MYH相关性息肉病的研究进展

MYH基因相关性息肉病(MAP)归属于家族性腺瘤性息肉病(FAP),是一种与MYH基因突变有关的常染色体隐性遗传病。MAP以多发性结直肠腺瘤性息肉和高危险性的结直肠癌为主要临床特点,因此早期诊断和及早防治,对于结直肠癌的早期发现及预防具有重要意义。确诊为MAP的患者可进行外科手术治疗、结肠镜下切除息肉或药物治疗。     

结直肠癌合并2型糖尿病患者的临床病理特征

目的:分析结直肠癌合并2型糖尿病患者的临床病理特征.方法:本研究的观察组对象是2018年12月至2020年12月在我院接受治疗的30例结直肠癌合并2型糖尿病患者,对照组对象是同时间段内于我院接受治疗的30例结直肠癌患者(未合并2型糖尿病),统计两组研究对象的各项基础资料,以及两组病患的TNM分期、肿瘤浸润深度、淋巴结转...     

单次乙状结肠镜检查预防结直肠癌

结直肠癌普查的合理性在英国,结直肠癌是最合适普查标准的疾病。每年约有28000例结直肠癌新病例,并有19000例死于此病。其近年的5年生存率仅35％,主要原因是许多病人确诊时已是进展期。乙状结肠镜普查可有效地预防结直肠癌,因为极大多数远段结直肠癌起源于良性腺瘤。而良性腺瘤转变成癌需10～35年。这样长的自然史意味着检出并摘除癌前期腺瘤可比检出早     

二甲双胍联合Folfox6治疗结直肠癌合并2型糖尿病的临床观察

目的 探讨研究二甲双胍联合Folfox6治疗结直肠癌合并2型糖尿病的临床效果.方法 选取该院2011年3月-2014年2月收治的结直肠癌合并2型糖尿病患者43例,根据治疗方法将其分为观察组(给予二甲双胍联合Folfox6治疗,22例)和对照组(给予Folfox6与其他降糖药物治疗,21例),对比两组患者临床疗效及不良反应发生情况.结果 观察组治疗总有效率为63.64％,不良反应发生率为9.52％;对照组治疗总有效率为33.33％,不良反应发生率为33.33％,两组治疗总有效率及不良反应发生率之间均有显著差异,P＜0.05.结论 二甲双胍联合Folfox6治疗方法治疗结直肠癌合并2型糖尿病效果显著.     

适宜外科手术对结直肠癌合并急性肠梗阻的效果影响

目的:探究外科手术治疗结直肠癌合并急性肠梗阻的疗效.方法:选取2008-01/2011-01承德医学院附属医院收治的结直肠癌合并急性肠梗阻患者108例为研究对象,给予所有患者外科手术治疗.观察患者术后并发症情况和围手术期死亡情况.结果:108例患者经外科手术治疗后并发症发生率为12.93%.其中一期切除手术的并发症发生率为7.39%,一期造瘘切除手术的并发症发生率为3.70%,单纯结肠造瘘手术和短路手术的并发症发生率均为0.92%.比较各组间差异具有统计学意义(P0.05).108例患者围手术期共死亡5例患者,死亡率为4.61%.其中一期切除手术的围手术期死亡率为1.85%,一期造瘘切除手术的围手术期死亡率为0.92%,单纯结肠造瘘手术和短路手术的围手术期死亡率均为0.92%.比较各组间差异不具有统计学意义(P0.05).结论:结直肠癌合并急性肠梗阻患者采用外科手术治疗具有较好的临床疗效,但是应当选择适当的手术方式,加强患者围手术期的护理,尽量降低术后并发症的发生率和围手术期的死亡率.     

