RESUMO
Objective To evaluate the curative effect and superiority of minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA.Method Local resection was clone in 15 patients with cancerate rectal adenoma or early rectal cancer,the tumours were excised intactly by 5 mm CUSA(submucosal or superficial muscularis),the incisions were closed by continuous suture in the lumen.Results All of the tumours were excised intactly,the incisal edges and funduses were all negative.The operation time was 30～180 min,average:60 min,the amount of bleeding during operation was 0～30 ml,average:10 ml.Complications:temporary fecal incontinence in 2 cases,acute urinary retention in 1 case.Pathology after operation:villous adenoma accompanied by high grade intra epithelial neoplasia in 8 cases,mixed adenoma in 2 cases,intra-mucosal carcinoma in 5 cases.15cases were followed up 4～48 months,averge 18 months,no tumour recur in original place.Conclusion Minimally invasive transanal surgery by CUSA is a safe and effective operation in the treatment of cancerate rectal adenoma and early rectal cancer.It can keep the anus and improve the quality of life.
RESUMO
Objective To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux-en-Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux-en-Y jejunal p-type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases. 86 patients (76%)have been followed up, the postoperative 1-,3-,5-year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9％,45.7％,37.2％;88.8％,55.5％,33.3％; and 80％,0％,0％ respectively. Conclusions The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.
RESUMO
Objective To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux en Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux en Y jejunal p type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases. 86 patients (76%)have been followed up, the postoperative 1 ,3 ,5 year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9%,45.7%,37.2%;88.8%,55.5%,33.3%; and 80%,0%,0% respectively. Conclusions The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.