Objectives To investigate the clinical value of ultrasound-guided percutaneous catheter drainage(PCD)for abdominal and pelvic abscess using a modified Seldinger technique with pulsed low-pressure saline irrigation.Methods Clinical data of 72 patients with abdominal and pelvic abscess who underwent ultrasound-guided PCD at Jiangyin People's Hospital between January 2023 and November 2025 were retrospectively analyzed.Patients were divided into an observation group(modified Seldinger technique with pulsed low-pressure saline irrigation,n=36)and a control group(conventional Seldinger technique,n=36)based on the actual drainage method used.The two groups were compared in terms of primary catheter placement success rate,procedure time,clinical efficacy,and complications.Results The primary catheter placement success rate was 97.2％(35/36)in the observation group versus 83.3％(30/36)in the control group,with no statistically significant difference(adjusted χ2=2.532,P=0.112).Procedure time was significantly shorter in the observation group than in the control group([14.1±2.8]min vs.[15.5±3.1]min,t=2.023,P=0.047).The overall effective rate was 100.0％in the observation group and 94.4％in the control group,with no significant difference(adjusted χ2=0.514,P=0.473).Complications occurred in 2 patients(5.6％)in the observation group(catheter obstruction in 1 and minor intra-abdominal hemorrhage in 1),and in 8 patients(22.2％)in the control group(catheter obstruction or dislodgement in 4,intra-abdominal bleeding in 2,intestinal fistula in 1,and infection spread in 1).All patients with complications recovered after symptomatic management,and no procedure-related deaths occurred.The overall complication rate was significantly lower in the observation group(χ2=4.181,P=0.041).Conclusion The ultrasound-guided modified Seldinger technique with pulsed low-pressure saline irrigation,while preserving the fundamental steps of conventional PCD,improves the local working environment within the abscess cavity before guidewire insertion and optimizes key procedural steps.This approach shortens procedure time and reduces complications for abdominal and pelvic abscess drainage,and shows a promising trend toward a higher primary catheter placement success rate.
Background Despite adjuvant systemic chemotherapy after surgical resection in patients with pT4 stage colon cancer,a high percentage of them will develop peritoneal metastases.Intraoperative hyperthermic intraperitoneal chemo-therapy(HIPEC)is a treatment option with the goal of preventing metachronous peritoneal metastases.The aim of this study was to report the longer-term outcomes of peritoneal control with the use of intraoperative HIPEC based on mito-mycin C after the last enrolled patient of the HIPECT4 trial reached 36 months follow-up.Methods Between November 2015 and March 2021,patients with resectable primary clinical T4N0-2M0 were included and randomized(1:1)to either adjuvant HIPEC with mitomycin C(30 mg/m2,60 minutes)or standard treatment.The primary endpoint was locore-gional control at 36 months.Kaplan-Meier survival analysis with a log-rank test was used to compare the two study groups.Results A total of 184 patients were included and followed up at 36 months.The locoregional control rate was improved with HIPEC compared with adjuvant chemotherapy alone(hazard ratio 0.19,95％confidence interval 0.04 to 0.86;P=0.031).Three years overall survival and disease-free survival did not differ between patients assigned to the HIPEC and control groups.Subgroup analysis showed better locoregional control with the use of HIPEC for patients with definitive pT4 colon cancer(hazard ratio 0.08,0.01 to 0.65;P=0.017)and per protocol(receiving adjuvant chemo-therapy)patients(hazard ratio 0.18,0.04 to 0.83;P=0.028).The pattern of recurrence was modified significantly using HIPEC with less peritoneal relapse.Conclusion The long-term outcome analysis of the HIPECT4 trial demonstrated that using mitomycin C-based HIPEC reduced peritoneal recurrence in patients with locally advanced colon cancer without in-creasing toxicity.However,there was no difference in overall survival and disease-free survival.
