Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patie...Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.展开更多
BACKGROUND The question of whether a colonoscopist should evaluate anal diseases is relevant.Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy,as they can be easily overlooked if ...BACKGROUND The question of whether a colonoscopist should evaluate anal diseases is relevant.Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy,as they can be easily overlooked if not properly examined.Specifically,one must clarify the responsibility of the colonoscopist in the diagnosis of anal neoplasms.Anal cancer is relatively rare,accounting for less than 2%of all cases annually.Owing to its rarity,population screening for anal cancer is not indicated,and monitoring is limited to high-risk groups.However,the number of anal cancer cases in high-risk groups has increased over the past four decades worldwide.AIM To assess the results of anal examinations performed during routine colonoscopy and emphasize the importance of diagnosing anal neoplasms.METHODS This was a retrospective study of 16836 patients who were screened by colonoscopy and received a detailed anal examination by videoanoscopy between 2006 and 2024.Among several other findings,the presence of anal neoplasms and suspicious anal cancer lesions was observed.All examinations,including complete anal examination,inspection,digital rectal examination,and videoanoscopy,were performed,and images were recorded and reported.The examinations were individually viewed by the work group,and the findings were analyzed.RESULTS Among the 22676 colonoscopies performed,16836 patients were identified,and 88 lesions suspected of neoplasia(0.52%)were found.Among them,there were 23 cases of neoplasia(0.13%),9 cases of confirmed squamous cell carcinoma of the anal canal(0.05%),5 cases of adenocarcinoma in the anal canal(0.03%),3 cases of rare neoplasms(0.01%),and 6 cases of adenoma(0.03%).CONCLUSION The systematic performance of anal examinations and anoscopy during routine colonoscopy allows the identification of numerous anal diseases,including incidental cases of anal cancer.展开更多
Management of the complex anal fistula represents a perennial challenge to surgeons.Conventional approaches often upset the balance between recurrence prevention and continence preservation with their high failure rat...Management of the complex anal fistula represents a perennial challenge to surgeons.Conventional approaches often upset the balance between recurrence prevention and continence preservation with their high failure rates and significant associated morbidity.The emergence of minimally invasive treatment in recent years,however,offers a promising paradigm shift.Regenerative solutions like autologous stem cell therapy or fistula plugs with extracellular and synthetic matrices represent new frontiers in anal fistula treatment,harnessing physiological regenerative capacities and avoiding the traditional postoperative burden of open wounds,drains,or setons in situ.Together with novel techniques like fistula laser closure,video-assisted fistula treatment,or over-the-scope clip burgeoning over the last decade,these state-of-the-art approaches have been touted for their total sphincter-sparing nature,preserving functional outcomes and quality of life.Despite gaining much scientific and clinical momentum,do these newer modalities live up to their promise?This review aims to critically appraise the latest evidence surrounding minimally invasive approaches,providing up-todate insights into the constantly evolving landscape of anal fistula management.Further long-term and comparative studies will nevertheless be needed to supplement the significantly heterogenous,retrospective analyses consolidated.展开更多
BACKGROUND Our research aimed to enhance treatment approaches for difficult anal fistula patients via classical Chinese surgical techniques and assess their healing results by examining past cases.AIM To compare the c...BACKGROUND Our research aimed to enhance treatment approaches for difficult anal fistula patients via classical Chinese surgical techniques and assess their healing results by examining past cases.AIM To compare the clinical effectiveness and safety of traditional Chinese medicineintegrated surgery with traditional seton-based care for patients with complicated anal fistulas.METHODS To assess the safety and therapeutic effectiveness of surgical treatment combined with traditional Chinese medicine with traditional seton-based management for patients with complicated anal fistulas.The standard care group(62 patients)received usual surgical care,including regular seton drainage and fistula cutting procedures.The 70 patients in the enhanced care group underwent specialized Chinese surgical therapy that included the transanal opening of intersphincteric space technique for high muscle-crossing fistulas,personalized set-on techniques,and auxiliary therapies such herbal steam treatments and washing.Our study compared healing success,wound closure time,sphincter function preservation,and after-surgery problems between these groups.RESULTS The improved care group achieved 90.0%overall success,which was notably better than the 78.8%overall success rate of the standard care group(P<0.05).Wounds healed in approximately 21.2 days with improved care compared with 29.5 days with standard care(P<0.01).Later checkups revealed that the improved group maintained better sphincter control and had fewer complications(6.0%compared with 15.0%in the standard group,P<0.05).CONCLUSION When treating challenging anal fistulas,the improved Chinese surgical technique undoubtedly improves healing results,recovery times,and post-operative complications while preserving improved bowel control.展开更多
