腹腔镜下直肠癌根治术的围术期护理

[目的]探讨腹腔镜下直肠癌根治术围术期的护理方法和要点。[方法]对35例行腹腔镜下直肠癌根治术病人实施整体护理,观察病人术前、术后的身体状况及生活质量。[结果]35例病人均顺利完成手术,未发生出血、吻合口瘘及吻合口狭窄,无死亡病例。2例有切口感染,经加强抗感染、换药等处理后均痊愈出院。[结论]做好腹腔镜下直肠癌根治术的围术期护理,能减轻病人术前的焦虑和痛苦、顺利完成手术治疗、减少并发症的发生。     

早期结直肠癌及癌前病变患者经内镜下黏膜切除术与黏膜剥离术治疗的疗效比较

目的比较内镜下黏膜切除术(EMR)与内镜下黏膜剥离术(ESD)在结直肠癌前病变与早期癌患者中的应用效果。方法选取2010年1月-2015年1月该院收治的116例早期结直肠癌患者与结直肠腺瘤患者为研究对象。其中,61例患者采用EMR治疗,为EMR组,55例采用ESD治疗,为ESD组。比较EMR与ESD在结直肠癌前病变与早期癌患者中的应用效果。结果 EMR组患者的手术时间明显短于ESD组患者,两组患者的病理情况、异型增生程度的差异无统计学意义(P0.05)。ESD组病变最大径≥2 cm的整块切除和病变最大径≥2 cm的组织治愈性切除的患者明显多于EMR组,差异有统计学意义(P0.05)。ESD组病变最大直径≥2 cm的患者明显多于EMR组,差异有统计学意义(P0.05)。EMR组和ESD组患者并发症总发生率分别为6.56%和23.63%,差异有统计学意义(P0.05)。EMR组和ESD组患者的复发率分别为5(8.20%)例和3(5.45%)例,差异无统计学意义(P0.05)。ESD术后出现并发症的危险因素为操作经验和病变大小(P0.05)。结论 ESD术和EMR术均能较好的整块切除病变最大径≥2 cm的早期结直肠癌与结直肠腺瘤,术后复发率较低。ESD术相对于EMR术更适合较大的病变,但术后复发率较高,且手术医师的操作经验和病变大小为ESD术后发生并发症的危险因素,应加强监测。     

腹腔灌洗液中CK20m RNA水平与结直肠癌不同术式的研究

目的探讨腹腔灌洗液中CK20m RNA的临床意义以及腹腔镜直肠癌根治术的临床应用价值。方法选择49例直肠癌手术患者,利用RT-PCR技术分别检测以上患者腹腔灌洗液中CK20m RNA表达,从而探究CK20m RNA的临床价值以及评价腹腔镜直肠癌根治术的临床实用性。结果 10例良性病变腹部手术组患者腹腔灌洗液中CK20m RNA无明显表达。39例结直肠癌患者腹腔灌洗液中可见CK20m RNA表达,术前、术中以及术后的总表达率为40.2%(47/117),且术前、术中以及术后CK20m RNA的表达率比较差异无显著性(P0.05)。17例开腹手术组和22例腹腔手术组术前、术中以及术后CK20m RNA阳性表达率的比较差异无显著性(P0.05)。结论腹腔镜结直肠癌根治术治疗结直肠癌安全有效,与开腹手术相比并不增加癌细胞局部种植的风险。     

Prevalence and Predictors of New-Onset Atrial Fibrillation After Elective Surgery for Colorectal Cancer

