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
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
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
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
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
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
Aim To establish a HPLC method for the separation of the enantiomers of zolmitriptan. Methods The separations were performed on Chiralcel OJ column with hexane-ethanol-diethylamine（85：15：0.2） as mobile phase at a ...Aim To establish a HPLC method for the separation of the enantiomers of zolmitriptan. Methods The separations were performed on Chiralcel OJ column with hexane-ethanol-diethylamine（85：15：0.2） as mobile phase at a flow rate of 0.8 mL·min^-1 and detecttion wavelength of 227 nm at 35 ℃. Several related parameters for separation were studied. Results Baseline separation （Rs 〉 1.5） was easily obtained in the case, and the R-isomer impurity in zolmitriptan was determined. Conclusion The method developed in this study has been successfully applied for quality-control purposes.展开更多
Aim To establish a new and sensitive HPLC-MS method for the determination ofzolmitriptan in human plasma and study the pharmacokinetics of zolmitriptan in healthy volunteers.Methods A single oral dose of 5 mg of zolmi...Aim To establish a new and sensitive HPLC-MS method for the determination ofzolmitriptan in human plasma and study the pharmacokinetics of zolmitriptan in healthy volunteers.Methods A single oral dose of 5 mg of zolmitriptan tablet was given to 20 healthy male volunteers.After dosing, blood samples were collected for a period of 24 h, and zolmitriptan concentration inplasma was analyzed by HPLC-MS. Results The plasma concentration-time course fitted well atwo-compartment open model with a lag time, giving the following pharmacokinetic parameters: T_(max)1.60 ± 0.24 h, C_(max) 9.73 ± 1.43 ng·mL^(-1). T_(1/2α)1.72±0.46 h, T_(1/2β) 4.52 + 0.97 h,and AUC_(0-t) 55.59 ± 5.12 ng·mL^(-1)·h. Conclusion The improved analytical method forzolmitriptan is rapid, sensitive and suitable for application to pharmacokinetic studies and routinedetermination of numerous samples.展开更多
Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conven...Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore,well accepted in clinical practise.However,for the more complex fistulae where a significant proportion of the anal sphincter is involved,great concern remains about damaging the sphincter and subsequent poor functional outcome,which is quite inevitable following conventional surgical treatment.For this reason,over the last twodecades,many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function.Among them,the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula.Another technique,the anal fistula plug,derived from porcine small intestinal submucosa,is safe but modestly effective in long-term follow-up,with success rates varying from 24%-88%.The failure rate may be due to its extrusion from the fistula tract.To obviate that,a new designed plug(GORE BioA ) was introduced,but long term data regarding its efficacy are scant.Fibrin glue showed poor and variable healing rate(14%-74%).Fi La C and video-assisted anal fistula treatment procedures,respectively using laser and electrode energy,are expensive and yet to be thoroughly assessed in clinical practise.Recently,a therapy using autologous adiposederived stem cells has been described.Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae,and studies remain in progress.The aim of this present article is to review the pertinent literature,describing the advantages and limitations of new sphincterpreserving techniques.展开更多
AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they unde...AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.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 efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received inf...AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received infliximab combined withsurgery to treat perianal fistulizing CD,which was followed by an immunosuppressive agent as maintenance therapy.RESULTS:A total of 28 patients with perianal fistulizing CD were included.At week 30,89.3%(25/28)of the patients were clinically cured with an average healing time of 31.4 d.The CD activity index decreased to70.07±77.54 from 205.47±111.13(P<0.01)after infliximab treatment.The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89(P<0.01).C-reactive protein,erythrocyte sedimentation rate,platelets,and neutrophils all decreased significantly compared with the pretreatment levels(P<0.01).Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up.After a median follow-up of 26.4 mo(range:14-41 mo),96.4%(27/28)of the patients had a clinical cure.CONCLUSION:Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD,and this treatment was associated with better longterm outcomes.展开更多
