Effect of partial rectal resection with transanal stapler in the treatment of rectum protrusion / 中国基层医药

Objective To investigate the clinical effect of transanal stapler partial rectal resection for rectocele.Methods From January 2012 to January 2018,90 patients with rectocele treated in Changzhi Traditional Chinese Medicine Hospital were divided into control group (45 cases) and observation group (45 cases) according to the operation method.The control group was treated with closed transrectal repair ,while the observation group was treated with partial rectal resection with anal stapler.The operative effect ,incidence of postoperative complications , recurrence rate,degree of pain after operation ,length of hospital stay and cost of treatment were compared between the two groups.Results The total effective rate of the two groups was 100.0%.The incidence of complications in the observation group was 2.2%(1／45),which was lower than that in the control group [17.8%(8／45)] (χ2 ＝4.444, P＝0.035).The recurrence rate in the observation group was 0(0／45),which was lower than that in the control group [13.3%(6／45)] (χ2 ＝4.464,P＝0.035).The hospitalization time in the observation group was shorter than that in the control group[(7.01 ±2.06)d vs.(11.31 ±2.42)d].Compared with the control group ,the treatment cost of the observation group was higher[(0.836 ±0.164)×104CNY vs.(0.605 ±0.136)×104CNY],and the post-operative pain score was lower [(4.24 ±1.33) vs.(6.45 ±1.17)] ( t＝9.076,7.273,8.369,all P＜0.001).Conclusion Transanal stapler partial rectal resection is effective in the treatment of rectocele , with less complications, lower recurrence rate and less pain after operation ,but the cost of treatment is higher.

Effect of partial rectal resection with transanal stapler in the treatment of rectum protrusion / 中国基层医药

Objective@#To investigate the clinical effect of transanal stapler partial rectal resection for rectocele.@*Methods@#From January 2012 to January 2018, 90 patients with rectocele treated in Changzhi Traditional Chinese Medicine Hospital were divided into control group (45 cases) and observation group (45 cases) according to the operation method.The control group was treated with closed transrectal repair, while the observation group was treated with partial rectal resection with anal stapler.The operative effect, incidence of postoperative complications, recurrence rate, degree of pain after operation, length of hospital stay and cost of treatment were compared between the two groups.@*Results@#The total effective rate of the two groups was 100.0%.The incidence of complications in the observation group was 2.2%(1/45), which was lower than that in the control group [17.8%(8/45)] (χ2=4.444, P=0.035). The recurrence rate in the observation group was 0(0/45), which was lower than that in the control group [13.3%(6/45)] (χ2=4.464, P=0.035). The hospitalization time in the observation group was shorter than that in the control group[(7.01±2.06)d vs.(11.31±2.42)d]. Compared with the control group, the treatment cost of the observation group was higher[(0.836±0.164)×104CNY vs.(0.605±0.136)×104CNY], and the post-operative pain score was lower[(4.24±1.33) vs.(6.45±1.17)](t=9.076, 7.273, 8.369, all P<0.001).@*Conclusion@#Transanal stapler partial rectal resection is effective in the treatment of rectocele, with less complications, lower recurrence rate and less pain after operation, but the cost of treatment is higher.

Laparoscopic resection of metachronous colorectal carcinoma / 中华普通外科杂志

Objective To evaluate laparoscopic radical resection of metachronous colorectal carcinoma.Methods A total of 13 patients with metachronous colorectal carcinoma undergoing laparoscopic resection in Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2013 to December 2015 were analyzed retrospectively.Results The mean time of surgery was (156 ± 9) min.Tumors were located in the right hemicolon in 3 cases,in the transverse colon in one,in the left hemicolon in 2,in the sigmoid colon in four and in the rectum in 4.The mean blood loss was (66 ± 21) ml.There was no conversion to open surgery.Two patients were done with protective ileostomy.Postoperative gastrointestinal function recovery time was (2.5 ± 0.7) days.One postoperative intra-abdominal bleeding was successfully controlled laparoscopically.Posteperative length of hospital stay was (26.2 ± 2.9) days.The median follow-up was 12 months (5-30 months) with no cancer recurrence.Conclusions Laparoscopic radical resection of metachronous colorectal carcinoma has good curative effect,and high success rate in spite of previous history of laparotomy.

