RESUMO
AIM: To improve the prevention of paracolostomic hernias. MATERIAL AND METHODS: We studied the prevention of paracolostomic hernia using mesh allograft. The study involved 73 patients with low-ampullary rectal cancer. Open or laparoscopic abdominoperineal extirpation of rectum was performed in all observations. 21 patients underwent prophylactic Sugarbaker's repair of paracolostomic area. We used the modifications of this surgical stage for transabdominal and retroperitoneal stoma. RESULTS: There were no postoperative complications associated with the use of allograft. The hernia occurred in one case (4.8%) of prevention group and in 14 (26.9%) patients of control group. CONCLUSION: The first results of composite allograft application to prevent paracolostomic hernias are encouraging. The absence of specific complications and favorable long-term results allow to continue the investigation.
Assuntos
Adenocarcinoma , Colostomia , Hérnia Incisional , Neoplasias Retais , Alotransplante de Tecidos Compostos Vascularizados , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Colectomia/métodos , Colostomia/efeitos adversos , Colostomia/métodos , Feminino , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Telas Cirúrgicas , Alotransplante de Tecidos Compostos Vascularizados/instrumentação , Alotransplante de Tecidos Compostos Vascularizados/métodosRESUMO
Mutations in the tumor suppressor gene p53 often lead to disarrangement of the cell cycle and of genetic integrity control of cells that may contribute to tumor development. We studied p53 gene mutations in 26 primary tumors of colorectal cancer patients. Mutations in p53 were found in 17 tumors (65.4%). All point mutations affected the DNA binding domain of p53 and were localized in exons 4-8 of the gene. Mutant p53 isoforms with altered domain structure and/or with alternative C-terminus arising from frameshift mutations or abnormal splicing were found in six tumors. Mutations Leu111Gln and Ser127Phe were shown in colorectal cancer for the first time. Isoforms p53-305 with C(4) insertion in codons 300/301 and p53i9* including an additional 44 nucleotides of the 3 -end of intron 9 were discovered for the first time. Mutations of p53 were associated with lymph node metastases and III/IV stage of tumors that are signs of unfavorable prognosis in colorectal cancer.
