Gastrointestinal stromal tumors(GIST)are an uncommon group of tumors of mesenchymal origin.GIST of the anal canal is extremely rare.At present,only 10cases of c-kit positive anal GIST have been reported in the literat...Gastrointestinal stromal tumors(GIST)are an uncommon group of tumors of mesenchymal origin.GIST of the anal canal is extremely rare.At present,only 10cases of c-kit positive anal GIST have been reported in the literature.There is no widely accepted treatment approach for this neoplasia.Literature is sparse on imaging evaluation of anal canal GIST,usually described as a lesion in the intersphincteric space.We describe the case of a 73-year-old man with a mass in the anal canal,and no other symptoms.Endoanal ultrasound and magnetic resonance imaging showed a well circumscribed solid nodule in the intersphincteric space.The patient was treated by local excision.Gross pathological examination showed a 7 cm×3.5 cm×3cm mass,and histological examination showed a proliferation of spindle cells,with prominent nuclear palisading.The mitotic count was of 12 mitoses/50 HPF.The tumor was positive for KIT protein,CD34 and vimentin in the majority of cells,and negative for desmin and S100.A diagnosis of GIST,with high risk aggressive behavior was made.An abdomino-perineal resection was discussed,but refused.The follow-up included clinical evaluation and anal ultrasound.After 5 years the patient is well,with maintained continence and no evidence of local recurrence.展开更多
Primary neoplasms arising in the anal canal are relatively unusual.In particular, adenomas and adenocarcinomas are distinctly rare entities in this region.We describe an infiltrating, well-differentiated adenocarcinom...Primary neoplasms arising in the anal canal are relatively unusual.In particular, adenomas and adenocarcinomas are distinctly rare entities in this region.We describe an infiltrating, well-differentiated adenocarcinoma arising in a villous adenoma from the distal anal canal, in an otherwise healthy patient at low risk for gastrointestinal malignancy.This is the case of an octogenarian man with a several year history of hemorrhoids and intermittent rectal bleeding, more recently complaining of continuous hematochezia.Examination revealed a blood-covered pedunculated mass with a long stalk protruding from the anus.The lesion was amputated at the bedside.Microscopic evaluation revealed an infiltrating well-differentiated adenocarcinoma, arising from a villous adenoma.This was further evaluated under anesthesia and complete excision of distal anal tissue was performed.Our report is the f irst describing the possible malignant degeneration of a villous adenoma in the anal canal.展开更多
AIM: To investigate the toxicity and response of intensity-modulated radiotherapy schedule intensified with a simultaneous integrated boost in anal canal cancer.METHODS: From March 2009 to March 2014, we retrospective...AIM: To investigate the toxicity and response of intensity-modulated radiotherapy schedule intensified with a simultaneous integrated boost in anal canal cancer.METHODS: From March 2009 to March 2014, we retrospectively analyzed 41 consecutive patients treated with intensity-modulated radiotherapy(IMRT) and concurrent chemotherapy for anal canal squamous cell carcinoma at our center. Radiotherapy was delivered via simultaneous integrated boost(SIB) technique by helical tomotherapy, and doses were adapted to two clinical target volumes according to the tumor-nodemetastasis(TNM) stage: 50.6 Gy and 41.4 Gy in 23 fractions in T1N0, 52.8 Gy and 43.2 Gy in 24 fractionsin T2N0, and 55 Gy and 45 Gy in 25 fractions in all patients with N positive and/or ≥ T3, respectively, to planning target volumes 1 and 2. The most common chemotherapy regimen was 5-fluorouracil and mitomycin-based. Human papilloma virus(HPV) p16 expression was performed by immunohistochemistry and evaluated in the majority of patients. Acute and late toxicity was scored according to CTCAe v 3.0 and RTOG scales.RESULTS: The median follow-up was 30 mo(range:12-71). Median age was 63 years(range 32-84). The stage of disease was: stage Ⅰ in 2 patients, stage Ⅱin 13 patients, stage ⅢA in 12 patients, and stage ⅢB in 14 patients, respectively. Two patients were known to be HIV positive(4.9%). HPV p16 expression status was positive in 29/34(85.3%) patients. The 4-year progression-free survival and overall survival in HPVpositive patients were 78% and 92%, respectively.Acute grade 3 skin and gastrointestinal toxicities were reported in 5% and 7.3% of patients, respectively;patients' compliance to the treatment was good due to a low occurrence of severe acute toxicity, although treatment interruptions due to toxicity were required in 7.3% of patients. At 6 mo from end of treatment,36/40(90%) patients obtained complete response;during follow-up, 5(13.8%) patients presented with disease progression(local or systemic).CONCLUSION: In our experience, intensified SIBIMRT with chemotherapy is very feasible in clinical practice, with excellent results in terms of overall survival and local control.展开更多
Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of stu...Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classifi cation of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely diffi cult to interpret the results of the various anaplastic procedures de in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.展开更多
BACKGROUND Transanal minimally invasive surgery(TAMIS)is a good choice for resection of rectal neoplasms.Endoscopic mucosal resection(EMR)is also widely used in the treatment of benign rectal tumors such as rectal pol...BACKGROUND Transanal minimally invasive surgery(TAMIS)is a good choice for resection of rectal neoplasms.Endoscopic mucosal resection(EMR)is also widely used in the treatment of benign rectal tumors such as rectal polyps and rectal adenomas.However,no studies have compared the outcome of TAMIS and EMR.AIM To compare the short-term outcomes after TAMIS and EMR for rectal carcinoid and benign tumors(including rectal polyps and adenomas).METHODS From January 2014 to January 2019,44 patients who received TAMIS and 53 patients who received EMR at The Fifth People's Hospital of Shanghai were selected.Primary outcomes(surgical-related)were operating time,blood loss,length of postoperative hospital stay,rate of resection margin involvement and lesion fragmentation rate.The secondary outcomes were complications such as hemorrhage,urinary retention,postoperative infection and reoperation.RESULTS No significant differences were observed in terms of blood loss(12.48±8.00 mL for TAMIS vs 11.45±7.82 mL for EMR,P=0.527)and length of postoperative hospital stay(3.50±1.87 d for TAMIS vs 2.72±1.98 d for EMR,P=0.065)between the two groups.Operating time was significantly shorter for EMR compared with TAMIS(21.19±9.49 min vs 49.95±15.28 min,P=0.001).The lesion fragmentation rate in the EMR group was 22.6%(12/53)and was significantly higher than that(0%,0/44)in the TAMIS group(P=0.001).TAMIS was associated with a higher urinary retention rate(13.6%,6/44 vs 1.9%,1/53 P=0.026)and lower hemorrhage rate(0%,0/44 vs 18.9%,10/53 P=0.002).A significantly higher reoperation rate was observed in the EMR group(9.4%,5/53 vs 0%,0/44 P=0.036).展开更多
AIM: Pelvic magnetic resonance imaging (MRI) and endoanalultrasound which are established imaging methods forperianal inflammatory lesions in patients with Crohn'sdisease require expensive specialized equipments a...AIM: Pelvic magnetic resonance imaging (MRI) and endoanalultrasound which are established imaging methods forperianal inflammatory lesions in patients with Crohn'sdisease require expensive specialized equipments andexpertise. We investigated the feasibility and sensitivity oftranscutaneous perianal ultrasound (PAUS) using regularultrasound probes in the imaging of perianal inflammatorylesions. The sonographic findings were correlated to pelvicMRI-scans.METHODS: We performed PAUS in 25 patients with Crohn'sdisease and clinical signs of perianal inflammatory disease.VCChin a median of 10 d (range 0-75) these patients underwentMRI of the pelvis. Regular convex and linear high resolutionprobes were used for PAUS. The sonographic findings werecorrelated to the MRI findings by blinded investigators.RESULTS: The sonographic investigations were welltolerated by all patients. Fistulae typically presented ashypoechoic tracks. Twenty-nine fistulae were detected in22 patients. Abscesses were detected in 7 patients andpresented as hypo- or anechoic formations. Twenty-six of29 fistulae and 6 of 7 abscesses could be confirmed byMRI. Kappa statistics showed an excellent agreement(kappa>0.83) between the two imaging methods.CONCLUSION: PAUS is a simple, painless, feasible, real-time method that can be performed without specific patientpreparation which is comparable in its sensitivity to pelvicMRI in the detection of perianal fistulae and/or abscesses.PAUS can especially be recommended as a screening toolin acute perianal disorders such as perianal abscess andfor follow-up studies of perianal inflammatory disease.展开更多
BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.The...BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.There are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different severities.AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.METHODS Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared.The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor.The explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point scale.Patients underwent proctologic follow-up examinations one,two,and four weeks after surgery.RESULTS We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;P<0.001).The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied with their quality of life after surgery other than the two who noticed no difference due owing to the fact that they experienced recurrences.CONCLUSION Scar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure.Anoplasty is unavoidable for moderate or severe stenosis,where cicatrized tissue is extensive.展开更多
AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrat...AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus.METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year.RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reductionwith regard to pain and irritation during defection (P= 0.0011),pricking or foreign body sensation in the anus (P = 0.0006) and pruritus or wetness around the anal verge (P = 0.0008).CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.展开更多
AIM To explore the relationship between such a construct and an existing continence score.METHODS A retrospective study of incontinent patients who underwent anal physiology(AP) was performed. AP results and Cleveland...AIM To explore the relationship between such a construct and an existing continence score.METHODS A retrospective study of incontinent patients who underwent anal physiology(AP) was performed. AP results and Cleveland Clinic Continence Scores(CCCS) were extracted. An anal physiology score(APS) was developed using maximum resting pressures(MRP), anal canal length(ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed.RESULTS Of 508(419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mm Hg(SD23.2 mm Hg) for men and 39 mm Hg(19.2 mm Hg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP(P = 0.0002), ACL(P = 0.0006) and pudendal neuropathy(P < 0.0001). The association between APS and CCCS was significant(P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%.CONCLUSION This study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores.展开更多
AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospi...AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively.Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments.RESULTS:Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation.Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5-245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5-27) months. Six patients had a long-term survival.CONCLUSION:Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N2-3 tumors.展开更多
文摘Gastrointestinal stromal tumors(GIST)are an uncommon group of tumors of mesenchymal origin.GIST of the anal canal is extremely rare.At present,only 10cases of c-kit positive anal GIST have been reported in the literature.There is no widely accepted treatment approach for this neoplasia.Literature is sparse on imaging evaluation of anal canal GIST,usually described as a lesion in the intersphincteric space.We describe the case of a 73-year-old man with a mass in the anal canal,and no other symptoms.Endoanal ultrasound and magnetic resonance imaging showed a well circumscribed solid nodule in the intersphincteric space.The patient was treated by local excision.Gross pathological examination showed a 7 cm×3.5 cm×3cm mass,and histological examination showed a proliferation of spindle cells,with prominent nuclear palisading.The mitotic count was of 12 mitoses/50 HPF.The tumor was positive for KIT protein,CD34 and vimentin in the majority of cells,and negative for desmin and S100.A diagnosis of GIST,with high risk aggressive behavior was made.An abdomino-perineal resection was discussed,but refused.The follow-up included clinical evaluation and anal ultrasound.After 5 years the patient is well,with maintained continence and no evidence of local recurrence.
