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1.
Sathiyavelavan Gopalan Jagadesh Chandra Bose S. Periasamy 《The Indian journal of surgery》2015,77(3):232-236
The aim of this study is to review the literature to find out the exact etiology of anastomotic cancers of colon post resection and differentiate them between a recurrence, second primary, and metastatic disease (local manifestation of systemic disease). Web-based literature search was done, and datas collected. We searched PubMed for papers using the keywords colon cancer recurrence, anastomotic recurrence, and recurrent colon carcinoma. We also searched for systematic review in the same topic. In addition, we used our personal referrence archive. Anastomotic recurrences of colon are postulated to arise due to inadequate margins, tumor implantation by exfoliated cells, altered biological properties of bowel anastomosis, and missed synchronous lesions. Some tumors are unique with repeated recurrence after repeated resection. Duration after primary surgery plays a major role in differentiating recurrent and second primary lesions. Repeated recurrences after repeated resections have to be considered a manifestation of systemic disease or metastatic disease due to the virulence of the disease. A detailed analysis and study of patients with colonic anastomotic lesion are required to differentiate it between a recurrent, a second primary lesion, and a metastatic disease (local manifestation of a systemic disease). The nomenclature is significant to study the survival of these patients, as a second primary lesion will have different survival compared to that of recurrent lesions. 相似文献
2.
Michael A. Gibney David Fitz-Patrick David C. Klonoff Shahista Whooley Betty Lu Wen Yue 《Current medical research and opinion》2020,36(10):1591-1600
Abstract
Objective
Two similarly designed studies compared user experiences with a second-generation extra-thin-wall, 5-bevel 32?G?×?4?mm pen needle (PN) with redesigned hub versus four thinner commercially available PNs. 相似文献3.
Carlos Sala M.D. Eduardo García-Granero M.D. Ph.D. María J. Molina M.D. Jose V. García M.D. Salvador Lledo M.D. Ph.D. 《Diseases of the colon and rectum》1997,40(8):958-961
PURPOSE: Epidural anesthesia is believed to benefit colorectal anastomotic blood flow because of the sympathetic blockade it produces. Our purpose is to measure with tonometry the effect of epidural anesthesia on colorectal anastomotic oxygenation. PATIENTS AND METHODS: Fifteen patients operated on for rectal cancer (radical anterior resection) were monitored postoperatively using tonometers placed in the stomach (celiac trunk), transverse colon (superior mesenteric artery), and the anastomotic area during the operation. An epidural catheter was placed at L1-2, and on the first postoperative day, 8 ml of bupivacaine (0.25 percent) was administered. The anesthetic effect extended up to T-4. Intramucosal pH (pHi) at the three locations was measured before, during, and after the epidural blockade. RESULTS: Gastric and transverse colon pHi increased during the epidural blockade from 7.35±0.01 to 7.41±0.01 and from 7.34±0.02 to 7.40±0.02, respectively. The anastomotic pHi decreased from 7.3±0.02 to 7.24±0.03 under the epidural and increased up to 7.34±0.02 after withdrawal of the effect on the following day. All pHi variations were statistically significant (P<0.05, paired Student'st-test and Wilcoxon's test), because it was the comparison between gastric and transverse colon pHi with the anastomotic pHi during the epidural (P<0.05, one-way analysis of variance and Kruskal-Wallis tests). None of the patients developed anastomotic or other complications. CONCLUSIONS: Epidural anesthesia with bupivacaine causes a significant decrease in the oxygenation-perfusion state of colorectal anastomosis in comparison with the increase in other areas of the digestive tract. Further studies need to be done to see if other epidural anesthetic-analgesic protocols also worsen colorectal anastomotic blood flow.Supported in part by a grant from the Spanish Society of Digestive Diseases, Madrid, Spain. All tonometric catheters and drugs were donated by the Clinic University Hospital of Valencia, Spain.Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996. 相似文献
4.
目的探讨镍钛记忆合金带膜内支架在治疗食管癌术后胸内吻合口瘘中的应用价值。方法在X线电视透视下对22例食管癌术后胸内吻合口瘘患者进行镍钛记忆合金带膜内支架植入治疗。结果19例一次植入成功,成功率86%,恢复正常饮食;不完全封堵瘘口3例(14%);16例术后出现轻度的胸骨后疼痛不适或胃液反流的症状;1例出现上消化道大出血。22例病人均治愈出院,治愈率100%。结论镍钛记忆合金带膜内支架植入治疗食管癌术后胸内吻合口瘘成功率高,治愈率高,操作简单,安全,见效快,并发症少,有效解除患者痛苦,宜在临床上推广使用。 相似文献
5.
本研究收集食管癌行食管癌切除胃代食管术病例265例,分为未用深静脉高营养组(NTPN)和深静脉高营养组(TPN)。分别对各组临床资料进行比较分析,结果显示:TPN组葡萄糖供给量(8.37±2.12g/kg/24小时)显著高于NTPN组(2.77±0.71g/kg/24小时)(P<0.01),(0.30±0.14g/kg/小时)P<0.05。吻合口瘘发生率TPN组(2.1%)则显著低于NTPN组(15.2%)P<0.001。结果提示TPN组可明显降低吻合口瘘发生率。作者于TPN促进吻合的愈合,预防吻合口瘘发生的有关机理进行了讨论。 相似文献
6.
