括约肌间瘘管结扎术治疗肛瘘临床效果及安全性的Meta分析

目的运用Meta分析方法比较括约肌间瘘管结扎术与切开挂线术治疗肛瘘的临床效果及安全性。方法收集2007年1月1日至2018年2月28日发表的有关括约肌间瘘管结扎术与切开挂线术治疗肛瘘的国内外相关文献,最终筛选后共纳入12篇文献,包括574例患者采用括约肌间瘘管结扎术治疗肛瘘,592例患者采用切开挂线术治疗肛瘘。对纳入的文献进行质量评价,利用Revman 5. 2软件对临床效果及安全性评价进行Meta分析。结果括约肌间瘘管结扎术手术与切开挂线术相比治疗肛瘘的临床治疗成功率差异无统计学意义(P 0. 05);在手术时间方面,切开挂线术优于括约肌间瘘管结扎术手术,差异有统计学意义(P 0. 01);而在住院时间、创面愈合时间及术后并发症发生率方面,括约肌间瘘管结扎术手术优于切开挂线术,差异有统计学意义(P 0. 01)。结论虽然LIFT手术与切开挂线术在成功率上无明显差别,但是LIFT手术与切开挂线术比较,术后愈合快,住院时间短,并发症少。     

瘘管结扎术联合消肿止痛洗剂治疗单纯性肛瘘临床疗效研究

目的 观察经括约肌间瘘管结扎术联合消肿止痛洗剂治疗单纯性肛瘘的临床效果.方法 将237例单纯性肛瘘患者随机分为治疗组124例,对照组113例.对照组给予经括约肌间瘘管结扎术治疗治疗组则给予消肿止痛洗剂熏洗.比较两组治疗效果.结果 治疗组所有患者的总有效率为94.36％高于对照组患者的79.64％,其差异具有一定的统计学意义(P＜0.05).结论 经括约肌间瘘管结扎术联合消肿止痛洗剂治疗单纯性肛痿,可改善机体的微循环,预防感染,促进创面的愈合,值得临床推广应用.     

腹腔镜下经腹或经肛门内括约肌切除术治疗低位直肠癌疗效对比

目的 比较腹腔镜下全直肠系膜间切除术(LA-TME)联合经腹或经肛门内括约肌切除术(ISR)治疗低位直肠癌的疗效。方法 回顾性分析2009年1月至2016年8月江苏大学附属第一人民医院胃肠外科收治的经电子肠镜检查及病理组织学检查确诊为低位直肠癌的28例患者的临床资料,按照手术方式将其分为经肛ISR组(接受LA-TME联合经肛门内ISR治疗,18例)和经腹ISR组(接受LA-TME联合经腹ISR治疗,10例)。对比分析2组患者的术中情况、术后的病理资料、并发症、肛门功能和预后情况。结果 患者手术时间、术中失血量、预防性造口比例、术后住院时间、术后复发率和肛门功能恢复方面组间比较,2组差异无统计学意义(P 0. 05)。结论 LA-TME联合经腹或经肛门内ISR对低位直肠癌的临床治疗效果相当,均可以作为腹腔镜辅助下ISR治疗低位直肠癌的术式。     

不同手术方法在老年重度混合痔患者治疗中的效果观察

目的:对比痔上黏膜环切术与痔结扎术治疗老年重度混合痔的临床效果.方法:回顾性选取 2021 年 7 月至2023 年 4 月期间我院收治的 84 例老年重度混合痔患者作为研究对象.按照不同手术方法为结扎组和环切组,每组各 42 例.对照组行痔结扎术,观察组行痔上黏膜环切术.比较两组的围术期指标、术后 1 w内肛门动力学(肛管舒张压、肛管静息压、最大收缩压)水平、肛门括约肌功能、疼痛程度及并发症状况.结果:与干预前相比,各治疗组疼痛程度和肛门括约肌功能评分、手术时间、住院时间、创面愈合时间、术中出血量均明显下降(P＜0.05),其中环切组更为显著(P＜0.05);与干预前相比,各治疗组最大收缩压、肛管舒张压、肛管静息压均显著升高(P＜0.05),其中环切组更显著(P＜0.05);两组的并发症发生率相比差异无统计学意义(P＞0.05).结论:痔上黏膜环切术治疗老年重度混合痔,能缩短手术时间、减少术中出血量,减轻术后疼痛感,促进肛门功能、肛门括约肌功能恢复,安全可靠.     

