Infections at the bottom end of the gastrointestinal tract

This article concentrates on specific infections of the distal gastrointestinal (GI) tract, particularly those that are transmitted sexually, by anal intercourse. Syphilis, gonorrhoea and lymphogranuloma venereum (LGV) are age old and well known diseases, but the features may be unfamiliar to GI histopathologists. Every histopathology trainee will have seen Herpes simplex virus (HSV) infection of squamous epithelium (e.g. oesophagus, vulva and anus), but the HSV pseudotumour of the anus/perineum can present a pitfall to those who have not previously encountered this entity. Another, more recently described, entity that has a predilection for the ano-rectal region is Epstein–Barr Virus (EBV) positive mucocutaneous ulcer, and this also presents a diagnostic trap to the unwary.     

Contrast‐Enhanced Colosonography for the Evaluation of Children With an Imperforate Anus

This case series describes a novel method for showing the preoperative anatomy of children with anorectal malformations using ultrasound contrast, which we have termed “contrast‐enhanced colosonography (ceCS).” Six patients with anorectal malformations without a perineal fistula were studied both by fluoroscopic distal colostography and ceCS, and their results were confirmed surgically. Contrast‐enhanced CS precisely showed the complex anatomic relationships in all cases. Compared to traditional fluoroscopic studies, ceCS has the benefit of no associated ionizing radiation and thus is safer for children.     

括约肌间切除术与人工肛门重建对低位直肠癌根治术患者术后生活质量的影响

目的:对比低位直肠癌根治术患者行括约肌间切除术(ISR)、人工肛门重建术后生活质量的差别。方法:对2015年1月至2019年6月70例低位直肠癌根治术患者进行EORTC的QLQ-C3O和QLQ-CR38问卷调查。其中42例患者行ISR(ISR组),28例患者行人工肛门重建(人工肛门重建组)。结果:QLQ-C30问卷结果显示,ISR组总体生活质量得分明显高于人工肛门重建组(73.41 vs 63.39,P=0.03);在社会功能方面,人工肛门重建组优于ISR组(78.57 vs 66.67,P=0.03);人工肛门重建组失眠、腹泻、疼痛、经济问题等出现概率较ISR组明显升高(P<0.05),而在其他功能、症状领域两组比较差异均无统计学意义(P>0.05)。QLQ-CR38相关领域内两组指标比较差异无统计学意义(P>0.05)。结论:对于低位直肠癌根治术患者,总体生活质量上ISR更优,社会功能方面人工肛门重建更佳。     

不同荷包高度对PPH术前后肛管直肠压力及疗效的影响

目的探讨痔PPH术中,不同荷包高度的选择对手术前后肛管直肠压力及疗效的影响。方法选择混合痔住院手术患者60例,随机分为3组,每组各20例,3组均采用PPH术,手术操作中采用不同荷包高度。分别对3组患者术中切除黏膜宽度、手术前后肛管直肠压力、术后并发症及疗效等指标进行临床观察统计。结果 3组患者的近期临床疗效、术中切除黏膜宽度、肛管静息压、术后疼痛及急便感的比较差异有统计学意义(P<0.05)。结论 PPH术中荷包高度选择在齿线上2～3cm,为适合国人的最佳PPH术选择荷包高度。肛管直肠测压为评定肛肠手术前后的肛管直肠动态功能提供科学客观的标准,对肛管直肠功能的鉴定有重要的指导意义,并可用于指导临床改进手术方式。     

Anal cancer – What is the optimum chemoradiotherapy?

Radical concurrent chemoradiotherapy with 5FU and Mitomycin C is the standard-of-care for squamous-cell carcinoma of the anus (SCCA). Phase III trials combined radiation doses of 50–60 Gy with concurrent Fluoropyrimidines, Mitomycin C and Cisplatin in various doses and schedules. CRT is highly successful for early T1/T2 cancers, but results in appreciable late morbidities and still fails to control larger and node-positive tumours.Compliance to chemotherapy is important for local control. Modern radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), rotational IMRT, image-guided radiotherapy (IGRT) have enabled smaller margins and highly conformal plans, resulting in decreased radiation doses to the organs at risk and ensuring a shorter overall treatment time. These advances offer the potential for integrating higher doses of radiation, escalation of the currently used drugs and the safe use of other more novel agents with acceptable toxicity. In this chapter potential novel approaches are discussed in the context of SCCA.     

人类后肠及肛门直肠胚胎发育中凋亡及细胞增殖的时空分布研究

目的：揭示肛门直肠的胚胎发育过程,初步探讨细胞增殖／凋亡在肛门直肠胚胎发育中的作用。方法本研究应用3～9周人胚标本,通过HE染色后连续动态观察肛门直肠的形态变化过程并结合TUNEL及PCNA免疫组织化学染色分析细胞增殖／凋亡的时空分布规律。结果第6周,凋亡细胞主要位于肛门直肠、尿直肠隔及尿生殖窦的上皮;尤其是在肛门开口区周围分布着大量凋亡细胞;第7周,凋亡细胞大量分布于直肠末端和直肠背侧间质区;第8周,直肠及肛管上皮中可以见到凋亡细胞,而在尿直肠隔背侧与泄殖腔膜内仅观察到少量的凋亡细胞。第6周,肛门直肠、尿生殖窦及尿直肠隔上可以观察到微弱的增殖细胞;散在的增殖细胞位于背侧泄殖腔膜;第7周,尿直肠隔间质中可见增殖细胞出现,这些细胞大部分位于肛门直肠和尿直肠隔腹侧的间质内;第8周,增殖细胞主要分布于尿道和肛门直肠的上皮中,同时在尿直肠隔与腹侧泄殖腔膜和融合区域内有大量增殖细胞聚集。结论在人类胚胎发育过程中,尿直肠隔与背侧泄殖腔膜并未发生融合,背侧泄殖腔膜和背侧泄殖腔在肛门直肠发育过程中发挥了重要作用;肛门开口后,尿直肠隔继续向头腹侧移位,与腹侧泄殖腔膜融合,腹侧泄殖腔膜在泌尿生殖道和会阴的胚胎发育中具有重要的意义。细胞凋亡促进了肛膜的崩解,使得肛门直肠与羊膜腔相通,在人类肛门直肠的胚胎发育过程中有重要的意义;胎龄第6～8周尿直肠隔,腹侧泄殖腔膜发生的细胞增殖和凋亡促进了尿生殖膈的头腹侧移位,在尿直肠隔与腹侧泄殖腔膜融合过程中发挥了重要的作用。