Cosman Bard C, Cajas-Monson Luis C, Ramamoorthy Sonia L
1 Halasz General Surgery Service, VA San Diego Healthcare System, San Diego, California 2 Department of Surgery, University of California San Diego School of Medicine, San Diego, California.
Dis Colon Rectum. 2017 Apr;60(4):399-404. doi: 10.1097/DCR.0000000000000773.
Colorectal and anal problems arise in chronic spinal cord injury care. We review 20 years of experience in a colorectal clinic at a veterans medical center treating mostly male veterans who have spinal cord injury.
We aim to show the results of colorectal interventions in a population with chronic spinal cord injury.
This study is a retrospective records review.
This study was conducted at a Department of Veterans Affairs regional spinal cord injury center.
Six hundred forty-one individuals (625 males) made 1208 visits. Mean age was 56 ± 13 years; ages ranged from 21 to 90 years.
Flexible sigmoidoscopy was done for diagnosis and screening, and hemorrhoid ligation was performed for symptomatic hemorrhoids.
The primary outcomes measured were the frequency, timing, and results of procedures.
Five hundred forty-eight people had 781 flexible sigmoidoscopies. At first examination, mean age was 65 ± 12 and the duration of injury was 19 ± 15 years. Sixty examinations (7.7%) displayed poor preparation. The interval between adequate-prepared examinations was 5.7 ± 2.0 years. The adenoma detection rate was 4.7%. Two hundred fifteen people had 406 hemorrhoid ligations. At first banding, the mean age was 52 ± 13 and the duration of injury was 20 ± 15 years. Mean number of ligations per procedure was 4.9 ± 2.0; a range of 1 to 20. Nine hemorrhoid operations were done in this period. Regarding the futility of procedures, 250 people died, with a mean age at death of 69 ± 11. The median time between any procedure and death was 4.4 years. Seventeen procedures were done within 6 months of death; these deaths were either unexpected or because of conditions identified at or after the procedure.
This was a retrospective review of a single institution, it involved a mostly male population, and it used a subjective assessment of bowel preparation.
In a spinal cord injury colorectal clinic, sigmoidoscopy can keep screening current, with an acceptable level of poor preparation. The adenoma detection rate may or may not be adequate. Hemorrhoid ligation can be expanded beyond its limits in the non-spinal cord-injured population, including multiple and external banding, taking the place of an operation in most cases. These procedures are well tolerated and rarely futile.
在慢性脊髓损伤护理中会出现结直肠和肛门问题。我们回顾了一家退伍军人医疗中心的结直肠诊所20年的经验，该诊所主要治疗患有脊髓损伤的男性退伍军人。
我们旨在展示在慢性脊髓损伤人群中进行结直肠干预的结果。
本研究是一项回顾性记录审查。
本研究在退伍军人事务部区域脊髓损伤中心进行。
641人（625名男性）进行了1208次就诊。平均年龄为56±13岁；年龄范围为21至90岁。
进行乙状结肠镜检查以进行诊断和筛查，对有症状的痔疮进行痔结扎术。
所测量的主要结果是手术的频率、时间和结果。
548人进行了781次乙状结肠镜检查。初次检查时，平均年龄为65±12岁，损伤持续时间为19±15年。60次检查（7.7%）显示准备不佳。充分准备的检查之间的间隔为5.7±2.0年。腺瘤检出率为4.7%。215人进行了406次痔结扎术。初次结扎时，平均年龄为52±13岁，损伤持续时间为20±15年。每次手术的平均结扎次数为4.9±2.0；范围为1至20次。在此期间进行了9次痔疮手术。关于手术的无效性，250人死亡，平均死亡年龄为69±11岁。任何手术与死亡之间的中位时间为4.4年。17次手术在死亡前6个月内进行；这些死亡要么是意外死亡，要么是由于手术时或手术后发现的疾病。
这是对单一机构的回顾性研究，主要涉及男性人群，并且使用了对肠道准备的主观评估。
在脊髓损伤结直肠诊所，乙状结肠镜检查可以保持筛查的及时性，准备不佳的情况处于可接受水平。腺瘤检出率可能足够，也可能不足。痔结扎术在非脊髓损伤人群中的应用范围可以扩大，包括多次和外部结扎，在大多数情况下可替代手术。这些手术耐受性良好，很少无效。
