直肠肛管恶性黑色素瘤的临床特征分析

目的了解原发性直肠肛管恶性黑色素瘤的临床特点。方法回顾性分析9例原发性直肠肛管恶性黑色素瘤的临床资料,并复习文献。结果直肠肛管恶性黑色素瘤以女性多见,平均发病年龄56岁,病程5.8个月;首发症状以血便为最常见,其次为肛门肿物突出。94.7%的直肠肛管恶性黑色素瘤在距离肛缘5.0cm范围内;肿瘤最大径(3.3±2.1)cm;其中54.5%可活动;有19.1%的肿瘤表面光滑;6.6%的肿瘤质地软;14.0%同期发现转移,肝转移最常见,腹股沟淋巴结转移其次;的病例出现误诊,超过者被误诊为良性疾病;手术治疗中以Miles术为主,经肛门局部切除术其次。结论直肠肛管恶性黑色素瘤极易误诊。手术治疗为主。     

低位直肠癌根治性切除保肛术式53例临床应用研究

本文介绍一种经腹低位直肠癌根治性切除，保留肛门，乙状结肠拖下固定术式。６年来共施行此手术５３例，占同期低位直肠癌（肿瘤下缘距齿状线２～８ｃｍ）手术部数的９６％（５３／５５）。术后２年和５年肿瘤复发率分别７．７％和１４．３％。术后４周、８周和６个月内完全肛门排便功能者分别占４．９１％、９８％和１００％。肛门功能恢复程度均属均属优良。作者对此术式的特点，并根据手术疗效对保留肛门功能的合理性及其根治性进     

Responses of sacral visceral afferents from the lower urinary tract,colon and anus to mechanical stimulation

The discharge characteristics of sacral visceral afferents supplying the urinary bladder, urethra, colon and anus to mechanical stimuli were analyzed in the anaesthetized cat. The stimuli used were passive distension (urinary bladder, colon), isovolumetric contraction (urinary bladder), movements of the urethral catheter and mechanical shearing stimuli (mucosal skin of the anal canal). (1) In total 245 afferent units which projected in the pelvic nerve were isolated from the sacral dorsal roots. From one of the following organs, urinary bladder, colon, urethra and anus 117 afferent units were activated. By these stimuli from the bladder, urethra and anus 122 afferent units could not be activated, and as far as tested also not from the colon; in 6 afferent units the classification was unclear. (2) Afferent units from the urinary bladder and the colon responded consistently to passive distension of the respective organ. The units from the urinary bladder showed graded responses at intraluminal pressures of about 10–70 mm Hg and responded also to isovolumetric contractions of the organ. The thresholds of the units from the bladder to passive distension and contraction varied from about 5 to 20 mm Hg intravesical pressure. (3) The afferent units from the urethra and the anus did not react or showed some weak phasic and irregular responses to distension and contraction applied to the urinary bladder or to distension of the colon. They were consistently excited by low threshold mechanical stimulation of the urethra and anus, respectively. (4) The axons from the bladder, urethra and anus were presumably myelinated (conduction velocity above 2 m/s) and conducted at 10.3±6.1 m/s (n=34, mean±SD), 26.3±9.3 m/s (n=13) and 9.5±5.1 m/s (n=37), respectively. The axons from the colon conducted at about 0.5 to 16 m/s (n=20), 13 of them conducting at less than 2 m/s. About 75% of the axons which could not be activated by mechanical stimulation of the visceral organs were presumably unmyelinated (conduction velocity below 2 m/s). (5) Some ongoing activity was found in 9 out of 26 afferent units from the anus but, with one exception, the afferent units from the bladder, urethra and colon were silent. (6) It is concluded that the pelvic afferent units from the urinary bladder, urethra, colon and anus consist of distinct populations with characteristic response patterns. There is no indication from this investigation that the urinary bladder is supplied by sacral afferents which are only recruited at high intravesical pressures during passive distension and isovolumetric contractions and which are possibly associated with pain.Supported by the Deutsche Forschungsgemeinschaft     

Ⅰ期手术治疗中高位无肛的疗效评估

目的 分析和评估Ⅰ期手术治疗新生儿中高位无肛的疗效和影响因素。方法 回顾性分析1997年10月—2002年12月收治的5例中高位无肛患儿，不作结肠造瘘，直接行腹骶会阴Ⅰ期手术治疗。结果 随访6个月—3年，肛门功能正常。术后腹部切口感染裂开1例，行伤口缝合后痊愈。全部患儿扩肛数月，排便正常。结论 中高位无肛通过腹骶会阴I期手术是安全的，疗效是满意的。     