战胜结直肠癌的重点：筛查与预防

结直肠癌是当前世界上发病率和病死率最高的肿瘤之一.早期结直肠癌5年生存率＞90％,而晚期则不足10％,绝大部分结直肠癌早期由结直肠腺瘤（多呈腺瘤样新生物）发展而来.研究表明,我国结直肠腺瘤近20年来发病率增加了1.88倍,同期结直肠癌增加了0.66倍[1].早期发现和诊断结直肠腺瘤性腺瘤,并采取相应措施如内镜下切除等,可以有效地降低结直肠癌的发生率和相应的死亡率.结直肠腺瘤多数没有明显症状,容易被患者忽视,从而失去治疗机会,有效地预防其发生和通过对人群进行筛查及随访减缓其发展显得尤为重要.我们对结直肠腺瘤预防的最新进展进行综述.     

结直肠高级别上皮内瘤变的临床分析38例

目的:研究结直肠高级别上皮内瘤变的临床病理特征,探讨临床合理治疗决策.方法:回顾性总结38例经内镜检查和病理初步诊断为结直肠高级别上皮内瘤变患者的,临床资料,分析其临床表现、内镜形态学、组织病理学特点、预后等,随访观察3-36 mo.结果:38例患者中,最终确诊17例为结直肠癌.21例仍为高级别上皮内瘤变.治疗前后诊断一致性较差(Kappa值为0.376).结直肠高级别上皮内瘤变合并癌的高危因素包括:肿瘤大小、内镜形态特点、症状严重、绒毛状腺瘤合并高级别上皮内瘤变、CEA或CA19-9增高等.结论:使用WHO新的诊断结直肠高级别上皮内瘤变需引起临床医生重视,特别是对于内镜下单纯活检病例.应当谨慎选择治疗方式和随访时间.     

快速康复外科理念下的优质护理在结直肠癌手术患者中的应用效果

目的 探究快速康复外科理念下的优质护理在结直肠癌手术患者中的应用效果.方法 对武汉大学人民医院2018年7月至2019年7月收治的100例结直肠癌外科手术患者展开对照研究,将其分为观察组(快速康复外科理念下的优质护理)与对照组(常规护理),各50例,分组方法为随机数字表法.探讨实施不同护理对术后恢复指标、术后并发症发生...     

14例转移性结直肠癌合并消化道穿孔临床病理特征及预后的回顾性系列分析

目的分析转移性结直肠癌合并消化道穿孔病例临床病理特征及预后。方法采用描述性病例系列研究方法回顾性分析2019年11月至2020年11月北京大学肿瘤医院消化内科收治的转移性结直肠癌合并消化道穿孔的14例患者临床病理及穿孔前后CT影像特征。并将14例患者中穿孔后积极手术干预的12例患者分为2组:术后继续抗肿瘤治疗组和术后最佳支持治疗组,随访两组患者的生存状态,绘制生存曲线,采用Log-rank法比较两组患者生存曲线的差异。结果14例转移性结直肠癌合并消化道穿孔患者中,男性9例(64.3%)、年龄≥60岁10例(71.4%)、左半结肠癌10例(71.4%)、RAS/BRAF突变型10例(71.4%)、一线治疗11例(78.6%)、肠梗阻同时合并消化道穿孔8例(57.1%);14例晚期结直癌合并消化道穿孔的患者中有10例在抗肿瘤治疗中出现穿孔,其中使用血管内皮生长因子(vascular endothelial growth factor,VEGF)抑制剂7例,治疗有效8例。穿孔术后继续抗肿瘤组总生存期显著优于穿孔术后最佳支持治疗组,差异有统计学意义(P<0.05)。结论转移性结直肠癌合并消化道穿孔临床特征包括老年、男性、左半、RAS/BRAF突变、肠梗阻、影像学显示局部分期T_4a~T_4b、憩室等。另外,晚期肠癌治疗中使用血管生成抑制剂及抗肿瘤治疗有效时也需高度警惕消化道穿孔风险。转移性结直肠癌合并消化道穿孔积极手术干预后继续进行抗肿瘤治疗生存获益。     

