Anus-preserving rectectomy using telescopic anastomosis for middle and lower rectal cancer, report of 402 cases / 中华普通外科杂志

Objective To study the clinical efficacy of anus-preserving rectectomy by using telescopic anastomosis of colon and rectal mucosa for the middle and lower rectal cancer. Methods A retrospective analysis was carried out in 402 cases with middle and lower rectal cancer undergoing telescopic anastomosis for anus-preserving procedure, including 241 males and 161 females, age ranging from 21 to 99 years, averaging at 55. 7 years. The distal margins of the tumors were within 6 - 9 cm to anal verge. According to TNM staging, there were 123 cases in Stage Ⅰ , 244 cases in Stage Ⅱ , 31 cases in Stage Ⅲ,and 4 cases in Stage Ⅳ. Results 345(345/402, 85. 8% ) cases were followed up, the median time of the follow-up was 6. 1 years. Postoperative complications included 17(4.2%) cases of stomal leakage, 11(2.7% ) cases of stomal stenosis. All patients recovered normal defecating function 12-24 weeks post operation. Local recurrence rate was 6. 3% (22/345). Hepatic and lung metastasis was 13. 6% (47/345) and 2. 6% (9/345)respectively. The five year survival rate was 68. 7% (112/163). Conclusions Anuspreserving rectectomy by using telescopic anastomosis is safe and effective procedure to treat middle and lower rectal cancer, with the preservation of anal function and without the increasing rate of local recurrence.

Anus-preserving surgery with anal intersphincteric resection in the treatment of ultra-low rectal cancer / 中华普通外科杂志

Objective To study clinical therapeutic effects of anus-preserving operation with resecting anal intersphincter to treat ultra-low rectal cancer through abdominal cavity. Methods We retrospectively analyzed 52 cases of ultra-low rectal cancer, with the inferior border of the cancers within 2 cm to anocutaneous line or 5 cm to the edge of anus treated by anus-preserving operation with resecting archos internal sphincter muscles through abdominal cavity and anus. There were 29 males, and 23 females, with age 28 to 76 years old, averaging 56. 3 years old. The inferior border of the cancer were within 4 cm to the edge of anus in 18 cases, including 6 cases of adenoma cancerization, and 5 cm to the anus in 34 cases. Pathologic diagnosis was well-differentiated adenocarcinoma in 21 cases, moderately differentiated in 29 cases, low differentiated in 2 cases, there were 6 cases with adenoma cancerization. 28 cases were Dukes A stage, and 24 B stage. Results The follow-up rate was 88. 4% (46/52), and the median time was 5.9 years. 2 case developed stoma leak (3.8%), and 3 developed stoma stenosis(5.7% ) after operation. The anus could roughly control defecation in 6 ～ 12 mouths after operation. The local recurrence rate was 5.7%, and the 5-year-survival rate was 72.7%. Conclusion By anus-preserving operation with resecting archos internal sphincter muscles, defecation controlling was well reserved by anus, and the 5-year-survival rate was not cut down. This operation is one of the safe and effective operations of anus-preserving procedure.

Long-term results of extended parietal cell vagotomy in treatment of duodenal ulcers and their complications: report of 321 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the long-term results of extended parietal cell vagotomy (EPCV) in the treatment of patients with duodenal ulcer and their complications.</p><p><b>METHODS</b>Form 1979 to 2001, EPCV was performed in 321 patients with duodenal ulcer and their complications. Of these patients 56 had chronic duodenal ulcer, 204 perforation, 16 hemorrhage and 40 stenosis. The following items were evaluated: complications of operation, gastric secretion, gastric emptying, endoscopical and radiographical findings, nutritional status, absorption function, and Visick scale.</p><p><b>RESULTS</b>Postoperative follow-up ranged from 0.5 to 22.0 years (mean 11.3 years) in 289 of the 321 patients with a follow-up rate of 90.0%. Neither operative mortality nor dumping syndrome was noted. Episodic postprandial fullness occurred in 19 patients (6.5%), acid regurgitation in 17 (5.8%) and adhesive ileus in 4 (1.4%). Ulceration recurred in 16 patients (5.5%). Duodenal ulcer was seen in 8 patients (19.5%), hemorrhage in 0 (0%), stenosis in 2 (5.3%), and perforation in 6 (3.1%). Ulcers healed rapidly after medical therapy in 10 patients. Six patients received antrectomy and gastrectomy. In 289 (91.7%) patients of Grade I and II of Visick scale, 191 (95.3%) had perforation.</p><p><b>CONCLUSIONS</b>EPCV is easy to perform with a low rate of post operative complication and ulcer recurrence. It should be a treatment of choice for acute perforation, hemorrhage or stenosis due to duodenal ulcer.</p>

Variations of cellular membrane phospholipids with genesis and hepatic metastasis of large intestine cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To separate and detect membrane phospholipids and study the relationship of metabolism and signal transduction pathways of membrane phospholipids with genesis and hepatic metastasis of large intestinal carcinoma.</p><p><b>METHODS</b>Forty-eight cases of colorectal cancer were detected with high performance liquid chromatography. Membrane phospholipids of phosphatidylinosital (PI), phosphatidylserine (PS), phosphatidylethanolamine (PE) and phosphatidylcholine (PC) in primary foci, paratumor intestinal mucosa and hepatic metastasis of large intestine cancer were separated and analyzed.</p><p><b>RESULTS</b>In primary foci, paratumor intestinal mucosa, and hepatic metastasis of the 48 cases, the contents (mg/g) of PI were: 0.92 +/- 0.12, 1.57 +/- 0.14, 1.54 +/- 0.15 respectively, and PC 56.47 +/- 5.33, 108.57 +/- 6.37, 116.35 +/- 6.85. The contents of PI and PC were higher in primary foci and hepatic metastasis than in paratumor mucosa (F = 363.10, 870.10, P < 0.01). The contents of PE in the three tissues were 18.23 +/- 3.56, 42.02 +/- 4.33, 79.51 +/- 5.52, and in hepatic metastasis was the highest (F = 1 149.63, P < 0.01). PI and PC in primary foci of hepatic metastatic group and nonmetastasis group were not significantly different (t = 3.55, P > 0.05). But the PE content was higher in hepatic metastasis than in primary foci (t = 115.87, P < 0.01).</p><p><b>CONCLUSIONS</b>Membrane phospholipids have obvious variations in genesis and hepatic metastasis of large intestine cancer. Rises of PI and PC were associated with genesis of large intestine carcinoma. The increase of PE content is closely related to invasion and hepatic metastasis of large intestine cancer.</p>

