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目的　探讨局部复发性直肠癌再手术的适应证及影响再手术的因素。方法　上海第二医科大学附属瑞金医院外科 1993年 10月至 2003年 10月收治的 78例复发性直肠癌再手术前均行放疗,对其疗效进行回顾性分析。结果　78例中,根治性切除 32例,姑息性切除 46例,根治切除率为 41 .03%。手术死亡 2例,手术死亡率为 2 .56%。根治性手术组和姑息性手术组中位生存期分别为 35 .8个月和 12. 4个月。结论　再手术结合术前放疗是局部复发性直肠癌的首选治疗方法。     

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目的：探讨局部进展期结直肠癌侵犯膀胱的临床特点及其诊断。方法；回顾性分析12年间收治的29例结直肠癌 侵犯膀胱的病人资料。结果：原发癌26例和复发癌3例。常见症状为排便习惯与粪便性状改变20例（占69．0％），其次为腹痛16例（55．2％）、泌尿系统症状15例（51．7％）、体重下降12例（41．4％）和食欲减退8例（27．6％）。常见体征为腹部包块11例（37．9％）和直肠肿物7例（24．1％）。B超、结肠镜、膀胱镜和盆腔CT扫描检查发现肿物的阳性率分别为93．8％（15／16）、95．0％（19／20）、91．7％（11／12）和100％（18／18）。入院前误诊率达62．1％（18／29），入院时误诊率为44．8％（13／29）。结论：本病缺乏特异性临床表现而易误诊，应根据本病的临床特点，并结合B超、结肠镜、膀胱镜和盆腔CT扫描检查而作出正确的诊断。     

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目的 探讨腹部手术后功能性胃排空障碍的病因、发生机制、诊断和治疗方法。方法 对1994年1月至2002年5月收治的36例腹部手术后胃排空障碍的临床资料进行回顾性分析。结果功能性胃排空障碍均发生于腹部手术后3—12天。35例(97．2％)经非手术治疗于术后13—48天恢复胃动力，痊愈出院，3周内治愈17例(47．2％)，4周内治愈32例(88．9％)，1例(2．8％)因经济原因放弃治疗而死亡。结论 腹部手术后功能性胃排空障碍的病因是多因素的，消化道造影及胃镜检查是诊断胃排空障碍及鉴别机械性梗阻的重要手段。采取非手术疗法可治愈胃排空障碍，应尽量避免再次手术。     

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目的 探讨原发骶前肿瘤的诊断和手术治疗方法。方法 分析1983-1999年治疗的23例原发骶前肿瘤病人的临床资料。结合文献进行讨论。结果 23例中先天性肿瘤为最常见类型。肛门指诊结合B超和CT检查对于术前评估非常重要。手术路径以经骶尾入路和经会阴入路最为常见。结论 如无手术禁忌证，所有原发骶前肿瘤均应予手术切除，应根据肿瘤的具体情况选择恰当的手术路径，术中应避免神经血管损伤，并尽可能完整切除肿瘤。     

提高对结直肠癌术后复发和转移的诊治水平

全世界结直肠癌发病率仍处于上升趋势 ,平均每年递增 2 %。在欧美国家其死亡率仍居癌症死亡的第二位。我国情况亦相似 ,以上海为例 ,发病率年递增 4.2 %,比全球平均递增速度还要高一倍多。1 990～ 1 992年我国十分之一人口抽样调查 ,结直肠癌平均调整死亡率为 4.5 4 / 1 0万 ,居癌症死亡第五位 [1] 。　　在治疗上 ,结直肠癌治疗效果还不够理想 ,近三十多年来提高并不显著。美国癌症协会 Cutler统计分析 2 5 0 0 0例结直肠癌资料 ,外科治疗结肠癌 5年生存率从 1 940～ 1 96 0年由 48%提高到 5 6 %;直肠癌由 44%提高到 5 0 %。英国牛津大学…     

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肿瘤的复发是指癌肿治愈性切除后 ,又长出和原来同样性质的肿块及由此而产生的症状。然而目前对复发概念的认识相当模糊 ,常将非治愈性切除病例 ,甚或姑息性切除病例残留病灶的发展增大也当成是肿瘤的复发。须知 ,肿瘤的生长分临床前和临床后两个阶段。临床前称第一阶段 (细胞学阶段 ) ;临床后称第二阶段 (肿块阶段 ) [1] 。治疗只是针对癌所形成的肿块及肿块所带来的临床症状 ,是肿瘤进展过程中的第二阶段。因此 ,复发也仅指消失后的肿块及临床症状的再现。因为在癌形成可以用现有手段发现的肿块以前 ,是不能诊断和治疗的 ,不能获得治疗的…     

右半结肠癌误诊36例临床分析

结肠癌是胃肠道中常见的恶性肿瘤，早期症状不明显，易被忽视，导致误诊、漏诊，延误治疗时机，本文收集了我院1998年3月～2003年10月收治的右半结肠癌误诊病例36例，现总结分析如下。     