全植入式人工尿道括约肌的研究现状

全植入式人工尿道括约肌是一种人工辅助装置在临术治疗各种原因造成的排尿功能丧失和并发性尿失禁中，具有很好的应用前景。本文对几种国外已临床应用和即将进入临床试验的人工尿道括约肌技术进行了介绍，主要介绍了套袖式人工尿道括约肌、插入式人工尿道括约肌和反馈式与双套式人工尿道括约肌的结构原理、功能及其优缺点，并指出，应研究能感知膀胱充盈程度并向大脑发出信号以使病人及时排尿的人工括约肌系统。     

脱细胞异体真皮基质填塞修复高位肛瘘

背景:治疗高位肛瘘的方法有瘘管剔除、切开挂线、选择性黏膜瓣推移、生物蛋白胶封堵、括约肌间瘘管结扎等,大都存在创面愈合间长、一次成功率较低、复发率偏高的不足,术后并发症发生率高。目的:观察应用脱细胞异体真皮基质治疗高位肛瘘的临床疗效,探讨治疗高位肛瘘的微创治疗新方法。方法:选择100例高位肛瘘患者,根据患者意愿分2组治疗,治疗组采用脱细胞异体真皮基质填塞治疗,对照组采用传统的肛瘘低位切开并高位挂线治疗,比较两组手术时间、术中出血量、术后目测类比评分、术后疼痛持续时间、肛门失禁严重程度评分、创面愈合时间、一期手术成功率、治愈率及复发率。结果与结论:治疗组手术时间、术中出血量、创面愈合时间、术后目测类比评分、术后疼痛持续时间、肛门失禁严重程度评分均低于对照组(P0.05),一期手术成功率及治愈率高于对照组(P0.05),两组复发率比较差异无显著性意义。表明脱细胞异体真皮基质填塞修复高位肛瘘具有创伤小、恢复快、疗程短、治愈率高和不损害肛门功能及外观的优点。     

全植入式人工尿道括约肌的研究现状

全植入式人工尿道括约肌是一种人工辅助装置在临术治疗各种原因造成的排尿功能丧失和并发性尿失禁中，具有很好的应用前景。本对几种国外已临床应用和即将进入临床试验的人工尿道括约肌技术进行了介绍，主要介绍了套袖式人工尿道括约肌、插入式人工尿道括约肌和反馈式双套式人工尿道括约肌的结构原理、功能及其优缺点，并指出，应研究能感知膀胱充盈程度并向大脑发出信号以便病人及时排尿的人工括约肌系统。     

消肿生肌汤辅助LIFT对高位单纯性肛瘘术后疼痛与康复进程的影响

目的:研究消肿生肌汤辅助经括约肌间瘘管结扎术(Ligation of intersphincteric fistula tract,LIFT)对高位单纯性肛瘘术后疼痛(Visual analogue scale,VAS)评分、康复进程的影响.方法:选取2020年8月至2022年8月于我院确诊的 94 例肛瘘患者作为研究对象,依随机对照法分为研究组和对照组,各 47 例.对照组采用LIFT术治疗,研究组在对照组基础上联合消肿生肌汤治疗.比较两组临床疗效、治疗后恢复情况及住院时间、治疗前后视觉模拟评分(VAS)、大便失禁严重性指数(Fecal incontinence severity index,FISI)、Wexner肛门失禁评分(Wexner)、肛肠动力学、相关血清指标水平.结果:研究组总有效率高于对照组(P＜0.05);治疗后,研究组 VAS、FISI、Wexner 评分均低于对照组(P＜0.05);研究组直肠静息压(Rectal resting pressure,RRP)、肛管最大收缩压(Analmaximal contraction pressure,AMCP)、肛管静息压(Anal tube resting pressure,ARP)、肛管最长收缩时间(Anal longest contraction,ALCT)水平高于对照组(P＜0.05);研究组血清转化生长因子-β1(Transforming growth factor-β1,TGF-β1)、纤维连接蛋白(Fibronectin,FN)高于对照组,淀粉样蛋白A(Serum amyloid A,SAA)、趋化因子 5(Chemokine ligand 5,CCL5)低于对照组(P＞0.05);研究组恢复情况及住院时间短于对照组(P＜0.05).结论:消肿生肌汤辅助LIFT对高位单纯性肛瘘患者术后效果显著,可有效促进患者创口愈合,减少炎症反应,降低肛肠疼痛度,缩短临床康复进程.     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿(附19例报告)

