腹腔镜辅助肛门直肠成形术致后尿道憩室的预防措施探讨CSCD

Objective To explore the preventive measures of posterior urethral diverticulum (PUD) after laparoscopic assisted anorectoplasty (LAARP). Methods From August 2013 to December 2018, perioperative and postoperative clinical data were reviewed for 6 children with anorectal malformation (ARM) developing PUD after LAARP. PubMed database was searched for all published English literatures of PUD after ARM surgery from 2000 to 2021. Since international naming of PUD is not standardized, there are two major names, i. e. remnant of original fistula and PUD. Thus retrieval keywords were anorectal malformation, remnant of original fistula and PUD. Results The diagnostic age was 17 months to 5 years after LAARP. The clinical manifestations included mucuria, recurrent urinary tract infection and dysuria, etc. Computed tomography (CT) and retrograde urethrography revealed prerectal cyst. A total of 13 articles were retrieved, reporting 102 cases of PUD after ARM surgery. The age was 1 — 44 years and the diameter of PUD 3 —70 mm. The major clinical symptoms were frequent urination, dysuria, recurrent urinary tract infection, urinary calculi, hematuria and urinary incontinence, etc. Some non-symptomatic cases were only discovered accidentally during follow-ups. ARM procedures included LAARP (n = 36), posterior sagittal anorectopasty (PSARP,n = 15), abdominoperineal pull-through (n=15) and APP (n=50). Conclusion PUD is a rare complication after ARM surgery. And potential risks of PUD may be minimized by strengthening perioperative managements and improving surgical techniques. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

Manometric Comparison of Anorectal Function after Posterior Vaginal Compartment Repair with and without Mesh

Background:

Although repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction, the data about posterior compartment are scarce. The aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse (POP).

Methods:

This was a prospective, double-blind, clinical pilot study of 22 postmenopausal women with symptomatic POP (overall POP-quantification [POP-Q] Stage III-IV) who underwent total pelvic floor reconstruction. Patients were grouped according to the use of mesh for posterior vaginal compartment repair: A mesh group and a nonmesh group. POP-Q stage, the pelvic floor impact questionnaire short form-7 (PFIQ-7) and anorectal manometry were evaluated before and 3 months after surgery. Anatomical success was defined as POP-Q Stage II or less. A t-test was used to compare preoperative with postoperative data in the two groups.

Results:

Totally, 17 (71%) were available for the follow-up. POP-Q measurements improved significantly compared to baseline (P < 0.05) in both groups. No recurrence was observed. Subjects in both groups reported improvement in pelvic floor symptoms, and there was no significant difference in the PFIQ-7 score between groups at follow-up (P > 0.05). Compared with baseline, the nonmesh group exhibited a statistically significant decrease in anal residual pressure, a significant increase in the anorectal pressure difference during bowel movement, and a reduced rate of dyssynergia defecation pattern (P < 0.05).

Conclusions:

Provided there is sufficient support for the anterior wall and apex of vagina with mesh, posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.     

肛肠病手术患者采用舒适护理的效果观察

目的:探讨对肛肠病手术患者进行舒适护理的临床效果。方法:选取2013年在我科接受手术治疗的605例肛肠疾病患者,随机分成观察组和对照组,对照组进行常规护理,而观察组在常规护理的基础上增加舒适护理,观察并比较分析两组患者的护理效果以及患者的满意度情况。结果:观察组经舒适护理后患者疼痛率明显低于对照组,观察组患者并发症发生率明显低于对照组,观察组患者总满意度明显比对照组高,差异均有统计学意义,P0.05。结论:肛肠病手术患者采用舒适护理临床效果好,减少了术后并发症的发生率,具有较高的临床应用价值。     

Differential functional brain network connectivity during visceral interoception as revealed by independent component analysis of fMRI time‐series

