Objective To study the feasibility, surgical techniques, and results of submental island flaps for reconstruction of hypopharyngeal noncircumferential defects. Methods A retrospective review of the archives was performed on 16 patients（6 males, 10 females, aged 41-78 years）who suffered from hypopharyngeal cancer. From August 1998 to August 2002, the patients underwent a partial removal of the hypopharynx and reconstruction by submental island flaps. Their hypopharyngeal carcinomas belonged to squamous carcinoma. Of the 16 patients (2 in UICC clinical stage Ⅱ, 11 in Ⅲ, 3 in Ⅳ), 9 had their pathologicalorigin in the pyriform sinus, 4 in the posterior pharyngeal wall, and 3 in the postcricoid. The flap area ranged from 8.0 cm×4.5 cm to 5.0 cm×3.0 cm. Results The follow-up for 3-7 years showed that the submental island flaps healed well in all patients with a success rate of 100%. The swallowing function returned to normal 1014 days after operation without complications of salivary fistula and infection. The 3-year and 5-year survival rates were 68.8% (11/16) and 62.5% (5/8), respectively. Conclusion Submental island flaps are convenient for reconstruction of hypopharyngeal noncircumferential defects, and they are safe and reliable, too.
Objective To evaluate the value of magnetic resonanace imaging (MRI) on the diagnosis of complex anal fistula. Methods The preoperative digital examination and MRI with the phased-array coil were implemented for 22 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results. Results Eighteen patients were diagnosed as complex anal fistula, 1 case of presacral cyst and 3 cases of chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI, while the patients with presacral cyst and perinaal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients suffered from transsphincteric fistula, 11 cases of supra-sphincteric and 5 cases of extra-sphincteric fistula. The diagnosis rates of the internal opening with digital examination and MRI were 33.3% and 72.2%, the rates of the primary tract were 83.3% and 100%, and the rates of the secondary extensions were 16.7% and 88.9%, respectively. The differences in detection of internal opening and secondary extensions between MRI and digital examination were significant (P=0.019, P=0.000), the difference in detection of primary tract was no significant (P=0.072). Conclusion MRI with the phased-array coil can develope the high accuracy in the diagnosis of complex anal fistulas, and reveal the relationship between anorectal sphincters and the complex fistula.
Objective To investigate the clinical efficacy of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids. Methods Seventy patients with Ⅲ-Ⅳ internal henmorrhoids and mixed hemorrhoids who were admitted into Jiangsu Provincial Hospital of Traditional Chinese Medicine form June 2015 to June 2016 were enrolled. The patients were randomly divided into two groups: the combined operativ group and control group. The combined operativ group in which 35 cases were treated by pouched suture plus external dissection and internal ligation, and the control group in which 35 cases were treated by external dissection and internal ligation. The wound healing time, clinical curative effect, hospital stay, the operative time and postoperative complications (postoperative pain, edema, postoperative bleeding volume, urination difficulties, residual skin tag, anorectal stenosis) between two groups were compared. Results No significant difference were found in the clinical curative effect, the operative time and anorectal stenosis in two groups (P>0.05). The visual analogue scale (VAS) scores and the edema scores of the combined operativ group on the first day, the third day, and the fifth day after operation were lower than those of control group, the difference was statistically significant (P<0.05), while there were no statistically significant on the seventh day after operation in two groups (P>0.05) . The wound healing time, hospital stay, postoperative bleeding volume, urination difficulties, and residual skin tag in the combined operativ group were significantly shorter or lower than those in the control group (P<0.05). Conclusion Pouched suture plus external dissection and internal ligation has the advantages of less pain, fewer complications and quicker recovery, it also meets the modern concept of minimally invasive, so it is worthy of popularization and application.
