Laparoscopy to correctly diagnose and stage metastatic breast cancer mimicking Crohn's disease

We report a case of metastatic lobular breast carcinoma with extrahepatic gastrointestinal disease. On the basis of clinical findings, radiologic investigations, computerized axial tomography, gastrointestinal endoscopy, and gastric biopsy, the diagnosis of gastric and ileal Crohn's disease was made. The correct diagnosis of peritoneal carcinomatosis was made at laparoscopy. This case exemplifies the utility of laparoscopy in establishing the diagnosis and staging for abdominal disease of uncertain etiology.     

经肛管括约肌间径路切除低位直肠癌保肛手术临床研究

目的探讨经肛门内外括约肌间径路切除超低位直肠癌保肛手术的安全可行性,并评价肿瘤根治效果及术后肛门功能。方法分析2000-2004年华中科技大学同济医学院附属协和医院经选择的经肛门内外括约肌间径路切除超低位直肠癌保肛手术病人42例的临床资料。结果腹部手术遵循TME原则,肛门手术在直视下距病灶下缘2cm切断直肠黏膜和肛门内括约肌,经括约肌间隙向上游离达肛管外括约肌环上方与腹部手术会合,近端结肠与肛管完成端端吻合。前瞻性随访术后病人肿瘤复发与肛门排便功能状况。37例病人完成手术,并发症包括发生急性肺栓塞并死亡1例,盆底肌肉出血1例,吻合口漏3例。36例病人获得随访,平均随访时间为40(24~60)个月。3例(8.33%)吻合口复发,其中1例死亡;1例同时肺、腹膜转移于术后24个月死亡;2例因肝转移分别于术后16、24个月死亡;1例腹腔内淋巴结、腹股沟淋巴结转移于术后16个月死亡。术后6个月肛门括约肌功能已比较满意。结论经肛门内外括约肌间径路切除术治疗超低位直肠癌的手术方法是一种可选择的安全性高、根治效果好的保肛术式。     

低位直肠癌原位肛门重建与生活质量

目的 探讨低位直肠癌原位肛门重建术能否在保证患者手术的根治性同时使其生活质量得到提高。方法 我科自1989年5月至今,对27例低位直肠癌(肿瘤距肛门4～8cm)患者,在Miles’术式的基础上,保留了部分肛门外括约肌,结肠双套叠式原位肛门重建术。结果 经随访2～11年,所有病例均健在,未发现远处转移,病人没有因手术而造成明显的思想负担及心理压力,日常生活满意,与同期住院的23例单纯行Miles’术治疗而情绪低落的直肠癌患者相比较,有显著差异。结论 原位肛门重建术在低位直肠癌中的应用,既能保证患者手术的根治性,同时对提高其生活质量具有积极意义。     

Esophageal stricture in Crohn's disease

We treated a 46-year-old Japanese man with Crohn's disease of the esophagus and for whom medical therapy was adequate. Crohn's disease of the esophagus is a rare disease without specific clinical features and establishment of the diagnosis with guided biopsy is extremely difficult. Therefore, Crohn's disease of the esophagus should be considered in the differential diagnosis of biopsy-negative carcinoma of the esophagus in order to avoid major surgery. Treatment of Crohn's disease of the esophagus should primarily be medical and esophagectomy should only be considered in cases of complications, intractability or a suspicion of malignancy in the biopsied specimen.     

克罗恩病合并妊娠的临床处理

目的总结克罗恩病合并妊娠的临床特点及治疗方法。方法介绍2例克罗恩病合并妊娠病例资料并进行文献复习。结果 2例克罗恩病患者孕前及孕期病情控制平稳。病例1既往有两次病情活动入院治疗,孕前病情稳定;病例2在孕前病情控制平稳,孕期病情无加重。2例患者均获得良好的妊娠结局。结论患有克罗恩病的育龄女性,若能正确认识妊娠和疾病之间的风险关系,在疾病的静止期有计划地受孕,孕期规范治疗以维持疾病的静止期,定期产检,多可获得良好的母婴结局。     

Clinical evaluation of urolithiasis in Crohn's disease

Objectives:   To investigate the characteristics of urolithiasis associated with Crohn's disease in a Japanese population.
Methods:   We studied 98 patients with Crohn's disease: 39 with urolithiasis and 59 without urolithiasis. Patients were treated at the Social Insurance Central General Hospital, or at the Toho University Omori, Ohashi, or Sakura Medical Centers.
Results:   Calculi were more frequent in men ( n  = 30) than women ( n  = 9). Mean time from diagnosis of Crohn's disease to diagnosis of calculi was 8.8 years (range 0 to 22 years). Calculi were present on the right side in 19 patients and the left side in 19 patients. Stone were composed of calcium oxalate in nine patients, calcium oxalate and calcium phosphate in two patients, and ammonium urate in five patients. The rate of concurrent calculi was significantly higher in ileostomates. The probability of developing calculi was approximately eight times higher for patients with a urine pH of ≤6.0 than for those with a urine pH of ≥6.5.
Conclusions:   The rate of concurrent urolithiasis was higher in patients with a urine pH of ≤6.0, ileostomy, or two or more bowel resections. To prevent formation of calculi, Crohn's disease patients require regular urological examination including urinalysis, ultrasonography, and kidney ureter bladder X-ray.     

