功能性便秘儿童的肛门直肠动力学特征和治疗的研究

目的研究功能性便秘患儿的直肠肛门动力学改变,观察便秘患儿对根据检测结果制定的相应方案的治疗反应。方法2004年5月至2005年6月采用多功能消化道测压仪观察便秘组即功能性便秘患儿[8例,年龄(11±5)岁]及对照组即排便习惯正常儿童[10例,年龄(11±4)岁]的肛门直肠动力学指标,并进行比较;对便秘组采用相应保守治疗方案,即结合肛门直肠动力学特征、口服双歧三联活菌制剂和益生元类制剂乳果糖(商品名杜秘克)、定时敦促排便,观察其疗效。结果便秘组和对照组的肛门括约肌有效长度、最大肛门括约肌主动收缩压(MSP)、>50%MSP时间比较差异无统计学意义,而便秘组的最低敏感量和最大耐受量大于对照组(t分别为2.178、1.574,P均<0.05);8例便秘患儿保守治疗,7例有效。结论功能性便秘患儿存在肛门直肠动力学异常;以动力学改变为依据的相应保守治疗方案有显著的临床疗效。     

先天性肛门直肠畸形WNT5a基因突变的筛查分析

目的 探讨WNT5a基因突变与先天性肛门直肠畸形(anorectal malformations,ARMs)发生的关系.方法 采用PCR和DNA直接测序的方法,检测88例ARMs患儿和120名健康儿童WNT5a基因第1、2外显子突变情况.结果 3例ARMs患儿存在WNT5a基因第2外显子多点突变,正常对照组未见突变发生.结论 WNT5a基因第2外显子的突变与ARMs可能存在相关性.     

先天性肛门直肠畸形患儿父母生活质量和社会支持研究进展

先天性肛门直肠畸形是一种常见的消化道畸形。手术治疗虽然挽救了患儿生命,但是术后肛门失禁、狭窄和便秘等并发症给患儿的身心健康带来严重影响。父母作为主要照顾者,既承担照顾患儿的繁重任务,又面临着沉重的经济和精神负担,成为亟待关注的群体。本文就先天性肛门直肠畸形患儿父母生活质量和社会支持的研究进展进行综述,以期为改善该人群生活质量提供参考依据。     

藤棱煎剂直肠滴入治疗慢性盆腔炎的临床疗效及对免疫功能的影响

目的 观察藤棱煎剂直肠滴入治疗慢性盆腔炎的临床疗效及对免疫功能的影响.方法 将慢性盆腔炎160例随机分为2组,治疗组100例予藤棱煎剂直肠滴入,对照组60例予妇炎康口服并康妇消炎栓外用.观察2组临床疗效和治疗前后外周血T淋巴细胞亚群水平变化.结果 治疗组总有效率95.0%,对照组总有效率80.0%,2组总有效率比较差异...     

Cigarette smoking and risk of cancers of the colon and rectum: A case–control study from Italy

The relationship between smoking habit and risk of colon and rectal cancers was considered in a case–control study conducted between 1991 and 1996 in six Italian centers. Cases were 1225 patients below age 75 with histologically confirmed cancer of the colon and 728 with cancer of the rectum.Controls were 4154 patients admitted to hospital for a wide spectrum of acute, non-neoplastic diseases. Compared to neversmokers, the odds ratios (OR) for current smokers of 25 or more cigarettes/day was 0.90 for patients with colon and 0.86 for those with rectal cancer and those for ex-smokers were 1.02 and 1.09 for colon and rectal cancer, respectively. No increase in risk was found with duration of the habit, the OR for 40 or more years being 0.79 for colon and 0.87 for rectal cancer. Furthermore, no relationship was apparent with time since starting (the OR for 40 or more years were 0.94 for colon and 1.01 for rectal cancer), or age at starting (the OR for < 18 years were 1.02 for colon and 1.00 for rectal cancer), or for pack-years smoked (the OR for 40 or more pack-years were 0.93 for colon and 0.91 for rectal cancer) or time since stopping among ex-smokers. No increase in risk was found in smokers of 15 cigarettes/day for 40 years or longer (OR: 0.93). No significant heterogeneity was found across strata of age at diagnosis, sex, education, physical activity at work, intake of alcohol, coffee, vegetables, total energy, and number of meals/day. Likewise, no significant association was apparent for various intestinal subsites. Thus, this study did not find cigarette smokers at higher risk for cancer of the bowel even after a long duration and a long period since starting.     

肛管直肠恶性黑色素瘤13例病理分析

目的 探讨肛管直肠恶性黑色素瘤(AMM)的临床病理学特征和鉴别诊断.方法 收集13例肛管直肠AMM,进行免疫组织化学染色,结合有关文献进行临床病理学分析.结果 13例肛管直肠AMM多为中老年人,平均年龄55.8岁,镜下肿瘤结构复杂,细胞形态多样,瘤细胞常呈巢状,弥散片状或梁状分布.多数瘤组织中含有黑色素,少数无色素.免疫组织化学显示瘤细胞染色S-100、HMB45阳性.结论 肛管直肠AMM恶性程度高,预后差,HMB45和5-100是其敏感性的标记物.     