Importance Locally advanced colon cancer carries a high risk of recurrence.Neoadjuvant chemotherapy has been proposed to improve outcomes,but evidence from phase Ⅲ trials remains limited.Objective To determine whether neoadjuvant chemotherapy improves disease-free survival(DFS)compared with upfront surgery in patients with locally ad-vanced colon cancer.Design,Setting,and Participants This randomized,open-label,phase Ⅲ clinical trial conducted from October 14,2013,to November 27,2020,with follow-up up to 3 years for DFS took place at 9 hospitals in Denmark,Norway,and Sweden.A total of 250 patients with locally advanced colon cancer staged by computed tomography,Eastern Cooperative Oncology Group performance status 0 to 2,and no distant metastases were enrolled.These data were ana-lyzed from January 2024 to October 2024.Interventions Patients were randomized 1:1 to upfront surgery followed by adjuvant chemotherapy as indicated(n=122)or 3 cycles of neoadjuvant capecitabine and oxaliplatin followed by surgery and adjuvant chemotherapy if indicated(n=126).Main Outcomes and Measures The primary end point was DFS.Sec-ondary end points included surgical and pathological outcomes,adjuvant chemotherapy use,adverse events,quality of life,and exploratory analysis by mismatch repair(MMR)status.Results A total of 248 patients were eligible and included in analyses(median age,66[min-max,24-84]years;111 women[45％]and 137 men[55％]).At 3 years,DFS was 87％in the upfront surgery arm and 83％in the neoadjuvant arm(P=0.36).Neoadjuvant chemotherapy was feasible and safe,achieved tumor downstaging,and reduced the proportion of patients meeting criteria for adjuvant chemotherapy(upfront surgery 73％vs neoadjuvant group 59％;P=0.02).Exploratory analyses suggested variation by MMR status,with DFS esti-mates higher after upfront surgery in patients with MMR-deficient tumors.Postoperative complications,adverse event pro-files,and quality of life were comparable between groups.Conclusions and Relevance Neoadjuvant chemotherapy did not improve DFS compared with upfront surgery,establishing the NeoCol trial as negative.However,feasibility,safety,downstaging effects,reduced adjuvant chemotherapy use,and MMR subgroup findings add to evidence from other random-ized trials supporting further evaluation of this strategy in individualized management of locally advanced colon cancer.
The procedure for prolapse and hemorrhoids(PPH)is a classic minimally invasive treatment for hemorrhoidal disease and is widely used in clinical practice due to its advantages of simple operation,minimal trauma,and rapid re-covery.However,postoperative complications should not be overlooked.Although complications related to retained tita-nium staples are rare,they may lead to serious adverse outcomes.This article reports a case of a patient admitted in 2023 with a rectal wall cyst caused by retained titanium staples after PPH,who was readmitted in 2025 due to second-ary anorectal fistula.The clinical data,diagnostic process,treatment strategy,and prognosis of the case are described in detail.Relevant domestic and international literature is reviewed to explore the causes of retained titanium staples after PPH,the pathogenesis,diagnostic key points,and prevention and treatment strategies for related complications,aiming to provide a reference for reducing the occurrence of such complications in clinical practice.
With advances in medical technology,the cure rate of low rectal cancer has greatly improved.However,local recurrence mainly presenting as lateral lymph node metastasis still occurs.There is considerable controversy and no con-sensus regarding the indications,extent,and timing of lateral lymph node dissection.In recent years,with the redefini-tion of surgical anatomical boundaries in the pelvis and continuous surgical advances,pelvic exenteration,despite being a complex procedure with high morbidity,has gradually become a widely accepted surgical technique for locally advanced and recurrent disease involving the colorectal,gynecologic,and urologic systems.From a total pelvic perspective,regional clearance of lateral pelvic lymph nodes based on metastatic risk and complete resection along pelvic membrane anatomy are more critical.Thorough dissection of the distal iliac internal vessels,pelvic wall nodes,and nodes around the lateral sacral vessels is of vital importance for high-risk patients.For different extents and levels of lateral lymph node dissec-tion,minimally invasive techniques and open surgery each have their applicable scenarios and should be individualized.
