结肠癌急性梗阻22例治疗体会

目的探讨结直肠癌急性肠梗的个体化手术治疗效果。方法 2006年2月至2009年5月,本院外科收治22例因结肠引起的肠梗阻,全组病例均行手术治疗,4例行Ⅰ期根治性肠切除＋吻合术;14例行根治性切除＋近断结肠造瘘术;2例行经腹会阴切除术;2例因肿瘤无法切除,行横结肠双腔造瘘术。结果 14例行肠切除Ⅰ期肠吻合者均未发生吻合口瘘,全部病例均安全度过手术关。术后病理诊断22例均确诊为结肠腺癌。结论对右半结肠癌性梗阻均可行Ⅰ期根治性右半结肠切除吻合术;左半结肠癌性梗阻须根据不同情况,采取个体化手术方案,才能取得满意的效果。     

Ⅰ期切除单层吻合技术治疗急性梗阻性左半结肠癌的分析

目的 探讨急性梗阻性左半结肠癌应用Ⅰ期切除单层吻合技术的可行性及安全性.方法 对46例急性梗阻性左半结肠癌患者采用术中结肠灌洗、Ⅰ期切除及单层吻合技术.结果 46例患者均顺利完成左半结肠切除术,且均未行预防性回肠及结肠造瘘;术后发生切口感染6例,肺部感染5例,吻合口瘘1例经保守治疗治愈,无手术死亡.结论 急性梗阻性左半结肠癌患者采用Ⅰ期切除单层吻合术是安全可行的.     

外科手术治疗急性梗阻性结肠癌的临床观察

目的探讨外科手术治疗急性梗阻性结肠癌的疗效。方法对惠州市惠阳区人民医院2006年12月至2009年1月收治的46例急性梗阻性结肠癌患者,40例行气管插管循环紧闭式静脉复合麻醉,6例行连续硬膜外腔麻醉。右半结肠癌伴急性结肠梗阻均行右半结肠切除、回肠横结肠一期吻合术;左半结肠癌伴结肠梗阻的一期左半结肠切除吻合术和Hartmann手术。结果本组46例中行右半结肠切除、回肠横结肠一期吻合术14例,无一例并发吻合口瘘;左半结肠一期切除吻合27例,发生吻合口瘘3例。切口感染4例占8．7％,无切口裂开。本组无手术死亡病例。结论外科手术是治疗急性梗阻性结肠癌的有效方式之一,且合理的术式选择对急性梗阻性结肠癌的治疗具有重要意义。     

左半结肠癌急性梗阻术中结肠封闭式顺行灌洗Ⅰ期切除吻合57例临床体会

目的探讨左半结肠癌急性梗阻术中行结肠封闭式顺行灌洗Ⅰ期手术切除吻合的可行性和安全性。方法回顾性分析广东省信宜市人民医院普通外科2001年至2010年间手术治疗左半结肠癌急性梗阻住院患者57例,术中均实施结肠封闭式顺行灌洗,Ⅰ期肿瘤切除吻合率为100%。结果 57例术中行结肠封闭式顺行灌洗根治性切除Ⅰ期吻合,均Ⅰ期愈合,均未发生吻合口漏。结论术中结肠封闭式顺行灌洗可作为左半结肠癌急性梗阻Ⅰ期切除吻合的理想方法。     

高龄梗阻性结肠癌治疗体会(附36例报告)

目的总结36例高龄梗阻性结肠癌的临床治疗体会。方法回顾性分析了作者1997年6月至2000年6月收治的36例高龄梗阻性结肠癌的病例。结果全组病例均经手术治疗，右半结肠切除、回结肠Ⅰ期吻合9例，横结肠切除Ⅰ期吻合、盲肠造瘘2例，降结肠或乙状结肠切除，远端关闭、近端造口22例，单纯横结肠造口1例，盲肠肿瘤切除、升结肠回肠双口造瘘1例，回、横结肠捷径手术1例。无近期死亡病例。结论对此类病人手术应取积极的态度，但术前应行周密准备。手术方式不强求根治，应以切除肿瘤、解除梗阻为目的。术后应加强护理，强效抗感染，注意防治并发症，全面营养支持，提倡肠内营养，特别注意保护病人的肠道功能。     

结肠癌致肠梗阻外科治疗体会

目的 探讨结肠癌致肠梗阻的外科治疗方法与效果.方法 回顾分析本院从1998年至2011年24例结肠癌致肠梗阻的外科治疗的临床资料.结果 全组24例患者均行急症一期结肠癌切除吻合术,无吻合口漏发生,患者手术后切口感染6例,无手术死亡病例.结论 在左半结肠癌致急性肠梗阻的急诊治疗中,结肠次全切除术是安全可行的,右半结肠癌致急性肠梗阻的急诊治疗中,一期右半结肠切除吻合术是安全可行的.     

