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Diagnosis and Treatment Experience of 84 Patients with Sacrococcygeal Pilonidal Sinus

Objective　To summarize the methods of diagnosis and treatment for sacrococcygeal pilonidal sinus. Methods　The processes of diagnosis and treatment for 84 patients with sacrococcygeal pilonidal sinus were analyzed retrospectively. The incision and primary suture with mattress-suture and exterminated dead space was performed in 36 patients （without recurrence and the length of fistulous tract was less than 5 cm）. The sinus resection and incision open surgery with excision of fully pathology tissue and regional treatment with Kangfuxin liquid was performed in 48 patients （with recurrence and the length of fistulous tract was more than 5cm）. Results　Two cases were recurrent after half a year and cured with sinus resection and incision open surgery and regional treatment with Kangfuxin liquid in the incision and primary suture group. The others were disposable healing. The healing time in the incision and primary suture group was from 14 to 35d， the mean time was 26d， which in the other group was from 30 to 45d， the mean time was 37d. Follow-up for more than one year， none of recurrence happened. Conclusion　Perfecting inspection before surgery， clarifying a diagnosis， choosing a suitable surgical treatment， and perioperative care could cure the disease and extremelyreduce recurrence.

Value of Fecal Calprotectin in Activity Evaluation of Ulcerative Colitis

Objective　To explore the value of fecal calprotectin （FCP） in the activity evaluation for ulcerative colitis （UC）. Methods　Sixty three patients with UC （UC group） and 30 patients with gastrointestinal symptoms but without abnormal results of colonoscopy （control group）， who were treated in The Forth Affiliated Hospital of China Medical University between Sep. 2007 to Dec. 2009 were enrolled to examine the FCP， C-creative protein （CRP）， and erythrocyte sedimentation rate （ESR）. Then comparison between UC group and control group was performed. Results　Levels of FCP and CRP in active gradeⅠ，Ⅱ， and Ⅲ group were all significantly higher than those of control group and inactive UC group （P＜0.05）， with the increase of active grade of UC， the level of FCP gradually increased （P＜0.05）. The levels of CRP in active grade Ⅱ and Ⅲ group were all significantly higher than those of gradeⅠgroup （P＜0.05）， but didn’t differed between active grade Ⅱ and Ⅲ group （P＞0.05）. There were no significant difference among 5 groups on ESR （P＞0.05）. Levels of FCP （rs=0.807， P＜0.01）， CRP（rs=0.651， P＜0.01）， and ESR （rs=0.371， P＜0.05） in active grade group were significantly related to histological grade under colonoscopy. Conclusion　FCP examination is simple， inexpensive， repeatable， and noninvasive， and FCP can be used as an marker of activity evaluation in UC.

Curative Effect of PPH Combining with Shaobei Injection on Moderate and Severe Degree Rectocele

目的評價痔上黏膜環切術（PPH)加芍倍注射術治療中重度（排糞造影檢查提示突出深度大于16 mm）直腸前突的療效。方法回顧性分析我院2006年12月至2010年9月期間應用PPH加芍倍注射術治療的45例中重度直腸前突患者的臨床資料，分析其手術時間、住院時間及復發和并發癥發生情況。結果本組患者手術時間為(18.8±2.2) min （15～25 min），住院時間為(7.2±0.6) d (6～8 d)。術后隨訪(12.3±6.6)個月(6～30個月)。34例(75.6%)排便費力、肛門堵塞、下墜等不適癥狀完全緩解; 10例(22.2%)癥狀明顯緩解，有輕度肛門下墜感，可忍受; 1例(2.2%)術后排便困難癥狀緩解，但肛門下墜感明顯，6個月后緩解。1例(2.2%)于術后25個月再次出現排便費力癥狀，排糞造影檢查提示直腸前突深度為17 mm(術前34 mm)。45例患者術中及術后均未發生大出血、直腸狹窄、直腸陰道瘺等并發癥。結論PPH加芍倍注射術治療中重度直腸前突具有創傷小、術后恢復快、療效顯著、并發癥少等優點，但是患者術后養成良好的排便習慣很重要。

Significance of Laboratory Examination in The Diagnosis of Ulcerative Colitis

ObjectiveTo summarize the significance of laboratory examinations in diagnosis of ulcerative colitis (UC). MethodsLiteratures at home and abroad were searched to review the clinical significance of laboratory examinations indexes in diagnosis of UC. ResultsAnti-neutrophilcytoplasmicantibodies (ANCA) had some value in diagnosis of UC, but it was limited in evaluation of UC in active patients. The positive rate of anti-intestinal goblet cell antibody (GAB) in patients with UC was higher than that of patients with Crohn's disease (CD), so it could be used as identification indexes of the two diseases, but it could not reflect the severity of the disease. Anti-saccharomyces cerevisiae antibodies (ASCA) and anti-pancreatic antibody (PAB) were mainly used in the differential diagnosis of UC and CD, but they had no significant advantages in diagnosis of UC. Fecal calprotectin (FCP) played a positive role in evaluation of recurrence and activity in UC. Although lactoferrin, M2-pyruvate kinase (M2-PK), and S100A12 were not as effective as FCP, but if combined with related indicators, they were also important. ConclusionsOf the relevant indexes of laboratory examination in the diagnosis of UC, FCP plays an importent role in the evaluation of recurrence and activity of UC.

