Diseases of the Colon & Rectum最新文献_第3页

Implementation of a Multimodal Enhanced Recovery Protocol in Ambulatory Anorectal Surgery: A Randomized Trial. 在门诊肛门直肠手术中实施多模式强化恢复方案：随机试验

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI: 10.1097/DCR.0000000000003435

Lucille Y Yao, Aaron B Parrish, Phillip R Fleshner, Karen N Zaghiyan

Background: Few studies report outcomes for enhanced recovery pathways in ambulatory anorectal surgery. We hypothesize that an ambulatory anorectal enhanced recovery pathway with multimodal analgesia can reduce postoperative opioid use.Objective: To compare postoperative opioid use in patients undergoing ambulatory anorectal surgery who receive multimodal analgesia versus standard of care without multimodal analgesia.Design: A prospective randomized trial of patients undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022.Setting: Urban teaching hospital.Patients: Adults aged 18 to 70 years undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022.Intervention: Multimodal enhanced recovery pathway including preoperative and postoperative nonopioid analgesia with oral acetaminophen, gabapentin, and ketolorac.Main outcome measures: Primary end point was oral opioid use during the first postoperative week. Secondary end points included maximum pain and nausea scores, adverse events, and emergency room or hospital admissions during the first 30 days postoperatively.Results: Of the 109 enrolled patients, 20 were lost to follow-up. The remaining 89 patients had a median age of 38 years (range, 20-67) and included 41 women (46%). There were no significant differences between the enhanced recovery protocol arm and non-enhanced recovery protocol arm in terms of preoperative and surgical characteristics. The primary end point of this study, that is, oral morphine milligram equivalents use during the first week, was significantly higher among patients in the non-enhanced recovery protocol arm (79 mg; range, 0-600) than patients in the enhanced recovery protocol arm (8 mg; range, 0-390; p = 0.002). On subgroup analysis, both fistula and hemorrhoid surgery patients assigned to the non-enhanced recovery protocol arm took significantly higher oral morphine milligram equivalents in the first week than patients in the enhanced recovery protocol arm. There was no significant difference in secondary end points.Limitations: Patients and providers were not blinded. Our findings are limited to hemorrhoid and fistula surgery and may not be applicable to other anorectal procedures.Conclusions: Enhanced recovery protocols including multimodal analgesia should be used in elective anal fistula and hemorrhoid surgery to decrease postoperative opioid use. See the Video Abstract .Clinical trial registration: ClinicalTrials.gov ID NCT03738904.Implementacin de protocolo de recuperacin acelerada multimodal en ciruga anorrectal ambulatoria un estudio aleatorizado: ANTECEDENTES:Pocos estudios reportan resultados de programas de recuperación ac

背景：很少有研究报道门诊肛门直肠手术强化恢复路径的结果。我们假设，采用多模式镇痛的门诊肛门直肠强化恢复路径可以减少术后阿片类药物的使用：比较接受多模式镇痛的非卧床肛门直肠手术患者与未接受多模式镇痛的标准护理患者的术后阿片类药物使用情况：一项前瞻性随机试验，对象为2018年9月至2022年5月期间接受择期肛瘘或痔疮手术的患者：城市教学医院：2018年9月至2022年5月接受择期肛瘘或痔疮手术的18至70岁成人.干预：多模式增强恢复路径，包括术前和术后口服对乙酰氨基酚、加巴喷丁和酮洛酸的非阿片类镇痛：主要终点是术后第一周口服阿片类药物的使用量。次要终点包括最大疼痛和恶心评分、不良事件以及术后前 30 天的急诊或住院情况：结果：109 名入选患者中，20 人失去了随访机会。其余 89 名患者的中位年龄为 38 岁（20-67 岁），其中包括 41 名女性（46%）。在术前和手术特征方面，强化恢复方案组（E组）和非强化恢复方案组（NE组）之间没有明显差异。研究的主要终点是第一周口服 MME 的使用量，NE 组患者（79 毫克；范围 0-600）明显高于 E 组患者（8 毫克；范围 0-390）（P = 0.002）。亚组分析显示，瘘管手术和痔疮手术患者在第一周口服 MME 的剂量明显高于 E 组患者。次要终点无明显差异：局限性：患者和医护人员均未接受盲法治疗。我们的研究结果仅限于痔疮和瘘管手术，可能不适用于其他肛门直肠手术：结论：在选择性肛瘘和痔疮手术中应采用包括多模式镇痛在内的强化恢复方案，以减少术后阿片类药物的使用。请参阅视频摘要：ClinicalTrials.gov ID NCT03738904。

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IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI: 10.1097/DCR.0000000000003457

Leonardo Alfonso Bustamante-Lopez, Liam Devane, Stacy Ranson, John R T Monson, Teresa DeBeche-Adams

引用次数: 0

Prehabilitation for Colorectal Cancer Surgery. 结肠直肠癌手术前康复。

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI: 10.1097/DCR.0000000000003456

Jennifer K Vu, Cherry E Koh

引用次数: 0

October 2024 Translations. 2024 年 10 月翻译.

