高迁移率族蛋白B1和血管内皮生长因子在老年直肠癌中的表达及其与预后的相关性

目的探讨老年直肠癌组织中高迁移率族蛋白(HMG)B1和血管内皮生长因子(VEGF)表达与直肠癌临床病理特征及直肠癌患者预后的相关性。方法选取该院2012年12月至2014年12月手术治疗的122例老年直肠癌患者,应用免疫组化法检测122例直肠癌组织中HMGB1和VEGF的表达,分析其与直肠癌临床病理特征的关系,二者在直肠癌中表达的相关性及其与老年直肠癌患者预后的相关性。采用KaplanMeier法作生存分析,分析HMGB1和VEGF的表达与患者预后生存期的关系。结果 HMGB1和VEGF在直肠癌组织中的阳性表达率分别为66.39%和59.02%,HMGB1的阳性表达率与TNM分期、淋巴结转移和浸润深度有关(P0.05),而与性别、分化程度和远处转移无关(P0.05)。VEGF阳性表达率与TNM分期、淋巴结转移、远处转移和浸润深度有关(P0.05),而与患者的性别、分化程度无关(P0.05)。HMGB1和VEGF在直肠癌中的阳性表达率呈显著正相关(r=0.576,P0.01)。Kaplan-Meier生存分析结果显示,HMGB1和VEGF表达阳性患者的中位生存期显著低于表达阴性者(P0.05)。结论直肠癌中HMGB1和VEGF的表达与直肠癌临床病理特征和预后密切相关,联合检测HMGB1和VEGF对判断结老年直肠癌的预后具有一定的指导意义。     

膀胱癌组织中p53、血管内皮生长因子、环氧化酶-2和表皮生长因子受体的表达

目的检测表皮生长因子受体(EGFR)、血管内皮生长因子(VEGF)、环氧化酶-2(COX-2)及p53在膀胱癌组织中的表达及其与临床病理特征的相关性。方法选择初发性膀胱癌石蜡标本48例,应用免疫组化SP法检测48例膀胱癌组织中的EGFR、VEGF、COX-2、p53的表达水平,并结合临床资料进行统计学分析。结果 EGFR、VEGF、COX-2、p53的表达与性别、年龄、肿瘤直径、病理分级无显著相关性(P>0.05);EGFR、VEGF、COX-2、p53的表达与分化程度、淋巴结转移、脉管侵犯、临床分期有显著相关性(P<0.05);膀胱癌组织中p53的表达强度与EGFR、VEGF、COX-2的表达强度呈正相关(r=0.205,P=0.020;r=0.278,P=0.001;r=0.218,P=0.004);COX-2表达强度与EGFR、VEGF的表达强度呈正相关(r=0.395,P=0.001;r=0.198,P=0.016)。结论 EGFR、VEGF、COX-2、p53在膀胱癌组织中高表达,与膀胱癌分化程度、淋巴结转移、脉管侵犯、临床分期密切相关,可作为临床判断转移及预后等生物学行为的重要参考指标。     

CTHRC1和VEGF-C在直肠癌组织中的表达及相关性

目的:探讨血管内皮生长因子(VEGF-C)和胶原三股螺旋重复蛋白1(CTHRC1)在直肠癌组织中的表达特点及二者的相关性.方法:收集我院2004-10/2006-08手术切除的直肠癌病理标本98例, 术前均未行任何治疗. 采用免疫组织化学方法检测VEGF-C和CTHRC1的表达. 分析他们的表达与患者年龄、性别以及直肠癌分化程度、临床分期及淋巴结转移的关系.结果:VEGF-C主要分布于肿瘤细胞中, 其表达与直肠癌分化程度、临床分期及淋巴结转移密切相关( P<0.05); CTRHC1表达与直肠癌分化程度、临床分期密切相关( P<0.05), 二者与直肠癌发生的年龄、性别无明显相关. 此外, CTRHC1与VEGF-C的表达量呈正相关( r =0.629, P<0.001).结论:VEGF-C和CTHRC1在直肠癌侵袭转移中可能起重要作用, 二者的表达可作为判定直肠癌生物学行为的参考指标.     

