大肠癌术后纤维结肠镜检查的价值

 126例大肠癌术后行纤维结肠镜检查，结果发现：复发癌18例、多原发癌10例，息肉恶变1例、息肉14例.笔者认为：凡病人术后有便血、腹痛、腹泻、腹部肿块、大便变细等，应及时行肠镜检查.术后定期肠镜随访有利于早期发现复发癌、多原发癌、息肉恶变和防治癌前期病变──大肠息肉。     

大肠镜对多原发大肠癌诊断价值探讨

近年来,我国大肠癌的发病呈明显上升趋势,随着大肠镜的普及和检诊技术的提高,多原发大肠癌的检出也在不断增多,今就我组9年间电子大肠镜检出的16例34个癌灶的多原发大肠癌作一总结,探讨大肠镜对多原发大肠癌的诊断价值。临床资料　一般资料:我院自1988年8月至1997年7月经电子大肠镜检出大肠癌278例,其中多原发癌16例,男12例,女4例,年龄40～70岁。同时多原发癌9例,异时癌5例,同时兼异时癌2例,异时癌相距时间最短1.5年,最长9年。病变及分布:16例多原发大肠癌共有癌灶34个,位于直肠8个,乙状结肠8个,降结肠3个,结肠脾曲1个,横结肠2个,结肠肝曲4…     

遗传性非息肉病性大肠癌的临床病理特点及手术方式选择——11个家系回顾性分析

 1991年 1月～ 2 0 0 2年 12月期间 ,在收治大肠癌 483例中进行家系调查 ,发现 11个遗传性非息肉病性大肠癌家系。遗传性非息肉病性大肠癌在临床病理和手术方式上与散发性大肠癌均有所不同 ,本文对这些病例进行回顾性分析 ,以提高对本病的认识 ,选择合理的手术方式。1　临床资料11个家系中共有 3 3例病人 ,男性2 5例 ,女性 8例。年龄 2 6～ 68岁 ,平均48岁。 10个家系有大肠以外的恶性肿瘤 16例 ,其中子宫内膜癌 3例、胃癌 4例、小肠癌、膀胱癌、前列腺癌、食道癌、胰腺癌、肝癌、肺癌、脑星型细胞瘤和慢性淋巴性白血病各 1例。在本院手术的 2 0例共有 3 0个癌灶 ,其中右侧结肠 2 1个 ,左侧结肠、直肠9个癌灶。 5例患同时性多原发癌 ,1例异时性多原发癌 ,2例为同时性和异时性多原发大肠癌。 2 0例共行大肠手术3 0例次 ,大肠外手术 8例次。 6例因大肠癌或大肠以外肿瘤作了 2次以上手术 ,其中经历 4、5次手术各 1例。Dukes分期 :B期 13例 ,C期 5例 ,D期 2例。高、中分化腺癌 10例 ,低分化癌 10例。 7例伴有散发性大肠息肉 ,其中 3例...     

多原发大肠癌51例分析

本文报告了经手术病理证实的多原发大肠癌５１例，其中同时性多发癌３１例，异时性多发癌１５例，同时性癌兼异时性癌５例。５１例多原发癌中伴腺瘤者２８例（５４．９％）；１８例腺瘤癌变，占癌伴腺瘤者的６４．３％。本病易被误诊和漏诊，术前常规结肠镜检查，术中全结肠探查和术后长期随访．是提高多原发大肠癌诊断率的重要措施。手术切除范围应根据分布部位、Ｄｕｋｅｓ分期及伴发腺瘤的多少与部位分布而定。     

胃癌术后胃镜随诊的临床意义(附986例报告)

目的 探讨胃癌（ＧＣ）术后胃镜随诊的临床意义。方法 ９８６例ＧＣ术后３周至２１年进行胃镜随诊检查，每例检查１￣５次，结果 检出残胃复发癌７５例，胃原重复癌４例，残胃癌９例，残胃功能性排空障碍１２例，胃管，硅胶管滞留９例。其他非癌性病变包括：吻合口周围炎１８７例，缝线残留９１例，金属钉外露４例，吻合口周围糜烂，溃疡分别为５１例和２２例，炎性息肉３８例，疤痕性狭窄１１２例。结论 ＧＣ术后胃镜随诊断及时     

