预防性手术治疗结直肠克罗恩病7例

为探讨预防性手术治疗结直肠克罗恩病的疗效，回顾分析7例结直肠克罗恩病患者的资料。结果显示，7例患者手术治疗共23次，手术方式以肠段切除吻合术最多（21／23，91．3％）；肠段切除范围在保证血运通畅的条件下尽量多地保留肉眼可见的正常肠段；手术后复发率为69．6％（16／23）；切缘阳性的复发率为75．0％（9／12），切缘阴性的复发率为63．6％（7／11），组间差异无统计学意义（P〉0．05）。结果表明，结直肠克罗恩病肠管切除范围及切缘有无病变残留不影响术后复发率；预防性手术是其一种有效的治疗方法，可以减少并发症的发生，提高患者生活质量，但不能改变其基本病程进展。     

对比增强超声定量检测对克罗恩病患者内镜下疾病活动度的评估价值

目的探讨对比增强超声定量检测对克罗恩病患者内镜下疾病活动度的评估价值。方法前瞻性入组2009年1月至2010年12月间在浙江省丽水市人民医院就诊或随访的59例克罗恩病患者．分别进行结肠镜检查和对比增强超声检查。采用克罗恩病简单内镜下评分将疾病分为非活动性病变和活动性病变。定量分析对比增强超声检查中的对比剂摄入情况．用以评估结直肠环（回肠末段至直肠）中病变肠段的血流状况,结果以感兴趣区（ROI）灰度值上升百分比表示。采用受试者工作特征曲线来评估DOI灰度值上升百分比对内镜下疾病活动度的判断价值。结果内镜评估结果显示．59例克罗恩病患者活动性病变45例．非活动性病变14例,其ROI灰度值上升百分比分别（90±32）％和（41±29）％,差异有统计学意义（P〈0．01）。取最佳截点45％,ROI灰度值上升百分比预测内镜下疾病活动度的敏感度、特异度和准确度分别为95．6％、78．6％和91．5％,Youden指数为0．74．曲线下面积为0．846。结论对比增强超声的定量检测能够有效地将肠镜下不同活动度的克罗恩病区别开来,可作为评估克罗恩病患者疾病活动度的理想方法。     

OPN和CD44V6在结直肠癌和结直肠腺瘤中的表达及意义

目的 探讨骨桥蛋白（OPN）和CD44拼接变异体6（CD44v6）在结直肠癌和结直肠腺瘤中的表达及意义.方法采用免疫组化法检测72例结直肠癌标本、60例结直肠腺瘤标本中OPN和CD44v6的阳性表达情况,分析两者与结直肠癌临床病理特征的关系.结果结直肠癌、腺瘤、正常组织OPN表达阳性率分别为81.9%、66.7%、2.8%,CD44v6表达阳性率分别为75.0%、56.7%、2.8%,各组OPN和CD44v6的表达阳性率差异均有统计学意义（P＜0.05）.OPN的表达与肿瘤浸润深度、分化状态、有无淋巴结转移存在相关性（P＜0.05）,CD44v6的表达与肿瘤浸润深度、有无淋巴结转移存在相关性（P＜0.05）.OPN与CD44v6表达存在显著正相关关系（r=0.517,P＜0.05）.结论 OPN、CD44v6的表达与结直肠腺瘤-癌的转化及结直肠癌细胞的侵袭力等密切相关,通过检测两者水平可对结直肠癌的早期预防、诊断及预后评估提供重要依据.     