目的:探讨后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效.方法:2009年6月～2011年10月,采用后腹腔镜肾蒂淋巴管结扎术治疗重症乳糜尿患者19例.结果:本组19例均于腔镜下顺利完成手术,无中转开放手术,术中、术后未发生严重的并发症.术后3～5 d拔出腹膜后引流管,切口均一期愈合.19例患者出院时尿液均无混浊,尿乙醚试验均为阴性;其中4例伴有不同程度的肉眼血尿,经对症治疗后均于2月内好转.随访2～20个月,乳糜尿均无复发.结论:后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿疗效确切,手术创伤小、术后恢复快,已成为乳糜尿手术的首选术式.     

经腹疝囊内口旷置腹膜外术治疗小儿腹股沟疝疗效分析

目的探讨小儿腹股沟疝治疗方法,分析经腹疝囊内口旷置腹膜外术治疗小儿腹股沟疝的疗效。方法选择我院2005年1月至2015年1月收治的102例腹股沟疝患儿,根据随机数字表法分为治疗组和对照组,治疗组55例采用经腹疝囊内口旷置腹膜外术,对照组47例采用经腹股沟疝囊高位结扎术。对比分析2组患者的切口长度、住院时间、手术时间、术后疼痛及医疗费用等情况。结果经腹疝囊内口旷置腹膜外手术时间、切口长度、术后疼痛均优于经腹股沟疝囊高位结扎术,差异具有统计学意义(P0.05)。结论经腹疝囊内口旷置腹膜外术治疗小儿腹股沟疝手术操作简单、手术时间短、术后并发症和复发率低、手术安全、疗效可靠。     

MRI在肛瘘疾病的术前诊断及评估

目的 探讨MRI对肛瘘的术前诊断价值。方法 收集2017年3月~2018年10月我院收治的肛瘘患者60例,常规进行盆腔MRI检查后2周内行手术切除,分析术前MRI显示肛瘘瘘管、外口、内口和肛提肌受累情况,以手术所见为标准,分析MRI对肛瘘显示准确率。结果 术前MRI显示肛瘘瘘管、外口及内口、肛提肌受累与手术结果比较,差异无统计学意义（P＞0.05）。瘘管在MRI表现为T1WI低信号,T2WI压脂序列为高信号,DWI序列为高信号;内口T2WI压脂序列为点状高信号;外口T1WI压脂序列为低信号,T2WI压脂序列为高信号。结论 MRI对肛瘘瘘管、内口、外口及肛瘘累及范围显示均较佳,在肛瘘术前诊断及评估中具有较大的价值。     

Descriptive epidemiology of isolated anal anomalies: A survey of 4.6 million births in Europe

The prevalence of anal anomalies among 4,618,840 births recorded in 33 EUROCAT registries between 1980 and 1994 was 4.05 per 10,000 births. Of the 1,846 recorded cases, 672 (36.4%) were isolated anal anomalies while 1,174 (63.6%) occurred together with other anomalies. Only isolated anal anomalies were analyzed in this study: 75.5% were atresias, 10.1% of which were above and 89.9% were below the level of the levator ani muscle. Fistula occurred in 53% of supralevator and 37% of infralevator atresia. Other anal anomalies were ectopic anus (3.4%), congenital anal fistula (14.7%), and persistent cloaca (0.9%). There was a predominance of males in anal atresia without fistula (male to female (M:F) ratio was 6.7 for supralevator and 2.3 for infralevator atresia), but no significant sex difference in atresias with fistula. There was a predominance of females in ectopic anus and congenital anal fistula (M:F = 0.11 and 0.36 respectively). High frequencies of fetal deaths were recorded in supralevator atresia without fistula (8.3%) and in persistent cloaca (11.1%). Mean gestational length and mean birth weights were reduced for persistent cloaca but were within normal limits for other isolated anal anomalies. Odds ratios (ORs) for mothers above 35 years were increased for supralevator atresia without fistula, supralevator atresia with fistula, and congenital anal fistula. ORs for mothers below 30 years were slightly increased for supralevator atresia without fistula and decreased for persistent cloaca. There were marked differences in prevalence and distribution of anal anomalies among the EUROCAT registries. The results indicated that there are epidemiological differences among the various types of anal anomalies which might reflect different embryological origins. © 2001 Wiley‐Liss, Inc.     

