结直肠癌术后吻合口瘘53例高危因素分析

目的 探讨结直肠癌术后吻合口瘘发生的高危因素,为预防吻合口瘘的发生提供依据.方法 选取916例结直肠癌术后发生吻合口瘘的53例患者为研究对象,对患者全身、局部因素与吻合口瘘发生的相关性进行统计分析.结果 结直肠癌患者全身因素中年龄、ASA分级、血红蛋白、红细胞、总蛋白及空腹血糖与吻合口瘘发生存在相关性(P<0.05),局部因素中的吻合方式、吻合口张力、引流管放置位置、术前有无肠梗阻、术前有无腹腔感染及肿瘤分化程度与吻合口瘘发生存在相关性(P<0.05).结论 结直肠癌术后引起吻合口瘘发生的高危因素较多,应做好围手术期的各项工作.

Abstract：

Objective To study the high risk factors of anastomotic leakage after colon cancer surgery ,so as to provide evidence for the prevention of anastomotic leakage. Methods Fifty-three patients with anastomotic leakage after colon cancer surgery of 916 cases were selected as research objects,then the correlation between systemic factors,local factors and occurrence of anastomotic leakage was analyzed and studied. Results The correlation between age, ASA grade, serum hemoglobin, red blood cell, total protein, fasting blood glucose of systemic factors except for sex and occurrence of anastomotic leakage was obvious (P< 0.05). There was correlation between the methods of anastomosis, anastomotic tension, setting position of drainage tube, intestinal obstruction, abdominal infection and degree of tumor differentiation except for with or without chemotherapy and radiotherapy and occurrence of anastomotic leakage(P < 0.05). Conclusion The high risk factors of anastomotic leakage after colon cancer surgery are multiple,and well various work should be done during perioperative period.     

结肠癌脐转移临床病理分析

目的 探讨结肠癌继发脐转移的临床病理特征、治疗和预后.方法 分析2000年1月至2010年9月结肠癌脐转移10例的临床资料.结果 4例行非根治性结肠癌切除术,同时切除脐部转移灶,术后均辅以腹腔灌注化疗,分别存活9个月、11个月、14个月和18个月;1例行回肠-横结肠吻合术,术后均辅以腹腔灌注化疗,术后存活6个月;2例全身广泛转移同时伴脐转移行单纯静脉化疗分别存活3个月、3.5个月;3例行结肠造瘘术,术后辅以静脉化疗分别存活5个月、5.5个月、7个月.结论 手术切除原发灶及脐转移灶,并予辅助治疗,可延长患者生存时间.

Abstract：

Objective To study the clinical pathological features, treatment and prognosis of umbilical metastases of colorectal carcinoma. Methods From January 2000 to September 2010, 10 umbilical metastases of colorectal carcinoma cases were admitted. The clinical features were reviewed. Results Four radical resection of colon cancer and resection of the umbilical plexus metastases cases with chemotherapeutic intraperitoneal perfusion lived 9,11,14 and 18 months respectively, 1 ileum-transverse colon anastomosis case with chemotherapeutic intraperitoneal perfusion lived six months, 2 patients with systemic widely transfer and umbilical transfer with pure venous chemotherapy lived 3, 3.5 months respectively, 3 colon intra-operative cases with venous chemotherapy lived 5 ,5. 5 and 7 months respectively. Conclusion Surgical resection of the primary focal and periumbilical metastases can prolong survival time with adjunctive therapy.     

封闭式顺行结肠灌洗法在左半结肠癌并梗阻中Ⅰ期切除吻合17例治疗体会

目的 探讨在左半结肠癌并梗阻术中利用封闭式顺行结肠灌洗以提高Ⅰ期切除吻合率,防止吻合口瘘发生的临床疗效.方法 回顾性分析利用封闭式顺行结肠灌洗后行Ⅰ期切除吻合治疗的17例左半结肠癌并梗阻患者的临床资料、手术方式可行性及预后.结果 17例患者均Ⅰ期切除吻合,无需分期手术,无一例死亡及吻合口瘘发生.结论 左半结肠癌并梗阻通过术中减压、灌洗后Ⅰ期切除吻合是可行的,Ⅰ期切除吻合是较为理想的手术方式.     