Clinical study of 208 cases of resection of mid-lower rectal cancer with colorectal telescopic mucosa anastomosis to preserve anus / 解放军医学杂志

Objective To study the clinical efficacy of colorectal mucosa anastomosis in resection of mid-lower rectal cancer to preserve the anus. Methods A retrospective analysis was carried out with 208 cases of mid-lower rectal cancer operated with the said surgical procedure, including 131 males and 77 females, aged 21-99 years with mean age of 53.7 years. The low margins of the tumors were located 6-8 cm from the anal verge. Pathologically, adenocarcinoma accounted for 201 cases, in whom 86 well-differentiated, 100 moderately differentiated, and 8 poorly differentiated, 7 mucinous adenocarcinoma, and 7 adenoma with malignant degeneration. According to Dukes classification, 76 belonged to Dukes′ A, 122 Dukes′ B, and 10 Dukes′ C. Results 182 cases (87.5%) were followed up, the median follow-up time was 5.9 years. Postoperative complications included 8 cases (3.4%) of stoma leak, and 3 cases (1.7%) of stoma stenosis. The defecation function recovered after 12-24 weeks postoperatively, with frequency of 1-3 times each day. Local recurrence was 4.9% (9/182). Hepatic metastasis was 14.2% (26/182). The five year survival rate was 72.5%. Conclusion Colorectal mucosa anastomosis is safe and efficacious for rectal cancer. With the procedure, the anal function can be preserved well, the incidence of stoma leak is decreased, and the 5 year survival rate is the same as that of Miles operation.

Evaluation of the defecation function after different modes of low anastomosis after colonic resection for rectal careinoma / 解放军医学杂志

Objective To evaluate the defecation function after different low anastomosis operations for rectal carcinoma. Methods 176 cases of resection of rectal carcinoma followed by different anal reconstruction techniques (anastomat anastomosis, telescopic colorectal mucosa anastomosis, and in situ colon-telescope anus reconstruction) were followed up for 2-3 years to evaluate the defecation function. Results After operations, the rate of satisfactory defecating function was 94.9% for all the 176 cases. In all the cases in whom the anastomosis was accomplished with anastomat showed good defecating function and normal sensation of defecation. While in telescopic colorectal mucosa anastomosis group and in situ colon-telescope anus reconstruction group, the rate of satisfactory defecating function was 95.8% and 84.4%, respectively. In 87.5% of patients with telescopic colorectal mucosa anastomosis there was normal sensation of defecation. The number of defecation did not have a regalarity. Conclusions Methods of anastomosis and its site have an influence on anal function. The control of defecation was normal in the remaining anus. Defecation function asually recovered in some degree during 4-6 months after anastomosis with staplers and telescopic anastomosis.

Sphincter-preserving transabdominal-anal radical resection of middle-lower rectal cancer by mucosa-mucosa coloanal anastomosis / 中国普通外科杂志

Objective To evaluate the safety and feasibility of sphincter-preserving transabdominal-anal excision of middle-lower rectal cancer by mucosa-mucosa coloanal anastomosis. Methods There were 169 cases undergoing this procedure including 107 males and 62 females. The low margins of the tumors located between 5~9 cm from the anal verge. Histopathological examination showed adenocarcinoma in 163 cases, mucinous adenocarcinoma in 6, and adenoma with canceration in 6.According to Dukes′ classification,61 belonged to Dukes′ A,101 Dukes′B, and 7 Dukes′C. Results Postoperative complications included stomal leak in 5 cases, stomal stenosis in 3, and defecation frequency increased to 6～12 times daily in all cases during the early stage and gradually back to normal 12～18 weeks postoperation. An average follow-up of 5.8 years was made in 154 cases(91.1%).Local recurrence was 5.8%.Hepatic metastasis was 13.7%.The five year survival rate was 66.9%. Conclusion This anal-sphincter preserving procedure while fulfilling radical resection for middle-lower rectal carcinoma is both safe and feasible alternative approach.

Extended parietal cell vagotomy for the treatment of acute perforation of duodenal ulcer / 中国普通外科杂志

Objective To evaluate the long-term results of extended parietal cell vagotomy (EPCV) for the treatment of acutely perforated duodenal ulcer. Methods EPCV was performed on 239 patients. Results were analyzed retrospectively. Results Follow up was made on 203 out of 239 patients (84.9%). There was no operative mortality. Inhospital complications included injury to the spleen in 4 cases (1.7%), adhesive ileus in 6(2.5%), acute diarrhea in 3 (1.3%), and postprandial epigastric distention in 18 (7.5%). Long-term complications included epigastric pain and sour regurgitation in 16 cases(7.8%), enterolysis in 4(1.9%), duodenal bulb allaxis in 39(18.2%), chronic gastritis in 21(10.3%), and recurrent ulcer in 6(2.9%). Basic acid output, maximal acid output and peak acid output decreased by 84.7%, 60.0%, and 58.0% respectively(all P