How does pouch construction for a final diagnosis of Crohn's disease compare with ileoproctostomy for established Crohn's proctocolitis?

PURPOSE: There is a difference of opinion concerning the role of ileal pouch-anal anastomosis in Crohn's disease, even in the absence of small-bowel or perianal disease. One view is that ileal pouch-anal anastomosis should never be entertained, the other is that ileal pouch-anal anastomosis, like ileoproctostomy, can be justified sometimes, because it allows young people a period of stoma-free life. The aim of this study was to examine the outcome of ileal pouch-anal anastomosis and to contrast it with ileoproctostomy in patients with Crohn's disease without small-bowel or perianal disease. METHODS: Ileal pouch-anal anastomosis was performed in 23 patients with Crohn's disease (12 of whom had evidence of Crohn's disease at the time of operation and 11 who were eventually found to have Crohn's disease as a result of complications) and ileoproctostomy in 35. Patients were matched for age, gender, follow-up, and medication, but all ileoproctostomy cases had relative rectal sparing. Thus, the groups were not comparable and the reasons for ileal pouch-anal anastomosis and ileoproctostomy were therefore quite different. RESULTS: The outcome in ileal pouch-anal anastomosis at a mean follow-up of 10.2 years was pouch excision, 11 (47.8 percent); proximal stoma, 1 (4.3 percent; patient preference); average small-bowel resection, 65 cm; persistent perineal sinus, 8 of 11 having pouch excision (73 percent); and mean time in hospital, 37 (range, 8–108) days. Of those in circuit having ileal pouch-anal anastomosis (n=12), 24-hour bowel frequency was 6, with no incontinence or urgency, but 6 (50 percent) were on medication. When ileal pouch-anal anastomosis was done for Crohn's disease in the resection specimen, only 4 of 12 (33 percent) were excised compared with 7 of 11 (64 percent) in whom the diagnosis was made as a result of complications. The outcome in ileoproctostomy at a mean follow-up of 10.9 years was rectal excision in 3 (8 percent), proximal stoma in 1 (3 percent), average small-bowel resection was 15 cm, persistent perineal sinus in 1 (3 percent), and time in hospital was 21 (range, 8–36) days. Of those in circuit (n=32), 24-hour bowel frequency was 5, 2 had incontinence, 3 had urgency, and 12 (36 percent) were taking medication. CONCLUSIONS: These results indicate that the overall outcome of ileal pouch-anal anastomosis is inferior to that of ileoproctostomy, especially if Crohn's disease was diagnosed as a result of complications. Nevertheless, the functional results of those with a successful outcome are comparable.Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000.     

Retrospective analysis of perianal Paget s disease with underlying anorectal carcinoma

AIM:To analyze clinical and pathological characteristics of an aggressive subtype of perianal Paget's disease(PPD) and explore its rational treatment modalities.METHODS:PPD patients were retrospectively collected in the institutional colorectal database of the Fudan University Shanghai Cancer Center.Detailed patient histories of past medical condition,diagnosis,treatment,and pathological findings were reviewed.Surgical specimen from diagnosis and surgery were reviewed by two independent pathologists for con...     

一期根治术治疗肛周脓肿100例疗效分析

为探讨一期根治术治疗肛周脓肿的临床价值,回顾分析2006～2008年行一期根治术治疗的100例肛周脓肿患者的临床资料。结果显示,100例患者中,治愈98例,后遗肛瘘2例。1年后回访,复发1例,无肛门畸形、肛门失禁等后遗症。结果表明,一期根治术治疗肛周脓肿疗效佳,避免了肛瘘形成后的二次手术治疗,减轻了患者的痛苦及经济负担,是治疗肛周脓肿的有效方法。     

复方亚甲蓝混合液皮内注射辅助治疗肛周瘙痒的临床观察

为评价复方亚甲蓝混合液局部皮内注射辅助治疗以肛周瘙痒为主要症状的肛周疾患的临床疗效,将248例以肛周瘙痒为主要症状的患者随机分为治疗组（132例）和对照组（116例）,治疗组采用皮损局部皮内注射亚甲蓝混合液（1％亚甲蓝1．5ml、0．75％布比卡因5ml、2％利多卡因5ml和10％碳酸氢钠10ml）加常规药物治疗,对照组只采用常规药物治疗,伴有痔、肛周尖锐湿疣或病变皮肤等均行手术切除。结果显示,治疗组痊愈96例,显效36例,无无效病例,有效率为100％;对照组痊愈51例,显效50例,无效15例,有效率为87．1％。治疗组有效率明显高于对照组,P〈0．01。随访3个月,治疗组复发率（3．8％）明显低于对照组（28．4％）,P〈0．01。结果表明,复方亚甲蓝混合液局部皮内注射辅助治疗以肛周瘙痒为主要症状的肛周疾患临床疗效满意、安全、复发率低。     