128例结直肠恶性肿瘤病人术后纤维结肠镜随访结果分析

为评价纤维结肠镜检在结直肠恶性肿瘤病人术后随访中的价值及确定如何制订随访计划,本文回顾性地分析了中山医院1979.1～1985.6月128例结直肠恶性肿瘤病人术后纤维结肠镜随访检查的资料。镜检距手术时间最短者1月,最长者12年。平均随访时间32.5月。全结肠检查成功率99.4％,无并发症。镜检发现复发癌6例、多发癌8例次、息肉21例次、吻合口炎6例次、吻合口狭窄1例次、结肠炎1例次,总阳性率25.％6。     

大肠多原发癌18例总结

本院收集了我院自1972年至1985年间485例大肠癌中18例大肠多原发癌(发病率3.75％),其中同时多原发癌8例(44.4％),异时多原发癌10例(55.5％)。首发癌部位无一定规律,后发生的原发癌多见于降结肠及乙状结肠。本组资料表明大肠息肉易发生多原发     

多原发性大肠癌

大肠癌中部分患者表现为多发原发性大肠癌。可分为同时性多原发癌 (syn-chronous carcinoma,SC)和异时性多原发癌 (metachrom ous carcinom a,MC)。现就我院收治的多原发性大肠癌 15例的临床特点及病理和诊断、治疗进行讨论。1　临床资料1.1　诊断标准　本组资料采用 L ee提出的诊断标准 [1 ] :(1)癌灶间隔以正常肠壁 ;(2 )肿瘤与正常肠壁间有异型细胞和异型腺体组成的移行区 ;(3)癌灶必须与原吻合口无关 ;(4 )必须除外 1癌灶内另1癌灶转移复发及粘膜下播散的可能 ;(5 )不包括溃疡性结肠炎或家族性结肠息肉病患者 ;(6 )多发癌灶于同时或 6…     

多原发大肠癌28例临床分析

多原发大肠癌日益被国内外学者所重视 ,临床报告也随之逐年增加。本文总结自 1980 - 1995年我院15年间 638例大肠癌中多原癌 2 8例 ,占同期大肠癌的 4 39%。并对其诊断及治疗进行分析报导。临床资料同时多发癌患者 15例 ( 2 35% ) ,异时多发癌患者 13例 ( 2 0 4 % ) ,共 2 8例。其中男性 16例 ,女性 12例 ,年龄为 2 4～ 78岁。同时癌中 15例 ,其中 7例为手术检查时发现 ,8例为术前检查时发现。异时癌 13例 ,诊断间隔在半年至 10年。在多原发癌中 ,伴发结直肠息肉者 8例 ( 30 % ) ,包括管状腺瘤、绒毛状腺瘤及管状绒毛状腺瘤 ,息肉大多未…     

多原发大肠癌70例临床分析

背景与目的:多原发大肠癌在大肠癌中并非少见,但其生物学行为较独特。本研究探讨多原发大肠癌(MPCC)的临床特点、诊断、外科治疗及预后。方法:对1997～2003年间手术治疗的70例MPCC患者的临床资料进行回顾性研究,其中同时性多原发大肠癌(SC)61例,异时性多原发大肠癌(MC)9例,并结合随访资料进行生存分析。结果:55例患者术前经肠镜、钡灌肠或CT诊断,15例患者因远端肿瘤过大无法进镜于术中诊断。70例患者中伴发结肠多发腺瘤性息肉者33例。除3例患者肿瘤广泛播散仅行短路手术外,其余均同期手术切除。其中根治性切除52例,姑息性切除15例。总的3年和5年生存率分别为65.7%和45.7%,其中根治性切除患者的3年和5年生存率分别为78.1%和59.3%。结论:MPCC的发生过程与腺瘤及息肉关系密切。其手术治疗并无固定模式,需根据肿瘤的位置、范围、间距以及患者的综合情况等决定。MPCC总体预后较好。应着重随访伴发腺瘤及息肉的MPCC患者。     

