Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, t...Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.展开更多
Background: Many women suffer from sexual problems after anal sphincter tears due to obstetric trauma. Aim: The study aimed to assess changes in sexual function after anal sphincter repair. Methods: The study was a no...Background: Many women suffer from sexual problems after anal sphincter tears due to obstetric trauma. Aim: The study aimed to assess changes in sexual function after anal sphincter repair. Methods: The study was a non-randomized prospective observational cohort study. Inclusion of the study was done at the University Hospital, Uppsala, Sweden, between 2002 and 2007. Thirty-nine consecutive female patients admitted for anal sphincter repair were invited to the study. Twenty patients accepted and were included, four were lost to follow up and one was unevaluable (due to the formation of a stoma) leaving a study group of 15 patients. The patients were assessed with questionnaires before surgery and at three and 12 months after surgery. Outcomes: Change in reported sexual activity and dyspareunia. Results: Before surgery, 12/15 patients reported that their sexual life was impaired due to anal incontinence. The corresponding figure at 12 months was 9/15 (p = 0.43). Three patients remained sexually inactive throughout the study, five patients increased their sexual activity and one had decreased activity. Out of the 12 who were active, four stated dyspareunia at baseline, and only one reported dyspareunia at 12 months. The mean Miller incontinence scores at baseline and 12 months were 10.1 and 8.7, respectively. The change in incontinence score did not differ between those with decreased, stable or increased sexual activity. However, there was a definite correlation (r = 0.54 - 0.60, p 0.05) between change in sexual function and deferring time for stool. Clinical Implications: Operative management of anal sphincter tears alone is not curative for sexual problems due to anal incontinence but can be a part of the treatment. Strengths and Limitations: The study is a prospective study of sexual function. The limitations are that the questionnaires were not validated due to lack of such questionnaires at the time of the study and that the study population is quite small. Conclusion: Patients with a sphincter injury and fecal incontinence often have an impaired sexual function. Increased deferring time for stools after surgery increases the likelihood of improved sexual function.展开更多
目的:分析经括约肌间入路松弛挂线术(以下简称松挂术)与切割挂线引流术治疗肛瘘(AF)的临床价值。方法:选取2022年11月—2023年12月厦门长庚医院收治的126例肛瘘患者的临床资料行回顾性分析,依照手术方式差异分为两组,对照组(n=63例)接...目的:分析经括约肌间入路松弛挂线术(以下简称松挂术)与切割挂线引流术治疗肛瘘(AF)的临床价值。方法:选取2022年11月—2023年12月厦门长庚医院收治的126例肛瘘患者的临床资料行回顾性分析,依照手术方式差异分为两组,对照组(n=63例)接受切割挂线引流术治疗,观察组(n=63例)接受松挂术治疗。比较两组手术及预后相关指标、并发症、不同时间点视觉模拟评分法(VAS)评分、术前及术后3个月肛门功能、术前及术后1 d血清炎性因子水平。结果:与对照组比较,观察组手术、术后便血、创面愈合、脓腐脱落、住院时间均较短,差异有统计学意义(P<0.05);重复测量方差Mauchly’s球形检验结果显示,两组不同时点VAS评分符合球形检验,结果无需经Greenhouse-Geisser法校正;经测量时间主效应发现,两组术后1 h、1 d、7 d VAS评分均呈先升高后降低趋势,差异有统计学意义(P<0.05);经组别主效应分析发现,观察组术后1 d、7 d VAS评分均较对照组低,差异有统计学意义(P<0.05);与对照组比较,观察组术后1 d血清白介素(IL-6)、肿瘤坏死因子-α(TNF-α)、IL-8水平、Wexner失禁评分较低,术后3个月平均肛门静脉压、平均肛门最大缩窄压较高,差异有统计学意义(P<0.05);观察组并发症发生率较对照组低,差异有统计学意义(P<0.05)。结论:松挂术治疗AF,能有效缩短手术时间,减轻疼痛程度,减少炎性应激,促进术后恢复,改善患者肛门功能,且并发症少。展开更多
目的将括约肌间瘘管结扎(ligation of intersphincteric fistulatract,LIFT)与瘘管隧道式切除术联合用于肛瘘中,探究其治疗效果。方法回顾性选取2021年6月—2023年9月浙江省人民医院毕节医院收治的87例肛瘘患者的临床资料,以手术方案分...目的将括约肌间瘘管结扎(ligation of intersphincteric fistulatract,LIFT)与瘘管隧道式切除术联合用于肛瘘中,探究其治疗效果。方法回顾性选取2021年6月—2023年9月浙江省人民医院毕节医院收治的87例肛瘘患者的临床资料,以手术方案分组,对照组41例单纯行LIFT,观察组46例行LIFT联合瘘管隧道式切除术。比较两组术后恢复、疼痛程度、水肿程度、肛门溢液发生率、肛门评分各指标差异。结果观察组术后首次排便、创面愈合及住院时间更短,差异有统计学意义(P均<0.05)。观察组患者术后3、7 d的疼痛程度、肛周水肿程度、肛门溢液发生率均低于对照组,差异有统计学意义(P均<0.05)。两组术前肛门功能评分对比,差异无统计学意义(P>0.05)。观察组患者术后肛门功能评分为(1.62±0.81)分,低于对照组的(3.01±1.07)分,差异有统计学意义(t=6.578,P<0.05)。结论对肛瘘患者而言,LIFT联合瘘管隧道式切除术可获得更理想的治疗效果,促使术后创面更快恢复,有效减轻疼痛及水肿程度,减少肛门溢液发生,改善患者肛门功能,值得临床借鉴。展开更多
基金This work was supported by a grant from the Education Department of Liaoning Province(No.05L484).