ROC分析法评价肿瘤标记物在大肠癌术后复发时的作用

本文应用ＲＯＣ(ＲｅｃｅｉｖｅｒＯｐｅｒａｔｉｎｇＣｈａｒａｃｔｒｉｓｔｉｃ)分析方法对 6种肿瘤标记物在结直肠癌术后复发的诊断性能进行了分析 ,探讨其应用价值。对象和方法1.对象 :无复发组 6 1例 (结肠癌 18例 ,直肠癌 43例 ) ,男34例 ,女 2 7例 ,年龄范围 2 1～ 78岁 ,平均 5 2 6岁。复发组 35例 (结肠癌 2 2例 ,直肠癌 13例 ) ,男 2 4例 ,女 11例 ,年龄范围18～ 85岁 ,平均 5 8 4岁。以上病例均经病理学确诊。2 .方法 :(1)ＣＥＡ(癌胚抗原 ) ,ＳＦ(血清铁蛋白 ) ,β Ｍｇ(β 微球蛋白 )测定 ,采用放免法 ,药盒购自北京原子能研…     

胃癌术后肿瘤标记物检测及其研究进展

<正>复发是影响胃癌病人手术疗效及预后的主要原因之一,而复发的基础是肿瘤的微转移。在肿瘤细胞未形成影像学可观察到的转移结节前,血液的包含成分或一些与肿瘤有关的蛋白、因子就会发生改变。因此,及早的检测这些改变,发现存在的微转移并给予治疗是胃癌术后预防复发和转移的有效措施,对提高胃癌病人术后生存质量和存活率具有重要意义。     

结肠癌侵犯十二指肠的外科治疗（附16例报告）

总结近５年１６例结肠癌侵犯十二指肠外科治疗经验。手术探查：除十一指肠侵犯外，多数病人还合并多脏器受累，本后病理组织学检查，４例肿瘤仅浸润肌层，７例区域淋巴结未见转移，右半结肠切除并十二指肠粘连松解４例，十二指肠部分切除空肠侧侧双Ｒｏｕｘ－Ｙ空肠浆膜瓣或吻合共５例，十二指肠成形术５例及胰头十二指肠切除２例。结果近期十二指肠瘘２例，因器官衰竭死亡３例，２年内二次手术探查５例，以局部复发为主。认为重视初     

Anastomotic Recurrence of Colon Cancer—is it a Local Recurrence,a Second Primary,or a Metastatic Disease (Local Manifestation of Systemic Disease)?

The aim of this study is to review the literature to find out the exact etiology of anastomotic cancers of colon post resection and differentiate them between a recurrence, second primary, and metastatic disease (local manifestation of systemic disease). Web-based literature search was done, and datas collected. We searched PubMed for papers using the keywords colon cancer recurrence, anastomotic recurrence, and recurrent colon carcinoma. We also searched for systematic review in the same topic. In addition, we used our personal referrence archive. Anastomotic recurrences of colon are postulated to arise due to inadequate margins, tumor implantation by exfoliated cells, altered biological properties of bowel anastomosis, and missed synchronous lesions. Some tumors are unique with repeated recurrence after repeated resection. Duration after primary surgery plays a major role in differentiating recurrent and second primary lesions. Repeated recurrences after repeated resections have to be considered a manifestation of systemic disease or metastatic disease due to the virulence of the disease. A detailed analysis and study of patients with colonic anastomotic lesion are required to differentiate it between a recurrent, a second primary lesion, and a metastatic disease (local manifestation of a systemic disease). The nomenclature is significant to study the survival of these patients, as a second primary lesion will have different survival compared to that of recurrent lesions.     

结肠肝曲癌右半结肠联合胰十二指肠切除术九例报道

目的探讨右半结肠(RH)联合胰十二指肠切除(PD)的必要性及疗效。方法对9例RH联合PD手术患者采用child方式重建;右半结肠切除采用回肠末端与横结肠对端吻合,胰肠吻合以嵌入式捆绑吻合的治疗及随访结果分析。结果本组无围手术期死亡,其中胆肠瘘,切口感染2例;胆肠瘘,胰瘘1例;切口感染1例,均经静脉营养,抑制胰酶分泌等综合治疗而痊愈,3例患者平均存活23个月后死亡,另6例患者平均存活15.8个月,仍在随访中。结论RH联合PD手术需严格掌握其适应证,其患者远期预后则取决于肿瘤分期和手术的完整切除。     

结肠癌致急性肠梗阻外科治疗（附18例报告）

目的探讨结肠癌致急性肠梗阻的手术时机及手术方式。方法回顾性分析2000．12～2006．10收治的18例结肠癌致急性肠梗阻的临床资料,结合相关文献,讨论手术时机及其手术方式在结肠癌致急性肠梗阻中的应用。结果行结肠一期切除吻合术15例;分期手术3例,出现吻合口瘘1例。结论重视结肠癌致急性肠梗阻的认识,合理选择手术时机及手术方式是提高疗效的重要措施。     

Metachronous ileal cancer after surgery for ascending colon cancer in a patient with Lynch syndrome: A case report

