:Sanhuang Qingre Tuming and Washing Decoction combined with Chinese medical excision in the treatment could shorten the healing time of the wound surface of horseshoe-shaped perianal abscess after high elevation and improve the recovery rate. The Sanhuang Qingre Fuming and Washing Decoction may reduce inflammatory reaction and oxidative stress damage, improve the level of growth factors and facilitate the postoperative tissue repair.
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As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.
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Objective To evaluate the efficacy of traditional herbal enema combined with vacuum sealing drainage in the treatment of perianal abscess.Methods A total of 87 patients who met the inclusion criteria were randomly divided into control group (43 cases) and study group (44 cases) by random number table method.The control group was treated with vacuum sealing drainage.The study group was given traditional herbal enema on the basis of the control group.Both groups were treated for 20 days and followed up for 6 months.The WBC,neutrophil count (NEU) and neutrophil percentage (NEU％) was measured by automatic blood cell analyzer,and the hospitalization and wound healing time was recorded.The recurrence rate of abscess and secondary anal fistula was observed during the follow-up period.Results The total effective rate was 97.7％ (43/44) in the study group and 88.4％ (38/43) in the control group.There was significant differences between the two groups (x2=4.010,P=0.045).The hospitalization time (14.2 ± 0.6 d vs.17.0 ± 1.2 d,t=13.970) and wound healing time (45.6 ± 0.7 d vs.48.7 ± 1.2 d,t=15.216) in the study group was significantly shorter than those in the control group (P＜0.01).After treatment,the WBC,NEU and NEU％ level in the study group was significantly lower than those in the control group (t=23.318,12.827,46.630,all Ps＜0.01).After 6 months of follow-up,the recurrence rate of abscess and the secondary anal fistula rate in the study group was significantly lower than those in the control group(x2=12.813,4.225,respectively,P＜0.01 or P＜0.05).Conclusions Traditional herbal enema combined with vacuum sealing drainage can significantly shorten the hospitalization and wound healing time,reduce the recurrence of abscess and secondary anal fistula,and improve the clinical efficacy.
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Resumen Los reportes de prolapso rectal encarcelado son infrecuentes y suponen un reto para el cirujano. Para un prolapso encarcelado no estrangulado, los pacientes deben tratarse con analgésicos y colocarse en la posición de Trendelenburg; y deberían aplicarse medidas conservadoras al prolapso con presión manual simultánea. Si la reducción exitosa no se logra, entonces el paciente generalmente requiere una rectosigmoidectomía con abordaje perineal (procedimiento de Altemeier). Caso clínico: hombre de 57 años, sin una historia previa de síntomas o comorbilidades con predisposición para esta patología. Se presenta en el departamento de urgencias con un prolapso rectal encarcelado posterior a realización de esfuerzo 5 horas antes del ingreso. Se inician medidas conservadoras con colocación en Trendelenburg y aplicación de azúcar granulada tópica. Las medidas fueron infructuosas. El paciente requirió una rectosigmoidectomía con abordaje perineal e ileostomía de protección. El curso postoperatorio no tuvo complicaciones, hubo un excelente resultado después del cierre de la ileostomía y no hubo recurrencia. Discusión: el encarcelamiento conlleva a estrangulamiento a lo largo del tiempo, la cirugía generalmente está indicada si la terapia conservadora fracasa. Aunque tradicionalmente recomendada para los pacientes adultos mayores y pacientes con comorbilidades, los procedimientos perineales son una opción para todos los pacientes y la mejor opción para el prolapso rectal encarcelado.
Abstract Reports of incarcerated rectal prolapse are rare and pose a challenge to the surgeon. For a incarcerated prolapse that is not strangulated, patients should be treated with analgesics and placed in the Trendelenburg position. Conservative measures should be applied to the prolapse with simultaneous manual pressure. If successful reduction is not achieved, then the patient usually requires rectosigmoidectomy with a perineal approach (Altemeier's procedure). Case: The patient was a 57-year-old man with no previous history of symptoms or comorbidities that would predispose him to this pathology. He came to the emergency department with an incarcerated rectal prolapse after attempting to have a bowel movement five hours earlier. Conservative measures of placing the patient in the Trendelenburg placement and topical application of granulated sugar were used. These measures were unsuccessful, so the patient required a rectosigmoidectomy with a perineal approach and protective ileostomy. The patient's postoperative recovery was without complications and had excellent results after the ileostomy was closed. There has been no recurrence. Discussion: Incarceration leads to strangulation over time, so surgery is usually indicated if conservative therapy fails. Although traditionally recommended for elderly patients and patients with comorbidities, perineal procedures are an option for all patients, and this is the best option for incarcerated rectal prolapse.
