中华胃肠外科杂志最新文献

Although the surgical treatment of slow transit constipation (STC) has been around for over a century, the choice of surgical method is still controversial. Specifically, the two most widely used operations in the world are total colectomy ileorectostomy (TC-IRA) and subtotal colectomy. Subtotal colectomy offers many methods for anastomosis, including ileocecal and cecorectal anastomoses and so on. Cecorectal anastomosis can be divided into two types: isoperistaltic anastomosis and antiperistaltic anastomosis. It is generally believed that total colectomy provides definitive effects but results in more severe postoperative diarrhea, while subtotal colectomy may reduce postoperative diarrhea but potentially increase the risk of constipation recurrence. Most studies of these surgical methods are retrospective small-sample studies with low-quality evidence. This is also one of the reasons for the lack of STC gold standard surgery in clinical practice. This paper discusses the selection of surgical methods for intractable slow transit constipation (STC) based on a review of literature published within the past 10 years, as well as our team's extensive 33-year experience in diagnosing and treating constipation surgically.

Objective: To evaluate the clinical efficacy of modified endoscopic mucosal resection (EMR) in the management of early gastrointestinal lesions. Methods: Upon endoscopic identification of the lesion, normal saline is injected into the submucosa to establish a fluid cushion, which elevates the lesion's mucosa. Methylene blue may also be applied to improve visualization of the relationship between the submucosa and muscular layer. A snare with a tip diameter of 2-3 mm is utilized to circumferentially incise the mucosal layer at the lesion's edge, forming a circular groove. The snare is anchored within this groove, allowing for complete resection of the lesion in a single step. The procedure involves a slow and alternating technique of electrosurgical cutting and coagulation to minimize bleeding risks, while upward tension on the snare during cutting reduces perforation risks. Direct coagulation of exposed blood vessels is performed using the snare tip, and hemostatic clips are applied to larger defects; nylon sutures may be utilized for substantial wounds. Results: Between June 2015 and April 2024, modified EMR was performed on 65 patients with early gastrointestinal lesions at Dongguan Children's Hospital, Guangdong Medical University. The mean operative time was (15.2 ± 3.1) minutes, with a complete resection rate of 100% and negative margins confirmed. Postoperative complications included one case each of delayed bleeding and electrosurgical syndrome. The average cost of consumables was (1887.2±187.6) yuan. Follow-up colonoscopies at 3 and 6 months postoperatively indicated no recurrences. Conclusions: Modified EMR demonstrates a short operative time, high safety and efficacy, and reduced material costs in the treatment of early gastrointestinal mucosal lesions.

Hemorrhoids, anal fissure, anal fistula and perianal abscess are the most common benign diseases around the anus, which obviously affect people's life and work, and need to be well diagnosed and treated. Based on damage control, the treatment principle is to eliminate relevant disease symptoms and protect the anal function at the same time. Perianal benign diseases are common and frequently occurring, which can be diagnosed and treated in many non-specialist hospitals. Therefore, there is great heterogeneity in the level of diagnosis and treatment, and related complications may occur due to iatrogenic factors such as the selection of treatment strategies, resulting in certain medical risks and subsequent passive treatment. Conservative treatment of internal hemorrhoids at degree I-II and acute anal fissure can achieve good results; internal hemorrhoids at degree III-IV, external hemorrhoids, anal fistula and perianal abscess can only be cured by surgery. The surgeon should pay attention to the protection of anal pad tissue and sphincter function to prevent serious complications such as postoperative anal stenosis and defecation dysfunction. It is imperative to accurately evaluate the specific clinical characteristics of each patient, formulate individualized treatment plans, and combine multiple treatment approaches.

Pelvic floor biofeedback is a major non-surgical treatment for anorectal dysfunction and has been recommended in several foreign guidelines. There is no consensus on the clinical practice of pelvic floor biofeedback in China currently. There are controversies in indications, contraindications and formulation of protocols. Launched by Pelvic Floor Medicine Specialty Committee of World Federation of Chinese Medicine Societies and Anorectal Branch of Chinese Medical Doctor Association, Chinese experts on this field were convened to write the Chinese expert consensus on pelvic floor biofeedback for anorectal dysfunction based on relevant references and combined the latest evidence and experts' clinical experience. This consensus recommends that before the use of pelvic floor biofeedback therapy, the patient's condition and pelvic floor function should be fully evaluated, and the guiding role of doctors and pelvic floor therapists should be emphasized to guide the standardized use of pelvic floor biofeedback therapy.

Horseshoe anal fistula is one of the most challenging subtypes of complex anal fistulas, closely related to the failure of anal fistula surgery and postoperative recurrence. Accurate preoperative assessment, correct classification, and appropriate surgical plans are crucial for improving treatment efficacy. This article primarily explores the clinical classification of horseshoe anal fistulas and the applicability of mainstream surgical techniques in different types of horseshoe anal fistulas, focusing on their cure rates, recurrence rates, and fecal continence, to assist surgeons to make reasonable surgical plans when treating horseshoe anal fistulas.

Chronic constipation is a common functional bowel disease, and its diagnosis is based on history and physical examination. Laboratory examination is important for determining the cause, type, severity and treatment effect of chronic constipation. At present, the commonly used workup of chronic constipation includes X-ray, magnetic resonance, pelvic floor ultrasound, neuroelectrophysiology and colorectal manometry, etc., which are recommended in many constipation diagnosis and treatment guidelines, but there has been no consensus on various examination indications, examination methods, judgment criteria and clinical value norms in detail. Led by the Anorectal Physicians Branch of the Chinese Medical Doctor Association, the editorial department of the Chinese Journal of Gastrointestinal Surgery convened domestic experts in related fields to summarize and sort out common laboratory examination methods for chronic constipation in combination with the latest evidence-based medical evidence at home and abroad, and conducted evidence quality assessment and recommendation strength classification according to the GRADE system. The Chinese Expert Consensus on the Examination and Evaluation of Chronic Constipation (2024 edition) was thus formed to help and guide the standardized examination in clinical practice and accurately interpret its clinical value.

Benign anorectal diseases represent a prevalent and intricate category of gastrointestinal disorders, encompassing conditions such as anal fissures, fistulas, hemorrhoids, incontinence, pain, and defecation disorders. These conditions include both anatomical abnormalities and functional disorders. Some patients continue to experience discomfort such as perianal discomfort, perineal heaviness, defecation difficulties, and abdominal bloating even after anatomical issues have been addressed, severely impairing social functioning. Generally, colorectal surgeons have paid little attention to somatic symptom disorder (SSD). This article introduced the manifestation of SSD in benign anorectal diseases from a psychosomatic perspective, advocating for the establishment of a biopsychosocial medical model in the diagnosis and treatment of these conditions to enhance patient rehabilitation outcomes. It is recommended that when benign anal diseases coexist with psychological disorders, SSD treatment should be used as a prerequisite. Surgical treatment should be considered only after the improvement of psychological disorders and SSD.