Perianal abscess is a common anorectal emergency.There remains insufficient systematic understanding of its prevention,standardized treatment,and postoperative rehabilitation in clinical practice.This guideline was jointly initiated by the Medical Science Popularization Branch of the Chinese Medical Doctor Association,the Anorectal Surgeons Branch of the Chinese Medical Doctor Association,and the Anorectal Science Popularization Group of the Medical Science Popular-ization Branch of the Chinese Medical Doctor Association,and was developed under the leadership of Professor Li Chu-nyu from The Fourth Affiliated Hospital of China Medical University,with the collaboration of renowned experts in ano-rectal diseases and science popularization across China.This guideline focuses on epidemiology and disease nature,clini-cal manifestations and diagnosis,tertiary prevention strategies,therapeutic principles and common methods,and postop-erative rehabilitation and long-term management for perianal abscess,aiming to provide a framework for medical person-nel to conduct disease prevention and science popularization in clinical practice and to promote the standardization and systematization of health popularization efforts for perianal abscess.
Objectives To investigate the clinical efficacy and safety of endoluminal vacuum-assisted closure(EVAC)in the treatment of colorectal anastomotic leakage in 17 patients.Methods Clinical data of 17 patients with colorectal anas-tomotic leakage who underwent EVAC treatment at the Department of General Surgery I of Jiangyin People's Hospital be-tween April 2023 and December 2025 were retrospectively analyzed.The location and size of the leakage were con-firmed by endoscopy in all patients,and the EVAC device was placed within the digestive tract or abscess cavity under endoscopic guidance.The following indicators were observed and recorded:efficacy outcomes(technical success rate and closure of the leakage),treatment-related indicators(duration of EVAC therapy,number of EVAC devices used,and total hospital stay),inflammatory markers(white blood cell count[WBC],C-reactive protein[CRP]),safety indicators(adverse events and complications during treatment,including pain,local and systemic infection,gastrointestinal bleeding,anasto-motic stricture,foreign body retention)and follow-up outcomes after treatment.Results All 17 patients successfully un-derwent at least one EVAC procedure,and leakage closure was achieved in 16 patients.The mean duration of EVAC therapy was(14.9±4.9)days,the mean number of EVAC devices used was(4.2±1.4),and the median total hospital stay was 25(21,35)days.Compared with pre-treatment levels,WBC and CRP levels were significantly reduced after treatment(P<0.05).During treatment,no patient developed major gastrointestinal bleeding,anastomotic stricture,foreign body re-tention,or any other complications,and no patient discontinued EVAC due to local pain or foreign body sensation.EVAC was completed uneventfully in 16 patients;one patient required immediate termination of EVAC and conversion to emer-gency surgery due to worsening abdominal and systemic infection.During follow-up,no recurrence of anastomotic leak-age or new abscess formation was observed,apart from the aforementioned complication.Conclusion EVAC demonstrates favorable clinical efficacy and safety in the treatment of colorectal anastomotic leakage,offering a novel minimally inva-sive therapeutic option for this condition.
Background The OPERA trial has shown that a contact X-ray brachytherapy 50 kV(CXB)boost with neoadju-vant chemoradiotherapy(NCRT)can increase organ preservation(OP)rate for early rectal adenocarcinoma(ADK)of low-mid rectum.We report the results after 5 years of follow-up.Patients and Methods OPERA was a multicentre,phaseⅢ trial that included operable patients(pts),with cT2-cT3b low-mid rectal ADK,tumours<5 cm,cN0 or cN1<8 mm.All pts received external beam radiotherapy(EBRT):45 Gy in 25 fractions with concurrent capecitabine.Pts were randomly assigned(1:1)to receive a boost of EBRT in group A(9 Gy/5 fractions)or a boost with CXB(90 Gy/3 fractions)in group B.The primary end point was OP rate.Results Out of 148 patients randomised,141 were eligible.Between week 14-24,a clinical complete(or near)response was observed in 44 pts in group A(64％)versus 66 in group B(92％);P<0.001.The 3-year OP rate was 59％in group A versus 81％in group B(P=0.003).After update the median follow-up was 61.1 months[56.8-64.5].The 5-year local regrowth was 39％in group A and 17％in group B(P=0.1).The difference in OP was still highly significant between both groups:A 56％versus B 79％(P=0.004).The difference was more significant if tumours<3 cm,with an OP rate of 93％in group B compared to 54％in group A.Of the 28 lo-cal regrowths,3 occurred after 3 years of follow-up.Rectal bleeding(grade 1-2),which was the most prevalent toxicity during follow-up,disappeared most of the time after three years.Bowel function was not worsened by the CXB boost.Conclusion The OPERA trial was the first trial to demonstrate that CXB dose escalation was increasing the OP rate with good bowel function at 3 years.At 5 years,these results are sustained,especially in small early-stage tumours.The occurrence of some local regrowth after 3 years necessitates close surveillance of these pts during the 5-year period.