AIM: To check the efficacy of the PERFACT procedure in highly complex fistula-in-ano.METHODS: The PERFACT procedure(proximal superficial cauterization, emptying regularly fistula tracts and curettage of tracts) entail...AIM: To check the efficacy of the PERFACT procedure in highly complex fistula-in-ano.METHODS: The PERFACT procedure(proximal superficial cauterization, emptying regularly fistula tracts and curettage of tracts) entails two steps: superficial cauterization of mucosa at and around the internal opening and keeping all the tracts clean. The principle is to permanently close the internal opening by granulation tissue. This is achieved by superficial electrocauterization at and around the internal opening and subsequently allowing the wound to heal by secondary intention. Along with this, all the tracts are curetted and it is ensured that they remain empty and clean in the postoperative period until they heal completely. The latter step also facilitates the closure of the internal opening by preventing collected fluid in the tracts from entering the internal opening and thus not letting it close. Objective incontinence scoring was done preoperatively and 3 mo after the operation.RESULTS: Fifty-one patients with complex fistula-inano were prospectively enrolled. The median followup was 9 mo(5-14 mo). The mean age was 42.7 ± 11.3 years. Male:female ratio was 43:8. Fistula was recurrent in 76.5%(39/51), horseshoe in 50.1%(26/51), had multiple tracts in 52.9%(27/51), had an associated abscess in 41.2%(21/51), was anterior in 33.3%(17/51), the internal opening was not found in 15.7%(8/51) and 9.8%(5/51) of fistulas had a supralevator extension. Seven patients were excluded(5 lost to follow up, 2 with tuberculosis leading to/associated with fistula-in-ano). The success rate was 79.5%(35/44) and the recurrence rate was 20.5%(9/44). Out of these recurrences, three underwent reoperation(2 PERFACT procedure, 1 fistulotomy) and all three were successful. Thus, the overall success rate was 86.4%. The only complication was a non-healing tract in 9.1%(4/44) of patients. There was no significant change in objective incontinence scores three months after the operation. The pain was minimal, with all patients resuming their normal activities within 72 h of the operation.CONCLUSION: The PERFACT procedure is a new effective method for complex fistula-in-ano, effective even in fistula associated with abscess, supralevator fistula-in-ano and where the internal opening is nonlocalizable.展开更多
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.
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.
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.
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.
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Aim To establish a HPLC method for the separation of the enantiomers of zolmitriptan. Methods The separations were performed on Chiralcel OJ column with hexane-ethanol-diethylamine（85：15：0.2） as mobile phase at a flow rate of 0.8 mL·min^-1 and detecttion wavelength of 227 nm at 35 ℃. Several related parameters for separation were studied. Results Baseline separation （Rs 〉 1.5） was easily obtained in the case, and the R-isomer impurity in zolmitriptan was determined. Conclusion The method developed in this study has been successfully applied for quality-control purposes.
文摘Aim To establish a new and sensitive HPLC-MS method for the determination ofzolmitriptan in human plasma and study the pharmacokinetics of zolmitriptan in healthy volunteers.Methods A single oral dose of 5 mg of zolmitriptan tablet was given to 20 healthy male volunteers.After dosing, blood samples were collected for a period of 24 h, and zolmitriptan concentration inplasma was analyzed by HPLC-MS. Results The plasma concentration-time course fitted well atwo-compartment open model with a lag time, giving the following pharmacokinetic parameters: T_(max)1.60 ± 0.24 h, C_(max) 9.73 ± 1.43 ng·mL^(-1). T_(1/2α)1.72±0.46 h, T_(1/2β) 4.52 + 0.97 h,and AUC_(0-t) 55.59 ± 5.12 ng·mL^(-1)·h. Conclusion The improved analytical method forzolmitriptan is rapid, sensitive and suitable for application to pharmacokinetic studies and routinedetermination of numerous samples.