Subtotal colectomy and 90 degree rotation cecorectal side-to-end anastomosis for slow transit constipation / 中华普通外科杂志

Objective To analyze the clinical efficacy of subtotal colectomy,90 degree rotation of the cecum and cecorectal side-to-end anastomosis for slow transit constipation (STC).Methods Clinical data of 31 STC patients treated by subtotal colectomy,90-degree rotation round its long axis and cecorectal anastomosis were retrospective analysed.Results Open surgery was performed in 14 cases,and laparoscopic-assisted surgery in 17 cases.There was no perioperative mortality.Anastomotic fistula occurred in 1 case.4 cases suffered from intestinal obstruction including early postoperative inflammatory bowel obstruction in 2 cases,and incomplete intestinal adhesions in 2 cases.All were cured by conservative treatment.In postoperative one month stool frequency averaged at 8 times/d,after half a year the stool frequency was averaged at 6 times/d,after 2 years it was 4 times/d.There was no stool seepage during night time.Conclusions Colon subtotal resection and 90 ° rotation cecal rectal anastomosis in the treatment of STC is effective and without severe complications.

Comparison of the influence on the healing of anastomotic stoma between two kinds of alimentary canal reconstruction after laparoscopic radical resection of low rectal cancer / 中国基层医药

Objective To investigate the different influencing on the healing of anastomotic stoma between two kinds of alimentary canal reconstruction after laparoscopic radical resection of low rectal cance.Methods The clinical data of July 2013 -January 2016 suffering from stage Ⅱ -Ⅲ low rectal cancer and in our hospital underwent laparoscopic colorectal cancer radical surgery patients was retrospectively analyzed.Through accessing to medical records,the patients of diabetes,hypoproteinemia,malnutrition,preoperative uncorrectable cases and received neoadjuvant therapy were excluded.More than a total of 59 cases were enrolled,34 cases of them received traditional alimentary canal reconstruction(traditional group,including 26 cases of low rectal cancer,8 cases of super low rectal cancer,also 21 cases of them in stageⅡand 13 cases in stage Ⅲ),25 cases of them received anal anastomosis resection (including 18 cases of low rectal cancer,7 cases of super low rectal cancer,also 20 cases of them in stage Ⅱ and 5 cases in stageⅢ).Results In the traditional group,1case of 34 patients with anastomotic leakage,3 cases of anastomotic bleeding, while in the improved group,2cases of 25 patients with anastomotic leakage,2 cases of anastomotic bleeding.There was no significant difference in the incidence of anastomotic leakage and anastomotic bleeding between the two groups (3cases vs.2cases,1case vs.2cases,χ2 =0.13,0.75,all P >0.05).All cases did not occur in patients with anastomotic stenosis,and all patients were cured and discharged.Conclusion Each of the two methods have their advantages and disadvantages.Through preoperative,intraoperative evaluation of tumor status,reasonable choice of tumor treatment and anastomosis,is more conducive to postoperative recovery.

Laparoscopic assisted total colorectal resection for familial adenomatous polyposis / 中华普通外科杂志

Objective To evaluate the safety,feasibility and value of treating familial adenomatous polyposis (FAP) with laparoscopic assisted total colorectal resection.Methods Thirty six patients with familial adenomatous polyposis from June 2009 to May 2014 were reviewed retrospectively.16 FAP patients underwent laparoscopic assisted total colorectal resection and 20 FAP underwent traditional laparotomy.The clinical data,including short term follow up outcomes,safety,and recovery were analyzed retrospectively.Results Laparoscopic assisted total colorectal resection was performed successfully on 16 patients without severe complications.The mean operation time of the laparoscopic group was (178 ± 33) min,the mean operative blood loss (72 ± 30)ml in the laparoseopic group were not significantly different when compared with the mean operation time (159 ± 24) min and the mean operative blood loss (110 ± 50) ml in the conventional group.Incision length (5.6 ± 1.1) cm,the intestinal function recovery time (2.7 ± 0.9) d,hospital stay after surgery (8.1 ± 1.6) d in the laparoseopic group were significantly different when compared with incision length (15.8 ± 1.8) cm,the intestinal recovery time (3.8 ±0.9) d,hospital stay after surgery (9.9 ± 1.6) d in the conventional group (P ＜ 0.05).There was no severe complications in neither group nor local recurrence,distant nletastases or death found during the follow-up of 6-56 months.Conclusions Laparoscopic assisted total colorectal resection for FAP can be performed safely and effectively with the advantages of minimal invasion,quick recovery and good short term effect.