文摘Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.
文摘Background: Many women suffer from sexual problems after anal sphincter tears due to obstetric trauma. Aim: The study aimed to assess changes in sexual function after anal sphincter repair. Methods: The study was a non-randomized prospective observational cohort study. Inclusion of the study was done at the University Hospital, Uppsala, Sweden, between 2002 and 2007. Thirty-nine consecutive female patients admitted for anal sphincter repair were invited to the study. Twenty patients accepted and were included, four were lost to follow up and one was unevaluable (due to the formation of a stoma) leaving a study group of 15 patients. The patients were assessed with questionnaires before surgery and at three and 12 months after surgery. Outcomes: Change in reported sexual activity and dyspareunia. Results: Before surgery, 12/15 patients reported that their sexual life was impaired due to anal incontinence. The corresponding figure at 12 months was 9/15 (p = 0.43). Three patients remained sexually inactive throughout the study, five patients increased their sexual activity and one had decreased activity. Out of the 12 who were active, four stated dyspareunia at baseline, and only one reported dyspareunia at 12 months. The mean Miller incontinence scores at baseline and 12 months were 10.1 and 8.7, respectively. The change in incontinence score did not differ between those with decreased, stable or increased sexual activity. However, there was a definite correlation (r = 0.54 - 0.60, p 0.05) between change in sexual function and deferring time for stool. Clinical Implications: Operative management of anal sphincter tears alone is not curative for sexual problems due to anal incontinence but can be a part of the treatment. Strengths and Limitations: The study is a prospective study of sexual function. The limitations are that the questionnaires were not validated due to lack of such questionnaires at the time of the study and that the study population is quite small. Conclusion: Patients with a sphincter injury and fecal incontinence often have an impaired sexual function. Increased deferring time for stools after surgery increases the likelihood of improved sexual function.
文摘目的:分析经括约肌间入路松弛挂线术(以下简称松挂术)与切割挂线引流术治疗肛瘘(AF)的临床价值。方法:选取2022年11月—2023年12月厦门长庚医院收治的126例肛瘘患者的临床资料行回顾性分析,依照手术方式差异分为两组,对照组(n=63例)接受切割挂线引流术治疗,观察组(n=63例)接受松挂术治疗。比较两组手术及预后相关指标、并发症、不同时间点视觉模拟评分法(VAS)评分、术前及术后3个月肛门功能、术前及术后1 d血清炎性因子水平。结果:与对照组比较,观察组手术、术后便血、创面愈合、脓腐脱落、住院时间均较短,差异有统计学意义(P<0.05);重复测量方差Mauchly’s球形检验结果显示,两组不同时点VAS评分符合球形检验,结果无需经Greenhouse-Geisser法校正;经测量时间主效应发现,两组术后1 h、1 d、7 d VAS评分均呈先升高后降低趋势,差异有统计学意义(P<0.05);经组别主效应分析发现,观察组术后1 d、7 d VAS评分均较对照组低,差异有统计学意义(P<0.05);与对照组比较,观察组术后1 d血清白介素(IL-6)、肿瘤坏死因子-α(TNF-α)、IL-8水平、Wexner失禁评分较低,术后3个月平均肛门静脉压、平均肛门最大缩窄压较高,差异有统计学意义(P<0.05);观察组并发症发生率较对照组低,差异有统计学意义(P<0.05)。结论:松挂术治疗AF,能有效缩短手术时间,减轻疼痛程度,减少炎性应激,促进术后恢复,改善患者肛门功能,且并发症少。
文摘目的将括约肌间瘘管结扎(ligation of intersphincteric fistulatract,LIFT)与瘘管隧道式切除术联合用于肛瘘中,探究其治疗效果。方法回顾性选取2021年6月—2023年9月浙江省人民医院毕节医院收治的87例肛瘘患者的临床资料,以手术方案分组,对照组41例单纯行LIFT,观察组46例行LIFT联合瘘管隧道式切除术。比较两组术后恢复、疼痛程度、水肿程度、肛门溢液发生率、肛门评分各指标差异。结果观察组术后首次排便、创面愈合及住院时间更短,差异有统计学意义(P均<0.05)。观察组患者术后3、7 d的疼痛程度、肛周水肿程度、肛门溢液发生率均低于对照组,差异有统计学意义(P均<0.05)。两组术前肛门功能评分对比,差异无统计学意义(P>0.05)。观察组患者术后肛门功能评分为(1.62±0.81)分,低于对照组的(3.01±1.07)分,差异有统计学意义(t=6.578,P<0.05)。结论对肛瘘患者而言,LIFT联合瘘管隧道式切除术可获得更理想的治疗效果,促使术后创面更快恢复,有效减轻疼痛及水肿程度,减少肛门溢液发生,改善患者肛门功能,值得临床借鉴。