上海市区居民1973-2005年结直肠癌发病趋势分析

Objective To explore the time trends of colorectal cancer incidence rates in urban Shanghai from 1973 to 2005. Methods Data on the incidence rates of colorectal cancer were obtained from a population-based cancer registry in Shanghai. A total of 32 962 colon cancer patients and 24 662 rectal cancer patients were registered. Population estimation were based on periodic censuses, with age-and sex-specific annual estimates derived for the remaining years. The rates were adjusted to the world standard population by using the direct method. Annul percent changes (APCs) in rates were estimated by means of a linear regression of the logarithm of the respective rates on calendar, weighted by the number of incidence cases. Results The incidence rates of colorectal cancer increased steadily during 1973 to 2005, the age-adjusted incidence rates of colon cancer increased from 6.09 and 5. 70 to 14.70 and 14. 35 per 100 000 in male and female respectively. The APCs were 3. 03 % (t=14. 77, P < 0. 01) and 3.21% (t=22. 15, P < 0. 01). The rates of rectal cancer increased from 7.68 and 6. 51 to 11.45 and 8. 28 per 100 000 in male and female respectively. The APCs were 1.34% (t=7. 28,P <0. 01) and 0. 93% (t=7. 34,P <0. 01). The top APCs for colon and rectal cancer in female were 5. 86% and 2. 79% at age above 85 and in male those were 4. 64% and 2. 38% at age of 80-. The APCs of colon cancer were greater than those of rectal cancer at the groups above 45 years old. The average ages when diagnosed were delayed from 57-60 to 66-70 during these 33 yearn The average diagnosed ages of colon cancer were later than those of rectal cancer slightly(from 2003 to 2005,the onset age of male colon cancer: 68. 61±12.17,male rectal cancer: 66.81±12. 62, t=4. 90, P < 0.01; female colon cancer:69. 20±12. 13, female rectal cancer:67. 75±12. 54,t=3. 81,P < 0. 01). Conclusion The incidence rates of colorectal cancer increased steadily during 1973 to 2005, especially for colon cancer. Further research is needed to identify the causes resulting in these changes.     

术中顺行灌肠法并Ⅰ期切除肠吻合治疗左半结肠梗阻

目的:探讨左半结肠癌并肠梗阻手术中采用顺行灌肠法,并Ⅰ期切除肿瘤肠吻合的治疗效果.方法:将2007年9月至2010年10月收治的左半结肠癌并肠梗阻需急诊手术的8例病人全部术中采用顺行灌肠清及Ⅰ期切除吻合术.结果:治愈7例、死亡1例,均无吻合口瘘发生,术后病人恢复良好,切口脂肪液化1例,肺部感染1例.结论:只要术中充分清洁肠道改善肠壁血运,左半结肠癌并肠梗阻Ⅰ期切除肿瘤及吻合术是可行的.     

大肠癌致肠梗阻27例治疗分析

目的:分析总结大肠癌所致肠梗阻的诊断、治疗经验。方法:选取2011~2014年经手术治疗的大肠癌并发急性肠梗阻的27例患者,16例右半结肠癌梗阻均行Ⅰ期切除吻合术,8例左半结肠癌梗阻中5例行Ⅰ期切除吻合术,吻合口瘘1例;3例行Hartmann手术,3例直肠癌均行乙状结肠双腔造瘘术。结论:大肠癌所致肠梗阻为肿瘤晚期表现,切除肿瘤解决肠梗阻,可提高大肠癌的治愈率,延长生存时间并提高生活质量,术中合理选择手术方案,重视围手术期的处理是治疗成功的关键。     

急性白血病患儿治疗期人体组成成分的变化

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

青春双歧杆菌和嗜酸乳酸杆菌对急性期和恢复期结肠炎小鼠Th1/Th2亚群的影响

Objective To observe and analyze the effect of B. Adolescentis and L. Acidophilus on the proportion of Th cell Th1/Th2 in peripheral blood of UC-mice in acute stage and recovery stage. Method 40 BABL/c mice were induced by 3% DSS water for 7 clays free drinking and then with distilled water for 10 days. They were randomly allocated in 4 groups: NS group, SASP group, BF0624 group and LT0637 group, also the fifth group-10 normal animals. The blood of mice were collected by removing their eyes at day 8 and day 18, and then the mononuclear cells were iso]atecl. The proportion of Th1/Th2 was analyze through flow eytometry,hy labeling the specific antibody ot Th cellular membrane with the CD4 antibody, and the cytoplastie antigen of Thl or Th2 with IIA antibody or IF'N-γ antibody. Result The proportion of Th1/Th2 in normal mouse was 0. 84 -0. 94,and it raised up in DSS-mice at both acute stage and recovery stage. It decreased unequally after 7 or 17 days'B, adoleseentis, L. Acidophilus and SASP treatment, but that of all three groups were lower than NS group (2.21±0. 83). Even the proportion got close to the normal animals after 17 days'L. Acidophilus -treated. Conclusion The proportion of Thl/Th2 increased at the acute stage and recovery stage of DSS-mice. Both B. Adoleseentis and L. Acidophilus had more effective than SASP on decreasing the proportion of Th1/Th2 at two stages,ospecially L. Acidophilus.     