文摘Primary neoplasms arising in the anal canal are relatively unusual.In particular, adenomas and adenocarcinomas are distinctly rare entities in this region.We describe an infiltrating, well-differentiated adenocarcinoma arising in a villous adenoma from the distal anal canal, in an otherwise healthy patient at low risk for gastrointestinal malignancy.This is the case of an octogenarian man with a several year history of hemorrhoids and intermittent rectal bleeding, more recently complaining of continuous hematochezia.Examination revealed a blood-covered pedunculated mass with a long stalk protruding from the anus.The lesion was amputated at the bedside.Microscopic evaluation revealed an infiltrating well-differentiated adenocarcinoma, arising from a villous adenoma.This was further evaluated under anesthesia and complete excision of distal anal tissue was performed.Our report is the f irst describing the possible malignant degeneration of a villous adenoma in the anal canal.
文摘AIM: To investigate the toxicity and response of intensity-modulated radiotherapy schedule intensified with a simultaneous integrated boost in anal canal cancer.METHODS: From March 2009 to March 2014, we retrospectively analyzed 41 consecutive patients treated with intensity-modulated radiotherapy(IMRT) and concurrent chemotherapy for anal canal squamous cell carcinoma at our center. Radiotherapy was delivered via simultaneous integrated boost(SIB) technique by helical tomotherapy, and doses were adapted to two clinical target volumes according to the tumor-nodemetastasis(TNM) stage: 50.6 Gy and 41.4 Gy in 23 fractions in T1N0, 52.8 Gy and 43.2 Gy in 24 fractionsin T2N0, and 55 Gy and 45 Gy in 25 fractions in all patients with N positive and/or ≥ T3, respectively, to planning target volumes 1 and 2. The most common chemotherapy regimen was 5-fluorouracil and mitomycin-based. Human papilloma virus(HPV) p16 expression was performed by immunohistochemistry and evaluated in the majority of patients. Acute and late toxicity was scored according to CTCAe v 3.0 and RTOG scales.RESULTS: The median follow-up was 30 mo(range:12-71). Median age was 63 years(range 32-84). The stage of disease was: stage Ⅰ in 2 patients, stage Ⅱin 13 patients, stage ⅢA in 12 patients, and stage ⅢB in 14 patients, respectively. Two patients were known to be HIV positive(4.9%). HPV p16 expression status was positive in 29/34(85.3%) patients. The 4-year progression-free survival and overall survival in HPVpositive patients were 78% and 92%, respectively.Acute grade 3 skin and gastrointestinal toxicities were reported in 5% and 7.3% of patients, respectively;patients' compliance to the treatment was good due to a low occurrence of severe acute toxicity, although treatment interruptions due to toxicity were required in 7.3% of patients. At 6 mo from end of treatment,36/40(90%) patients obtained complete response;during follow-up, 5(13.8%) patients presented with disease progression(local or systemic).CONCLUSION: In our experience, intensified SIBIMRT with chemotherapy is very feasible in clinical practice, with excellent results in terms of overall survival and local control.
文摘Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classifi cation of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely diffi cult to interpret the results of the various anaplastic procedures de in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.
基金the Science and Technology Commission of Shanghai Municipally,No.17411967600.