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Humanos , Masculino , Pessoa de Meia-Idade , Prolapso Retal , Protectomia , Métodos , Ileostomia , Açúcares , Tratamento ConservadorRESUMO
Objective To study the effect of Chinese medicine fumigation bath combined with acupuncture and hemorrhoids on improving the pain edema of elderly patients after anorectal pain.MethodsA total of 168 elderly patients with anorectal surgery were enrolled in our hospital from April 2013 to April 2016.The patients were randomly divided into two groups: the group (n=84) and the conventional treatment group (n=84) N=84).Routine treatment group given conventional Western medicine and potassium permanganate solution bath treatment, fumigation acupuncture group on the basis of conventional Western medicine treatment to give Chinese fumigation bath and acupuncture hemorrhoids treatment, compared the two groups of clinical efficacy, pain, Wound recovery and skin adverse reactions.ResultsThe total effective rate, no pain rate, edema disappearance time and wound healing time were 94.0%, 38.1%, (5.13±1.59) d, (16.47±4.06) d, respectively, compared with those in the conventional treatment group 84.5%, 22.6%, (6.74±1.23) d, (19.38±3.75) d, the difference was statistically significant (P<0.05).ConclusionChinese medicine fumigation bath combined acupuncture hemorrhoids acupuncture points can improve the local blood circulation, anti-bacterial anti-inflammatory pain, relieve senile patients after anorectal pain edema symptoms, speed up the rehabilitation process.
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Objective:To explore the effect of the traditional Chinese medicine fumigating and washing on improving anorectal routine postoperative pain and edema. Methods:From Mar 2013 to Dec 2014,126 cases of anorectal surgery patients were randomly divided into the observation group and the control group. Two groups of patients were given intravenous injection of antibiotics. The control group was treated with Potassium Permanganate bath, sooner or later each time, each time 20 min, continuous bath for 3 days for a course of treatment. The observation group was treated with the use of pain relief, Chinese medicine, sooner or later each time. Fumigation sitz bath for 20 min, each fumigation end in advance disinfection tampons and medication during fasting spicy stimulation food,to prevent the fire caused by dry stool. Satisfaction survey,visual analogue scale (VAS) was used,edema score, postoperative complications and clinical efficacy was analyzed. Results:Before treatment, there was no difference between the two groups of patients with pain and edema (P>0.05) . After treatment with 1-2, the pain and edema of the two groups significantly decreased, but the observation group was significantly lower than that in the control group (P<0.05) . Observation group patients appeared pain, edema, hemorrhage, the number of burning and itching was significantly lower than that in the control group (P<0.05) . The total effective rate in the observation group was significantly higher than that in the control group (P<0.05) . Conclusion:Anorectal diseases surgery patients using traditional Chinese medicine fumigating and washing, can significantly improve pain and edema,reduce the incidence rate of adverse reactions,improve the treatment efficiency.
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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.
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Objective To evaluate the diagnostic value of per perineal high -frequency ultrasound and/or per rectal endoscopic ultrasound in anorectal diseases. Methods 54 patients suffered from anorectul diseases, including 22 patients with anal fistula, 14 patients with perianal abscess, 12 patients with rectal cancer, and 6 patients with perianorectal inflammation, were performed with per perineal high-frequency ultrasound and/or per rectal endoscopic ultrasound examination. The diagnostic results were confirmed by clinical diagnosis, including operative and pathological detection. Results Except for the misdiagnosis of 4 cases of orifice location and 1 case of rectal cancer, all the other cases were correctly diagnosed. Conclusion Combined application of per perineal high-frequency ultrasound and per rectal endoscopic ultrasound examination has great practical value for ascertaining the trend and internal orifice location of anal fistula, location of perianul abscess, the infiltration depth of rectal cancer, and lymph node metastases.
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Objective To observe the effect of Gangshu lotion on treatment of anorectal disease. Methods 125 patients with anotectal disease were randomly divided into two groups. Treatment group 75 cases, using Gangshu lotion; control group 50 cases, using 1:5000pp sitz bath; 2 weeks are one course of treatment, the efficacy was evaluated after 1 course of treatment. Results The effects of treatment group were better than that of control group (P<0.01) and there was a significant difference between the two groups (P<0.01). Conclusion Gangshu lotion had good curative effect in improving the symptoms such as pain, hemorrhage, edema, pruritus and so on.
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PURPOSE:Benign anorectal disease will often cause great concern to the patient and the practitioner about a more proximal colon pathology. The aim of this study is to evaluate the significance of routine colonoscopy for patients with benign anorectal disease. METHODS:A retrospective analysis of 108 patients with benign anorectal disease who had undergone colonoscopic examination from April 1997 to August 1998 at Gil Medical Center was done. RESULTS:The mean age of all patients was 43 years; the male-to-female ratio was 1:1.1. The diagnoses of anorectal disease were hemorrhoids in 84 cases, anal fissures in 13 cases, chronic anal pain syndrome in 6 cases, anorectal fistulas in 5 cases, and other in 9 cases. There were 37 patients (34.3%) with 53 abnormal findings:14 tubular adenomas, 11 inflammatory polyps, 4 hyperplastic polyps, 1 tuberculous colitis, 1 angiodysplasia, 6 diverticula, 6 nonspecific ileitis or colitis, 2 melanosis coli, 2 rectal ulcers, 2 ileal ulcers, and 3 other diseases. Among them, clinically significant lesions, such as neoplastic lesion, tuberculous colitis and angiodysplasia, were detected in 12 patients (11.1%). Because the lesions in 7 patients of the 12 patients were within the reach of sigmoidoscopy, only 5 patients (4.6%) needed a colonoscopic examination. In regard to neoplasms, patients presenting with anal bleeding and old age were not found to have a higher frequency of neoplasia. Also, the specific type of anorectal disease was not associated with an increased risk for colorectal neoplasia (P>0.05). CONCLUSIONS:Sigmoidoscopy is a more acceptable primary diagnostic tool in patients with benign anorectal disease, but in patients with gastrointestinal symptoms, a high risk for colorectal cancer, suspicious inflammatory bowel disease, or fear of cancer, selective colonoscopy will be needed.