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a...BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.展开更多
BACKGROUND Anal canal adenocarcinoma with secondary perianal Paget’s disease(PPD)is clinically rare and exhibits atypical symptoms,often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema,leadin...BACKGROUND Anal canal adenocarcinoma with secondary perianal Paget’s disease(PPD)is clinically rare and exhibits atypical symptoms,often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema,leading to delayed treatment.Further summarization of diagnostic and therapeutic key points,as well as reasons for misdiagnosis,is necessary to enhance clinical awareness.CASE SUMMARY A retrospective analysis was conducted on a 72-year-old female patient with a 2-year history of perianal moisture,pruritus,and hematochezia,who was repeatedly misdiagnosed with mixed hemorrhoids.The diagnosis of anal canal adenocarcinoma with secondary PPD was confirmed through colonoscopy,perianal skin biopsy,and immunohistochemical staining(CK7,CK20,etc.).The patient underwent 3D laparoscopic-assisted abdominoperineal resection(APR)with extended perianal skin excision,achieving negative margins and primary wound healing.No recurrence or metastasis was observed during the 12-month follow-up.CONCLUSION Secondary PPD has a high misdiagnosis rate.Clinicians should maintain a high index of suspicion for elderly patients with prolonged perianal symptoms(e.g.,pruritus,hematochezia>6 months)and promptly perform colonoscopy and immunohistochemical testing for definitive diagnosis.APR combined with extended perianal resection is an effective treatment,and standardized long-term follow-up is crucial for prognosis.展开更多
BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures ...BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.展开更多
BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors,and surgery remains the primary treatment.However,the rising incidence of antibiotic resistance,particularly to cefuroxime,complicates ...BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors,and surgery remains the primary treatment.However,the rising incidence of antibiotic resistance,particularly to cefuroxime,complicates perioperative management.The role of gut microbiota in influencing this resistance is not well understood.AIM To investigate the relationship between gut microbiota composition and cefuroxime resistance in anal fistula patients and to assess probiotic intervention impact.METHODS This study included 30 anal fistula patients categorized into cefuroxime-sensitive(Cefur-S)and cefuroxime-resistant(Cefur-NS)groups.Gut microbiota samples were collected during colonoscopy,and 16S ribosomal DNA sequencing was performed to analyze microbial diversity.Patients in the Cefur-NS group received a 7-day course of Clostridium butyricum tablets.Post-intervention,microbial composition and cefuroxime resistance were reassessed.RESULTS Alpha and beta diversity analyses showed no significant differences in microbial diversity between the Cefur-S and Cefur-NS groups.However,effect size analysis identified Roseburia and Butyricicoccus as dominant genera in the Cefur-S group,with higher butyrate production potentially protecting against cefuroxime resistance.Post-intervention,the Cefur-NS group showed a significant reduction in cefuroxime resistance,improved stool consistency,and reduced bowel movement frequency.CONCLUSION This study suggests that specific gut microbiota,particularly Butyricicoccus and Roseburia,may mitigate cefuroxime resistance in anal fistula patients by increasing butyrate production.Probiotic intervention targeting gut microbiota composition presents a promising strategy for reducing antibiotic resistance and improving clinical outcomes.展开更多