The Diagnosis and Treatment of McKittrick-Wheelock Syndrome

Comparison of Procedure for Prolapse and Hemorrhoids and Block Repair Procedure in Treatment for Rectocele

Objective　To compare the therapeutic effect of procedure for prolapse and hemorrhoids （PPH） and Block repair procedure for rectocele．Methods　A retrospective study of 62 patients with surgical treatment for rectocele was analyzed．The patients were divided into PPH group （n=32） and Block group （n=30） according to the different operation procedure．The symptoms score of improvement of the patients after surgery was compared between the two groups， including operation time，intraoperative blood loss， postoperative pain score， required analgesic times， postoperative complications，hospitalization time，and hospitalization expenses．Results　The symptoms of constipation of patients in two groups was significantly improved afer operation．Comparing one month with three months of Longo’s obstructed defecation syndrome （ODS） score after the operation，there was no significant difference in the PPH group（P＞0.05）， but significant difference in the Block group（P＜0.01）．Although the expenses of the PPH group was much higher than that of the Block group （P＜0.01）， the outcomes of the PPH group were much better than those of the Block group （P＜0.01）， including the postoperative Longo’s ODS score of one month and three months，operation time，intraoperative blood loss， postoperative pain score，required analgesic times，and hospitalization time．Two cases of lightly postoperative incontinence occurred in the PPH group，but completely recovered after three months in the clinical follow-up．Conclusions　The PPH is as safe and effective as Block repair procedure for rectocele. The short time effect and lower recurrence rate of the PPH are better than those of the Block repair procedure．

A comparative study on the clinical efficacy and anorectal dynamics of two combined operations in the treatment of mixed hemorrhoids

ObjectiveTo study the curative effect and postoperative anorectal dynamics change of tissue-selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) respectively combined with mixed Milligan-Morgan and lauromacrgol injection in the treatment of Ⅲ–Ⅳ degree mixed hemorrhoid.MethodsClinical data of 158 patients with Ⅲ–Ⅳdegree mixed hemorrhoid who received operation in the Department of Colorectal and Anal Surgery, Chaoyang Central Hospital, from May 2016 to March 2018 were analyzed retrospectively, the observation group (TST+Milligan-Morgan+lauromacrgol injection, 80 cases) and control group (PPH+Milligan-Morgan+lauromacrgol injection, 78 cases). The clinical efficacy, adverse reactions, postoperative complications and recurrence of the two groups were observed, and the changes of anorectal dynamic indexes before and after operation were observed.ResultsPostoperative symptoms of mixed hemorrhoid prolapse could be alleviated by 100% in both the observation group and the control group, and the relief rate of hematochezia was 93.8% and 92.3%, respectively, and the effective rate of 1 year after surgery was 97.5% and 94.9%, respectively. Comparison between the two groups showed no statistical difference (P>0.05). The operative time, intraoperative blood loss, VAS pain score and hospital stay of the observation group were all better than those of the control group (P<0.05). In terms of postoperative massive hemorrhage and anastomotic stenosis, although the incidence rate of the control group was higher than that of the observation group (3.8% vs. 1.3% and 2.6% vs. 0.0%, respectively), there was no statistical significance in the two groups (P>0.05). Postoperative anal drop, stool urgency, postoperative urinary retention and postoperative stimulation of anal papilla hypertrophy and proliferation complications were significantly better in the observation group than in the control group (P<0.05). The difference of maximum anal systolic pressure (MASP) in the two groups of patients between before and after surgery and the comparison of MASP results between the two groups after surgery showed no statistical differences (P>0.05). The differences of resting anal sphincter pressure (RASP) and rectal sensory threshold volume (RSTV) between before and after operation were not statistically significant (P>0.05). The difference of rectal maximum threshold volume (RMTV) value and the comparison of RASP, RSTV and RMTV value between the two groups after surgery showed that the observation group were superior to the control group and the differences were statistically significant (P<0.05).ConclusionsTST or PPH combined with Milligan-Morgan and lauromacrgol injection both are effective and minimally invasive methods for the treatment of Ⅲ–Ⅳ degree mixed hemorrhoid. However, the observation group has shorter operative time and hospital stay, less intraoperative blood loss, and lower postoperative pain score. What is more important is that the postoperative complications are less and the anal function is protected to the maximum extent, and the quality of life of patients after operation is greatly improved.

