Introduction Haemorrhoidal disease affects 25–40% of adults worldwide and constitutes a primary reason for outpatient colorectal consultations. Surgical management is essential for grade III–IV or treatment-refractory cases. Numerous procedures have emerged, including Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty. However, randomised controlled trials and conventional meta-analyses report conflicting results on efficacy, postoperative pain, recurrence rates and complications such as bleeding, stenosis and incontinence. Although network meta-analyses exist, an updated synthesis is needed because outcomes and follow-up vary across trials. This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis, providing evidence-based guidance for clinical practice and guideline development.Methods and analysis The Cochrane Library, Web of Science, MEDLINE, Embase, China National Knowledge Infrastructure, VIP, SinoMed and Wanfang databases will be searched from inception to January 2025, limited to English or Chinese publications. Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included, with outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration. Risk of bias will be assessed using RoB 2. Pairwise meta-analyses will be conducted in RevMan; network meta-analysis will employ Bayesian frameworks in GeMTC or R, incorporating consistency evaluation, node-splitting and surface under the cumulative ranking curve for treatment ranking. Subgroup analyses (haemorrhoid grade, follow-up duration), sensitivity analyses and publication bias assessments will be performed. Evidence certainty will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Confidence in Network Meta-Analysis (CINeMA) framework.Ethics and dissemination As only published data will be used, ethical approval is not required. Results will be disseminated via peer-reviewed publication and conference presentations.PROSPERO registration number CRD420251053697.

BACKGROUND:The healing rate after treatment in patients with high anal fistula (HAF) remains low. In individuals with HAF, the loose combined cutting seton (LCCS) technique has shown promising effectiveness, demonstrating a high cure rate, low incidence of incontinence and reduced pain levels. OBJECTIVES:To assess the long-term efficacy and safety of LCCS technique in patients with HAF. MATERIAL AND METHODS:The LCCS procedure was conducted in patients with HAF between December 2020 and February 2022. All participants were followed up for 12 months. The primary outcome was fistula healing, while secondary outcomes included fistula recurrence, visual analogue scale (VAS) pain score, severity of fecal incontinence, and quality of life. RESULTS:A total of 132 patients with HAF were included in the final analysis, with a mean follow-up duration of 17.0 ±3.8 months. At the 12-month follow-up, 130 patients (98.5%) achieved fistula healing. Among them, 103 patients who received primary HAF treatment at our center fully recovered, while 27 of 29 patients previously treated unsuccessfully at other hospitals achieved healing within 12 months, corresponding to a 93.1% success rate. Ninety patients (68.2%) reported no fecal incontinence at follow-up (Wexner Continence Grading Scale (WCGS) score = 0), and 42 patients had a WCGS score of 1. The LCCS procedure was associated with a persistently low risk of postoperative perianal discomfort, with 127 patients (96.2%) scoring 0 and only 5 (3.8%) scoring 1 on the VAS. CONCLUSIONS:The LCCS technique is a safe and effective treatment for patients with HAF.

To evaluate the total societal costs of postoperative antibiotic use compared to non-use in patients undergoing surgery for high horseshoe anal fistula (HHAF), based on a randomized controlled trial. We conducted a single-blinded randomized controlled trial in 90 patients with HHAF treated using a standardized loose combined cutting seton (LCCS) procedure at the Department of Colorectal Surgery, China-Japan Friendship Hospital, between January and October 2023. Participants were randomly assigned to either a postoperative Antibiotic group or a No Antibiotic groups. The primary outcome was total societal cost. Clinical outcomes, including wound healing time and early recurrence, were assessed as secondary measures A societal cost-minimization analysis (CMA) was performed, encompassing direct medical costs, outpatient visit costs, and indirect costs due to lost productivity. Patient follow-up was completed by December 2024. Ninety patients were randomized equally (45 per group) with comparable baseline data. The Antibiotic group showed significantly higher hospitalization costs (¥13,202 ± 3,054 vs. ¥9,322 ± 1,205; p < 0.001) and longer stays (12.5 ± 5.8 vs. 7.9 ± 2.4 days; p < 0.001), without differences in wound healing (p = 0.490). Regression confirmed that both incision number (β = 1735.18, p = 0.020) and antibiotic use (β = 3287.06, p < 0.001) independently increased cost, with a significant interaction (β = 3641.00, p = 0.010). Antibiotic use also led to more outpatient visits (5.25 vs. 2.75; p = 0.013) and higher total societal costs (¥9,802 vs. ¥7,931; p = 0.014). Sensitivity analyses under multiple scenarios consistently confirmed higher overall costs in the Antibiotic group. Routine postoperative antibiotics showed no significant additional clinical benefit in terms of wound healing or recurrence in HHAF patients treated with LCCS, yet significantly increase societal costs and postoperative burdens. A selective, evidence-based approach to antibiotic use should be adopted in the surgical management of complex anal fistulas. This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400093477) on December 5, 2024, after the enrollment of participants began in January 2023. The retrospective registration is in accordance with the journal’s editorial policy for studies involving healthcare interventions in human participants.

