ObjectiveTo evaluate the efficacy of XiaochengqiMixture (XM) on promoting healing of colonic stoma. MethodsForty Wistar rats were divided into two groups randomly after colonectomy: experimental group (n=20) and control group (n=20). In early postoperatively stage rats were given gastric administration of XM in the experimental group and pure water in the control group. On day 3, 7, and 14 after establishment of animal models, laparotomy was performed in two groups of rats, respectively. Anastomotic stoma and surrounding tissues were harvested to detect the context of hydroxyproline and collagen fiber proportion by Masson dying. ResultsOn day 3 after establishment of animal models, hyperplastic collagen with small fiber was observed while no fasciculus was found. Hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.05). On day 7 after operation, many fasciculuses were found in two groups of rats, hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.01). On day 14 after operation, fasciculuses became bigger and more regular in arrangement, but there was no significant difference between the two groups (Pgt;0.05). ConclusionXM is capable of promoting healing of colonic stoma and might prevent the occurrence of anastomotic fistula.
ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer. MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model. ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.
目的 探討應用雙吻合器低位直腸癌前切除術后吻合口漏的早期診斷和防治措施。方法 回顧性分析 2005～2011年期間筆者所在醫院收治的160例應用雙吻合器行低位直腸癌前切除患者的臨床資料。結果 本組患者術后發生吻合口漏13例（8.1%），發生吻合口漏的時間為術后 3～12d，平均7d；8例經保守治療后治愈，4 例經二次手術行結腸或回盲部造瘺后好轉，1 例于術后12d死亡。結論 直腸癌前切除術后吻合口漏的早期正確診斷和合理治療是降低患者死亡率的關鍵；早期的造瘺手術和通暢引流是治愈吻合口漏的必要措施。
Objective To investigate the effect of local delayed releasing vascular endothelial growth factor (VEGF) on accelerating healing of intestinal anastomotic stoma. Methods An intra-abdominal infection modal of rabbit was established by artificial appendix perforation, and excision and anastomosis of terminal ileum were subsequently performed after 12 h. The animals were divided into four groups (32 for each group) with different reagents on anastomotic surface: control group, fibrin glue group (FG group), VEGF group, and VEGF＋FG group. The incidence of stomal leak, anastomosic bursting pressure, hydroxyproline content, and expression of VEGF in cured stoma tissue were measured respectively on day 3, 5, 7 and 14 after operation. Results The total incidence rate of leakage was lower in FG group and VEGF group than that in control group, but there was no statistical significance （Pgt;0.05）. The incidence rate was significantly lower in FG＋VEGF group than that in control group （Plt;0.05）. On day 14 postoperatively, the bursting pressure of anastomotic stoma, hydroxyproline content, and positive cell expression rate of VEGF protein (except VEGF group) were significantly increased in FG＋VEGF group than those in other three groups （Plt;0.05, Plt;0.01）. Conclusion Local delayed release of VEGF by fibrin glue can improve the healing of intestinal anastomotic stoma and reduce the incidence of stomal leak.
ObjectiveTo study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following laparoscopic anterior resection of rectal cancer.MethodsThe clinical data of patients who underwent laparoscopic anterior resection of rectal cancer in our hospital from January 2017 to March 2020 were retrospectively collected. According to different surgical methods, they were divided into two groups: pedicled seromuscular sleeve sheath group (referred to as sleeve sheath operation group) and traditional operation group. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 87 patients with rectal cancer were included, 37 in the sleeve sheath operation group and 50 in the traditional operation group. There were no significant differences in the baseline data such as the gender, age, body mass index (BMI), complicating disease, distance from lower tumor margin to anal verge, histological classification, neoadjuvant radio- chemotherapy, and TNM stage between the two groups (P>0.05). There were no significant differences in the volumes of intraoperative blood loss, the number of lymph node dissection, the first postoperative anal exhaust time and the hospitalization expense between the two groups (P>0.05). Compared with the traditional operation group, the operative time of the sleeve sheath operation group was longer (P<0.05), the postoperative hospitalization time of the sleeve sheath operation group was shorter (P<0.05). The incidence of postoperative anastomotic leakage in the sleeve sheath operation group and the traditional group were 0.0% (0/37) and 12.0% (6/50), respectively, and the difference was statistically significant (P<0.05). There were no significant differences in the anastomotic stenosis, the lymphatic fistula and the incision infection between the two groups (P>0.05). All patients were followed-up for 6 to 36 months, with a median time of 21 months. No recurrence or death occurred.ConclusionThe sheath technique with seromuscular sleeve of pedicled colon can increase the anti tension ability of anastomotic stoma and reduce the incidence of anastomotic leakage, which is a safe and effective surgical method.
