小儿肛肠疾病治疗进展

肛肠疾病是小儿外科最具代表性的病种,主要包括先天性巨结肠、便秘与失控、先天性肛门畸形以及一些肛肠会阴杂病,如:肛瘘、便血、血管瘤等。下面就治疗进展分别作一些回顾。     

肠脂垂病变1例报告

肠脂垂病变文献已报告225例,可见并非罕见。但亦往往被临床医师所忽略。为引起对本病的重视,提高诊治水平,现将我们遇到的1例报告如下,并略加讨论。     

多潘立酮在增强结肠运动中的作用

Objective To observe the prokinetic effect of domperidone on colon and compare with that of mosapride and cisapride.Methods ① In viva experiment:forty rats were divided into control,domperidone,mosapride,and cisapride groups with 10 in each group.Stran gauges were planted both in proximal and distal colons and colonic motor activities were recoded in conscious rats.② In vitro experiment:the prokinetics effects of dopamine or dopamine combined with domperidone on the contraction of isolated rat colon strips were recorded by tone-transducers in the thermostatic muscle bath.Results In viva experiments:① in the interdigestive period of resting,activities of rhythimic phasic contraction were recoded in colon at conscious rats,and ② it had been showed that dornperidone significantly enhanced the contraction of colon in dose-dependent manner.Compared with control group,the mean contraction amplitude of proximal colon and distal colon increased by 84.61% ± 7.26% and 76.37 % ± 8.47% in domeridone group,respectively,which was higher than those in mosapride group (50.32%±8.16% and 45.13%±7.16%,respectively),but as same as those in cisapride group (92.55% ± 8.37% and 81.27% ± 9.95%,respectively).In vitro experiments:① perfusion of dopamin (40 mg/ml) could significantly decrease the contraction of isolated colon strip by 91.56% ± 10.24% in comparison with Krebs-Ringer solution,and ① domperidone could block the relaxant effect of dopamin on the isolated colon strip.Conclusions Domperidone can significantly enhance the colonic motor activities via antidopaminergic action.The effects of domperidone are similar as eisapride and greater than mosapride.     

肺癌术后结肠转移1例

病人 男，80岁。刺激性咳嗽、痰中带血6个月。查体：双肺底可闻及哮鸣音．余无阳性体征，胸部CT见右肺下叶4．5cm×5．5cm类圆形分叶状软组织密度影，并可见胸膜凹陷征：纤维支气管镜检查未见异常。     

腹腔镜全结肠切除术的临床应用

经过10余年的发展，经腹腔镜已能进行右半结肠切除、左半结肠切除、乙状结肠切除、直肠切除(Miles手术、Dixon手术)等结直肠手术，但腹腔镜全结肠切除术开展数量仍较少，国内多限于个案报道，原因主要是其技术难度大和适应证窄等，本就腹腔镜全结肠切除术的有关原则和方法做一概述。     

结肠癌致急性肠梗阻9例临床分析

结肠梗阻是结肠癌的常见并发症，而低位性肠梗阻主要病因为结肠癌。结肠癌由于起病隐匿，发展缓慢，易被忽视。一旦发生肠梗阻表现，临床处理非常棘手，选择何种处理方式，对患者的预后、生活质量、经济负担，均有较大差异。本院自近年以来共收治9例结肠癌急性肠梗阻。现将诊断、治疗体会报告如下。     

对37例结肠造口病人健康教育需求的调查

直肠癌是消化道常见的恶性肿瘤，50％～60％直肠癌病人需做结肠造口术^[1]。这不仅给病人的生活造成极大不便，同时要承受躯体、心理等多方面的痛苦。为了提高病人自理能力，帮助病人建立规律排便，以提高病人的生活质量，对37例直肠癌结肠造口术后病人进行了健康教育需求的调查。现报告如下。     

金属夹定位结肠病变在腹腔镜手术中的应用

目的：探讨腹腔镜结肠手术术前病灶定位的方法。方法：22例腹腔镜结肠手术术前行纤维结肠镜检查，并用金属夹标记结肠病变部位，并摄平卧位腹平片确定体表投影部位。结果：22例腹腔镜结肠手术均顺利找到病变部位。结论：术前用金属夹定位病变，有助于腹腔镜结肠手术时顺利找到病灶。     

三氧化二砷抑制人结肠癌细胞生长的实验研究

目的探讨三氧化二砷(As2O3)抗人结肠癌细胞SW480生长及其机制。方法采用MTT法和流式细胞术对细胞生长、凋亡、细胞周期、增殖细胞核抗原(PCNA)、Fas、Bcl-2表达率及细胞内钙离子(IECa2+)含量进行分析。结果As2O3可显著抑制SW480细胞生长并诱导凋亡,且呈现剂量和时间依赖关系,其24、48和72h的半数抑制浓度(IC50)分别为9.71、8.78和7.34μmol/L。As2O3作用的SW480细胞周期阻滞在G2/M期,Fas和IECa2+含量增加、PCNA表达下降(P<0.01),但Bcl-2表达无变化(P>0.05)。结论As2O3可有效抑制SW480生长并诱导凋亡,其机制可能与上调Fas和IECa2+含量、降低PCNA表达及阻滞细胞周期有关。     

中下段直肠癌外科治疗规范(草案)

为了提高我国直肠癌的诊断与治疗水平，直肠癌的外科治疗规范化是非常迫切而必要的。为此，中国抗癌协会大肠癌专业委员会近期拟定了“中下段直肠癌外科治疗规范(草案)”。现我刊予以全文刊载供全国胃肠外科医师在临床上参考，并请在应用过程中提出修改补充意见，使之更加完善。全文共分两部分，除目前刊登的治疗部分外，还有3个附件，即直肠癌病理取材要点、结肠系膜切除标准和TME应用于中下段直肠癌的临床试验——开放性前瞻性多中心试验。由于篇幅所限，本期先刊出草案的第一部分，3个附件将于下期刊出。