ObjectiveThe epidemiological profile of anal fistula and anorectal abscess has not been well studied. Based on the results of a retrospective cross-sectional survey, we aimed to investigate the potential influential factors associated with anal fistula and anorectal abscess.MethodsWe conducted a retrospective analysis of outpatients who visited the proctology department at China-Japan Friendship Hospital between January 2017 and May 2022. A comprehensive questionnaire was designed to collect potential influential factors, and according to formal anorectal examination and the corresponding diagnostic criteria, all the participants were divided into patients with anal fistula or perianal abscess and healthy control group. Multiple logistic regression was used to identify factors in significant association with anal fistula and perianal abscess. Additionally, we combined restricted cubic spline regression to examine the dose-response relationship between factors and the risk of developing anal fistula or anorectal abscess.ResultsThe present study included 1,223 participants, including 1,018 males and 206 females, with 275 anal fistulas, 184 anorectal abscesses, and 765 healthy controls. We found no statistically significant differences between patients and controls in basic information and preoperative assessment of life factors, except for body mass index. It was indicated that people with overweight or obesity were more prone to anal fistula (OR overweight = 1.35, 95% CI: 1.00–1.82, P = 0.047; OR obesity = 3.44, 95% CI: 2.26–5.26, P < 0.001) or anorectal abscess (OR overweight = 1.41, 95% CI: 1.00–1.99, P = 0.05; OR obesity: 2.24, 95% CI: 1.37–3.67, P = 0.001) than normal-weight individuals. The dose-response research indicated the J-shaped trend between the ascending BMI levels and the higher risk of suffering from anal fistula and anorectal abscess.ConclusionsOur findings indicate that overweight and obesity are risk factors for anal fistula and anorectal abscess, which plays a role in the prevention of anorectal diseases. This provides some theoretical basis for clinicians to provide health education to their patients.

Background:Anal fistula is an anorectal infectious disease caused by a perianal abscess or perianal disease. Accurate anorectal examinations are of great significance. The two-finger digital rectal examination (TF-DRE) has been used in clinical practice, with a lack of comprehensive research on the value of the TF-DRE in the diagnosis of anal fistula. This study will compare the difference in the diagnostic value of the TF-DRE, traditional digital rectal examination (DRE), and anorectal ultrasonography in the diagnosis of anal fistula.Methods:For patients who meet the inclusion criteria, a TF-DRE will be performed to explore the number and location of the external and internal orifices, the number of fistulas, and the relationship between the fistula and the perianal sphincter. A DRE and anorectal ultrasonography will also be performed, and the same data will be recorded. To make a comparison, the final diagnosis results of the clinicians during the operation will be taken as the gold standard, the accuracy of the TF-DRE in diagnosing anal fistula will be calculated, and the significance of the TF-DRE in the preoperative diagnosis of anal fistula will be studied and analyzed. All the statistical results will be analyzed using SPSS22.0 (IBM, USA), and a P value <0.05 will be considered statistically significant.Discussion:The research protocol details the advantages of the TF-DRE compared to the DRE and anorectal ultrasonography in the diagnosis of anal fistula. This study will provide clinical evidence of the diagnostic value of the TF-DRE in the diagnosis of anal fistula. Currently, there is a lack of high-quality research using scientific methods on this innovative anorectal examination method. This study will provide rigorously designed clinical evidence on the TF-DRE.Registration:Chinese Clinical Trials Registry ChiCTR2100045450.

