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 summarize the experience of single incision laparoscopic colorectal surgery and to discuss the operative techniques. Methods The clinical data of 21 cases who underwent single incision laparoscopic colorectal surgery in Shengjing Hospital from Jan. 2010 to Jun. 2011 were collected and analyzed. Results Of 21 cases underwent single incision laparoscopic surgery， right hemicolectomy performed in 5 cases， sigmoidectomy performed in 2 cases， rectal anterior resection performed in 9 cases， rectal abdominoperineal resection performed in 2 cases， total colectomy performed in 1 case， and colostomy performed in 2 cases. Twenty cases completed by single incision， but 1 case was added an extra 12 mm incision in order to dissect the lower segment of rectum. The operative time was （189±75） min （40-335min）；the postoperative hospitalization time was （11.5±3.4） d （7-16d）. There were no bleeding， anastomosis leakage or intestinal obstruction after operation， and no incision infection， rupture or hernia were founded. No recurrence was found within 6 months’ follow up after operation. Conclusions Under reasonable selection of indication， single incision laparoscopic colorectal surgery is safe and feasible， and it also has a satisfactory cosmetic effect and better minimally invasive effect.
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。
目的 探讨Miles手术重建盆底腹膜困难时的处理对策。方法 对Miles手术重建盆底腹膜困难的患者，根据其大网膜的解剖情况，将带血管蒂大网膜经左或右结肠旁沟放入骶前腔，利用大网膜去填塞骶前腔或修补盆底腹膜缺损。结果 3例患者分别用带蒂大网膜加气囊填塞骶前腔、带蒂大网膜单纯填塞骶前腔、带蒂大网膜修补盆底腹膜等方法，减轻了缝合盆底腹膜时的张力，使盆底腹膜得以顺利重建。结论 用带血管蒂大网膜填塞骶前腔或修补盆底腹膜缺损，可防止Miles术后并发症发生，促进患者早日康复。
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA ) on the selection of operative procedures in lower rectal cancer.MethodsProspectively enrolled 130 patients diagnosed definitely as lower rectal cancer (distance of tumor to the dentate line ≤7 cm) at West China Hospital of Sichuan University from July 2007 to September 2008 were randomly assigned into two groups with 65 participants, respectively. In one group named MSCT+SAAgroup, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only the preoperative MSCT was made. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation program, respectively.ResultsAccording to the criteria, 119 patients with colorectal cancer were actually included into MSCT+SAA group (n=58) and MSCT group (n=61). The baselines characteristics of two groups were basically identical. For MSCT+SAAgroup, the accuracies of preoperative staging T, N, M and TNM were 89.66%, 79.31%, 100% and 77.59%, respectively; For MSCT group, the corresponding rates were 86.89%, 70.49%, 100% and 65.57%, respectively. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (93.10% vs. 80.33%, P=0.041). The clinical staging (P=0.001), preoperative T staging (P=0.000), M staging (P=0.016), TNM staging (P=0.013) and serum level of SAA (P=0.029) were related to the selection of operative procedures when analyzing the relationship between the operative procedures and multiple clinicopathologic factors in lower rectal cancer. ConclusionCombinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, thus provide higher predictive coincidence rate to operative procedures for surgeon.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.