克罗恩病术后复发行再次手术的危险因素分析

目的 探讨克罗恩病术后复发行再次手术的危险因素.方法 回顾性分析2004年3月至2013年9月中国医学科学院北京协和医院收治的108例克罗恩病行肠切除术患者的临床资料.其中82例患者行单次手术,26例行再次手术.分析可能影响克罗恩病患者术后复发行再次手术的25项因素,包括患者性别、年龄、血型、术前WBC、术前中性粒细胞、术前淋巴细胞、术前Hb、术前Alb、术前前白蛋白、超敏C-反应蛋白（hs-CRP）水平、抗酿酒酵母抗体（ASCA）表达、中性粒细胞胞质抗体（ANCA）表达、病变原发部位、疾病类型、肠外表现、肛周病变、吸烟史、阑尾手术史、初次手术前病程、初次手术前1年内使用免疫抑制剂、初次手术前BMI、术前小野寺预后营养指数（OPNI）、初次手术前应用肠内营养、是否急诊手术、初次术后并发症情况.单因素分析采用x2检验或Fisher确切概率法,多因素分析采用Logistic回归模型.结果 单因素分析结果表明：术前前白蛋白、hs-CRP、病变原发部位、疾病类型、吸烟史、初次手术前1年内使用免疫抑制剂及初次手术前应用肠内营养是克罗恩病患者术后复发行再次手术的危险因素（x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P＜0.05）.多因素分析结果表明：病变原发部位为回结肠型（L3型）、初次手术前1年内使用免疫抑制剂及初次手术前应用肠内营养制剂提供热量＜500 kcal/d是克罗恩病患者术后复发行再次手术治疗的独立危险因素（OR=1.908,3.535,5.489,95％可信区间：1.035～3.518,1.087 ～ 11.494,1.816 ～ 16.590,P＜0.05）.结论 克罗恩病病变部位为回结肠型（L3型）、初次手术前1年内行免疫抑制剂治疗及初次手术前2周内每日肠内营养制剂提供热量＜ 500 kcal的患者有较高的复发再次手术风险.     

结直肠漏评分系统预测左侧结直肠切除术后吻合口漏的分析北大核心CSCD

目的 评价结直肠漏评分（Colon Leakage Score,CLS）系统对左侧结直肠切除术后吻合口漏的预测价值.方法 以海南省人民医院胃肠外二科接受左侧结直肠切除术的304例结直肠癌患者为研究对象,根据术后是否发生吻合口漏将患者分为有吻合口漏和无吻合口漏两组,应用ROC曲线及Logistic回归评价CLS评分系统对吻合口漏发生的预测价值并确定预测临界值.结果 有吻合口漏组与无吻合口漏组的CLS评分差异有统计学意义（F =68.23,P＜0.001）,ROC曲线下面积为0.965（CI：0.913～1.00）,OR值为2.9（CI：1.59 ～4.83,P＜0.001）,最佳临界值为“11”,预测敏感度和特异度分别为86.4％和87.2％.结论 CLS评分系统对左侧结直肠切除术后吻合口漏的发生具有良好的预测价值,CLS分值“11”可作为划分高低风险的最佳预测临界值.     

前列腺特异性抗原升高的组织病理学基础

目的 探讨前列腺特异性抗原(PSA)与前列腺结节增生、Ⅳ型前列腺炎及前列腺癌之间的关系,探讨PSA升高的病理学基础.方法 有完整临床病理资料的前列腺疾病504例患者,均无前列腺癌和穿刺活检史,均行PSA、全身骨扫描、MRI和前列腺穿刺活检.直肠B超引导下以18G自动穿刺活检枪行双侧叶6-13点法前列腺穿刺活检.对患者穿刺的病理标本按前列腺结节增生、前列腺癌以及Ⅳ型前列腺炎病理诊断标准进行评价.结果 504例患者经病理证实前列腺癌185例(37%),Ⅳ型前列腺炎109例(21%),前列腺增生210例(42%).3组总PSA(t-PSA)分别为27.6(0.4～7116)、10.6(0.2～168)和9.2(0.3～60)ng/ml,3组间比较差异有统计学意义(P＜0.01);f-PSA分别为3.5(0.1～3356)、1.7(0.1～42)和1.5(0.06～15.8)ng/ml,3组间比较差异有统计学意义(P＜0.001);f/t-PSA分别为0.14(0＜0.94)、0.17(0.04～0.91)和0.16(0.02～0.75).3组间比较差异有统计学意义(P=0.019);3组间年龄、B超、直肠指诊结果比较差异无统计学意义(P＞0.05).前列腺癌分级与f-PSA(r=0.33,P＜0.001)、t-PSA(r=0.27,P＜0.001),f/t-PSA(r=0.22,P=0.003)具有显著相关性;多元线性回归分析发现前列腺癌分级与f-PSA(t=-2.34,P=0.02),t-PSA(t=2.77,P=0.006),f/t-PSA(t=3.97,P＜0.001)具有显著相关性.前列腺癌临床分期间f-PSA和t-PSA差异有统计学意义(P＜0.001).210例前列腺增生患者若按腺体增生为主和间质增生为主2类比较,t-PSA和f-PSA差异均有统计学意义(P＜0.05).多元线性回归分析发现t-PSA足前列腺增生病理结节类型最相关的指标,t-PSA≥2.5 ng/ml,确定腺体增生为主型前列腺增生的敏感性为96%,特异性为20%(P＜0.05).Ⅳ型前列腺炎109例和前列腺增生210例,2组间比较f-PSA,t-PSA,f/t-PSA差异有统计学意义(P＜0.05).通过ROC曲线确定前列腺癌敏感指标的界值:f-PSA≥0.85 ng/ml,t-PSA≥4 ng/ml和f/t-PSA≤0.16(P＜0.05).结论 血清PSA升高的病理基础为任何破坏前列腺上皮血屏障的病变;任何形成前列腺上皮增生,分泌更多PSA的病变;其中以破坏前列腺上皮血屏障最重要.     