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-09-05 DOI: 10.1097/DCR.0000000000003522

引用次数: 0

Efficacy of Traditional Acupuncture Compared to Biofeedback Therapy in Fecal Incontinence: A Randomized Controlled Trial. 传统针灸与生物反馈疗法对大便失禁的疗效比较：随机对照试验

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-07-02 DOI: 10.1097/DCR.0000000000003357

Yvonne Y Ng, Koon Yaw Tan, Yun Zhao, Isaac Seow-En, Aik Yong Chok, Julia Chuang, Megan S Loy, Emile K Tan

Background: Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy, including biofeedback therapy, improves mild symptoms with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity, resulting in low uptake and acceptability. Although acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well accepted as a treatment strategy.Objective: To determine the effectiveness of traditional Chinese medicine acupuncture, compared to biofeedback therapy, in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life after treatment.Design: Randomized controlled trial.Setting: Prospective, single-institution study.Patients: Patients with 2 or more episodes of fecal incontinence per week or St. Mark's incontinence score of 5 or higher were recruited. Patients were randomly assigned into biofeedback therapy, which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks.Main outcome measures: Incontinence episodes, St. Mark's score, and fecal incontinence quality-of-life scale.Results: Eighty-five patients were randomly assigned to biofeedback therapy (n = 46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different ( p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer episodes at week 15 ( p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 ( p < 0.05). Although the St. Mark's score was significantly reduced in both arms at week 15 ( p < 0.001), the acupuncture arm's score was significantly lower ( p = 0.002).Limitations: Longer follow-up is required.Conclusions: Acupuncture is clinically effective and improves the quality of life in patients with fecal incontinence. See Video Abstract .Clinical trial registration: Clinicaltrials.gov : NCT04276350.Eficacia de la acupuntura tradicional comparada con la terapia de biorretroalimentacin en la incontinencia fecal un ensayo controlado aleatorio: ANTECEDENTES:La incontinencia fecal tiene un impacto devastador en la calidad de vida e impone una carga socioeconómica sustancial. La mejor terapia médica, incluida la terapia de biorretroalimentación, mejora los síntomas leves, con un impacto mínimo sobre los síntomas moderados a graves. El tratamiento quirúrgico de la incontinencia conlleva un grado de morbilidad qu

背景：大便失禁会对生活质量造成严重影响，并带来巨大的社会经济负担。包括生物反馈疗法在内的最佳药物疗法可改善轻度症状，但对中度至重度症状的影响微乎其微。手术治疗尿失禁有一定的发病率，因此接受率和接受程度都很低。在新加坡，针灸是治疗多种疾病的常见方法，但在治疗大便失禁方面却相对陌生。然而，在我们当地，针灸作为一种治疗策略，既方便又便宜，而且有可能被广泛接受：目的：确定中医针灸与生物反馈疗法在治疗大便失禁方面的有效性。次要目的是调查治疗后生活质量的差异：设计：随机对照试验：前瞻性单一机构研究：患者：招募每周大便失禁次数≥2次或圣马克失禁评分≥5分的患者。患者被随机分配到生物反馈疗法（包括 10 周内的 3 次治疗）或 10 周内的 30 次针灸治疗中：尿失禁发作次数、圣马克评分和大便失禁生活质量量表：85名患者随机接受了生物反馈疗法（46人）或针灸疗法（39人）。人口统计学和基线临床特征无差异（P > 0.05）。两种疗法的尿失禁次数中位数都有所减少，针灸治疗组在第15周时的尿失禁次数明显减少（P < 0.001）。针灸还能改善生活质量，在第 15 周时，生活方式、应对能力、抑郁和窘迫感都有所改善（P < 0.05）。在第 15 周时，两组的圣马克评分均显著降低（p < 0.001），但针灸组的评分显著降低（p = 0.002）：局限性：需要更长时间的随访：结论：针灸对大便失禁患者有临床疗效，并能改善患者的生活质量。参见视频摘要：临床试验注册：Clinicaltrials.gov：NCT04276350。