直肠癌术后准确病理分期诊断对辅助治疗和预后判断的影响

准确的病理学检查在直肠癌的诊治流程中发挥着“承前启后”的作用,其既能评判新辅助放化疗及手术切除的效果,又能指导术后辅助治疗,甚至能够用于评判预后的风险程度。TNM分期是直肠癌常规病理诊断的基础,分子病理诊断已经进入临床应用。常用于指导辅助治疗和预后评估的病理学指标包括T分期、N分期、环周切缘、新辅助治疗反应、脉管浸润、神经周围浸润、RAS基因状态、错配修复状态等。     

Tracheo-bronchitis as a complication of Crohn's disease —A case report—

A case of Crohn's enterocolitis associated with diffuse tracheo-bronchitis is presented herein. Although respiratory tract involvement in Crohn's disease is extremely rare, our review of the world literature revealed several common clinical pathologic features. These features include a productive cough with chest X-ray films which are normal except for some peripheral involvement. Bronchoscopy, however, shows diffuse inflammation of the trachea and bronchi with widely scattered whitish lesions while biopsy reveals a granulomatous infiltration of inflammatory cells. This tracheobronchitis typically responds well to treatment with prednisone.     

从病理学角度分析直肠癌局部复发因素

直肠癌是最常见的恶性肿瘤之一,近半数病人5年内死于复发转移。探讨影响直肠癌病人预后的相关因素对制定防治策略、选择合理治疗方案具有重要意义。影响直肠癌预后的因素很多,除了一些得到广泛认可的因素以外,近年来的研究又发现了一些显著影响预后的高危因素,从病理学的角度分析近期发现的与直肠癌局部复发相关的因素对判断预后具有重要意义。     

Routine endoscopic surveillance for local recurrence of rectal cancer is futile

Background

National Comprehensive Cancer Network guidelines for rectal adenocarcinoma regarding routine surveillance with proctoscopy for local recurrence have been evolving. The purpose of this study was to examine the utility of rectal surveillance.

Methods

This is a single-center, retrospective review of patients (2004 to 2011) who underwent total mesorectal excision for rectal cancer. The primary end point was cancer recurrence, with detection method(s) noted. The number of surveillance procedures was collected.

Results

The study included 112 patients. There were no local recurrences identified by rectal surveillance. There were 1 local recurrence and 17 distant recurrences (16%). The local recurrence was identified by carcinoembryonic antigen and symptoms. There were 20 anoscopies, 44 proctoscopies, and 495 flexible sigmoidoscopies performed, with estimated charges of $266,000.

Conclusions

Rectal surveillance at this center was not beneficial. This study supports the recent (2015) change in the National Comprehensive Cancer Network guidelines, which no longer recommend routine rectal surveillance and challenge other society guidelines.     

新辅助放化疗对直肠/肛管癌患者行经内外括约肌间切除术后近远期疗效的影响

目的 探讨新辅助放化疗对直肠/肛管癌患者行经内外括约肌间切除术（ISR）后近远期疗效的影响.方法 直肠/肛管癌患者115例,根据患者术前是否行长周期（8周）新辅助放化疗分组,术前行长周期（8周）新辅助放化疗的患者定义为A组,术前未行长周期（8周）新辅助放化疗的患者定义为B组.两组均行经内外括约肌间切除术（ISR）.结果 从术后并发症发生率来看,A组肛周感染率明显高于B组（7.5％vs 0％）（P＜0.05）.从患者术后肛门功能恢复情况来看,两组术后2、3年肛门功能均较术后1年明显改善（P＜0.05）.两组间比较,A组术后1、2、3年肛门功能均较B组差（P＜0.05）.从远期效果来看,两组局部复发率及生存率差异无统计学意义（P＞0.05）.结论 新辅助化疗联合ISR治疗超低位直肠/肛管癌较单纯ISR,没有延缓患者术后近期恢复,且能够获得相似的生存率及局部复发率,但是,新辅助化疗增加了ISR手术患者术后肛周感染发生率,同时,对患者术后肛门功能造成一定的影响,但仍在患者可接受范围之内.     