文摘Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore,well accepted in clinical practise.However,for the more complex fistulae where a significant proportion of the anal sphincter is involved,great concern remains about damaging the sphincter and subsequent poor functional outcome,which is quite inevitable following conventional surgical treatment.For this reason,over the last twodecades,many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function.Among them,the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula.Another technique,the anal fistula plug,derived from porcine small intestinal submucosa,is safe but modestly effective in long-term follow-up,with success rates varying from 24%-88%.The failure rate may be due to its extrusion from the fistula tract.To obviate that,a new designed plug(GORE BioA ) was introduced,but long term data regarding its efficacy are scant.Fibrin glue showed poor and variable healing rate(14%-74%).Fi La C and video-assisted anal fistula treatment procedures,respectively using laser and electrode energy,are expensive and yet to be thoroughly assessed in clinical practise.Recently,a therapy using autologous adiposederived stem cells has been described.Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae,and studies remain in progress.The aim of this present article is to review the pertinent literature,describing the advantages and limitations of new sphincterpreserving techniques.
文摘AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.
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.
基金Supported by Grants from Priority Academic Program Development of Jiangsu Higher Education Institutions,Jiangsu Provincial Clinical Medicine of Science and Technology Project,No.BL2014100
文摘AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received infliximab combined withsurgery to treat perianal fistulizing CD,which was followed by an immunosuppressive agent as maintenance therapy.RESULTS:A total of 28 patients with perianal fistulizing CD were included.At week 30,89.3%(25/28)of the patients were clinically cured with an average healing time of 31.4 d.The CD activity index decreased to70.07±77.54 from 205.47±111.13(P<0.01)after infliximab treatment.The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89(P<0.01).C-reactive protein,erythrocyte sedimentation rate,platelets,and neutrophils all decreased significantly compared with the pretreatment levels(P<0.01).Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up.After a median follow-up of 26.4 mo(range:14-41 mo),96.4%(27/28)of the patients had a clinical cure.CONCLUSION:Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD,and this treatment was associated with better longterm outcomes.
文摘AIM: To check the efficacy of the PERFACT procedure in highly complex fistula-in-ano.METHODS: The PERFACT procedure(proximal superficial cauterization, emptying regularly fistula tracts and curettage of tracts) entails two steps: superficial cauterization of mucosa at and around the internal opening and keeping all the tracts clean. The principle is to permanently close the internal opening by granulation tissue. This is achieved by superficial electrocauterization at and around the internal opening and subsequently allowing the wound to heal by secondary intention. Along with this, all the tracts are curetted and it is ensured that they remain empty and clean in the postoperative period until they heal completely. The latter step also facilitates the closure of the internal opening by preventing collected fluid in the tracts from entering the internal opening and thus not letting it close. Objective incontinence scoring was done preoperatively and 3 mo after the operation.RESULTS: Fifty-one patients with complex fistula-inano were prospectively enrolled. The median followup was 9 mo(5-14 mo). The mean age was 42.7 ± 11.3 years. Male:female ratio was 43:8. Fistula was recurrent in 76.5%(39/51), horseshoe in 50.1%(26/51), had multiple tracts in 52.9%(27/51), had an associated abscess in 41.2%(21/51), was anterior in 33.3%(17/51), the internal opening was not found in 15.7%(8/51) and 9.8%(5/51) of fistulas had a supralevator extension. Seven patients were excluded(5 lost to follow up, 2 with tuberculosis leading to/associated with fistula-in-ano). The success rate was 79.5%(35/44) and the recurrence rate was 20.5%(9/44). Out of these recurrences, three underwent reoperation(2 PERFACT procedure, 1 fistulotomy) and all three were successful. Thus, the overall success rate was 86.4%. The only complication was a non-healing tract in 9.1%(4/44) of patients. There was no significant change in objective incontinence scores three months after the operation. The pain was minimal, with all patients resuming their normal activities within 72 h of the operation.CONCLUSION: The PERFACT procedure is a new effective method for complex fistula-in-ano, effective even in fistula associated with abscess, supralevator fistula-in-ano and where the internal opening is nonlocalizable.
