Clinical Study on the Treatment of Low Anal Fistula in Infants and Young Children by Anal Gland Excision and Virtual Hanging Procedure

Objective:To compare the efficacy of anal adenectomy with virtual hanging wire and anal fistulotomy in the treatment of low anal fistula in infants and children.Methods:60 children with low anal fistula who were admitted to our hospital from October 2021 to March 2022 and met the inclusion criteria were randomly divided into two groups of 30 cases each;the treatment group was treated with anal adenectomy and virtual hanging wire surgery,and the control group was treated with anal fistula resection.The clinical efficacy after treatment was compared.Results:The total effective rate of both groups was 96.67%and the difference between the two groups was not statistically significant(P>0.05).The postoperative pain score of the treatment group was lower than that of the control group(P<0.05).The length of hospitalization and healing time of the treatment group was lower than that of the control group(P<0.05).The anal function of the patients in both groups was normal,and there was no adverse reaction.Conclusion:Anal gland excision and virtual hanging surgery for the treatment of low anal fistula in infants and children have the advantages of mild pain,reduced length of hospitalization,short healing time,and better patient experience as compared to anal fistula excision.

Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis

BACKGROUND The neutrophil-to-lymphocyte ratio(NLR),a composite inflammatory biomarker,is associated with the prognosis in patients with colorectal tumors.However,whether the NLR can be used as a predictor of symptomatic postoperative ana-stomotic leakage(AL)in elderly patients with colon cancer is unclear.AIM To assess the role of the NLR in predicting the occurrence of symptomatic AL after surgery in elderly patients with colon cancer.METHODS Data from elderly colon cancer patients who underwent elective radical colectomy with anastomosis at three centers between 2018 and 2022 were retrospectively analyzed.Receiver operating characteristic curve analysis was performed to determine the best predictive cutoff value for the NLR.Twenty-two covariates were matched using a 1:1 propensity score matching method,and univariate and multivariate logistic regression analyses were used to determine risk factors for the development of postoperative AL.RESULTS Of the 577 patients included,36(6.2%)had symptomatic AL.The optimal cutoff value of the NLR for predicting AL was 2.66.After propensity score matching,the incidence of AL was significantly greater in the≥2.66 NLR subgroup than in the<2.66 NLR subgroup(11.5%vs 2.5%;P=0.012).Univariate logistic regression analysis revealed statistically significant correlations between blood transfusion intraoperatively and within 2 d postoper-atively,preoperative albumin concentration,preoperative prognostic nutritional index,and preoperative NLR and AL occurrence(P<0.05);multivariate logistic regression analysis revealed that an NLR≥2.66[odds ratio(OR)=5.51;95%confidence interval(CI):1.50-20.26;P=0.010]and blood transfusion intraoperatively and within 2 d postoperatively(OR=2.52;95%CI:0.88-7.25;P=0.049)were risk factors for the occurrence of symptomatic AL.CONCLUSION A preoperative NLR≥2.66 and blood transfusion intraoperatively and within 2 d postoperatively are associated with a higher incidence of postoperative symptomatic AL in elderly patients with colon cancer.The preoperative NLR has predictive value for postoperative symptomatic AL after elective surgery in elderly patients with colon cancer.

Non-invasive measurement of pan-colonic pressure over a whole digestive cycle:Clinical applications of a capsule-style manometric system

AIM： To study the prolonged colonic motility under normal conditions with a novel capsule-style microsystem and to assess its clinical significance. METHODS： A single use telemetry capsule （10 mm in diameter, 20 mm in length） embedded with a pressure sensor was ingested by the subjects. The sensor is capable of transmitting colonic pressure wirelessly for more than 130 h. The time of capsule entering the segmental colon was detected by ultrasound. The ultrasonic electrodes were mounted on the surface of the ileocecum and navel and at the junction of the left and rectosigmoid colon of the subjects in sequence, which were identified by abdominal X-rays with radiopaque markers. To verify the accuracy and reliability of ultrasonic detection of telemetry capsules at key points of colon, the segmental colonic transit time was simultaneously recorded by using radiopaque markers. RESULTS： The signal lamp showed that all recorders could receive the radio signal transmitted by the telemetry capsule. The X-rays showed that all telemetry capsules were detected successfully when they were passing through the key points of colon. There was a significant correlation between the transit results obtained by ultrasonic detection or by radiopaque markers. Colorectal recording was obtained from 20 healthy subjects during 613 h （411 h during waking, 202 h during sleep）. Compared to waking, the number of pressure contractions and the area under pressure contractions were significantly （P 〈 0.05） decreased during sleep （21 ± 5 h^-vs 15 ± 4 h1, 463 ± 54 mmHg·/min vs 342 ± 45 mmHg·/min）. The colonic motility exhibited significant regional variations both in the circadian behavior and in response to waking and meal. CONCLUSION： The capsule-style micro-system is reliable and noninvasive, and may represent a useful tool for the study of physiology and pathology of colonic motor disorders.