Objectives To identify independent risk factors for abdominal and pelvic infection(API)after colorectal can-cer surgery and to construct and validate a nomogram-based risk prediction model.Methods This retrospective study en-rolled 786 patients who underwent colorectal cancer surgery at the Affiliated Hospital of Qinghai University between June 2019 and June 2024.Patients were randomly assigned to a training set(n=550)and a validation set(n=236)in a 7:3 ratio.Independent risk factors for postoperative API were identified using univariate and multivariate logistic re-gression analyses,which were then used to develop a nomogram prediction model.The model's discrimination,calibra-tion,and clinical utility were assessed using receiver operating characteristic(ROC)curves,the Hosmer-Lemeshow test,calibration plots,and decision curve analysis(DCA).Results Univariate analysis showed that diabetes mellitus,prior ab-dominopelvic surgery,comorbid hypoalbuminemia,preoperative chemotherapy,duration of drain placement,tumor node metastasis stage,and anastomotic leakage were associated with postoperative API(P<0.05).Multivariate analysis further identified diabetes mellitus(OR=3.286,95％CI:1.533-7.151),prior abdominopelvic surgery(OR=3.594,95％CI:1.728-7.640),duration of drain placement≥10 days(OR=3.703,95％CI:1.737-8.084),and anastomotic leakage(OR=11.127,95％CI:5.026-25.126)as independent risk factors.The nomogram model built on these factors achieved an area under the ROC curve of 0.834(95％CI:0.763-0.906)in the training set and 0.794(95％CI:0.688-0.900)in the validation set.The Hosmer-Lemeshow test indicated good model fit,with no significant deviation in either the training set(χ2=6.454,P=0.168)or the validation set(χ2=2.367,P=0.669).Calibration curves demonstrated high agreement between predicted and observed probabilities.DCA showed that the model offered clinical utility across threshold probability ranges from 20％to 90％.Conclusion Diabetes mellitus,prior abdominopelvic surgery,duration of drain placement≥10 days,and anas-tomotic leakage are independent risk factors for API after colorectal cancer surgery.The nomogram prediction model based on these factors exhibits good discrimination,calibration,and clinical applicability.
Mesenteric anatomy constitutes the core foundation for the theoretical framework of abdominal anatomy and the advancement of gastrointestinal surgical techniques.Over time,anatomists and surgeons have successively proposed the primitive mesenteric continuity model,the fragmented mesentery model,and the modern mesenteric continuity model.Traditional anatomy defined the mesentery as a double-layered peritoneal fold and held that the mesocolon of the ascending and descending colon were congenitally absent.This fragmented theory,disseminated through authoritative text-books,dominated academic thinking for over a century,despite its evident anatomical limitations.With in-depth embry-onic anatomical research and the popularization of precise surgical procedures in colorectal surgery,modern mesenteric anatomy has verified that the mesentery is a continuous,independent organ extending from the esophagus to the anus,serving as the anatomical and functional hub for the development,support and systemic connection of all abdominal di-gestive organs.The mesenteric continuity model divides the abdomen into mesenteric and non-mesenteric regions.Based on morphological characteristics,the mesentery is subdivided into superior,middle and inferior zones,each with distinct structural characteristics while maintaining continuity and gradual transition between regions.This theory not only reason-ably elucidates the fixation mechanism of intestinal tracts,but also provides anatomical support for the standardized implementation of radical colorectal surgery.Meanwhile,it delivers a novel anatomical reference for abdominal ap-proaches in hepatobiliary-pancreatic surgery,vascular surgery and urological surgery.