Objective:This study aims to develop an assessment tool for postoperative wound healing in adult patients with benign anal canal and rectal diseases and to validate its reliability and validity.Methods:Based on Levine...Objective:This study aims to develop an assessment tool for postoperative wound healing in adult patients with benign anal canal and rectal diseases and to validate its reliability and validity.Methods:Based on Levine’s Conservation Model as the theoretical framework,an item pool was formed through literature review,and the initial draft of the scale was refined through two rounds of Delphi expert consultation.A total of 200 postoperative patients were selected for item analysis,internal consistency testing,content validity,and structural validity analysis.Results:The final tool comprises four dimensions:energy conservation,structural integrity,personal integrity,and social integrity,with a total of 24 items.It demonstrates good content validity(I-CVI 0.82-1.00,S-CVI/Ave 0.95,S-CVI/UA 0.87)and excellent internal consistency(Cronbach’sαfor the overall scale was 0.934).Exploratory factor analysis revealed a KMO value of 0.931,Bartlett’s test of sphericityχ^(2)=4147.853(p<0.001),and four common factors were extracted,accounting for a cumulative variance contribution rate of 64.345%,indicating ideal structural validity.Conclusion:The results indicate that the assessment tool has good reliability and validity and can systematically evaluate postoperative wound healing,providing a scientific basis for clinical individualized nursing interventions.展开更多
Treatment delays during radiotherapy for head and neck cancer(HNC)are a well-established factor negatively affecting clinical outcomes,with similar trends observed in other cancers.In this first part of a two-part rev...Treatment delays during radiotherapy for head and neck cancer(HNC)are a well-established factor negatively affecting clinical outcomes,with similar trends observed in other cancers.In this first part of a two-part review,we assessed the impact of overall treatment time(OTT)prolongation on locoregional control(LRC)and survival(SV)in cervical cancer(CC),prostate cancer(PC),and anal cancer(AC),while updating evidence for HNC.A comprehensive literature search was performed in evidence-based databases,including MEDLINE,identifying studies evaluating the relationship between OTT prolongation and outcomes.Particular attention was paid to the strength of evidence,distinguishing univariate analysis from multivariate analysis(MV-An).For CC,37 articles were identified,with 88.8%reporting a detrimental impact on LRC and/or SV,mostly supported by MV-An.In AC,15 studies were found,with 33.3%showing negative impacts,although with weaker evidence.For PC,12 articles were reviewed,with 66.6%demonstrating detrimental effects mainly on LRC or biochemical control,and occasional associations with cancer-specific SV.Recent studies in HNC reinforced prior findings.When available,radiobiological parameters and practical recommendations are provided.In conclusion,strong evidence confirms that prolonged OTT worsens outcomes in HNC and CC,with less consistent but relevant effects in PC and AC.展开更多
Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over t...Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus.展开更多
Anal intraepithelial neoplasia(AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the Unit...Anal intraepithelial neoplasia(AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus(HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPVmediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations.展开更多
To explore the relationship between such a construct and an existing continence score. METHODSA retrospective study of incontinent patients who underwent anal physiology (AP) was performed. AP results and Cleveland Cl...To explore the relationship between such a construct and an existing continence score. METHODSA retrospective study of incontinent patients who underwent anal physiology (AP) was performed. AP results and Cleveland Clinic Continence Scores (CCCS) were extracted. An anal physiology score (APS) was developed using maximum resting pressures (MRP), anal canal length (ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed. RESULTSOf 508 (419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mmHg (SD 23.2 mmHg) for men and 39 mmHg (19.2 mmHg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP (P = 0.0002), ACL (P = 0.0006) and pudendal neuropathy (P < 0.0001). The association between APS and CCCS was significant (P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%. CONCLUSIONThis study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores.展开更多
Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of stu...Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anoplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.展开更多
AIM to evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I -IV. hemorrhoids received two different sonographic exami...AIM to evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I -IV. hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades. and. hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen's kappa coefficient. RESULTS All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a 'mosaic pattern'. In patients with grades III and IV hemorrhoids, the number of patients with 'mosaic pattern' as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a 'mosaic pattern' in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz's muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen's kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between 'mosaic pattern' in the TPUS and arteriovenous fistula in pathology was very good (K = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05). CONCLUSION Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a 'mosaic pattern' in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. 'Mosaic pattern' may be a parameter for surgical indication of grades III and IV hemorrhoids.展开更多
AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included ...AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.展开更多
AIM： To evaluate the effectiveness of three-dimensional endoanal ultrasound （3D-EAUS） in the assessment of anal fistulae with and without H202 enhancement. METHODS： Sixty-one patients （37 males, aged 17-74 years...AIM： To evaluate the effectiveness of three-dimensional endoanal ultrasound （3D-EAUS） in the assessment of anal fistulae with and without H202 enhancement. METHODS： Sixty-one patients （37 males, aged 17-74 years） with anal fistulae, which were not simple low types, were evaluated by physical examination and 3D-EAUS with and without enhancement. Fistula classification was determined with each modality and compared to operative findings as the reference standard. RESULTS： The accuracy of 3D-EAUS was significantly higher than that of physical examination in detecting the primary tract （84.4% vs 68.7%, P = 0.037） and secondary extension （81.8% vs 62.1%, P = 0.01） and localizing the internal opening （84.2% vs 59.7%, P = 0.004）. A contrast study with H202 detected several more fistula components including two primary suprasphincteric fistula tracks and one supralevator secondary extension, which were not detected on non-contrast study. However, there was no significant difference in accuracy between 3D-EAUS and H202- enhanced 3D-EAUS with respect to classification of the primary tract （84.4% vs 89.1%, P = 0.435） or secondary extension （81.8% vs 86.4%, P = 0.435） or localization of the internal opening （84.2% vs 89.5%, P = 0.406）. CONCLUSION： 3D-EAUS was highly reliable in the diagnosis of an anal fistula. H2O2 enhancement was helpful at times and selective use in difficult cases may be economical and reliable.展开更多
AIM To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). METHODS In this unmatched case control stud...AIM To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). METHODS In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups. RESULTS Patients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 +/- 3.59 mm vs 28.87 +/- 4.84 mm, P < 0.05 and 9.67 +/- 1.57 mm vs 8.85 +/- 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23 degrees +/- 1.81 degrees vs 89.94 degrees +/- 2.07 degrees in control group, P < 0.05) and straining (88.47 degrees +/- 3.32 degrees vs 90.72 degrees +/- 1.87 degrees in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23 degrees +/- 1.81 degrees vs 88.47 degrees +/- 3.32 degrees respectively, P > 0.05). CONCLUSION The association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.展开更多
Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the ...Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.展开更多
AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed af...AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate.CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.展开更多
文摘Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.
文摘BACKGROUND The question of whether a colonoscopist should evaluate anal diseases is relevant.Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy,as they can be easily overlooked if not properly examined.Specifically,one must clarify the responsibility of the colonoscopist in the diagnosis of anal neoplasms.Anal cancer is relatively rare,accounting for less than 2%of all cases annually.Owing to its rarity,population screening for anal cancer is not indicated,and monitoring is limited to high-risk groups.However,the number of anal cancer cases in high-risk groups has increased over the past four decades worldwide.AIM To assess the results of anal examinations performed during routine colonoscopy and emphasize the importance of diagnosing anal neoplasms.METHODS This was a retrospective study of 16836 patients who were screened by colonoscopy and received a detailed anal examination by videoanoscopy between 2006 and 2024.Among several other findings,the presence of anal neoplasms and suspicious anal cancer lesions was observed.All examinations,including complete anal examination,inspection,digital rectal examination,and videoanoscopy,were performed,and images were recorded and reported.The examinations were individually viewed by the work group,and the findings were analyzed.RESULTS Among the 22676 colonoscopies performed,16836 patients were identified,and 88 lesions suspected of neoplasia(0.52%)were found.Among them,there were 23 cases of neoplasia(0.13%),9 cases of confirmed squamous cell carcinoma of the anal canal(0.05%),5 cases of adenocarcinoma in the anal canal(0.03%),3 cases of rare neoplasms(0.01%),and 6 cases of adenoma(0.03%).CONCLUSION The systematic performance of anal examinations and anoscopy during routine colonoscopy allows the identification of numerous anal diseases,including incidental cases of anal cancer.