Clinical observation of rectal resection for 35 patients with rectal cancer / 中国基层医药

Objective To investigate the clinical efficacy of rectal resection for rectal cancer.Methods 35 patients with rectal cancer were diagnosed by pathological examination.They were treated with laparoscopic rectal cancer resection and conventional chemotherapy.The patients were followed up for 3 years.The operative time,blood loss,intraoperative and postoperative complications,postoperative recovery,death and so on were observed.Results The patients were operated successfully,and no tumor cells were found in the bowel edge.The average operative time was (171.74 ± 58.24) min,average blood loss was (85.74 ± 68.32) ml,there were no infection,bleeding,anastomotic complications.After 2 ～ 3 years of follow-up,there was 1 patient with liver metastases,and no local recurrence,no fecal incontinence and no deaths.Conclusion Rectal resection for rectal cancer had good effect and could improve patients' quality of life.

Cicatrização do cólon após mucosectomia mecânica e sutura evertente em ratos / Healing of colon after mechanic mucosectomy and evertent suture in rats

A mucosectomia é utilizada durante a confecção de reservatórios ileais nas proctocolectomias por doença inflamatória intestinal. Entretanto, tem-se relatado aumento da incidência de obstruções intestinais em pacientes submetidos ao procedimento, sendo que o contato de uma grande área de submucosa poderia ser responsável pela ocorrência de estenoses, além de poder relacionar-se com aumento da pressão de ruptura desses segmentos. Com o objetivo de avaliar as alterações macroscópicas após a mucosectomia e a pressão de ruptura desses segmentos, foram estudados 16 ratos Holtzman distribuídos em dois grupos: A (n=8), anastomose colo-cólica em plano único extramucoso invertente com pontos separados de fio absorvível e B (n=8), mucosectomia e anastomose colocólica em plano único evertente com pontos separados de fio absorvível. No terceiro dia pós-operatório, foram estudadas as alterações macroscópicas e a pressão de ruptura dos segmentos colônicos contendo as anastomoses. Os resultados obtidos mostraram aumento na incidência e intensidade das aderências peritoneais nos animais do grupo B (p=0,01), incidência de 100% de estenoses das anastomoses, sem que ocorresse qualquer estenose no grupo A (p=0,01) e aumento não significativo na pressão de ruptura das anastomoses no grupo B (4,3 ± 2,4 mmHg vs. 10,5 ± 8,2 mmHg). Concluindo, a mucosectomia aumentou a reação inflamatória tecidual, sendo causa não só de aumento na pressão de ruptura como na incidência de estenoses de anastomoses colônicas de ratos.

The mucosectomy is used during the making of the ileal pouch in proctocolectomy due to inflammatory bowel disease. However, there are reports of increased incidence of intestinal obstructions in patients undergoing the procedure, when the contact of a large submucosal area could be responsible for the stenosis, and can relate to the increase of burst pressure of these segments. To evaluate the macroscopic alterations after the mucosectomy and the burst pressure of these segments, 16 Holtzman rats were studied divided into two groups: A (n = 8), colo-colic anastomosis in extra mucosal single invertent plan with separate absorbable sutures and B (n = 8), mucosectomy and colo-colic anastomosis in a single evertent plane with separate absorbable sutures. On the third post-operatory day the macroscopic alterations and burst pressure of the colony segments containing the anastomosis were studied. The found results showed increase in the incidence and intensity of peritoneal adherences in the animals of group B (p=0,01), incidence of 100% of the anastomosis steanosis, with no occurrence of stenosis in the group A (p=0,01), and no significant increase in the burst pressure in the group B (4,3 ± 2,4 mmHg vs. 10,5 ±8,2 mmHg). Conclusion : the mucosectomy increased the tissue inflammatory reaction, giving cause to the increase of the burst pressure as well as the incidence of colonic anastomosis steanaosis in rats.