Endoscopic follow-up in resected colorectal cancer patients

Patients resected for colorectal cancer are at risk for anastomotic recurrence, for adenomatous polyps and for metachronous cancer. The present retrospective study was conducted to evaluate the incidence of neoplasms of the colon, both metachronous or recurrent, in 322 patients. They were observed and resected for colorectal cancer between 1970 and 1988, with complete staging, and all agreed to be included in a follow-up program (median followup: 105 months). All the patients were submitted to colonoscopy once yearly for the first 5 years and then every 2 years. Anastomotic recurrence was observed in 22 of the 253 patients who underwent resection for rectal or sigmoid adenocarcinoma (8.7%). Sixteen of these patients were submitted to a second curative resection with a median survival of 35 months; the median survival was 6 months in the 6 patients who could not undergo this operation (p=0.0018). Metachronous adenomas of the residual colon were found in 24 patients and metachronous cancers in 5 at Stage A, according to Dukes' classification. In conclusion, a regular colonoscopic surveillance in patients resected for colorectal cancer is justified for early detection and potential resection of anastomotic recurrences, new primary cancer and adenomatous polyps. In patients resected for rectal or sigmoid carcinoma, a sigmoidoscopy should be performed every 6 months for the first 2 years for the early detection of anastomotic recurrences. In all cases, a colonoscopy should be performed every 5 years after surgery to detect metachronous lesions. Before surgery, a "clean colon" should always be established to detect possible synchronous lesions.     

Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Compliance, recurrence, and survival

Between January 1975 and December 1984 1769 polyps were endoscopically removed from 1219 patients. Eight percent of these patients had polyps containing severe atypia and 5.0% had polyps containing invasive cancer. A close postoperative surveillance program was followed by only a few patients, but compliance improved with longer follow-up intervals. Metachronous polyps were observed with similar frequency in patients with benign polyps (34.8%) and those with polyps containing severe atypia (23.8%) or cancer (41.7%). Patients in whom malignant polyps were endoscopically removed had a 5-year survival rate of 84.3% that did not differ from that of patients' whose polyps contained severe atypia (79.0%). It was concluded that endoscopic removal of malignant polyps with favorable histologic conditions does not impair survival. The follow-up program of these patients should be adapted to that of patients with benign polyps, a procedure that may even improve patient compliance.     

Clinical manifestations in patients with hereditary nonpolyposis colorectal cancer

The clinical manifestations of 1,042 Japanese patients with nonpolyposis colorectal cancer who underwent a resection between 1972 and 1992 at the National Kyushu Cancer Center were examined. Hereditary nonpolyposis colorectal cancer (HNPCC) was found in 39 (3.7%) patients. Some characteristic findings in HNPCC cases included early age of onset, a preponderance of right colon cancers, an increased frequency of colorectal cancers, and a favorable survival. Metachronous (postoperative) colorectal cancers developed significantly more often in cases with HNPCC than in those without (12.8% vs. 1.8%, P = 0.0001). Metachronous (postoperative) extracolonic cancers tended to develop more often in cases with HNPCC than in those without (10.2% vs. 3.5%, P = 0.053). In cases with HNPCC, the mean interval between the initial surgery and the diagnosis of the second cancer was 61 months (range; 12–153 months). These findings thus indicate the importance of routine and long-term follow-up to identify any second lesions, especially in patients with HNPCC. © 1996 Wiley-Liss, Inc.     

