微波凝固+黏膜下5-Fu注射治疗早期低位直肠癌9例体会

直肠癌是常见的消化道恶性肿瘤之一.位于肛缘7 cm以下的低位直肠癌占直肠癌的 81%～98%.对于早期低位直肠癌经腹会阴根治术(Miles)是传统的手术方式.我院1996年1月至2006年1月10年间对9例早期低位直肠癌运用微波凝固 黏膜下5-Fu注射,并在微波治疗后运用5-Fu溶液保留灌肠,取得了满意地疗效,现报告如下.……     

双吻合技术联合全直肠系膜切除在低位直肠癌保肛术中的应用

为探讨双吻合技术（DST）联合全直肠系膜切除（TME）在低位直肠癌保肛术中的应用价值,回顾分析采用DST联合TME行低位保肛术的39例低位直肠癌资料。结果显示,39例患者均顺利完成手术,无手术死亡病例。术后发生吻合口漏3例（7．7％）,吻合口狭窄2例（5．1％）,吻合口出血1例（2．6％）。术后随访3个月至2年,肝转移1例（2．6％）,局部复发3例（7．7％）。结果表明,DST联合TME能提高低位直肠癌保肛术的成功率,改善患者生存质量,是治疗低位直肠癌安全、有效的方法。     

低位直肠癌保肛术与腹会阴联合切除术后生存和复发多因素分析

目的 探讨低位直肠癌保肛术与腹会阴联合切除术对病人术后生存和肿瘤复发影响。方法 随访1995年1月至2005年6月期间,汕头大学医学院肿瘤医院外科手术治疗286例低位直肠癌,对保肛手术（SPO）与经腹会阴联合切除术（APR）两组病人的临床病理指标、存活率和局部复发状况进行统计学分析。结果 保肛手术组160例,术后局部复发率10％,生存期24．4个月,5年存活率为61.6％;经腹会阴切除术（APR）组126例,术后局部复发率13．5％,生存期33,2个月,5年存活率为68.8％,两组存活率比较差异无显著意义（P=0．22）。两组术后局部复发率比较差异也无统计学意义（P=0．23）。结论 低位直肠癌保肛术与腹会阴联合切除术并不影响低位直肠癌病人术后的生存和肿瘤复发。     

腹腔镜下Dixon与Miles手术治疗Ⅲ期低位直肠癌的远期疗效比较及影响因素

比较Ⅲ期低位直肠癌患者行腹腔镜下Dioxn或Miles术后的生存状况,探讨影响两种术式治疗低位直肠癌患者的临床相关因素。回顾性分析我院2009—2014年60例Ⅲ期低位直肠癌行Dioxn或Miles术患者的临床资料;调查以问卷形式进行,随访3年,进行Kaplan-Meier生存分析。腹腔镜Dixon组累计1年、2年、3年生存率分别为100%、86.2%、62.1%,平均生存在期为(31.65±1.20)个月,Miles组累计1年、2年、3年生存率分别为100%、89.5%、68.0%,平均生存在期为(32.25±1.18)个月,两组总体生存时间差异无统计学意义(P0.05)。多因素分析显示肿瘤大小、CEA水平、淋巴结转移数、新辅助放化疗是影响Ⅲ期低位直肠癌手术方式的独立因素。对于Ⅲ期低位直肠癌采取保肛手术,术前应先行新辅助放化疗再评估,血清CEA水平、淋巴结转移数、肿瘤浸润深度、肿瘤大小可作为参考指标。对于无上述高危因素者可选择保肛术。     

低位直肠癌保肛术后肿瘤复发的治疗

目的探讨低位直肠癌保肛术后复发的治疗方法及预后。方法回顾性分析了47例低位直肠癌保肛术后复发患者的临床及随访资料。结果22例复发患者接受了新辅助治疗．其中3例复发病灶不同程度降期．11例复发病灶明显缩小．总有效率达63．6％。31例复发患者行再次切除手术．其中根治性切除16例，姑息性切除15例：16例未行切除手术．其中单纯造瘘者11例．单纯放疗或化疗者4例，另1例未予任何治疗。根治性切除术组3年、5年生存率分别为42．3％和22．6％，姑息性切除术组3年、5年存活率分别为23．6％和11．8％。单纯造瘘和单纯放化疗者术后中位生存时间分别为12．6个月和8．5个月．1例未予治疗者仅存活6个月．结论低位直肠癌术后复发者仍应积极行根治性手术．术前行新辅助治疗。可提高再次手术成功率；对于无法再次根治性切除的患者．通过减瘤手术或造瘘术．也可以延长部分患者的生存期．改善患者生活质量。     