There are only limited data on the prevalence and risk factors for postoperative atrial fibrillation (AF) after elective abdominal surgery. We retrospectively studied the clinical characteristics and hospital outcomes in 563 consecutive patients (mean age: 67 ± 13 years, 245 men) with colorectal cancer who underwent elective colectomy. The baseline clinical characteristics of patients who underwent open (OC) versus laparoscopic colectomy (LC) were similar. Postoperative AF developed in 25 patients (4.4%). Patients who developed postoperative AF were older (P = 0.017), had a higher prevalence of hypertension (P = 0.05), more major postoperative events (P = 0.02), an elevated neutrophil count on postoperative day (POD) 1 (P = 0.007), longer hospitalizations (P = 0.02), and were more likely to undergo OC (P = 0.067). In multiple regression analysis, independent predictors of postoperative AF were OC (odd ratio: 3.3 , 95% confidence interval: 1.3–8.0, P = 0.008), and an elevated neutrophil count on POD 1 (odd ratio: 3.2 , 95% confidence interval: 1.3–7.8, P = 0.01). The incidence of postoperative AF after elective colorectal cancer surgery was approximately 4%. Postoperative AF was more commonly observed in patients with OC versus LC and in those with elevated postoperative neutrophil counts.     

腹腔镜根治术与开腹手术治疗结肠、直肠癌单中心对照研究

目的探讨腹腔镜根治术治疗结直肠癌的临床应用价值及其安全性。方法将本院2008年5月—2012年5月收治的78例结直肠癌患者随机分为2组,每组39例。治疗组采用腹腔镜根治术,对照组采用传统开腹手术,分析比较2组患者治疗前后的临床及手术资料。结果与对照组相比,治疗组的手术时间、术中出血量、术后平均住院时间、下床活动时间、术后肠道功能恢复时间、术后并发症发生率均显著降低。治疗组术后48 h、72 h血浆胃动素水平均显著高于对照组。结论腹腔镜根治术治疗结直肠癌具有出血少、恢复快、手术安全、创伤小、胃肠功能恢复快等优点,值得临床进一步推广应用。     

T1期结直肠癌内镜切除术后复发的风险因素研究

目的探讨T_1期结直肠癌(CRC)行单独内镜切除术或内镜切除术后追加手术治疗后的复发情况。方法该研究采用回顾性分析方法,纳入2005年1月-2012年12月在该院接受内镜下切除手术的389例T_1期CRC患者。比较内镜切除术后追加手术组(ER+SURG组,n=205)患者和单独内镜切除术组(单独ER组,n=184)患者临床结果。结果无追加手术指征(垂直切缘阴性、黏膜下深层浸润、淋巴管或静脉浸润、分化较差及高芽殖)患者复发风险极低。有追加手术指征患者,ER+SURG组累积复发风险(CRRs)为3.7%,单独ER组为20.1%(P=0.001)。即使未接受追加手术,仅黏膜下深层浸润患者CRRs较低(ER+SURG组:2.3%vs单独ER组:3.4%,P=0.537)。相反,除黏膜下深层浸润外还伴有其他手术指征患者(高风险患者),接受追加手术能够显著改善临床结局(CRRs:ER+SURG组5.8%,单独ER组58.0%,P=0.001)。结论仅黏膜下深层浸润患者肿瘤复发风险较低,具有其他高风险特征患者肿瘤复发风险较高,接受追加手术获益较大。     

结直肠癌患者住院期间造口并发症预警模型的建立与评估

目的 分析影响术后结直肠癌患者住院期间造口并发症的危险因素,建立列线图预警模型,并评价模型的准确性,为分级护理提供临床依据.方法 回顾性分析2018年1月—2019年2月本院收治的372例结直肠癌造口手术患者临床资料,根据是否发生并发症分为并发症组(n=67)与非并发症(n=305),采用logistic回归模型筛选影...     

