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 explore the impact of restrictive fluid administration for patients with colorectal cancer combined diabetes. Methods The clinical data of patients diagnosed definitely as colorectal cancer with diabetes were analyzed retrospectively from January 2007 to October 2009 in this hospital, the clinical effects on postoperative early rehabilitation were studied and the differences between restrictive fluid regimen (fluid restriction group) and tradition fluid regimen (tradition therapy group) were compared. Results The time of first aerofluxus and the first ambulation in fluid restriction group were shorter than those of tradition therapy group, the differences had statistical significances (Plt;0.05). The incidence of wound infection in fluid restriction group was lower than that in tradition therapy group (Plt;0.05). The differences of preoperative hemoglobin (Hb), white blood cell (WBC), glucose (GLU) and blood urea nitrogen (BUN) were not statistically significant between two groups, but the difference of postoperative GLU was statistically significant between two groups (Plt;0.05). Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for diabetic, and has a certain promoter action to the early rehabilitation after rectal surgery.
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。
ObjectiveTo investigate the value of postoperative CT examination for evaluation of local complications in patients with low rectal carcinoma after total mesorectal excision with anal sphincter preservation. MethodsThe patients with low rectal carcinoma who received total mesorectal excision (TME) with anal sphincter preservation were examined using contrastenhanced CT in one year period from May 2009 to May 2010. Particular attention was paid to the presence of anastomotic leakage, local recurrence and status of lymph nodes. ResultsTotal of 82 patients (52 men, 30 women； mean age 57.8 years old； range 25.74 years old) were included in the study. Over a mean 10-month follow-up， 8 cases （9.8%） had clinically or surgically confirmed anastomotic leak, 6 cases （7.3%） had local recurrence around the anastomotic site， and 4 cases （4.9%） showed pelvic and distant metastatic lymphadenopathy. ConclusionPostoperative CT examination, including baseline and follow-up CT studies, is very useful for diagnosing anastomotic leakage, local tumor recurrence and lymphadenopathy.
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.