术中结肠灌洗在梗阻性左半结肠癌I期切除吻合术中的应用

目的探讨提高左半结肠癌Ⅰ期切除吻合术的安全性。方法采用术中结肠灌洗法清洁肠道,Ⅰ期切除肿瘤吻合肠道。结果病死率5.3%,吻合口漏发生率2.6%。结论术中结肠灌洗应用于梗阻性左半结肠癌Ⅰ期切除吻合,安全可行,避免了患者二次手术痛苦,降低了肿瘤复发率。     

术中结肠灌洗在梗阻性左半结肠癌Ⅰ期切除吻合术中的应用

目的探讨提高左半结肠癌Ⅰ期切除吻合术的安全性。方法采用术中结肠灌洗法清洁肠道,Ⅰ期切除肿瘤吻合肠道。结果病死率5.3%,吻合口漏发生率2.6%。结论术中结肠灌洗应用于梗阻性左半结肠癌Ⅰ期切除吻合,安全可行,避免了患者二次手术痛苦,降低了肿瘤复发率。     

40例大肠癌致肠梗阻的外科治疗

目的和方法;分析我院1994～2003年间40例大肠癌致肠梗阻的治疗资料,探讨外科治疗的方法。结果：40例病人Ⅰ期行右半结肠切除7例,左半结肠8例,Ⅰ期行左半结肠切除．结肠造口,Ⅱ期闭瘘21例,2例行Miles手术,2例无法切除近端造口。结论;大肠癌致肠梗阻右半结肠Ⅰ期切除吻合。左半结肠Ⅰ期切除造口,Ⅱ期闭瘘。     

结肠癌致急性梗阻36例外科治疗体会

我院自１９９６～２００２年手术治疗结肠癌致急性肠梗阻共３６例。１一般资料本组结肠梗阻３６例中 ,男２２例 ,女１４例。发病年龄３９～８７岁 ,梗阻部位在左半结肠２４例 (６６ ７ % ) ,右半结肠１２例(３３ ３ % ) ,行肿瘤切除Ⅰ期吻合术１９例 ,行肿瘤切除Ⅰ期吻合 ,近端造瘘７例 ,行肿瘤切除 ,近端造瘘 ,远端关闭９例 ,不能切除肿瘤行内转流术 (捷径手术 )者１例。２结果术后出现肠漏４例 ,其中左半结肠癌３例 ,右半结肠癌１例 ,术后死亡３例 ,均为左半结肠癌 ,２例行造瘘 ,１例行Ⅰ期吻合合并肺部感染后死亡。３讨论３ １术前准备 :…     

Autografting colonic adenocarcinomas into the colonic submucosa in rats

After inducing colonic tumors in 47 rats by weekly subcutaneous injections of 1,2-dimethylhydrazine, all rats were laparotomized and tumors were autotransplanted to tumor-free areas of the transverse colon. True autotransplants were considered to be tumors occurring in the grafted areas, which were covered by normal colonic mucosa. The frequency of auto-grafted tumors was 35.5%. In a previous work, a low incidence of 1,2-dimethylhydrazine-induced tumors was found in the transverse colon of the rat. The present results suggest that the failure of tumor growth in the transverse colon may be unrelated to an intrinsic natural "resistance" of that segment of the colon to tumor growth.     

左半结肠癌致肠梗阻的一期手术治疗56例体会

目的：探讨左半结肠癌致肠梗阻的一期手术治疗的可行性途径。方法：针对我科近几年来的左半结肠癌所致肠梗阻的治疗,采用术中肠道冲洗快速准备的方法,对56例左半结肠癌致肠梗阻的病人行一期吻合术,同时加强围手术期的管理。结果：本组56例病人,术后吻合口瘘2例,占本组病例的3.6％．死亡1例．占本组病例的1.8％。其他病人顺利康复。结论：加强国手术期的管理,针对病人的特点采取综合治疗,左半结肠癌致肠梗阻的一期切除吻合术是安全可靠的。     

Ileal and colonic mucosal bile acids in Crohn's disease and right colonic carcinoma

Bile acids are supposed to promote colonic cancer. In Crohn's disease, colonic carcinomas are relatively rare. We, therefore, compared ileal and right colonic mucosal bile acids analysed by gas-liquid chromatography in 8 patients with ileal Crohn's disease (14-48 yrs.) and 7 patients with right colonic carcinoma (28-77 yrs.) who underwent surgery. In both ileal and colonic mucosa, nonsulphated bile acid concentrations were somewhat higher in Crohn's disease (20.98 micrograms/g +/- 4.77 SEM; 12.09 micrograms/g +/- 2.55) than in colonic carcinoma (16.06 micrograms/g +/- 3.46; 7.75 micrograms/g +/- 4.28). In ileal mucosa, percentages of lithocholic and deoxycholic acids were slightly higher in colonic carcinoma (3.9%; 23.2%) than in Crohn's disease (1.1%; 14.9%). In colonic mucosa, carcinoma patients had more lithocholic (7.6%) and less deoxycholic acid (11.9%) than patients with Crohn's disease (1.7%; 20.3%). Bile acid sulphate esters were similar in both diseases (ca. 3.0 micrograms/g in ileal, 1.4 micrograms/g in colonic mucosa). Our results show that ileal and right colonic mucosal nonsulphated bile acids tend to be even lower in right colonic carcinoma than in Crohn's disease. This agrees well with our earlier findings of low mucosal bile acid concentrations in patients with left colonic carcinoma (Tokai J Exp Clin Med 8: 59-69, 1983) and does not support the assumption that bile acids are envolved in right colonic carcinogenesis.     

