大肠癌的靶向治疗

大肠癌是常见的恶性肿瘤之一,发病率及死亡率亦逐年上升,严重威胁人们的生命。目前对大肠癌的治疗仍是以手术为主、辅以局部或全身放疗及化疗的综合治疗。早期大肠癌手术治疗效果明确,但有20～25%左右的患者在首诊时已有其它器官的转移给治疗带来了困难。而靶向治疗作为一种新的治疗手段,为晚期大肠癌的治疗开辟了新途径。     

Surgical therapy of ileus of the large intestine

Acute colonic obstruction is a life threatening emergency. In this prospective study 69 patients suffering from large bowel obstruction, admitted between November 1993 and March 1998 to the University hospital of Bern, were analyzed with regard of the performed surgical procedure. The causes of obstruction were colorectal carcinomas (38%), other malignancies (19%), volvulus (13%), hernias (10%), diverticulitis (7%) and others (13%), 8 benign and 19 malignant lesions were surgically treated without colonic resection, the latter by colostomy (13), ileostomy (5) or bypass (1). All the other 42 patients had their obstruction resected within 24 hours after admission, 24 of them with primary anastomosis and 18 as a two-staged procedure. However, 9/18 (50%) patients never have had restoration of bowel continuity. No three-stage procedure was planned or performed. In-hospital mortality was 4/69 (5.8%), all of them after staged resections due to non-surgical complications. No anastomotic leakage was clinically apparent, neither in one-stage procedures, nor in completed two-stage procedures. Median length of total hospital stay in one-stage and two-stage procedures was 14 and 30 days, respectively. The advantages of one-stage procedures, especially in terms of subtotal colectomy, are discussed on the basis of an overview of the literature.     

Surgical therapy of tumor-induced ileus of the large intestine

The principle of staged surgical approach to tumour-dependent colonic ileus is no longer justified in all situations. One single right-side hemicolectomy has proved to be superior to the staged approach in cases of colonic ileus on the right to transverse centre. Surgical treatment was applied to 22 patients with right colonic ileus, between 1983 and 1986. Seven of them died after surgery, including three of eight who had undergone palliative operations and four of 14 who had undergone radical surgery in one single session. Transversal colostomy as a first step of a staged approach has proved to be successful on patients with left colonic ileus, from transverse centre. It was found to be just as promising as one single approach. One single approach required intestinal evacuation, using a specific aseptic technique. Incontinence resection (Hartmann's operation) has proved to be an effective method. The majority of 31 patients with left colonic ileus underwent staged surgery. Hartmann's operation was performed on seven of them, and external defecation without resection was applied to 24. Twelve of them died after the first operation, including two after Hartmann's operation and ten of 23 after external defecation without tumour removal.     

Diagnosis and treatment of acute intestinal obstruction in cancer of the large intestine

A complex program of treatment of acute intestinal obstruction in carcinoma of the large bowel has been developed on the basis of an analysis of 71 patients. Urgent operations were performed in 70% of the patients with acute intestinal obstruction after a short preoperative preparing. Due to substantial metabolic and immunologic shifts the complex parenteral immunostimulating therapeutic measures are necessary in the postoperative period for all the patients.     

Ileus of the large intestine caused by endometriosis. Report of 2 cases and review of the literature

Two cases of distal colonic obstruction due to endometriosis prompted the authors to elaborate on problems implied in diagnosis and therapy of this rare cause of ileus. Accurate preoperative diagnosis was usually not obtainable from case histories, endoscopy, and X-ray checks. Only emergency operations should be performed on ileus cases (colostomy, Hartmann's operation). Hormonal and surgical treatment should then be continued in consultation with the gynaecologist. Resections should be minimised and mutilating interventions (rectal amputation) avoided.     

Diagnosis and treatment of digestive endometriosis

Excision of intestinal implants in association with ovarian conservative surgery appears to be a safe procedure in most cases of intestinal endometriosis. Newer surgical techniques (selective laser vaporisation of abnormal tissue), advances in medical therapy (danazol, LH-RH agonists) and earlier diagnosis before obstructive phenomena, might allow conservative medical or surgical management before the development of major complications.     

膀胱子宫内膜异位症的诊断与治疗

目的 探讨膀胱子宫内膜异位症的临床特点、诊治方法及预后. 方法 回顾性分析10例膀胱子宫内膜异位症患者的临床资料,年龄30 ～48岁,平均38岁.8例以经期尿路刺激症状为主,主要表现为尿频、尿急、尿痛,其中伴血尿6例,伴下腹痛2例;2例无任何症状,为体检时发现.病程1 ～36个月,平均18个月.B超检查提示膀胱壁内边界欠清的低或中低回声肿物,单发,宽基底,内部回声不均,无明显血流信号.CT检查提示突入膀胱内的软组织密度肿物. 结果 10例患者中行膀胱部分切除术8例,行经尿道电切治疗2例.术后病理诊断均为膀胱子宫内膜异位症.术后随访10 ～72个月,中位随访时间(30.0±5.6)个月,均无复发及远处异位. 结论 子宫内膜异位至膀胱者少见,结合影像学资料能够初步诊断,确诊依靠膀胱镜检及病理活检,治疗以手术为主.     

尿路子宫内膜异位症的诊断及治疗

目的探讨尿路子宫内膜异位症（endometriosis，EMS）的诊断及治疗。方法总结12例尿路EMS的临床特点、诊断、治疗及随访情况。结果12例EMS患者中，膀胱EMS7例，输尿管EMS5例，所有病例均经病理证实；7例膀胱EMS均行膀胱部分切除术，5例输尿管EMS中，2例行经输尿管镜激光治疗，1例行输尿管部分切除及输尿管膀胱再植术，2例行输尿管部分切除、输尿管-输尿管端端吻合术。结论尿路EMS常无特异性症状，但可造成肾功能损害，值得重视；出现尿路梗阻时，及时手术治疗，可取得良好效果。     

Anastomosis in emergency large intestine resections in the therapy of obstructing colonic cancer

A comparative inquiry has been performed on 57 cases of colonic resections for colon carcinoma carried out in emergency with intestinal anastomoses which have been performed according to Gambee's technique (single layer little introflecting suture), Nockemann's technique (a continuous suture in dexon comprising mucosal and submucosal layers and a separate no introflecting stitch suture of the serosal and mucosal layers in teflene) and 'Auf Stoss'-technique (single layered end-on, no introflecting, no mucosal comprising). We have noticed leakages in 20% of the cases performed with the first method, 13% with the second and 12% with the third method. Here below shown the reasons, why the second and the third method are to be considered the best ones and the indications relevant to their usage. Also are discussed: intraoperative irrigation of the colon according to Dudley and the own technique, short term chemotherapeutic prophylaxis, transanastomotic drain, fibrin glue on colon anastomosis.