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Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.
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<p><b>OBJECTIVE</b>To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.</p><p><b>METHODS</b>Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.</p><p><b>RESULTS</b>All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.</p><p><b>CONCLUSION</b>Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Abdomen , Anal Canal , Blood Loss, Surgical , Digestive System Surgical Procedures , Methods , Laparoscopy , Length of Stay , Neoplasm Recurrence, Local , Operative Time , Perineum , Postoperative Complications , Postoperative Period , Rectal Neoplasms , General Surgery , Rectum , Retrospective StudiesABSTRACT
Objective To compare the incidence of adverse reaction,clinical manifestation and serious degree of adverse reaction and the intravenous injection time of the two different drugs,and provide references for the safe dosage of the drugs in clinic.Methods 200 patients from June 2009 to June 2010,who visited department of dermatology because of allergic dermatitis were chosen.They were randomly divided into the sodium thiosulfate group and the calcium gluconate group according to the drugs which were injected intravenouly.And incidence of adverse reaction,clinical manifestation and serious degree of adverse reaction and the intravenous injection time were compared between two groups.Results Compared with the calcium gluconate group,the rate of the adverse reaction of the sodium thiosulfate group is lower,and the average time needed is shorter,in addition,there is no serious adverse reaction during injection.Conclusions Intravenous injection of sodium thiosulfate has the advantage of lower incidence of adverse reaction,shorter time needed,and fewer serious adverse reaction,which is worthy of wide spread.
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Objective To explore the expression of endothelial growth factor-D (VEGF-D) and uroki-nase-type plasminogen activator(uPA) in rectal carcinoma and to reveal their correlation to the tumor invasion and metastasis.Methods The expression of VEGF-D and uPA in 30 cases with rectal carcinoma and normal tissue was detected by immunohistochemistry and Western blot.Results The expression of VEGF-D and uPA was de-tected both in tumor tissue and normal tissue, but significantly higher in tumor tissue (P < 0.01), they expressed mostly in endochylema.The expression of VEGF-D or uPA was significantly higher in Dukes' stage C + D than that in Dukes' stage A + B(P <0.01), was also higher in tissues with lymph node metastasis or distant metasta-sis than those without metastasis(P <0.05 ,P <0.01).They were found to be lower in cancer tissue along with the differentiation degree increase(P < 0.05) .Condnsions The overexpression of VEGF-D and uPA in rectal carcinoma may play an important part in the tumorigenesis and progression of rectal carcinoma.
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Objective To explore the expressions of endothelial growth factor-D (VEGF-D) and urokinase-type plasminogen activator (uPA) in colon carcinoma and to reveal their correlation with the tumor invasion and metastasis. Methods The expressions of VEGF-D and uPA were detected by immunohistochemistry and Western blotting in 30 specimens of colon carcinoma and 30 specimens of normal neighbouring colon tissue 5 cm away from the lesions. Results The expressions of VEGF-D and uPA mostly located in endochylema, less in nucleus, of both tumor tissue and normal tissue, and they were significantly higher in tumor tissue than normal tissue (P