目的 探讨双吻合器法回肠储袋肛管吻合治疗溃疡性结肠炎的临床疗效。方法 回顾性分析采用双吻合器法回肠储袋肛管吻合治疗11例溃疡性结肠炎患者的临床资料。 结果 手术时间（4.5±1.7）h（2.5～6.0h）， 出血量（470±120）ml （200～800ml），住院时间（16±5.9） d （14～27d）。所有患者均获随访，随访时间为（31.3±5.7）个月（6～42个月）。 随访期内肛门功能恢复满意；主要并发症包括切口相关并发症5例，腹痛伴间断便血4例，储袋炎4例，肠梗阻3例，吻合口漏1例。 结论 双吻合法回肠储袋肛管吻合是治疗溃疡性结肠炎的有效手段，合理选择手术时机及方式可有效降低术后并发症的发生。
Objective To overview the systematic review(SR) of efficacy and safety of fecal microbiota transplantation (FMT) in clostridium difficile infection (CDI). Methods PubMed, The Cochrane Library, EMbase, CNKI, VIP, WanFang Data databases and related website (http://scholar.google.com/) were electronically searched to collect SR and meta-analysis on FMT of CDI. The quality of collected documents and evidences were evaluated by OQAQ (Overview Quality Assessment Questionnaire) and GRADE (Grading of Recommendations Assessment, Development and Evaluation), respectively. Results Eleven SRs were included, in which 4 were completed by meta-analysis. The results of OQAQ showed that the score of one review was 2, the others SR received scores from 5 to 9. There were 9 SRs had reported the CDI clinical resolution rate (CRR), of which one SR showed CRR was 36.2%, and the others showed CRR were about 90%. Compared to upper gastrointestinal FMT, all studies showed lower gastrointestinal FMT (colonoscopy, enemas, etc.) had a higher CRR. The outcomes of selection and random fecal donor had no significant differences, and authors suggested that there should be made a standardization of donor screening table for safe fecal. Present evidence showed FMT were safety, and the majority of adverse events of FMT appeared to be mild, self-limiting and gastrointestinal in nature. The GRADE quality level of SR indicated from very low to moderate. Conclusion FMT, as a treatment for CDI, shows significant efficacy and safety, but need more high-level evidences because of its clinical translation difficulties. The study also give a reference to develop standardized clinical pathways of FMT to policy researchers.
ObjectiveTo summarize the recent progress in studies of intestinal immunity in inflammatory bowel disease (IBD). MethodsThe literatures on studying the intestinal immunity in IBD, including ulcerative colitis and Crohn disease were reviewed and analyzed. ResultsIBD comprised two main diseases that cause inflammation of the intestines: ulcerative colitis and Crohn disease. Although the diseases had some features in common, there were some important differences in clinical symptoms and pathological features. Accumulating evidence suggested that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Immunity studies highlighted the importance of host-microbe interactions in the pathogenesis of these diseases. Prominent among these findings were genomic regions containing nucleotide oligomerization domain 2 (NOD2), autophagy genes, miRNAs, and components of the interleukin-23/type 17 helper T-cell (Th17) pathway. The disfunction of the intestinal microbiome, intestinal epithelium, intestinal immune cells, and the intestinal vasculature played a key role in the process of IBD. The treatment with monoclonal antibody had been introduced to treat IBD and had been certificated effective. ConclusionThe study of basic intestinal immunity and regulation network of molecules in pathogenic process of IBD provides theory basis on prevention of IBD, while related genes of IBD can offer more gene therapy targets.
ObjectiveTo systematically review the methodological quality of clinical practice guidelines (CPGs) on the management of acute gastroenteritis/diarrhea in children, then to compare differences and similarities of drug recommendations, in order to provide references for clinical practice. MethodsGuidelines concerning acute gastroenteritis/diarrhea in children were searched in CNKI, VIP, WanFang Data, CBM, PubMed and EMbase databases from inception to April 2015. The websites of GIN (Guidelines International Network), CGC (China Guideline Clearinghouse), NGC (National Guideline Clearinghouse), APP (American Academy of Pediatrics), NICE (National Institute for Health and Clinical Excellence) and the WHO (World Health Organization) were also searched for additional guidelines. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations of included guidelines were compared. ResultsA total of 9 guidelines on acute gastroenteritis/diarrhea in children were included. Among them, 3 guidelines were developed by USA, 1 by Malaysia, 1 by EU, 1 by UK, 1 by South Wales, 1 by Australia and 1 by South Africa. Five guidelines were evidence-based guidelines, and the other 4 were non-evidence-based guidelines. The average scores of guidelines in six domains of AGREE Ⅱ were 79% (clarity of presentations), 74% (scope and purpose), 44% (stakeholder involvement), 35% (rigor of development), 32% (applicability), and 30% (editorial independence), respectively. The recommendations of management and treatment were almost consistent. ConclusionThe overall quality of included guidelines was not high. The domain scores of "clarity of presentations" and "scope and purpose" were higher, but the domain scores of "stakeholder involvement", "rigor of development", "applicability" and "editorial independence" needed to be improved. There is still no local guideline of acute gastroenteritis/diarrhea in children in China, so it's urgent to develop guideline that should be suite able for Chinese condition.
ObjectiveTo systematically review the correlation between acute gastrointestinal infection and IBS. MethodsLiterature search was performed in The Cochrane Library (Issue 8, 2013), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data to collect the prospective cohort studies about association between acute gastrointestinal infection and IBS, from inception to August 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality using NOS, and then Meta analysis was conducted using RevMan 5.2 software. ResultsA total of 11 cohort studies involving 6 274 patients were included. According to the different follow-up times for subgroup analysis, the results of meta-analysis showed that, compared with the healthy volunteers who did not expose the acute gastrointestinal infection, the patients with acute gastroenteritis had a increase risk of irritable bowel syndrome within 3 months, 6 months, 12 months, and 2-3 years (3 months: RR=6.46, 95%CI 1.85 to 22.58, P=0.003; 6 months: RR=4.68, 95%CI 2.07 to 10.60, P=0.000 2; 12 months: RR=4.95, 95%CI 2.90 to 8.45, P < 0.000 01; 2-3 years: RR=3.11, 95%CI 2.72 to 3.56, P < 0.000 01). However, after the fifth year of acute gastroenteritis, there was no statistical significance in the risk of irritable bowel syndrome between the two groups (RR=1.69, 95%CI 0.68 to 4.24, P=0.26). ConclusionAcute gastrointestinal infection within 3 years after onset was associated with the risk of IBS. Sex, diarrhea duration, bloody purulent stools and abdominal cramps at acute stage are important risk factors of intriguing the occurrence of post-infectious IBS. The acute gastrointestinal infection and IBS are not associated in the fifth year; however, more high-quality trials are needed for further verifying the aforementioned conclusion.
目的 简化全大肠切除回肠贮袋肛管吻合术，避免全大肠切除术时腹壁回肠造瘘。方法 采用全大肠切除直肠肌鞘内回肠肛管吻合改进术式治疗25例家族性腺瘤性息肉病及1例溃疡性结肠炎患者，并进行了定期随访。结果 术后1年患者的肛门功能恢复正常，大便1～4次/天，可正常参加工作； 除2例发生术后早期不完全性小肠梗阻和1例癌变患者术后发生性功能障碍外无其它并发症。结论 该术式具有技术简单、病变切除彻底、无回肠造袋、不需要回肠造瘘、直视下剥离粘膜完全、止血操作容易、并发症少、术后肛门功能满意等优点。