肛门良性疾病术前全结肠镜检查的临床意义

目的探讨肛门良性疾病患者术前应用全结肠镜检查的临床意义,比较无痛结肠镜检查和普通结肠镜检查的成功率。方法回顾性分析2010年4月至2011年3月中山大学附属第六医院收治的术前行全结肠镜检查的333例肛门良性疾病患者的临床资料。结肠镜检查发现结直肠病变患者为病变组（120例）,未发现结直肠病变患者为正常组（213例）。根据结肠镜检查结果及检查方式进行分层分析。计量资料比较采用t检验,计数资料比较采用X^2检验。结果病变组患者的年龄为（48±14）岁,显著高于正常组的（42±14）岁,两组比较,差异有统计学意义（t=3．75,P〈0．05）。病变组40岁以上患者的构成比为72．50％（87／120）,显著高于正常组的39．44％（84／213）,两组比较,差异有统计学意义（X2=33．59,P〈0．05）。病变组男、女患者构成比分别为71．67％（86／120）和28．33％（34／120）,正常组分别为62．44％（133／213）和37．56％（80／213）,两组比较,差异无统计学意义（X^2=2．90,P〉0．05）。病变组结直肠病变包括息肉80例、肠炎30例、恶性肿瘤7例、炎性肠病7例、憩室5例、溃疡1例。无痛结肠镜在病变组和正常组中的应用率分别为51．67％（62／120）和54．93％（117／213）,两组比较,差异无统计学意义（∥=0．33,P〉0．05）。无痛结肠镜检查到达回肠末段的成功率为99．44％（178／179）,显著高于普通结肠镜检查的95．45％（147／154）,两者比较,差异有统计学意义（X^2=5．61,P〈0．05）。结论肛门良性疾病患者可能合并结直肠病变,建议40岁以上患者术前行无痛全结肠镜检查。     

结直肠同时性多发癌临床病理特征分析

目的 研究结直肠同时性多发癌发病特点及临床病理特征，探讨其早期诊断措施。方法 回顾性分析1994年6月至2003年12月中山大学附属第一医院根治性手术治疗的1225例结直肠癌患者资料，根据癌灶数目、家族史、发病年龄等情况分为结直肠同时性多原发癌组（多发组）和结直肠单发癌组（单发组）。比较两组发病年龄、性别构成、肿瘤Dukes分期、肿瘤部位、并发息肉和患者预后等情况。所有资料采用SPSS10．0软件统计分析。结果 多发组39例（3．2％），其中2例为遗传性非息肉病性结直肠癌患者，并发癌以腺瘤恶变多见。多发组中右半结肠癌占45．7％，明显高于单发组22．7％（χ^2=25．757，P=0．0001）；息肉并发率两组分别为33．3％和16％（χ^2=6．787，P=0．009）。异时性肿瘤发生率分别为5．1％和1．2％，差异有统计学意义（χ^2=4．545，P=0．033）。多发组5年生存率为57％，单发组为64％，χ^2=0．084，P=0．772。结论 结直肠同时性多发癌占结直肠癌总数的3．2％，多位于右半结肠，并发癌以腺瘤恶变多见，其预后与单发癌患者相当。     