文摘Management of the complex anal fistula represents a perennial challenge to surgeons.Conventional approaches often upset the balance between recurrence prevention and continence preservation with their high failure rates and significant associated morbidity.The emergence of minimally invasive treatment in recent years,however,offers a promising paradigm shift.Regenerative solutions like autologous stem cell therapy or fistula plugs with extracellular and synthetic matrices represent new frontiers in anal fistula treatment,harnessing physiological regenerative capacities and avoiding the traditional postoperative burden of open wounds,drains,or setons in situ.Together with novel techniques like fistula laser closure,video-assisted fistula treatment,or over-the-scope clip burgeoning over the last decade,these state-of-the-art approaches have been touted for their total sphincter-sparing nature,preserving functional outcomes and quality of life.Despite gaining much scientific and clinical momentum,do these newer modalities live up to their promise?This review aims to critically appraise the latest evidence surrounding minimally invasive approaches,providing up-todate insights into the constantly evolving landscape of anal fistula management.Further long-term and comparative studies will nevertheless be needed to supplement the significantly heterogenous,retrospective analyses consolidated.
文摘BACKGROUND Our research aimed to enhance treatment approaches for difficult anal fistula patients via classical Chinese surgical techniques and assess their healing results by examining past cases.AIM To compare the clinical effectiveness and safety of traditional Chinese medicineintegrated surgery with traditional seton-based care for patients with complicated anal fistulas.METHODS To assess the safety and therapeutic effectiveness of surgical treatment combined with traditional Chinese medicine with traditional seton-based management for patients with complicated anal fistulas.The standard care group(62 patients)received usual surgical care,including regular seton drainage and fistula cutting procedures.The 70 patients in the enhanced care group underwent specialized Chinese surgical therapy that included the transanal opening of intersphincteric space technique for high muscle-crossing fistulas,personalized set-on techniques,and auxiliary therapies such herbal steam treatments and washing.Our study compared healing success,wound closure time,sphincter function preservation,and after-surgery problems between these groups.RESULTS The improved care group achieved 90.0%overall success,which was notably better than the 78.8%overall success rate of the standard care group(P<0.05).Wounds healed in approximately 21.2 days with improved care compared with 29.5 days with standard care(P<0.01).Later checkups revealed that the improved group maintained better sphincter control and had fewer complications(6.0%compared with 15.0%in the standard group,P<0.05).CONCLUSION When treating challenging anal fistulas,the improved Chinese surgical technique undoubtedly improves healing results,recovery times,and post-operative complications while preserving improved bowel control.
文摘BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
基金Supported by Guangdong Provincial Medical Research Fund General Program,No.B2025209。
文摘BACKGROUND Anal canal adenocarcinoma with secondary perianal Paget’s disease(PPD)is clinically rare and exhibits atypical symptoms,often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema,leading to delayed treatment.Further summarization of diagnostic and therapeutic key points,as well as reasons for misdiagnosis,is necessary to enhance clinical awareness.CASE SUMMARY A retrospective analysis was conducted on a 72-year-old female patient with a 2-year history of perianal moisture,pruritus,and hematochezia,who was repeatedly misdiagnosed with mixed hemorrhoids.The diagnosis of anal canal adenocarcinoma with secondary PPD was confirmed through colonoscopy,perianal skin biopsy,and immunohistochemical staining(CK7,CK20,etc.).The patient underwent 3D laparoscopic-assisted abdominoperineal resection(APR)with extended perianal skin excision,achieving negative margins and primary wound healing.No recurrence or metastasis was observed during the 12-month follow-up.CONCLUSION Secondary PPD has a high misdiagnosis rate.Clinicians should maintain a high index of suspicion for elderly patients with prolonged perianal symptoms(e.g.,pruritus,hematochezia>6 months)and promptly perform colonoscopy and immunohistochemical testing for definitive diagnosis.APR combined with extended perianal resection is an effective treatment,and standardized long-term follow-up is crucial for prognosis.
