造口旁疝的治疗近况

近年来随着肛肠外科学的发展，手术例数增多，与此同时，造口旁疝的问题又困扰了医生和病人，这里重点介绍治疗的进展。     

国际肛肠外科新书发布

Pertinax Publishing新近出版了2本结直肠外科专著。其中意大利MarioPescatori教授主编的死eArtofSurgicalProctology（肛肠外科艺术）一书涵盖肛周脓肿、肛瘘、痔、便秘、直肠脱垂及肿瘤等手术技巧，从艺术的角度对直肠外科作出了精彩诠释。书中明确指出了术中哪些操作是应该的，哪些是不应该的，而且还分享了其40年肛肠手术中对于预防术中及术后并发症的许多窍门。     

改良结肠旷置术治疗老年顽固性便秘

2006年9月至2007年9月．河北医科大学第三医院肛肠外科对i0例老年顽固性便秘患者采用改良结肠旷置术、盆底修补、功能性直肠悬吊及子宫悬吊联合手术进行治疗，取得了较为满意的疗效．现总结报道如下。     

便秘外科治疗的进展

便秘外科治疗的进展北京航天中心医院（１０００３９）杨新庆，王立勇近年来，对除外全身性疾患或器质性病变导致的顽固性便秘患者经严格的保守治疗无效时，采用外科手术治疗取得了较满意的疗效。现将有关便秘外科治疗的情况作一介绍。一、便秘外科治疗的适应证选择便秘是...     

出口梗阻型便秘诊治中国专家共识(2022版)

近年来, 中国医师协会肛肠医师分会等我国多个学会陆续发布了便秘相关的多个诊治指南及专家共识, 对我国慢性便秘外科诊治的规范化开展起到了积极的作用。但是作为功能性便秘最常见亚型的出口梗阻型便秘(OOC), 由于其临床症状多样、盆底解剖复杂, 还涉及到功能和心理等多个方面, 其诊断和治疗仍然是一个非常有争议的问题, 尚缺乏金标准与高级别的临床研究证据。为了规范我国OOC的诊治流程, 提高临床疗效和减少治疗并发症, 由中国医师协会肛肠医师分会及其临床指南工作委员会牵头, 中国中西医结合学会大肠肛门病专业委员会、中国女医师协会肛肠专业委员会、中华便秘医学会等共同发起, 由《中华胃肠外科杂志》组织召集国内本研究领域的专家组成工作团队, 针对OOC的诊断、OOC的分类和检查及评估、治疗包括培养良好的饮食生活习惯、药物治疗、生物反馈治疗、盆底功能训练、心理干预、中医中药治疗和外科治疗等, 在检索相关文献的基础上, 结合国内外最新循证医学证据和临床经验, 经过多次讨论修改, 并对相关内容进行投票表决, 达成了《出口梗阻型便秘诊治中国专家共识(2022版)》, 旨在帮助肛肠外科医生做出临床决策, 规范诊...     

造口旁疝的治疗近况(综述)

近年来随着肛肠外科学的发展,手术例数增多,与此同时,造口旁疝的问题又困扰了医生和病人,这里重点介绍治疗的进展.     

2011年（第六届）全国肛肠外科新技术新进展研讨会会议征文通知

由《中华胃肠外科杂志》编辑部、中华中医药学会肛肠分会和湖南省肛肠外科学组主办，湖南省人民医院承办的“2011年（第六届）全国肛肠外科新技术新进展研讨会”拟定于2011年5月20-22日在湖南省长沙市举行。大会内容包括结直肠肛门外科疾病的基础研究、临床诊断、治疗的新进展和新技术。大会以临床应用为核心，侧重于新技术、新疗法的推广及现场手术演示。会议邀请了中华医学会外科学分会结直肠肛门外科学组组长汪建平教授、中华中医药学会肛肠分会会长田振国教授等国内肛肠外科知名专家到会演讲和手术演示。热忱欢迎大家踊跃投稿参会。     

手术治疗慢传输性便秘所致不完全性肠梗阻15例体会

目的 总结手术治疗慢传输性便秘所致不完全性肠梗阻的临床体会.方法 2009年1月至2011年11月对15例因肠梗阻收治后明确诊断为慢传输性便秘,同时行排便造影、肛肠测压以排除出口梗阻型便秘,均在全麻下行结肠全切除+盲直肠吻合+阑尾切除术.并根据症状评分判定便秘疗效.结果 电话及门诊随访1～30个月.临床痊愈13例,显效2例.结论 慢传输性便秘所致不完全性肠梗阻外科治疗效果良好,可在明确诊断及严格把握手术适应证的情况下安全开展.     

