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<p><b>OBJECTIVE</b>To explore the efficacy of partial resection of puborectalis combined with mutilation of internal anal sphincter(IAS) in the treatment of puborectalis syndrome with high anal pressure.</p><p><b>METHODS</b>Twenty-five cases of puborectalis syndrome with high anal resting pressure in the preoperative examination received the operation of partial resection of puborectalis combined with mutilation of IAS in Zhongnan Hospital of Wuhan University between January 2013 and May 2015. The position of puborectalis was confirmed by touching with the exposure under the transfixion device, and a transverse incision was made by electrotome between 3 and 5 o'clock direction of puborectalis, then partial puborectalis was lifted by vessel clamp at 5 o'clock direction, and about 0.5 cm of muscular tissue was resected. Between 8 to 10 o'clock direction of anal tube, about 1 cm length of transverse incision was made by electrotome, then partial IAS was lifted by vessel clamp and cut off. Preoperative and postoperative 3-month anorectal manometry and defecography were carried out. Wexner constipation score and Cleveland Clinic incontinence score were implemented before surgery and 3, 6, 12 months after operation. This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ORB-16007695).</p><p><b>RESULTS</b>Of the 25 cases, 18 were male and 7 were female, the average age was 55 years old and the average course of disease was 9 years. Compared with pre-operation, the postoperative 3-month anal resting pressure and maximal squeeze pressure were significantly decreased [(53.56±9.05) mmHg vs. (92.44±7.06) mmHg, (142.80±20.35) mmHg vs. (210.88±20.56) mmHg, respectively, both P=0.000]; anorectal angulation at resting state and forced defecation state increased significantly [(102.32±4.96)degree vs. (95.88±4.01)degree, (117.88±5.95)degree vs. (89.52±3.25)degree, respectively, both P=0.000]. Wexner constipation score of postoperative 3-month, 6-month, 12-month (8.28±3.91, 7.40±3.64 and 8.04±4.74) was significantly lower than the preoperative score (16.00±3.69, all P<0.05), while the score was not significantly different among 3 time points after operation (P>0.05). Cleveland Clinic incontinence score was 0 at postoperative 6 and 12 months, and revealed 20 cases were effective among all the surgical patients(80%).</p><p><b>CONCLUSION</b>Partial resection of puborectalis combined with mutilation of internal anal sphincter can effectively reduce anal pressure and improve symptoms of outlet obstruction, which is an effective method in the treatment of puborectalis syndrome with high anal pressure.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Anal Canal , General Surgery , Constipation , General Surgery , Defecation , Defecography , Digestive System Surgical Procedures , Methods , Gastrointestinal Diseases , General Surgery , Manometry , Muscle Hypertonia , General Surgery , Pelvic Floor , General Surgery , Pressure , Treatment OutcomeABSTRACT
Objective To observe the clinical effect of thrombus removal of external hemorrhoid combined with procedure for prolapse and hemorrhoids(PPH) in the treatment of circumferential mixed hemorrhoid with incarceration.Methods A total of 118 cases of circumferential mixed hemorrhoid with incarceration were divided into two groups:experimental group of 60 cases was treated by thrombus removal combined with PPH;control group of 58 cases was treated by Milligan-Morgan.We observed the differences of postoperative visual analogue scale (VAS)score,edema,bleeding,residual skin tag,wound healing time,anal stenosis,fecal incontinence,anorectal manometry and satisfaction in the two groups.Results There was significant difference between the experimental group and the control group in postoperative edema,bleeding and residual skin tag(χ2=6.63,4.19,6.64,P0.05).Postoperative VAS score,wound healing time,satisfaction,anal resting and anal maximal squeeze pressure between the two groups were all statistically different(P<0.01).Conclusion The operation of thrombus removal of external hemorrhoid combined with PPH can effectively reduce the postoperative complications and promote recovery.
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<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the perineal rectosigmoidectomy (Altemeier procedure) in the treatment of full thickness rectal prolapse.</p><p><b>METHODS</b>Clinical and follow-up data of 52 patients with full thickness rectal prolapse undergoing Altemeier procedure in 9 hospitals from September 2010 to July 2016 were analyzed retrospectively. Of which 38 cases were from Zhongnan Hospital of Wuhan University, 1 case from Suizhou Central Hospital of Hubei province, 1 case from Jingzhou Second People's Hospital of Hubei province, 3 cases from Wuxue First People's Hospital of Hubei province, 1 case from Jingmen First People's Hospital of Hubei province, 1 case from Tuanfeng County Hospital of Hubei province, 4 cases from Jingzhou Central Hospital of Hubei province, 2 from PLA Rocket Army General Hospital, 1 case from the Affiliated Hospital of Xuzhou Medical University in Jiangsu province. Altemeier operation steps: The line shaped teeth, the prolapsed rectum is first exposed to the anus. In the dentate line proximal 1-3 cm with ultrasonic knife or Ligasure ring outer rectal incision, using electric knife to mark pre resection line in rectal mucosa. Open down in front of the pelvic peritoneum. Incision of the outer intestine and the reduction of the internal rectum and part of sigmoid colon. To free and remove excess pelvic retroperitoneal, pelvic peritoneum and be at the top of the colon or rectum anterior pelvic reconstruction suture. The rear of the levator ani muscle forming rectum. Pull gently to the anus and rectum and sigmoid, in the absence of tension, 2-3 cm outside the anus was selected as the proximal inner bowel pre resection line, along the line of pre transection of proximal bowel resection, again the broken end of intestine full-thickness end-to-end anastomosis. Postoperative complication and recurrence were summarized. Gastrointestinal quality of life index (GIQLI), Wexner constipation score and Wexner fecal incontinence score were used to evaluate the efficacy.</p><p><b>RESULTS</b>All the 52 patients were beyond moderate full thickness rectal prolapse. Thirty-one were male and 21 were female with age ranging from 22 to 83 (average 53) years. The length of prolapsed rectum was 6 to 20 (average 9) cm and course of disease was 0.5 to 46(average 19.5) years. No perioperative death. Five patients (9.6%) had postoperative complications, including 2 anastomotic bleeding, 1 wall portion dehiscence of anastomosis, 1 anastomotic stenosis, and 1 malnutrition. Recurrence rate was 9.6%(5/52) within the long-term follow-up of 5 to 71 (median 40) years. Compared with the preoperative results, Wexner constipation score and Wexner fecal incontinence score decreased obviously (2.1±1.4 vs. 4.6±3.4, 4.8±4.1 vs. 6.8±4.1), and GIQLI significantly increased from 99.6±8.0 to 103.0±9.1 (all P<0.05) at 6-month after operation. Above 3 scores were sustained and continuously improved at 12-, 24-, and 36-month during the follow-up (all P<0.05).</p><p><b>CONCLUSION</b>Altemeier procedure possesses good efficacy with low morbidity of complication and recurrence in the treatment of full thickness rectal prolapse.</p>