黏膜切除术治疗结直肠广基隆起性腺瘤性息肉98例临床研究

目的探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗结直肠广基隆起性腺瘤性息肉患者的疗效。方法回顾性分析98例结直肠广基隆起性腺瘤性息肉(息肉直径0.6~2.0 cm)患者的临床资料并行EMR治疗。结果 98例均经电子结肠镜检查及术前病理诊断为腺瘤性息肉,均为广基隆起性病变,共120枚,行EMR,留取完整标本病理检查,创面均给予钛夹封闭。术后病理诊断为腺瘤性息肉113例,高级别瘤变4例,局部癌变3例,7例切缘均无癌细胞,未追加外科手术。1个月后复查见病变部位黏膜光滑,未见息肉及病变黏膜残留。高级别瘤变及局部癌变7例随访3年,未见肿瘤复发及它处转移。结论对于广基隆起性腺瘤性息肉行EMR较既往单纯的高频电灼或氩离子凝固术有助于发现早期癌,改善患者的预后。     

早期大肠癌内镜治疗的临床评价

背景：早期大肠癌可以采用内镜下切除治疗，但其疗效和预后仍是人们普遍关心的问题。目的：评价内镜治疗早期大肠癌的疗效和预后。方法：对1986年1月～2005年10月经内镜确诊的早期大肠癌患者，按治疗方法的不同分为内镜治疗组和外科手术治疗组，对两组的临床资料、治疗方法和随访结果进行回顾性分析。结果：99例早期大肠癌（104个癌灶）中，无症状人群普查发现34例，临床就诊发现65例。内镜治疗69例（共72个癌灶），外科手术治疗30例（包括内镜治疗后追加手术者，共32个癌灶）。内镜治疗组癌灶完全切除率为97．5％，无严重并发症发生。外科手术治疗组有1例病理证实癌组织浸润达黏膜下深层，肝脏有多个微结节转移灶。内镜治疗组经3个月～19年的随访，除19例失访、6例死于心脏病等疾病外，无一例肿瘤复发。比较两组黏膜和黏膜下层早期大肠癌的临床资料、随访结果和5年生存率，内镜治疗组的疗效与手术治疗组相似（P〉0．05）。结论：早期大肠癌，特别是黏膜层早期大肠癌内镜治疗的疗效和随访结果与手术治疗相似，且损伤小、安全、简便。黏膜下深层癌易发生转移，内镜下切除应注意判断肿瘤黏膜浸润深度，非提起征是内镜切除的关键指征。无症状自然人群普查是发现早期大肠癌的重要途径。     

Recurrent colorectal cancer after endoscopic resection when additional surgery was recommended

AIM: To evaluate the type of recurrence after endoscopic resection in colorectal cancer patients and whether rescue was possible by salvage operation.METHODS: Among 4972 patients who underwent surgical resection at our institution for primary or recurrent colorectal cancers from January 2005 to February 2015, we experienced eight recurrent colorectal cancers after endoscopic resection when additional surgical resection was recommended.RESULTS: The recurrence patterns were: intramural local recurrence(five cases), regional lymph node recurrence(three cases), and associated with simultaneous distant metastasis(three cases). Among five cases with lymphatic invasion observed histologically in endoscopic resected specimens, four cases recurred with lymph node metastasis or distant metastasis. All cases were treated laparoscopically and curative surgery was achieved in six cases. Among four cases located in the rectum, three cases achieved preservation of the anus. Postoperative complications occurred in two cases(enteritis).CONCLUSION: For high-risk submucosal invasive colorectal cancers after endoscopic resection, additional surgical resection with lymphadenectomy is recommended, particularly in cases with lymphovascular invasion.     