结直肠癌患者血清中血管内皮生长因子和一氧化氮表达水平及其临床意义

目的:探讨结直肠癌患者血清中血管内皮生长因子(VEGF)和一氧化氮(NO)表达水平及其临床意义.方法:分别采用酶联免疫吸附测定(ELISA)法和分光光度法检测74例结直肠癌患者术前和45例结直肠腺瘤患者以及40例健康人血清中VEGF和NO的含量.结果:结直肠腺瘤患者血清VEGF和NO含量与健康人无明显差异(P＞0.05);结直肠癌患者血清VEGF和NO表达水平分别较结直肠腺瘤组以及健康人明显增高(P＜0.01),且结直肠癌浸润深度、有无淋巴结转移以及Dukes分期与血清VEGF和NO含量呈明显正相关(r=0.834,P＜0.01).结论:VEGF和NO与结直肠癌的发生发展密切相关,术前检测血清VEGF和NO含量可作为判断结直肠癌浸润转移以及Dukes分期的有效生物学指标.     

荧光定量PCR检测CK20在直肠癌外周血中表达的意义

目的:分析外周血中CK20基因产物的表达与直肠癌Dukes分期和组织学分型的关系,探讨用FQ-PCR检测CK20来预测直肠癌微转移以及判断患者预后的价值.方法:采集47例直肠癌患者外周血标本、10例良性肠道病患者及10例健康志愿者外周血标本.用FQ-PCR检测外周血CK20的表达情况.结果:10例良性肠道病患者及10例健康志愿者外周血中均检测不到CK20的表达,与直肠癌组有明显差异(72.34%,34/47)(χ2=37.434,P<0.01).47例直肠癌患者外周血中CK20的表达量与Dukes分期呈正相关(r=0.680,P<0.01).结论:直肠癌外周血中CK20的表达量与肿瘤分期有关,并且分期越晚CK20的表达量越多,用CK20FQ-PCR检测癌转移较常规病理组织学敏感,对直肠癌患者病情的判定、疗效评价及恢复情况具有重要临床意义.     

胰腺癌组织中p53、血管内皮生长因子的表达与血管生成的关系及其临床意义

目的探讨胰腺癌组织中p53、血管内皮生长因子(VEGF)和血管生成的关系.方法用免疫组织化学方法检测48例胰腺癌组织及癌旁组织、6例正常胰腺组织中p53、VEGF表达和微血管密度(MVD).结果胰腺癌组织中VEGF、p53的阳性表达率分别为54.17%和50%,显著高于癌旁组织及正常组织的表达率(P < 0.01),胰腺癌组织中MVD显著高于癌旁组织及正常组织.VEGF表达与肿瘤大小和分期有关(P=0.038,P=0.045),VEGF表达与MVD有相关性(r=0.294 P=0.043).p53与淋巴结转移及预后相关(P < 0.05)而与VEGF、MVD之间无关.MVD与胰腺癌临床病理特征无关,MVD与生存期存在负相关(r=-0.371 P=0.011).多元回归分析显示p53、VEGF和MVD都不是影响胰腺癌预后的独立因素.结论 p53基因突变为胰腺癌分子事件的晚期事件,可作为评价胰腺癌预后的一项指标,抗血管生成可能有利于胰腺癌的治疗.     

胃癌组织中eIF4E、VEGF和Cyclin D1的表达及其意义

目的:研究胃癌组织中真核细胞起始因子4E(eukaryotic initiation factor 4E.eIF4E),血管内皮生长因子(vascular endothelial growthfactor,VEGF)和细胞周期素D1(Cyclin D1)蛋白的表达水平及其与临床病理的关系.方法:胃癌组织91例和正常胃黏膜组织30例采用免疫组织化学方法检测eIF4E,VEGF和Cyclin D1的表达,分析其表达差异,并结合其临床病理资料进行综合分析.结果:与正常胃组织相比,eIF4E,VEGF和Cyclin D1蛋白在胃癌组织中均呈高表达(95.6%,68.1%,84.6% vs 0.0%,均P＜0.01).eIF4E,VEGF和Cyclin D1的阳性表达率与患者的年龄、性别以及肿瘤分化程度均无明显相关性,但随着肿瘤浸润深度加深、淋巴转移产生、临床分期提高而升高(P＜0.05).eIF4E与VEGF,eIF4E与Cyclin D1的表达呈正相关(r=0.407,P＜0.05;r=0.780,P＜0.01).结论:eIF4E,VEGF和Cyclin D1的表达与胃癌的侵袭、转移密切相关,eIF4E表达与VEGF以及Cyclin D1显著相关.     

