Sixty two patients with low anal fistula were treated by anal fistulectomy (fistula group) and 82 patients with mixed hemorrhoids were treated by automatic ligation of hemorrhoids (RPH group) and 38 patients with anal fistula plus mixed hemorrhoids were treated by the RPH and anal fistulectomy (fistula plus RPH group),the clinical data of patients were retrospectively analyzed.The complication rate,the degree of pain and,the urination disorders,the postoperative recurrent rate,scar area and the anal functions were observed and compared.There were no differences in pain degree at d1 and d3 among three groups(P ＞ 0.05).There was significant difference in urination disorders between the fistula group and anal fistula plus RPH group (8％ vs.32％,P ＜ 0.05),but no differences between the RPH group and anal fistula plus RPH group (11％ vs.32％,P ＞ 0.05).There were significant differences in scar area and the anal functions between anal fistula group and anal fistula plus RPH group(P ＜ 0.05).There were no postoperative massive hemorrhage,proctenclisis and infection in all three groups.

The clinical data of 288 patients with gastrointestinal perforation undergoing surgical treatment from Jul 2014 to Jul 2017 were retrospectively analyzed,among whom the surgical incision infection occurred in 112 patients(38.9％).The risk factors of the incision infections were examined with logistic regression analysis.The univariate analysis showed that preoperative albumin level (≤30 g/L),body mass index (＞24.0 kg/m2),duration of abdominal pain(＞24 h),extension of incision,preoperative shock,colostomy,preoperative antibiotic use and the operation time were associated with incision infections(P＜0.05),while the gender,age,preoperative hemoglobin level,diabetes,incision length were not associated with the incision infections(P＞0.05).The multivariate logistic regression analysis showed that the body mass index(OR=1.61,P＜0.01),gastrointestinal perforation site(colon and rectum,OR=5.60,P＜0.01),extension of incision (OR=3.94,P＜0.01) and operation time(OR=1.04,P=0.02)were independent risk factors of theincision infection.The results suggest that the full preoperative preparation,intensive treatment of underlying diseases,avoiding incision extension and shortening operation time may be able to reduce the surgical incision infections for patients with the gastrointestinal perforation.

Clinical data of 12 patients with gastric cancer, in whom the Roux and Y space hernia developed after gastrectomy with Roux-en-Y anastomosis in our hospital from June 2010 to December 2018, were retrospectively analyzed. The clinical symptoms of patients were abdominal pain, distension and ileus. The main CT findings were torsion of mesentery with whirlpool sign, intestinal obstruction and exudants around the small bowels. During the operation it was found that small bowels herniated into the Roux and Y space in all 12 patients, the necrotic small intestines were resected in 4 patients. Ten patients were recovered, and 2 died. No recurrence was observed in all 10 patients during 3 month-follow up. The postoperative Roux and Y space hernia is a internal hernia and difficult to be diagnosed. The CT scan is valuable for diagnosis of Roux and Y space hernia; the main CT signs were swirled appearance of mesentery and small bowel obstruction. Once diagnosis is made the emergency operation is necessary.