Search

Treatment ofⅠ Stage Exeresis and Intestinal Anastomosis for Left Hemicolon Carcinoma Affiliating Obstruction

摘要:目的:探讨左半结肠癌合并肠梗阻Ⅰ期手术切除肠吻合的方法和注意事项。〖HTH〗方法:〖HTSS〗分析36例左半结肠癌合并肠梗阻患者Ⅰ期行手术切除肠吻合手术及术后恢复情况。结果:36例左半结肠癌并肠梗阻患者,Ⅰ期手术切除、肠吻合无一例吻合口瘘,术后恢复良好。〖HTH〗结论:〖HTSS〗只要围手术期、术中处理得当,左半结肠癌合并肠梗阻患者选择Ⅰ期手术切除肠吻合,可以减少患者痛苦、节约医疗费用,同时也是安全的。

两种机械吻合方式在腹腔镜辅助右半结肠癌术中的回顾性对照研究

目的比较体外机械性侧侧吻合与端侧吻合在腹腔镜辅助右半结肠癌根治术中的应用效果。方法回顾性分析笔者所在医院 2015 年 6 月至 2018 年 6 月期间采用机械吻合进行消化道重建的 89 例腹腔镜辅助右半结肠癌根治术患者的临床资料，其中机械性侧侧吻合 32 例，机械性端侧吻合 57 例；比较 2 组患者的一般资料、手术时间、术中出血量、术后首次肛门排气时间、耐受流质饮食时间和术后住院时间；并比较术后并发症发生情况。结果2 组患者的一般资料、术中出血量、耐受流质饮食时间和术后住院时间的差异均无统计学意义（P>0.05）；端侧吻合组手术时间短于侧侧吻合组 ［160.0（150.0，177.5） min 比 170.0（156.3，203.8）min］，差异有统计学意义（P=0.049）；端侧吻合组首次肛门排气时间短于侧侧吻合组 ［（2.5±0.9）d 比（3.0±1.0）d］，差异有统计学意义（P=0.021）；2 组患者术后各并发症发生率差异无统计学意义（P>0.05）。结论腹腔镜辅助右半结肠癌根治性切除手术中相比机械性侧侧吻合，机械性端侧吻合的手术时间及术后首次肛门通气时间较短，其并发症无统计学差异，提示机械性端侧吻合可能更具优势。

Investigation of Diagnosis and Treatment for Colorectal Cancer with Intestinal Perforation

目的 探讨结肠癌和直肠癌并发肠穿孔的外科诊治方法。方法 分析13例结直肠癌并发肠穿孔患者的临床资料。结果 13例患者中4例行肿瘤所在肠段一期切除吻合术； 4例行一期病灶切除吻合术，近端肠段行外置双管造瘘术； 2例切除肿瘤所在肠段，近端行端式结肠造瘘术，远端行封闭（Hartmann）术； 3例行单纯肠造瘘术。术后并发症发生率为46.15%（6/13），手术死亡率为15.38%（2/13）。结论 重视对结直肠癌并发肠穿孔的认识及选择合适的手术方式是减少并发症、提高疗效的重要措施。

Clinical Application of Laparoscopic Total Colectomy in Familial Adenomatous Polyposis(Report of 4 Cases)

目的 探讨腹腔镜全结肠切除术在家族性腺瘤性息肉病（FAP）中的应用价值。方法 回顾性分析我院2008年1月至2009年10月期间收治的行腹腔镜全结肠切除术的4例FAP患者的临床资料，对手术安全性和术后恢复情况进行分析。结果 4例患者均顺利行腹腔镜全结肠切除术，无中转开腹，无手术并发症及死亡。腹部切口长6.0 cm，手术时间300～380 min（平均330 min），术中出血量90～250 ml（平均160 ml）。术后2～3 d肛门开始排气，术后住院时间7～11 d（平均9 d）出院。出院后大便稀薄，8～12次/d，给予易蒙停治疗后缓解。随访2～22个月（平均14个月），无近期并发症发生。结论 腹腔镜全结肠切除术治疗FAP安全、有效，近期效果良好。

Influence of Combinative Assessment of 64 Multi-Slice Spiral Computer Tomography and Serum Amyloid A Protein on Surgery Strategy of Colon Cancer