Skp2在结直肠癌中的表达及其与VEGF、MVD的关系

背景:近年来结直肠癌的发病率和死亡率呈上升趋势,从基因水平诊断和治疗癌症已成为一种新兴的有效手段。目的:探讨S期激酶相关蛋白2(Skp2)在结直肠癌中的表达及其与血管内皮生长因子(VEGF)、肿瘤微血管密度(MVD)的关系。方法:选取2014年3月—2015年3月湖北医药学院附属人民医院35例结直肠癌患者,以15例癌旁组织作为对照。采用免疫组化SP法检测Skp2、VEGF表达和MVD值,分析其与临床病理特征的关系。结果:结直肠癌组织中Skp2表达显著高于癌旁组织(P=0.000),且与肿瘤分化、淋巴结转移呈正相关(P0.05),与性别、年龄、TNM分期无明显相关性(P0.05)。结直肠癌VEGF表达和MVD值显著高于癌旁组织(P=0.019,P=0.002),且与结直肠癌淋巴结转移和TNM分期相关(P0.05)。结直肠癌Skp2表达与VEGF表达、MVD值均呈正相关(r=0.569,P=0.000;r=0.481,P=0.017)。结论:结直肠癌组织Skp2异常高表达可能与肿瘤血管生成有关,Skp2、VEGF表达和MVD值可作为判断结直肠癌恶性程度的重要指标。     

贲门癌组织环氧化酶-2和血管生成因子的表达及其与血管生成的关系

目的:探讨环氧化酶-2(COX-2)和血管生成因子(VEGF)在贲门癌组织中的表达及其与肿瘤血管生成的关系.方法:免疫组化法检测贲门癌手术切除标本46例和癌旁正常黏膜标本21例中COX-2,VEGF表达.采用抗CD34抗体标记微血管内皮细胞,计算微血管密度(MVD).分析COX-2,VEGF表达与MVD和贲门癌主要临床病理特征的相关性.结果:贲门癌组织COX-2,VEGF阳性表达率、MVD值显著高于癌旁正常黏膜的(80.4% vs 14.3%,x~2=26.22,P<0.01;76.1% vs 19.1%,x~2=19.28,P<0.01:31.95±3.87 vs 16.28±1.55,t=17.76,P<0.01).COX-2,VEGF表达、MVD值与肿瘤临床TNM分期和淋巴结转移密切相关,TNM分期中Ⅲ Ⅳ期的贲门癌组织中COX-2,VEGF表达率、MVD值显著高于Ⅰ Ⅱ期的(90.3% vs 60.0%,x~2=5.91,P<0.05;96.8% vs 46.7%,x~2=16.13,P<0.01;33.43±3.34 vs 28.90±3.08,t=4.42,P<0.01).伴有淋巴结转移的贲门癌组织中COX-2,VEGF表达率,MVD值显著高于无淋巴结转移的(94.1% vs 41.7%,x~2=15.51,P<0.01:91.2% vs 50.0%,x~2=9.56,P<0.01;33.53±3.21 vs 27.48±1.03,t=6.38,P<0.01).Spearman等级相关分析表明,COX-2,VEGF表达与MVD呈显著正相关(r= 0.823:r=0.892,P<0.01).结论:COX-2,VEGF异常表达及其诱导的血管生成在贲门癌的侵袭和淋巴结转移中起重要作用.     