术中结肠灌洗临床应用研究

目的　探讨术中结肠灌洗在治疗左半结肠癌并急性肠梗阻中行Ⅰ期切除吻合的安全性及可行性。方法　治疗组 54例病人均采用术中结肠灌洗 ,肿瘤Ⅰ期切除吻合。结果　治疗组除 2例出现切口感染外 ,所有病例均无吻合口瘘 ,无腹腔内感染 ,无死亡病例发生。结论　术中结肠灌洗Ⅰ期肿瘤切除和吻合在治疗左半结肠癌并急性肠梗阻在理论上和临床上是安全的、可行的     

Advances in colonic drug delivery

Targeting drugs and delivery systems to the colonic region of the gastrointestinal tract has received considerable interest in recent years. Scientific endeavour in this area has been driven by the need to better treat local disorders of the colon such as inflammatory bowel disease (ulcerative colitis and Crohn's disease), irritable bowel syndrome and carcinoma. The colon is also receiving significant attention as a portal for the entry of drugs into the systemic circulation. A variety of delivery strategies and systems have been proposed for colonic targeting. These generally rely on the exploitation of one or more of the following gastrointestinal features for their functionality: pH, transit time, pressure or microflora. Coated systems that utilise the pH differential in the gastrointestinal tract and prodrugs that rely on colonic bacteria for release have been commercialised. Both approaches have their own inherent limitations. Many systems in development have progressed no further than the bench, while others are expensive or complex to manufacture, or lack the desired site-specificity. The universal polysaccharide systems appear to be the most promising because of their practicality and exploitation of the most distinctive property of the colon, abundant microflora.     

结肠肿瘤的早期诊断

结肠肿瘤主要包括各种结肠息肉、腺瘤和结肠癌.结肠痛的癌前病变阶段漫长,易于检出及根治,是一种适合大规模人群筛选的恶性肿瘤.结肠肿瘤的早期诊断包括尤症状患者早发现、有症状患者早就诊、就诊忠者早诊断3方面,其中涉及人群筛查、新技术应用、患者配合及舆论支持等多方面因素.本文分析针对各人群结肠肿瘤的早期诊断手段,以期有的放矢进行筛查,提高患者对治疗的依从性,及时就诊.     

己酮可可碱对慢传输型便秘模型大鼠的结肠黏液分泌和结肠肌电活动的影响

目的研究己酮可可碱对大鼠慢传输型便秘模型结肠肌电活动特点及其黏膜上皮杯状细胞黏液分泌情况的影响,探讨己酮可可碱对慢传输型便秘的疗效及相关机制。方法灌胃给予复方苯乙哌啶并限水导致大鼠慢传输型便秘模型,结扎分离取出的盲结肠段随即固定,制作石蜡切片,AB-PAS染色,供组织学观察;埋植电极,观察大鼠结肠肌电活动。结果己酮可可碱中、高剂量组粪便表面出现较多黏液,与模型组相比差异具有统计学意义(P<0.05)。已酮可可碱组的肠电慢波、慢波频率变异系数及频率、振幅变异系数,与模型组比较差异具有统计学意义(P<0.05)。结论己酮可可碱可以通过改善便秘模型大鼠的肠道微循环,提高肠道动力,增加结肠黏液的分泌,恢复结肠肌电的慢波频率及振幅,从而起到治疗慢传输型便秘的作用。     

The colonic mesenteric margin is most susceptible to injury in an experimental model of colonic ulceration

BACKGROUND: Crohn's disease ileal ulcers and indomethacin-induced jejunal ulceration in the rat tend to occur in the mucosa nearest to the mesentery (mesenteric margin), an area of the bowel wall that has a critical blood supply. Mercuric chloride induces caecal and colonic ulceration in the Brown Norway rat. AIM: To examine whether the mesenteric margin is more sensitive to injury by a substance known to be vasculotoxic in the caecum and colon. METHODS: Brown Norway rats received a single subcutaneous dose of either mercuric chloride 1 mg/kg or saline. The gastrointestinal tract was examined macro- and microscopically for lesions 48 h later. The vascular anatomy of the normal rat colon and caecum was also examined using the carbon ink perfusion technique. RESULTS: Mercuric chloride induced caecal and colonic ulceration preferentially along the mesenteric margin of the bowel wall. Histologically, the lesions showed mucosal necrosis and neutrophil infiltration. There was also extensive vascular degeneration/necrosis with microaneurysm formation and extensive submucosal haemorrhage. Cellular infiltration of the vasculature was not a feature. The caecal and colonic mesenteric margins in control rats were supplied by small end arteries. CONCLUSIONS: The colonic and caecal mesenteric margins are susceptible to injury by mercuric chloride, a chemical known to induce haemorrhagic vasculopathy in the rat gastrointestinal tract. The large bowel mesenteric margin may be susceptible to injury by mercuric chloride because of the critical blood supply to that side of the bowel wall.