Introduction and importanceColorectal surveillance via colonoscopy in patients with Lynch syndrome reduces the mortality of colorectal cancer. On the other hand, it is unclear whether surveillance for other malignancies, including small bowel cancer, is beneficial. We report a patient with Lynch syndrome who developed ileal cancer after surgery for ascending colon cancer.Case presentationA 47-year-old man visited our hospital for a check-up for positive fecal occult blood. He was diagnosed with ascending colon cancer and met the clinical criteria for the diagnosis of Lynch syndrome based on his past and family history. The Bethesda markers demonstrated high-frequent microsatellite instability. Laparoscopy-assisted right hemicolectomy was performed. He received follow-up colonoscopy the next year, which revealed ileal cancer near the anastomosis. He underwent resection of the second cancer via a laparoscopic approach, and has been free from recurrence for five years.Clinical DiscussionSmall bowel cancer has a dismal prognosis because a high percentage of patients were diagnosed at advanced stages. The diagnosis of metachronous ileal cancer by the first follow-up colonoscopy after surgery for ascending colon cancer offered a long disease-free survival in our patient.ConclusionThe clinical course suggested the importance of inspecting the small bowel in Lynch syndrome patients, especially when colorectal cancer is diagnosed.     

腹腔镜下左半结肠切除术56例临床分析

目的探讨腹腔镜下左半结肠切除术的安全性和可行性。方法对56例腹腔镜下左半结肠切除术患者的临床资料和随访情况进行回顾性分析。结果54例手术在腹腔镜下顺利完成,中转开腹2例、中转率3.57%（2/56）,无手术死亡。平均手术时间（168±42）min,平均出血量（75±45）ml,辅助切口平均长（6±1.5）cm,术后平均住院日（9±3）d。手术并发症发生率3.70%（2/54）,其中术后肠梗阻1例（发生率1.85%、1/54）、肺炎1例（发生率1.85%、1/54）。54例患者术后随访3～63个月,3例远处癌转移（复发率5.77%、3/52）,2例死亡,全组患者的腹壁穿刺孔及辅助小切口无肿瘤种植。结论腹腔镜下左半结肠切除术是安全可行的,手术近期疗效令人满意,长期结果有待进一步观察。     

高龄结肠癌并发穿孔19例临床分析

目的探讨高龄结肠癌患者并发穿孔的临床特点、手术方式的选择以及围手术期的处理。方法回顾性分析2000年1月至2010年7月我科收治的19例高龄结肠癌患者并发穿孔的临床资料。结果 3例行肿瘤切除Ⅰ期吻合术,其中1例发生吻合口漏;12例患者行Hartman术,围手术期1例死于呼吸衰竭;4例行单纯双腔造瘘术,围手术期1例死于脓毒血症。围手术期的死亡率为10.53%。结论结肠癌并发穿孔后早期手术是治疗本病的关键,呼吸衰竭和脓毒血症是常见的死亡原因,手术方式应根据患者的具体情况选择个体化的手术治疗方案,Hartman术作为安全有效的手术方式,值得推荐。     

Laparoscopic colectomy for persistent descending mesocolon in sigmoid colon cancer: A case report

A 55-year-old-man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. Preoperative barium enema showed a slightly medial displacement of the descending colon, and the sigmoid colon was quite long. The operative findings showed that the descending colon was not fused with the retroperitoneum and shifted to the midline and the left colon adhered to the small mesentery and right pelvic wall. Thus, a diagnosis of persistent descending mesocolon (PDM) was made. The left colon, sigmoid colon, and superior rectal arteries often branch radially from the inferior mesenteric artery. The sigmoid mesentery shortens, and the inferior mesenteric vein is often close to the marginal vessels. By understanding the anatomical feature of PDM and devising surgical techniques, laparoscopic sigmoidectomy for sigmoid colon cancer with PDM could be performed without compromising its curative effect and safety.     

Laparoscopic colectomy for transverse colon cancer in an automated peritoneal dialysis patient: A case report

INTRODUCTIONTo date, intra-abdominal surgery in patients undergoing peritoneal dialysis (PD) has been considered to be associated with increased risk even when it is performed laparoscopically. To our knowledge, this is the first case of laparoscopic colectomy for transverse colon cancer in a patient undergoing automated PD (APD).PRESENTATION OF CASEA 67-year-old man undergoing APD for end-stage chronic renal failure secondary to diabetic nephropathy was diagnosed with transverse colon cancer. Laparoscopic tumor resection without removal of the PD catheter was performed uneventfully. After surgery, PD was interrupted for 4 weeks and then safely resumed after confirming no severe complications of anastomotic leakage or intra-abdominal abscess.DISCUSSIONIn patients undergoing PD, the safety of laparoscopic surgery without removal of the catheter and the optimal timing of resuming postoperative PD with or without temporary hemodialysis remain controversial.CONCLUSIONWe believe that laparoscopic colectomy can be safely performed in patients undergoing PD. Further case reports and investigations on this procedure with special reference to safety are warranted in future.