Objectives To investigate the clinical correlation and mechanisms between postoperative ileus(POI)and en-terogenous infection.Methods Clinical data of 300 patients who underwent radical gastrectomy at the Affiliated Drum Tower Hospital,Medical School of Nanjing University from December 1,2022 to June 30,2023 were retrospectively analyzed.A POI model was established in 6-to-8-week-old male C57BL/6 mice,which were divided into the intestinal manipulation(IM)group and the sham operation(Sham)group,with 10 mice in each group.Model validation was performed by observing intestinal morphology and measuring peripheral blood inflammatory markers.Differential gene expression and functional enrichment analysis were conducted using single-cell RNA sequencing(scRNA-seq)and bioinformatics analysis.Results No statistically significant differences were found between the two groups in terms of gender,age,BMI,history of diabetes,preoperative albumin level,operation time,intraoperative blood loss,proportion of intestinal anastomosis,or opioid use(P>0.05).The time to first postoperative rectal exhaust was significantly longer in the infection group than in the non-infected group(P<0.05).Among 15 patients with enterogenic infection,13 developed POI;among 285 patients without enterogenic infection,20 developed POI,with a significant difference in the incidence of POI between the two groups(χ2=84.38,P<0.001).Animal experiments showed that compared with the Sham group,the IM group exhibited obvious intestinal congestion,edema,and stasis of intestinal contents on gross inspection,along with significantly elevated total white blood cell count,neutrophil percentage,and absolute neutrophil count(P<0.000 1).UMAP dimensionality reduction clustering revealed that,compared with the Sham group,the proportions of neutrophils and macrophages among intestinal immune cells were increased in the IM group,while the proportions of B cells,T cells,and NK cells were decreased.Gene set enrichment analysis showed that the"response to molecules of bacterial origin"pathway was significantly activated in the immune cells of the IM group(P<0.05).scRNA-seq analysis of intestinal epithelial cells from POI mice showed that the gene expression of tight junction proteins 1(Tjp1)and closure protein(Ocln)in the intestinal epithelial cells of the IM group was significantly downregulated(P<0.000 1),and the"tight junction"pathway was significantly inhibited in the IM group(P<0.05).In addition,bubble plot visualization of the differential expression profiles of intestinal epithelial barrier-related gene sets from the scRNAseq data showed that the average expression levels of key intestinal epithelial barrier genes such as Cldn3 and Cldn4 were lower in the IM group than in the Sham group.Conclusion POI is closely related to enterogenous infection.The mechanism may involve the activation of inflammatory pathways related to bacterial responses of intestinal immune cells mediated by POI,as well as the disruption of the intestinal epithelial barrier.Clinically,improving postoperative intestinal motility and preserving intestinal barrier function may help reduce the occurrence of enterogenic infection.
Background FOLFOXIRI plus bevacizumab improved efficacies and increased some adverse events in untreated metastatic colorectal cancer (mCRC), compared with the doublet plus bevacizumab. The clinical outcomes of ramucirumab (RAM) in combination with FOLFIRI or FOLFOXIRI as a first-line treatment are unknown. In this randomized phase Ⅱ study (WJOG9216G), we compared the efficacy and safety of these regimens to determine which is more promising. Methods Patients with untreated mCRC were randomly assigned to the FOLFIRI-RAM or FOLFOXIRI-RAM arms. The primary endpoint was a confirmed objective response rate (ORR), and secondary endpoints included early tumor shrinkage (ETS), progression-free survival (PFS), overall survival (OS), and safety. Results In total, 122 patients were randomized. The confirmed ORR was 59.3% and 60.3% in the FOLFIRI-RAM and FOLFOXIRI-RAM arms, respectively (odds ratio 1.04; P＝0.91). With a median follow-up period of 42.1 and 40.4 months, PFS was comparable between the FOLFIRI-RAM and FOLFOXIRI-RAM arms (median, 11.5 and 10.5 months). ETS rate (71.2% and 52.4%) and OS (median, 32.6 and 28.2 months) were significantly better in the FOLFIRI-RAM arm than in the FOLFOXIRI-RAM arm. The major grade ≥ 3 adverse events in the FOLFIRI-RAM and FOLFOXIRI-RAM arms were neutropenia (44.1% and 72.6%), anorexia (3.4% and 14.5%), and febrile neutropenia (3.4% and 11.3%). Conclusions FOLFOXIRI plus RAM was not superior to FOLFIRI plus RAM in terms of efficacy, including ORR, in patients with untreated mCRC. Instead, first-line FOLFIRI plus RAM showed clinical efficacy and safety profiles comparable to those of doublet chemotherapy plus bevacizumab.