Objective To explore the clinical characteristics of Crohn’s disease (CD) with perianal fistula by analyzing the clinical data of them. Methods A total of 139 cases of CD with perianal fistula who got treatment from January 2010 to January 2017 in The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were analyzed retrospectively. Results The proportion of males and females in 139 patients was about 3.3∶1.0, the age was (28±8) years, and 47.5% of patients had perianal fistula before CD diagnosis. The percents of patients with perianal surgery history and medication history were 64.7% and 74.1%, respectively. The ratio of L3 type (diseased position) was 49.6%. The ratios of inflammatory type (B1 type) and stenotic type (B2 type) of the disease were 51.8% and 41.0%, respectively. The complex perianal fistula accounted for 90.6%, and 31.7% of patients combined analrectal stricture. Symptoms of diarrhea were found in 46.0% of patients and perianal lesions alone in 29.5% of patients; 54.0% of patients combined with abnormal BMI; 64.7% of patients were in the active stage of Crohn’s disease activity index (CDAI) and 94.2 % of patients were in the active period of perianal disease activity index (PDAI). The patients with erythrocyte sedimentation rate (ESR) higher than normal were 53.2%. The results of logistic showed that, age and degree of CDAI were influencing factors for CD with stenosis of perianal fistula. Conclusions Characteristics of patients with CD combined with perianal fistula include: young, men predominant, high prevalence of ileocolic position involvement, as well as inflammation and stenosis disease behavior. Fistula symptoms often preced the intestinal symptoms and diarrhea is the most common intestinal performance. History of perianal abscess and fistula operation are common. The anorectal stricture are complicated usually. Intestinal inflammation is active. Some patients show abnormal laboratory indicators of inflammation. This suggests that patients with perianal fistula with these clinical features should be alert to the possibility of CD, so as toavoid the consequences of blind surgery. The higher CDAI score and the older the diagnosis age, the higher the risk ofrectal stenosis.
Objective To explore the effect of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease (CD). Methods Thirty cases of CD combined with anal fistula admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2015 to July 2017 were collected prospectively, 12 cases were divided into experimental group and 18 cases were divided into control group. Cases of the experimental group received demolition of drainage seton+IFX+local injection of high concentration of glucose treatment, cases of the control group received the drainage setons removing+IFX only. Before treatment, and at 6, 14, 22, and 30 weeks after IFX treatment, the laboratory indicators of the 2 groups were detected, and BMI, Crohn’s diseaseactivity index (CDAI), perianal disease activity index (PDAI), and clinical efficacy were evaluated. Results Therewas no significant difference on the group effect and interaction of group and time (P>0.05), but time (P<0.05). Both in the experimental group and the control group, compared with before treatment group, the counts of WBC and platelet, levels of C reaction protein (CRP) and erythrocyte sedimentation rate (ESR), CDAI, and PDAI at 6 months after IFX therapy decreased and maintained at the latter period, but the level of hemoglobin (Hb) and BMI increased at 6 weeks after IFX therapy and maintained at the latter period. On the clinical effect, there was no significant difference at the time points of 14, 22, and 30 weeks of IFX therapy (P>0.05). Conclusion The treatment of local injection of high concentration of glucose when removing setons has not shown any positive effect to CD combined with anal fistula, this conclusion needs to be further studied.
ObjectiveTo investigate long-term efficacy of infliximab (IFX) combined with seton placement in treatment of perianal fistulizing Crohn disease (CD) and to analyze factors affecting its clinical healing and recurrence.MethodsThe patients with perianal fistulizing CD underwent the IFX combined with seton placement therapy from July 2010 to January 2017 were collected from the HIS database of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The healing and recurrence of perianal fistulizing CD were counted and their influencing factors were analyzed.ResultsA total of 103 patients with perianal fistulizing CD were included in the study. After a median follow-up of 36 months, 64 patients (62.1%) had a complete fistula healing, 34 patients (33.0%) relapsed. The cumulative recurrence rates of fistula in the 1, 3, and 5 years was 21.8%, 32.6%, and 37.4%, respectively. The multivariate analysis showed that the Montreal classification B1 ［HR=3.987, 95% CI (1.640, 9.694), P=0.023］ and without abscess ［HR=2.724, 95% CI (1.101, 6.740), P=0.030］ were positively associated with the long-term healing of fistula, and the IFX maintenance treatment >3 times ［HR=5.497, 95% CI (1.197, 25.251), P=0.028］ was a risk factor for the recurrence of the fistula.ConclusionsLong-term healing rate of fistula by IFX combined with seton placement therapy is higher. Montreal classification B1, without abscess, and IFX maintenance treatment less than 3 times are expected to have a better long-term efficacy.