中华胃肠外科杂志最新文献

Anorectal abscess is a common anorectal disease. In daily clinical practice, there are certain controversies regarding the clinical examination and diagnosis of anorectal abscesses, the selection of surgical methods for different types of abscesses, postoperative management, and treatment strategies for special types of anorectal abscesses.In recent years, there have been new advances in the clinical diagnosis and treatment of anorectal abscess. To promote the development of the specialty and standardize and improve the diagnosis and treatment level of specialist doctors, the Colorectal Physician Branch of the Chinese Medical Doctor Association organized experts in this field. Based on summarizing new research progress in this field at home and abroad, and after repeated discussions by expert group members, nine important clinical questions were summarized. Nineteen recommendations were formed targeting clinical diagnosis and examination strategies, surgical method selection, postoperative management, and treatment strategies for special types of anorectal abscesses, aiming to provide important guidance for specialist physicians, medical personnel, and patients who wish to understand the treatment of related diseases included in the guidelines.

Anorectal surgery is transitioning from a tradition of experience-based practice toward modern precision medicine. This evolution is driven by greater societal focus on benign diseases, changing disease patterns due to lifestyle shifts and an aging population, and rising patient expectations for painless procedures and rapid recovery, all of which present more complex clinical challenges and higher demands for humanistic care. In this context, the management of benign anorectal diseases continues to advance, supported by theoretical breakthroughs, technological innovations, and shifts in clinical philosophy. From the cushion theory of hemorrhoids and the refined understanding of anal fistula anatomy, to the use of energy devices and high-resolution imaging guidance, treatment goals have shifted from anatomical repair to functional restoration and quality-of-life improvement. This progression demonstrates both the preservation of traditional wisdom and the pursuit of rational surgical innovation. This article systematically reviews the evolution of concepts, techniques, and approaches in benign anorectal disease management, and discusses the value of multidisciplinary collaboration and individualized clinical decision-making.

Objective: To investigate the clinical efficacy and safety of laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD) and to analyze risk factors for postoperative recurrence in male patients. Methods: A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure in the Anorectal Department of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine between March 2019 and December 2024. Perioperative outcomes and postoperative recurrence were analyzed. The cohort included 313 males and 56 females, with 43 patients aged ≤18 years. The median body mass index was 26.3 (IQR: 22.9, 29.6) kg/m², and the median disease duration was 28 months (IQR: 4, 76). Among them, 218 male SPD patients who underwent surgery received preoperative sex hormone testing. A logistic regression model was used to analyze the risk factors for recurrence. Results: All patients completed the surgery. The median intraoperative ablation energy delivered was 426.8 (IQR: 243.9, 683.9) J, with no occurrence of major intraoperative complications. Postoperatively, a total of 31 patients (8.4%) required analgesic medication. Within the first postoperative week, 12 patients experienced wound oozing/bleeding; hemostasis was achieved by compression alone in 5 cases, while the remaining 7 instances required suture hemostasis after failed compression attempts. No other complications were observed. The median postoperative hospital stay was 6 (IQR: 4, 8) days, and the median time to return to regular work and life was 7 (IQR: 5, 12) days. The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male. Multivariate logistic regression analysis identified age ≤18 years (OR = 4.764, 95%CI: 2.424-34.905, P = 0.008) and a history of previous SPD surgery (OR = 5.078, 95%CI: 1.431-18.019, P = 0.012) as independent risk factors for recurrence after SPD laser ablation and closure surgery. Conclusion: Laser ablation and closure are safe, effective, and minimally invasive treatments for SPD. However, particular attention should be paid to the risk of recurrence in young male patients and those with a history of previous SPD surgery.

In recent years, the proportion of early gastric cancer and proximal gastric cancer has risen, and function-preserving gastrectomy has received increasing attention. Proximal gastrectomy has also been highly valued. Reflux esophagitis is an issue that cannot be ignored in the reconstruction of the digestive tract after proximal gastrectomy. For this reason, a series of anti-reflux surgical methods have emerged and been applied in clinical practice. Jejunal interstitial reconstruction is one of the widely used anti-reflux surgical methods in clinical practice at present, but there is a lack of standardized guidance in terms of application indications and operation procedures. This consensus was formulated based on the latest evidence-based medical evidence and after multiple expert discussions, aiming to provide reference and guidance for clinicians in choosing proximal gastrectomy and jejunal interstitial reconstruction.

Objective: To evaluate the application value of a digital technology-based multiparameter vital signs monitoring system in perioperative comprehensive full-cycle surveillance. Methods: A comprehensive multidimensional vital signs monitoring system was developed through the integration of medical-grade wireless wearable devices, incorporating patch-type ambulatory electrocardiographic monitor, continuous glucose monitoring sensor, pulse oximeter, wireless digital thermometer, smart wristband, and bioelectrical impedance analyzer. This system facilitates continuous real-time acquisition of multiple physiological parameters including electrocardiogram, blood glucose, oxygen saturation, body temperature, physical activity, and body composition indices. The acquired data were systematically integrated and analyzed through a four-level digital architecture consisting of nurse mobile interfaces, bedside patient terminals, centralized ward monitoring displays, and hospital management information systems. One patient with gastric cancer complicated by diabetes mellitus was selected for full-cycle digital monitoring from preoperative evaluation to hospital discharge. The technical performance of the monitoring system was assessed in terms of data acquisition continuity and timeliness of abnormal event alerts. Results: The monitoring system effectively identified early postoperative abnormalities, such as decreased oxygen saturation and blood glucose fluctuations, providing timely guidance for clinical intervention. The built-in algorithm enabled visualization of perioperative stress levels through heart rate variability indices and continuous glucose monitoring data. The patient demonstrated good compliance with early postoperative mobilization, and the satisfaction score for monitoring management was 4 points based on the Likert 5-point scale. Conclusions: The multiparameter vital signs monitoring system enhanced the precision of perioperative management through continuous and dynamic physiological status assessment. Its modular design aligns with the principles of enhanced recovery after surgery, offering a novel technological solution for intelligent perioperative management.

The integration of immunotherapy into neoadjuvant treatment for locally advanced rectal cancer has markedly increased complete response rates, offering greater potential for organ preservation. However, the reduced restaging accuracy after immunotherapy has limited the applicability of the watch-and-wait strategy. As an organ-preserving approach that enables residual lesion removal and pathological assessment, local excision not only reduces the risk of local regrowth associated with watch-and-wait, but also enables full-thickness tumor bed sampling to determine pathological stage, regression pattern, and molecular characteristics, thereby supporting risk stratification and individualized decision-making. Moving forward, local excision is expected to achieve precise, risk-adapted organ preservation by optimizing surgical timing and techniques, and integrating multimodal parameters including imaging, pathology, and the tumor microenvironment, ultimately attaining the dual aim of maximizing both oncologic efficacy and functional preservation.