HIF-1α在结直肠癌中的表达及临床意义

目的 探讨HIF-1α在结直肠癌中的表达情况及其与临床资料之间的关系.方法 利用免疫组化方法检测150例结直肠癌患者组织标本中HIF-1α、HK-Ⅱ、VEGF的表达情况,并将检测结果与患者的临床资料进行对比分析.结果 HIF-1α、HK-Ⅱ、VEGF的表达与患者年龄无关(P＞0.05),HIF-1 α、HK-Ⅱ、VEGF与结直肠癌的分期、分化程度有关,在分期晚、分化程度差的结直肠癌组织中的表达率高,且HIF-1α与结直肠癌淋巴结转移有关(P＜0.05),HK-Ⅱ、VEGF与结直肠癌淋巴结转移无关(P＞0.05).HK-Ⅱ、VEGF的在结直肠癌组织中的表达率与HIF-1α的表达率呈正相关.结论 HIF-1α表达可以提示结直肠癌的分期、分化程度及淋巴结转移情况,且HIF-1可能诱导HK-Ⅱ及VEGF表达,对结直肠癌的早期筛查、预后判断具有指导意义.     

Evaluation of Rectal Sensory and Motor Function by Means of the Electronic Barostat After Stapled Hemorrhoidopexy

Purpose  Stapled hemorrhoidopexy is designed to replace the hemorrhoids into the anal canal by excising the redundant rectal mucosa above the anorectal ring, thus resulting in an intrarectal suture. Few studies have evaluated rectal function after this procedure. This prospective study was designed to use the electronic barostat to assess whether rectal motor and sensory functions change after stapled hemorrhoidopexy. Methods  Ten patients (4 women, mean age, 46 ± 9 years) with third-degree and fourth-degree hemorrhoids who underwent stapled hemorrhoidopexy were studied. One week before and six months after surgery, they underwent three different rectal distensions (pressure-controlled stepwise, volume-controlled stepwise, and ramp) controlled by an electronic barostat. Results  Rectal distensibility was significantly lower after surgery during pressure stepwise (P = 0.01), during volume stepwise (P = 0.006), and during ramp distension (P = 0.001). Volume thresholds for desire to defecate, urgency, and discomfort were significantly lower after surgery during all three distensions (P < 0.05). Volume threshold for first perception also was significantly lower after surgery during volume ramp distension (P = 0.01). Conclusions  Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. These impairments persist for at least six months after surgery. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.     

Magnetic resonance imaging based rectal cancer classification: Landmarks and technical standardization

Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we propose our new classification based of Magnetic resonance imaging(MRI). We determine the relation of the tumor to fixed parameters in MRI, which areperitoneal reflection and levator ani muscle. Then, we classify the rectal cancer into four levels based on tumor distal margin and invasion to MRI parameters. We applied all three classifications to 60 retrospectively collected patients of different rectal cancer distance and we compared our classifications to the others. Based on each level we standardize our surgical approach. For stages Ⅰ-Ⅲ, We found that level Ⅰ where tumor distal margin is located above the peritoneal reflection and all of them were received low anterior resection(LAR) without chemoradiation. Level Ⅱ where tumor distal margin is located from the peritoneal reflection and above the levator ani insertion on the rectum. 90% of them were received LAR ± chemoradiation. Level Ⅲ where tumor distal margin is located at the level of levator ani insertion or invading any part of the levator ani. 60% of them had ULAR + coloanal anastomosis ± chemoradiation. Level Ⅳ where the tumor distal margin is located below the levator ani insertion; 77% were received APR ± chemoradiation. The overall kappa for all levels between surgeons and radiologist was 0.93(95%CI: 0.87-0.99), which is indicating almost perfect agreement. We concluded that the management of rectal tumors differed among each tumor level and our new MRI based classification might facilitate the prediction of surgical and chemoradiation management with better communication among a multidisciplinary team comparing to other classifications.     

Isolated rectal diverticulum complicating with rectal prolapse and outlet obstruction： Case report

The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently. Treatments of these complicated events range from conservative treatments to major surgical interventions. We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.     

