直肠癌的发病率逐年上升，居消化道恶性肿瘤之首； 低位直肠癌位于腹膜返折以下，约占直肠癌总数的70%，其中约2/3属低位直肠癌患者需实施切除肛门的改道手术。所以，提高肿瘤切除率、降低局部复发率、提高5年生存率、提高保肛率及改善患者术后的生活质量一直是普外学科努力的方向。全直肠系膜切除术(total mesorectal excision, TME)这一具有划时代意义的创新术式，应用于临床20余年，降低了局部复发率，提高了5年生存率及保肛率，已为越来越多的结、直肠外科医生作为直肠癌治疗的金标准。随着TME理念的深入和腹腔镜技术的发展，腹腔镜全直肠系膜切除术（laparoscopic total mesorectal excision，LTME）及其保肛术式正在兴起，前瞻性临床研究已显示出良好的应用前景。
Objective To understand the current research status of sentinel lymph node (SLN) biopsy in colorectal cancer. Methods Literatures about the application of SLN biopsy in the field of colorectal surgery were collected and reviewed. Results The results of SLNs biopsy accurately reflected the status of the nodal basin. Focused examination of the SLNs could identify micrometastases that might otherwise had been missed by standard histopathological analysis, thus upstaged this group of patients. Conclusion SLN biopsy represents a new and effective technique to predict the tumor status of regional lymph nodes, which offers a potential alternative to improve the accuracy of tumor staging in colorectal cancer.
目的 探讨十二指肠损伤后预防肠瘘的合理手术方式。方法 对我院2005年3月至2009年10月期间收治的28例十二指肠损伤患者的临床资料进行回顾性分析。结果 28例均行手术治疗，其中1例因多器官功能衰竭于术后第2天死亡，3例十二指肠瘘均经保守治疗后痊愈。27例患者术后随访2～6个月（平均3.5个月），2例发生不全性肠梗阻，1例发生盆腔脓肿，均经非手术治疗后痊愈。结论十二指肠损伤后选择合理的手术方式是预防术后发生十二指肠瘘的关键因素。
目的 观察左侧结肠癌伴急性肠梗阻一期手术的疗效，探讨理想的手术治疗方法。方法 回顾性分析四川大学华西医院2007年1月至2009年11月期间收治的46例左侧结肠癌伴急性肠梗阻患者一期手术切除吻合的临床资料。结果 46例均未实施术中结肠灌洗，而行彻底的无污染肠减压法。其中行根治性切除一期吻合35例，姑息性切除一期吻合11例。术后发生吻合口漏3例，切口感染6例，肺部感染2例，盆腔积液1例，均经非手术方法治愈。全组手术无死亡病例。结论 左侧结肠癌伴急性肠梗阻一期切除吻合，用彻底的无污染肠减压法替代结肠灌洗是安全、可行的。
【Abstract】ObjectiveTo investigate the role of PPARδ in the pathogenesis of colorectal cancer. MethodsLiteratures about PPARδ and the pathogenesis of colorectal cancer were reviewed and analyzed.ResultsPPARδ is expressed in the nucleuses of glandular epithelia lining colon and rectum. It is normally suppressed by wild-type adenomatous polyposis coli (APC) but is up-regulated by enhanced β-catenin/T cell factor-4 (TCF-4) binding to TCF-4-responsive elements in the PPAR promoter when an inactivating APC mutation occurs, which indicates PPAR is a potential downstream target of the APC/β-catenin/TCF-4 signaling pathway in colorectal cancer. Consistent with PPAR’s role as an APC/β-catenin/TCF-4 target, some studies reported that PPAR mRNA is frequently overexpressed in colorectal cancers of both humans and rodent animals, which indicates that PPAR is relevant to the tumorigenesis of colorectal cancer. ConclusionPPARδ is closely related with the pathogenesis of colorectal cancer.
【Abstract】ObjectiveTo study the current research status of minichromosome maintenance protein 2 (MCM2), the cell cycle proliferation marker, in the diagnosis of colorectal carcinoma. MethodsLiteratures about the application of MCM2 in the study of colorectal carcinoma were collected and reviewed.ResultsMCM2, as a marker of cell dysplasia and malignancy, was usually used in the study of carcinoma. The study on expression of MCM2 in the cell of colorectum in different proliferational stage might help to screen colorectal carcinoma as early as possible. ConclusionAs a relatively specific and sensitive marker of cell proliferation, MCM2 might become a promising mark for diagnosing colorectal carcinoma in the early stage.