ARC换药流程在结直肠癌术后造口周围皮肤的应用研究

目的探讨ARC换药流程在结直肠癌造口术后患者造口周围皮肤的应用效果。方法选取122例结直肠癌行结肠或回肠造口术后的患者,随机分为观察组和对照组,观察组执行ARC造口换药流程并对患者及家属进行相关宣教;对照组执行常规护理流程和术后宣教。于出院前、出院1个月和3个月时对两组患者周围皮肤情况进行DET评分;每次换药如发生造口周围皮肤并发症则分类记录;比较两组患者出院后再就诊费用的总数。结果观察组的皮肤并发症发生率、出院后2次DET评分、再就诊费用均低于对照组,差异有统计学意义(P0.05)。结论在结直肠癌造口术后患者中执行ARC造口换药流程能减少造口周围皮肤并发症的发生,改善造口周围皮肤情况,减轻患者再就诊的经济负担,提高造口患者保护造口周围皮肤的意识,进一步为医护人员造口换药操作流程提供参考。     

中国汉族群体中PDCD1基因多态性与结直肠癌的相关性CSCD

目的探讨程序性细胞死亡受体1（ programmed cell death 1,PDCD1）基因多态性与结直肠癌的发生发展的关联性。方法应用聚合酶链反应-限制性片段长度多态性（PCR-restriction fragment length polymorphism, PCR-RFLP）方法对426例结直肠癌患者及500名正常个体的rs36084323、rs11568821、rs2227981、rs2227982和rs10204525位点进行多态性分析。结果rs36084323位点G等位基因在显性遗传模型下与TNM分期进展期结直肠癌的发生正关联（OR＝1.59,95%CI：1.02～2.48）。rs36084323、rs11568821、rs2227981、rs2227982和rs10204525位点组成的单倍型G-G-C-T-A和A-G-C-C-G与结直肠癌的发生负关联。结论PDCD1基因rs36084323位点AG和GG基因型与TNM分期进展期的结直肠癌存在正关联。而G-G-C-T-A和A-G-C-C-G单倍型与结直肠癌的发生负关联。     

左侧结直肠癌并发急性肠梗阻的急诊处理

本文报道198O年—1989年间532例左侧结直肠癌中并发急肠梗阻40例,1期切除14例(35%),Ⅱ期切除10例(25%),其他术式16例(40%).1期手术的五年存活率36.0%,Ⅱ期手术的五年存活率20.0%,Ⅰ期手术的吻合口漏3例,手术死亡1例,均发生在未行术中肠道灌洗的5例中;Ⅱ期切除木吻合口漏1例,无手术死亡.作者分析本组资料并结合文献认为,左侧结直肠癌并发急性肠梗阻应以急诊手术治疗为主,术前必须迅速纠正病人水电解质平衡,掌握好适应症.Ⅰ期切除吻合术中行全结肠灌洗是预防术后并发症的关键:     

Association between liver targeted antiviral therapy in colorectal cancer and survival benefits: An appraisal

In colorectal cancer (CRC), liver metastasis remains a major contributor to the cause of cancer-related death. Putative biomarkers, therapeutic efficacy, and drug insensitivity still pose clinical challenges for metastatic CRC patients. Interestingly, previous studies indicated that tumor cells in CRC did not metastasize to the injured liver, which included hepatitis or cirrhotic liver. The benefits of antiviral therapy on hepatocellular carcinoma have also been identified. This review discusses the role of antiviral therapy on the liver. Antiviral therapy may reduce potential liver metastasis associated with CRC in several mechanistic aspects.     

Severe anaphylactic reactions in patients receiving oxaliplatin therapy: a rare but potentially fatal complication

Goals The most well-known adverse events of oxaliplatin are hematologic toxicity, gastrointestinal tract toxicity, and sensory neuropathy. However, hypersensitivity reaction of oxaliplatin, especially severe anaphylactic reactions (SAR), was less often reported. Materials and methods Three hundred and three patients with colon cancer treated by oxaliplatin-containing chemotherapy in one institution were analyzed. Patients were considered to have oxaliplatin-induced SAR if they suffered from at least one of the following symptoms after oxaliplatin infusion: symptomatic bronchospasm, allergy-related edema/angioedema, unstable blood pressure, or anaphylaxis. The reported cases in published literatures that met our definition were also reviewed. Result There were 4 out of 303 patients suffering from SAR after receiving oxaliplatin infusion, with an estimated incidence of 1.32%. Two of them became unconscious and had hypertensive crisis, and one patient had consciousness loss with hypotension. All four patients needed various level of oxygen support. Twenty-seven cases of oxaliplatin-induced SAR were found from Medline. Among the 31 reported cases, the most frequent SAR symptom was hypotension. However, we reported two unique SAR cases with hypertension crisis. In only four out of ten cases, patients could tolerate rechallenge of oxaliplatin. There is no association between the occurrence of oxaliplatin-induced SAR and metastatic sites. Conclusion Oxaliplatin-induced SAR is a rare but potentially fatal complication. Hypertension crisis can be one of the oxaliplatin anaphylactic reactions. Only few patients suffering this complication could tolerate subsequent treatment of oxaliplatin by prolonged infusion time or using a desensitization schedule, thus changing regimen might be a better alternative for them.     