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IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-07-08 DOI: 10.1097/DCR.0000000000003305

Lester Gottesman

引用次数: 0

Early Postoperative Prediction of Complications and Readmission After Colorectal Cancer Surgery Using an Artificial Neural Network. 利用人工神经网络对结直肠癌术后并发症和再入院情况进行早期预测

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-10-01 Epub Date: 2024-07-03 DOI: 10.1097/DCR.0000000000003253

Annamaria Agnes, Sa T Nguyen, Tsuyoshi Konishi, Oliver Peacock, Brian K Bednarski, Y Nancy You, Craig A Messick, Matthew M Tillman, John M Skibber, George J Chang, Abhineet Uppal

Background: Early predictors of postoperative complications can risk-stratify patients undergoing colorectal cancer surgery. However, conventional regression models have limited power to identify complex nonlinear relationships among a large set of variables. We developed artificial neural network models to optimize the prediction of major postoperative complications and risk of readmission in patients undergoing colorectal cancer surgery.Objective: This study aimed to develop an artificial neural network model to predict postoperative complications using postoperative laboratory values and compare the accuracy of models to standard regression methods.Design: This retrospective study included patients who underwent elective colorectal cancer resection between January 1, 2016, and July 31, 2021. Clinical data, cancer stage, and laboratory data from postoperative days 1 to 3 were collected. Complications and readmission risk models were created using multivariable logistic regression and single-layer neural networks.Setting: National Cancer Institute-Designated Comprehensive Cancer Center.Patients: Adult patients with colorectal cancer.Main outcome measures: The accuracy of predicting postoperative major complications, readmissions, and anastomotic leaks using the area under the receiver operating characteristic curve.Results: Neural networks had larger areas under the curve for predicting major complications compared to regression models (neural network 0.811; regression model 0.724, p < 0.001). Neural networks also showed an advantage in predicting anastomotic leak ( p = 0.036) and readmission using postoperative day 1 to 2 values ( p = 0.014).Limitations: Single-center, retrospective design limited to cancer operations.Conclusions: In this study, we generated a set of models for the early prediction of complications after colorectal surgery. The neural network models provided greater discrimination than the models based on traditional logistic regression. These models may allow for early detection of postoperative complications as early as postoperative day 2. See the Video Abstract .Prediccin post operatoria temprana de complicaciones y reingreso despus de la ciruga de cncer colorrectal mediante una red neuronal artificial: ANTECEDENTES:Los predictores tempranos de complicaciones postoperatorias pueden estratificar el riesgo de los pacientes sometidos a cirugía de cáncer colorrectal. Sin embargo, los modelos de regresión convencionales tienen un poder limitado para identificar relaciones no lineales complejas entre un gran conjunto de variables. Desarrollamos modelos de redes neuronales artificiales para optimizar la predicción de complicaciones postoperatorias importantes y riesgo de reingreso en pacientes somet

背景：术后并发症的早期预测指标可以对接受结直肠癌手术的患者进行风险分层。然而，传统的回归模型在识别大量变量之间复杂的非线性关系方面能力有限。我们开发了人工神经网络模型来优化结直肠癌手术患者术后主要并发症和再入院风险的预测：本研究旨在开发一种人工神经网络模型，利用术后化验值预测术后并发症，并将这些模型的准确性与标准回归方法进行比较：这项回顾性研究纳入了 2016 年 1 月 1 日至 2021 年 7 月 31 日期间接受择期结直肠癌切除术的患者。研究收集了术后第 1 至 3 天的临床数据、癌症分期和实验室数据。利用多变量逻辑回归和单层神经网络建立了并发症和再入院风险模型：美国国家癌症研究所指定的综合癌症中心：主要结果指标：主要结果测量：使用接收者操作特征曲线下面积预测术后主要并发症、再入院和吻合口漏的准确性：与回归模型相比，神经网络预测主要并发症的曲线下面积更大（神经网络为0.811；回归模型为0.724，p < 0.001）。神经网络在预测吻合口漏（p = 0.036）和使用术后第 1-2 天的数值预测再入院（p = 0.014）方面也显示出优势：局限性：单中心、回顾性设计，仅限于癌症手术：在这项研究中，我们建立了一套结直肠手术后并发症早期预测模型。与基于传统逻辑回归的模型相比，神经网络模型提供了更高的区分度。这些模型可在术后第 2 天早期发现术后并发症。请看视频摘要。

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Clinicopathological Characteristics and Outcomes of Colorectal Cancer With Heterogenous Staining of Mismatch Repair Protein. 错配修复蛋白异质性染色的结直肠癌临床病理特征和预后

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-09-27 DOI: 10.1097/DCR.0000000000003527

Xian Zhang, Yu-Jue Wang, Lin-Yong Sun, Yin-Xia Tu, Yue Li, Dan Jiang

Background: Scant data are available on heterogenous staining of mismatch repair protein in colorectal cancer.