文摘BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.
基金Supported by the Jiaxing Science and Technology Project,No.2023AD11016 and No.2023AD31028.
文摘BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors,and surgery remains the primary treatment.However,the rising incidence of antibiotic resistance,particularly to cefuroxime,complicates perioperative management.The role of gut microbiota in influencing this resistance is not well understood.AIM To investigate the relationship between gut microbiota composition and cefuroxime resistance in anal fistula patients and to assess probiotic intervention impact.METHODS This study included 30 anal fistula patients categorized into cefuroxime-sensitive(Cefur-S)and cefuroxime-resistant(Cefur-NS)groups.Gut microbiota samples were collected during colonoscopy,and 16S ribosomal DNA sequencing was performed to analyze microbial diversity.Patients in the Cefur-NS group received a 7-day course of Clostridium butyricum tablets.Post-intervention,microbial composition and cefuroxime resistance were reassessed.RESULTS Alpha and beta diversity analyses showed no significant differences in microbial diversity between the Cefur-S and Cefur-NS groups.However,effect size analysis identified Roseburia and Butyricicoccus as dominant genera in the Cefur-S group,with higher butyrate production potentially protecting against cefuroxime resistance.Post-intervention,the Cefur-NS group showed a significant reduction in cefuroxime resistance,improved stool consistency,and reduced bowel movement frequency.CONCLUSION This study suggests that specific gut microbiota,particularly Butyricicoccus and Roseburia,may mitigate cefuroxime resistance in anal fistula patients by increasing butyrate production.Probiotic intervention targeting gut microbiota composition presents a promising strategy for reducing antibiotic resistance and improving clinical outcomes.
基金Sichuan Provincial Nursing Research Project of the Sichuan Nursing Association in 2023(Project No.:H23028)。
文摘Objective:This study aims to develop an assessment tool for postoperative wound healing in adult patients with benign anal canal and rectal diseases and to validate its reliability and validity.Methods:Based on Levine’s Conservation Model as the theoretical framework,an item pool was formed through literature review,and the initial draft of the scale was refined through two rounds of Delphi expert consultation.A total of 200 postoperative patients were selected for item analysis,internal consistency testing,content validity,and structural validity analysis.Results:The final tool comprises four dimensions:energy conservation,structural integrity,personal integrity,and social integrity,with a total of 24 items.It demonstrates good content validity(I-CVI 0.82-1.00,S-CVI/Ave 0.95,S-CVI/UA 0.87)and excellent internal consistency(Cronbach’sαfor the overall scale was 0.934).Exploratory factor analysis revealed a KMO value of 0.931,Bartlett’s test of sphericityχ^(2)=4147.853(p<0.001),and four common factors were extracted,accounting for a cumulative variance contribution rate of 64.345%,indicating ideal structural validity.Conclusion:The results indicate that the assessment tool has good reliability and validity and can systematically evaluate postoperative wound healing,providing a scientific basis for clinical individualized nursing interventions.
文摘Treatment delays during radiotherapy for head and neck cancer(HNC)are a well-established factor negatively affecting clinical outcomes,with similar trends observed in other cancers.In this first part of a two-part review,we assessed the impact of overall treatment time(OTT)prolongation on locoregional control(LRC)and survival(SV)in cervical cancer(CC),prostate cancer(PC),and anal cancer(AC),while updating evidence for HNC.A comprehensive literature search was performed in evidence-based databases,including MEDLINE,identifying studies evaluating the relationship between OTT prolongation and outcomes.Particular attention was paid to the strength of evidence,distinguishing univariate analysis from multivariate analysis(MV-An).For CC,37 articles were identified,with 88.8%reporting a detrimental impact on LRC and/or SV,mostly supported by MV-An.In AC,15 studies were found,with 33.3%showing negative impacts,although with weaker evidence.For PC,12 articles were reviewed,with 66.6%demonstrating detrimental effects mainly on LRC or biochemical control,and occasional associations with cancer-specific SV.Recent studies in HNC reinforced prior findings.When available,radiobiological parameters and practical recommendations are provided.In conclusion,strong evidence confirms that prolonged OTT worsens outcomes in HNC and CC,with less consistent but relevant effects in PC and AC.