Radical resection with total mesentery excision (TME) for the treatment of rectal cancer: a clinical analysis of 67 cases / 中国基层医药

Objective To discuss the clinical effect and the application value of total mesentery excision to the rectal cancerous patients. Methods The clinical data of 67 rectal cancerous patients who received the radical resection which following the TME principle,and with a 2 ～3 years follow-up were analyzed. Results All the 67 patients received the radical resection,including 1 anastomotic fistula,3 anastomotic stenosis, neither local recurrence nor distant metastasis. Conclusion TME played an important role in preventing the local recurrence of rectal cancer, and it met the standards of surgical treatment of rectal cancer better.

Update for Indeterminate Colitis

The distinctive diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. Both UC and CD show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of indeterminate colitis (IC), which was proposed by pathologists for colectomy specimens in 1978, usually from patients operated on for severe colitis, especially in cases of acute fulminant disease of the colorectum. The subgroup of patients with an uncertain diagnosis has been classified as IC. Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, or other features allowing a diagnosis of either UC or CD. More recently, the term IC has been applied to biopsy material when it is not been possible to differentiate between UC and CD. However, this term IC has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease, has led to much confusion. In resected specimens, the term colitis of uncertain type or etiology is preferred. Over time, the majority of patients remain with a diagnosis of IC or show symptoms similar to UC. Ileal pouch anal anastomosis can be performed in such patients, with outcomes of pouch failure and with functional outcomes that are similar to those in patients with UC, but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, its natural history, and the outcomes of restorative proctocolectomy.

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy? / Tratamento cirúrgico da polipose adenomatosa familiar: anastomose íleo-retal ou bolsa ileal?

Context: Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. OBJECTIVES: To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. Methods: Charts from patients treated between 1977 and 2006 were retrospectively analyzed. Clinical and endoscopic data, results of treatment, pathological reports and information regarding early and late outcome were recorded. Results: Eighty-eight patients - 41 men (46.6 percent) and 47 women (53.4 percent) - were assisted. At diagnosis, 53 patients (60.2 percent) already had associated colorectal cancer. Operative complications occurred in 25 patients (29.0 percent), being 17 (19.7 percent) early and 8 (9.3 percent) late complications. There were more complications after restorative proctocolectomy (48.1 percent) compared to proctocolectomy with ileostomy (26.6 percent) and ileorectal anastomosis (19.0 percent) (P = 0,03). There was no operative mortality. During the follow-up of 36 ileorectal anastomosis, cancer developed in the rectal cuff in six patients (16,6 percent). Cumulative cancer risk after ileorectal anastomosis was 17.2 percent at 5 years, 24.1 percent at 10 years and 43.1 percent at 15 years of follow-up. Age-dependent cumulative risk started at 30 years (4.3 percent), went to 9.6 percent at 40 years, 20.9 percent at 40 years and 52 percent at 60 years. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8 percent). Conclusions: 1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated...

Contexto: As controvérsias quanto a melhor forma de tratamento da polipose adenomatosa familiar confrontam a morbidade da proctocolectomia restauradora contra a suposta mortalidade decorrente de câncer retal após íleo-reto anastomose. OBJETIVOS: Avaliar as complicações operatórias e a evolução oncológica dos pacientes submetidos a íleo-reto anastomose ou proctocolectomia restauradora. Métodos: Analisaram-se os dados dos doentes tratados entre 1977 e 2006, procedendo ao levantamento de dados clínicos gerais, endoscópicos, resultados do tratamento cirúrgico, dados anatomopatológicos e informações sobre a evolução precoce e tardia dos pacientes. Resultados: Foram tratados 88 pacientes, sendo 41 homens (46,6 por cento) e 47 mulheres (53,4 por cento). Por ocasião do diagnóstico, 53 pacientes (60,2 por cento) já tinham câncer colorretal associado à polipose. Registraram-se complicações operatórias em 25 doentes (29,0 por cento) dentre os 86 operados, sendo 17 (19,7 por cento) precoces e 8 (9,3 por cento) tardias. Houve mais complicações após proctocolectomia restauradora (48,1 por cento) em comparação às proctocolectomias com ileostomia (26,6 por cento) e íleo-reto anastomose (19,0 por cento) (P = 0,03). Não houve mortalidade operatória. O risco cumulativo de câncer retal após íleo-reto anastomose foi de 17,2 por cento após 5 anos, 24,1 por cento após 10 anos e 43,1 por cento após 15 anos de seguimento pós-operatório. Já o risco cumulativo idade-dependente começou a existir a partir de 30 anos (4,3 por cento), passando para 9,6 por cento aos 40 anos, 20,9 por cento aos 40 anos e 52 por cento aos 60 anos. Entre os pacientes submetidos a bolsa ileal com seguimento (26), apenas 1 doente (3,8 por cento) desenvolveu câncer na bolsa ileal. Conclusões: 1. Ocorreram complicações operatórias em cerca de 1/3 dos pacientes, sendo mais frequentes após a confecção de bolsa ileal; 2. idade maior, tempo de seguimento e câncer colônico prévio se associaram...