Distribution of Cancer and Adenomatous Polyps in the Colorectum: Study in an Iranian Population

Objective: There is consensus that the majority of colorectal carcinomas (CRCs) arise from adenomatous polyps. ‍Therefore, for management of colorecatl cancer, diagnosis and endoscopic resection of adenomas is advised. If the ‍same etiologic factors are operating for polyps and cancers their anatomical distributions should be the same. The ‍present study was conducted to determine whether the distribution of adenomas is consistent with that of CRCs and ‍for comparison with other studies, especially in Western populations. Materials and methods: We reviewed, ‍retrospectively , endoscopically reported anatomic sites of all adenomatous polyps and CRCs which were histologically ‍confirmed from Jan 1992 to Dec 2005 in Tabriz, the North-west of Iran. One hundred and forty-three CRC’s and ‍180 adenomatous polyps (in 145 patients) were found. Patients with polyposis syndromes were excluded the analysis. ‍Age and sex of patients, size and anatomic sites of polyps and cancers were studied. Results: The average ages of ‍patients with adenomas and cancers were 46.3(SD 14.7) and 53.9(SD 13.3)years, with 55.5% and 62.2% in males, ‍respectively. In both cancer and adenoma cases the most common presenting symptoms were rectal bleeding and ‍bloody diarrhea ( 52.4% , 16.9% and 39.2% , 15.8% for cancers and adenomas, respectively )without any significant ‍difference(0>05). The vast majority of adenomas (85%) and cancers (81.7%) were left sided (p>0.05). The propensity ‍for polyps to be found in the descending colon was of corderline significance (p=0.07). The cecal segment uniquely ‍demonstrated cancers(p=0.01) without any polyps. Conclusion: A similar anatomic distribution pattern and left ‍shift of colorectal adenomas and cancers in this Iranian population is compatible with most other Asian countries . ‍However, because of the occurrence of the neoplasms in the right colon total colonoscopy should still be considered ‍for screening purposes.     

Temporal relationship between prostate brachytherapy and the diagnosis of colorectal cancer

PURPOSE: To identify the location of pretreatment and posttreatment colorectal malignancies and posttreatment colorectal polyps in patients with clinically localized prostate cancer managed with brachytherapy. METHODS AND MATERIALS: From April 1995 through July 2004, 1,351 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (American Joint Committee on Cancer, 2002) prostate cancer. Supplemental external beam radiotherapy (XRT) was administered to 699 patients. The median follow-up was 4.6 years. Operative and pathology reports were reviewed for all patients with pretreatment and posttreatment colorectal cancer and posttreatment colorectal polyps. Multiple parameters were evaluated for the development of colorectal cancer or colorectal polyps. RESULTS: Colorectal cancer was diagnosed in 23 and 25 patients before and after prostate brachytherapy, respectively. No differences were identified in the distribution of colorectal cancers either before or after treatment (3 and 4 rectal cancers in the pre- and postbrachytherapy cohorts). Thirty-five of the 48 colorectal cancers (73%) were diagnosed within 5 years of brachytherapy with a peak incidence 1 year after brachytherapy. One hundred ninety-two colorectal polyps were diagnosed after brachytherapy, 160 (83%) occurred within 4 years of brachytherapy, and only 27 (14%) were located in the rectum. In multivariate Cox regression analysis, prostate D(90) (minimum percentage of the dose covering 90% of the target volume) predicted for posttreatment colorectal cancer. Rectal polyps were most closely related to patient age and percent positive biopsies, whereas sigmoid/colon polyps were best predicted by patient age, planning volume, and supplemental XRT. CONCLUSIONS: Colorectal cancer was diagnosed with equal frequency before and after brachytherapy with comparable geographic distributions. In addition, the vast majority of postbrachytherapy colorectal polyps were located beyond the confines of the rectum.     

全胃切除预防返流性食管炎方法的探讨

本文对28例胃癌行全胃切除,用改进的Plenk法行消化道重建,有效地防止了返流性食管炎。术后行胃镜检查,吻合口处无胆汁糜烂、出血、息肉,也未发生吻合口漏和吻合口梗阻。本文较详细地介绍了手术方法,并与其他手术术式进行了分析和比较,作者认为本法简单、可靠、易行。     

