|
|
|
题名
|
作者
|
年代
|
出处
|
被引量
|
| 1 | Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse显示文摘External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented. | Jan J van Iersel Tim JC Paulides Paul M Verheijen John W Lumley Ivo AMJ Broeders Esther CJ Consten | 2016 | World Journal of Gastroenterology2016，22，21： | 20 |
| 2 | Validation of a new scoring system: Rapid assessment faecal incontinence score显示文摘AIM: To implement a quick and simple test- rapid assessment faecal incontinence score(RAFIS) and show its reliability and validity.METHODS: From March 2008 through March 2010, we evaluated a total of 261 consecutive patients, including 53 patients with faecal incontinence. Demographic and comorbidity information was collected. In a single visit, patients were administered the RAFIS. The results obtained with the new score were compared with those of both Wexner score and faecal incontinence quality of life scale(FIQL) questionnaire. The patient withoutinfluence of the surgeon completed the test. The role of surgeon was explaining the meaning of each section and how he had to fill. Reliability of the RAFIS score was measured using intra-observer agreement and Cronbach's alpha(internal consistency) coefficient. Multivariate analysis of the main components within the different scores was performed in order to determine whether all the scores measured the same factor and to conclude whether the information could be encompassed in a single factor. A sample size of 50 patients with faecal incontinence was estimated to be enough to detect a correlation of 0.55 or better at 5% level of significance with 80% power.RESULTS: We analysed the results obtained by 53 consecutive patients with faecal incontinence(median age 61.55 ± 12.49 years) in the three scoring systems. A total of 208 healthy volunteers(median age 58.41 ± 18.41 years) without faecal incontinence were included in the study as negative controls. Pearson's correlation coefficient between 'state' and 'leaks' was excellent(r = 0.92, P < 0.005). Internal consistency in the comparison of 'state' and 'leaks' yielded also excellent correlation(Cronbach's α = 0.93). Results in each score were compared using regression analysis and a correlation value of r = 0.98 was obtained with Wexner score. As regards FIQL questionnaire, the values of 'r ' for the different subscales of the questionnaire were: 'lifestyle' r =-0.87, 'coping/behaviour' r =-0.91, 'depression' r =-0.36 and 'embarrassment' r =-0.90,(P < 0.01). A multivariate analysis showed that all the scoring systems measured the same factor. A single factor may explain 80.84% of the variability of FI, so all the scoring systems measure the same factor. Patient's continence improves when RAFIS and Jorge-Wexner scores show low values and when the values obtained in the FIQL questionnaire are high.CONCLUSION: RAFIS is a valid and reliable tool to assess Faecal Incontinence. | Fernando de la Portilla Arantxa Calero-Lillo Rosa M Jiménez-Rodríguez Maria L Reyes Manuela Segovia-González María Victoria Maestre Ana M García-Cabrera | 2015 | World Journal of Gastrointestinal Surgery2015，7，9： | 5 |
| 3 | Prospective evaluation of a new device for the treatment of anal fistulas显示文摘AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5(range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion(on the 10 th postoperative day), the persistence of inflammatory tissue around the fistula tract(at the 2-mo follow up), and the persistence of serum discharge(at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results. | Carlo Ratto Francesco Litta Lorenza Donisi Angelo Parello | 2016 | World Journal of Gastroenterology2016，22，30： | 2 |
| 4 | Sphincter lesions observed on ultrasound after transanal endoscopic surgery显示文摘AIM: To assess the morphological impact of transanal endoscopic surgery on the sphincter apparatus using the modified Starck classification. METHODS: A prospective,observational study of 118 consecutive patients undergoing Transanal Endoscopic Operation/Transanal Endoscopic Microsurgery(TEO/TEM) from March 2013 to May 2014 was performed. All the patients underwent an endoanal ultrasound prior to surgery and one and four months postoperatively in order to measure sphincter width,identify sphincter defects and to quantify them in terms of the level,depth and size of the affected anal canal. To assess the lesions,we used the 'modified' Starck classifi-cation,which incorporates the variable 'sphincter fragmentation'. The results were correlated with the Wexner incontinence questionnaire.RESULTS: Of the 118 patients,twelve(sphincter lesions) were excluded. The results of the 106 patients were as follows after one month: 31(29.2%) lesions found on ultrasound after one month,median overall Starck score of 4(range 3-6); 10(9.4%) defects in the internal anal sphincter(IAS) and 3(2.8%) in the external anal sphincter(EAS); 17 patients(16%) had fragmentation of the sphincter apparatus with both sphincters affected in one case. At four months: 7(6.6%) defects,all in the IAS,overall median Starck score of 4(range 3-6). Mean IAS widths were 3.5 mm(SD 1.14) preoperatively,4.38 mm(SD 2.1) one month postoperatively and 4.03 mm(SD 1.46) four months postoperatively. The only statistically significant difference in sphincter width in the IAS measurements was between preoperatively and one month postoperatively. No incontinence was reported,even in cases of ultrasound abnormalities.CONCLUSION: TEO/TEM may produce ultrasounda b n o r m a l i t i e s b u t t h i s i s n o t a c c o m p a n i e d b y clinical changes in continence. The modified Starck classification is useful for describing and managing these disorders. | Laura Mora López Xavier Serra-Aracil Salvador Navarro Soto | 2015 | World Journal of Gastroenterology2015，21，46： | 0 |
您所在的机构暂未开通此部分的功能，请联系管理员