旷置结肠综合征的临床报告

目的:探讨选择性结肠切断旷置术后旷置结肠综合征的临床表现和原因.方法:回顾性分析以选择性结肠切断旷置术治疗28例结肠瘫痪症患者.结果:28例患者中痊愈25例(89.3%),缓解3例(10.6%),出现选择性结肠切断旷置术后旷置结肠综合征4例(14.3%).结论:选择性结肠切断旷置术治疗结肠瘫痪症术式简化,术程缩短,安全有效,有较大临床应用价值.部分患者术后出现轻度粪便返流引起的旷置结肠综合征,说明结肠瘫痪症患者结肠的蠕动和排空功能严重障碍,非手术治疗无效.     

节段性食管旷置治疗胸段食管穿孔

目的探讨节段性食管旷置治疗食管穿孔的效果。方法应用节段性食管旷置治疗6例食管穿孔患者。结果经过3～6周治疗，4例患者痊愈；1例改行食管旷置结肠带食管颈部吻合；1例死于多脏器衰竭。结论节段性食管旷置治疗食管穿孔符合食管穿孔的治疗原则，手术创伤小、手术操作简便、疗效可靠。     

肠舒汤保留灌肠对旷置性结肠炎病理改变的影响

目的:观察肠舒汤保留灌肠对末端回肠造口术后旷置性结肠炎病理改变的影响。方法:选择2015年12月—2018年6月在我科因梗阻性结肠癌或直肠癌保肛手术,一期肿瘤切除、吻合并行预防性末端回肠双腔造口的60例患者,随机均分为对照组和观察组,每组30例。对照组以温生理盐水经肛门插管逆行灌肠治疗,观察组以同法给予肠舒汤保留灌肠治疗,连续治疗2周,每天1次,在灌肠治疗前及灌肠治疗2周后各行1次电子结肠镜检查。检查整个旷置结肠的黏膜改变情况。结果:灌肠2周后,对照组患者旷置结肠的黏膜红斑肿胀有效率为26.67%,观察组为70.00%;对照组炎性滤泡增生的有效率为20.00%,观察组为47.82%;对照组溃疡糜烂的有效率为5.56%,观察组为45.00%。观察组红斑肿胀、滤泡增生的有效率显著优于对照组(P 0.05),溃疡糜烂及炎性息肉的有效率差异无统计学意义。结论:肠舒汤保留灌肠可以较好地修复旷置性结肠肠黏膜的损伤,促进肠黏膜的恢复。     

结肠慢传输型便秘24例外科治疗体会

目的 探讨结肠慢传输型便秘(slow transit constipation,STC)病人的合理手术方式.方法 回顾性分析了24例接受手术治疗的结肠STC病人的临床资料.结果 结肠次全切除、逆蠕动盲肠直肠吻合术10例,结肠大部分旷置、逆蠕动盲肠直肠吻合术8例,结肠旷置、回肠直肠吻合术4例,结肠旷置、回肠乙状结肠吻合术...     

预防性肠造口还纳术前行电子结肠镜致肠穿孔四例分析

目的探讨预防性肠造口还纳术前结肠镜致肠穿孔的主要危险因素和应对策略。方法回顾性分析2013年9月-2015年4月我院结直肠肛门外科预防性肠造口还纳术前行结肠镜检查致肠穿孔4例患者的临床资料。结果结肠镜检查并发结肠穿孔4例,均为诊断性穿孔,其中1例穿孔部在横结肠盲端,3例在乙状结肠。4例患者均发现不同程度结直肠炎症表现,造口存在时间6-12个月,其中2例患者接受过结直肠肿瘤术后不同剂量的放疗。结论对于结直肠肿瘤术后预防性肠造口还纳患者,由于长期结肠旷置,且部分患者有放疗史,极容易形成旷置性肠炎和放射性肠炎,电子结肠镜检查容易导致肠穿孔。     

选择性结肠切断旷置术治疗重度结肠慢传输性便秘的探讨

目的：探讨一种可行的重度结肠慢传输性便秘的外科手术方式。方法：有选择性地保留近端结肠肠段，将远端结肠之口侧封闭后旷置。用保留的肠段行结-乙或结-直吻合。结果：28例中痊愈25（89．3％），缓解3例（10．6％）。结论：选择性结肠切断旷置术治疗重度结肠慢传输性便秘术式简化，术程缩短，安全有效，有较大『临床应用价值。     

