Gastrointestinal dysfunction is associated with mortality in severe burn patients:a 10-year retrospective observational study from South China

Background:Data on severe and extensive burns in China are limited,as is data on the prevalence of a range of related gastrointestinal(GI)disorders[such as stress ulcers,delayed defecation,opioid-related bowel immotility,and abdominal compartment syndrome(ACS)].We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality.Methods:This retrospective analysis was conducted on patients with severe[≥20%total burn surface area(TBSA)]and extensive(>50%TBSA or>25%full-thickness TBSA)burns admitted to three university teaching institutions in China between January 1,2011 and December 31,2020.Both 30-and 90-day mortality were assessed by collating demographic data,burn causes,admission TBSA,%full-thickness TBSA,Baux score,Abbreviated Burn Severity Index(ABSI)score,and Sequential Organ Failure Assessment(SOFA)score,shock at admission and the presence of an inhalation injury.GI dysfunction included abdominal distension,nausea/vomiting,diarrhoea/constipation,GI ulcer/haemorrhage,paralytic ileus,feeding intolerance and ACS.Surgeries,length of intensive care unit(ICU)stay,pain control[in morphine milligram equivalents(MME)]and overall length of hospital stay(LOHS)were recorded.Results:We analyzed 328 patients[75.6%male,mean age:(41.6±13.6)years]with a median TBSA of 62.0%(41.0%–80.0%);256(78.0%)patients presented with extensive burns.The 90-day mortality was 23.2%(76/328),with 64(84.2%)of these deaths occurring within 30 d and 25(32.9%)occurring within 7 d.GI dysfunction was experienced by 45.4%of patients and had a significant effect on 90-day mortality[odds ratio(OR)=14.070,95%confidence interval(CI)5.886–38.290,P<0.001].Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and%full-thickness TBSA.Overall,88.2%(67/76)of deceased patients had GI dysfunction[hazard ratio(HR)for death of GI dysfunction=5.951],with a survival advantage for functional disorders(diarrhoea,constipation,or nausea/vomiting)over GI ulcer/haemorrhage(P<0.001).Conclusion:Patients with severe burns have an unfavourable prognosis,as nearly one-fifth died within 90 d.Half of our patients had comorbidities related to GI dysfunction,among which GI ulcers and haemorrhages were independently correlated with 90-day mortality.More attention should be given to severe burn patients with GI dysfunction.

Stapled transperineal repair for low-and mid-level rectovaginal fistulas:A 5-year experience and comparison with sutured repair

BACKGROUND Currently,rectovaginal fistula(RVF)continues to be a surgical challenge worldwide,with a relatively low healing rate.Unclosed intermittent suture and poor suture materials may be the main reasons for this.AIM To evaluate the efficacy and safety of stapled transperineal repair in treating RVF.METHODS This was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China).Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included.Among the 82 total patients,37 underwent repair with direct suturing and 45 underwent repair with stapling.Patient demographic data,Wexner faecal incontinence score,and operative data were analyzed.Recurrence rate and associated risk factors were assessed.RESULTS The direct suture and stapled repair groups showed similar clinical characteristics for aetiology,surgical history,fistula features,and perioperative Wexner score.The stapled repair group did not show superior results over the suture repair group in regard to operative time,blood loss,and hospital stay.However,the stapled repair group showed better postoperative Wexner score(1.04±1.89 vs 2.73±3.75,P=0.021),less intercourse pain(1/45 vs 17/37,P=0.045),and lower recurrence rate(6/45 vs 17/37,P=0.001).There was no protective effect from previous repair history,smaller diameter of fistula(<0.5 cm),better control of defecation(Wexner<10),or stapled repair.Direct suture repair and preoperative high Wexner score(>10)were risk factors for fistula recurrence.Furthermore,stapled repair gave better efficacy in treating complex RVFs(i.e.,multiple transperineal repair history,mid-level fistula position,and poor control of defecation).CONCLUSION Stapled transperineal repair is advantageous for management of RVF,providing a high primary healing rate and low recurrence rate.

肠道Cajal细胞数量对行吻合器经肛直肠切除术(STARR)的梗阻性排便综合征患者的预后和预测价值

目的:本研究旨在评估吻合器经肛直肠切除术(STARR)治疗梗阻性排便综合征(ODS)的功能学结果,并探讨肠道Cajal细胞(ICC)数量与STARR手术疗效的关系。方法:将50例行STARR手术的ODS患者的全层直肠标本,采用免疫组化方法检测直肠样本中的ICC细胞数量,并取20例来自直肠癌癌旁组织的直肠样本作为对照。收集排粪造影和直肠测压的功能学参数。结果:无论是在黏膜下层表面(SM)、肌纤维(IM)还是环形肌与纵形肌的肌间隙(MY)中,与对照标本相比,ODS直肠标本中的ICC细胞数量均显著减少(均P<0.05)。术前克利夫兰便秘评分(CCS)为24.2˘64.1,术后1、2、3、4和5年CCS评分均显著下降(均P<0.05)。术后3年,58.3%(28/48)的患者疗效满意(CCA≤10)。单因素分析显示,术前需手辅助排便(P=0.017)、ICC-MY细胞数量减少(P=0.067)、直肠感觉阈值增加(P=0.073)的ODS患者,术后功能学结果不良。多因素分析证实,ICC-MY细胞数量减少是术后不良功能学结果的独立预测因素(OR=0.097,95%CI:0.012-0.766)。结论:STARR手术治疗ODS总体疗效满意,但随时间推移,肛门功能会有所恶化。直肠标本中ICC细胞数量减少的患者术后肛门功能不良,提示术前对直肠进行全层组织学评估或可预测STARR手术的功能学结局.

起源于肛门直肠的Fournier坏疽患者的临床结局:重点关注会阴区未受感染的坏疽

背景:Fournier坏疽(FG)是一种发生于外生殖器和会阴部的真菌感染。本研究旨在探讨源自肛门直肠、继发于肛瘘和肛周脓肿的FG的临床特征。方法:回顾性收集2013年5月至2017年4月间中山大学附属第六医院和福建中医药大学附属人民医院收治的FG病例,对其临床特征及治疗结局进行分析。结果:60例FG患者纳入研究。最常见的病原微生物是大肠杆菌。影像学和手术探查证实,分别有52例和59例患者病变累及生殖区和直肠周围,但有7例(12%)患者会阴区未被感染。早期彻底清创和应用广谱抗生素治疗效果满意,患者病死率为1.7%。10例患者进行了保护性结肠造口术。无一例患者行睾丸切除术或尿道转流术。结论:原发于肛门直肠区域的FG病情进展迅速,致死率高。肛门直肠的病变可不经会阴组织而直接感染生殖区。要获得满意的治疗效果,必须对坏死组织进行积极的外科清创,但保护性结肠造口则不是必需的。