A conservative approach to adenomas containing invasive carcinoma removed colonoscopically

A controversy exists as to the correct therapeutic approach to colorectal polyps that contain malignancy and are removed colonoscopically. This paper presents our experience in the management of such polyps. Between 1977 and 1983, a total of 117 patients underwent colonoscopic polypectomy for 178 adenomas. Nine adenomas from nine patients showed carcinomatous invasion across the line of muscularis mucosae. None of these carcinomas was poorly differentiated and in all but two cases there was histologic evidence of complete excision. Seven patients whose adenomas containing foci of malignant changes were treated by polypectomy alone are alive without recurrence at periods from six months to over five years (mean, 40 months). The two patients in whom endoscopic removal of cancerous adenomas was found to be either doubtfully complete or incomplete, had further surgical treatment; both are alive and well after one and five years, respectively. Nine other patients whose adenomas containing malignant changes were considered unsuitable for colonoscopic polypectomy, underwent surgical resection and in none was regional lymph node or distant metastases found at laparotomy. In conclusion, our results of local endoscopic excision for adenomas containing malignant changes suggest a conservative approach to such polyps and this policy is supported by the finding that, in none of our operated patients was there any evidence of metastatic disease.     

Endoscopic stenting for recurrence-related colorectal anastomotic site obstruction: Preliminary experience

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.METHODS: The medical records of patients who underwent endoscopic self-expanding metal stents (SEMS) insertion for colorectal obstructions between February 2004 and January 2014 were retrospectively reviewed. During the study period, a total of 218 patients underwent endoscopic stenting for colorectal obstructions. We identified and examined the patients who underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer.RESULTS: Five consecutive patients [mean age, 56.4 years (range: 39-82 years); 4 women, 1 man] underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer. Technical and clinical success was achieved in all 5 patients, without any early complications. During follow-up, 3 patients did not need further intervention, prior to their death, after the first stent insertion; thus, the overall success rate was 3/5 (60%). Perforations occurred in 2 patients who required a second SEMS insertion due to re-obstruction; none of the patients experienced stent migration.CONCLUSION: SEMS placement is a promising treatment option for patients who develop obstructions of their colonic anastomosis sites due to cancer recurrence.     

Experience of Endoscopic Transanal Resections With a Urologic Resectoscope in 131 Patients

Purpose Endoscopic transanal resection of rectal adenomas and other presumably benign lesions is not widespread. The purpose of this study was to evaluate the efficacy and the safety of endoscopic transanal resection. Methods Patients who underwent endoscopic transanal resection at three Stockholm hospitals between 1993 and 2004 were studied retrospectively with respect to patient and lesion characteristics, complications, follow-up time, and recurrence rates. Results One hundred eighty endoscopic transanal resection procedures were performed in 131 patients. The tissue diagnosis was adenoma in 160 operative cases, cancer in 12 operative cases, and hyperplasia, fibrosis, or normal mucosa in the remaining 8 operative cases. Among the patients with rectal adenomas, one endoscopic transanal resection was sufficient in 77 cases and in 16 cases the surgery was performed in more than one session because of the large size of the adenoma. In 27 cases there were recurrences that needed additional endoscopic transanal resection or other surgery. The median time until recurrence was seven months, but there were no recurrent rectal carcinomas. In 16 operative cases there were complications. Two patients had to undergo a Hartman's procedure as a result of a bowel perforation, and one patient had to be reoperated on because of bleeding. There were no perioperative deaths. The median follow-up time without recurrence was 32 (range, 0–67) months. Conclusions Endoscopic transanal resection is a feasible and oncologically safe option for treatment of rectal adenomas, especially in cases where conventional transanal resection or transanal endoscopic microsurgery are unavailable or unsuitable because of the characteristics and localization of the lesion. Presented at the Swedish Surgical Week, G?vle, Sweden, August 22 to 26 2005. Reprints are not available.     