直肠脱垂外科诊治中国专家共识(2022版)

外科手术是目前唯一可能治愈直肠脱垂的治疗方式。规范化的术前诊断评估、合理的手术方式选择是直肠脱垂外科手术获得良好效果的关键。随着国内外系列临床研究的开展, 经腹手术(例如腹侧补片固定术)和经会阴(肛门)手术(例如Altemeier)术等治疗直肠脱垂手术方式已经获得广泛认可。对直肠脱垂术前精准评估以及手术途径方式的合理选择, 对降低患者术后复发率、减少手术相关并发症具有重要临床意义。但是目前国内直肠脱垂评估体系有待完善, 对于合理手术方式的选择仍存争议。为了指导我国直肠脱垂患者规范化外科诊疗, 中国医师协会肛肠医师分会、中国医师协会肛肠医师分会盆底外科专委会和中国医师协会肛肠医师分会临床指南工作委员会联合组织全国结直肠盆底外科治疗领域的专家, 对直肠脱垂患者规范化外科诊疗的核心内容进行多次研讨, 共同制定了《直肠脱垂外科诊治中国专家共识(2022版)》。希望通过本共识的推广, 能够为广大结直肠盆底外科医生提供有益参考, 共同推进我国直肠脱垂的规范化外科诊疗。     

结直肠外科的专科化发展及问题思考

随着中国经济的发展，需要有与之相适应的医疗体系及专业医师培训、准入制度。结直肠外科在欧美是一专科性极强的专业，在我国与结直肠外科相应的是肛肠外科，其主要分布于中医院，而一些大中型医院常常对结直肠肛门疾病不够重视。随着结直肠肿瘤、炎性肠病、便秘等结直肠外科疾病发病率的明显增加以及人们对生存质量的更高要求，     

Fecal continence in patients having undergone posterior sagittal anorectoplasty procedure for a high anorectal malformation improves at adolescence, as constipation disappears

BACKGROUND/PURPOSE: Constipation is a major complication in patients who have undergone posterior sagittal anorectoplasty (PSARP) operation for a high anorectal malformation. Overflow incontinence is the main cause of fecal soiling in these patients. The aim of this study was to outline the natural history of constipation in patients with high anorectal malformations and relate this to the functional outcome at the end of the patient's growth period. METHODS: The study group consisted of 22 pubertal or postpubertal patients (median age 15; range, 13 to 25) with high or intermediate anorectal malformations repaired by PSARP procedure. The patients have been followed-up since birth. Constipation was defined as a need to use medical treatment or diet to ensure bowel emptying. Continence was classified as follows: grade 1, no soiling in any circumstances; grade 2, staining less than once a week, no fecal accidents; grade 3, staining more than once a week, no fecal accidents; grade 4, daily soiling or accidents, need for regular enemas, or the antegrade colonic enema procedure. All patients underwent anorectal manometry and magnetic resonance imaging of the spine and spinal cord. RESULTS: At the time of the study 2 (9%) of the 22 study group patients had constipation, but 15 (68%) had been constipated before puberty. Eleven patients (50%) were fully continent (grade 1) without constipation. Six of those had a history of constipation associated soiling. Three patients (14%) had occasional staining (grade 2) and no constipation. Two of them had been constipated with significant soiling before the onset of puberty. In the 5 (22%) patients with frequent staining (grade 3) the degree of soiling had decreased after the disappearance of constipation. Two of the 3 patients with poor outcome (grade 4) require regular enemas for recalcitrant constipation. Spinal cord anomalies were detected in 4 and abnormal sacrum in 15 patients. Of the anorectal manometric parameters, only the force of voluntary sphincter squeeze correlated with the functional result. CONCLUSION: In the majority of patients who underwent PSARP procedure for high anorectal malformation, constipation disappears at adolescence, and this is associated with improved fecal continence outcome.     

