| Objective To observe the effects of different surgical method on the treatment of puborectalis syndrome and to provide clinical evidence for exploring a better surgical method of puborectalis syndrome.Methods Collected the clinical data of 98 cases that suffered from puborectalis syndrome and were completed operation and follow-up visits in the Department of General Surgery,Zhongnan Hospital of Wuhan University between January 2013 and December 2015.They were divided into two groups:group A(partial resection of puborectalis)and group B(partial resection of puborectalis combined with mutilation of internal anal sphincter)according to different operation methods.Group A was further divided into group A1(normal pressure)and group A2(high pressure)according to whether high anal resting pressure before operation.It was high anal resting pressure in the group B.Anorectal manometry,Defecography,Wexner constipation score and Cleveland Clinic incontinence score were completed before operation and postoperative 3 months.These score were finished again at 6 and 12 months follow-ups.SPSS 18.0 statistical software was used to analyze the changes of pre and postoperative indicators above and the surgical effects between groups.Results Each index comparison between groups of patients:Preoperative anal resting pressure was significant difference(t=24.88,P=0.00)between group A1(60.06±4.97 mmHg)and group A2(92.76±6.14 mmHg).But it was no significant difference(t=0.19,P=0.85)between group A2(92.76±6.14 mmHg)and group B(92.44±7.06 mmHg).Postoperative anal resting pressure was significant difference(t=27.31,P=0.00)between group A1(57.23±5.28 mmHg)and group A2(91.37±5.39 mmHg)and it was also difference(t=20.79,P=0.00)between group A2(91.37±5.39 mmHg)and group B(53.56±9.05 mmHg).Preoperative anal maximal squeeze pressure was no significant difference(t=0.56,P=0.58)between group A1(211.06±21.88 mmHg)and group A2(213.68±18.08 mmHg)and it was also no significant difference(t=0.57,P=0.57)between group A2(213.68±18.08 mmHg)and group B(210.88±20.56 mmHg).Postoperative anal maximal squeeze pressure was no significant difference(t=1.76,P=0.08)between group A1(137.54±10.54 mmHg)and group A2(142.39±12.61 mmHg)and it was also no significant difference(t=0.09,P=0.92)between group A2(142.39±12.61 mmHg)and group B(142.80±20.35 mmHg).At the resting state,preoperative anorectal angulation was no significant difference(t=0.24,P=0.81)between group A1(95.66±3.960)and group A2(95.87±3.53°)and it was also no significant difference(t=0.01,P=0.99)between group A2(95.87±3.53°)and group B(95.88±4.01°).Postoperative anorectal angulation was no significant difference(t=1.72,P=0.09)between group A1(103.23±5.44°)and group A2(100.87±3.75°)and it was also no significant difference(t=1.32,P=0.19)between group A2(100.87±3.75°)and group B(102.32±4.960).At the forced stool's state,preoperative anorectal angulation was no significant difference(t=0.08,P=0.94)between group A1(89.54±2.88°)and group A2(89.61±3.71°)and it was also no significant difference(t=0.09,P=0.93)between group A2(89.61±3.71°)and group B(89.52±3.25°).Postoperative anorectal angulation was no significant difference(t=0.49,P=0.62)between group A1(117.66±5.49°)and group A2(118.34±6.29°)and it was also no significant difference(t=0.29,P=0.77)between group A2(118.34±6.29°)and group B(117.88±5.95°).Each index comparison in groups before surgery and postoperative 3 months:In the group A1,anal resting pressure was no significant difference(t=1.83,P=0.07,60.06±4.97 mmHg vs.57.23±5.28 mmHg).But anal maximal squeeze pressure and anorectal angulation at the resting and forced stool's state were all significant difference(t=20.34,P=0.00,211.06±21.88 mmHg vs.137.54±10.54 mmHg;t=10.59,P=0.00,95.66±3.96° vs.103.23±5.44°;t=28.12,P=0.00,89.54±2.88° vs.117.66±5.49°).In the group A2,anal resting pressure was no significant difference(t=1.68,P=0.10,92.76±6.14 mmHg vs.91.37±5.39 mmHg).But anal maximal squeeze pressure and anorectal angulation at the resting and forced stool's state were all significant difference(t=22.79,P=0.00,213.68±18.08 mmHg vs.142.39±12.61 mmHg;t=8.98,P=0.00,95.87±3.53° vs.100.87±3.75°;t=24.65,P=0.00,89.61±3.71°vs.118.34±6.29°).In the group B,anal resting and squeeze pressure and anorectal angulation at the resting and forced stool's state were all significant difference(t=25.91,P=0·00,92.44±7.06 mmHg vs.53.56±9.05 mmHg;t=17.64,P=0.00,210.88±20.56 mmHg vs.142.80±20.35 mmHg;t=8.13,P=0.00,95.88±4.01°vs.102.32±4.96°;t=21.32,P=0.00,89.52±3.25° vs.117.88±5.95°).Three groups' Wexner constipation total score were lower significantly at 3,6,12 months after operation than preoperative one(P<0.01).In the specific contents,every items were all lower after operation than before operation(P<0.01)in addition to the defecation times and constipation period.Endless defecate feeling score was higher at postoperative 3 months than 6,12 months(P<0.01).Cleveland clinic incontinence score was no significant difference between every group at each time point(P>0.05).But it was higher at postoperative three months than other three time points(P<0.01).The effective cases after the operation were 27 in group Al,20 in group A2 and 20 in group B.A1 and A2 groups were significant differences(?2 =4.77,P=0.04),group A1 was no significant difference compared with group B.(?2 =0.70,P=0.79).There was a significant difference between group A and group B(?2 =4.87,P=0.03).Conclusion Initially,the effects of partial resection of puborectalis combined with mutilation of internal anal sphincter was better than pure partial resection of puborectalis in the patients with high preoperative anal resting pressure.The effects of pure partial resection of puborectalis was good in the patients not with high preoperative anal resting pressure.But it was bad with high pressure.Additionally,this operation could effectively relieve the symptoms of outlet obstructed constipation in the patients suffered from puborectalis syndrome.Finally,surgical method might influence the function of the anus in the short term.But it could recover gradually.At the same time,this combined operation would not increase the risk of anal incontinence.Objective To study the structural changes of muscle tissue,cell and organelle and the changes of miRNA expression in patients with puborectalis syndrome and to provide theoretical basis for probing its pathogenesis and miRNA interference treatment.Methods The research object was divided into two groups:the experimental and control group.The experimental group was patients with puborectalis syndrome and control group was patients with rectal cancer who suffered from abdominoperineal resection for anus and return.observing changes of microstructure and ultrastructure of muscle tissue with pathological section of hematoxylin-eosin staining and electron microscopy.In addition,to detect the changes of miRNA expression profile in this muscle of above two groups with chip technology of miRNA OneArray.Results Compared with the control group,puborectalis had greater volume,abundant cytoplasm,bigger and darker nucleus and some fibrous tissue proliferation under general microscope and it had nucleus enrichment,nuclear chromatin clumping edge set and greater mitochondria under electron microscopy.MicroRNAs OneArray chip testing has found 46 microRNAs that were different expression(P<0.05).15 microRNAs were up and 31 were down in the experimental group.Conclusion They had changed significantly of morphological structure of tissue,cells and organelles and the microRNAs expression in patients with puborectalis syndrome... |
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