延续护理模式在直肠癌患者术后的应用

目的探讨直肠癌术后延续护理模式的应用与护理。方法选择本院接受直肠癌手术80例患者,按照随机数字法分为实验组和对照组,各40例,对照组在术后仅接受常规的出院护理指导,实验组则接受延续性护理。比较2组患者出院后6个月后自我护理能力、生活质量及并发症情况。结果 6个月后,2组患者的自我护理能力均有不同程度上的提高,但实验组提高幅度显著高于对照组(P0.05);实验组出院6个月后在生活质量各维度的评分均显著优于对照组(P0.05);实验组并发症发生率均显著低于对照组(P0.05)。结论直肠癌术后延续性护理模式的应用与护理不仅能够提高患者自我护理能力及生活质量,还能减少相关并发症的发生。     

Ultrasonographic diagnosis of advanced colorectal cancer

We investigated the efficacy of transabdominal ultrasonography for the diagnosis of advanced colorectal cancer. Colonic examination by colonoscopy, barium study, or surgery was carried out in our institution on 1579 patients during the past 5 years. This study focused on 1564 of these patients, 15 who has been diagnosed with colorectal cancer before ultrasound examination having been excluded. The results included 51 ultrasound-positive cases, 9 ultrasound-false-positive cases, 1476 ultrasound-negative cases, and 28 ultrasound-false-negative cases. Sensitivity was 64.6 percent and specificity was 99.6 percent. Of the 28 ultrasound-false-negative cases, the lesion was detected in the ascending colon in 2, in the transverse colon in 6, in the descending colon in 1, in the sigmoid colon in 3, and in the rectum in 16. Obstruction and dilatation suggested colorectal cancer in 3 cases, which were thus classified as ultrasound-negative when no tumors were detected. Sensitivity was investigated by site. Sensitivity was lowest at 30.4 percent in rectal cancer, but was 78.6 percent in colon cancer, exclusive of rectal cancer. Laboratory findings and clinical symptoms which were suggestive of colorectal cancer were used as information before ultrasound examination was performed. Sensitivity of examinations carried out on examinees on whom prior information was available and on those on whom there was no information did not differ significantly. Furthermore, ultrasound was thought to detect approximately 65 percent of advanced colorectal cancers when it was used aggressively to investigate the large intestine. Ultrasound was thus considered effective for detecting advanced colorectal cancer.     

血浆SEPT9基因甲基化在结直肠癌根治术后复发监测中的应用

目的 分析血浆SEPT9基因甲基化(mSEPT9)在结直肠癌根治术患者术后复发监测中的应用效果.方法 选取2014年4月至2018年4月在该院行根治术的154例结直肠癌患者作为研究对象,采用试剂盒检测患者外周血标本中的mSEPT9和癌胚抗原(CEA),并分析mSEPT9与年龄、性别、体质量指数(BMI)、淋巴结转移、发...     

腹腔镜结直肠癌根治术对结直肠癌患者细胞免疫功能、胃肠激素及预后的影响*

目的探讨腹腔镜结直肠癌根治术对结直肠癌患者细胞免疫功能、胃肠激素及预后的影响。方法选择2016年7月-2017年10月收治的结直肠癌患者86例为研究对象,采用随机数字表法分为观察组和对照组各43例。对照组给予开腹结直肠癌根治术,观察组给予腹腔镜结直肠癌根治术,比较两组手术相关指标、细胞免疫功能、胃肠激素的变化和不良反应等情况。结果观察组手术时间明显长于对照组,排便时间、排气时间、住院时间明显短于对照组,术中出血量明显少于对照组(t=10.67,11.22,13.58,8.56,19.52;P 0.05);T淋巴细胞CD3~+、CD4~+、CD8~+和CD4~+/CD8~+减少值均明显少于对照组(t=10.99,17.76,10.46,10.49;P 0.05);血清胃泌素(GAS)、胃动素(MTL)减少值均明显低于对照组(t=10.31,13.73;P 0.05);并发症发生率11.63%明显低于对照组30.23%(χ2=4.50,P 0.05)。结论腹腔镜结直肠癌根治术有助于促进患者术后康复,降低术后并发症的发生,可能与对机体细胞免疫功能和胃肠激素影响较小等因素有关。     