肛管直肠环V形切除术治疗出口梗阻型便秘48例

为探讨治疗出口梗阻型便秘的疗效,对48例因肛管商肠环肥大、僵硬而导致的山口梗阻型便秘患者,均采用肛管直肠环V形切除术．主要切除肌管直肠环肥大、俺硬、管腔狭窄部,切除肛管直肠环的前后直径1/2或1／3,左右间距1．5～2．0cm．要边切边缝合,确保肛管直肠环的相互连续性。结果显示,48例均恢复排便顺应性,肛管直肠环弹性良好,肛门自制功能正常．随游巾无复发病例。结果表明．肛管直肠环V形切除术治疗肛管直肠环肥大、僵硬导致的出口梗阻型便秘疗效肯定。     

成年人先天性巨结肠的诊治体会

目的探讨成年人先天性巨结肠的诊断及治疗方法。方法回顾性分析我院于1998年10月-2006年10月收治的成年人先天性巨结肠10例的临床资料。结果全组除1例由于多次腹部及肛门直肠手术史选用了保守治疗，效果理想外，其余均采用手术治愈。结论成年人先天性巨结肠误诊率高。诊断依据主要是追溯自幼便秘史，钡灌肠、全消化道钡餐X线透视及24、48h，甚至72h钡滞留X线摄片。诊断不能确定时加直肠黏膜活检及肛门直肠测压。有过多次手术史者，再手术时应视病情而定，并尽可能多地收集既往手术资料。强调治疗及手术方式应个体化。     

Antegrade continence enema and its application in Africa

BACKGROUND: Antegrade continent enema (ACE) procedure has been accepted worldwide as the salvage procedure for intractable constipation and faecal incontinence after anorectal malformation surgery. Its application only has been reported from the developed countries. METHODS: The authors performed four such operations on incontinent children in a poor socioeconomic group in South Africa. RESULTS: Three patients had previous surgery for anorectal malformation, and one had intractable encopresis. The patients kept clean with water washouts only, starting 1 week after the operation. CONCLUSIONS: The ACE procedure can be used easily by patients in disadvantaged communities of Africa, and its use requires minimal but sympathetic supervision only. The authors recommend that all pediatric surgeons dealing with these unfortunate children should perform this procedure after a trial period of medical treatment. This is also the first report of the ACE procedure performed for an encopretic child.     

Chronic Constipation Due to Delayed Diagnosis of a Congenital Anal Web

Congenital anal web is a rare form of anorectal malformation. In cases of delayed diagnosis, patients can present with signs ranging from mild constipation to complete bowel obstruction. The diagnosis is made by thorough anorectal inspection and a digital rectal exam. We present the case of a 9-month-old boy with Down's syndrome with chronic constipation secondary to an anal web. To our best knowledge, this is the first report of an anal web in a patient with Down's syndrome presenting with severe chronic constipation.     

Anatomically-induced diagnostic and technical surgical problems and complications in surgery of the anorectum]

Preservation and reconstruction are the key principles for surgical therapy of the anorectal organ of continence. The occlusive strength of the sphincter system varies significantly among individuals. As a rule, women have weaker sphincter muscles than men. Both sexes experience a decrease in sphincter strength with age. The physiological weakness of the anorectal sphincters in females is explained by a relatively smaller amount of sphincter muscle mass and an asymmetric sphincter anatomy which is characteristic for the female pelvic floor. In addition, the spinal centers controlling continence are structurally less complex in women than in men. Chronic constipation and the stress of vaginal deliveries frequently cause damage to the pelvic floor in women by overstretching muscular elements. They appear to play a leading role in the development of spontaneous incontinence, a condition occurring exclusively in women. Preoperative assessment of sphincter strength can be accomplished easily by using a very simple measuring device described earlier. Sphincter pressure measurements are felt to be an essential part of any preoperative work-up in anorectal surgery. The numerous procedures described for reconstructing anorectal sphincter function in patients with incontinence are symbolic operations which at the most create an illusion of continence. Narrowing the levator muscles with plastic bands may improve continence if there is some residual sphincter musculature which is still functional. But it will never cure anorectal incontinence. Recommendable procedures for treatment of anorectal prolaps, anorectal fistulas, and hemorrhoids are discussed. Operative treatment of hemorrhoids which are caused by hyperplastic enlargement of parts of the corpus cavernosum recti is also associated with a greater risk of incontinence in women than in men.     