结直肠多原发癌患者的临床分析

目的 探讨结直肠多原发癌患者的发病特点及预后。方法 回顾分析1994年6月至2002年6月间收治的1125例结直肠癌患者的临床资料，根据是否并发结直肠或其他脏器原发癌分为多发癌组和散发癌组。比较两组的临床病理和预后。结果 本组多原发癌发生率为7．4％(83／1125例)。其中多发性结直肠癌47例，异时性12例；合并结直肠外肿瘤者36例，异时性3l例，有12例为胃癌。多发癌组和散发癌组在发病年龄、性别及年龄构成方面比较，差异均无统计学意义。多发癌组并发息肉者较单发癌组多(P=0．002)，有癌症家族史的比率也显著高于单发癌组(P=0．036)。复发的病例在多发癌组有15例，其比率明显高于单发癌组(P=0．047)，两组生存率比较差异无统计学意义。多发癌组先证癌位于右半结肠者占41．0％，明显高于单发癌组(P=0．048)，且第2癌以腺瘤恶变多见(44．7％，21／47)。结论 癌症家族史和结直肠息肉是结直肠多原发癌发生的高危因素。结直肠多原发癌患者的肠外肿瘤以胃癌最多见，第2癌以腺瘤恶变多见。     

影像学检查在小肠克罗恩病活动期与慢性期的诊断价值

目的 探讨CT、X线小肠钡餐造影及消化内镜检查对小肠克罗恩病活动期与慢性期的诊断价值.方法 回顾性分析2008年6月至2011年8月苏北人民医院收治的39例克罗恩病患者的临床资料,根据病变是否有活动性将患者分为活动期组(28例)与慢性期组(11例),比较两组患者的CT、X线小肠钡餐造影及消化内镜检查等影像学征象的差异,并通过与术中探查结果比较,评价影像学检查对克罗恩病的诊断效能.计数资料采用x2检验.结果 活动期组患者肠壁病变中分层增厚、水肿带、重度强化、溃疡,肠腔狭窄,肠外并发症中的肠瘘、蜂窝组织炎、淋巴结肿大、木梳征的发生率高于慢性期组相应指标的发生率,两组比较,差异有统计学意义(x2=10.700,3.954,22.025,7.661,10.700,7.661,6.810,7.661,4.592,P＜0.05);慢性期组患者肠壁单层增厚、脂肪、轻度强化、不强化、炎性息肉,肠外并发症中的腹腔脓肿、炎性包块的其发生率高于活动期组相应指标的发生率,两组比较,差异有统计学意义(x2=17.475,11.345,18.050,5.366,22.856,12.662,5.846,P＜0.05).CT检查诊断克罗恩病肠壁增厚、肠腔病变及肠外并发症的效能均较高,但难以诊断肠壁溃疡及炎性息肉;X线小肠钡餐造影及消化内镜检查诊断肠壁溃疡及炎性息肉的效能较高,但难以诊断肠壁增厚及肠外并发症.结论 以CT检查为首选,辅助以X线小肠钡餐造影及消化内镜检查,有利于揭示克罗恩病的活动期与慢性期表现.     

The differences between American and Chinese patients with Crohn’s disease

Aim The effect of race on Crohn’s disease (CD) remains uncertain. This study compared the characteristics of American white patients and Chinese patients with CD. Method A retrospective chart review was conducted for patients who required management of colorectal CD between 1985 and 2004 at either Cleveland Clinic Florida (CCF) or at the 301 Hospital in China. Data included a family history of CD, smoking history, location of the CD and histopathology. Results The mean age of onset in the 153 patients was 29.8 ± 16.4 years for American white patients and 32.4 ± 15.3 years for Chinese patients (not significant). Sixty per cent of American white patients were women vs 37% of Chinese patients (P = 0.003). Twelve per cent of American white patients vs 1% of Chinese patients had a family history of CD (P = 0.016). American white patients had significantly higher rates of arthritis (32%vs 4%), abscess (19%vs 0%), rectal and perineal fistula (52%vs 0%), and disease involving the colon and rectum when compared with Chinese patients (all P < 0.05). American white patients had more colorectal sites involved and higher rates of extraintestinal diseases (40%vs 20%) than Chinese patients (all P < 0.05). Chinese patients had higher rates of ileocaecal disease (82%vs 52%) and deep ulcers (66%vs 24%) in the colorectum (all P < 0.001). There were no statistical differences in the incidence of smoking, perforation, intra‐abdominal fistula, stenosis, bowel obstruction, toxic megacolon or granuloma formation. Conclusion This study found that colorectal CD had a more severe clinical presentation and pathological involvement in American white patients than in Chinese patients.     