探讨经会阴、非开腹手术治疗小儿短段型巨结肠症的可行性及疗效观察

目的探讨经会阴实施肛门内括约肌和商肠末端肌层切开术治疗小儿短段、超短段型先天性巨结肠症的可行性及疗效。方法2000年7月～2010年3月,笔者所在医院与协作医院,共计对68例术前诊断为小儿短段、超短段型先天性巨结肠病例,分别实施了非开腹手术,即经会阴切口施行肛门内括约肌和直肠末端肌层切开手术,对其适应证、具体手术方法及治疗效果进行综合分析讨论。结果术中及术后病理组织检查确诊为非短段型巨结肠者7例,术后巨结肠症复发,改为开腹手术;其余61例（54例病理组织检查确诊为短段、超短段型先天性巨结肠,7例病理组织检查确诊为先天性巨结肠类缘病）术后均得到随访,随访短者2年,长者6年,巨结肠症均未见复发。结论经会阴实施肛门内括约肌及直肠未端肌层切开手术,治疗小儿短段型、超短段型先天性巨结肠症,方法安全可行、操作简便、免开腹手术、创伤小、疗效满意,值得进一步实践并推广应用。     

MRI对先天性肛门直肠畸形的诊断价值

目的探讨MR I对先天性肛门直肠畸形手术前后的诊断价值。方法对5例正常对照组,14例先天性肛门直肠畸形病例均行盆腔、骶尾部MR检查。观察肛门内、外括约肌、耻骨直肠肌形态,肛门直肠本身发育缺陷以及骶椎、泌尿生殖系统等畸形。结果本组MR显示耻骨直肠肌、括约肌群发育好13例,发育较好3例,发育差3例,T1W I不抑脂序列为显示肛周肌群较好的序列。7例合并骶尾椎畸形,5例合并泌尿系统畸形。结论MR I对先天性肛门直肠畸形具有重要诊断价值,可从形态上了解盆底肌的发育,并能明确骶骨、椎管、泌尿系统等畸形,在确定手术方式及评价手术疗效方面具有重要意义。     

A phase II trial for the optimisation of treatment position in the radiation therapy of prostate cancer

BACKGROUND: Patient immobilisation and position are important contributors to the reproducibility and accuracy of radiation therapy. In addition the choice of position can alter the external contour of the treated area and has the potential to alter the spatial relationship between internal organs. The published literature demonstrates variation in the use of the prone and supine position for prostate cancer radiation therapy. Previous investigators using different protocols for patient preparation, imaging and target volume definition have demonstrated changes in the calculated therapeutic ratio comparing the two positions. We did not use rigid immobilisation, laxatives, rectal catheters or bladder voiding and assessed if in the prone position would cause a reduction of the dose to the rectum. We performed a prospective comparison of the two positions in 26 patients to determine if the differences in the spatial relation between the rectum and the planning target volume (PTV) would impact on dose-volume histograms to organs at risk (OAR). We also determined if any such improvement might permit dose escalation. MATERIALS AND METHODS: Twenty-six patients with clinically localized prostate cancer consented to participate in this study. All patients underwent a planning CT scan in both the prone and supine treatment positions. The PTV and OAR were drawn on each set of scans by one of the investigators. The PTV included the prostate and seminal vesicles with a 1cm margin except posteriorly where this margin was reduced to 5mm. The outer circumference of the bladder, rectal wall, small bowel (when present) was drawn along with femoral heads. 3D conformal treatment plans were computed using Helax TMS version 6.1B. A 3-field treatment technique was employed with energy of 10/15 MV. The prescribed dose was 70 Gy and the PTV was encompassed by the 95% isodose and the maximum dose was always less than 107%. Cumulative dose-volume histograms were calculated for the PTV, rectum, bladder, femoral heads and small bowel (when present). These non-uniform histograms for both the prone and supine treatment positions were transformed into uniform ones using the effective volume method [Kutcher J, Burman C. Calculation of probability factors for non-uniform normal tissue irradiation: the effective volume method. Med Phys 1987;14:487]. RESULTS: Twenty-one of the 26 (80%) patients had a lower effective volume of rectum irradiated if the prone instead of the supine treatment position was used. The median value of the effective volume in the supine treatment position was 31.74 Gy while the median value in the prone position was 22.48 Gy. The dose escalation was applied to the patients in the prone treatment position until the effective volume for the rectum was the same as that in the supine position. The range of dose escalation possible for these patients was 0.1-7.9 Gy. These patients could potentially have the dose escalated from the prescribed dose of 70 Gy for the supine position without any increase in side effects. For the five patients where no potential benefit was found when changing treatment position, only two patients displayed a significant (>1 Gy) advantage for the supine treatment position. Twenty-one of the 26 patients also showed an advantage for the prone treatment position in relation to bladder dose. CONCLUSION: The use of the prone position reduced the dose to the unprepared rectum and unvoided bladder in the majority of cases. It should be considered particularly in cases where large posterior seminal vesicles cause significant overlap between the planning target volume and the rectum.     

Colitis cystica profunda: MRI appearance

Colitis cystica profunda (CCP) is an uncommon benign condition characterized by mucin-filled cysts located in the submucosa, frequently associated with the solitary ulcer and rectal prolapse syndromes. The diagnosis of this entity is important as it can mimic rectal cancer and therefore may result in unnecessary surgical resection. Endoscopic examination and barium enema findings are suggestive but not specific, neither are superficial biopsy findings. Transrectal ultrasound is helpful in the diagnosis by imaging the layers of the rectal wall. The authors report a 16-year-old male with a rectal lesion mimicking malignant mass on endoscopic examination. The lesion was defined as CCP, based on MR imaging findings which disclosed multiple noninfiltrating submucosal cysts, confirmed by histopathological examination. To our knowledge, this is the first case of CCP in the radiology literature describing MRI findings.