目的 总结基层医院初期开展腹腔镜直肠癌根治术的临床经验。 方法 回顾分析2008年10月-2009年10月收治的20例腹腔镜直肠癌手术的临床资料。 结果 16例顺利完成手术，4例中转开腹，1例发生吻合口瘘。随访2~10个月，均无操作孔种植及肿瘤复发。 结论 采用手术者已习惯的手术路径，电刀、超声刀相结合游离直肠肠管，直视下裸化和用凯途闭合肠管，缩短了手术学习曲线,降低了手术成本，有助于在基层医院推广。
Objective To explore the safety, effectiveness, operation mode and clinical value of the laparoscopic colorectal resection. Methods The clinical data and experiences of laparoscopic resection for 18 cases with colorectal neoplasm from Jun. 2007 to Mar. 2008 were studied retrospectively. Results Among 18 cases, there were 5 cases of rectal cancer, 6 cases of sigmoid colon carcinoma, 2 cases of sigmoid colonic polyp, 2 cases of descending colon carcinoma, 2 cases of ascending colon carcinoma and 1 case of ascending colonic lipoma. Fifteen cases of laparoscopic colorectal resection were performed successfully, including Dixon procedure 4 cases, Miles operation 1 case, radical resection of sigmoid colon 5 cases, palliative resection of sigmoid colon 2 cases, left hemicolectomy 2 cases and right hemicolectomy 1 case. Three cases converted to laparotomy due to adiposity or advanced status of local disease. Average intraoperative blood loss was 110 ml. The average number of lymph nodes dissected was 13.5. It took about 40 hours to restore intestinal function. The average time of hospitalization was 9 days. No one died during operation and no complications such as anastomotic leakage and postoperative hemorrhage occurred. Conclusion Laparoscopic resection for colorectal neoplasms possesses less trauma and rapid postoperative recovery. Laparoscopic colorectal surgery is safe and effective with skill and indication.
目的:探讨结直肠癌KAI1/CD82与E－cadherin的表达与预后的关系。方法: 采用免疫组化S-P法检测105例结直肠癌中KAI1/CD82与E-cadherin的表达。结果: 74例中5年生存率为48.6%。生存5年以上的KAI1/CD82的阳性表达率(86.11%),明显高于生存5年以下者(57.89%)(Plt;0.01);而E－cadherin生存5年以上者的阳性表达率(6389%)亦明显高于生存5年以下者(31.58%)(Plt;0.01%)。结论:联合检测KAI1/CD82与E-cadherin的表达对临床判断结直肠癌的预后有重要价值。
目的:探讨老年结直肠癌并急性肠梗阻的处理原则和方法。方法:回顾性分析10年间收治的78例(70～80岁)结直肠癌并急性肠梗阻的临床资料。78例中Dukes B期20例,C期18例,D期40例。全部患者经手术治疗,包括急诊手术46例,择期性手术32例。采用右半结肠一期切除肠吻合治疗30例,左半结肠一期切除吻合40例。Hartmann 5例, Di×on手术2例,肿瘤近端肠管造瘘1例。结果:术后出现并发症16例(20.5%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡3例(3.85%),75例(96.2%)痊愈出院。结论:对于急性结直肠癌性梗阻除非有急诊手术指征,应首先采用非手术治1～2 d,尽可能转为择期手术;一期切除吻合治疗结直肠癌并发急性梗阻,是方便可行而安全有效的方法,加强围手术期处理是手术成功的关键。
Objective To study the effectiveness of local excision of low rectal tumor by Mason operation. Methods Twenty-our patients with low rectal tumor underwent Mason operation from 1997-2002 and their information was collected and studied. Results o recurrence was observed in the follow-p period from 5 months to 6 years after operation.Conclusion Mason operation for resection of tumor in low segment of rectum has the advantages of easy manipulation, minimal invasiveness and good exposure in operation.
Objective To discuss the strategies for building the framework of team culture of multi-disciplinary team (MDT) for colorectal cancer. Methods By comprehending the traditional concept of volunteer and probing into the value of traditional team culture, combining the needs of MDT for colorectal cancer, build appropriate team culture and core idea of MDT for colorectal cancer. Results Confirm that building of volunteers groups and the volunteers culture is the core of the team culture of MDT for colorectal cancer. Analyze characters of volunteers groups and the operation strategies, and find the way of maintaining the volunteers culture. Conclusion With the development of volunteers groups and increased participants, the team culture of MDT for colorectal cancer will show more sociality and extent. And it is also the important idea and direction for development in future. As team culture, organization structure and personnel structure supplements each other, adjusting and perfecting the team culture in practice continually is a long-term work for MDT.
Objective To investigate the prophylaxes, diagnosis and treatment of pelvi-peritoneal hernia (PPH) after Miles operation for rectal carcinoma. Methods Three hundred and nine patients who underwent Miles operation from January 1986 to June 1999 were collected and analysed retrospectively, 11 of them were complicated with PPH. Results The morbidity of PPH after Miles operation was 3.6% (11/309). The main manifestations included abdominal distention to some extent (11 cases), pain (3 cases), vomiting (2 cases), gastric liquid more than 500 ml a day by gastric tube (3 cases), and non-exsufflation of the stoma of colostomy (11 cases). Two cases had pea green small intestinal liquid by perineal tube. The signs were slight abdominal tender (5 cases), active or excessive intestinal gurgling sound (7 cases), and diminished intestinal gurgling sound (4 cases). Abdominal plane films, showing the distant small intestinal obstruction, were taken in all 11 cases. Only 2 patients were correctly diagnosed before reoperation, and other patients were regarded as adhesive intestinal obstruction. The average observational time following appearance of the clinical manifestations after Miles operation was 7.4 days. All patients were diagnosed by laparotomy, 3 of them underwent adhesion lysis and reposition, and 8 patients partial ileum resection and anastomosis. The content of the hernias was ileum. The morbidity after reoperation was 27.3% (3 cases), and the complication was wound infection. All 11 patients were cured and left hospital. Conclusion The PPH after Miles operation is often lack of typical clinical manifestations. The early diagnosis and laparotomy in time is key to management. It is important to prevent the complication.
Until Issue 2 in 2008, the Cochrane Database of Systematic Reviews had included 23 systematic reviews concerning colorectal tumors by the colorectal cancer group. These reviews involved prevention, diagnosis, treatment, prognosis and follow-up. The preventive ability of non-steroid anti-inflammatory drugs, accuracy of chromoscopy, shortterm outcomes of laparoscopic colorectal resection and outcomes of laparoscopic total mesorectal excision were confirmed. Meanwhile, the effect of dietary fibre in prevention, mechanical preoperative preparation, and prophylactic anastomotic drainage was questioned. Because of the low quality of trials, no firm conclusions were revealed in some reviews, such as traditional Chinese medicine in chemotherapy. Through the study of Cochrane systematic reviews, medical practitioners and researchers can obtain high-quality evidence, and identify future research direction in the field of colorectal cancer.