缝线反应导致肠外瘘1例报告

1 病例介绍 　　患者女,48岁,因“次全结肠切除术后3年,腹部切口疼痛伴分泌物渗出1个月“于2006年6月26日入院.2003年9月因重度结肠慢传输性便秘行选择性结肠切除、旷置,升直结肠侧侧吻合术;术后腹胀、排便不畅,于2005年12月行剖腹探查、肠粘连松解术、结肠旷置切除术、升直结肠端端吻合术.……     

近端切开挂线远端旷置引流治疗单纯性高位肛瘘的临床应用

目的:评估近端切开挂线远端旷置引流法治疗单纯性高位肛瘘的临床疗效。方法:对32例诊断为单纯性高位肛瘘患者采用近端切开挂线远端旷置引流法治疗。结果:所有病例全部治愈,未出现肛门括约肌功能不全及局部大瘢痕形成等并发症。结论:近端切开挂线远端旷置引流法治疗单纯性高位肛瘘可取得满意疗效,并能有效减少手术后遗症。     

全结肠旷置加回直逆蠕动侧侧吻合术治疗高龄慢传输型便秘

目的评估全结肠旷置、回直逆蠕动侧侧吻合术治疗高龄特发性结肠慢传输便秘的安全性和可行性。方法回顾性分析2009年5月至2011年9月间在武汉大学中南医院接受全结肠旷置、回直逆蠕动侧侧吻合术的13例高龄结肠慢传输型便秘患者的临床资料。结果13例患者中男5例,女8例,年龄63～82（平均74）岁,病程7～38（中位10）年。手术时间（55±4）min,术中出血量（30±2）ml,术后住院时间10～16（平均11．4）d,术后首次排粪时间为术后2N8（平均4）d。无手术意外及术后严重并发症发生。术后随访6～29（中位12）月。术后12个月患者每日排粪3-4次,无便秘复发或腹泻。术后14个月发生盲袢综合征1例。术后6个月,Wexner便秘评分较术前显著降低（5．4±2．1比22．8±3．3,P〈0．05）,胃肠道生活质量指数较术前显著提高（120．8±13．0比93．6±20．5,P〈O．05）。结论全结肠旷置、回直逆蠕动侧侧吻合术为高龄结肠慢传输便秘患者的一种安全、有效、简便的手术方式,可显著的缓解患者的临床症状。     

结肠旷置回直肠吻合术治疗慢传输型便秘32例

我们采用结肠旷置、回直肠吻合术治疗结肠慢传输型便秘32例，取得满意疗效，现报告如下。     

经肛门串联重叠手术治疗直肠前突的临床研究

目的：探讨直肠前突病例的手术术式和治疗结果。方法：48例中，重度直肠前突采用经肛门直肠前壁切开将肌肉串联黏膜重叠缝合修补术，同时常规将内括约肌挑出切断术，包括耻骨直肠肌部分切除术和肠疝经腹切除冗长肠段，作对端缝合，疗效观察。结果：全部病例经6个月至2年的随诊，复查，排便通畅，临床症状消失，效果优者35例，良好11例，术后症状轻度改善2例，症状改善总有效率95.8%。结论：选择性直肠前突施行经肛门直肠前壁黏膜切开，肌肉串联，黏膜重叠缝合术效果满意，黏膜的分离，串联重叠缝合程度是手术成功的关键。     

Replacement of colonic mucosa by free and pedicled grafts of ileal mucosa in the dog

Mucosal proctectomy and ileo-anal anastomosis is a relatively new operation in the treatment of patients with ulcerative colitis. The diseased rectal mucosa is removed and gastrointestinal continuity is restored by replacing it with full thickness ileum. The main disadvantage of the operation is frequency of bowel action and in an attempt to resolve this problem the feasibility of replacing colonic mucosa with grafts of ileal mucosa alone was explored. Both free and pedicled autografts of ileal mucosa were grafted into isolated loops of canine colon, denuded of mucosa and submucosa. All the free grafts failed to survive (eight dogs) and histological examinations confirmed graft rejection. All the pedicled grafts (seven dogs) were successful and retained the histological characteristics of normal ileum. Net movement and bidirectional transport of water and electrolytes were measured in six dogs with pedicled grafts and in four control dogs with intact full thickness ileal loops. Whereas the control loops absorbed water and electrolytes, the grafted loops secreted water, sodium, and potassium and absorbed significantly less chloride. The mucosa of the colon can thus be replaced successfully by grafts of ileal mucosa provided that an intact blood supply is preserved. The capacity and sensation of the neorectum after mucosal proctectomy may be improved if mucosal grafts were used instead of full thickness ileum. Before this procedure could be used in man, however, practical problems would have to be overcome and the secretion of water and electrolytes corrected.     