The correlation between the status of circumferential resection margin and the prognosis of patients With middle and lower rectal carcinoma / 中华普通外科杂志

Objective To study the relationship between circumferential resection margin status and prognosis of patients with middle and lower rectal cancer.Methods Specimens from 49 patients with middle and lower rectal cancer undergoing total mesorectal excision were studied by the large slice pathologic technique.The local recurrence,metastasis and five-year survival rate were evaluated by Kaplan-Meier Survival analysis.The related clinicopathologic factors were also analyzed.Results The cancer involvement rate of the circumferential resection margins was 24%(12/49).The overall local recurrence rate was 12%(6/49),the distant metastasis and recurrence rate was 27%(13/49),and the five-year survival rate was 67%(33/49).For the 12 patients in which the eircumferential resection margin was tumor positive.the local recurrence rate was 33%compared with 5%in those with negative circumferential resection margin(X2=6.577,P=0.010),distant recurrence was 50%compared with 19%in those with tumor negative margin(X2=4.491,P=0.034).Kaplan-Meier survival analysis showed that patient's survival time was statistically correlative with the circumferential resection margin status(log-rank.P=0.009).Five-year survival rate was 33%in patients with positive circumferential resection margin,compared with 78%in those with negative margins.Tumor diameter(X2=4.451,P=0.035),T staging (X2=20.283,P=0.000),N staging(X2=7.773,P=0.018),the distance away from the anocutaneous line(X2=6.502,P=0.04),tumor location(X2=4.421,P=0.035)and operation type(X2=5.754,P=0.016)were significantly correlated with the circumferential resection margin status of the middle and lower rectal cancer.Conclusions The circumferential resection margin status was an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.and the status is significantly correlated with tumor diameter,T staging,N staging,the distance away from the anocutaneous line,tumor location and operation type.

Laparoscopic versus open surgery in the treatment of colorectal cancer / 中华普通外科杂志

Objective To compare the therapeutic efficiency of laparoscopic and open radical colorectal surgery in the treatment of colorectal carcinoma. Methods Clinical data of 77 cases undergoing laparoscopic colorectal surgery from September 2004 to October 2007 were compared with 90 patients treated by open surgery. Results Mean operating time was longer in the laparoseopic group than that in the open group [248 minutes vs. 225 minutes (t = -2. 11 ,P =0. 036)], blood loss was less in laparoscopic group [210 ml vs. 315 ml (t = 2. 82, P = 0. 005)]. Laparoscopic surgery was associated with lower rate of analgesia use [48% vs. 80% (x2 = 18. 69 ,P < 0. 01)], earlier recovery of bowel function [2. 9 days vs. 4. 3 days(t =5.59,P <0. 01)]and shorter hospital stay [12. 5 days vs. 15.5 days (t =2. 32,P=0. 039)]compared with open surgery. The number of removed lymph nodes [14. 2 vs. 15.3 (t = 1.04, P = 0. 3)]and length of reseeted bowel [18. 9 cm vs. 20. 0 cm, (t = 0. 88,P = 0. 383)]were not different between the two groups. The mean follow-up time of the two groups were 28 months, local recurrence rate, metachronous metastases rate and 3-year cumulative survival rate were not statistically different between the two groups. Conclusion Laparoscopic surgery is as effective as conventional open surgery in the treatment of colorectal carcinoma.

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.