Purpose Anal fistula is an anorectal infectious disease caused by perianal abscess or perianal disease. Surgery is the main treatment method for anal fistula. Accurate anorectal examination is of great significance to reduce the missed diagnosis rate of anal fistula, especially the misdiagnosis of anal fistula with no clear external opening. Two-Fingers digital rectal examination (TF-DRE) is a method improved by Professor Zheng Lihua on the basis of traditional digital anus examination. It has been used since 2012 and has accumulated a lot of clinical experience. However, there is a lack of comprehensive research on the value of TF-DRE for the diagnosis of anal fistula. The main purpose of this study is to compare the difference in the diagnostic value of TF-DRE, traditional digital rectal examination, and anorectal ultrasonography in the diagnosis of anal fistula. Methods For patients who met the inclusion criteria, TF-DRE was performed to explore the number and location of the external orifice, internal orifice, the number of fistula and the relationship with the perianal sphincter, as well as the data recorded by digital rectal examination and anorectal ultrasonography To make a comparison, the final diagnosis results from clinicians during the operation was taken as the gold standard, the diagnostic accuracy of TF-DRE for anal fistula is calculated, and the significance of TF-DRE in the preoperative diagnosis of anal fistula is studied and analyzed. All statistical results were analyzed using SPSS22.0, and P < 0.05 indicated that the difference was statistically significant. Conclusion The research protocol details the advantages of TF-DRE compared with digital rectal examination and anorectal ultrasonography in the diagnosis of anal fistula, and provides clinical evidence for the diagnostic value of TF-DRE in anal fistula. As an innovative anorectal examination method, there is still a lack of high-quality research using scientific methods in the current literature. This study will provide rigorously designed clinical evidence for TF-DRE.

目的 通过对外院术后复发的高位肛瘘患者进行再次手术,观察手术疗效,分析并归纳手术失败原因,旨在降低高位肛瘘复发率.方法 回顾2020年1月至2020年12月中日友好医院收治的外院术后复发的22例高位肛瘘患者临床资料,随访术后6、12个月的复发率、疼痛评分、肛门失禁WEXNER评分等临床疗效,分析高位肛瘘手术失败原因.结果 高位肛瘘手术失败的主要原因是内口遗漏11例(50.00％),其次为内口未完全处理合并瘘管未完全处理7例(31.82％),此外还有瘘管遗漏2例(9.09％),内口遗漏合并瘘管遗漏1例(4.55％),内口遗漏合并异物残留1例(4.55％).本院治愈率为100％.术后3、6、12个月的复发率为0.术后12个月疼痛评分小于术后6个月,差异有显著性(P<0.05);术后6、12个月肛门功能差异无显著性(P>0.05).术后6、12个月,肛门对成形大便的控制能力可,均未出现固体大便失禁,控制液体和气体的能力稍差,术后12个月对液体或稀便的控制能力优于术后6个月,差异有显著性(P<0.05);术后6个月与术后12个月对气体的控制方面差异无显著性(P>0.05).结论 高位肛瘘手术失败常见原因是肛瘘内口及瘘管的遗漏和/或未完全处理、创口引流不畅、异物残留等,选择合适的手术方式,正确有效地处理肛瘘内口及瘘管,确保术后引流通畅,无异物残留,都是临床治疗高位肛瘘过程中必须重视的重要环节.