Objectives To investigate the impact of perianal infectious lesions on postoperative recurrence(POR)in pa-tients with Crohn's disease(CD).Methods A retrospective cohort study was conducted.Patients with CD who under-went ileocecal resection(ICR)at Shanghai Ninth People's Hospital between July 2016 and June 2025 were screened through the electronic medical record system.Of 203 initially screened patients,125 were finally enrolled after excluding those who did not meet the criteria.Based on the presence of preoperative perianal infectious lesions(perianal abscess and perianal fistula),patients were divided into a non-lesion group(n=92)and a lesion group(n=33),with the latter including 14 cases of perianal abscess and 19 cases of perianal fistula.Baseline characteristics and surgical-related parameters were compared between the two groups,and the association between preoperative perianal infectious lesions and postoperative recurrence was analyzed.Kaplan-Meier curves were used to compare recurrence-free survival between patients with and without perianal lesions and among different lesion subtypes.Cox proportional hazards regression analysis was performed to identify factors associated with overall postoperative recurrence and independent risk factors.Results No significant differences were observed between the non-lesion group and the lesion group in sex,age,body mass index,Montreal classification A or B,extraintestinal manifestations,history of surgery for penetrating lesions,or prior CD-related surgery(P>0.05).Compared with the non-lesion group,the lesion group had longer disease duration,a higher proportion of patients with Montreal classification L,higher erythrocyte sedimentation rate(ESR),and a lower pro-portion of patients receiving side-to-side anastomosis(P<0.05).Overall postoperative recurrence occurred in 56 patients,endoscopic recurrence(ePOR)in 43,and surgical recurrence(rPOR)in 29.There were no significant differences between the two groups in the incidence or time to onset of overall recurrence,ePOR,or rPOR(P>0.05).Subgroup survival analysis by lesion subtype revealed a significant difference in recurrence-free survival among the non-lesion,perianal ab-scess,and perianal fistula groups(log-rank χ2=6.414,P=0.041).Univariate Cox proportional hazards regression analysis identified Montreal classification L3(ileocolonic type),perianal abscess,and ESR as factors associated with overall recur-rence.Multivariate Cox proportional hazards regression analysis showed that Montreal classification L3 was an indepen-dent risk factor for overall postoperative recurrence.Conclusion Preoperative perianal infectious lesions are not associ-ated with overall recurrence,ePOR,or rPOR in CD patients after surgery.However,different subtypes of perianal lesions(abscess vs.fistula)may lead to variations in recurrence-free survival.Montreal classification L3(ileocolonic type)is an independent risk factor for overall postoperative recurrence.
Open abdomen therapy is an integral component of damage control surgery in abdominal practice and plays a critical role in the management of intra-abdominal infections and abdominal compartment syndrome.When exposed bowel ruptures and is left open to the air,there is a substantial risk of progression to an enteroatmospheric fistula(EAF),which remains a particularly challenging complication to manage.To address this,our team has adopted a compre-hensive strategy combining temporary abdominal closure using negative pressure wound therapy(NPWT),intracavitary negative pressure suction for diversion of digestive juices,botulinum toxin injection into the abdominal wall musculature,and definitive surgical reconstruction of the abdominal wall for EAF resection.These approaches have yielded satisfactory outcomes and favorable prognoses.In this article,we review the pertinent literature and summarize our team-based clini-cal experience in open abdomen wound management and EAF prevention and treatment,with the aim of sharing practi-cal insights with fellow clinicians.
