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大肠癌治疗的进展

自1833年Reybard第一个为乙状结肠癌成功地施行切除手术以来，外科手术一直是结、直肠癌的首选治疗手段，对此，人们并无置疑。然而从手术的内涵和方式方法上经历了巨大的变化，最根本的变化是人们的观念和目标发生了变化。由于癌肿的致命性，因此，手术的目标是“根除癌肿、挽救生命”。手术的方法从单纯的局部肿瘤切除、肠段切除、根治性肠切除到扩大根治术，最后认识到手术能力的限度和扩大手术带来的创伤和并发症，“付出”与“得益”间的不平衡，从而接受并统一了根治性切除的方法。当然，对问题始终会有不同的认识，因此，还有一小部分的外科医师在为扩大根治术进行争辩，但这已经不是发展的主流了。因为随着科技的发展，人们对大肠癌解剖、病理、诊断、治疗手段、器械设备等方面的深入了解和发展，以及随着经济的发展，对生活水平和生活质量要求的提高，手术目标已从单一的“根除癌肿”变为“既要根除癌肿又要保存功能”，从原来追求“生命”变为“生命+生存质量”的双重目标，而这一概念和目标已成了当前外科手术发展的主流。至于那些为扩大根治手术争辩的理由之一就是除了手术以外，似乎放疗、化疗对大肠癌都是无效的，那么手术就成了挽救患者生命的唯一希望和可以采用的手段。然而，近年来放疗与化疗的进展已达到从双重目标来发挥其作用，下面扼要介绍这些进展。1外科手术在治疗低位直肠癌中的变化

CLINICAL STUDY OF GASTRIN IN SURUM AND TISSUES OF LARGE INTESTINE CARCINOMA

Gastrin(G) concentration in fasting blood, cancer tissues and its adjacent mucosas sampled from fourty-three patients with large intestine carcinoma (LIC) were measured. The results showed fasting G levels in patients with LIC were significantly higher than those in the normal surum controls (Ｐ＜0.05),and dropped to normal value after resection of the cancers. Surum G levels were correlated with cell differentiations of the cancer.The cancer tissues and its adjacent mucosas contained higher levels of G than the normal mucosas (Ｐ＜0.05). The results provided a laboratory evidence that the growth of LIC in vivo were regulated by G and G level might be an indicative parameter for selection of patients with LIC to be treated with hormone therapy and the study of biological character of LIC.

Molecular Switch of T Cell Factor-4 in Carcinogenesis of Colorectal Cancer

Objective　To investigate the role of T cell factor-4 (TCF-4) in the carcinogenesis of colorectal cancer. Methods　Relevant references about TCF-4 and the carcinogenesis of colorectal cancer, which were published recently domestic and abroad, were collected and reviewed. Results　For TCF-4 gene, multiple isoforms are generated by way of alternative splicing, which encode different proteins. TCF-4 protein is sequence-specific DNA binding protein and is incapable of activating or repressing transcription independently, but it can interact with distinct partners to lead to different effects through multiple domains. Conclusion　TCF-4 might be viewed as nuclear vehicles targeting other auxiliary proteins to a specific set of promoters and functions as molecular switch during the carcinogenesis of colorectal cancer.

Study on the Expression of bcl2 and bax Gene in Cancerous Tissue and Transitional Mucosa in Colorectal Cancer

ObjectiveTo study the expression of apoptosissuppressing gene (bcl2) and apoptosispromoting gene (bax) in colorectal cancerous tissue and transitional mucosas. MethodsColorectal cancerous tissue, transitional mucosas (3 cm from the cancerous tissue) and normal tissue were taken respectively in thirtyone cases. Immunohistochemical technique SP method was used to detect the expression in those tissues. ResultsThe positive expression rate of bcl2 protein in cancerous tissue and transitional mucosa were 64.5%and 60.0% respectively and significantly higher than that in normal tissue (P＜0.05). The positive expression rate of bcl2 protein in normal tissue was 35.0%. The positive expression rate of bax protein in cancerous tissue and transitional mucosa were 45.2%and 45.0% respectively and significantly lower than that in normal mucosa (P＜0.05). The positive expression rate of bax protein in normal tissue was 60.0%. There was no obvious difference in the positive rate of bax and bcl2 protein between cancerous tissue and transitional mucosa (Pgt;0.05). The expression rate of bax and bcl2 protein in colorectal cancer was irrelative to clinical pathological gradation and clinical stage (Pgt;0.05). ConclusionThere is over expression of bcl2 protein and low expression of bax protein in colorectal cancer and transitional mucosa. bcl2 protein and bax protein can affect the generation of colorectal cancer by participating in the regulation of apoptosis. But it is irrelative to clinical pathological gradation and clinical stage. Transitional mucosas should be viewed as precancerous lesion and resected during operation.