Background:High perianal abscess is an emergency in the anorectal department. It can result in long-term pain and a huge psychological burden to patients, and seriously affects the quality of life of patients. At present, the effect of antibiotics alone for high perianal abscess is not satisfactory. Loose combined cutting seton (LCCS) can effectively treat high anal fistulas and high perianal abscesses in our clinical practice, but there is no sufficient evidence for its effectiveness in the treatment of high perianal abscesses. The purpose of this study is to observe the effectiveness and safety of LCCS in the treatment of high perianal abscess.Methods:This study is a single-center, prospective, single-blind, randomized, controlled, non-inferiority clinical study. This study will include patients who are diagnosed with high perianal abscesses and hospitalized for surgery in the Department of Proctology in China-Japan Friendship Hospital (enrollment time: from January 2022 through December 2024). Patients in the experimental group will be treated with LCCS, while patients in the control group will be treated with incision and drainage. Follow-ups will be performed at 1, 3, 7, 14, 21, 28, 90, and 180 days after the operation. The main outcome measures are as follows: (I) cure rate; (II) half-year recurrence rate; (III) postoperative pain visual analog scale (VAS) score; (IV) wound healing time; (V) postoperative anal function evaluation by the Wexner scale; (VI) pressure measurement of the anal canal and rectum before and at half a year after surgery; and (VII) the incidence of adverse events.Discussion:This study will assess the effectiveness and safety of LCCS in the treatment of high perianal abscess through a strictly designed randomized controlled study, and provides evidence for treatment in clinical practice, thereby improving the treatment effect and improving patients' quality of life.Trial Registration:Chinese Clinical Trial Registry ChiCTR2100049198.

Background: Surgery is the clinically preferred treatment for high perianal abscesses.Incision and seton drainage improve the cure rate and reduce recurrence.We aimed to systematically evaluate the clinical effect and safety of incision and seton drainage in the treatment of high perianal abscess.Methods: China Knowledge Network (CNKI), WanFang database, VIP database, PubMed, and Cochrane Library were searched and all relevant Chinese and English language documents until July 2021were retrieved.All records that described randomized clinical trials (RCTs) of incision and seton drainage for the treatment of high perianal abscess were eligible.Documents that met the inclusion criteria were evaluated for bias using the Cochrane Collaboration Risk Evaluation Standard, and Revman5.4 software was used to analyze the data.Results: Fourteen RCTs were included.The results of nine studies showed that the clinical cure rate of the incision-seton group was higher than that of the incision-drainage group (P<0.05).Seven studies showed that the wound healing time of the incision-seton group was shorter than that of the incision-drainage group (P<0.05).Four studies showed that the visual analogue scale (VAS) score of the incision-seton group was lower than that of the incision-drainage group (P<0.05).Five studies showed that the Wexner score of the incision-seton group was lower than that of the incision-drainage group (P<0.05).Six studies showed that the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group (P<0.05).Six studies demonstrated that the recurrence rate of abscess in the incision-seton group was lower than that in the incision-drainage group (P<0.05).Seven studies showed that the incidence of adverse events in the incision-seton group was lower than that in the incision-drainage group (P<0.05).Five studies demonstrated that the length of stay in the incision-seton group was shorter than that of the incisiondrainage group (P<0.05).Discussion: The choice of surgical methods in clinical research has always been controversial.The incision-seton method can effectively and safely treat high perianal abscess.However, the results of this meta-analysis still leave some gaps in the evidence.More large-sample, high-quality, and multi-center RCTs are needed.

目的 探讨采用低纤维饮食联合亚甲蓝肛门注射法建立功能性排便障碍(function defecation disorder,FDD)动物模型.方法 低纤维饮食联合局部亚甲蓝肛门注射法建立FDD动物模型,通过对大鼠粪便性状、粪便质量、胃肠传输功能、排便功能、大鼠行为学、结肠及直肠组织形态学、血清及直肠组织中脑肠肽含量进行观察,以评估FDD模型构建情况.结果 亚甲蓝各剂量组粪便干硬,呈黑褐色,结、直肠固有层可见大量的炎性细胞浸润,伴见血管扩张,球囊排出时间延长,肛管直肠静息压降低,开臂滞留时间百分比(OT％)及开臂进入次数百分比(OE％)降低,血清及直肠组织中脑肠肽含量水平异常,胃肠传输功能无明显改变.结论 低纤维饮食联合亚甲蓝肛门注射法建立的大鼠动物模型具有FDD的病理特征,可作为一个较理想的动物模型进一步用于药物治疗学及发病机制的研究.