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Objective To observe the Lactulose Oral Solution's influence in PPH postoperative complications and patients′ satisfactory rate for constipation and to find more intervention measures for reducing the complications. Methods A hundred and twenty cases of hemorrhoids with constipation were randomly divided into the two groups: the experimental group, the control group in 60 cases in each group. All patients’ postoperative bleeding, anal edema, stool impaction and satisfaction were observed and compared within 30 days. Results In the control group, the postoperative bleeding’ cases were of 23, anal edema’s were of 20 and stool impaction‘s were of 8. The incidence was 38.3%, 33.3% and 13.3% severally. The satisfactory patients were of 49 and the degree of satisfaction was of 81.7%. In the experimental group, the postoperative bleeding’ cases were of 12, anal edema’s were of 8 and stool impaction's was of 1. The incidence was 20%, 13.3% and 1.7% respectively. The cases who were satisfactory were of 58 and the degree of satisfaction was 96.7%. The postoperative bleeding , anal edema , stool impaction and satisfaction were different statistically in the two groups above (P < 0.05). Conclusion It can reduce PPH postoperative complications and increase patients′satisfaction by using Lactulose Oral Solution in patients with constipation and it will have a certain clinical value if these patients take this oral solution routinely.
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Objective To observe the changes of serum potassium concentration in rectal cancer patients from the admission to before the operation,to provide clinical evidence for preventing serum potassium disorder during and after their operation.Methods Monitoring of the changes of serum potassium concentration of 40 cases of rectal cancer patients according to three time points including the first day of admission,before taking of cathartics and the morning before operation.They were divided into different groups according to their age(young,middle age and elderly group),gender(male and female group),diet(normal,decreased slightly and serious decline group) and course(long,middle and short course group) of disease.The serum potassium concentration was observed between each time point of each group and SPSS13.0 statistical software was used to analyze the changes above.Results The mean of all patients' serum potassium concentration was (4.09 ± 0.62) mmol/L on the first day of admission,was (3.83 ± 0.46) mmoL/L before taking of cathartics that was decreased compared to the former and there was significant difference (P ＜ 0.01),it was (3.36 ±0.40) mmol/L on the morning of operation and had significant difference with the above two groups (P ＜ 0.01).It hadn't significant difference between different gender and age groups at different time points (P ＞ 0.05) except between the young group and the elderly group in the morning of the operation (P ＜ 0.05).There were statistically significant differences between the different diet condition and different course at anytime point (P ＜ 0.01).Conclusions The rectal cancer patients were possiblely in hypokalemia before operation,the causes might be relative to the long course of disease,the decreased diet,the aged and infirm,the diet structure change after admission and taking cathartics cleaning intestinal tract.
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Objective In order to provide clinical evidence of reducing postoperative complications of procedure for prolapse and hemorrhoids and observe the effects of constipation on postoperative complications of procedure for prolapse and hemorrhoids.Methods One hundred and sixty cases of hemorrhoid were divided into two groups according to whether suffering from constipation:there were eihgty cases who were suffered from constipation in the experimental group and eighty cases who were not suffered from constipation in the control group.All patients' postoperative bleeding,anal edema,stool impaction and satisfaction were observed within 30 days and these data were compared and analysed by using SPSS 13.0 software.Results In the experimental group,the postoperative bleeding incidence was 37.5 ％ (30/80),the anal edema incidence was 31.3 ％ (25/80),the stool impaction inci dence was 8.6％ (7/80),and the patients' satisfaction rate was 88.6％ (71/80).In the control group,the postoperative bleeding incidence was 18.6％ (15/80),the anal edema's incidence was 15.0％ (12/80),the stool impaction incidence was 1.3％ (1/80),and the patients' satisfaction rate was 97.5％ (78/80).All the indexes above were different statistically in the two groups (P ＜ 0.05).Conclusion constipation could increase complications and reduce the degree of satisfaction after procedure for prolapse and hemorrhoids.
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A total of 120 patients with Ⅲ/Ⅳ degree hemorrhoids were randomly divided into 3 groups.Self-made drainage(A group),traditional device(B group)and stuffing(C group) were used at the end of operation.The patient postoperative complications and satisfaction were observed and compared.The results showed that postoperative abdominal distension,pain,medical dressing dampness and satisfaction were better in A group than those in B and C groups(all P ＜0.01).Postoperative abdominal distention in B group was lighter than that in C group and medical dressing dampness less in C group than that in B group (all P ＜ 0.01).Thus the self-made drainage device may reduce the levels of postoperative abdominal distension,pain and medical dressing dampness and increase postoperative patient satisfaction.