克罗恩病复发再手术的并发症危险因素分析

目的探讨克罗恩病（CD）复发再手术后并发症的危险因素及其疗效。方法回顾性收集1995-2009年间在福建医科大学附属第一医院65例CD复发再手术患者的临床资料（再手术组）,对其术后并发症的危险因素进行分析。同时选取同期年龄匹配的65例CD初次手术患者（初次手术组）。比较再手术与初次手术的术中及术后情况。结果再手术组复发再手术后有25例（38．5％）出现并发症,显著高于初次手术者（12．3％）。术中行预防性肠造口的19例患者术后仅3例（15．8％）出现并发症,而未行预防性肠造口的46例患者有22例（47．8％）出现并发症,差异有统计学意义（Х^2=5．831,P=0．016）。与初次手术相比,再手术组手术时间更长、腹膜粘连更严重、术后住院时间更长（均P〈0．05）。结论CD复发再手术术式复杂．有着较高的术后并发症发生率。预防性肠造口有助于降低术后并发症发生率。     

原发性结直肠癌解剖部位在美国白人与中国人之间分布趋势的比较

目的比较研究美国白人患者与中国患者原发性结直肠癌(CRC)的部位分布特点,并探讨与年龄、性别的关系。方法回顾性分析1990～2000年间美国克里夫兰佛罗里达临床中心结直肠外科690例和中国第一军医大学南方医院普通外科870例连续完整的CRC患者资料。结果CRC部位分布、年龄和性别在美国白人患者和中国患者间差异有显著性意义。位于近侧结肠者为36.3%比26.0%(P<0.001),位于远侧结直肠者为63.7%比74.0%(P<0.001)。近年来,在白人男性中远侧结直肠癌有减少和近侧结肠癌有增加的趋势,80岁以上老年组更明显。在近侧结肠癌中白人男性较女性更常见(P<0.01)。肿瘤分布及性别构成在中国患者中无变化。白人患者平均年龄69.8岁,而中国患者为48.3岁(P<0.001)。结论美国白人较中国人易患近侧结肠癌,其部位分布近年有从远侧向近侧结肠转移而重新分布的趋势。中国人易患远侧结直肠癌,其发病年龄较美国白人明显年轻。     

克罗恩病并发不全性肠梗阻的肠内营养治疗

目的 探讨应用肠内营养（EN）治疗活动期克罗恩病（CD）并发不全性肠梗阻的临床效果.方法 回顾性分析2003年1月至2009年9月接受EN治疗的37例活动期CD并发不全性肠梗阻患者的临床资料,CD活动度评分（CDAI）均介于150分和450分之间.通过鼻饲管或经皮内镜下胃（或空肠）造口予以EN,每日总热量125 kJ/kg.CDAI下降超过70分定义为临床有效,CDAI小于150分定义临床缓解.分别于开始治疗时、治疗后4周和12周对患者疾病活动度、营养学指标及不良反应进行评估.结果 本组患者病变位于回肠8例,回结肠19例,结肠4例,空回肠5例,十二指肠1例.治疗4周后,CDAI评分为（112.0±39.6）分,临床有效率43.2%（16/37）,临床缓解率72.9%（27/37）,与治疗前的（174.6±34.7）分比较,差异有统计学意义（P＜0.05）;治疗12周后,CDAI评分为（70.2±32.9）分,临床有效率70.2%（26/37）,临床缓解率78.4%（29/37）;与治疗4周比较,差异亦有统计学意义（P＜0.05）.其他疾病活动度指标（C反应蛋白和红细胞沉降率）和营养学指标（BMI、白蛋白、前白蛋白、转铁蛋白、血红蛋白）亦呈现同样趋势.治疗期间有7例患者出现肠梗阻加重,予以手术切除病变肠管.11例患者因家庭EN输注不当引起腹胀或腹泻,遵医嘱后改善.结论 EN用于治疗并发不全性梗阻的活动期CD 可有效控制疾病活动度,并可减轻炎性反应以缓解梗阻,同时有助于改善营养状态,不良作用甚小,具有积极的治疗价值.     