BACKGROUND High anal fistula (HAF) is a refractory infectious disease. Surgery is the most effective way to treat HAF. Dressing change is an indispensable part of the rehabilitation process after surgery. The purpose of this study is to provide feasibility and evidence of safety for the implementation of a simplified dressing change after loose combined cutting seton (LCCS) surgery and to offer a better method for clinical treatment and postoperative rehabilitation of HAF. METHODS In this single-blind randomized controlled trial, 76 patients diagnosed with HAF will be randomly divided into two groups: the simplified dressing change group (n=38) or the traditional debridement and dressing change group (n=38). Compared with traditional debridement and dressing change, simplified dressing change was conducted without mechanical debridement and disinfection. All patients were treated surgically with the LCCS and dressing change. Postoperative follow-up will be carried out on the 3rd, 7th, 14th, 21st, and 180th day after the operation. The primary outcomes will be: complete healing rate of wound and fistula, long-term recurrence rate, poor wound healing rate, and complete wound healing time. The following secondary outcomes will be evaluated: postoperative pain using a visual analogue scale (VAS) score, wound secretions, edema, granulation shape, depth of wound, duration of each dressing change, and incidence of adverse events. DISCUSSION Dressing change after HAF surgery is a necessary stage of recovery after anorectal surgery. Effective dressing change can reduce false healing and increase the cure rate. However, traditional dressing change takes a long time, and the patient endures severe pain. We have found that the dressing change process can be simplified in the clinic for patients treated with LCCS. In particular, simplification of the dressing change process may be related to the unobstructed drainage provided by the combination of LCCS and the separation of the dotted line. We will treat HAF using LCCS and compare the simplified dressing change method after the operation with traditional routine debridement and dressing change to demonstrate whether the simplified dressing change can be used in patients with HAF treated with LCCS. TRIAL REGISTRATION ChiCTR2100047312.

Granular cell tumors (GCTs) are rare submucosal neoplasms, with tumors in the oral mucosa accounting for about a third of all cases. In contrast, GCT is a rare anal neoplasm, with fewer than 30 cases of perianal GCT reported in the literature. We report the case of a 36-year-old woman with a perianal lump with no obvious local lesion as the main clinical complaint. The tumor was completely resected and histologically confirmed as a GCT. The patient remained under continuous follow-up. GCT is difficult for surgeons and pathologists to diagnose, and biopsy and immunohistochemical analysis are prerequisites for an accurate diagnosis. An integrated understanding of GCT in terms of its differential diagnosis will contribute to better identification and more appropriate treatment of this disease.

BACKGROUND:High anal fistula (HAF) treatment is more complicated than low anal fistula treatment. Improper treatment can easily affect anal function. The main treatment of HAF is surgery; however, external medicine and systemic medicine may also be used as adjuvant treatments. This study used bibliometric methods to analyze the relevant literature and provide a rough outline of the current status of HAF research.METHODS:A subject word-search strategy was used to retrieve HAF-related documents from the Science Citation Index Expanded (SCI-E) database. CiteSpace software was used to analyze the exported raw data files, and draw a visual map, and BUSRT was used to detect and analyze the usage of keywords.RESULTS:A total of 1,020 documents were retrieved using "high anal fistula" as the search term, and the number of documents generally shows an increasing trend over time. These papers were mainly published in developed countries, such as Europe and the United States (US). The US is the country that has carried out the most relevant cooperative research; however, there is a lack of cooperation among a large number of authors. The keyword analysis showed that the current research focus is the treatment of HAF, while research on the prevention of HAF is largely lacking.CONCLUSIONS:More international multi-center clinical research studies on HAF should be conducted, and research on HAF prevention should also be strengthened.