套入式结肠直肠黏膜吻合术治疗低位直肠癌86例的临床研究

目的 探讨低位直肠癌保留肛门括约肌功能最理想的治疗术式。方法 对86例低位直肠癌切除后经肛门行套入式结肠直肠黏膜吻合术。肿瘤下缘距肛缘6－7cm 62例，8－10cm 24例。结果 全组无手术死亡，无吻合口瘘和吻合口狭窄发生。术后8－12周时排便功能控制良好，排便次数为1－4次／d，18周时肛门排便功能基本恢复正常，排便次数为1－2次／d。术后随访3个月至8年，总的局部复发率为3．7％（3／81），总的5年生存率为66．7％（14／21）。结论 套入式结肠直肠黏膜吻合术可避免腹部结肠造口，并防止吻合口瘘的发生，作为低位直肠癌保肛手术，是一种安全的术式。     

低位直肠癌根治性切除套入式吻合保肛术231例临床研究

目的探讨套入式结肠直肠黏膜吻合保肛术治疗中低位直肠癌的可行性和安全性及临床疗效。方法对231例中低位直肠癌经腹肛门根治性切除行套人式结肠直肠黏膜吻合保肛术进行回顾性分析。结果231例术后随访率为85．3％（197／231）,中位随访时间为5．9年（2个月-14年）。术后发生吻合口瘘8例（3．4％）,吻合口狭窄3例（1．2％）,术后12—24周时排便功能基本恢复正常。术后局部复发率为5．1％（10／197）,肝转移率为15．2％（30／197）。肺转移率为2．5％（5／197）,术后5年总体生存率为71．6％。结论套入式吻合保肛术既能减少吻合口瘘发生,又可保留良好的肛门排便控制功能,可显著提高患者术后生活质量,是中低位直肠癌一种安全有效的保肛术式。     

低位直肠癌括约肌间切除超低位吻合的疗效评估

目的评价超低位直肠癌行括约肌间切除手术（ISR）后的舡肠动力学变化、肛门功能及肿瘤根治效果。方法总结分析2004年1月至2007年8月间施行ISR手术的30例超低位直肠癌患者的临床资料。结果30例患者肿瘤距肛缘2．5～4．0（平均3．4）cm。与术前比较．术后肛管静息压、肛门最大收缩压和直肠最大耐受容积明显降低（P〈0．01）．有27例（90．0％）患者术后肛门直肠抑制反射消失,且随着时间推移无明显恢复。按Williams的排便自制标准．术后3、6、12个月分别有86．7％、93．3％和96．7％的患者达到功能良好效果。全组患者随访1年至3年8个月．无死亡病例;未出现盆腔或吻合口局部复发、远处转移和吻合口瘘。10例术后出现肛周粪渍性湿疹,2例结肠黏膜脱出,1例肛管狭窄。结论ISR超低位吻合保肛手术治疗低位直肠癌可以达到良好的根治性．并能较好地保留肛门功能。     

低位直肠癌保肛手术探讨

目的：探讨低位直肠癌保肛手术的适应证及疗效。方法：回顾性分析32例低位直肠癌保肛手术。结果：低位直肠癌保肛率为41％。其中Dixon手术22例，Parks手术5例，Bacon手术5例。术后排便功能优良，无围手术期死亡。吻合瘘2例(6.2％)；1年内吻合口狭窄3例(9．4％)，局部复发5例(17．9％)。结论：低位直肠癌如果病例选择适当行保肛手术，并不影响疗效，并且提高了病人的术后生存质量。     

三维适形放疗在低位直肠癌保肛术后复发患者中的应用

为探讨低位直肠癌保肛术后局部复发患者行三维适形放疗（3DCRT）的疗效,我们对21例低位直肠癌保肛术后局部复发的患者采用3D-CRT。观察结果显示,经过3D-CRT,肿瘤完全缓解7例（33．3％）,部分缓解9例（42．9％）,无变化5例（23．8％）,总有效率为76．2％（16／21）。1、2、3年的生存率分别为71．4％（15／21）、38．1％（8／21）和14．3％（3／21）。结果表明,低位直肠癌保肛术后行3D-CRT可大大提高患者的治愈率和生存率。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.