结直肠癌组织中p27基因甲基化与其临床病理的关系

目的 检测结直肠癌组织中p27基因启动子区CpG岛甲基化水平及其表达,并结合其临床病理参数进行分析,探讨其在结直肠癌发生发展中的作用.方法 应用甲基化特异性聚合酶链反应分析技术检测106例结直肠癌组织及其正常结直肠黏膜组织、22例结肠腺瘤组织中p27基因启动子甲基化,用免疫组织化学SP方法检测其蛋白表达.结果 本组结直肠癌组织中p27甲基化阳性率为59.4%(63/106),结肠腺瘤组织中为18.2%(4/22),而正常结直肠黏膜组织中为3.8%(4/106),前组与后两组之间相比差异有统计学意义(P＜0.05).低分化组结直肠癌组织中p27甲基化阳性率明显高于高中分化组(48.0%比24.7%,P＜0.05);Dukes-A+B期组与C+D期组之间相比差异有统计学意义(20.0%比41.2%,P＜0.05);有无淋巴结转移两组之间的阳性率相比差异有统计学意义(41.5%比23.1%,P＜0.05);浸润深达浆膜层的结直肠癌组织中的甲基化阳性率与未达浆膜层组相比差异无统计学意义(32.5%比24.1%,P＞0.05).结论 结直肠癌组织中存在p27基因启动子甲基化.p27基因的高甲基化与结直肠癌分化程度、浸润深度、Dukes分期及有无淋巴结转移有关.

Abstract：

Objective To investigate the relationship between p27 gene methylation and pathology of colorectal carcinoma. Methods p27 gene methylation promotor region and p27 protein expression were detected respectively by methylation specificity polymerase chain reaction and immunohistochemical staining SP in 106 cases of colorectal carcinoma and each adjacent normal mucous membrane tissue and 22 cases of colorectal adenoma tissue. Results The positive expression rate of p27 gene methylation was statistically different in colorectal carcinoma tissue compared with normal mucous membrane and colorectal adenoma tissue (P＜0.05). Their positive expression rate were 59.4% (63/106), 18.2% (4/22) and 3.8%(4/106) respectively in colorectal carcinoma tissue,colorectal adenoma and normal mucous membrane tissue (P ＜ 0. 05). p27 gene methylation in poorly differentiated group was significantly higher than that in welldifferentiated group (48.0% vs. 24. 7%, P ＜0. 05), in Dukes-A + B stage group was significantly lower than that in Dukes C + D stage group(20. 0% vs. 41.2%, P ＜ 0. 05 ), and it was higher in lymph nodes metastases group than that in lymph nodes negative group(41.5% vs. 23. 1%, P ＜0. 05), that in positive serosa infiltration group was higher than negative serosa infiltration group(32. 5% vs. 24. 1%, P ＞ 0. 05 ).Conclusions Methylated p27 gene protein expression in colorectal carcinoma was significantly higher than normal mucous membrane and colorectal adenoma tissue. The methylation rate of p27 gene in colorectal carcinoma was significantly associated with tumor differentiation, invasive depth, Dukes stage, lymph node metastasis.     

凝血因子在结直肠癌中的表达及相关性的研究

目的 研究结肠癌患者血浆中凝血因子D-二聚体和纤溶酶原激活物抑制剂-1（PAI-1）的变化及其临床意义.方法 选择结直肠癌患者74例为实验组,其中37例施行传统开腹手术（open resection,OR）,37例施行腹腔镜下手术（laparoscop-ic resection,LR）,于手术前后采血并检测血浆D-二聚体和PAI-1浓度,良性病患者37例为对照组,同时实验组内患者按照Dukes分期标准分为AB、CD两期,并对各组间D-二聚体水平进行比较和统计分析.结果 两实验亚组结直肠癌患者的D-二聚体和PAI-1水平非常显著高于对照组（P＜0.01）.在结直肠癌患者的Dukes分期检测中,DukesCD期患者的D-二聚体和PAI-1水平明显高于AB期（P＜0.05）.结论 结直肠癌患者血液的高凝状态是其重要病机特征,D-二聚体和PAI-1的检测对结直肠癌的分期及预后有一定的指导意义.     