ObjectiveTo summarize the causes, clinical manifestations, diagnosis and treatment methods for the intestinoseminal vesicle fistula. MethodLiteratures about intestinoseminal vesicle fistula at home and abroad were retrieved, the causes, clinical manifestations, diagnosis and treatment methods were analyzed. ResultsThe clinical reports of 19 patients with intestinoseminal vesicle fistula were searched.The intestinoseminal vesicle fistula occurred after the rectal low anterior resection with stomal leak, sigmoid diverticulum, inflammatory bowel disease, prostatectomy or radiotherapy.The main clinical symptoms were pneumaturia, fecaluria, fever, scrotal swelling and pain, orchitis, epididymitis and so on.Imaging methods such as enhanced CT or CT with rectal contrast and so on could confirm the diagnosis.The conservative treatment such as indwelling catheter, antibiotics, parenteral nutrition, and the operation methods such as sinus incision and drainage, mucosa/skeletal muscle flap repairment, urine/stool bypass could cure majority of cases. ConclusionsThe intestinoseminal vesicle fistula is a rare and independent disease.Through the discussion of the intestinoseminal vesicle fistula, it could improve the knowledge, and avoid misdiagnosis and mistreatment of the intestinoseminal vesicle fistula.
目的 探討直腸癌雙吻合器保肛術后預防吻合口漏的措施。方法 回顧性分析2006年1月至2009年7月期間在我院行Dixon術的358例直腸癌患者的臨床資料。結果 本組病例均一次吻合成功,術后出現吻合口漏30例（8.4%），多發生在術后5~10 d,均經非手術綜合性措施治療后漏口愈合,愈合時間14~60 d,中位時間37 d。結論 術前一般狀況調整、術中嚴密操作、正確的引流管放置與灌洗引流、營養支持等綜合性措施對低位直腸癌Dixon術后吻合口漏的防治效果較好。
目的探討自制雙套管持續負壓吸引對低位直腸癌經腹前切除術后吻合口漏的防治效果。 方法2006年1月至2012年12月期間筆者所在醫院施行了106例低位直腸癌經腹前切除術，均采用自制雙套管持續負壓吸引，回顧性分析其預防和治療吻合口漏的效果。 結果本組106例患者術后發生吻合口漏6例（5.66%），給予雙套管持續滴注沖洗結合持續低負壓吸引，同時給予全身抗感染、禁食、腸外營養或后期腸內營養處理。12～16 d（平均14 d）后患者的大便成型、沖洗液清亮，遂拔除引流管。其中1例為直腸陰道瘺，經保守治療失敗后行橫結腸雙腔造瘺術，于術后6周恢復，3個月后行造瘺口關閉術。 結論低位直腸癌保肛手術應用自制雙套管持續負壓吸引技術后，吻合口漏的發生率較低；其還能有效控制盆腔感染，從而促進漏口愈合。
目的 探討直腸癌前切除術吻合口漏的原因及對策。方法 對符合行直腸前切除術的73例直腸癌患者行全直腸系膜切除術,用雙吻合器技術（double-stapling technique,DST）吻合結直腸。2004年1月以后收治的病例特別注意了會陰助推、 遠側直腸密閉試驗、吻合器穿刺頭穿刺點的選擇、吻合口漏氣試驗和經肛門至結腸及經腹壁至吻合口旁放置引流管的技術細節。結果 全組2例(2.74%)發生吻合口漏，均為2004年1月以前的病例，1例經橫結腸造瘺治愈，另1例經引流管沖洗治療治愈； 2004年1月以后的65例無吻合口漏發生。結論 注意直腸癌前切除術中的一些技術細節， 可在一定程度上降低全直腸系膜切除條件下DST吻合的吻合口漏發生率。
目的 探討圓形吻合器在高齡賁門胃底癌經腹切除術中的應用。方法 回顧性分析1999年1月至2009年5月期間在我院接受圓形吻合器經腹切除術的238例70歲以上高齡賁門胃底癌患者的臨床資料，并對圍手術期結果進行分析。 結果 全組手術時間3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。術中并發大出血1例，給予積極止血，無術中死亡。所有病例機械吻合術后未出現吻合口漏。術后60例患者（25%）出現不同程度的并發癥，其中吻合口出血2例, 左側胸腔積液13例，肺部感染15例, 心衰3例, 肺不張2例, 心律失常10例，右側胸腔積液15例。無圍手術期死亡。術后隨訪3年，出現返流性食管炎45例，吻合口狹窄30例，無吻合口腫瘤復發，3年生存率為64%(152/238)。結論 應用圓形吻合器在高齡胃底賁門癌患者經腹切除術是安全、有效的。