Number of aberrant crypt foci in the rectum is a useful surrogate marker of colorectal adenoma recurrence

Aim: Endoscopic screening and removal of colorectal adenomas can reduce the incidence of colorectal cancer. However, given the possibility of adenoma recurrence, surveillance colonoscopy is currently recommended after the initial screening and removal of colorectal adenomas. Aberrant crypt foci (ACF) have been shown to serve as a reliable surrogate marker of colorectal carcinogenesis. In this study, the relationship between the number of ACF at the initial endoscopic polypectomy and the likelihood of colorectal adenoma recurrence after polypectomy were investigated. Methods: High‐magnification chromoscopic colonoscopy was performed in 82 subjects who underwent endoscopic polypectomy to identify ACF in the lower rectum. Surveillance colonoscopy was then performed 3 years after the baseline polypectomy at Yokohama City University Hospital. Results: The number of ACF was greater in patients who showed adenoma recurrence (7.88 ± 6.35) than in those who did not (2.19 ± 2.95) (P < 0.001). Receiver–operating curve analysis showed that the number of ACF was a highly specific predictor of the risk of adenoma recurrence. Conclusions: This is the first study conducted to investigate the relationship between the number of ACF after endoscopic polypectomy and the likelihood of recurrence of colorectal adenomas. These results suggest that the number of ACF is a useful predictor of the likelihood of colorectal adenoma recurrence.     

Endoscopic snare papillectomy for tumors of the duodenal papillae

BACKGROUND: Tumors of the major and the minor duodenal papillae can be malignant or premalignant, and traditionally are treated by surgical excision. This study evaluated the safety and the outcome of endoscopic snare resection of such tumors. METHODS: All patients with tumors of the major or the minor papilla treated by endoscopic snare resection over a 10-year period (1994-2003) were identified from an ERCP database. Patients with tumors that had endoscopic features of malignancy and those proven to be cancerous by biopsy were excluded. Papillectomy was performed by electrosurgical snare resection. A pancreatic stent usually was placed before or after excision. Residual tumor was eradicated by repeated procedures. Endoscopic surveillance was at the discretion of the endoscopist. RESULTS: Seventy snare resections were performed in 55 patients (mean age 59 years). Histopathologic diagnoses were the following: adenoma (45 patients; 7 with focal high-grade dysplasia, 6 with intraductal extension), adenocarcinoma (5), carcinoid tumor (2), gastric heterotopia (1), and normal histology (2). Fourteen patients had familial adenomatous polyposis. Of the 39 patients with isolated extraductal adenoma per cholangiogram, two underwent surgical resection because of persistent high-grade dysplasia, and 37 were successfully treated by endoscopic papillectomy alone. During follow-up (mean 30 months), 18 of 37 patients (49%) had no recurrence, 7 had recurrent adenoma (mean time interval to recurrence 27 months), two died of unrelated illnesses, and 10 are awaiting follow-up. Of the 6 patients with intraductal adenoma per cholangiogram, two underwent surgical resection, two had intraductal photodynamic therapy, and two had endoscopic snare resection. Intraductal tumor in the 4 latter patients was eliminated, although it recurred in one of the patients who had photodynamic therapy. Of the 7 patients with adenocarcinoma or carcinoid tumor, pancreaticoduodenectomy was performed in 3 and palliative papillectomy was performed in 4 unsuitable for surgery. One patient with carcinoid tumor of the minor papilla is alive, without recurrence, at 5 years after papillectomy. There were 10 procedure-related complications (14.5%), including pancreatitis (5), bleeding (4), and mild perforation (1). There was no procedure-related death. CONCLUSIONS: Most adenomas of the duodenal papillae without intraductal extension can be fully resected by snare papillectomy. However, adenoma recurs in about a third of patients. Endoscopic therapy appears to be a reasonable alternative to surgery for management of papillary tumors. Longer follow-up is needed to determine the true recurrence rate and if endoscopic re-treatments are effective.     