Preoperative anemia in colon cancer: assessment of risk factors

Anemia is common in cancer patients and is associated with reduced survival. Recent studies document that treatment of anemia with blood transfusion in cancer patients is associated with increased infection risk, tumor recurrence, and mortality. We therefore investigated the incidence of preoperative anemia in colorectal cancer and assessed risk factors for anemia. Prospective data were collected on 311 patients diagnosed with colorectal cancer over a 6-year period from 1994 through 1999. Patients were stratified by age, gender, presenting complaint, preoperative hematocrit, American Joint Committee on Cancer (AJCC) stage, and TNM classification. Discrete variables were compared using Pearson's Chi-square analysis. Continuous variables were compared using Student's t test. Differences were considered significant when P < 0.05. The mean age of the study cohort was 67 +/- 9.2 with 98 per cent of the study population being male. The mean AJCC stage was 2.2 +/- 1.2 and the mean preoperative hematocrit was 35 +/- 7.9 with an incidence of 46.1 per cent. The most common presenting complaints were hematochezia (n = 59), anemia (n = 51), heme-occult-positive stool (n = 33), bowel obstruction (n = 26), abdominal pain (n = 21), and palpable mass (n = 13). Preoperative anemia was most common in patients with right colon cancer with an incidence of 57.6 per cent followed by left colon cancer (42.2%) and rectal cancer (29.8%). Patients with right colon cancer had significantly lower preoperative hematocrits compared with left colon cancer (33 +/- 8.5 vs 36 +/- 7.4; P < 0.01) and rectal cancer (33 +/- 8.5 vs 38 +/- 6.0; P < 0.0001). Patients with right colon cancer also had significantly increased stage at presentation compared with left colon cancer (2.3 +/- 1.3 vs 2.1 +/- 1.2; P < 0.02). Age was not a significant risk factor for preoperative anemia in colorectal cancer. We conclude that there is a high incidence of anemia in patients with colon cancer. Patients with right colon cancer had significantly lower preoperative hematocrits and higher stage of cancer at diagnosis. Complete colon evaluation with colonoscopy is warranted in patients with anemia to improve earlier diagnosis of right colon cancer. A clinical trial of preoperative treatment of anemic colorectal cancer patients with recombinant human erythropoietin is warranted.     

胃、结直肠癌患者手术前后贫血状况的多中心临床调查研究

目的 明确胃、结直肠恶性肿瘤患者手术前后肿瘤性贫血、缺铁性贫血的发生率及其治疗现状.方法 前瞻性收集2009年8月至12月在北京市8家综合医院明确诊断为胃、结直肠恶性肿瘤的患者共262例,检测术前、术后7 d空腹静脉血血红蛋白、血清铁及铁蛋白水平,分析患者手术前后肿瘤性贫血和缺铁性贫血的发生率.结果 在131例胃癌患者中,手术前肿瘤相关性贫血发生率为36.6%,缺铁性贫血发生率为52.1%,其中贫血患者平均年龄高于无贫血患者年龄[(62±11)岁比(57±12)岁,P＜0.05];手术后缺铁性贫血发生率升至72.6%,明显高于术前(P＜0.05).131例结直肠癌患者手术前肿瘤相关性贫血发生率为37.4%,缺铁性贫血发生率为61.2%,其中45%贫血患者结肠肿瘤部位为右半结肠癌;手术后缺铁性贫血发生率明显高于术前(76.7%,P＜0.05).消化道肿瘤性贫血的术前治疗率为10.3%,术后治疗率为22.7%,半数以上的肿瘤性贫血患者接受了输血治疗.结论 胃、结直肠恶性肿瘤患者中缺铁性贫血及肿瘤相关性贫血发生率高,主要病因为缺铁性贫血.老年患者、右半结肠癌患者中贫血发生率高.贫血患者接受治疗比例较低,需要建立系统的肿瘤性贫血治疗规范.