Prognostic Significance of Epidermal Growth Factor Receptor Expression in Colon Cancer Patients Undergoing Curative Surgery

Background To investigate the role of epidermal growth factor receptor (EGFR) expression as a prognostic marker for prediction of cancer behavior and clinical outcomes in colon cancer patients undergoing potentially curative surgery. Methods EGFR determination using a commercially available immunohistochemistry kit was performed in tissues from 149 colon cancer patients receiving primary surgical treatment and in 25 normal colon mucosa specimens from noncancer patients. EGFR positivity was correlated in univariate and multivariate analyses with disease recurrence and survival. In addition, p27, p53, and vascular endothelial growth factor expression were assessed by immunohistochemistry in 104 patients and correlated with EGFR tumor expression and clinical outcome. Results EGFR expression was detected in approximately one third of colon cancer patients (53 of 149; 35.6%). In 126 curatively treated patients, EGFR expression was correlated with disease recurrence and worse survival in both univariate and multivariate analyses. In a multivariate model for predicting recurrence and survival, Dukes’ staging, p27, and EGFR expression were the only independent covariates. In particular, in Dukes’ A and B patients the 5-year survival probability was 96% for EGFR-negative and high p27 expression cases and was 30.7% for EGFR-positive and low p27 expression cases. Conclusions EGFR expression was an independent prognostic indicator of disease recurrence and poor survival in colon cancer patients undergoing curative surgery. In the context of novel therapeutic options such as molecularly targeted therapies, these findings suggest that anti-EGFR drugs could be evaluated in the adjuvant treatment of EGFR-positive colon cancer patients.     

Endoscopy in colonic volvulus.

Flexible fiberoptic gastrointestinal endoscopy has greatly simplified the diagnosis and treatment of colonic volvulus. The management of 39 patients with colonic volvulus treated over 9 years was reviewed. Five per cent were treated with rectal tube decompression alone, 23% were treated with either sigmoidoscopic or colonoscopic reduction, and 26% were treated exclusively with operation. Endoscopic reduction was attempted in nearly half of the patients in preparation for operation. Recurrent volvulus occurred in 57% of patients initially treated with endoscopic reduction alone. Sigmoidoscopic examination did not confirm the diagnosis in 24% of instances in which it was used, although colonoscopy was always diagnostic. The overall mortality rate was 8%, but increased to 25% in patients with gangrene of the colon. Three patients who later proved to have gangrene of the colon had a normal initial sigmoidoscopic examination. Two of these patients died of intra-abdominal sepsis from a perforated colon. In five patients an accurate endoscopic diagnosis of gangrene prompted immediate exploration. None of these patients died. Endoscopy is a safe and effective diagnostic tool for the initial evaluation of patients with suspected colon volvulus. In addition, endoscopy may result in therapeutic decompression and may provide visual assessment of the viability of the bowel mucosa, thus assisting in the timing of appropriate operative treatment.     

The utility of routine preoperative computed tomography scanning in the management of veterans with colon cancer

BACKGROUND: The aim of this study is to assess the clinical utility of routine preoperative computed tomography (CT) scanning in patients with cancer of the intraperitoneal colon.METHODS: From November 1997 to June 2001, all patients at VA Puget Sound Healthcare System with a diagnosis of colon cancer were referred for a preoperative CT scan. Medical records and operative notes were reviewed to determine the influence of preoperative CT on clinical management.RESULTS: Seventy patients received a CT per protocol. Preoperative CT provided information that was used in treatment planning and management in 26 (37%) cases. However, if preoperative scans had not been performed, the clinical management would have been definitively altered in only 13 (19%) patients.CONCLUSIONS: Although these data suggest potential benefit for routine preoperative CT scanning, we believe additional study, including cost analysis, should precede the adoption of CT scanning as a routine preoperative study in patients with colon cancer.     