Stapled fistulectomy to treat enteroenteric fistulas in Crohn's disease

We report herein our technique of performing stapled fistulectomy as minimum surgery for the resection of nine entero-enteric fistulas in six patients with Crohn's disease. The surgical outcome was successful in all patients. It would seem that fistulous sites without a severe affected lesion are a favorable indication for this procedure and we recommend this simplified fistulectomy for selected conditions in Crohn's disease.     

克罗恩病并发症的特点与治疗

目的 总结克罗恩病并发症的特点和治疗方法.方法 回顾性分析2000年1月至2007年12月南京军区南京总医院收治的202例合并并发症的克罗恩病患者的临床资料.其主要并发症为肠梗阻、肠瘘、急性肠穿孔、脓肿及腹腔包块等.结果 全组202例患者中有116例出现2次以上并发症,首次并发症为肠梗阻72例,肠瘘31例,急性肠穿孔23例,脓肿及腹腔包块各22例,肛周病变21例和消化道出血11例.再次并发症早期(≤3个月)以肠瘘(36例)为主;中晚期(＞3个月)以肠梗阻(24例)、肠瘘(22例)、脓肿(11例)多见.首次并发症202例患者中有170例行手术治疗,32例行非手术治疗.再次并发症116例患者中有96例行手术治疗,20例行非手术治疗.手术治愈127例,好转33例,死亡6例;非手术治疗患者症状好转,无死亡.结论 克罗恩病并发症以肠梗阻最多见,其次为肠瘘;手术是目前治疗克罗恩病并发症的重要方法.

Abstract：

Objective To investigate the characteristics and treatment of the complications of Crohn's disease. Methods The clinical data of 202 patients with Crohn's disease and relevant complications who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2000 to December 2007 were retrospectively analyzed. The main complications included intestinal obstruction, fistula, acute perforation,abscess, abdominal mass and et al. Results Of the 202 patients, 116 had more than two complications. Intestinal obstruction (72 patients) was the most common complication among the initial complications, and followed by fistula (31 patients), acute perforation (23 patients), abscess (22 patients), abdominal mass (22 patients),anal complications (21 patients) and gastrointestinal bleeding (11 patients). Fistula was mostly observed in patients with secondary complications during the early stage (≤three months), while obstruction (24 patients),fistula (22 patients) and obscess (11 patients) were prevalent during the mid-late stage (＞ three months). Of the 202 patients with primary complications, 170 received surgical treatment and 32 received non-surgical treatment. Of the 116 patients with secondary complications, 96 received surgical treatment and 20 received non-surgical treatment. A total of 127 patients were cured by surgical treatment, the condition of 33 patients was improved and six patients died. The condition of patients received non-surgical treatment was improved, and no patient died.Conclusions The incidence of complications of Crohn's disease is increasing steadily. Intestinal obstruction is the most common complication, and then followed by fistula. Surgery is important in the treatment of the complications of Crohn's disease.     

Anal stenosis: use of an algorithm to provide a tension‐free anoplasty

Background: Anal stenosis is a debilitating condition that often is iatrogenic in cause. Various surgical procedures to manage this problem have been described. The present study evaluates the use of different anoplasty techniques in a series of 11 patients with anal stenosis. To the best of the authors' knowledge, this is the first study to provide a stepwise algorithm for the anoplasty techniques used. Methods: A series of 11 patients were evaluated for presenting symptoms, cause of anal stenosis, type of anoplasty used, complications and post‐operative success in relieving symptoms. All operations were performed by one surgeon in three hospitals, and were followed up by the same surgeon and by a surgical registrar. Results: The most common presenting symptoms were constipation and decreasing calibre of stool. The main causes of anal stenosis were previous surgery, neoplasia and fissure. Transverse closure, Y‐V and diamond advancement flaps were used in an escalating manner to deal with increasing severity of stenosis. All 11 patients had some level of improvement in symptoms post‐operatively. There were no long‐term complications. Conclusion: Anoplasty is a safe and successful option in the treatment of anal stenosis, and this stepwise algorithm takes the guesswork out of choosing the most appropriate procedure for each patient.     

结直肠癌微转移检测方法研究的现状

淋巴结转移是直肠癌主要的转移途径之一,而跳跃转移足直肠癌淋巴结转移的一个重要特点.很多病例在系膜淋巴结尚未有明确转移时就发现侧方淋巴结或上方淋巴结已有转移或微转移.准确地检测、判断淋巴结转移情况有助于临床治疗,更影响预后水平.近年来淋巴结微转移研究有了进一步的发展,这对直肠癌的治疗也将是一种促进.