RESUMO
OBJECTIVE: To investigate the effect of intra- and out-anorectal drainage in the prevention of anastomotic leakage after low anterior resection (LAR). METHODS: Two hundred and thirty-five patients undergone LAR were divided into two groups according to two periods, the former group from Mar. 2003 to Aug. 2004 and the later group from Sep. 2004 to Nov. 2007. Technique advances were adopted in the later group, especially the routine intra- and out-anorectal drainage. Incidence of anastomotic leakage and clinicopathological data of two groups were compared. RESULTS: Anastomotic leakage occurred in 4 patients of the former group (4/89) and 1 of the later group (1/146). Logistic analysis found that intra- and out-anorectal drainage was the main issue which prevented anastomotic leakage. CONCLUSION: Intra- and out-anorectal drainage is useful for the prevention of anastomotic leakage after low anterior resection.
Assuntos
Canal Anal/cirurgia , Drenagem/métodos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
AIM: To explore the germline mutations of the two main DNA mismatch repair genes (hMSH2 and hMLH1) between patients with hereditary non-polyposis colorectal cancer (HNPCC) and suspected (atypical) HNPCC. METHODS: Genomic DNA was extracted from the peripheral blood of the index patient of each family, and germline mutations of hMSH2 and hMLH1 genes were detected by PCR-single strand conformation polymorphism (PCR-SSCP) and DNA sequencing techniques. RESULTS: For PCR-SSCP analysis, 67% (4/6) abnormal exons mobility in typical group and 33% (2/6) abnormal exons mobility in atypical group were recognized. In direct DNA sequencing, 50% (3/6) mutation of MMR genes in typical group and 33% (2/6) mutation of MMR genes in atypical group were found, and 4/6 (66.67%) and 1/6 (16.67%) mutations of hMSH2 and hMLH1 were identified in typical HNPCC and atypical HNPCC, respectively. CONCLUSION: Mutation detection of the patients is of benefit to the analysis of HNPCC and, PCR-SSCP is an effective strategy to detect the mutations of HNPCC equivalent to direct DNA sequence. It seems that there exist more complicated genetic alterations in Chinese HNPCC patients than in Western countries.
Assuntos
Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Proteínas de Ligação a DNA , Proteínas de Neoplasias/genética , Proteínas/genética , Proteínas Proto-Oncogênicas , Proteínas Adaptadoras de Transdução de Sinal , Povo Asiático/genética , Sequência de Bases , Proteínas de Transporte , Neoplasias Colorretais Hereditárias sem Polipose/etnologia , Análise Mutacional de DNA , Saúde da Família , Mutação da Fase de Leitura , Testes Genéticos , Mutação em Linhagem Germinativa , Humanos , Proteína 1 Homóloga a MutL , Proteína 2 Homóloga a MutS , Proteínas Nucleares , Reação em Cadeia da Polimerase , Polimorfismo Conformacional de Fita SimplesRESUMO
OBJECTIVE: To study the clinicopathological features of the Chinese hereditary non-polyposis colorectal cancer and its germline mutation of hMLH(1) and hMSH(2). METHODS: Thirteen typical Chinese hereditary non-polyposis colorectal carcinoma (HNPC)C kindreds and 19 non-typical HNPCC families were registered and followed up. The germline mutation of the hMLH(1) and hMSH(2) of 12 index cases of 6 typical and 6 non-typical HNPCC were screened by PCR-SSCP. Samples with abnormal mobility were sequenced directly. RESULTS: The average age of typical HNPCC was 47, no difference existed between sexes. Location of the tumors of typical HNPCC represented 44.7% on the right half colon and non-typical HNPCC 65.8% on the rectum. The rate of the metachronos cancer was 11.5%. The 3-, 5-and 10-year survival rate was 64.0%, 45.3% and 31.2% respectively. Among 12 cases, 8 showed abnormal mobility. Except for an intron polymorphism, six exons abnormalities were found in 5 of 12 proband. Sequencing showed 4 missense, 7 insertion and a nonsense mutations. CONCLUSIONS: Chinese HNPCC is early onset, more common on proximal colon and better prognosis. Mutation of hMSH(2) is dominant in the Chinese typical HNPCC, but mutation of hMLH(1) is more common in the non-typical group.
Assuntos
Proteínas de Transporte/genética , Neoplasias Colorretais Hereditárias sem Polipose/genética , Mutação em Linhagem Germinativa , Proteína 2 Homóloga a MutS/genética , Proteínas Nucleares/genética , Proteínas Adaptadoras de Transdução de Sinal , Adulto , Povo Asiático/genética , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Análise Mutacional de DNA , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Mutação de Sentido Incorreto , Linhagem , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVE: To investigate the specificity and sensitivity of the immunohistochemistry for hMLH1 and hMSH2 with detection of microsatellite instability (MSI) to identify the kindreds with hereditary nonpolyposis colorectal cancer and to analyse its value in clinical practice. METHOD: Specimens of 16 cases with HNPCC and 16 cases with sporadic colorectal cancer were detected by immunostaining with hMLH1 and hMSH2 and MSI was also detected. RESULTS: The specificity and sensitivity of the immunohistochemistry for hMLH1 and hMSH2 were 91.7% and 87.5% respectively. The specificity and sensitivity of MSI were 100% and 75.0%. By combining two methods, the specificity and sensitivity were 91.7% and 93.8% respectively. CONCLUSIONS: By combination of the immunohistochemistry for hMLH1 and hMSH2 and detection of MSI to identify the kindreds with HNPCC, the specificity and sensitivity are improved which is better than to use either of them alone. And it is very easy and cheap that it can be used in clinics.