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Humanos , Adenoma , Angiodisplasia , Colite , Colo , Colonoscopia , Neoplasias Colorretais , Diagnóstico , Divertículo , Fístula , Hemorragia , Hemorroidas , Ileíte , Doenças Inflamatórias Intestinais , Melanose , Patologia , Pólipos , Estudos Retrospectivos , Sigmoidoscopia , ÚlceraRESUMO
PURPOSE: Urinary retention is a frequent postoperative complication after benign anorectal surgery. Factors, known to affect postoperative urinary retention, are age, sex, anesthetics, operative method, operative time and perioperative fluid injection. This study was performed to know whether the incidence of urinary retention might be controlled by reducing the amount of perioperative fluid. METHODS: Eighty patients underwent surgery for hemorrhoids and chronic anal fissures were allocated into two groups, fluid restriction group (n=37) and hydration group (n=43). All patients were consecutively randomized from May 1998 to January 1999 and they were under 50 years old without urologic abnormality. Fluid was infused at 100 ml/h from the midnight then it's rate was changed into 10 ml/h for 4 hours from the beginning of the anesthesia for the restriction group, whereas 1000 ml/h only during operation for the hydration group. Thereafter it was changed into the same rate with 100 ml/h on both groups. RESULTS: There was no significant differences with regard to age, sex, operation time, degree of pain and use of analgesics between two groups. Although there was a significant difference in the total volume of the infused fluid (Restriction group: 53.4 119.5 ml versus Hydration group: 778.6 319.0 ml, mean SD, p<0.001). Catheterization was done in 29 patients of the restriction group (78.4%) and 37 patients of the hydration group (86.0%), respectively. The frequency of catheterization was 1.3 0.7 times in the former and 1.6 0.7 times in the latter group. CONCLUSIONS: A strict restriction of fluid infusion appeared to be unnecessary for the purpose of preventing the urinary retention during surgery of benign anorectal diseases with spinal anesthesia.
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Humanos , Pessoa de Meia-Idade , Analgésicos , Anestesia , Raquianestesia , Anestésicos , Cateterismo , Catéteres , Hemorroidas , Incidência , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Prospectivos , Retenção UrináriaRESUMO
BACKGROUND: Anorectal procedures are performed in the prone jack-knife or lithotomy position. The effect of lithotomy and prone jack-knife position on the heart rate, arterial blood pressure and arterial blood gas has not been compaired. METHODS: 39 consecutive patients who underwent surgery for anorectal disease were performed saddle block. They were randomly classified into two groups: prone jack-knife position(J; n=19) and lithotomy position(L; n=20); patients with cardiovascular disease were excluded. The two groups were well matched for age, gender, weight and height. After spinal anesthesia, heart rate(HR), blood pressure(BP), and arterial blood gases(ABG) including pH, PaO2, PaCO2, HCO3- were measured in the supine position to establish a base line. After position change to either jack-knife or lithotomy, HR, BP(systolic, mean and diastolic) at 10, 20, and 30 minutes and ABG at 20minutes were measured again in each group. The two groups were then compared and any changes were recorded. Premedication was not perfomed in both group. Statistical analysis was performed by Mann-Whitney U test; significance was set at P <0.05. RESULTS: There were no differences between the two groups in terms of baseline HR, BP and ABG. However, HR at 10, 20 and 30 minutes after position change in the L group were increased compared with those of J group(deltaHR (number/minute) at 10 minutes: +3.2+/-7.0(L) versus - 2.8+/-4.9(J), P <0.05, 20 minutes: +5.6+/-7.4(L) versus - 1.8+/-5.2(J), P <0.05, 30 minutes: +6.4+/-8.4(L) versus - 1.2+/-6.0(J), p <0.05), and systolic BP at 30 minutes was increased in the J group(deltaBP: +4.0+/-9.0 mmHg(L) versus +10.1+/-9.9 mmHg(J), p <0.05). 3 patients in the J, and 2 in the L group had complaint of headache and/or upper arm discomfort. CONCLUSION: HR was increased in the lithotomy position, systolic BP at 30 minutes after position change was increased in the J group. But the differences were not so significant clinically. Another parameters were no differences between the two groups. Therefore there is no supiriority in lithotomy or jack-knife position on HR, BP and ABG when anorectal procedure is undergone under spinal anesthesia.