The success of colorectal cancer surgery is closely associated with the prevention of surgical complications,for which effective preoperative bowel preparation plays a critical role.In clinical practice,the concept of preoperative bowel preparation has evolved,and current strategies encompass conventional mechanical bowel preparation,oral antibi-otic administration,their combination,as well as the increasingly recognized approaches of nutritional optimization,meta-bolic modulation,and gut microbiota management.Furthermore,different preoperative bowel preparation strategies have distinct application characteristics and applicability.The selection of an optimal strategy should take into account indi-vidual patient status,type of surgery and surgical protocol,and clinical evidence.This article reviews the research prog-ress in preoperative bowel preparation for colorectal cancer surgery,from multiple perspectives,including mechanical bowel preparation,preoperative oral antibiotics,nutritional support,carbohydrate loading,gut microbiota regulation,and management in special clinical scenarios.
Postoperative wound healing in perianal diseases is dynamically regulated by the local microbiota.Due to the proximity to the anus,the wound microbiota exhibits high complexity,dominated by Firmicutes,Bacteroidetes,and Proteo-bacteria,with poor microenvironmental stability.The balance of the microbiota influences the process and outcome of wound healing.A balanced microbiota promotes healing through three core mechanisms:inhibiting pathogens,modulating immune responses via multiple pathways,and promoting tissue repair through metabolites.Conversely,an imbalanced mi-crobiota impairs healing by inducing persistent inflammation,promoting biofilm formation,producing cytotoxicity,and in-terfering with immune regulation.Current therapeutic strategies have shifted from simple antimicrobial approaches to ho-listic regulation of the microbiota,mainly including inhibition of harmful bacteria(e.g.,targeted use of antibiotics,applica-tion of functional dressings),supplementation of beneficial bacteria(e.g.,oral or topical probiotics),and the holistic regu-lation of traditional Chinese medicine("strengthening the body resistance and eliminating pathogenic factors").Future ef-forts should focus on dynamic evolution of the microbiota and precise regulatory interventions combined with multi-omics analysis for individualized treatment strategies,providing unique theoretical support and practical reference for im-proving postoperative wound healing in perianal diseases.
Objectives To investigate the clinical efficacy of external clamp resection combined with internal dilatation and ligation for circumferential mixed hemorrhoids.Methods A total of 110 patients with circumferential mixed hemorrhoids who underwent inpatient surgery in our department from January 2024 to September 2025 were enrolled.According to different surgical procedures,patients were divided into an observation group(treated with external clamp resection combined with internal dilatation and ligation)and a control group(treated with conventional external dissection and internal ligation),with 55 cases in each group.Clinical efficacy,surgery-related indicators(wound healing time,hospitalization cost)and postoperative complication(anal pain,anal bleeding,wound edema,anal stricture)scores were compared between the two groups.Results The total clinical effective rate was 100％in both groups,with no statistically significant difference(P＞0.05).Compared with the control group,the observation group had shorter wound healing time,lower hospitalization cost,and lower scores for anal pain,anal bleeding,wound edema,and anal stricture.Moreover,the improvement in anal stricture was more pronounced and the rate of improvement was faster in the observation group(P＜0.05).Over time,the scores for anal pain,anal bleeding,wound edema,and anal stricture decreased in both groups(P＜0.05).Conclusion External clamp resection combined with internal dilatation and ligation achieves comparable clinical efficacy to conventional external dissection and internal ligation for circumferential mixed hemorrhoids,while significantly shortening wound healing time,reducing hospitalization cost,al-leviating postoperative complications,and facilitating early recovery of anal function.
