梗阻性结肠癌的外科治疗体会

我院１９８９年～１９９８年共收治梗阻性结肠癌３７例,均采用手术治疗,疗效良好,现分析报告如下。 临床资料 １．一般资料 男２０例,女１７例,年龄３１～７５岁,平均５１岁。全组病例均以急性腹痛入院,有典型的肠梗阻症状,出现腹膜刺激征２６例。腹部平片提示肠腔积气和多个液平。术前钡剂或泛影葡胺灌肠检查提示结肠占位合并梗阻２４例。腹痛出现时间０．５～４ｄ。完全性肠梗阻２８例,不完全性肠梗阻９例。右半结肠癌１９例,左半结肠癌１８例。病理类型：腺癌２６例,粘液腺癌９例,未分化癌２例。 ２．治疗方法与结果 病人术…     

梗阻性左半结肠癌的外科处理

目的：探讨左半结肠癌致肠梗阻的外科处理方法。方法：对35例患者均进行手术治疗。Ⅰ期肿瘤切除，肠吻合术15例，占42．8％，分期手术17例，姑息手术3例，占57．2％。结果：术后切口感染3例，肠漏1例。出现心肌梗塞死亡1例。结论：对以急性肠梗阻为主要表现的左半结肠癌，选择合适的病例，遵循“上要空，口要正，下要通”的原则，行一期肿瘤根治切除，肠吻合是安全可行的。     

梗阻性左半结肠癌Ⅰ期手术16例临床治疗体会

目的：探讨左半结肠癌急性梗阻Ⅰ期切除吻合术的可行性。方法：对1986年8月～2001年8月收治的无严重并存病的左半结肠癌急性梗阻16例Ⅰ期切除吻合进行回顾分析。结果：均采用Ⅰ期切除吻合术。无吻合口漏；腹壁切口感染3例；无死亡病例。结论：严格掌握手术指征，积极的术前准备，尽早手术，术中彻底灌洗肠腔，轻柔细致的肠吻合，术后扩肛，合理应用抗生素，加强营养支持，Ⅰ期切除吻合术是可行的。     

老年梗阻性结直肠癌的外科治疗体会

结直肠癌是消化道常见恶性肿瘤,为老年人肠梗阻的主要原因,发生率约8％～29％[1].老年患者合并症多,年龄大且反应差,在临床治疗中有较大风险.笔者就58例老年梗阻性结直肠癌患者的手术治疗做一总结,报道如下. 1 资料与方法 1.1一般资料本组共58例,男33例,女25例:年龄60～86岁平均年龄74岁.右半结肠癌27例,平均年龄77岁:左半结肠癌11例,平均年龄65岁;直肠癌20例,平均年龄74岁.     

急性梗阻性大肠癌的外科治疗

由于大肠的解剖及生理特点，一旦发生大肠癌致急性梗阻，急诊手术时处理比较困难。对该病的处理应注意，①抗菌药物在急性梗阻性大肠癌中的应用；②梗阻上段肠内容物的清除；③结肠—期切除或扩大的右半结肠切除术；④分期手术；⑤腹壁结肠造口方法的改进。     

右半结肠癌侵犯十二指肠的外科处理

目的:探讨右半结肠癌侵犯十二指肠的外科处理方法:方法:近十年中对9例右半结肠癌侵犯十二指肠的病人,根据不同情况作了手术处理,术式包括十二指肠局浸润部分切除,并缝合修补;缝合修补加带蒂肠壁浆肌复盖加固并行十二指肠憩室化;胰头十二脂肠切除等。结果:9例术后均一期恢复。其中6例生存3年以上。结论:原来普遍认为右半结肠癌浸润十二指肠即失去根治机会,多予姑息处理是不全面的。而根据临床分型作出积极的外科处理将有助于改善病情或使病人得以痊愈。     