A novel device for minimally invasive ‘core-out’ fistulectomy of high fistula-in-ano

Purpose: With the aim of facilitating core fistulectomy of high fistula-in-ano and reducing the risk of harmful injuries to sphincter muscles, we fabricated a novel fistulectomy set. Methods: The set circumferentially separates approximately 2.5?mm thickness of the tract by moving a special tubular blade along it and removes the separated tissues by rotating a special cannulated screw which is housed in the blade. A straight rigid probe is used for identifying the tract path and guiding the device along it. Results: We used this set for circumferential excision of fistula models created in cubic pieces of fresh cow muscle with excellent results. Conclusions: With regard to results of our tests, it is anticipated that the new set will provide significant advantages in treatment of high anal fistulas, namely noticeable reduction in the diameter of fistulectomy lumen, reducing the injuries to anal sphincters, minimizing the risk of faecal incontinence and shortening the convalescence period.     

高位挂线加低位脱细胞真皮基质填塞治疗高位复杂性肛瘘

目的 探究高位挂线加低位脱细胞真皮基质（AEM）填塞治疗高位复杂性肛瘘。方法 选取于2017年3月~2018年3月安徽医科大学附属合肥市第二人民医院收治的56例高位复杂性肛瘘患者作为研究对象,随机分为治疗组和对照组,每组28例。治疗组给予AEM治疗,对照组给予以传统瘘管切开挂线术治疗,比较两组患者的治疗效果、治愈率及复发率。结果 治疗组的疼痛持续时间、伤口愈合时间均短于对照组（P＜0.05）;其术后并发症总发生率及复发率分别为3.57%和0,均低于对照组的39.28%和7.14%,差异有统计学意义（P＜0.05）;治疗组治愈率为85.71%,高于对照组的71.43%,差异有统计学意义（P＜0.05）。结论 对高位复杂性肛瘘患者采取高位挂线加低位脱细胞真皮基质填塞治疗疗程短,治愈率高,复发率低,临床治疗上具有一定的优势。     

肛瘘切除一期缝合与敞开疗法的临床比较

为缩短肛瘘治疗的愈合时间、减轻患者痛苦，用切除一期缝合法治疗低位单纯性肛瘘48例，与41例切除敞开疗法对照。结果表明，低位单纯性肛瘘采取切除一期缝合可以缩短愈合时间，减轻患者疼痛，在保持肛门外形和功能上明显优于敞开疗法。     

藻酸盐敷料在低位单纯性肛瘘术后创面的应用

目的 观察藻酸盐辅料应用于低位单纯肛瘘术后创面换药的临床效果。方法 选取2016年6月~2018年3月在我院诊断低位单纯性肛瘘,并行低位肛瘘手术的患者作为研究对象,随机数字表法分为观察组和对照组,每组121例。观察组术后换药应用藻酸盐敷料覆盖创面,对照组采用凡士林纱布覆盖创面。比较两组患者创面换药次数、创面清洁度和愈合时间。结果 观察组平均换药次数为（9.03±3.86）次,少于对照组的（13.47±3.92）次,差异有统计学意义（P＜0.05）;观察组创面Ⅰ级清洁率（76.03%）高于对照组（13.22%）,Ⅱ、Ⅲ级清洁率低于对照组,差异有统计学意义（P＜0.05）;观察组平均愈合时间为（17.67±5.37）d,短于对照组的（25.32±3.49）d,差异有统计学意义（P＜0.05）。结论 藻酸盐敷料应用于低位单纯肛瘘术后创面换药,可显著减少换药次数、创面分泌物,愈合时间较传统敷料明显缩短,效果优良。     

微创肛瘘封堵器的结构设计与实验研究

目的 设计一种适用于肛瘘内口闭合手术的封堵器,研究封堵器的结构设计以及植入物与组织的相互作用,评估内口封堵性能。 方法 对封堵器进行整体结构设计与样机制作;建立封堵有限元模型,研究封堵过程中组织的应力分布及损伤面积;搭建组织穿刺实验平台对仿真模型及结果进行验证;搭建拔出力实验平台对内口封堵效果进行评估。 结果 封堵过程中,进给机构的最大扭矩为 36 mN·m,组织的最大应力为 19. 75 MPa,其损伤面积为1. 35 cm2。 有限元理论模型与实验结果基本吻合,最大拔出力达到 5. 11 N。 结论 封堵过程中的组织损伤面积满足肛瘘的微创治疗要求。 本文设计的微创肛瘘封堵器可实现内口的有效封堵,有助于医生更加便捷、快速、有效地完成肛瘘的微创手术。     