Influential theories of brain‐viscera interactions propose a central role for interoception in basic motivational and affective feeling states. Recent neuroimaging studies have underlined the insula, anterior cingulate, and ventral prefrontal cortices as the neural correlates of interoception. However, the relationships between these distributed brain regions remain unclear. In this study, we used spatial independent component analysis (ICA) and functional network connectivity (FNC) approaches to investigate time course correlations across the brain regions during visceral interoception. Functional magnetic resonance imaging (fMRI) was performed in thirteen healthy females who underwent viscerosensory stimulation of bladder as a representative internal organ at different prefill levels, i.e., no prefill, low prefill (100 ml saline), and high prefill (individually adapted to the sensations of persistent strong desire to void), and with different infusion temperatures, i.e., body warm (～37°C) or ice cold (4–8°C) saline solution. During Increased distention pressure on the viscera, the insula, striatum, anterior cingulate, ventromedial prefrontal cortex, amygdalo‐hippocampus, thalamus, brainstem, and cerebellar components showed increased activation. A second group of components encompassing the insula and anterior cingulate, dorsolateral prefrontal and posterior parietal cortices and temporal‐parietal junction showed increased activity with innocuous temperature stimulation of bladder mucosa. Significant differences in the FNC were found between the insula and amygdalo‐hippocampus, the insula and ventromedial prefrontal cortex, and the ventromedial prefrontal cortex and temporal‐parietal junction as the distention pressure on the viscera increased. These results provide new insight into the supraspinal processing of visceral interoception originating from an internal organ. Hum Brain Mapp 36:4438–4468, 2015. © 2015 Wiley Periodicals, Inc.     

Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.     

电刺激治疗神经源性膀胱感觉功能障碍的疗效观察

目的:观察电刺激治疗神经源性膀胱感觉功能障碍的疗效。方法:在2009年3月~2010年10月收治的神经源性膀胱患者中,选取以膀胱感觉功能障碍为主诉、经查体和尿动力学检查证实存在膀胱感觉功能障碍的患者38例,其中18例接受电刺激治疗(治疗组),男11例,女7例,年龄23~50岁,平均31.4岁,完全性脊髓损伤患者10例,不完全性脊髓损伤患者8例,病程1~32个月,平均7.2个月;其余20例不接受电刺激治疗,为对照组,男15例,女5例,年龄21~48岁,平均28.6岁,完全性脊髓损伤患者13例,不完全性脊髓损伤患者7例,病程1~27个月,平均6.9个月。尿动力学检查:治疗组中10例膀胱感觉消失,8例膀胱感觉减弱;对照组中11例膀胱感觉消失,9例膀胱感觉减弱。两组年龄、性别、膀胱感觉障碍类型相匹配。治疗组除常规训练外,每天先后进行膀胱腔内电刺激和经皮膀胱电刺激各1次;对照组只进行常规膀胱训练,不行电刺激治疗,1个月后比较两组患者膀胱感觉变化情况。结果:治疗组11例膀胱感觉获得不同程度改善,7例膀胱感觉无变化;8例膀胱感觉减弱患者平均初始尿意膀胱容量和强烈尿意膀胱容量治疗前分别为414±46ml、540±42ml,治疗后分别为255±41ml、420±82ml,治疗前后比较有显著性差异(P<0.05)。对照组治疗前后膀胱感觉无明显变化,平均初始尿意膀胱容量和强烈尿意膀胱容量治疗前分别为466±37ml、562±45ml,治疗后分别为421±21ml、598±47ml,治疗前后比较无显著性差异(P>0.05)。治疗前平均初始尿意膀胱容量和强烈尿意膀胱容量两组间比较无显著性差异(P>0.05),治疗后平均初始尿意膀胱容量和强烈尿意膀胱容量两组间比较有显著性差异(P<0.05)。结论:综合电刺激治疗能改善部分神经源性膀胱患者的膀胱感觉功能。     

OOC患者血清胆囊收缩素与直肠肛管压力的相关性研究

目的：研究直肠肛菅压力及血清胆囊收缩素（CCK）的改变在功能性出口梗阻型便秘（OOC）患者发病中的作用。方法：采用四通道环状固态压力传感器测压导管测定50例OCC患者直肠肛管压力;采用酶联免疫吸附测定（ELISA）检测其中20例血清CCK水平,并与20例正常人做对照。结果：与正常对9最组相比,OCC患者的肛管静息压、最大缩榨压明显降低,引起直肠初始感觉、初始便意感觉和最大感觉阈值的容积均明显升高（P值均〈O．01）。OCC组血清CCK水平显著低于正常对照组,与最大感觉阈值呈负相关。结论：OCC患者存在直肠肛管压力异常、直肠感觉功能下降及血清CCK的异常。直肠容量的感知能力与血清CCK含量呈负相关。     

Reconstructive perineoplasty in the management of non-healing wounds after anorectal surgery