经腹膜外通路造设人工肛门术

目的 :探讨直肠癌腹会阴联合切除术后 ,经腹膜外通路人工肛门造设的方法及效果。方法 :回顾性分析 1985年 5月～ 2 0 0 2年 12月间 4 34例直肠癌腹会阴联合切除术后 ,经腹膜外通路 337例 (称腹膜外组 ) ,经腹膜内通路 97例 (称传统组 )分别造设人工肛门的结肠造口术后患者的临床资料 ,对有关数据作统计学处理。结果 :腹膜外组有 2例患者 (0 . 5 % )发现造口狭窄 ,5例患者 (1 4. 8% )发现造口周围炎 ,1例患者 (0 . 3% )发现造口旁疝 ,87例患者获排便感觉 ,并发症发生率为 2 . 1%。腹膜内组造口狭窄 11例 (11. 34% ) ,发现造口周围炎 3例 (5. 5 % )、造口回缩 2例 (2 .16 % )、造口脱垂 4例 (4. 12 % ) ,并发症发生率为 2 9 98% ,患者没有排便感觉。两组并发症发生率及排便感觉上都有明显差异 (P <0 .0 5 ,P <0 .0 5 )。结论 :直肠癌APR术后经腹膜外通路造设人工肛门术 ,较传统手术并发症少 ,手术操作简单 ,便于护理且可获排便感觉。     

后矢状位肛门直肠成形术后便秘原因初探

目的　研究无肛畸形胎鼠直肠盲端神经元细胞分布情况 ,探讨后矢状位肛门直肠成形术 (PSARP)后便秘发生原因。方法　选用 2～ 3个月龄 ,体重 2 5 0～ 30 0g健康Wistar大白鼠 12只 ,其中雌鼠 8只 ,雄鼠 4只。实验组雌鼠为 5只 ,对照组为 3只。雌雄交配后第 11d对实验组 5只雌鼠使用乙烯硫脲 (ethylenethiourea ,ETU)灌胃 (1%乙烯硫脲溶液 ,12 5mg/kg) ,对照组孕鼠在同一天使用等量蒸馏水灌胃。第 2 2d对两组孕鼠剖宫取胎 ,形态学研究取实验组及对照组各一只孕鼠 ,获实验组无肛胎鼠 6只 ,正常 5只 ,对照组胎鼠 10只。对胎鼠盆腔进行正中矢状切片 ,HE染色后在光镜下观察其形态。免疫组化研究将两组剩余孕鼠 (实验组 4只 ,对照组 2只 ) ,获胎鼠实验组无肛、正常和对照组各 2 7只、16只和 2 1只 ,取胎鼠直肠盲端 ,利用神经元特异性烯醇化酶 (neuronspecificenolaseNSE)和S 10 0蛋白标记肠壁内源性神经元细胞及胶质细胞 (SP)法 ,分别对肌间神经元、粘膜下神经元及胶质细胞进行计数并与对照组对比 ,进行统计学分析。结果　实验组无肛胎鼠盆腔正中矢状切面可显示直肠盲端的形态。直肠盲端与对照组直肠肌间神经元细胞数分别为 2 .0 9± 0 .5 0 ,2 .74±0 .5 1;直肠盲端与对照组直肠粘膜下神经元细胞数分别为 0 .72     

先天性肛门直肠畸形Hoxc-8基因表达的研究及其意义

目的　对先天性肛门直肠畸形 (congenitalanorectalmalformations,CAM )末端直肠组织Hoxc 8基因表达水平的测定以探讨其分子水平的发病机制。方法　应用RT PCR(逆转录 聚合酶链反应 )技术检测 32例CAM的末端直肠组织及 8例对照组直肠标本的Hoxc 8基因表达 ,以 β actin基因 (是一种在组织中表达稳定的基因 )作为阳性内对照 ,观察Hoxc 8基因的表达水平。结果　CAM组Hoxc 8表达的相对比值为 0 .892± 0 .0 6 8,对照组则为 1.0 0 6± 0 .0 82。Hoxc 8在CAM组的表达与对照组比较差异有非常显著性意义 ,P <0 .0 1。结论　CAM的发生与Hoxc 8基因密切相关 ,该基因在肛门直肠组织中表达减弱可能参与导致其相应的靶器官发育异常而产生畸形。     

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。     

Chemoradiotherapy for Squamous Cell Cancer of the Anal Canal: A Systematic Review

Squamous cell cancer of the anal canal is a rare tumour for which there remains uncertainty regarding optimal therapy. A systematic review was conducted to summarise the evidence examining concurrent chemotherapy and radiotherapy or different chemotherapy regimens in combination with radiotherapy. MEDLINE, EMBASE and conference proceedings were searched for relevant randomised controlled trials. Outcomes of interest were colostomy rate, local failure, overall survival, disease-free survival, adverse effects and quality of life. Six randomised controlled trials were identified. Two trials reported lower colostomy and local failure rates for concurrent 5-fluorouracil (5-FU) plus mitomycin C (MMC) and radiotherapy compared with radiotherapy alone. The omission of MMC from this regimen resulted in higher colostomy and local failure rates and lower disease-free survival. Induction chemotherapy followed by concurrent 5-FU plus cisplatin and radiotherapy resulted in a higher colostomy rate than concurrent 5-FU plus MMC and radiotherapy. Haematological toxicity rates were lower in patients who received radiotherapy with 5-FU alone or 5-FU plus cisplatin compared with 5-FU plus MMC. No benefit was seen for the addition of induction or maintenance chemotherapy to concurrent chemoradiotherapy. The available evidence continues to support the use of radiotherapy with concurrent 5-FU and MMC as standard treatment for cancer of the anal canal to decrease colostomy and local failure rates.