Objective To study the effect of probiotics on the change of intestinal permeability and inflammatory reaction after surgery of colorectal cancer. Methods Sixty patients who underwent colonic surgery were randomly divided into two groups: probiotic group and control group, with 30 cases in each group. Each group received nutritional support of the same nitrogen and calorie from day 3 to day 7 after operation. The patients in probiotic group were orally administrated probiotic (2 g/d) from the first day after surgery for 7 days. Every patient’s body temperature and heart rate were observed after operation, and white blood cell counts were observed before operation and on day 1, 5, 8 after operation. The levels of microbial DNA in whole blood and plasma D-lactate, and urine lactulose/mannito (L/M) ratio were measured before operation and on day 1 and day 8 after operation, respectively. In addition, the occurrence of postoperative systemic inflammatory response syndrome (SIRS) and complications of inflammation were closely observed. Results The average heart rate in postoperative 5 days was significantly lower in probiotics group than that in control group (P＜0.01). The duration of fever and the recovery time for white blood cell counts decreasing to normal were significantly less in probiotics group than those in control group (P＜0.01) as well. There was no significant difference of positive rate of microbial DNA in peripheral blood on day 1 after operation between two groups. However, the number of patients that showed positive result of microbial DNA PCR test in probiotic group （1 case, 3.3%） was significantly less than that of control group (7 cases, 23.3%）on day 8 after operation (P＜0.05). The level of plasma D-lactate in probiotic group 〔decreasing from (6.90±1.41) ng/ml on day 1 to (0.56±0.18) ng/ml on day 8〕 was also significantly lower than that in control group 〔decreasing from (6.63±1.29) ng/ml on day 1 to (0.95±0.83) ng/ml on day 8〕 on day 8 after operation (P＜0.05). Urine L/M ratio increased from 0.053±0.019 on day 1 to 0.063±0.016 on day 8 after operation in control group; while in probiotic group, the ratio decreased from 0.047±0.012 on day 1 to 0.031±0.008 on day 8 after operation, and there was significantly statistical difference of the ratio between two groups on day 8 (P＜0.01). There was no significant difference of the occurrence rate of SIRS and complications of inflammation between two groups (Pgt;0.05). Conclusion Probiotics can decrease intestinal permeability and maintain the intestinal barrier function after operation. It may be helpful for the recovery of patients with early inflammatory response after surgery of colorectal cancer.
【摘要】目的 探讨低位直肠癌保肛手术的术式选择及其治疗效果。方法 回顾性分析我院1997年7月至2002年7月期间行低位直肠癌保肛手术治疗的90例患者的临床资料。结果 行低位直肠癌保肛手术者占同期的66.2%(90/136)。90例中距肛缘5 cm以内者14例，5~8 cm者76例； 行Dixon术84例，经肛门局部切除术4例，Parks术2例。术后发生吻合口漏8例，其中Dixon术7例，Parks术 1例； 肛门狭窄2例，其中Dixon术1例，Parks术 1例； 无手术死亡。90例患者术后均获随访,64例随访23~59个月，中位随访时间为39个月，其中Dixon术59例，Parks术2例，局部切除术3例。局部复发6例，其中Dixon术5例，局部切除术1例。 结论 Dixon术是低位直肠癌保肛手术的主要术式； 在严格掌握适应证的情况下，可考虑施行低位直肠癌的局部切除术。
目的 评价卡培他滨+伊立替康与氟尿嘧啶/醛氢叶酸（5-FU/LV）+伊立替康治疗转移性结直肠癌的有效性和安全性。 方法 计算机检索PubMed、CENTRAL、Embase、中国生物医学数据库、中国期刊全文数据库、维普数据库和万方数据库，检索时间均从建库至2011年9月。对符合纳入标准的随机对照试验进行质量评价和Meta分析。 结果 纳入3个随机对照试验，共计419例患者，卡培他滨+伊立替康在中位生存期、完全缓解率[RR=1.58，95%CI（0.27，9.11），P=0.61]、部分缓解率[RR=0.86，95%CI（0.68，1.09），P=0.20]、总有效率[RR=0.88，95%CI（0.71，1.09），P=0.26]上表现出与5-FU/LV+伊立替康相似的效果，安全性方面卡培他滨+伊立替康有较高的Ⅲ/Ⅳ级恶心[RR=1.92，95%CI（1.05，3.54），P=0.04]、腹泻[RR=3.23，95%CI（2.14，4.89），P＜0.000 01]发生风险和较低的Ⅲ/Ⅳ级中性粒细胞减少[RR=0.72，95%CI（0.53，0.98），P=0.04]发生风险。 结论 根据当前现有证据，5-FU/LV+伊立替康可能较卡培他滨+伊立替康更为有利于转移性结直肠癌患者的治疗，但仍需结合临床实际情况进行化疗方案的优选。