青春双歧杆菌和嗜酸乳酸杆菌对急性期和恢复期结肠炎小鼠Th1/Th2亚群的影响

Objective To observe and analyze the effect of B. Adolescentis and L. Acidophilus on the proportion of Th cell Th1/Th2 in peripheral blood of UC-mice in acute stage and recovery stage. Method 40 BABL/c mice were induced by 3% DSS water for 7 clays free drinking and then with distilled water for 10 days. They were randomly allocated in 4 groups: NS group, SASP group, BF0624 group and LT0637 group, also the fifth group-10 normal animals. The blood of mice were collected by removing their eyes at day 8 and day 18, and then the mononuclear cells were iso]atecl. The proportion of Th1/Th2 was analyze through flow eytometry,hy labeling the specific antibody ot Th cellular membrane with the CD4 antibody, and the cytoplastie antigen of Thl or Th2 with IIA antibody or IF'N-γ antibody. Result The proportion of Th1/Th2 in normal mouse was 0. 84 -0. 94,and it raised up in DSS-mice at both acute stage and recovery stage. It decreased unequally after 7 or 17 days'B, adoleseentis, L. Acidophilus and SASP treatment, but that of all three groups were lower than NS group (2.21±0. 83). Even the proportion got close to the normal animals after 17 days'L. Acidophilus -treated. Conclusion The proportion of Thl/Th2 increased at the acute stage and recovery stage of DSS-mice. Both B. Adoleseentis and L. Acidophilus had more effective than SASP on decreasing the proportion of Th1/Th2 at two stages,ospecially L. Acidophilus.     

青春双歧杆菌和嗜酸乳酸杆菌对急性期和恢复期结肠炎小鼠Th1/Th2亚群的影响

Objective To observe and analyze the effect of B. Adolescentis and L. Acidophilus on the proportion of Th cell Th1/Th2 in peripheral blood of UC-mice in acute stage and recovery stage. Method 40 BABL/c mice were induced by 3% DSS water for 7 clays free drinking and then with distilled water for 10 days. They were randomly allocated in 4 groups: NS group, SASP group, BF0624 group and LT0637 group, also the fifth group-10 normal animals. The blood of mice were collected by removing their eyes at day 8 and day 18, and then the mononuclear cells were iso]atecl. The proportion of Th1/Th2 was analyze through flow eytometry,hy labeling the specific antibody ot Th cellular membrane with the CD4 antibody, and the cytoplastie antigen of Thl or Th2 with IIA antibody or IF'N-γ antibody. Result The proportion of Th1/Th2 in normal mouse was 0. 84 -0. 94,and it raised up in DSS-mice at both acute stage and recovery stage. It decreased unequally after 7 or 17 days'B, adoleseentis, L. Acidophilus and SASP treatment, but that of all three groups were lower than NS group (2.21±0. 83). Even the proportion got close to the normal animals after 17 days'L. Acidophilus -treated. Conclusion The proportion of Thl/Th2 increased at the acute stage and recovery stage of DSS-mice. Both B. Adoleseentis and L. Acidophilus had more effective than SASP on decreasing the proportion of Th1/Th2 at two stages,ospecially L. Acidophilus.     

青春双歧杆菌和嗜酸乳酸杆菌对急性期和恢复期结肠炎小鼠Th1/Th2亚群的影响

Objective To observe and analyze the effect of B. Adolescentis and L. Acidophilus on the proportion of Th cell Th1/Th2 in peripheral blood of UC-mice in acute stage and recovery stage. Method 40 BABL/c mice were induced by 3% DSS water for 7 clays free drinking and then with distilled water for 10 days. They were randomly allocated in 4 groups: NS group, SASP group, BF0624 group and LT0637 group, also the fifth group-10 normal animals. The blood of mice were collected by removing their eyes at day 8 and day 18, and then the mononuclear cells were iso]atecl. The proportion of Th1/Th2 was analyze through flow eytometry,hy labeling the specific antibody ot Th cellular membrane with the CD4 antibody, and the cytoplastie antigen of Thl or Th2 with IIA antibody or IF'N-γ antibody. Result The proportion of Th1/Th2 in normal mouse was 0. 84 -0. 94,and it raised up in DSS-mice at both acute stage and recovery stage. It decreased unequally after 7 or 17 days'B, adoleseentis, L. Acidophilus and SASP treatment, but that of all three groups were lower than NS group (2.21±0. 83). Even the proportion got close to the normal animals after 17 days'L. Acidophilus -treated. Conclusion The proportion of Thl/Th2 increased at the acute stage and recovery stage of DSS-mice. Both B. Adoleseentis and L. Acidophilus had more effective than SASP on decreasing the proportion of Th1/Th2 at two stages,ospecially L. Acidophilus.     