Reservorio ileal con anastomosis reservorio anal por colitis ulcerosa: Complicaciones y resultados funcionales a largo plazo / Ileal pouch-anal anastomosis for ulcerative colitis: Complications and long term functional results

Background: The ileo anal-pouch-anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis (UC). Aim To analyze the surgical outcomes, long term evolution and functional results of IPAA. Material and methods: All patients subjected to an IPAA, from 1984 to 2006 were identified from a prospectively constructed inflammatory bowel disease database. Surgical variables, postoperative complications and functional evaluation, using Oresland score were analyzed. Chi square, Fischer exact test, T Student, Mann Whitney and binary logistic regression were included in the statistical analysis. Results: In the study period 107 patients, aged 14 to 62 years (61 females), subjected to an IPAA, were identified in this period. All patients, except 4, had a J pouch. All were protected with a loop ileostomy Thirteen patients (12.1 percent) had specific postoperative complications: pelvic collections in five (4.6 percent), wound infection in four (3.7 percent), fistula of the anastomosis in two (1.8 percent), hemoperitoneum and pouch necrosis in one each. Three (2.7 percent) patients were reoperated. There was no post-operative (30 days) mortality. A complete follow-up was obtained in 106 of 107 patients: four evolved as Crohn disease; four lost their pouch and two died for other causes. One patient required an ileostomy due to a vaginal fistula. Seventy two patients were followed more than 36 months after ileostomy closure and 92 percent have a satisfactory intestinal function. In the univariate analysis, poorest intestinal function was related to age of diagnosis of UC and presence of chronic pouchitis. In the multivariate analyses age of diagnosis was associated with poor function. Conclusions: IPAA has a low rate of complications. The long term intestinal function is satisfactory in most patients. A poorer intestinal function was observed in older patients and those with chronic pouchitis).

Clinical research of low resection of rectal carcinoma in pull-through anus operation / 中国医师进修杂志

Objective To explore the value of low resection of rectal carcinoma in pull-through anus operation and its influence factor with rectal carcinoma distant metastases along intestine wall.Method Clinical pathological and visited data of 43 patients with rectal carcinoma were analyzed prospectively.Resuits Forty--one cases were successfully accepted resection in pull-through anus (95.3%).No patient suffered from stoma leak,3 cases appeared recurrence after operation.Compared between high differentiation patients and mid differentiation patients,there was no significant difference, while the difference of comparing between high or mid differentiation patients and low differentiation patients respectively,there was significant difference.The difference of comparison among Dukes stage A,B or C was significant.Conclusions The right length of incising distant intestine tube is more than 2.0,3.0,4.0 cm respectively for rectal careinoma of high,mid and low differentiation or that of Dukes stage A,B or C.low resection of rectal carcinoma in puB-through anus should be considered as a regular operation.

Study of non-neoplasma touch and neoplasmacide technology on cancer of colon D_3 radical correction / 中国基层医药

Objective To explore the significance of non-neoplasma touch and neoplasmacide technology on cancer of colon D_3 radical correction.Methods 67 cases of cancer of colon D_3 radical correction were selected from 1998 January to 2003 March.They were treated with non-neoplasma touch and neoplasmacide technology and their curative effect were compared with the control group treated with D_ 1～2 modus operandi and without non-neoplasma touch and neoplasmacide technology.Results In the treatment group,no complication appeared after the operation.All cases cured.After 3 years follow-up,the recurrence rates were 34.9% in the control group and 14.9% in the treatment group.It had significant difference(P

The rectum cancer that reserves a pelvic autonomic nerve preservation 23 clinic analysis / 中国基层医药

Objective To the function that the rectum cancer of a pelvic autonomic nerve preservation to the male sufferer. Methods 23 cases of the rectum cancer patients in Dukes A,B,C underwent the operation of reserving a pelvic autonomic nerve perservation(2 among them for reserve the single side plant nerve). Results 7 cases happened d vsuresia in 21 cases of perserving double autoonomic nerve, whose occurrence rate was 30. 4 % (7 /23), and 6 cases happened sexual disturbance (26.1% ,6/23). It had signicant difference compared with the traditional operation(X2 = 10.3604,P = 0.001

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.

A comparison of defecation function between coloplasty pouch and colonic J-pouch in patients after resection for rectal carcinoma / 中国普通外科杂志

0.05). Conclusion The defecation function was similar between CPP group and CJP group. Therefore, the coloplasty pouch seems to be superior because of feasibility, simplicity, and effectiveness.