Objective: This study aimed to improve insights into clinicopathologic features and prognosis of colorectal cancer harboring heterogenous mismatch repair protein staining.

Design: A single-center retrospective observational study.

Setting: This study was conducted in a tertiary referral center in China between 2014 and 2018.

Patients: Colorectal cancers with heterogenous staining of mismatch repair protein were included.

Main outcomes measures: Clinicopathologic and molecular features, and survival outcomes were analyzed.

Results: A total of 151 out of 6721 colorectal cancers (2.2%) exhibited heterogenous staining for at least one mismatch repair protein, with intraglandular heterogeneity being the most common pattern (89.4%). Heterogenous MLH1 staining was significantly associated with distant metastasis (p = 0.03), while heterogenous MSH2 staining was associated with left-sided (p = 0.03) and earlier pT stage tumors (p = 0.02). The rates of microsatellite instability-high, KRAS and BRAF mutation were 12.6%, 47.3% and 3.4%, respectively. Microsatellite instability-high was significantly associated with higher intraglandular MSH6 heterogeneity frequency (p < 0.001) and decreased MSH6 expression level (< 27.5%, p = 0.01). BRAF mutation was associated with the coexistence of intraglandular and clonal heterogeneity (p = 0.003) and decreased PMS2 expression level (p = 0.01). Multivariable analysis revealed that progression-free survival was significantly associated with tumor stage (p = 0.003), stroma fraction (p = 0.004), and heterogenous PMS2 staining (p = 0.02). Overall survival was linked to tumor stage (p = 0.006) and BRAF mutation (p = 0.01).

Limitations: The limitations of this study include the absence of testing for MLH1 promoter methylation and mismatch repair gene mutations, its retrospective design, and insufficient data related to direct comparison with deficient mismatch repair and proficient mismatch repair colorectal cancer.

Conclusions: Heterogenous mismatch repair protein staining in colorectal cancer exhibits distinct associations with tumor location, stage, microsatellite instability, BRAF mutation and prognosis. It is recommended to report MSH6 heterogeneity as it may indicate microsatellite instability-high. See Video Abstract.

背景：关于结直肠癌错配修复蛋白异源染色的数据很少：本研究旨在提高对带有异源性错配修复蛋白染色的结直肠癌的临床病理特征和预后的认识：单中心回顾性观察研究：本研究于2014年至2018年在中国的一家三级转诊中心进行：主要结果指标：分析临床病理和分子特征以及生存结果：在6721例结直肠癌中，共有151例（2.2%）至少一种错配修复蛋白出现异质性染色，其中腺内异质性是最常见的模式（89.4%）。异源性MLH1染色与远处转移显著相关（p = 0.03），而异源性MSH2染色与左侧（p = 0.03）和pT分期较早的肿瘤相关（p = 0.02）。微卫星不稳定性高、KRAS和BRAF突变率分别为12.6%、47.3%和3.4%。微卫星不稳定性高与较高的腺内 MSH6 异质性频率（p < 0.001）和 MSH6 表达水平下降（< 27.5%，p = 0.01）显著相关。BRAF突变与腺内异质性和克隆异质性并存（p = 0.003）和PMS2表达水平下降（p = 0.01）相关。多变量分析显示，无进展生存期与肿瘤分期（p = 0.003）、基质部分（p = 0.004）和异质性 PMS2 染色（p = 0.02）显著相关。总生存率与肿瘤分期（p = 0.006）和BRAF突变（p = 0.01）有关：本研究的局限性包括：未检测 MLH1 启动子甲基化和错配修复基因突变，研究为回顾性设计，与错配修复缺陷型和错配修复熟练型结直肠癌直接比较的相关数据不足：结论：结直肠癌中的异源性错配修复蛋白染色与肿瘤位置、分期、微卫星不稳定性、BRAF突变和预后有明显的关联。建议报告MSH6异质性，因为它可能预示着微卫星不稳定性高。参见视频摘要。

