ObjectiveTo evaluate the efficacy of XiaochengqiMixture (XM) on promoting healing of colonic stoma. MethodsForty Wistar rats were divided into two groups randomly after colonectomy: experimental group (n=20) and control group (n=20). In early postoperatively stage rats were given gastric administration of XM in the experimental group and pure water in the control group. On day 3, 7, and 14 after establishment of animal models, laparotomy was performed in two groups of rats, respectively. Anastomotic stoma and surrounding tissues were harvested to detect the context of hydroxyproline and collagen fiber proportion by Masson dying. ResultsOn day 3 after establishment of animal models, hyperplastic collagen with small fiber was observed while no fasciculus was found. Hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.05). On day 7 after operation, many fasciculuses were found in two groups of rats, hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.01). On day 14 after operation, fasciculuses became bigger and more regular in arrangement, but there was no significant difference between the two groups (Pgt;0.05). ConclusionXM is capable of promoting healing of colonic stoma and might prevent the occurrence of anastomotic fistula.
ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer.
MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model.
ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.
ObjectiveTo summarize the causes, clinical manifestations, diagnosis and treatment methods for the intestinoseminal vesicle fistula.
MethodLiteratures about intestinoseminal vesicle fistula at home and abroad were retrieved, the causes, clinical manifestations, diagnosis and treatment methods were analyzed.
ResultsThe clinical reports of 19 patients with intestinoseminal vesicle fistula were searched.The intestinoseminal vesicle fistula occurred after the rectal low anterior resection with stomal leak, sigmoid diverticulum, inflammatory bowel disease, prostatectomy or radiotherapy.The main clinical symptoms were pneumaturia, fecaluria, fever, scrotal swelling and pain, orchitis, epididymitis and so on.Imaging methods such as enhanced CT or CT with rectal contrast and so on could confirm the diagnosis.The conservative treatment such as indwelling catheter, antibiotics, parenteral nutrition, and the operation methods such as sinus incision and drainage, mucosa/skeletal muscle flap repairment, urine/stool bypass could cure majority of cases.
ConclusionsThe intestinoseminal vesicle fistula is a rare and independent disease.Through the discussion of the intestinoseminal vesicle fistula, it could improve the knowledge, and avoid misdiagnosis and mistreatment of the intestinoseminal vesicle fistula.
Objective To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer. Methods In total of132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n=65） and air leak＋methylene blue solution leak test group （n=67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper endof bowel， then injecting 500 mL distilled water to pelvic， and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus， and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened， and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum， 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected， observing the location where the methylene blue solutionleaking out and repaired it. Results Three cases （4.62%） of anastomotic leakage were found during operation in air leak test group， and 9 cases （13.85%） were found after operation. Of the 9 cases， 5 cases were cured with placement of adeq-uate drainage and symptomatic treatment， 3 cases were cured with anal patch， and 1 case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage， 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene bluesolution leak test group， but no one suffered anastomotic leakage after operation. Compared with air test group， detectionrate of anastomotic leakage during operation was higher （P＜0.05）， and incidence rate of anastomotic leakage after opera-tion was lower in air leak＋methylene blue solution leak test group （P＜0.05）. Conclusions Large anastomotic leakage can be found by using air leak test， and small and hidden leakage can be found by using methylene blue solution leak test， combination method of the two experiments is better. Repair can be performed effectively under direct vision.
Objective To investigate the measures to prevent the anastomotic leakage following anterior resection of rectum. Methods A series of seventy-four patients with rectal cancer undergoing anterior resection from January 1991 to October 1998 were analyzed.Results The clinical anastomotic leakage rate was 4.05 per cent (3/74). The causes of leakage were presacral infection and insufficiency of blood supply in incisional margin. Conclusion The proximal colon must be completely mobilized and blood supply of incisional margin should be sufficient. Persistent postoperative presacral suction must be performed to protect fluid accumulation resulting in infection. Intracolonic drainage is an important factor in prevention of anastomotic leakage. Temporary stoma is not necessary.