复方菊花冲剂保留灌肠治疗溃疡性结肠炎的临床和实验研究

为探讨复方菊花冲剂保留灌肠治疗湿热内蕴型溃疡性结肠炎（UC）的临床疗效及作用机理,随机设复方菊花冲剂治疗组（30例）和柳氮磺吡啶对照组（30例）,对治疗前后主要症状、体征积分值及肠镜黏膜像等进行对比观察,并造模形成大鼠UC,用药后观察大鼠结肠大体形态及结肠组织的病理变化。结果显示,治疗组在临床总疗效、主要症状、体征、黏膜像等方面均显著优于对照组（P〈0．05）。实验研究证明,复方菊花冲剂能促进大鼠肠黏膜炎症的吸收,促进溃疡修复愈合。结果表明,复方菊花冲剂保留灌肠治疗湿热内蕴型UC疗效确切,无明显副作用,使用方便。     

Appraisal of surgical treatment for distal ulcerative colitis

Most patients with ulcerative colitis respond well to medical treatment, however surgical treatment may be required in cases with severe clinical symptoms. We treated eight patients with distal ulcerative colitis (DUC), limited to the rectum and distal sigmoid colon, who were treated at St. Mark's Hospital by excision of the rectum and sigmoid colon with permanent colostomy. Four who did not respond to medical treatment and had severe and intermittent symptoms of long-standing, three with no control of the distressing diarrhea with a shorter history, and those with a severe dysplasia evidenced by rectal biopsy were surgically treated. Two of eight had a recurrence at the proximal colon within 6 and 10 years respectively but responded well to conservative management. From these observations it concluded that the procedure for patients with DUC may be one of adequate operations. Histological features of the resected specimens did not relate to the postoperative outcome of these patients.     

Appraisal of surgical treatment for distal ulcerative colitis

Most patients with ulcerative colitis respond well to medical treatment, however surgical treatment may be required in cases with severe clinical symptoms. We treated eight patients with distal ulcerative colitis (DUC), limited to the rectum and distal sigmoid colon, who were treated at St. Mark's Hospital by excision of the rectum and sigmoid colon with permanent colostomy. Four who did not respond to medical treatment and had severe and intermittent symptoms of long-standing, three with no control of the distressing diarrhea with a shorter history, and those with a severe dysplasia evidenced by rectal biopsy were surgically treated. Two of eight had a recurrence at the proximal colon within 6 and 10 years respectively but responded well to conservative management. From these observations it concluded that the procedure for patients with DUC may be one of adequate operations. Histological features of the resected specimens did not relate to the postoperative outcome of these patients.     

Polyamine levels and gastrin receptors in colon cancers.

Polyamines and gastrin receptors (GR) were studied in samples of colon cancer and mucosa from 40 patients and in control mucosa from 11 patients without cancer. Polyamines (i.e., putrescine, spermidine, spermine) are essential for growth and differentiation. The concentration of polyamines is elevated in rapidly proliferating normal tissues and in some cancers. The presence of GR in human colon cancers has been previously reported. The purpose of the present study was twofold: (1) to determine whether polyamine levels are elevated in colon cancers and in adjacent normal colon mucosa compared to colon mucosa from patients without cancer; and (2) to examine the relationship between polyamine levels and GR in colon cancers. Polyamine levels in colon cancers were significantly higher than in the normal colon mucosa from the same patients. The polyamines, spermidine and spermine, were significantly higher in colon mucosa from patients with cancer compared to patients without cancer. Spermidine and the spermidine:spermine ratio, an index of cell proliferation, were increased in colon cancers with GR compared to cancers without GR. There were no significant correlations between polyamine levels and the following: patient age, CEA level, site of cancer, stage, or differentiation. Because polyamine levels are increased in colon mucosa from patients with cancer, measurement of polyamines may detect patients at risk for subsequent development of colon cancer. Increased levels of polyamines in colon cancers with GR is evidence that gastrin may play a trophic role in human colon cancers.     

外科治疗慢性缺血性结肠炎的初步研究

目的 缺血性结肠炎是肠缺血的最常见形式,其中少部分病例需要外科干预,这一群体的最普遍症状是结肠梗阻.本研究的目的是总结慢性缺血性结肠炎外科治疗经验.方法 回顾性总结自2009年3月至2010年7月9例进行外科治疗的缺血性结肠炎患者的临床资料.结果 9例患者表现为缺血性结肠炎的慢性并发症接受外科治疗,包括5例男性和4例女性,年龄分布为39～78岁.所有患者有外伤或心血管疾病的病史,诊断依靠腹部CT扫描、结肠气钡双重造影、肠镜检查过和血管造影,手术为一期或分期的病变肠段切除,所有诊断为病理所证实,随访最长至33个月,患者状况良好,未见复发.结论 对慢性缺血性结肠炎并伴有并发症的患者,外科治疗效果确切.