Non-healing wounds (NHW) following anorectal surgery cause great distress to the patient and may be followed by a retracting scar causing anal deformity and incontinence. The management of NHW is controversial. The aim of this study was to review our experience with reconstructive perineoplasty in the treatment of such condition. From January 1992 to June 2000, we treated 12 patients affected by NHW (4 men and 8 women, mean age 47 years), not responding to conservative treatment. None had Crohn's disease or HIV infection. Pre- and postoperative anal manometry and ultrasound were carried out in 8 patients. All had microspinal anesthesia, mechanical preparation of the intestine, and perineal wound cleansing. Reconstructive perineoplasty was performed by means of local flaps (i. e. cutaneous, fasciocutaneous, myocutaneous). Median follow-up was 13 months (range, 1 to 70). Postoperative complications were as follows: 5 perineal suture dehiscences (1 total, 4 partial), the flap being resutured in one case under local anesthesia; one patient required dilatations for mild anal stricture. No case of gross fecal incontinence, retracting scar or perineal ulcer was observed. Among those patients who had disordered anal continence prior to surgery, all but one improved continence score following perineoplasty from 2.8±2.2 to 1.8±1.2 (mean ± sdm, not significant). Following reconstructive perineoplasty, no significant change was observed in functional and morphologic patterns of the anal sphincters either at manometry or by ultrasound. Reconstructive perineoplasty resulted in a good functional and clinical outcome in most cases and, therefore, may be considered an effective procedure in the managment of NHW. Received: 20 December 2000 / Accepted: 15 February 2001     

Explaining Change Over Time in Quality of Life of Adult Patients With Anorectal Malformations or Hirschsprung's Disease

Purpose The aim of this study was to examine changes in the quality of life of adult patients with anorectal malformations or Hirschsprung's disease over a three-year interval and to identify demographic, clinical, and psychosocial variables that explain possible quality-of-life changes. Understanding the factors that affect changes in quality of life over time is particularly important to provide adequate care. Methods Questionnaires were administered to 261 patients (77 percent), with a three-year interval. Background characteristics, including demographic and clinical variables, and psychosocial variables (i.e., self-esteem, mastery, social support, disease cognition) were measured on one occasion. Generic and disease-specific quality of life were measured twice. Results On average patients indicated no change in quality-of-life level after three years. However, variance in the change scores revealed individual variation, indicating the presence of patients who improved and patients who deteriorated. Patients who were female, older, have other congenital diseases, or a stoma reported poorer quality of life over time. The psychosocial variable “disease cognition” most strongly affected the change in quality of life of patients with anorectal malformations or Hirschsprung's disease. Conclusions Our results could alert clinicians to patients who are at risk for quality-of-life deterioration and might therefore be in need for extra care. Our findings illustrate the importance of psychosocial functioning for enhancing the quality of life over time of these patients. Supported by The Netherlands Digestive Diseases Foundation (MLDS) and Doctors for Children. Presented at the Dutch Science Conference, Amsterdam, The Netherlands, January 27, 2005, initiated by Emma Children's Hospital of the Academic Medical Center, University of Amsterdam. Reprints are not available.     

Management of anorectal horseshoe abscess and fistula

Over a 10-year period 69 patients were treated consecutively for posterior and anterior horseshoe abscesses and fistulas. Fifty-nine patients had posterior and ten had anterior abscesses or fistulas. There were 52 patients with acute abscess. Treatment consisted of incision and drainage, incision and drainage with primary fistulotomy, incision and drainage with primary fistulotomy and counter-drainage, and incision and drainage with insertion of seton. Seventeen patients with chronic fistulas were treated by primary fistulotomy with curettage, or incision and drainage with insertion of seton. Patients were followed from three months to ten years with a mean follow-up of three years. No incidences of incontinence were reported in this series. The overall rate of recurrence was 18 percent, and included only patients with posterior abscesses and fistulas. Recurrence was related to the failure to maintain prolonged drainage in the midline after primary fistulotomy. The use of seton for delayed fistulotomy appears to promote wound drainage and precludes premature wound closure. More liberal use of the seton in the treatment of horseshoe abscesses and fistulas is advocated. Read at the meeting of the American Society of Colon and Rectal Surgeons, Houston, Texas, May 11 to 15, 1986. Supported in part by the Dorothy Rider Pool Health Care Trust Fund.