{"title":"Clinicopathological Characteristics and Outcomes of Colorectal Cancer With Heterogenous Staining of Mismatch Repair Protein.","authors":"Xian Zhang, Yu-Jue Wang, Lin-Yong Sun, Yin-Xia Tu, Yue Li, Dan Jiang","doi":"10.1097/DCR.0000000000003527","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003527","url":null,"abstract":"Background: Scant data are available on heterogenous staining of mismatch repair protein in colorectal cancer.Objective: This study aimed to improve insights into clinicopathologic features and prognosis of colorectal cancer harboring heterogenous mismatch repair protein staining.Design: A single-center retrospective observational study.Setting: This study was conducted in a tertiary referral center in China between 2014 and 2018.Patients: Colorectal cancers with heterogenous staining of mismatch repair protein were included.Main outcomes measures: Clinicopathologic and molecular features, and survival outcomes were analyzed.Results: A total of 151 out of 6721 colorectal cancers (2.2%) exhibited heterogenous staining for at least one mismatch repair protein, with intraglandular heterogeneity being the most common pattern (89.4%). Heterogenous MLH1 staining was significantly associated with distant metastasis (p = 0.03), while heterogenous MSH2 staining was associated with left-sided (p = 0.03) and earlier pT stage tumors (p = 0.02). The rates of microsatellite instability-high, KRAS and BRAF mutation were 12.6%, 47.3% and 3.4%, respectively. Microsatellite instability-high was significantly associated with higher intraglandular MSH6 heterogeneity frequency (p < 0.001) and decreased MSH6 expression level (< 27.5%, p = 0.01). BRAF mutation was associated with the coexistence of intraglandular and clonal heterogeneity (p = 0.003) and decreased PMS2 expression level (p = 0.01). Multivariable analysis revealed that progression-free survival was significantly associated with tumor stage (p = 0.003), stroma fraction (p = 0.004), and heterogenous PMS2 staining (p = 0.02). Overall survival was linked to tumor stage (p = 0.006) and BRAF mutation (p = 0.01).Limitations: The limitations of this study include the absence of testing for MLH1 promoter methylation and mismatch repair gene mutations, its retrospective design, and insufficient data related to direct comparison with deficient mismatch repair and proficient mismatch repair colorectal cancer.Conclusions: Heterogenous mismatch repair protein staining in colorectal cancer exhibits distinct associations with tumor location, stage, microsatellite instability, BRAF mutation and prognosis. It is recommended to report MSH6 heterogeneity as it may indicate microsatellite instability-high. See Video Abstract.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long Rectal Cuff and Remnant Mesorectum Are Major Preventable Causes of Ileal Pouch Failure. 长直肠袖带和残余中直肠是回肠袋失败的主要可预防原因。

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-09-26 DOI: 10.1097/DCR.0000000000003530

Mehmet Gulmez, Pranav Hinduja, Eren Esen, Michael J Grieco, Arman Erkan, Andre da Luz Moreira, John Kirat, Feza H Remzi

Background: Long rectal cuff (>2 cm) and remnant mesorectum are known causes of pouch dysfunction due to obstructive defecation, as well as pelvic sepsis after prolonged obstruction.

Objective: The aim of this study is to report the rates and the management of patients who underwent re-do ileal pouch anal anastomosis due to pouch failure associated with retained mesorectum and long rectal cuff.

Design: This is a retrospective study.

Settings: The investigation is based on a quaternary inflammatory bowel disease center.

Patients: Patients undergoing re-do ileal pouch anal anastomosis surgery and had long rectal cuff and/or remnant mesorectum between September 2016 and September 2023 were included in the study.

Main outcome measures: The main outcomes were functioning pouch rate and functional results.

Results: Of the 245 patients who underwent re-do ileal pouch anal anastomosis surgery, 98 (40%) patients had long rectal cuff and/or remnant mesorectum. Re-do ileal pouch anal anastomosis in this patient group was successful (92%) at a median follow-up of 28 (18-52) months.

Limitations: The retrospective nature of the study and this is the experience of a single specialized center.

Conclusions: Long rectal cuff and remanent mesorectum are major causes of pouch failure which can be successfully managed with re-do ileal pouch anal anastomosis surgery. Nearly half of pouch failure patients who had successful re-do ileal pouch anal anastomosis surgery initially received unnecessary biologic therapy before coming to our center. See Video abstract.