BACKGROUND:Suprasphincteric anal fistula is a type of high anal fistula. The traditional method of cutting seton (CS) has a high recurrence rate and can cause severe damage to the anal sphincter and anal incontinence. The combination of loose and cutting seton is a novel method developed on the basis of the traditional cutting seton technique, and has already been adopted by some clinicians in China. This study will examine the effectiveness and safety of the loose combined cutting seton (LCCS) technique for the treatment of suprasphincteric anal fistulas.METHODS:This is a single-blinded randomized controlled trial conducted in the Anorectal Department of the China-Japan Friendship Hospital. A total of 76 patients diagnosed with suprasphincteric anal fistula will be randomly divided into two groups. One group will be treated with the LCCS method (the LCCS group; n=38) and the other group will be treated with the traditional CS method (the CS group; n=38). There will be 3 intervention periods, including the screening period, the surgical treatment period, and the postoperative follow-up period. Postoperative follow-up will be carried out on days 3, 5, 7, 14, 21, 28, 90, 180, and 365 after the operation. The main outcome measures are the complete cure rate of postoperative wounds and fistulas, the long-term recurrence rate, and evaluation of postoperative anal function (Wexner anal function assessment and anal function questionnaire). The secondary outcomes are the visual analogue scale (VAS) score for postoperative pain, pressure measurements of the anal canal and rectum before and after treatment, and the incidence of adverse events. All statistical results will be analyzed using the SPSS software 21.0 version. P values <0.05 will be considered statistically significant.DISCUSSION:This research introduces a novel method for the treatment of suprasphincteric anal fistulas. The LCCS method will be compared with the traditional CS method in terms of safety and efficacy. If the LCCS technique is a safe and effective treatment for suprasphincteric anal fistula, its clinical application should be promoted.TRIAL REGISTRATION:ClinicalTrials, Registration number: ChiCTR2100045450; pre-results.PROTOCOL VERSION:2020-09-10 1.0 version.

目的 观察降钙素基因相关肽(CGRP)和胆碱酯酶(AchE)在功能性排便障碍(FDD)大鼠模型结直肠中的表达,探讨FDD发生的可能机制.方法 SD大鼠随机分为空白对照组、低纤维饮食组、利多卡因组、模型组,空白对照组予以普通饲料饲养,其余组采用低纤维饲料饲养;利多卡因组及模型组于饲养第63天,分别予以2 mL 2％利多卡因、0.1％亚甲蓝注射液肛周及直肠周围间隙注射1次.观察大鼠粪便性状、质量及排便功能;酶联免疫吸附试验(ELISA)检测结、直肠中AchE含量;实时荧光定量PCR(qPCR)检测结、直肠中CGRP mRNA的表达,免疫组化及Western blot法检测CGRP蛋白的表达.结果 肛周注射后,与空白对照组相比,低纤维饮食组和利多卡因组的粪便干结、呈深褐色,模型组的粪便干硬、呈黑褐色,粪便质量均下降.模型组模拟球囊排出时间较其余组长,肛管直肠静息压较其余组低;结肠及直肠中AchE含量较空白对照组和低纤维饮食组低(P<0.05);结肠中CGRP mRNA表达水平高于空白对照组,与低纤维饮食组和利多卡因组差异无统计学意义;直肠中CGRP mRNA表达水平较其余组高;免疫组化检测CGRP蛋白表达高于其余组(P<0.05);而Western blot检测各组CGRP蛋白表达差异均无统计学意义.结论 大鼠结直肠中CGRP及AchE的表达异常可能与FDD发生的神经机制有关.