复方紫草膏对肛周脓肿术后创面愈合的影响

为观察复方紫草膏纱条用于肛周脓肿术后创面换药的临床疗效,将151例肛周脓肿患者随机分为观察组75例采用复方紫草膏纱条换药;对照组76例采用凡士林纱条换药,观察两组创缘红肿消失时间、脓性分泌物消失时间、肉芽组织生长情况、创口愈合时间、平均住院时间。结果显示,观察组以上指标均明显优于对照组。结果表明,复方紫草膏纱条用于肛周脓肿术后创面换药,疗效明显,可缩短疗程,无毒副作用。     

中药液冲洗换药对肛周脓肿术后患者创面的影响

为探讨中药液冲洗换药对肛周脓肿术后患者创面的影响,将90例肛周脓肿术后患者分为治疗组和对照组各45例。治疗组患者用中药液冲洗换药,对照组患者用2％双氧水、抗生素冲洗换药。每天观察效果并记录,5d后评估创面疼痛、水肿、肉芽生长情况以及愈俞时间。结果显示,在创面疼痛、水肿、肉芽生长方面治疗组优于对照组,治疗组创面愈合时问较短。结果表明,肛周脓肿患者术后采用中药液冲洗换药能促进创面愈合。     

New aspects of the Slug Mucosal Irritation assay: predicting nasal stinging, itching and burning sensations

Stinging, itching and/or burning (SIB) sensations cannot be detected by animal tests or in vitro models. In the past, the Slug Mucosal Irritation (SMI) assay demonstrated a relation between an increased mucus production in slugs and an elevated incidence of SIB sensations in humans. A new 1-day SMI test procedure was developed focusing on the prediction of these short-term sensations. The objective of this study was to verify whether this new procedure is capable predicting mucosal tolerance of several marketed nasal formulations using the slug Arion lusitanicus. Irritation and tissue damage were quantified with a 5-day repeated exposure study by means of the mucus produced and proteins and enzymes released. The new protocol predicted SIB sensations by means of mucus production. The effects of six liquid nasal formulations were tested with both protocols, while five physiologic saline solutions were only tested with the new protocol to optimize it. None of the tested liquid nasal formulations resulted in tissue damage; however, exposure to the different formulations had a clear effect on the mucus production of the slugs and moderate discomfort was observed in some cases. These effects were due to the active ingredient, the presence of benzalkonium chloride as a preservative or the hyperosmolality of the formulation. For the most part results agreed with clinical data found in literature. It was concluded that the SMI assay, and the new 1-day protocol in particular, is a good tool to predict nasal clinical discomfort.     

一次性根治术治疗瘘管性肛周脓肿临床观察

目的:探讨瘘管性肛周脓肿一次性根治的可行性及治疗方法.方法:回顾性总结一次性根治术治疗瘘管性肛周脓肿30例,分析其手术方法、注意事项及疗效.结果:所有病例经随访6个月～2年,术后形成肛瘘1例,脓肿复发1例,余28例均一次性根治,未出现肛门狭窄、肛门溢液及排便功能障碍等并发症.结论:一次性根治术治疗瘘管性肛周脓肿,复发率低,并发症少,避免二次手术,减轻病人痛苦及经济负担,不失为瘘管性肛周脓肿的首选治疗方法.     

可弯曲空心探针在肛门直肠周围脓肿一次根治术中的应用研究

目的研究可弯曲空心探针在肛门直肠周围脓肿一次根治术中的应用,进一步探讨其创造性、实用性、新颖性,体现专利技术在临床医学中的价值。方法将我院诊断为肛门直肠周围脓肿的120例患者随机分成两组,实验组和对照组各60例。实验组采用可弯曲空心探针及联合染色、造影诊疗,对照组采用传统探针诊疗。观察两组手术时间、一次性手术治愈率、复发率、疗程,并进行统计学分析。结果实验组患者全部一次治愈,一次手术治愈率为100.0%;对照组一次治愈52例,其余患者多次手术治愈,一次手术治愈率为86.7%;实验组平均手术时间为（25±3）min;对照组平均手术时间（50±6）min;疗程实验组平均（27±5）d,对照组平均（37±4）d;实验组手术时间、一次性手术治愈率、疗程均明显优于对照组。两组疗效比较差异有高度统计学意义（P〈0.01）。结论可弯曲空心探针应用于肛门直肠周围脓肿一次根治术中具有明显的先进性、创造性、实用性,可明显减少患者痛苦,该项科技成果具有一定的临床意义。     

OB棉条联合皮肤保护膜护理肛周皮肤损伤的疗效观察

目的探讨干预腹泻或大便失禁所致的肛周皮肤损伤的护理方法。方法将因腹泻或大便失禁所致肛周皮肤损伤的92例神经内科患者随机分成两组,各46例。实验组采用OB棉条塞肛法联合皮肤保护膜进行护理,对照组单用OB棉条塞肛法护理,观察两组的护理疗效和治愈时间及压疮发生率。结果两组的护理疗效比较具有显著性差异,实验组治愈率明显优于对照组（P〈0．01）,治愈时间明显缩短（P〈0．05）,压疮发生率明显下降（P〈0．05）。结论OB棉条塞肛法联合皮肤保护膜护理腹泻或大便失禁所致的肛周皮肤损伤患者,临床疗效显著。