Study on the effect and mechanism of Yanghe decoction Huacai(阳和汤化裁) on tissue repair of Yin syndrome after anal fistula surgery

OBJECTIVE:To observe the clinical efficacy and safety of Yanghe decoction Huacai(阳和汤化裁)for the repair of Yin syndrome wounds with slow-healing after anal fistula surgery.METHODS:A total of 120 patients with slow-healing negative wounds with after low-grade anal fistula surgery who met the inclusion criteria were divided into a treatment group and a control group based on a random number table method,with 60 patients in the treatment group and 60 patients in the control group.The treatment group was given Yanghe decoction Huacai in combination with routine treatment;the control group was only given routine treatment,in which the wound surface was disinfected with iodine,and then covered with sterile gauze.The course of treatment in both groups was 10 d.After treatment,the wound secretion score,wound granulation tissue score,the expression levels of basic fibroblast growth factor(bFGF),transforming growth factorβ1(TGF-β1),and epidermal growth factor(EGF)in the wound,wound healing time and clinical efficacy were compared.RESULTS:There was no significant difference in age or gender between the two groups(P>0.05).On the 10th and 15th days after the surgery,the wound secretion scores were higher in the treatment group than in the control group(P<0.01).Comparing the two groups at the 10th and 15th day after surgery,the granulation tissue growth scores in the treatment group were better than the in control group(P<0.01).On the 10th and 15th day after operation,the expression levels of bFGF,TGF-β1 and EGF factors in the treatment group were stronger than those in the control group.The healing time of the wounds in the treatment group was significantly shorter than in the control group(P<0.01).The clinical efficacy of the two groups after treatment was compared,and the overall efficacy of the treatment group was significantly higher than that of the control group(P<0.01).CONCLUSIONS:Yanghe decoction Huacai have significant efficacy in the treatment of slow-healing wounds with Yin syndrome after anal fistula surgery.It improves wound secretions,promotes the growth of wound granulation tissue,and shortens wound healing time.Its mechanism of action may be related to the control of wound inflammation.It is related to increasing the expression of bFGF,TGF-β1 and EGF in wound tissue,and promoting wound angiogenesis and fibroblast proliferation.

Metachronous isolated penile metastasis from sigmoid colon adenocarcinoma:A case report

BACKGROUND Sigmoid colon adenocarcinoma has a high incidence among gastrointestinal tumors,and it very rarely metastasizes to the penis.The literature reports that the prognosis after penile metastasis is generally poor,with a median survival of about 9 mo.Metachronous isolated metastasis to the penis originating from sigmoid colon adenocarcinoma has not been reported so far.Here,we report a case of sigmoid colon adenocarcinoma with isolated penile metastasis occurring 2 years after surgery.The mass was pathologically confirmed as metastatic adenocarcinoma,and oral chemotherapy with capecitabine was given after surgery.The tumor did not recur during the 2-year follow-up period.CASE SUMMARY A 79-year-old man presented to the urology department with"a mass located at the root of the penis since 1 mo".Enhanced computed tomography(CT)examination suggested a 12 mm×10 mm×9 mm nodule at the root of the right penile corpus cavernosum.Cranial,pulmonary,and abdominal CT;and bone scan did not show any tumorigenic lesions.The carcinoembryonic antigen(CEA)level was slightly elevated(6.01 ng/mL,reference value 0-5 ng/mL).The patient had undergone laparoscopic radical sigmoidectomy for sigmoid colon cancer 2 years ago.The postoperative pathology showed moderately differentiated adenocarcinoma of the sigmoid colon,and the stage was PT2N0M0.The penile mass was removed under general anesthesia.The postoperative pathology showed adenocarcinoma,and immunohistochemistry showed CDX2(+),CK20(+),and Villin(+).Based on the medical history,he was diagnosed with penile metastasis from sigmoid colon adenocarcinoma.The CEA level returned to normal(3.34 ng/mL)4 d after surgery.Oral chemotherapy with capecitabine was given subsequently,and tumor recurrence was not found during the 2-year follow-up period.CONCLUSION To our knowledge,this is a rare case of metachronous isolated penile metastasis from sigmoid colon adenocarcinoma.The penis is a potential site of metastasis of colon adenocarcinoma,and the possibility of metastasis should be considered in patients with a history of colon cancer who present with a penile mass.Solitary penile metastasis can be removed surgically,in combination with chemotherapy,and it may have good long-term outcomes.