腹会阴直肠癌柱状切除术经改良后治疗低位直肠癌的30例临床效果分析

摘要目的：探讨分析改良后的腹会阴直肠癌柱状切除术治疗低位直肠癌,降低局部复发率的临床效果。方法：回顾性分析2010年1月至2012年6月入住我院并采用改进后的腹会阴直肠癌柱状切除术（CAPR）治疗低位直肠癌的患者30例,男性20例,女性10例,年龄为57＋3．8岁,肿瘤分期为T3-T4。结果：采用改进的CAPR能切除更多远端直肠周围组织;切除标本呈柱状;30例均无术中肠穿孔;会阴切口均Ⅰ期愈合;1例发生会阴血清肿;30倒均无盆底会阴疝形成;术后30例直肠环周切缘均无癌残留;术后平均随访2．1±3．1个月,均无局部复发。结论：经改进的腹会阴直肠癌柱状切除术不仅降低了手术的操作难度,扩大了直肠周围的切除范围,降低了术中直肠穿孔率和环周切缘阳性率,从而降低术后局部复发率,该术式值得在临床上进一步推广。     

柱状经腹会阴直肠癌切除术后并发症分析及对策

目的:探讨分析柱状经腹会阴直肠癌切除术术后并发症发生的可能原因,并提出解决对策。方法:回顾分析我院自2010年1月至2014年5月采用柱状经腹会阴直肠癌切除术的68例直肠癌患者的临床资料。记录并分析患者发生术后并发症的情况,探讨发生的可能原因及可行对策。结果:68例患者术后出现并发症共9例,占13.2%。切口并发症4例,术后排尿困难2例,术后骶尾部疼痛3例。结论:柱状经腹会阴直肠癌切除术因为手术切除范围大,术后并发症亦随之凸显。但通过精细的术中解剖、重叠缝合腹膜关闭盆底、骶前通畅引流、合理掌握尿管拔管时机等手段,可有效降低术后并发症的发生。     

经肛门改良Soave 术和经腹治疗先天性巨结肠的疗效对比研究

目的:探讨经肛门改良Soave术和经腹治疗先天性巨结肠的临床疗效。方法:对大于3岁的41例患儿(经肛门改良Soave术治疗28例,经腹治疗24例,在术后并发症和排便功能等方面进行回顾性对比分析。结果:并发症的总发生率经肛门改良Soave术明显少于经腹,HAEC发生率低于经腹组,有统计学意义。总的排便控制和大便形态方面经肛门改良Soave术优于经腹。结论:经肛门改良Soave术治疗先天性巨结肠方法可行、安全,效果优于经腹,但是术后仍有诸多并发症,特别在排便控制方面,仍需大量的病例进行长期的随访研究评估。     

经肛门改良Soave术和经腹治疗先天性巨结肠的疗效对比研究

目的：探讨经肛门改良Soave术和经腹治疗先天性巨结肠的临床疗效。方法：对大于3岁的41例患儿（经肛门改良Soave术治疗28例,经腹治疗24例,在术后并发症和排便功能等方面进行回顾性对比分析。结果：并发症的总发生率经肛门改良Soavc术明显少于经腹。HAEC发生率低于经腹组,有统计学意义。总的排便控制和大便形态方面经肛门改良Soave术优于经腹。结论：经肛门改良Soave术治疗先天性巨结肠方法可行、安全,效果优于经腹,但是术后仍有诸多并发症,特别在排便控制方面,仍需大量的病例进行长期的随访研究评估。     