结直肠癌患者诊断期高频症状的研究

目的 描述结直肠癌患者诊断期相关症状发生率、严重程度、困扰程度特点,提示该类患者症状的发生率、严重度及困扰度各方面出现的高频症状,为制定针对性护理措施提供依据。方法 采用自制的结直肠癌患者症状调查问卷对110例结直肠癌诊断期患者进行调查。结果 结直肠癌诊断期患者症状发生率前5位的症状是为便血（61例,占55.5%）、消瘦（47例,占42.7%）、疲乏（47例,占42.7%）、排便不尽感（44例,占40%）、大便变细（43例,占39.1%）。症状严重程度居前的是便秘、悲伤、大便变细、焦虑、大便不成形;症状的困扰程度排序居前的是便血、消瘦、纳差、疲乏、睡眠不安、便秘、悲伤、大便变细、焦虑、失眠、大便不成形(中位数均为3.00)。结论 结直肠癌患者诊断期在发生率、严重度、困扰度各方面存在不同的高频症状,因此护理人员要根据此做好评估并制定护理计划对症状进行管理。     

疾病获益感在结直肠癌病人人群中的研究现状

介绍疾病获益感在结直肠癌病人人群中的研究现状,为临床识别、预估结直肠癌病人积极心理水平、探讨有效提升病人疾病获益感水平的干预措施提供参考。认为结直肠癌病人疾病获益感的研究仍不成熟,更多关于疾病获益感在结直肠癌病人中的作用机制及循证基础上干预方案的制定等研究有待进一步开展。     

Comparing treatment trends for colorectal cancer in clinical database and cancer registry data: implications for monitoring cancer care

Background Recent UK policy has promoted routine monitoring of the performance of cancer services. Clinical databases are one method of collecting the detailed data required for clinically relevant analyses and of supplementing that collected by cancer registries. Objective To describe characteristics of patients, their treatment and surgical care recorded in the North Thames Prospective Audit of Colorectal Cancer database compared with the Thames Cancer Registry database between 1999 and 2004. Methods We defined the geographical area served by the prospective audit and extracted a registry dataset for the same area. We compared the numbers, age, sex, cancer site and staging of patients in each database. The proportions recorded as receiving surgery, radiotherapy and chemotherapy were compared over time, and clinical standards recorded for preventing post‐operative complications and for specialist care were determined from the clinical database. Results Clinical and registry databases differed in case mix. The clinical database began to capture data on a larger number and wider range of patients over time, and generally included more complete staging data. Treatment trends differed between the databases, with the registry data showing lower proportions undergoing surgery and a slight increase in rectal cancer surgery over time. There was a suggestion that a higher proportion of men received radiotherapy and chemotherapy than women. Recording of surgical standards in the clinical database was generally poor, although decreased leak and infection rates and post‐operative mortality were suggested in the initial years of the audit. Conclusions The clinical database contributed some additional information on patient characteristics and the performance of services, but variable data quality and completeness prevented many planned analyses. Collecting additional data requires funded structures and quality assurance systems and such effort should focus on the data required to answer the most pressing clinical questions.     

Advances in prognostic markers for colorectal cancer*

Introduction: Colorectal cancer (CRC) is one of the most common malignant tumors worldwide and contributes significantly to cancer-related deaths. Since CRC is largely asymptomatic until alarm features develop to advanced stages, the incidence and mortality rate of CRC is relatively high and increases year by year.

Areas covered: This review mainly summarizes the recent advances of genetic, epigenetic, and proteomic molecular markers that may be used to predict the prognosis of CRC. Moreover, we made an introduction to immune biomarkers and emerging microbial biomarkers. We also discussed the recent movement of molecular pathological epidemiology (MPE) in the context of prognostic biomarkers. Finally, we discussed the pros and cons of various biomarkers for improving prognostic judgment.

Expert opinion: A great number of molecular targets have been identified as prognostic markers for CRC. However, because of some limitations, the efficiency of these biomarkers is restricted in clinical application. Combining a panel of several approaches may present a promising alternative tool for clinical practice. Further large-scale clinical trials are required to validate the prognostic value of these biomarkers in clinical use.