Martin A. Luchtefeld M.D. Dr. Jeffrey W. Milsom M.D. Anthony Senagore M.D. James A. Surrell M.D. W. Patrick Mazier M.D. 《Diseases of the colon and rectum》1989,32(9):733-736
Anastomotic stenosis is a poorly understood and underexamined complication of gastrointestinal surgery, reportedly most frequent
in the coloproctostomy. In order to better define this problem, a questionnaire was sent to members of the American Society
of Colon and Rectal Surgeons regarding patients with gastrointestinal anastomotic stenosis. A total of 123 patients with intestinal
anastomotic stenosis were analyzed. Eighty-two anastomoses were stapled and 41 were handsewn. Nearly all stenoses occurred
in the distal bowel (70 rectal, 23 sigmoid colon). Preoperative risk factors identified were obesity (28 patients) and abscess
(12 patients). Incomplete “doughnuts” were noted in 12 patients. Postoperative anastomotic leaks (15 patients), pelvic infection
(13 patients), and postoperative radiation (7 patients) were believed to be contributing factors. Dilatation, using a variety
of techniques, was the sole treatment for 65 patients, however, intra-abdominal surgery was necessary in 34 patients. Large
intestinal anastomotic stenosis probably occurs most commonly following coloproctostomy (both with handsewn and stapled anastomoses).
Dilatation alone resulted in adequate treatment in most patients in the study. Major surgery was required to correct this
problem in a significant number of patients (28 percent) in this series. The true incidence of anastomotic stenosis in colorectal
surgery is unknown and warrants further study.
Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17,
1988. 相似文献
7.
目的:探讨低位直肠癌保肛术后吻合口漏的原因及合理有效的防治方法。方法:对我院近10年来出现的低位直肠癌全系膜切除低位吻合手术后吻合口漏的发生及治疗情况进行回顾性分析。对吻合口漏的患者采用手术及保守治疗(骶前双腔管冲洗引流加肛管引流)。结果:共行低位保肛手术348例,术后发生吻合口漏11例,吻合口漏的发生率为3.2%。患者的年龄、吻合技术和肿瘤组织学分型与吻合口漏的发生无关。而患者的性别、肿瘤的大小与吻合口漏的发生密切相关(P〈0.05)。11例患者中有3例行手术治疗(HA手术),8例采用保守治疗后均痊愈出院,吻合口漏发生至出院时间平均为10~15d。结论:充分的术前准备和良好的吻合技术是防止吻合口漏发生的关键。正确判断吻合口漏的发生及采用正确的处理方法是治疗的前提,双腔引流管加肛管引流是保守治疗吻合口漏的有效方法。 相似文献
8.
2003年12月30日一辆装载7.28t苯胺的槽车从宁波开往温州的路上在甬台温高速公路温岭市境内翻车,造成5.3t左右的苯胺泄漏在高速公路旁的环境中,除少量的液体被清除外,绝大部分渗入地下,造成了水井污染.从12月31日开始我们对周围的水井开展了监测,现将监测结果分析如下: 相似文献
9.
Björn-Christian Link Emre F. Yekebas Dean Bogoevski Asad Kutup Gerhard Adam Jakob R. Izbicki Gerrit Krupski 《Journal of gastrointestinal surgery》2007,11(2):166-170
Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity
and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be
burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g.,
nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable
option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic
biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous
transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The
procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous
transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending
on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an
alternative for treatment of symptomatic biliary leakage instead of immediate reoperation.
Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation). 相似文献
10.
食管癌切除术后不同重建途径吻合口瘘的原因及预防 总被引:21,自引:3,他引:18
目的了解食管癌切除术后经不同径路重建,发生吻合口瘘的情况;探讨系统性淋巴结清扫后,经胸骨后胃代食管颈部吻合口瘘发生率较高的原因及预防方法。方法1105例行食管癌切除术的患者,229例经左胸行胸内吻合(A组),716例经右胸食管床胃代食管行颈部吻合(B组),160例予以系统性淋巴结清扫术后经胸骨后行颈部吻合(C组)。分析比较不同手术径路的3组患者术后吻合口瘘发生的情况。结果吻合口瘘发生率分别为:A组5/229(2.2%)、B组85/716(11.9%)、C组31/160(19.4%),C组吻合口瘘发生率显著高于A、B组(P<0.01和P<0.05)。比较C组不同重建方式吻合口瘘发生率显示,手工吻合与器械吻合(22.2%与11.6%,P=0.133)、全胃重建与管状胃重建(25%与15.6%,P=0.146)间吻合口瘘发生率无明显差异,而延长胃肠减压管留置时间至术后7d,吻合口瘘发生率由23.3%降至9.1%(P<0.05)。结论胸骨后胃代食管吻合口瘘发生率较高的主要原因,是前纵隔内的胃体受压、冲击吻合口所致;通过延长胃肠减压管留置时间能有效减少瘘的发生。 相似文献