手辅助腹腔镜在肛门全直肠系膜切除术治疗中低位直肠癌中的应用价值

目的:探讨手辅助腹腔镜在肛门全直肠系膜切除术(TaTME)治疗中低位直肠癌中的应用价值。方法:选取2014年5月至2016年9月期间在广州市红十字会医院接受TaTME术治疗的中低位直肠癌患者130例为研究对象,根据数字表法将其随机分为研究组和对照组,其中研究组(60例)患者行手辅助腹腔镜下TaTME术治疗,对照组(70例)行腹腔镜下TaTME术治疗。比较两组手术时间、淋巴结清扫数目、术中出血量、保肛率、住院时间、切口愈合时间、首次下床活动时间,并比较两组术后并发症发生率、远期复发率及死亡率。结果:研究组术中出血量、手术时间较对照组减少(P<0.05),而保肛率、淋巴结清扫数目两组比较无差异(P>0.05)。研究组首次下床活动时间、切口愈合时间较对照组缩短(P<0.05),而术后住院时间两组比较无差异(P>0.05)。研究组术后出现切口感染、吻合口瘘、尿道感染、盆腔脓肿及肠梗阻等并发症发生率为3.33%(2/60),少于对照组的10.00%(7/70),但两组比较无差异(P>0.05)。术后4年内,研究组总复发率和总死亡率与对照组比较,差异均无统计学意义(P>0.05)。结论:中低位直肠癌患者行TaTME术治疗,运用手辅助腹腔镜可明显缩短手术时间,减少术中出血,尽快促进切口愈合,且术后并发症发生率、远期复发率及死亡率较低,实用性高,值得推广应用。     

中药外用治疗直肠癌术后放化疗后局部复发的探索

直肠癌术后、放化疗后局部复发患者主要采用放射治疗、化疗以及中医中药等多学科、多层次、多方位的综合治疗。患者大多经过多程治疗后复发,体质较差,甚至有明显的恶病质,对这类患者进行大剂量放、化疗或对产生耐药的患者再次进行放疗或者化疗,只能使虚弱的生命更加垂危,加速患者死亡,中医药治疗在此阶段优势凸显出来。中医药外用治疗以扶正祛邪为法则,攻补兼施,达到改善生活质量的作用,所以在直肠癌术后放化疗后局部复发的治疗方法中,中医药外用治疗值得进一步研究探索。     

经肛门微创手术治疗小儿先天性巨结肠症40例临床疗效分析

目的:探讨经肛门微创手术治疗小儿先天性巨结肠症的临床效果.方法:将我院收治的40例先天性巨结肠患儿,随机分为对照组和试验组,对照组采用经腹会阴联合手术治疗,试验组采用经肛门微创手术治疗.分析两组手术时间、术中出血量、恢复肠道排气时间、住院时间,并发症发生情况等.结果:组术中出血量、肠道恢复排气时间、住院时间均显著优于对照组,差异有统计学意义(P＜0.05).试验组手术时间与对照组差异无统计学意义(P＞0.05).试验组并发症发生率低于对照组,差异有统计学意义(P＜0.05).试验组术后排便控制功能显著优于对照组,差异有统计学意义(P＜0.05).结论:采用经肛门微创手术治疗小儿先天性巨结肠症,术后患者排便功能恢复好,手术情况佳,并发症少,疗效优于经腹会阴联合手术,值得临床推广应用.     

肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的临床研究

目的:探讨肛提肌外腹会阴联合切除术(ELAPE)在低位进展期直肠癌中的应用。方法:回顾性分析2011年1月至2013年12月我院胃肠外科30例接受ELAPE和18例接受传统腹会阴联合直肠癌切除术(APR)的低位直肠癌病人的临床资料,通过对手术用时、失血量、术中穿孔发生率、术后住院时间、术后并发症以及出院后随访相关指标等的比较来分析ELAPE的可行性。结果:和APR相比,ELAPE治疗低位直肠癌可降低术中直肠穿孔和CRM阳性的发生率,术后会阴部切口愈合延迟率以及出院后肿瘤局部复发、远处转移以及患者死亡的发生率,差异均有统计学意义(P0.05)。行ELAPE术的手术时间、术中出血量、平均住院天数,术后引流管拔管时间、尿潴留发生率以及出院随访的骶尾部不适率均稍大于行APR术的患者,但差异均尚无统计学意义(P0.05);进行两种手术的患者住院两组间围手术期死亡病例、会阴部血清肿的发生率、肠梗阻发生率、造口问题发生率以及出现并发症的情况差异不大(P0.05)。结论:和APR相比,ELAPE治疗低位进展期直肠癌可降低术中肠管穿孔发生率、CRM阳性率和住院期间发生会阴部切口愈合延迟率,短期随访预后良好,有望成为治疗进展期低位直肠癌的推荐术式。     