Intestinal obstruction is a common acute abdominal emergency worldwide,with an incidence of approximately 231.393 per 100,000 in China.The etiology is complex and can be classified into three types:mechanical,dynamic,and vascular intestinal obstruction,each with distinct pathogenic mechanisms.Previous reviews have mostly focused on diagnostic and treatment strategies or on mechanisms of a single type,lacking a systematic synthesis based on etiological classification.This article takes etiology as the main thread to review and compare the pathogenesis of the three types.It focuses on the inflammatory-fibrotic regulatory pathways in mechanical intestinal obstruction,the neuro-immune dysregulation mechanisms in dynamic intestinal obstruction,and the ischemia-reperfusion injury pathways in vascular intestinal obstruction.Future research directions and technical applications of interest are also discussed.
Objectives To investigate the expression of microRNA-155-5p(miR-155-5p)and suppressor of cytokine signaling 1(SOCS1)in colorectal cancer(CRC)tissues and their clinical significance.Methods A total of 121 patients with newly diagnosed CRC who received initial treatment at Baoding First Hospital from May 2020 to May 2024 were enrolled.Surgical cancer tissue specimens were collected,and the expression levels of miR-155-5p and SOCS1 mRNA were measured.Based on the median expression levels,patients were divided into lowexpression groups(miR-155-5p＜2.61,SOCS1＜0.92)and highexpression groups(miR-155-5p ≥ 2.61,SOCS1 ≥ 0.92).Followup ended in May 2025.According to outpatient followup results,patients without recurrence or metastasis were assigned to the good prognosis group(n=87),and those with re-currence or metastasis were assigned to the poor prognosis group(n=34).Clinicopathological data were compared between the two groups.The targeting relationship and binding sites between miR-155-5p and SOCS1 were predicted using the TargetScan database.Pearson correlation analysis,logistic regression analysis,receiver operating characteristic(ROC)curves,and mediation effect modeling were used to assess the impact of miR-155-5p and SOCS1 mRNA levels on patient prognosis.Results The expression levels of miR-155-5p and SOCS1 mRNA in CRC tissues were associated with smoking history,diabetes history,TNM stage,differentiation degree,and lymph node invasion(P＜0.05).A potential binding site for SOCS1 was identified in the miR-155-5p sequence,suggesting a possible targeting relationship.Pearson correlation analysis showed that SOCS1 mRNA level was negatively correlated with miR-155-5p level(r=-0.528,P＜0.05).Univariate analysis indicated that diabetes history,TNM stage,differentiation degree,lymph node invasion,and miR-155-5p and SOCS1 mRNA levels were associated with CRC prognosis(P＜0.05).Logistic regression analysis showed that miR-155-5p and SOCS1 mRNA levels were independent prognostic factors for poor prognosis,with significant trends(P for trend＜0.001).ROC curve analysis showed that the optimal cutoff value of the combination of miR-155-5p and SOCS1 mRNA for diagnosing poor prognosis in CRC was 0.19,with an area under the curve of 0.897,which was significantly better than either indicator alone(Z for combination=1.629,Z for combination vs.SOCS1 mRNA=3.372,Z for miR-155-5p vs.combination=2.425;all P＜0.05).Mediation analysis indicated that SOCS1 mRNA played a partial mediating role in the association between miR-155-5p and poor prognosis.The indirect effect accounted for 23.4％of the total effect,and the direct effect accounted for 76.6％of the total effect.Conclusion Patients with poor prognosis of CRC show increased miR-155-5p expression and decreased SOCS1 mRNA expression.Both are closely associated with the clinical characteristics and prognosis of colorectal cancer.
The evolution from multiport laparoscopic surgery to single-port laparoscopic surgery,and from multiport ro-botic surgical system to single-port robotic surgical system,reflects that minimal invasiveness and precision are the main-stream trends in colorectal surgery.Among these,the multi-instrument collaborative mode of the single-port robotic surgi-cal system enables the creation of an ideal surgical working space while preserving only one external incision,drawing attention to its value in colorectal surgery.This review,based on relevant literature,introduces the development and ap-plication of the single-port robotic surgical system,summarizes the current research on its use in colorectal surgery,and briefly discusses its current limitations and potential directions for optimization in this field.