Magnetic Resonance Imaging of the Rectum During Distension

PURPOSE A knowledge of the relationships between the rectum and its surrounding structures during distention may improve our understanding of the results of studies assessing rectal sensory-motor responses to distention. This magnetic resonance imaging study was designed to assess the shape of the rectum and the degree of distention at which the surrounding structures are compressed.METHODS Nine healthy patients underwent magnetic resonance imaging of the rectum under resting conditions and after the inflation of a plastic bag to volumes of 50, 100, 150, 200, and 250 ml. The thickness of the rectovesical space was assessed as a measure of the compression of the perirectal structures, and the perception of sensations were recorded.RESULTS The shape of the rectum changed from being quasicylindrical at distention volumes of <100 ml to bean-shaped at larger volumes. The thickness of the rectovesical space at a distention volume of 50 ml was the same as when the bag was not inflated, but it progressively decreased until the difference became statistically significant at distention volumes of ≥200 ml, corresponding to a mean ± standard deviation rectal radius of 2.66 ± 0.37 cm. Statistically significant compression of the rectovesical space was recorded when the sensations of gas, desire to defecate, and urgency were perceived. CONCLUSIONS The shape of the rectum changes during distention; it significantly compresses the extrarectal structures in the tested range of distention that induces nonpainful sensations. Magnetic resonance imaging is a useful means of assessing the morphologic changes in the rectum during distention.Presented at the Digestive Disease Week, New Orleans, Louisiana, May 15 to 20, 2004.Supported by the Associazione Amici della Gastroenterologia del Padiglione Granelli, Milano, Italy.     

Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis

The aim of our study was to determine if the rectal mucosa regenerates after rectal mucosectomy and endorectal ileoanal anastomosis for chronic ulcerative colitis. Such regenerated rectal mucosa could be the site of recurrent disease, leading to complications of the operation, and potential malignant degeneration. Pathologic specimens of the ileoanal anastomosis, surrounded by rectal muscular cuff, were obtained from eight patients who required takedown of their ileoanal anastomosis between one and 18 months after construction. Reepithelialization of the rectal cuff was not observed. In two patients, small islets of rectal mucosa and anal glands were identified. In all patients, the rectal muscularis propria was adherent to the serosa of the ileum by fibrous reaction. Three patients were diagnosed, both clinically and pathologically, as having chronic ulcerative colitis at the original ileoanal operation, but features suggestive of Crohn's disease were noted in the subsequently resected neo-rectum. Our observations suggest that, although isolated rectal mucosal cells may remain after mucosectomy, extensive rectal mucosal regeneration does not occur, thus minimizing the risk of recurrent disease and potential malignant change. Failure of an ileoanal anastomosis is therefore most likely related either to technical factors or to the presence of unsuspected Crohn's disease.     

The appreciation of rectal distention in fecal incontinence

The subjective response to rectal balloon sensation was assessed with anorectal manometry and pudendal nerve terminal motor latency measurement (PNTML) in three groups of patients. There were 37 healthy subjects, 54 patients with idiopathic fecal incontinence (IFI), and 36 with complete rectal prolapse and incontinence (CRP). There was no significant difference for any parameter of rectal balloon sensation between patients with IFI and normals. Patients with CRP differed only in onset (P=.001). The results show that the appreciation of rectal distention is maintained in IFI.     

