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。
ObjectiveTo study the effects of recombinant human growth hormone (rhGH) on proliferation of human rectal cancer cell in vitro. MethodsThe experiment was divided into control group,rhGH group,Oxaliplatin (LOHP) group and rhGH+LOHP group. The double proliferation time of cells,cell inhibition rate,cell cycle, proliferation index (PI) and DNA inhibition rate of human rectal cancer line,HR8348,were studied by cell culture, MTT assay and flow cytometry on different concentration of rhGH. ResultsIn vitro the markedly accelerated effects of rhGH on multiplication of HR8348 cell line were not found: there was no statistical significance as compared rhGH group with control group or compared rhGH+LOHP group and LOHP group （Pgt;0.05）. The double proliferation time of cells was markedly lengthened, cell inhibition rate and the cells arrested in G0-G1 phase were obviously increased, meanwhile, the cells in S phase （P＜0.05） and G2-M phase and PI were markedly decreased and DNA inhibition rate was obviously risen as compared rhGH+LOHP group with control group or rhGH+LOHP group and rhGH group （P＜0.01）.ConclusionIn vitro rhGH does not accelerate the multiplication of human rectal cancer cells.
目的 探讨经肛门内镜显微手术(TEM)治疗直肠肿瘤的疗效。方法 回顾性分析2009年1~12月期间我院行TEM治疗7例直肠腺瘤患者的临床资料。结果 7例直肠肿瘤均获完整切除，切缘均阴性。手术时间55～240 min，平均110 min; 术中出血量5～100 ml,平均45 ml。术后病理诊断: 直肠绒毛状腺瘤4例，绒毛管状腺瘤2例，直肠腺癌1例。手术并发症: 术中直肠穿孔1例，肺部感染1例，尿潴留1例。 7例随访6~13个月,平均8个月，肿瘤无复发。结论 TEM治疗直肠肿瘤安全、有效。
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 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.
To investigate the pathological characteristics, diagnosis and treatment of rectal carcinoid tumors, 26 cases, which had been diagnosed and treated in our hospital from 1987 to 1997, were retrospectively analysed. The rectoscopic examination were taken in all 26 patients and final diagnosis were made by pathological examination, among them, 19 cases were treated with local resection or expensively local resection, 7 cases with radical operation because the diameter of tumor was beyond 2 cm. These patiests were followed up 1-10 years with 5 patients died. The authors consider that rectoscopic examination and biopsy are important method to diagnose rectal carcinoid tumors preoperatively, in addition, for suspicious case, argentation and immunohistochemistry staining should be further made besides routine HE staining. The operative treatment is the best therapy to this kind of disease, the choice of operative mode must be made according to the size, infiltration of the tumor, the condition of infiltrated lymph node and hepatic metastasis.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
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.