Abstract：

Objectives To determine the prevalence of cancer-related anemia and iron deficiency anemia( IDA ) in patients with gastric and colorectal cancer in North of China. Methods A cross-sectional study of 262 inpatients diagnosed with gastric or colorectal cancer admitted to eight general hospitals in Beijing from August 2009 to December 2009 was performed. The blood samples were took on the day after admission and the seventh day after operation for the tests of hemoglobin, serum iron and ferritin. The morbidity of cancer-related anemia and IDA before and after the surgery was also compared respectively.Results The preoperative morbidity of cancer-related anemia was 36. 6% in 131 patients with gastric cancer, and the morbidity of IDA was 52. 1%. The mean age of the anemic patients was higher than that in cases without anemia[(62 ± 11 ) yrs vs. (57 ± 12) yrs, P ＜ 0. 05]; the postoperative morbidity of IDA increased to 72. 6% ( P ＜ 0. 05 ). In the 131 cases with colorectal cancer, the preoperative incidence of cancer-related anemia and IDA was 37. 4% and 61.2%, respectively. About 45% of the cases with anemia had a tumor in the right colon. Postoperative incidence of IDA was significantly higher than that before the surgery ( 76. 7%, P ＜ 0. 05 ). Only 10. 3% of the anemic patients were treated with chalybeate therapy before surgical procedures, and the proportion was 22. 7% after the operation. More than 50% of anemic patient received blood transfusion. Conclusions Cancer-related anemia is a common clinical manifestation in patients with gastrointestinal cancer, and anemia occurs more frequently in elder and patients with right colon tumor. The treatment to cancer-related anemia is insufficient and a systematic therapy is needed to be established.     

INFLAMMATORY BOWEL DISEASE IN HONG KONG CHINESE: A RETROSPECTIVE STUDY IN A REGIONAL HOSPITAL

Background: Inflammatory bowel disease (IBD) is reported to be rare in the Hong Kong Chinese. Aim: To study the characteristics of IBD in our ethnic Chinese. Method: We performed a retrospective analysis of all consecutive Chinese patients of IBD diagnosed and treated at our hospital from year 1993 to 2000. Results: There were 35 and 15 patients with an established diagnosis of ulcerative colitis (UC) and Crohn’s disease (CD), respectively, as determined by a combination of clinical, radiological, endoscopic and histologic criteria. The male to female ratio was 1 : 1.3 and 1 : 1.1 for UC and CD, respectively. The mean age at diagnosis was 42.0 (range, 18–79) and 41.1 (range, 10–74) for UC and CD, respectively. No documented positive correlation between smoking and CD was evident. None of the patients had a family history of IBD. Common presenting symptoms were blood in stool (86%), diarrhoea (71%), abdominal pain (49%) and weight loss (14%) for UC. Main presenting symptoms for CD were abdominal pain (55%), diarrhoea (45%), blood in stool (45%) and weight loss (36%). Extraintestinal manifestations were rare. One patient had sclerosing cholangitis in association with UC. Another patient with CD developed sacroiliitis. Of the 15 patients with CD, 8 had ileocolic disease (55%), 5 colonic disease alone (36%) and 2 isolated small intestine disease alone (9%). A predilection to involve the colon (87%) is a distinct feature. Of the 35 patient with UC, 11 had proctitis (31%), 8 rectosigmoiditis (24%), 3 left sided colitis (9%) and 13 extensive colitis (39%). All patients with UC responded to medical therapy. None required surgical resection. Ten patients (67%) with CD responded to medical therapy alone. Surgical resection was undertaken in 5 CD patients (33%). Conclusions: In comparison with Western figures, a relatively higher proportion of distal colitis alone namely, proctitis and rectosigmoiditis was seen in our Chinese UC patients whereas a predilection to involve the colon was a distinct feature in our Chinese CD patients. A higher age at diagnosis and the absence of family history were also characteristic features of IBD patients in our series.     

结直肠肿瘤根治术后腹腔乳糜漏的诊治

目的 总结结直肠肿瘤根治术后腹腔乳糜漏的诊治及预防经验.方法 比较1259例不同术式（开腹与腹腔镜）、不同部位（右半、左半结肠与直肠）结直肠肿瘤根治术后腹腔乳糜漏的发生率.结果 本组46例患者（3.6%）术后发生腹腔乳糜漏,开腹组与腹腔镜组的发生率分别为3.2%（18/570）和4.1%（28/689）,差异无统计学意义（P＞0.05） 右半结肠根治术后腹腔乳糜漏的发生率为9.6%（16/167）,显著高于左半结肠的2.6%（7/268）和直肠的2.8%（23/824）（P＜0.05）.45例患者经保守治疗（治疗措施包括禁食、肠外营养、静脉使用生长抑素和延缓拔除腹腔引流管）治愈,1例经行腹腔淋巴管漏口结扎术并局部喷洒医用胶治愈,无死亡病例.结论 根治性右半结肠切除是术后发生乳糜漏的高危因素 术后腹腔乳糜漏保守治疗有效.