目的 比较虚实结合挂线疗法与传统弹力线挂线疗法治疗肛门括约肌上瘘的临床疗效.方法 选取2016年1月至2017年1月于中日友好医院肛肠科诊断并住院手术治疗的肛门括约肌上瘘患者40例,采用随机数字表法分为治疗组(虚实结合挂线法)和对照组(传统弹力线挂线法)各20例.治疗组术中予深部括约肌实挂线,结扎线松动时不紧线,采用丝线虚挂引流,待脓腔肉芽组织填充后再拆线;对照组术中内口上方括约肌予弹力线实挂线,挂线后每1周紧线1次,直至所挂的括约肌完全切断.术后观察两组疼痛、创面愈合、肛门症状及复发情况,并做定期随访.结果 治疗组治愈18例,显效2例,治愈率90％;对照组治愈17例,显效2例,有效1例,治愈率85％;两组差异无显著性(χ2=3.031,P=0.420);随访24个月,治疗组均无复发,对照组12、24个月各复发1例.两组患者术后肛门症状评分随时间推移总体呈现下降趋势,术后3个月,治疗组肛门坠胀、肛门疼痛、肛门不适感评分低于对照组,差异有显著性(P＜0.05);术后6个月,治疗组肛门失禁、肛门瘙痒及肛门不适感评分低于对照组,差异有显著性(P＜0.05);术后12个月,治疗组肛门失禁、肛门坠胀及便急感评分低于对照组,差异有显著性(P＜0.05);术后24个月,治疗组肛门失禁、脱出、肛门坠胀、肛门疼痛评分低于对照组,差异有显著性(P＜0.05).治疗组未出现括约肌完全切断情况,对照组括约肌完全切断时间6～29d,平均(13.73±4.88)d,其中术后第1周完全离断4例,术后第2周9例,术后3周5例,术后第4周1例,术后第5周1例.两组患者术后疼痛评分总体呈现下降趋势,其中两组术后3d疼痛评分程度相当,差异无显著性(P＞0.05);在术后7、14d,治疗组疼痛评分显著低于对照组,差异有显著性(P＜0.05);术后28、56d,两组疼痛情况差异无显著性(P＞0.05);两组术后愈合时间24～37d,平均(27.87±4.85)d;对照组23～49d,平均(33.21±5.34)d,治疗组平均愈合时间显著低于对照组,差异有显著性(P＜0.05).两组术后创面面积都趋于减小,在术后7、14、28d,治疗组创面面积显著小于对照组,差异有显著性(P＜0.05),在术后56d,两组患者创面面积差异无显著性(P＞0.05).结论 虚实结合挂线法治疗肛门括约肌上瘘较传统挂线法能更好地保护肛直环,保护肛门括约肌功能,减少了肛门不全失禁的发生,同时降低术后疼痛,缩短愈合时间.

目的 研究豚鼠结肠黑变病模型(MC)结肠组织中原癌基因c-myc、K-ras和p53的表达相对正常组织的差异,探讨MC与结肠癌变的关系.方法 采用大黄灌胃法建立豚鼠MC模型,逆转录实时荧光定量聚合酶链反应(PCR)法检测豚鼠结肠组织中c-myc、K-ras和p53 mRNA的表达水平,比较模型组和正常对照组豚鼠结肠组织中c-myc、K-ras、p53 mRNA的相对表达量.结果 模型组豚鼠结肠组织中c-myc mRNA的相对表达量明显高于正常对照组(P﹤0.01);模型组豚鼠结肠组织中K-ras mRNA的相对表达量略高于正常对照组,p53 mRNA的相对表达量略低于正常对照组,但差异均无统计学意义(P﹥0.05).结论 MC豚鼠结肠组织中原癌基因c-myc的表达明显上调,提示MC具有向结肠癌演变的潜能.

目的 观察穴位埋线联合生物反馈疗法治疗功能性排便障碍(FDD)的临床疗效及对患者心理状况的影响.方法 60例FDD患者随机分成治疗组和对照组各30例.两组患者均接受生物反馈治疗,治疗组在此基础上加用穴位埋线治疗,两组均治疗8周后观察患者临床有效率,两组患者治疗前后进行主要症状评分、生存质量评分,检测肛管静息压(ARP)、肛管收缩压(AMCP)、排便压(DP)及肛门外括约肌收缩持续时间(ALCT),比较焦虑自评量表(SAS)、抑郁自评量表(SDS)评分.结果 治疗组临床有效率(92.86％)明显高于对照组(69.23％,P＜0.05).治疗后两组主要症状评分、DP均较治疗前明显降低,ALCT明显升高(P＜0.05),其中治疗后排便费力感,排便时间,下坠、不尽、胀感及腹胀评分治疗组明显低于对照组(P＜0.05).治疗组生存质量评分,SAS、SDS评分及对照组SAS评分明显低于治疗前(P＜0.05).治疗后治疗组生存质量评分、SDS评分、AMCP、DP明显低于对照组,ALCT明显升高(P＜0.05).结论 穴位埋线联合生物反馈疗法能够更有效地从临床症状、肛管直肠压力及心理状态等方面提高FDD患者的临床疗效.