结直肠癌伴发息肉的处理策略

目的：了解结直肠癌患者伴发大肠息肉的发生规律,探讨结直肠癌伴发息肉的合理治疗策略。方法：对311例结直肠癌患者临床资料进行回顾性分析,对患者伴发息肉情况进行统计分析。结果：在311例结直肠癌中有68例伴发大肠息肉,共136枚,其中99枚为腺瘤性息肉,有中度不典型增生94枚,有2枚息肉有局灶性癌变;术前诊断66枚,术中诊断35枚,术后诊断35枚,梗阻性结直肠癌伴发息肉的发病率（21/58）高于非梗阻性结直肠癌（χ^2=5.06,P〈0.05）。结论：重视结直肠癌伴发息肉的处理,术前应仔细的肠镜全结肠检查,必要时行术中肠镜检查,对于手术前未能行全结肠检查的患者建议术后早期进行肠镜检查,对息肉可酌情采取活检夹除、电灼、电凝套切、粘膜下切除及术中切除等方法处理。     

老年直肠癌术后吻合口瘘的高危因素分析

目的:探讨老年直肠癌术后吻合口瘘的高危因素。方法:选择我院于2014年5月至2018年5月期间收治的老年直肠癌患者437例,均采用腹腔镜直肠癌根治法。分析影响老年直肠癌术后吻合口瘘的高危因素。影响因素包括性别、术前白蛋白、手术时间、合并高血压、合并糖尿病、吻合口距肛缘距离、肠梗阻、Dukes分期、BMI、出血量、血管侵犯和神经侵犯。结果:老年直肠癌患者行腹腔镜根治术后发生吻合口瘘29例,发生率为6.64%。经单因素分析表明,两组性别、合并高血压、合并糖尿病、Dukes分期、BMI、出血量和神经侵犯比较差异无统计学意义（P>0.05）;吻合口瘘组术前白蛋白≤35 g/L、手术时间＞3 h、吻合距肛缘距离≤7 cm、肠梗阻、血管侵犯人数明显增多,差异具有统计学意义（P<0.05）。将上述单因素分析差异具有统计学意义的纳入多因素分析显示,术前白蛋白≤35 g/L、手术时间＞3 h、吻合距肛缘距离≤7 cm、肠梗阻和血管侵犯为影响术后吻合口瘘的高危因素。结论:老年直肠癌术后吻合口瘘受术前白蛋白、手术时间、吻合距肛缘距离、肠梗阻和血管侵犯影响,为降低术后吻合口瘘,需按照相关因素采取针对性预防措施。     

食管癌术后吻合口狭窄预防方法的探讨

背景与目的：食管癌是我国常见的恶性肿瘤之一。吻合口狭窄是食管癌术后常见的并发症之一,严重影响患者术后生活质量。该研究通过吻合技术的改变,探讨预防食管癌术后吻合口狭窄的方法。方法：患者随机分组,单号入院者为对照组,双号入院者为实验组。对照组患者行食管胃吻合时采用吻合器直接行食胃管吻合,实验组患者行食管胃吻合前,先荷包缝合收缩吻合部胃壁再上吻合器行食管胃吻合。术后6个月后随访,统计两组患者吻合口狭窄的发生率并进行统计学比较。结果：对照组患者术后吻合口狭窄发生率为19.2%,实验组患者为0%,差异有统计学意义(χ2=22.8,P<0.005),对照组吻合口狭窄发生率明显高于实验组。结论：食管癌手术用吻合器吻合胃和食管前先荷包缝合收缩吻合部胃壁的方法可有效降低食管癌术后吻合口狭窄的发生。     

单层排线吻合法在食管癌及贲门癌手术中的应用价值

目的评价单层排线吻合法在食管癌及贲门癌术中的应用价值。方法 157例食管癌、贲门癌患者采用单层排线法吻合(单层排线组),155例采用传统食管-胃双层包埋法吻合(传统组),对比两组术后吻合口瘘及狭窄的发生情况。结果单层排线组术后无1例发生吻合口瘘,仅有2例轻度吻合口狭窄(占1.27%);传统组术后发生吻合口瘘5例(3.23%),吻合口狭窄8例(5.16%),其中5例为中、重度狭窄。两组术后吻合口瘘及狭窄的发生率比较差异有统计学意义(均P<0.05)。结论以单层排线吻合法行食管癌、贲门癌根治术食管-胃吻合,操作简单、省时、易学,并能有效预防术后吻合口瘘及吻合口狭窄。