文摘Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus.
文摘Anal intraepithelial neoplasia(AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus(HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPVmediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations.
文摘To explore the relationship between such a construct and an existing continence score. METHODSA retrospective study of incontinent patients who underwent anal physiology (AP) was performed. AP results and Cleveland Clinic Continence Scores (CCCS) were extracted. An anal physiology score (APS) was developed using maximum resting pressures (MRP), anal canal length (ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed. RESULTSOf 508 (419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mmHg (SD 23.2 mmHg) for men and 39 mmHg (19.2 mmHg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP (P = 0.0002), ACL (P = 0.0006) and pudendal neuropathy (P < 0.0001). The association between APS and CCCS was significant (P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%. CONCLUSIONThis study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores.
文摘Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anoplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.
基金the National Natural Science Foundation of China,No.81460133Innovation Program of regional Cooperation of Xinjiang Uygur Autonomous region,No.2016E02063
文摘AIM to evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I -IV. hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades. and. hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen's kappa coefficient. RESULTS All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a 'mosaic pattern'. In patients with grades III and IV hemorrhoids, the number of patients with 'mosaic pattern' as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a 'mosaic pattern' in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz's muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen's kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between 'mosaic pattern' in the TPUS and arteriovenous fistula in pathology was very good (K = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05). CONCLUSION Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a 'mosaic pattern' in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. 'Mosaic pattern' may be a parameter for surgical indication of grades III and IV hemorrhoids.
文摘AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.
文摘AIM： To evaluate the effectiveness of three-dimensional endoanal ultrasound （3D-EAUS） in the assessment of anal fistulae with and without H202 enhancement. METHODS： Sixty-one patients （37 males, aged 17-74 years） with anal fistulae, which were not simple low types, were evaluated by physical examination and 3D-EAUS with and without enhancement. Fistula classification was determined with each modality and compared to operative findings as the reference standard. RESULTS： The accuracy of 3D-EAUS was significantly higher than that of physical examination in detecting the primary tract （84.4% vs 68.7%, P = 0.037） and secondary extension （81.8% vs 62.1%, P = 0.01） and localizing the internal opening （84.2% vs 59.7%, P = 0.004）. A contrast study with H202 detected several more fistula components including two primary suprasphincteric fistula tracks and one supralevator secondary extension, which were not detected on non-contrast study. However, there was no significant difference in accuracy between 3D-EAUS and H202- enhanced 3D-EAUS with respect to classification of the primary tract （84.4% vs 89.1%, P = 0.435） or secondary extension （81.8% vs 86.4%, P = 0.435） or localization of the internal opening （84.2% vs 89.5%, P = 0.406）. CONCLUSION： 3D-EAUS was highly reliable in the diagnosis of an anal fistula. H2O2 enhancement was helpful at times and selective use in difficult cases may be economical and reliable.
基金Supported by the State administration of Traditional Secretary and the nanjing health Bureau,no.YKK12142
文摘AIM To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). METHODS In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups. RESULTS Patients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 +/- 3.59 mm vs 28.87 +/- 4.84 mm, P < 0.05 and 9.67 +/- 1.57 mm vs 8.85 +/- 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23 degrees +/- 1.81 degrees vs 89.94 degrees +/- 2.07 degrees in control group, P < 0.05) and straining (88.47 degrees +/- 3.32 degrees vs 90.72 degrees +/- 1.87 degrees in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23 degrees +/- 1.81 degrees vs 88.47 degrees +/- 3.32 degrees respectively, P > 0.05). CONCLUSION The association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.
文摘Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.
文摘AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate.CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.