青春双歧杆菌和嗜酸乳酸杆菌对急性期和恢复期结肠炎小鼠Th1/Th2亚群的影响

Objective To observe and analyze the effect of B. Adolescentis and L. Acidophilus on the proportion of Th cell Th1/Th2 in peripheral blood of UC-mice in acute stage and recovery stage. Method 40 BABL/c mice were induced by 3% DSS water for 7 clays free drinking and then with distilled water for 10 days. They were randomly allocated in 4 groups: NS group, SASP group, BF0624 group and LT0637 group, also the fifth group-10 normal animals. The blood of mice were collected by removing their eyes at day 8 and day 18, and then the mononuclear cells were iso]atecl. The proportion of Th1/Th2 was analyze through flow eytometry,hy labeling the specific antibody ot Th cellular membrane with the CD4 antibody, and the cytoplastie antigen of Thl or Th2 with IIA antibody or IF'N-γ antibody. Result The proportion of Th1/Th2 in normal mouse was 0. 84 -0. 94,and it raised up in DSS-mice at both acute stage and recovery stage. It decreased unequally after 7 or 17 days'B, adoleseentis, L. Acidophilus and SASP treatment, but that of all three groups were lower than NS group (2.21±0. 83). Even the proportion got close to the normal animals after 17 days'L. Acidophilus -treated. Conclusion The proportion of Thl/Th2 increased at the acute stage and recovery stage of DSS-mice. Both B. Adoleseentis and L. Acidophilus had more effective than SASP on decreasing the proportion of Th1/Th2 at two stages,ospecially L. Acidophilus.     

左半结肠癌急性梗阻46例治疗体会

目的探讨左半结肠癌急性梗阻一期切除吻合的可行性。方法回顾性分析46例左半结肠癌急性梗阻急诊手术的手术时机、术式选择及术中灌洗方法。结果38例行一期切除吻合术,术中灌洗;5例行结肠造瘘术,二期手术切除;1例行Hartmann术;2例行永久性结肠造瘘术。切口感染3例;吻合口瘘1例,为行一期切除吻合术患者;腹腔感染1例,全组无死亡病例。结论选择合适的病例,行左半结肠癌急性梗阻一期切除吻合是可行的,合理的围术期处理,术中彻底的结肠减压及灌洗,是手术成功的关键。     

结肠癌并梗阻114例外科治疗体会

目的探讨结肠癌并梗阻的外科治疗及术式选择原则。方法回顾性总结我院1995~2008年114例结肠癌并梗阻的临床治疗资料。结果本组病例施行右半结肠切除48例,左半结肠切除66例(30例行左半结肠Ⅰ期切除吻合术,18例Hartmann术,12例短路手术,6例单纯造口)。均恢复良好,治愈出院。结论根据结肠癌并梗阻临床特点,正确的选择手术时机和合理的手术方式能获得良好的预后,符合手术适应症患者一期吻合能取得更满意效果。     

结肠癌所致肠梗阻及穿孔手术治疗效果分析

目的探讨结肠癌所致肠梗阻手术术式选择及临床疗效。方法回顾性分析42例结肠癌所致肠梗阻手术治疗患者临床资料,其中3例梗阻导致肠穿孔。42例患者中行Ⅰ期切除吻合术28例,分期手术10例,姑息性切除解除梗阻造瘘2例,远端行封闭(Hartmann)术2例。结果 42例患者中1例患者死亡,死亡原因为肠穿孔合并中毒性休克及多器官功能衰竭,其余41例治愈出院。4例患者出现切口并发症,其中伤口感染2例,切口裂开2例。本组患者无吻合口瘘发生。结论结肠癌引起的肠梗阻如病情允许应争取行Ⅰ期切除吻合术,早期诊断、选择合理的手术方式是提高临床疗效以及改善患者预后的关键。