盆底失弛缓综合征患者肛管直肠动力学改变与便秘关系的研究

为探讨盆底失弛缓综合征患者肛管直肠动力学改变与便秘的关系,本研究采用多导单囊肛管直肠功能测定仪对30例盆底失弛缓综合征患者的肛管直肠压力、直肠感知阈值、直肠最大耐受量和肛管一直肠抑制阈值进行检测,并与正常人进行对比分析。结果显示,与正常人相比,盆底失弛缓综合征患者的肛管舒张压降低,肛管静息压、直肠静息压、肛管最大收缩_压、直肠感知阈值、直肠最大耐受量及肛管一直肠抑制阈值均增高,差异均有统计学意义,P〈0．05。结果表明,盆底失迟缓综合征患者的肛管直肠动力学改变可能是形成便秘的原因之一。     

Identification of patients likely to benefit from biofeedback for outlet obstruction constipation

BACKGROUND: Biofeedback for outlet obstruction constipation has a varying success rate. The aim of this study was to identify which patients are likely to respond to biofeedback. METHODS: Thirty patients with severe outlet obstruction constipation were treated by a specialist nurse using three or four sessions of visual and auditory feedback of anal sphincter pressures. All patients were assessed by evacuating proctography, whole-gut transit studies and anorectal physiology before treatment. RESULTS: Two patients did not complete the course of biofeedback. Nine patients improved. Before treatment these patients had predominantly normal anorectal physiology and were all able to open the anorectal angle at evacuating proctography. Nineteen patients did not improve, of whom only three had no measured abnormality other than inability to empty the rectum. Ten of these patients had abnormal anorectal physiology which may have been due to previous vaginal delivery. CONCLUSION: Biofeedback for outlet obstruction constipation is more likely to be successful in patients without evidence of severe pelvic floor damage.     

Haemorrhoids,constipation and faecal incontinence: is there any relationship?

Aim Little is known about the association of haemorrhoids and anorectal function. Moreover, available data on the impact of constipation on the presence of haemorrhoids are conflicting. The present study aimed to assess any potential relationship between haemorrhoids and anorectal dysfunction. Method All participants who attended the Austrian nationwide healthcare programme for colorectal cancer screening at four medical institutions were enrolled prospectively between 2008 and 2009. A colonoscopy and detailed anorectal examination were performed on all patients. Haemorrhoids were classified according to an international grading system. Faecal incontinence was defined as the involuntary loss of solid stool, liquid stool or gas, at least once a month. Constipation was recorded by a constipation scoring system. Results Of 976 participants, 380 (38.9%) were found to have haemorrhoids. There was an association between healthy individuals, patients with symptomatic and patients with asymptomatic haemorrhoids and incontinence of liquid stool. No association was found regarding incontinence for solid stool and gas. The median constipation score was significantly higher in those patients with haemorrhoids (grade I–IV) compared with patients without haemorrhoids (2.5 points (range, 0–19) and 3 points (range, 0–19); P = 0.0113). ‘Painful evacuation effort’ and ‘assistance for defaecation (stimulant laxatives, digital assistance or enema)’ showed a significant correlation with haemorrhoids (P = 0.0394 and P = 0.0143). Conclusion Although the median constipation score was low in both groups, there was a significant association between constipation and haemorrhoids in adult patients.     

Crucial role of rectoanal inhibitory reflex in emptying function after anoplasty in infants with anorectal malformations

Constipation is a common problem after reconstructive surgery for anorectal malformations. The underlying pathophysiology of the constipation in these patients is unclear. The objective of this study was to compare manometric disturbance in infants with and without post-anoplasty constipation. Anorectal manometry studies were performed within 12 months of anoplasty, as a part of the follow-up protocol, in 24 infants aged less than 3 years who had anorectal malformations. The manometric profiles studied were mean resting anal pressure (ArP), mean resting rectal pressure (RrP), mean resting rectoanal pressure gradient (RRPG), peak squeeze pressure (PSP), and the presence of the rectoanal inhibitory reflex (RAIR). Eight of 24 infants (33%) experienced constipation during the examination period. There was no difference in pressure profiles between low and non-low anomalies. In the non-constipation group, RrP was 5.1 mmHg, ArP was 21.0 mmHg, RRPG was 16.0 mmHg, and PSP was 88.4 mmHg. In the constipation group, RrP was 7.3 mmHg (p = 0.37), ArP was 37.5 mmHg (p = 0.03), RRPG was 3.05 mmHg (p = 0.05), and PSP was 81.7 mmHg (p = 0.77). RAIR was present in 93.75% of cases without constipation and 12.5% of cases with constipation (p < 0.01). One patient who had clinical conversion from constipation to a good result also showed positive conversion of the RAIR. RAIR and anal resting tone play important roles in emptying function. As far as possible, these functions should be preserved during reconstruction.