Rectal compliance as a routine measurement

PURPOSE: The clinical impact of rectal compliance and sensitivity measurement is not clear. The aim of this study was to measure the rectal compliance in different patient groups compared with controls and to establish the clinical effect of rectal compliance. METHODS: Anorectal function tests were performed in 974 consecutive patients (284 men). Normal values were obtained from 24 controls. Rectal compliance measurement was performed by filling a latex rectal balloon with water at a rate of 60 ml per minute. Volume and intraballoon pressure were measured. Volume and pressure at three sensitivity thresholds were recorded for analysis: first sensation, urge, and maximal toleration. At maximal toleration, the rectal compliance (volume/pressure) was calculated. Proctoscopy, anal manometry, anal mucosal sensitivity, and anal endosonography were also performed as part of our anorectal function tests. RESULTS: No effect of age or gender was observed in either controls or patients. Patients with fecal incontinence had a higher volume at first sensation and a higher pressure at maximal toleration (P=0.03), the presence of a sphincter defect or low or normal anal pressures made no difference. Patients with constipation had a larger volume at first sensation and urge (P<0.0001 andP<0.01). Patients with a rectocele had a larger volume at first sensation (P=0.004). Patients with rectal prolapse did not differ from controls; after rectopexy, rectal compliance decreased (P<0.0003). Patients with inflammatory bowel disease had a lower rectal compliance, most pronounced in active proctitis (P=0.003). Patients with ileoanal pouches also had a lower compliance (P<0.0001). In the 17 patients where a maximal toleration volume<60 ml was found, 11 had complaints of fecal incontinence, and 6 had a stoma. In 31 patients a maximal toleration volume between 60 and 100 ml was found; 12 patients had complaints of fecal incontinence, and 6 had a stoma. Proctitis or pouchitis was the main cause for a small compliance. All 29 patients who had a maximal toleration volume>500 ml had complaints of constipation. No correlation between rectal and anal mucosal sensitivity was found. CONCLUSION: Rectal compliance measurement with a latex balloon is easily feasible. In this series of 974 patients, some patient groups showed an abnormal rectal visceral sensitivity and compliance, but there was an overlap with controls. Rectal compliance measurement gave a good clinical impression about the contribution of the rectum to the anorectal problem. Patients with proctitis and pouchitis had the smallest rectal compliance. A maximal toleration volume<60 ml always led to fecal incontinence, and stomas should be considered for such patients. A maximal toleration volume>500 ml was only seen in constipated patients, and therapy should be given to prevent further damage to the pelvic floor. Values close to or within the normal range rule out the rectum as an important factor in the anorectal problem of the patient.Drs. Sloots and Poen were supported by a grant from Janssen-Cilag. Presented at the meeting of the Dutch Society of Gastroenterology, Veldhoven, the Netherlands, October 7 to 8, 1999.     

Malignant lymphoma of the rectum

Malignant lymphoma involving the rectum is rare. Of 61 patients with malignant lymphoma involving the rectum seen at the Mayo Clinic between 1950 and 1977, 49 had extensive lymphoma with secondary involvement of the rectum, and 12 had lymphoma confined to the rectum. Patients with widespread lymphoma were treated with radiation, chemotherapy, or both. Of the 12 patients with lymphoma confined to the rectum, five had surgical excision and seven were treated nonoperatively; the overall five-year survival was 20 percent. Patients with widespread lymphoma had a five-year survival of 15 percent. Patients with lymphoma confined to the rectum had a five-year survival of 50 percent, and patients who had surgical excision did better than those treated nonoperatively.     

Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection

Background We experienced some technical difficulty in dividing the middle and lower rectum through the right-lower quadrant intracorporeally. The aim of this study was to determine whether multiple stapler firings during rectal division are associated with anastomotic leakage after laparoscopic rectal resection. Methods Laparoscopic anterior resection with double-stapling technique anastomosis was performed in 180 consecutive rectal cancer patients. We often used vertical rectal division through a suprapubic site instead of the standard transverse rectal division for laparoscopic total mesorectal excision (LapTME). We attempted to determine whether there was an association between the number of stapler firings and procedures in rectal division. Moreover, we identified risk factors for anastomotic leakage after laparoscopic rectal resection by multivariate analysis. Results Anastomotic leakage occurred in 5% of the subjects of this study. Vertical rectal division through the suprapubic site after Lap TME required fewer staples than transverse division through the right-lower port and a smaller percentage of patients required three or more staples for vertical rectal division than for transverse division (15% vs. 45%, p = 0.03). In the multivariate analysis, TME and the number of staplers used for rectal division were the factors found to be associated with a significantly greater risk of subsequent leakage (odd’s ratio = 5.3; 95% CI 1.2–22.7 and odd’s ratio = 4.6; 95% CI 1.1–19.2). Conclusion TME and multiple stapler firings during distal rectal division were associated with anastomotic leakage after laparoscopic rectal resection. Vertical rectal division through a suprapubic site was a useful method of avoiding multiple stapler firings during laparoscopic TME.