背景：长直肠套管（>2 厘米）和残余直肠系膜是导致排便受阻造成肛袋功能障碍以及长期梗阻后发生盆腔败血症的已知原因：本研究旨在报告因直肠中膜残留和直肠长袖带导致肛门吻合术失败而接受回肠袋肛门吻合术的患者的比例和处理方法：这是一项回顾性研究：调查基于一个四级炎症性肠病中心：研究对象：2016年9月至2023年9月期间接受回肠袋肛门吻合术再手术且有长直肠袖带和/或残余直肠中膜的患者：主要结果为功能袋率和功能结果：在接受回肠袋肛门吻合术的245例患者中，98例（40%）患者有长直肠袖带和/或残余直肠系膜。在中位随访28（18-52）个月时，这组患者中再做回肠袋肛门吻合术的成功率为92%：局限性：本研究为回顾性研究，且仅为一家专科中心的经验：结论：长直肠袖带和残留的直肠系膜是导致肠袋失败的主要原因，通过重新进行回肠肠袋肛门吻合手术可以成功解决这一问题。在成功接受回肠袋肛门吻合术的失败患者中，有近一半的患者在来本中心之前接受了不必要的生物治疗。查看视频摘要。

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引用次数: 0

Quality of Life, Functional Outcomes, and Recurrence After Resection Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse Repair. 直肠脱垂修复术中切除直肠与腹侧网片直肠术后的生活质量、功能效果和复发。

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum

Pub Date : 2024-09-26 DOI: 10.1097/DCR.0000000000003467

Anna R Spivak, Marianna Maspero, Rebecca Y Spivak, Jessica Sankovic, Stephanie Norman, Caitlyn Deckard, Scott R Steele, Tracy L Hull

Background: Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse, however reports on long-term recurrence rates and functional outcomes are lacking.

Objective: We compared quality of life, long-term functional outcomes and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy.

Design: We retrospectively reviewed our prospectively collected rectal prolapse surgery database.

Settings: Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included.

Patients: Two hundred twenty patients were included, of which 208 (94%) female; 85 (39%) underwent resection rectopexy, 135 (61%) ventral mesh rectopexy.

Main outcomes measure: Prolapse recurrence.

Results: The resection rectopexy group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001). After a median follow-up of 110 (IQR 94 - 146) months for resection rectopexy and 113 (87 - 137) for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group (p = 0.041). Median time to recurrence was 44 (18 - 80) months in the resection rectopexy group and 28.5 (11 - 52.5) in the ventral mesh rectopexy group (p = 0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy vs ventral mesh rectopexy. Recurrence rate for re-do prolapses was higher in the ventral mesh rectopexy group 63% at 10 years, versus 25% in resection rectopexy group (p = 0.006). Functional outcomes were similar between the two groups.

Limitations: Retrospective review, recall bias.

Conclusion: Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair. See Video Abstract.

背景：切除直肠和腹侧网片直肠切除术是广为接受的治疗直肠脱垂的手术方案，但缺乏有关长期复发率和功能效果的报告：我们比较了切除直肠与腹侧网片直肠切除术后的生活质量、长期功能效果和脱垂复发情况：设计：我们对前瞻性收集的直肠脱垂手术数据库进行了回顾性审查：纳入2009年至2016年期间在本中心接受切除直肠或腹腔网片直肠切除术的患者：主要结果：脱垂复发：结果：结果：直肠切除术组年龄较小（中位 52 岁对 60 岁，P = 0.02），开放手术较多（20% 对 9%，P < 0.001）。中位随访110（IQR 94 - 146）个月（切除直肠整形术组）和113（87 - 137）个月（腹腔网直肠整形术组）后，切除直肠整形术组有21人（26%）复发，腹腔网直肠整形术组有50人（39%）复发（p = 0.041）。切除直肠整形术组的中位复发时间为 44（18 - 80）个月，腹侧网片直肠整形术组为 28.5（11 - 52.5）个月（p = 0.14）。切除直肠与腹侧网片直肠切除术的原发性脱垂复发率没有差异。腹侧网片直肠切除术组 10 年后再次脱垂的复发率为 63%，高于切除直肠切除术组的 25%（P = 0.006）。两组的功能结果相似：局限性：回顾性研究，回忆偏倚：结论：切除式直肠整形术和腹侧网片直肠整形术后的长期生活质量和功能效果相当。腹侧网片直肠切除术与复发性直肠脱垂修复术后较高的脱垂复发率有关。参见视频摘要。

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引用次数: 0