Effects of chemotherapy on the health-related quality of life of Japanese lower rectal cancer patients after sphincter-saving surgery

We examined the effects of adjuvant chemotherapy on the health-related quality of life (HRQOL) of lower rectal cancer patients receiving sphincter-saving surgery (SSS). In all, 109 patients completed a questionnaire before surgery and 1, 6, and 12 months afterwards. In the chemotherapy group, physical and social functioning scores were significantly lower 12 months after surgery compared with the nonchemotherapy group. These effects of adjuvant chemotherapy suggest that a different clinical approach might more effectively improve physical and social functioning in lower-rectal cancer patients undergoing chemotherapy. Healthcare providers should be alert for adverse events in patients with lower-rectal cancer and promptly address such conditions.     

低位直肠癌保肛手术临床价值分析

目的：分析并研究低位直肠癌保肛手术临床应用效果。方法将该院于2011年4月—2013年5月所救治低位直肠癌患者60例作为该次研究对象,平均分成两组（保肛组、非保肛组）,每组30例患者,保肛组患者给予低位直肠癌保肛治疗,非保肛组实施非保肛手术,观察两组患者临床手术结果。结果经相应手术治疗后,两组患者临床症状均明显变化,保肛组患者医治结果、肛门功能等和非保肛组患者相比,差异无统计学意义,P>0.05;保肛组患者并发症发生率、围术期治疗指标均优于非保肛组患者,P<0.05,两组间差异具备统计学意义。结论借助保肛手术治疗低位直肠癌患者,临床效果显著,可降低并发症发生率,提高生活质量,值得推广使用。     

内镜食道静脉瘤套扎器治疗直肠神经内分泌肿瘤的疗效分析

目的评估超声内镜结合内镜食道静脉瘤套扎器行内镜下圈套器法黏膜切除术(EMR-L)治疗直肠神经内分泌肿瘤(NENs)的临床有效性、安全性以及技术的可行性。方法回顾性分析北京世纪坛医院消化内科2015年11月-2017年11月收治的13例直肠NENs患者临床资料,治疗前均行超声内镜检查,后进行EMR-L切除病变。观察患者内镜表现、EMR-L操作过程及其并发症、病理结果,术后定期结肠镜随访。结果 13例患者顺利完成EMR-L切除病变,耗时10 min 36 s~52 min 21 s,平均(21.9±10.6)min。1例患者发生急性出血,予药物喷洒及钛夹封闭创面治疗后出血停止。无急性或迟发性直肠出血、穿孔等并发症。结论应用内镜食道静脉瘤套扎器行EMR-L可有效、安全的切除小于1.0 cm的直肠NENs,同时治疗费用较食管静脉曲张连环套扎器少,有很好的临床应用价值。     

HPLC法同时测定蒲药灌肠液中3个有效成分的含量

摘 要 目的： 建立蒲药灌肠液中香蒲新苷、异鼠李素-3-O-新橙皮苷和延胡索乙素的HPLC含量测定方法。方法: 采用ZORBAX SB-C₁₈色谱柱（250 mm×4.6 mm,5 μm）,以乙腈-0.1%磷酸（三乙胺调节pH至6.0）为流动相,梯度洗脱程序,流速:1.0 ml·min^-1,检测波长为254 nm（0～14 min）和281 nm（14～25 min）,柱温:30 ℃。结果: 香蒲新苷、异鼠李素-3-O-新橙皮苷和延胡索乙素的线性范围分别为19.840～198.400 μg·ml^-1（r=0.999 6）、20.520～205.200 μg·ml^-1（r=0.999 8）和10.040～100.400 μg·ml^-1（r=0.999 7）,回收率分别为98.8%、98.6%和98.9%,RSD分别为1.4%、1.6%和1.3%（n=6）。结论: 该方法灵敏度高,专属性强,可用于蒲药灌肠液的质量控制。     

Peripheral blood CD45RO+T cells is a predictor of the effectiveness of neoadjuvant chemoradiotherapy in locally advanced rectal cancer

To investigate the relationship between the changes in circulating CD45RO⁺T lymphocyte subsets following neoadjuvant therapy for rectal cancer in patients with locally advanced rectal cancer.The clinicopathological data of 185 patients with rectal cancer who received neoadjuvant therapy in the General Surgery Department of Beijing Chaoyang Hospital affiliated to Capital Medical University from June 2015 to June 2017 were analyzed. Venous blood samples were collected 1 week before neoadjuvant therapy and 1 week before surgery, and the expression of CD45RO⁺T was detected by flow cytometry. The receiver operating characteristic curve analysis was used to determine the optimal cut-off point of CD45RO⁺ratio. Log-rank test and multivariate Cox regression were used to analyze the overall survival rate (OS) and disease-free survival rate (DFS) associated with CD45RO⁺ratio.Circulating CD45RO⁺ratio of 1.07 was determined as the optimal cut-off point and CD45RO⁺ratio-high was associated with lower tumor regression grade grading (P = .031), T stage (P = .001), and tumor node metastasis (TNM) stage (P = .012). The 3-year DFS and OS rate in the CD45RO⁺ratio-high group was significantly higher than that in the CD45RO⁺ratio-low group (89.2% vs 60.1%, P<.001; 94.4% vs 73.2%, P<.001). The multivariate Cox analysis revealed that elevated CD45RO⁺ratio was an independent factor for better DFS (OR, 0.339; 95% CI, 0.153–0.752; P = .008) and OS (OR, 0.244; 95% CI,0.082–0.726; P = .011).Circulating CD45RO⁺ratio could predict the tumor regression grade of neoadjuvant therapy for rectal cancer, as well as long-term prognosis. These findings could be used to stratify patients and develop alternative strategies for adjuvant therapy.     