结、直肠癌的早期诊断——(附13例临床分析)

要早期发现结、直肠癌必须采取以下积极措施:重视血便、指检、镜检与病理活检,必要时住院观察、追踪监护定期复查(CEA)。正确的手术治疗几乎100％可获得治愈。     

大肠癌发生发展中cyclinD_1和P_(16)的表达及意义

目的 探讨cyclinD1和P16在大肠癌癌变过程中的表达和意义。方法 应用免疫组化染色法检测大肠癌手术切缘粘膜上皮、癌旁组织、大肠腺瘤及大肠癌中cyclinD1和P16的表达。结果 cyclinD1表达在大肠癌发生发展中呈增高趋势,P16表达呈下降趋势,二者在癌旁、腺瘤和癌组织中的表达与手术切缘粘膜上皮相比均有显著性差异(P<0.01或0.05),cyclinD1和P16的表达与癌的淋巴结转移密切相关(P<0.05),cyclnD1还与癌浸润深度有关(P<0.05)。结论cyclinD1和P16在大肠癌癌变过程中起重要作用,并有促进肿瘤转移的效应,可作为大肠癌早期诊断和判断预后的重要分子指标。     

改良FOLFOX4方案治疗晚期大肠癌

目的 评价改良FOLFOX4方案治疗晚期大肠癌的疗效和毒性。方法 自2000年1月—2002年5月，作以改良FOLFOX4方案治疗晚期大肠癌病人34例。方案L-OHP 85mg/m^2 id d1、2,CF25mg/m^2dl,5-FU400mg/m^2静推d1、2 5-FU6000mg/m^2静脉持续d1、2，每2周重复。结果 总有效率：28％；中位缓解期：6个月，中位生存期：11个月，主要毒副反应为神经毒性。结论 本方案对晚期大肠癌有效，毒副反应可耐受。     

VEGFR-3与大肠癌淋巴结转移关系的研究

目的检测血管内皮生长因子受体3（VEGFR-3）在大肠癌中的表达，探讨其与淋巴结转移的关系。方法标本来自南昌大学第四附属医院普外科2006年1～6月手术根治性切除大肠癌56例，详细记录患者临床病理情况，并以同时期同科室手术切除20例结肠良性腺瘤作为对照。应用免疫组化方法检测组织标本中的VEGFR-3蛋白表达，并计算微淋巴管密度（LMVD）。结果VEGFR-3在大肠癌中的表达强度明显较大肠腺瘤中的高，差异具有显著性（P〈0．05）。大肠癌中LMVD数值高于大肠腺瘤中的LMVD，差异具有显著性（P〈0．05）。结论VEGFR-3蛋白在大肠癌组织中表达增高，并可能与大肠癌的经淋巴道转移增加有关。     

Preparación mecánica y profilaxis antibiótica por vía oral en cirugía colorrectal. Análisis de la evidencia científica y revisión narrativa

The role of oral antibiotic prophylaxis and mechanical bowel preparation in colorectal surgery remains controversial. The lack of efficacy of mechanical preparation to improve infection rates, its adverse effects, and multimodal rehabilitation programs have led to a decline in its use. This review aims to evaluate current evidence on antegrade colonic cleansing combined with oral antibiotics for the prevention of surgical site infections. In experimental studies, oral antibiotics decrease the bacterial inoculum, both in the bowel lumen and surgical field. Clinical studies have shown a reduction in infection rates when oral antibiotic prophylaxis is combined with mechanical preparation. Oral antibiotics alone seem to be effective in reducing infection in observational studies, but their effect is inferior to the combined preparation. In conclusion, the combination of oral antibiotics and mechanical preparation should be considered the gold standard for the prophylaxis of postoperative infections in colorectal surgery.