　Objective　To discuss the influence of combination of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) for preoperative assessment on colon cancer surgery strategy. 　Methods　Ｔhe examination data of 110 patients diagnosed definitely as colon cancer in the West China Hospital of Sichuan University from Nov. 2007 to Nov. 2008 were studied prospectively, and randomly assigned into the MSCT+SAA group and MSCT group, respectively. Both MSCT and SAA combinative assessment were made for preoperative evaluation in MSCT+SAA group, while only MSCT was made preoperatively in MSCT group. Furthermore, the preoperative staging and prediction of operative procedures were compared with postoperative pathologic staging and practical of operative procedures, respectively. 　Results　According to the inclusion criteria, 99 colon cancer patients were actually included into MSCT+SAA group (n=49) and MSCT group (n=50). The baseline characteristics of two groups were statistically identical. For MSCT+SAA group, The accuracies of preoperative staging T, N, M and TNM were 81.6%, 79.6%, 100% and 77.6%, respectively. For MSCT group, the corresponding rates were 82.0%, 60.0%, 98.0% and 62.0%, respectively. The difference of accuracies on staging N between two groups was observed statistically (χ2=4.498, P=0.034). There was also a statistically significant difference of the accuracy of prediction of operative procedures in MSCT+SAA group and MSCT group (95.9% vs. 82.0%, χ2=4.854, P=0.028). The preoperative staging N (P=0.008), M (P=0.010), TNM (P=0.009) and level of SAA (P=0.004) were related to the selection of operative procedures when analyzed the relationship between the operative procedures and multiple clinicopathologic factors in colon cancer. 　Conclusion　The strategy of the combinative assessment of MSCT and SAA could advance the accuracy of preoperative staging, thus serve surgeon the more accurate prediction to surgery strategy in colon cancer.

Analysis on Prognosis Factors of Elderly Patients with Colon Cancer

ObjectiveTo investigate the clinicopathological characteristics and prognosis of elderly patients with colon cancer. MethodsThe clinicopathological and followup data of patients with colon cancer were compared retrospectively between those older than 60 years (405 patients) and those younger than 40 years (146 patients). ResultsFamily history, comorbidities, preoperative intestinal obstruction, and differentiation grade were significantly different between two groups (P＜0.05). The 5-year survival rate of patients in elder group and younger group was 64.9% and 56.8% respectively, and there was significant difference （P＜0.05）. The multivariate analysis indicated that the independent predictors of survival were comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage. ConclusionPatients older than 60 years with colon cancer have unique clinicopathological characteristics and better prognosis. The independent predictors of survival are comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage.

Effects of Nimesulide on Expression of Matrix Metalloproteinase- 2 in Human Colonic Cancer Cell Lines

【Abstract】Objective To investigate the effects of selective cyclooxygenase-2 (COX-2) inhibitor nimesulide on the proliferation of colon adenocarcinoma cells in vitro and the expression of matrix metalloproteinase-2 (MMP-2). Methods The human colon cancer cell lines HT-29 and HCT-116 were employed in the study, grouped as nimesulide group, DMSO control group and blank control group. After treatment with nimesulide, the inhibitory effect of nimesulide on the proliferation of cancer cells was quantified by MTT assay, and the expression of MMP-2 in the cells was detected by quantitative zymography. Results Nimesulide inhibited the proliferation of HT-29 and HCT-116 cells in time and dosedependent manners. The inhibitory effect on HT-29 cells was ber than that on HCT-116 cells. Nimesulide downregulated the MMP-2 expression in HT-29 cells, whereas the expression in HCT-116 cells remained unchanged. Conclusion Nimesulide can obviously inhibit the growth of colon cancer HT-29 cells with positive COX-2 protein, suggesting that nimesulide may downregulate the expression of MMP-2 by inhibiting the activity of COX-2.

Expression of p53 and Vascular Endothelial Growth Factor and Its Correlation with Hematogenous Metastasis in Colorectal Cancer

Objective To study the expression of p53 and vascular endothelial growth factor (VEGF) and its correlation with hematogenous metastasis in colorectal cancer. MethodsAvidinbiotin complex method was used to study the expression of p53 and VEGF in 79 cases of colorectal cancer.ResultsThe positive rates of p53 and VEGF were 48.1% and 58.2% respectively in 79 cases of colorectal cancer. p53 and VEGF expression were identical in 49 (62.0%) cases. There was significant association between p53 or VEGF expression and venous invasion or hematogenous metastasis (P＜0.05). The incidence of hematogenous metastasis in the p53（＋）/VEGF（＋） subgroup was 66.7% and was significantly higher than that in the p53（－）/VEGF（－） or p53（＋）/VEGF（－） subgroup （P＜0.01）. Neither synchronous nor metachronous hematogenous metastasis were found in the p53（－）/VEGF（－） subgroup.Conclusion The combination of p53 and VEGF expression is an important predictor for hematogenous metastasis in patients with colorectal cancer.

胆囊结石、胆囊切除术与大肠癌关系的临床研究

合并 2 型糖尿病对晚期结直肠癌患者疾病无进展生存时间的影响

目的 观察合并 2 型糖尿病（type 2 diabetes mellitus，T2DM）对晚期结直肠癌患者疾病无进展生存时间（progression-free survival，PFS）的影响。 方法 选择 2010 年 1 月—2015 年 9 月收治的晚期结直肠癌患者 2 156 例，根据是否合并 T2DM 分为 A、B 组，A 组（合并 T2DM）96 例，B 组（未合并糖尿病）2 060 例，排除手术、介入、射频消融术、局部放射治疗以及使用靶向药物的患者，最终纳入 A 组 20 例，B 组 24 例，观察两组患者的PFS。 结果 A 组 PFS 为（289.45±203.60）d，B 组 PFS 为（181.00±156.08）d，差异有统计学意义（P=0.019）。 结论 合并 T2DM 的晚期结直肠癌患者之间 PFS 存在差异。