RESUMO
OBJECTIVE: To discuss the feasibility of water infusion colonoscopy and its difference with traditional air insufflation colonoscopy in application value. METHODS: A prospective randomized controlled clinical study was designed to include 200 patients who underwent sedation-free diagnostic colonoscopy. Among them, 100 patients were treated with water infusion colonoscopy (observation group) and 100 patients were treated with air insufflation colonoscopy (control group). All operations were performed independently by the same experienced physician. The differences in colonoscopy related values, colon adenoma detection rate, and follow-up findings between the patients of two groups were compared. RESULTS: There was no significant difference in the Boston bowel preparation scale (BBPS) score of the left hemicolon, transverse colon, right hemicolon, total BBPS scores, and bubble amount between the two groups (P>0.05). In the observation group, the scope-forward time, the time to reach the ileocecal junction, and the total operation time were significantly longer than that of the control group (P<0.01). The proportion of patients in whom the ileocecal junction was successfully reached was significantly higher in the observation group. The intraoperative abdominal pain visual analog scale (VAS) score, abdominal distension VAS score, the proportion of postural change, and the proportion of abdominal compression were all significantly lower in the observation group (P<0.05). There were no significant differences in the endoscope hardness adjustment rate, the scope withdrawal time, total detection rate of adenomas, and the size or location of colon adenomatous lesions between the two groups (P>0.05). Compared with control group, the incidence of abdominal pain and VAS scores were significantly lower in the observation group (P<0.05), and the willingness of patients to perform colonoscopy again was significantly higher (P<0.01). CONCLUSION: Patients' tolerance and examination satisfaction are significantly better when using water infusion colonoscopy compared with traditional air insufflation colonoscopy, but the operation times are longer.
RESUMO
BACKGROUND The aim of this study was to investigate the clinical effect of tunnel-like fistulectomy plus draining seton combined with incision of internal opening of anal fistula (TFSIA) in the treatment of high transsphincteric anal fistula. MATERIAL AND METHODS There were 80 patients with high transsphincteric anal fistula randomly divided into TFSIA group and control group, 40 cases in each group. The control group was treated with cutting seton, and the seton was tightened weekly after discharge from the hospital until the seton dropped off. In the TFSIA group, the anal fistula was dissected and resected in tunnel-like form through the external opening to the intersphinceteric space, drained with seton through the tunnel, and cut open the internal opening of the anal fistula and the intersphincteric space and expanded the drainage. The operative time, blood loss, postoperative uroschesis, anal wound pain score, healing time, Wexner anal incontinence score, keyhole-like deformity, and recurrence rate were compared between the 2 groups. RESULTS The differences of the blood loss, operative time, anal wound pain score at 6 hours after operation, postoperative uroschesis and the recurrence rate after operation were not statistically significant (P>0.05), but the TFSIA were better than the control group in the anal wound pain score at 1 week after operation, healing time, Wexner anal incontinence score, and anal keyhole-like deformity rate (P<0.05). CONCLUSIONS TFSIA is effective in treating high transsphincteric anal fistula, and it can reduce adverse complications after operation.