术前放化疗对低位直肠癌患者术后免疫水平及保肛率的作用分析

目的 研究术前放化疗对低位直肠癌患者疗效、术后并发症及T淋巴细胞的影响,以期为临床治疗提供参考.方法 108例T3～T4期低位直肠癌患者分为术前放化疗组53例,单纯手术组55例,放化疗组患者术前接受放疗治疗(3周),对比两组患者手术时间、出血量,治疗后保肛率,术后并发症并使用流式细胞仪检测两组手术前后及血清中T细胞亚群水平.结果 两组手术时间、术中出血量、术后并发症发生率无统计学意义(P＞0.05),但两组保肛率方面,放化疗组保肛率显著高于单纯手术组(P＜0.05);治疗前放化疗组和单纯手术组血清T细胞亚群水平组间比较差异无统计学意义(P＞0.05);放化疗结束后的1周,放化疗组的T淋巴细胞同单纯手术组比较有差异统计学意义(P＜0.05);手术结束后3个月放化疗组的CD4+细胞百分率,CD4+/CD8+比值升高,同放疗前及放疗结束后1周比较具有显著差异性(P＜0.05),同单纯手术组比较差异无统计学意义.结论 术前放化疗能够明显提高低位直肠癌患者的保肛率,且不会增加手术难度和术后并发症发生率;并未影响机体免疫功能,是一种安全、有效合理的辅助治疗方法.     

Long-term results of suture rectopexy in patients with fecal incontinence associated with incomplete rectal prolapse

Suture rectopexy is the recommended therapy for complete rectal prolapse that is associated with fecal incontinence. It has been suggested that correction of an incomplete rectal prolapse is also worthwhile for patients with fecal incontinence. PURPOSE: Aims of this study were 1) to evaluate the clinical outcome of suture rectopexy in a consecutive series of patients with incomplete rectal prolapse associated with fecal incontinence, and 2) to compare these results with those obtained from patients with complete rectal prolapse. METHODS: Between 1979 and 1994, suture rectopexy was performed in 13 incontinent patients (3 males; median age, 65 (range, 45–77) years) with incomplete rectal prolapse (Group I) and in 24 incontinent patients (21 females; median age, 71 (range, 24–86) years) with complete rectal prolapse (Group II). RESULTS: After a median follow-up of 67 months, continence was restored in 5 of 13 (38 percent) patients with incomplete rectal prolapse and in 16 of 24 (67 percent) patients with complete rectal prolapse. In both groups, all male patients became continent. CONCLUSIONS: For the majority of incontinent patients with incomplete rectal prolapse, a suture rectopexy is not beneficial. The clinical outcome of this procedure is only good in incontinent patients with complete rectal prolapse. Based on these data, it is questionable whether incomplete rectal prolapse plays a causative role in fecal incontinence.Read at the meeting of the International Society of University Colon and Rectal Surgeons, Lisboa, Portugal, April 14 to 18, 1996.No reprints are available.     

Results and DVH analysis of late rectal bleeding in patients treated with 3D-CRT or IMRT for localized prostate cancer

In patients undergoing radiotherapy for localized prostate cancer, dose–volume histograms and clinical variables were examined to search for correlations between radiation treatment planning parameters and late rectal bleeding. We analyzed 129 patients with localized prostate cancer who were managed from 2002 to 2010 at our institution. They were treated with 3D conformal radiation therapy (3D-CRT, 70 Gy/35 fractions, 55 patients) or intensity-modulated radiation therapy (IMRT, 76 Gy/38 fractions, 74 patients). All radiation treatment plans were retrospectively reconstructed, dose–volume histograms of the rectum were generated, and the doses delivered to the rectum were calculated. Time to rectal bleeding ranged from 9–53 months, with a median of 18.7 months. Of the 129 patients, 33 patients had Grade 1 bleeding and were treated with steroid suppositories, while 25 patients with Grade 2 bleeding received argon plasma laser coagulation therapy (APC). Three patients with Grade 3 bleeding required both APC and blood transfusion. The 5-year incidence rate of Grade 2 or 3 rectal bleeding was 21.8% for the 3D-CRT group and 21.6% for the IMRT group. Univariate analysis showed significant differences in the average values from V65 to V10 between Grades 0–1 and Grades 2–3. Multivariate analysis demonstrated that patients with V65 ≥ 17% had a significantly increased risk (P = 0.032) of Grade 2 or 3 rectal bleeding. Of the 28 patients of Grade 2 or 3 rectal bleeding, 17 patients (60.7%) were cured by a single session of APC, while the other 11 patients required two sessions. Thus, none of the patients had any further rectal bleeding after the second APC session.     

经肛三联术治疗三度直肠脱垂的临床效果分析

目的：探究分析经肛三联术来治疗患有三度直肠脱垂患者的临床疗效。方法采用回顾性分析的方法,分析了78例患有三度直肠脱垂患者的临床资料,根据治疗方法的不同,将其分为对照组和实验组（n=39）,对照组选择常规手术进行治疗,实验组选择经肛三联术式予以治疗,观察2组患者的治疗情况以及术中术后情况。结果实验组的治疗总有效率达97.44%,明显高于对照组的治疗总有效率79.49%,差异有统计学意义（P<0.05）;且实验组术中出血量明显比对照组少（P<0.05）,并发症出现概率也明显减少。结论经肛三联手术可以有效治疗三度直肠脱垂,减轻患者的痛苦,提高治疗有效率,减少术中出血量,降低并发症等危险发生,应值得临床广泛推广应用。     

Appearance of a colovesical fistula at cystoscopy

Colovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast‐enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.