直肠癌术后护理观察体会

对分别进行了两种直肠癌手术后的患者进行护理,严密观察病情变化。方法我院2008年11月至2011年11月直肠癌患者100例,其中经肛局部切除的患者50例,miles手术50例。术后均给予相应的临床护理。结果100例患者手术完成顺利,术后伤口感染20例,其中行肛局部切除患者感染3例,miles术后感染17例,经过三周护理感染症状消失,均痊愈出院。结论直肠癌术后实施临床护理干预有助于预防患者感染及促进感染后患者恢复。     

经直肠超声在直肠癌术前分期中的应用及进展

直肠癌治疗手段主要为根治性切除术为主并辅以放化疗治疗;肿瘤侵润的范围、淋巴结及远处转移的有无构成了临床TNM分期并影响着直肠癌的治疗和判断预后。经直肠超声检查术(Transrectal ultrasound,TRUS)可以显示直肠壁各层组织的变化,不仅对肿瘤浸润深度诊断准确性较高,而且提高了术前对肠周淋巴结转移诊断的准确性,对直肠癌术前的TNM分期具有重要的意义,从而指导医师选择最佳的手术方式及是否需要术前放化疗以达到根治直肠癌、提高患者生活质量与延长寿命的目的。     

Abdominal resection of rectal cancer]

Preservation of anal sphincters in the surgical treatment of rectal cancer is often controversial as far as an extent of surgery, incidence of complications and an increase in mortality rate in perioperative period are concerned. The study was aimed at results of the retrospective analysis of patients, who undergone abdominal excision of the rectum for malignant tumours. Totally 136 patients were operated. Perioperative mortality rate was 5.14%. Totally 26.4% of patients survived for at least 5 years, including 80% of patients operated in A stage of cancer, according to Duke, and 43.3% of patients with tumour in B stage. An emphasis is on the necessity to leave a 2-centimeter margin of healthy tissues around the tumour, provided, that the result of intraoperative histological examination was negative. Such a margin is sufficient for anastomosis. Low anastomoses do not produce early complications and recurrences.     

Causes of local recurrence after curative surgery for rectal cancer

The rate of local recurrence (LR) has been 20-40% after resective surgery for rectal cancer by the traditional - Miles or Dixon - operative technics. The authors performed curative resection in 358 patients with rectal cancer in a 10 year period (01.01.1990 - 31.12.2000) in the Surgical Department of Szeged University. Since 01.01.1996 the authors changed this type of surgery for the Heald technics (total mesorectal excision - TME - with sharp dissection, using the UltraCision device) for the surgical treatment of middle or lower third rectal cancer. To compare the results of the two procedures, the authors analysed their material in two periods: Period I: 01.01.1991 - 31.12.1992: 62 patients operated on with the traditional operative technics; LR 15% within 2 years after surgery. Period II: 01.01.1997 - 31.12.1998: 78 patients operated on with the Heald technics (TME with sharp dissection); LR 6.4% within 2 years after surgery. Based on their results, the authors found that the modern operative technics by Heald, used in the second period of the study, was a relevant factor decreasing LR from 15% to 6.4%, while the gender, age of the patients, ratio of the abdominoperineal extirpation versus anterior resection (APRE/AR) and the free margin of more than 3 cm proved to be irrelevant.     

Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis

Aim

The aim of this study was to compare the short-term and mid-term effects of laparoscopic intersphincteric resection with the conventional open approach for patients with low rectal cancer through a meta-analysis.