ObjectiveTo evaluate the efficacy, safety, and feasibility of fecal drainage technique on rectal anastomosis for preventing anastomotic leakage after operation for middle-low rectal cancer.MethodsThe retrospective analysis was used to collect the middle-low rectal cancer which completed operation in this hospital from 2014 to 2019. According to the way of preventing annstomotic leakage, the patients were divided into two groups: fecal drainage on rectal anastomosis group (Abbreviation: fecal drainage group) and end ileum prophylactic stoma group (Abbreviation: ileostomy group). The incidence of anastomotic leakage after operation and the different treatment methods following leakage were compared between the two groups.ResultsA total of 231 cases were recorded, including 84 cases in the fecal drainage group, 147 cases in the ileostomy group. There were no significant differences in the baseline data such as the gender, age, preoperative complications, operation mode, etc. between the two groups (P>0.050). There were no significant differences in the operation time, intraoperative blood loss, incision infection, postoperative intestinal obstruction, total hospitalization cost, death, anastomotic leakage (overall, each grade, treatment, and outcome) between the two groups (P>0.050). Although the length of hospital stay except the patients with anastomotic leakage in the fecal drainage group was significantly longer than that in the ileostomy group (P<0.001), there was no significant difference in the total length of hospital stay between the two groups (P>0.050), and the incidence of anastomotic stenosis in the fecal drainage group was significantly lower than that in the ileostomy group (P=0.029).ConclusionAccording to the results of this study, fecal drainage technique on rectal anastomosis is effective, safe, and feasible in preventing anastomotic leakage after operation for middle-low rectal cancer.
ObjectiveTo explore the predictive value of systemic immune-inflammation index (SII) combined with neutrophil-monocyte ratio (NMR) on postoperative anastomotic leakage in elderly colon cancer. MethodsThe clinical data of 493 elderly colon cancer patients who attended the Department of General Surgery of the First Hospital of Lanzhou University from January 2018 to October 2023 were retrospectively analysed, and divided into an anastomotic leakage group (n=29) and a non-anastomotic leakage group (n=464) according to the occurrence of anastomotic leakage or not, and the differences between the two groups in terms of SII and NMR at different time points were compared. Area under the curve (AUC) of receiver operating characteristic (ROC) was used to compare the predictive value of SII, NMR and the combination of the two on the occurrence of anastomotic leakage after surgery in elderly colon cancer patients. Logistic regression was used to analyse the independent risk factors for postoperative anastomotic leakage in elderly colon cancer patients. ResultsThe SII and NMR in the anastomotic leakage group were higher than those in the non-anastomotic leakage group on the 3 rd and 5 th day after operation (P<0.05). ROC curve analysis showed that the AUC values for SII on postoperative day 3, NMR on postoperative day 5, and the combination of the two to predict anastomotic leakage were 0.613, 0.743, and 0.750, respectively. The results of DeLong’s test suggested that the difference between the AUC values of NMR on postoperative day 5 combined with SII on postoperative day 3 and SII on postoperative day 3 was statistically significant (P=0.047). Multifactorial logistic regression analysis showed that age, male, diabetes, preoperative radiotherapy and chemotherapy, tumor located in the left colon, SII on postoperative day 3, and NMR on postoperative day 5 were independent risk factors for postoperative anastomotic leakage in elderly patients with colorectal cancer (all P<0.05). ConclusionsPostoperative day 3 SII combined with postoperative day 5 NMR, postoperative day 3 SII, and postoperative day 5 NMR all have predictive value for postoperative anastomotic leakage in elderly patients with colorectal cancer. Both have the potential to serve as important predictors of postoperative anastomotic leakage in elderly patients with colon cancer.
Objective
To study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following radical resection of rectal cancer.
Method
The clinical data of 11 patients with rectal cancer underwent the Dixon plus sheath technique with seromuscular sleeve of pedicled colon from January 2017 to October 2017 in the PLA Navy Anqing Hospital were analyzed.
Results
All the operations were completed successfully in the 11 patients with rectal cancer, including 9 cases of laparoscopy and 2 cases of laparotomy. The operative time was (255.5±51.5) min, the intraoperative bleeding was (80.0±28.3) mL, the first postoperative anal exhaust time was (4.4±2.0) d, the postoperative hospitalization time was (16.0±3.1) d. For the postoperative pathology, there were 5 cases of T4 stage, 2 cases of T3 stage, 2 cases of T2 stage, and 2 cases of T1 stage. The number of lymph node dissection was 5–23 with an average of 12.5 per case, 7 cases with lymph node metastasis. One case of lymphatic leakage and 1 case of incision infection occurred, and no anastomotic leakage and narrow occurred. After 3–10 months of follow-up (average follow-up 7 months), no local recurrence and distant metastasis were found.
Conclusion
Sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following radical resection of rectal cancer is feasible.