大肠癌合并肠梗阻的外科治疗

目的：探讨大肠癌并肠梗阻的外科治疗方法。方法：回顾性分析我院1993至2003年收治手术52例大肠癌并肠梗阻临床资料。结果：52例患者中一期右半结肠切除12例；一期左半结肠切除23例；一期左半结肠或直肠上段癌切除、近端结肠造瘘、封闭远端结肠或直肠二期吻合14例：直肠癌晚期无法切除根治行乙状结肠造瘘5例，术后并发症发生率13．46％(7／52)，围手术期死亡率3．85％(2／52)。结论：提高本病认识，合理选择外科治疗；做好围手术期处理是提高疗效和改善生活质量的关键。     

梗阻性左半结肠癌的外科处理

1984～1998年我们共收治梗阻性左半结肠癌31例,依其病情分别采用了不同的手术方法,现结合本组资料,就治疗中的几个问题进行讨论.     

老年大肠癌的外科处理

随着人们寿命的延长,老年人大肠癌也越来越多见。他们对于手术的耐受性如何?治疗原则有无改变?老年患者合适的治疗选择是什么?本文围绕这些问题进行了讨论。由于肿瘤增大或浸润性病变引起的缩窄导致堵塞和梗阻,手术是不可避免的,而且主要治疗是切除肿瘤。因为老年患者具有极高的夹杂症发生率,手术危险性是高的,所以发现和处理隐匿的夹杂症对施行确切的手术来说是重要的。手术目的是切除肿瘤以防发生梗阻和提高生活质量,任何扩大根治术对老年患者都是不适宜的,文中详细讨论了手术方式的选择。     

梗阻性结肠癌外科治疗近况

结肠癌是胃肠道常见恶性肿瘤之一,以41～51岁发生率最高。我国近20年来本病发生率有上升趋势,大城市尤为明显。结肠癌早期常无明显症状,临床主要表现为排便习惯性改变与粪便的性状改变,以及出现腹痛、腹部肿块等。其中8％～29％口’患者的患者以肠梗阻症状就诊,此时一般属结肠癌的晚期,多为慢性低位不完全性肠梗阻。左半结肠癌有时以急性完全性结肠梗阻为首发症状。     

Endoscopic Management of Polypoid Early Colon Cancer

Endoscopic management of polypoid early colonic cancer (malignant polyps and polypoid carcinomas) is no longer controversial. When the endoscopist is satisfied that excision is complete and histology is "favorable" (a resection margin of 2 mm and well or moderately well differentiated tumor), surgery is unnecessary. When histology show "unfavorable" characteristics (which a few histologists still take to include invasion into lymphatics), surgical or laparoscopic resection may be indicated, providing the patient is considered at suitable risk. Surgery kills some patients without finding residual cancer and cannot save others with metastases, so it should be recommended only with due clinical consideration. Sessile or broad-based polyps, especially those in the rectum, are more likely to be "high risk" and merit specialist management if local removal is to be attempted and to allow proper histologic assessment. Endoscopic approaches such as saline injection polypectomy, india-ink tattooing, and use of the argon beam coagulator are applicable in some cases. New approaches that still require trials include ultrasonographic probes, which occasionally clarify the degree of invasion, and prototype stapling devices to allow full-thickness histologic specimens to be obtained.     

Surgical Management of Recurrent Colon Haemorrhage of Unknown Origin

Although both endoscopy and angiography have profoundly changed the management of lower GI bleeding, the choice, timing and sequence of these procedures as well as the indications for surgery remain a matter of debate. In cases of massive bleeding, early angiography should be performed as the first choice examination. When this fails, exploratory laparotomy, including peroperative colonoscopy after colonic wash-out, should not be discarded as a diagnostic possibility. If no source of bleeding is identified notwithstanding colonoscopic evaluation in excellent conditions, and it can be assumed that the bleeding has ceased, a conservative attitude may reasonably be advocated.     