胆囊结石合并大肠癌10例漏诊原因分析

Nuclear Factor-κB and Colon Cancer

ObjectiveTo explore the relationship between nuclear factor κB (NFκB) and the occurrence, metastasis, and treatment of colon cancer. MethodsThe literature on the structure and the property of molecular biology of NFκB, the relationship between NFκB and apopotosis, malignant tumor and colon cancer were reviewed.ResultsNFκB had action of antiapopotosis. The occurrence of malignant tumor had close relation with the oncogene by NFκB, the metastasis of malignant tumor was that cell of cancer escaped the killing and supervising of immunity by NFκB. NFκB affected the occurrence and metastasis of colon cancer by regulating cmyc, Cox2, ICAM1.Conclusion NFκB has important action in the occurrence and metastasis of colon cancer. It will become a new target of treatment.

THE RELATIONSHIP BETWEEN GASTRIN AND c-myc， c-fos EXPRESSION IN COLORECTAL CANCEROUS TISSUE

Objective To study the relationship between gastrin and c-myc, c-fos expression in colorectal cancerous tissue and the mechanism of gastrin effect on colorectal cancer.Methods The gastrin and c-myc, c-fos expression in 48 cases of colorectal cancerous tissue and canceradjacent mucosa were detected with immunohistochemistry techniques.Results The positive rate of gastrin in colorectal cancerous tissue was 39.58%. The rate of the well differentiated adenocarcinoma was higher than that of the poorly differentiated and mucinous adenocarcinoma(P＜0.05). The positive rates of c-myc and c-fos in colorectal cancerous tissue were higher than those in canceradjacent and normal mucosa. The positive rate of c-myc and c-fos in the group with gastrin positive expression were 78.94% and 73.68%, higher than those in the group with negative gastrin expression(37.93% and 31.04%). Conclusion Some of colorectal cancer cells formed and secreted gastrin through autocrine. The increase of cmyc, c-fos etc oncogene expression probably stimulate the cancer cells proliferation.

Evaluation of Neoadjuvant Chemotherapy and Expression of Multidrug Resistance Indicater in Gastrointestinal Carcinomas

ObjectiveTo evaluate the effect of neoadjuvant chemotherapy and find the mechanism of multidrug resistance. MethodsTwenty patients with gastric cancer and 31 patients with colorectal cancer underwent neoadjuvant chemotherapy and then operations. The preoperative specimens were stained by immunohistochemical techniques for testing p53,multidrug resistanceassociated protein (MRP), glutathione S transferase（GST）, telomerase. Resection specimens were evaluated for chemotherapy effect by routine histology; at the same time, the postoperative morbidity and mortality were observed. ResultsIn 51 patients, the response rate of neoadjuvant chemotherapy was 27.45%(14/51),so multidrug resistance was a kind of common phenomena in gastrointestinal carcinomas. The postoperative morbidity was 15.69%(8/15), the main operation complication was infection,the mortality was 1.96%(1/51),only one person died from severe infection.The expression rate of p53, MRP, GST, telomerase was 58.0%,51.0%,66.7%,74.0%respectively, the location of p53 was at cell nucleus,location of MRP,GST was at cell memberane and cytoplasm,location of telomerase was at cytoplasm.The response rate had nothing to do with age, sex and metastasis. But it was related with p53 and telomerase expression. ConclusionNeoadjuvant chemotherapy is an effective, safe therapy. But the rate of drug resistance is high in gastrointestinal carcinomas, and the response rate is related to p53, telomerase expression.

The Influence of Cationic LiposomeMediated Endostatin Gene on Colorectal Carcinoma Liver Metastasis

Objective To investigate the influence of cationic liposomemediated endostatin gene on colorectal cancer liver metastasis. Methods Animal model for colorectal carcinoma liver metastasis were established. The plasmid expressing endostatin genelipofectAMINE were injected in vein. Results After cationic liposomemediated endostatin gene were injected in vein, the incidence of liver metastasis and mean numbers of liver tumors were decreased, survival time of animal was significantly longer. Conclusion Intravenous injection of cationic liposomemediated endostatin gene can control the development of colorectal cancer liver metastasis effectively.

Surgical Treatment of Dukes D Stage Colorectal Carcinoma and Its Effectiveness

ObjectiveTo evaluate the significance and effect for surgery of Dukes D stage colorectal carcinoma. MethodsEightytwo cases of Dukes D stage colorectal carcinoma who underwent surgery from 1991 to 1998 were analyzed retrospectively. ResultsTwentyone patients experienced extended resections,29 patients palliative resection, 19 patients sideside anastomosis and 13 patients laparotomy and biopsy of the tumor. Patients with extended resections had significantly long survival time, quality of life in these patients were excellent in 71.4%, good in 23.8%, and fair in 4.8%; whereas quality of life in the group with palliative resections were excellent in 62.1%, good in 17.2%, fair in 13.8%, and poor in 6.9%. The other two groups had a bad postoperative effect, short survival time and poor quality of life. ConclusionIf the patients with Dukes D stage colorectal carcinoma have operative indications,surgical therapy should be actively performed and the postoperative survival rate and quality of life can be improved.