直肠周围筋膜的解剖特点及其临床意义

目的 :为全直肠系膜切除术治疗直肠癌提供解剖学基础。方法 :在 5 0侧成人防腐固定的盆腔标本上解剖观测直肠系膜、Denonvilliers筋膜及直肠周围腔隙的结构特点。结果 :1、直肠系膜中上段较厚 ,与直肠连结疏松 ,有纤维束伸入直肠壁 ;下段逐渐变薄至 ( 2 .1± 1.2 )mm ,并有 ( 1.5 9± 0 .47)cm长的系膜与直肠肌层连结紧密 ,末端借致密结缔组织与肛提肌相连。 2、Denonvilliers筋膜薄而致密 ,最薄处为 ( 1.4± 0 .5 )mm。 64 %的筋膜有细小纤维束伸入前列腺、精囊腺 (或阴道 )之间。 3、未见明显呈束状结构直肠侧韧带。结论 :直肠系膜及Denonvilliers筋膜是包裹直肠的独立结构 ,沿骶前间隙及直肠两侧壁锐性分离可完整游离直肠系膜 ,但直肠下端的系膜与直肠壁、Denonvilliers筋膜与前列腺 (或阴道 )之间结合紧密 ,分离时应慎重     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.     

腹腔镜结直肠癌根治术常见并发症及中转开腹

腔镜乳腺手术是利用腔镜的优势从远离病灶部位的切口和入路进行手术，改变了传统乳腺外科的手术方式和程序，具有微创和美容效果。呈现出良好的发展趋势。随着腔镜乳腺手术的开展，腔镜乳腺手术技术的安全性和预防、处理并发症问题备受关注心。本文结合文献和个人体会重点介绍腔镜乳腺手术并发症的发生原因及处理。[第一段]     

基于开腹手术模式的腹腔镜根治性右半结肠切除术（D3术）技巧

对腹腔镜辅助根治性右半结肠切除（1aparoscopyassisted radical colorectomy，LRRH）的认识经历了两个阶段，早年认为该术在腹腔镜结肠切除术中难度最低．适于掌握初级腹腔镜技能的外科医师操作。随着众多结直肠专科医师应用LRRH后，由于认识到必须解剖及清扫肠系膜上静脉外科干周围淋巴组织．才感到手术难度明显大于其他腹腔镜根治性结直肠手术，使其发展相对滞后。传统开腹根治性右半结肠切除手术的原则．是自上而下处理血管，由内而外整块切除病灶及其淋巴引流区。然而．国内外文献报道，LRRH手术模式多为从内到外、从下向上处理血管并整块切除病灶及其淋巴引流区。该手术模式在解剖胃结肠静脉干和结肠中动脉时较困难．盲目分离可能出血难。而我们历年来沿用传统开腹手术模式行LRRH．感手术视野开阔，遇上述区域出血较易处理．特总结如下．供同道们参考。     

盆腔自主神经的解剖特点及其在直肠癌术中的临床应用

目的 根据自主神经的解剖特点探讨保留自主神经的直肠癌根治术，对性功能及排尿功能的保护作用。方法 ①在25侧成人男性骨盆矢状标本及17具成人男性躯干标本上解剖观测有关内脏神经丛及分支的形态及位置；②对40例直肠癌患者术中采用保留自主神经和不保留自主神经的手术效果进行分析。结果 ①盆丛位于直肠膀胱陷凹上外侧2．984．71cm处的盆壁之间；左右腹下神经分别位于骶骨岬中点至左右坐骨大切迹下缘内侧一横指处；上腹下丛位于腹主动脉分又至骶骨岬下约2cm之间；②保留自主神经术后排尿功能障碍率男为11．1％女为18．2％，性功能障碍率男为11．1％女为9．1％。不保留自主神经术后排尿功能障碍率男为45．4％女为88．9％，性功能障碍率男为81．8％女为66．7％。结论 保留自主神经的直肠癌根治术能有效降低术后性功能障碍及排尿功能障碍.     

5-氟脲嘧啶腹腔化疗对胃肠肿瘤术后免疫系统的影响

目的 观察不同剂量５－氟脲嘧啶（５－Ｆｕ）腹腔化疗对胃肠肿瘤术后免疫系统的影响。方法 检测７例胃癌与３３例大肠癌根治术后６个疗程腹腔化疗前后的体液免疫与细胞免疫指标的变化。结果 在每一疗程化疗前后的短期内免疫系统均未受抑制。随着５－Ｆｕ剂量在各疗程的逐步递增，血ＩｇＧ，ＩｇＡ，Ｃ６，ＣＤ３及ＮＫ活性明业下降低于对照组。结论 ５－Ｆｕ腹腔化疗抑制机体的体液免疫与细胞免疫。     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.     

肛管直肠恶性黑色素瘤（附2例报告）

肛管直肠恶性黑色素瘤（附２例报告）福建医科大学附属协和医院普外科王弼，林挺，池畔，陈大良我科于１９９３年１２月至１９９５年６月收治肛管直肠恶性黑色素瘤２例，均经手术和病理证实。现就临床有关的问题结合文献报告如下。一、病例报告例１，男性，７０岁。因排便...     

直肠癌腹腔镜手术技巧

腹腔镜结直肠部根治术在中国大陆经历了10余年的艰苦探索,近5年在数量与质量上有了突飞猛进的发展,已完全可以与欧美国家相媲美。低位直肠癌根治术是该领域难度最大的。我科从2000年9月始,至今共行腔镜下结直肠癌根治术400余例,其中直肠癌250余例,现将我们有限的经验总结如下,供同道们参考。     

腹腔镜与开腹低位直肠癌保肛手术预后对比分析

目的对比分析腹腔镜与开腹低位保肛手术的预后。方法对国内外有关腹腔镜与开腹低位保肛手术预后比较的文献进行综述。结果腹腔镜直肠癌低位保肛手术与传统开腹手术比较并不增加局部复发率及远处转移率。结论腹腔镜低位直肠癌保肛手术的安全性、可行性以及长期预后尚需更多随机对照的临床试验以及更多的循证医学证据来验证。