胃癌术后梗阻性黄疸的手术治疗

目的总结胃癌术后梗阻性黄疸的手术治疗效果。方法对15例胃癌术后梗阻性黄疸患者施行再手术治疗,其中根治性切除术5例,姑息性减黄术10例。结果1例行残胃切除 肝外胆道切除 胆道和消化道重建的患者术后7d死于胆瘘,其余患者黄疸平均于术后16.8(5～27)d消退。生存期平均12.9个月(7d～66个月),其中根治性切除平均24.8个月(7d～66个月),姑息性减黄手术平均7.0(2～17)个月。结论对胃癌术后梗阻性黄疸患者,条件许可时施行根治性切除术可提高根治率,延长生存时间;对无法根治者施行减黄手术可缓解症状,提高生存质量。     

梗阻性结肠癌术后复发35例临床分析

目的：探讨梗阻性结肠癌术后复发的原因，复发后的早期诊断，以提高术后复发的治疗效果。方法：对1996～2003年35例梗阻性结肠癌术后复发病人的诊断与治疗进行回顾性分析。结果：吻合口复发16例，腹腔内种植复发8例，盆腔内种植复发6例，腹壁切口复发6例，肝脏转移8例。35例均再次行手术治疗，根治性切除12例，姑息性切除23例。结论：梗阻性结肠癌因病期较晚而复发率高，预防主要是初次手术严格无瘤操作，定期随访有助于复发的早期诊断，再次手术仍然是梗阻性结肠癌术后复发的最好治疗方法，应积极手术治疗，以延长生存期，提高生活质量。     

Surgical Management of Early Colorectal Cancer

An early colorectal carcinoma is TNM stage T1NxMx. Most early carcinomas of the colon and rectum can be treated by adequate local excision, such as colonoscopic polypectomy and per-anal excision. If there are adverse risk factors, especially poorly differentiated carcinoma, lymphovascular invasion, or incomplete excision, a radical resection is indicated if there is no contraindication. In the case of a low rectal carcinoma, adjuvant chemoradiation should be considered. Recently a new classification has been developed: sm1 is invasion to the upper one-third of the submucosa, sm2 is invasion to the middle one-third, and sm3 is invasion to the lower one-third. Lesions of sm1 and sm2 have a low risk of local recurrence and lymph node metastasis; local excision is adequate. The sm3 lesions and sm2 flat and depressed types have a high risk of local recurrence and lymph node metastasis; further treatment is indicated. E-pub: 3 July 2000     

Colonic Stent as Bridge to Surgery in Patients with Obstructive Left-Sided Colon Cancer

Objective:

We assessed the optimal time interval between endoscopic stenting and subsequent surgery in patients with obstructive left-sided colon cancer.

Methods:

We reviewed the medical records of patients who underwent endoscopic colonic stenting for obstructive left-sided colon cancer between January 2009 and January 2012. Patients who had successful endoscopic intervention as a bridge to surgery were included in the study. Other variables studied were the duration between endoscopic stenting and surgery, the reobstruction rate, the stoma creation rate, the anastomotic leak rate, and the in-hospital mortality rate.

Results:

The medical records of 53 patients who underwent endoscopic stenting for obstructive left-sided colon cancer were reviewed, and 43 were included in the study. The median duration between endoscopic stenting and surgery was 7 days (range, 5–33).

Conclusion:

A median duration of 7 to 9 days after endoscopic stenting in patients with obstructive left-sided colon cancer is enough time to subsequently perform a safe surgical procedure. Extending this duration may expose the patient to the risk of reobstruction and emergency surgery.     

Current Surgical Management of Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer characterized by erythema and edema of at least one-third of the breast. The diagnosis remains a clinical one. Standard of care involves trimodality therapy with anthracycline-based neoadjuvant chemotherapy and human epidermal growth factor receptor 2 (HER2)-directed therapy if HER2 positive, followed by modified radical mastectomy and post-mastectomy radiation therapy to the chest wall in addition to regional nodal basins including supraclavicular and internal mammary nodes. Current evidence does not support de-escalation of surgical therapy in the breast and axilla in IBC, and positive surgical margins have been associated with worse outcomes. Furthermore, sentinel node biopsy for axillary staging has a high false negative rate prohibiting its use in IBC. Delayed reconstruction is recommended for IBC due to a high recurrence rate and a potential for delay in adjuvant therapy. Contralateral prophylactic mastectomy may be considered at the time of delayed reconstruction. In this paper, we discuss available evidence and controversies in the current surgical management of patients with IBC.