吻合器痔上黏膜環形切除術輔助剪口結扎治療357例混合痔患者的長期療效評價

目的研究吻合器痔上黏膜環形切除術（PPH）輔助剪口結扎治療357例混合痔的長期療效。 方法回顧性分析2007年1月至2009年1月期間在中國醫科大學附屬第四醫院肛腸外科行PPH輔助剪口結扎治療的369例混合痔患者的臨床資料。觀察混合痔患者術后的排便疼痛、出血、肛門瘙癢等癥狀，隨訪至少5年并記錄痔復發、肛門狹窄、吻合口狹窄、肛門控便能力等情況。 結果最終完成隨訪患者有357例，所有患者均未發生陰道直腸瘺、陰道尿道瘺、排便失禁、吻合口大出血及吻合口感染并發癥，患者術后疼痛、出血、肛門瘙癢癥狀人數早期（術后6個月）與術前比較有明顯減少（P＜0.05），中長期（術后5年與術后1年）比較差異無統計學意義（P＞0.05），其5年隨訪改善率分別為94.9%、96.1%、96.6%。隨訪5年內痔復發患者12例（3.4%），外痔復發11例（3.1%），吻合口狹窄2例（0.6%），無肛門狹窄患者，無排便失禁患者。 結論PPH輔助剪口結扎治療混合痔安全、有效，長期復發率低。

Antiacute Rejection Effect of Pachymic Acid in Heart Transplantation Rats

Abstract: Objective To study the antiacute rejection effect of Pachymic acid (PA) in heart transplantation rats, in order to select a new antirejection medicine with low side effect from traditional Chinese medicine. Methods We established the model by transplanting Wistar rats (32,donor) heart allografts into the abdomen of SD rats (32,receptor). The homologous hearttransplanted rats were then randomly divided into 4 groups with 16 rats in each group. Olive oil solution with PA 1 mg/(kg·d), PA 10 mg/(kg·d), Cyclosporine (CsA) 5 mg/(kg·d) and olive oil solution 0.5 ml/(kg·d) were respectively given intragastrically to lowdosage PA group, highdosage PA group, CsA group and the control group till the end of observation. Survival time of heart allografts, heart beating and the histological changes of allografts were examined and serum level of interleukin2 (IL-2) and interferon-γ (IFN-γ) were determined by enzymelinked immunosorbent assay (ELISA). Results Survival time in the highdosage PA group, the lowdosage PA group and the CsA group were 24.90±0.99 d, 15.50±1.60 d and 26.80±0.88 d respectively, which is much better than the control group (6.10±1.10 d, q=22.363, P=0.000; q=44.793, P=0.000; q=49.272,P=0.000). IL-2 serum level in the highdosage PA group, the lowdosage PA group and the CsA group were all lower than that in the control group (q=14.483, P=0.000; q=3.705, P=0.000; =21.418,P=0.000), whileIL-2 serum level in the highdosage group was lower than that in the lowdosage group (q=10.778,P=0.000). Similarly, IFN-γ serum level in the first three groups were all lower than that in the control group (q=16.508,P=0000; q=4.281, P=0.000;q=19.621, P=0.000) and IFNγ serum level in the highdosage group was also lower than that in the lowdosage group (q=14.975, P=0.000). Pathological examination 7 days after the surgery showed that pathologic lesion was much more relieved in the two PA groups and the CsA group than the control group. Conclusion Acute rejection of heart transplantation can be effectively suppressed by PA.

Clinical Observation of Procedure for Prolapse and Hemorrhoids Combined with Shaobei Injection in Treatment for Patients with Rectocele

Objective　To evaluate the safety and efficacy of procedure for prolapse and hemorrhoids （PPH） combined with Shaobei injection in treatment for obstructed defecation syndrome （ODS） caused by rectocele. Methods　Seventy-two female patients with rectocele from December 2009 to January 2011 in this hospital were divided into PPH combined with Shaobei injection group （36 cases） and only PPH group （36 cases）. The Longo ODS score was performed on week one，month one，month three，and month six after operation，respectively；pain was evaluated， complications such as urine retention，postoperative bleeding，and anal function were observed；hospital stay and recovery work time were recorded in two groups. Results　All patients were followed up for 6 months，there were no significant differences in complications，hospital stay，and the Longo ODS score on week one and month one after operation between two groups （P＞0.05）. But the Longo ODS score of the PPH combined with Shaobei injection group on month three and month six after operation were significantly lower than those of the only PPH group （P＜0.05）. Conclusion　PPH combined with Shaobei injection has a better efficacy as compared with only PPH，and at least as safe as only PPH.