生物反馈式人工肛门感知系统的研制及效果

背景：人工肛门为治疗肛门失禁开辟了一条新的思路,然而现有的人工肛门没有感知和反馈功能。患者只能通过习惯而不是肠内容物的实际情况排便。因此人工肛门感知和反馈系统的研制是亟待解决的问题。 目的：研制能感知和反馈肠内容物量和压力变化的人工肛门感知系统。 方法：通过实验分别向20只新西兰兔近结肠远端10 cm肠管内注入不同体积的模拟气体、液体、半流体、固体肠内容物,并测量肠管和压力感应套囊的压力变化,分析4种状态肠内容物体积与肠管压力和压力感应套囊压力的关系。 结果与结论：实验结果表明,肠管内压力和套囊压力随肠内容物体积的增加而增大,套囊压力与肠内容物体积和肠管压力在一定范围内成正相关。通过实验证实,该生物反馈式人工肛门感知系统能有效的反映肠内容物的多少和肠内压的变化,是解决人工肛门感知和反馈的有效策略,为生物反馈式智能人工肛门的研制打下基础。     

Surgical or biologic sphincterotomy in the treatment of chronic anal fissure

BACKGROUND: Chronic anal fissure is a lineal ulcer of the lower part of the anal canal. It is a painful condition characterized by postdefecational pain and bleeding. It is associated with internal anal sphincter spasm. The relief of internal anal sphincter spasm is the key for providing fissure healing. Gold standard in the treatment of chronic anal fissure is partial lateral internal anal sphincterotomy. METHODS: Sixty patients with chronic anal fissure were randomly assigned into two groups treated either by surgical sphincterotomy or injections of botulinum toxin into internal anal sphincter. Manometric measurements were performed before and three months after treatment. Follow up period was six months. The aim of the study was to compare results between these two groups. RESULTS: Both methods efficiently reduced resting anal pressure and successfully healed chronic anal fissure. CONCLUSION: Surgical and biologic sphincterotomy are almost equally effective in the treatment of chronic anal fissure. Injecting botulinum toxin into internal anal sphincter is a safe, easy to apply and effective method in the management of anal fissure.     

Histological evidence for enhanced anal fistula repair using autologous fibroblasts in a dermal collagen matrix

An anal fistula has a primary track passing from an internal anal or rectal opening to an external opening in the perianal area. Surgery aims to eradicate sepsis whilst preserving faecal continence. Fistulotomy, when all tissue caudal to the primary fistulous track is opened, provides the surest method of cure but may diminish patient continence. An alternative sphincter-preserving procedure is to instill a sealant into the track. An experimental porcine model of fistula-in-ano has been developed in the Surgical Research Department at Northwick Park Institute for Medical Research. This allows histological assessment of fistula tracks after novel, sphincter-preserving surgery and treatments have been applied. Under general anaesthetic, 24 anal fistulae were created and treated, three in each of eight adult Large White/Landrace crossbred pigs. Under the same general anaesthetic, a split skin graft was taken from which to culture fibroblasts for future treatment. All tracks were treated at 4 weeks post-track induction when the tracks were established and very similar in clinical appearance to human tracks. All tracks were prepared for treatment using an instrument designed to remove granulation tissue from the wall of the track. Five control tracks were not infilled but simply had their internal and external openings closed with a Vicryl suture. Nine tracks were treated by infill using an acellular porcine dermal collagen matrix. Ten tracks were treated using a mixture of this matrix and autologous cultured fibroblasts. Histological examination of six tracks was carried out at 2 weeks, nine tracks at 2 months and nine tracks at 3 months. Histological assessment demonstrated persistent fistula tracks in only two fistulae, both of which were control tracks. All treated tracks were closed and cured at all times of examination. When autologous fibroblasts were added to the infill material, cellular integration and vascularization were improved. Using this pre-clinical model, provided fistulous tracks were prepared using a new, in-house developed instrument; treatment with acellular collagen matrix alone healed all tracks. Adding autologous fibroblasts improved the quality of wound healing. A pilot study using this treatment in human fistula patients is in progress. This paper was first presented at the European Histology Forum Annual Conference on 24–26 April 2006.