文摘BACKGROUND Transanal minimally invasive surgery(TAMIS)is a good choice for resection of rectal neoplasms.Endoscopic mucosal resection(EMR)is also widely used in the treatment of benign rectal tumors such as rectal polyps and rectal adenomas.However,no studies have compared the outcome of TAMIS and EMR.AIM To compare the short-term outcomes after TAMIS and EMR for rectal carcinoid and benign tumors(including rectal polyps and adenomas).METHODS From January 2014 to January 2019,44 patients who received TAMIS and 53 patients who received EMR at The Fifth People's Hospital of Shanghai were selected.Primary outcomes(surgical-related)were operating time,blood loss,length of postoperative hospital stay,rate of resection margin involvement and lesion fragmentation rate.The secondary outcomes were complications such as hemorrhage,urinary retention,postoperative infection and reoperation.RESULTS No significant differences were observed in terms of blood loss(12.48±8.00 mL for TAMIS vs 11.45±7.82 mL for EMR,P=0.527)and length of postoperative hospital stay(3.50±1.87 d for TAMIS vs 2.72±1.98 d for EMR,P=0.065)between the two groups.Operating time was significantly shorter for EMR compared with TAMIS(21.19±9.49 min vs 49.95±15.28 min,P=0.001).The lesion fragmentation rate in the EMR group was 22.6%(12/53)and was significantly higher than that(0%,0/44)in the TAMIS group(P=0.001).TAMIS was associated with a higher urinary retention rate(13.6%,6/44 vs 1.9%,1/53 P=0.026)and lower hemorrhage rate(0%,0/44 vs 18.9%,10/53 P=0.002).A significantly higher reoperation rate was observed in the EMR group(9.4%,5/53 vs 0%,0/44 P=0.036).
文摘AIM: Pelvic magnetic resonance imaging (MRI) and endoanalultrasound which are established imaging methods forperianal inflammatory lesions in patients with Crohn'sdisease require expensive specialized equipments andexpertise. We investigated the feasibility and sensitivity oftranscutaneous perianal ultrasound (PAUS) using regularultrasound probes in the imaging of perianal inflammatorylesions. The sonographic findings were correlated to pelvicMRI-scans.METHODS: We performed PAUS in 25 patients with Crohn'sdisease and clinical signs of perianal inflammatory disease.VCChin a median of 10 d (range 0-75) these patients underwentMRI of the pelvis. Regular convex and linear high resolutionprobes were used for PAUS. The sonographic findings werecorrelated to the MRI findings by blinded investigators.RESULTS: The sonographic investigations were welltolerated by all patients. Fistulae typically presented ashypoechoic tracks. Twenty-nine fistulae were detected in22 patients. Abscesses were detected in 7 patients andpresented as hypo- or anechoic formations. Twenty-six of29 fistulae and 6 of 7 abscesses could be confirmed byMRI. Kappa statistics showed an excellent agreement(kappa>0.83) between the two imaging methods.CONCLUSION: PAUS is a simple, painless, feasible, real-time method that can be performed without specific patientpreparation which is comparable in its sensitivity to pelvicMRI in the detection of perianal fistulae and/or abscesses.PAUS can especially be recommended as a screening toolin acute perianal disorders such as perianal abscess andfor follow-up studies of perianal inflammatory disease.
文摘BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.There are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different severities.AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.METHODS Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared.The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor.The explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point scale.Patients underwent proctologic follow-up examinations one,two,and four weeks after surgery.RESULTS We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;P<0.001).The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied with their quality of life after surgery other than the two who noticed no difference due owing to the fact that they experienced recurrences.CONCLUSION Scar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure.Anoplasty is unavoidable for moderate or severe stenosis,where cicatrized tissue is extensive.
文摘AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus.METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year.RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reductionwith regard to pain and irritation during defection (P= 0.0011),pricking or foreign body sensation in the anus (P = 0.0006) and pruritus or wetness around the anal verge (P = 0.0008).CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.
文摘AIM To explore the relationship between such a construct and an existing continence score.METHODS A retrospective study of incontinent patients who underwent anal physiology(AP) was performed. AP results and Cleveland Clinic Continence Scores(CCCS) were extracted. An anal physiology score(APS) was developed using maximum resting pressures(MRP), anal canal length(ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed.RESULTS Of 508(419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mm Hg(SD23.2 mm Hg) for men and 39 mm Hg(19.2 mm Hg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP(P = 0.0002), ACL(P = 0.0006) and pudendal neuropathy(P < 0.0001). The association between APS and CCCS was significant(P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%.CONCLUSION This study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores.
文摘AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively.Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments.RESULTS:Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation.Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5-245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5-27) months. Six patients had a long-term survival.CONCLUSION:Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N2-3 tumors.