腺瘤性息肉的癌变及治疗

为探讨已癌变的结肠腺瘤性息肉的最佳治疗选择，回顾性总结了内镜诊断和治疗的３１４例腺瘤性息肉中３７例癌变息肉的结果。３７例中为管状腺瘤癌变者２５例（占８．９％），绒毛状腺瘤癌变者１１例（占３６．３％），混合性腺瘤癌变１例。１８例仅行内镜下电切，电切后又追加手术８例，手术切除１１例。分期为原位癌１２例，早期浸润癌１３例，浸润癌１２例。１９例手术及术后病理证实的淋巴结转移者３例（１５．７％），包括１例绒毛状腺瘤恶变的早期浸润癌和２例浸润癌。认为除原位癌外，对电切后病理证实的早期浸润癌或浸润性癌，只要无手术禁忌，应追加外科手术治疗为妥。     

双吻合器技术下直肠前切除术后吻合口出血临床分析

目的探讨双吻合器技术下直肠前切除术后吻合口出血的危险因素和处理策略。 方法收集2010年01月至2014年12月,455例使用双吻合器行直肠癌前切除术患者的临床资料,对发生吻合口出血病例进行回顾性分析。 结果开腹手术303例,腹腔镜142例,共发生吻合口出血10例（2.2%）,均为超低位吻合,其中开放手术7例（2.3%）,腹腔镜3例（2.1%）,静滴止血药物后治疗3例,内镜下钛夹止血4例,肛窥下缝合止血、介入治疗止血、二次手术止血各1例。 结论直肠前切除术后吻合口出血可能与吻合平面低有关,该并发症以预防为主,明确吻合口出血后以非手术治疗为主,介入及内镜治疗是有效的止血方法。     

Endoscopic Therapy of Early Colorectal Cancer (pT1) - A Prospective Study

INTRODUCTION: In a prospective study initiated in 1982, we have been investigating the question as to whether - and if so, which - pT1 carcinomas of the colorectum can be treated exclusively via the endoscope. METHOD: In the period between February 1, 1982 and April 30, 2001, a total of 5,470 polyps were removed endoscopically at the Medical Department I of the Klinikum Ludwigsburg. Among these lesions, a total of 144 (2.6 %) pT1 carcinomas were found in 141 patients. We were able to follow 120 patients with 123 pT1 carcinomas over a mean follow-up period of 46 months (range: 1-60). In low-risk situations (definitive removal in healthy tissue, G1-G2, no lymphatic involvement), endoscopic treatment alone usually represented sufficient treatment. In high-risk cases (removal in healthy tissue uncertain or negative, and/or lymphatic vessel involvement, and/or G3/G4), subsequent surgical resection was carried out. RESULTS: 64 cases were classified as high-risk, 59 as low-risk. Nevertheless, 9 patients with 10 low-risk carcinomas were submitted to surgery (young age, patient's own request). In none of these 10 cases was residual tumour or lymph node metastasis detected in the surgical specimen. 47 patients with 49 low-risk carcinomas were treated solely by endoscopic polypectomy using the diathermy snare, and 45 patients with 47 carcinomas remained recurrence-free during the follow-up period. In a single case, a local recurrence was detected 2 months after polypectomy and underwent curative resection. In another case, peritoneal carcinosis with tumour infiltrating into the colon developed 8 months after initial treatment; this, however, was most probably a recurrence of a previously operated carcinoma of the uterus. Among the high-risk cases, 10 were not submitted to surgery on account of advanced age and/or rejection of an operation by the patient; all remained recurrence-free. Among the surgically treated high-risk carcinomas, 3 surgical specimens contained residual tumour, while 2 revealed a lymph node metastasis. In our group of patients, no tumour-related mortality was seen among endoscopically treated patients. DISCUSSION: In the light of the fact that the reported mortality rate associated with open surgery for colorectal carcinoma is 3 % as compared with about 1 % risk of lymph node metastasis and 0,1 % mortality rate for the endoscopic modality, endoscopic removal of a pT1 tumour in a low-risk situation followed by appropriate surveillance can be considered as adequate treatment.