Methods

The PubMed, EMBASE, Cochrane, and Ovid databases were searched for eligible studies until March 2017. Operation time, blood loss, circumferential resection margin-positive rate, distal margin length, number of resected lymph nodes, diverting stoma rate, postoperative overall morbidity, anastomotic leakage, and hospital stay were the main short-term effect endpoints. We also examined disease-free survival, overall survival, local recurrence, and post-operational anal function as secondary outcomes to evaluate the mid-term effects of laparoscopic surgery.

Results

Five studies involving 620 patients were included in the analyses. Compared with the open approach, the laparoscopic ISR had less blood loss (weighted mean difference [WMD]?=???214.65 ml, 95% CI [??370.44, ??196.13], p?<?0.01), less postoperative overall morbidity (OR?=?0.58, 95% CI [0.40, 0.86], p?<?0.01), and shorter duration of hospital stay (WMD?=???5.87 days, 95% CI [??11.35, ??0.40], p?<?0.05); however, the operation time was significantly longer in the laparoscopic group (WMD?=?47.34 min, 95% CI [4.10, 90.58], p?<?0.05). No other significant differences were observed.

Conclusion

Laparoscopic ISR for low rectal cancer offers fewer complications and faster recovery, with similar operation quality and mid-term oncological results than the conventional approach. Although this technique is comparatively more complex than the conventional approach and requires practice, laparoscopic ISR shows great potential as a surgical option and deserves further clinical study.

     

Early distant relapse after optimal local control in locally advanced rectal cancer

We present a case of locally advanced rectal cancer with initial optimal local control after neoadjuvant concurrent chemoradiotherapy followed by surgery; early liver recurrence then occurred and was treated again with curative intent with neoadjuvant combination chemotherapy followed by liver surgery. We reflect on this difficult problem and discuss relevant topics to this case report.     

直肠癌术后肺转移72例的临床分析

目的：探讨直肠癌根治术后肺转移的治疗效果和影响预后的因素。方法：回顾性分析1978～2008年间的直肠癌根治术后发生单纯性肺转移的72例病例资料。结果：自原发灶切除术后全组病例中位生存时间34个月,行转移灶的切除手术23例,中位生存49个月;其余49例行非手术治疗,中位生存33个月;其中转移瘤大于3个组中位生存时间28个月,转移瘤小于等于3个组中位生存时间41个月。手术患者和转移灶个数少的患者的总生存率较大,总生存率可能和是否手术、转移灶的个数有关,但尚未发现年龄、性别、原发灶病理类型、分期、转移灶大小对生存率有明显影响。结论：直肠癌肺转移灶的手术治疗是安全、有效的。手术及转移灶个数可影响患者生存率。     

微生态制剂在早期结直肠癌根治术后的作用

目的 探讨微生态制剂在早期结直肠癌(CRC)根治术后的作用,并为此类患者提供一种术后康复支持疗法。 方法 选取2017年6月-2019年6月于本院接受早期CRC根治术术后97例患者作为研究对象,采用随机数字表分为观察组50例和对照组47例。两组术后均接受常规治疗,观察组在对照组基础上接受双歧杆菌三联活菌胶囊治疗,比较两组治疗前后细胞免疫指标、肠道微生态复杂度及属水平相对丰度、肠道菌群OTU数量、肠道黏膜屏障功能。 结果 治疗后观察组NK细胞、CD3+T、CD4+T、CD4+/CD8+T均提高(P+T治疗前后相近(P>0.05);治疗后对照组上述指标与治疗前差异均无统计学意义(P>0.05),观察组NK细胞、CD3+T、CD4+T、CD4+/CD8+T均高于对照组(P0.05);治疗后观察组Chao1指数、Shannon指数、肠道菌群OTU数量均高于对照组(P结论 微生态制剂可有效改善早期CRC患者根治术后的细胞免疫水平,有效纠正早期CRC术后患者肠道菌群失调,增强早期CRC根治术后患者肠黏膜屏障功能。