目的 探讨原发性骶前肿瘤的诊断及外科治疗。方法 回顾性分析徐州医学院附属医院普外科1980年1月至2012年7月期间收治的50例原发性骶前肿瘤患者的临床资料，并结合文献复习进行讨论。结果 原发性骶前肿瘤的术前诊断主要依靠直肠指检、B超、CT、MRI等相关检查。手术采用经骶尾部入路22例，经下腹部正中入路22例，经腹、骶尾部联合入路6例。肿瘤被完整切除33例，行部分切除10例，未切除7例。并发症有术中出血、直肠损伤，术后切口感染、脓肿形成等。结论 骶前肿瘤如无禁忌证均应行手术治疗。充分的术前评估、合理选择手术入路、多学科协作以及对术中和术后并发症的充分认识是手术成功的关键。
Objective To investigate the clinical characteristics, therapeutic methods, and prognostic factors of patients with rectal stromal tumor. Methods The clinicopathological data of 33 patients with rectal stromal tumor who treated in the Affiliated Hospital of Xuzhou Medical University from January 2008 to November 2014 were retrospectively reviewed, and the therapeutic methods and prognostic factors of these patients were further analyzed. Results The major clinical manifestations of 33 patients included abdominal discomfort in 21 patients, changes of defecation habit and fecal property in 15 patients, bloody stool in 13 patients, and anal pain in 9 patients. CT and MRI examination showed a mass in the pelvic with the clear boundary, growed through the wall of rectum, with the heterogeneous density and signal, sometimes with necrosis, calcification, and haemorrhage. The results of immunohistochemical staining showed that, 31 patients were strongly positive for CD117, 28 patients were strongly positive for CD34, 15 patients were positive for smooth muscle actin (SMA), 13 patients were positive for vimentin, and 3 patients were positive for soluble acid protein (S-100). The therapeutic methods of 33 patients included local excision in 13 patients, low anterior resection in 11 patients, abdominal pelvic resection in 5 patients, and conservative treatment in 4 patients. A total of 26 patients underwent surgery combiend with imatinib therapy. The follow-up time was 10–102 months and the median time was 58 months. During follow-up period, there were 8 patients suffered from recurrence or metastasis, and 15 patients died. The results of Cox proportional hazards regression model showed that, postoperative relapse and metastasis were prognostic factors for survival〔RR=19.338, 95% CI was (2.821, 132.568), P=0.003〕. The survival situation of the patients suffered from postoperative relapse and metastasis was poor. Conclusions CD117 and CD34 could serve as valuable diagnostic indexes for rectal stromal tumor. Surgery is an effective treatment for rectal stromal tumor.
目的总结低位直肠癌采用柱状经腹会阴切除术（APR）的应用体会。 方法徐州医学院附属医院普通外科于2010年1月至2013年7月期间采用柱状APR治疗22例低位直肠癌患者（柱状APR组），并与同期行传统APR治疗的35例患者（传统APR组）进行对比，分析术中、术后和随访的各项指标。 结果与传统APR组比较，柱状APR组的环周切缘阳性率及术中穿孔率明显降低〔4.55%（1/22）比34.29%（12/35）和4.55%（1/22）比31.43%（11/35）〕，差异有统计学意义（P＜0.05）；2组手术时间、术中出血量、并发症发生率比较，差异无统计学意义（P＞0.05）。术后随访3～30个月（平均21个月），柱状APR组无肿瘤复发及远处转移患者，未见死亡病例；传统APR组出现盆底局部复发4例，远处转移3例，死亡2例。2组局部复发、远处转移及死亡率比较差异均无统计学意义（P＞0.05）。 结论柱状APR可以切除更多的肿瘤周围组织，降低环周切缘阳性率，减少术中肠穿孔的发生，降低局部复发。
ObjectiveTo summarize experiences of laparoscopic extralevator abdominoperineal excision (ELAPE) in treatment of advanced low rectal cancer. MethodsThe clinical data of 46 patients with advanced low rectal cancer underwent laparoscopic ELAPE in our center from January 2012 to May 2015 were retrospectively analyzed.During the procedures,the anus and its surrounding tissue were individually resected by perineal approach with jackknife position.The pelvic perinium was closed laparoscopically.The operation time,intraoperative blood loss,retrieval of lymph nodes,radial margin,and postoperative complications were recorded. ResultsThe procedures were successfully performed without any intraoperative complications,complications associated with laparoscopy,or conversion to the open approach.The operation time was (175.3±26.5) min.The intraoperative blood loss was (55.7±28.6) mL.The number of lymph node retrieval was 16.3±7.7.No positive radial margin was identified. ConclusionSufficient resection of circumferential tissue,lower intraoperative perforation rate and satisfactory circumferential margin-negative rate could be achieved by laparoscopic ELAPE in treatment of advanced low rectal cancer.
Objective To investigate the clinical features, treatment, and influence factors of prognosis in patients with gastric neuroendocrine neoplasms (GNENs). Methods From March 2011 to January 2016, the clinicopathological data of 44 patients with GNENs who treated in The Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed to summarize the choice of treatment plan and analyze influence factors of prognosis. Results A total of 44 patients enrolled in this study. The major clinical manifestation included abdominal pain in 18 patients (40.9%), abdominal distension in 16 patients (36.4%), loss of appetite in 4 patients (9.1%), acid regurgitation and belching in 4 patients (9.1%), nausea and vomiting in 1 patient (2.3%), eating after choking sense in 3 patients (6.8%), gastrointestinal bleeding in 2 patients (4.5%), diarrhea in 1 patient (2.3%), and palpitations with weakness in 3 patients (6.8%). The treatment of 44 patients included radical resection in 26 patients (59.1%), endoscopic resection in 13 patients (29.6%), local excision in 1 patient (2.3%), and 4 patients had distant metastasis before operation were conducted of palliative treatment〔palliative resection in 2 patients (4.5%) and conservative treatment in 2 patients (4.5%)〕. Univariate analysis showed that the gender, the age, the tumor size, and the N staging (lymph node metastasis) were not associated with prognosis (P>0.050), but the tumor location and the depth of tumor invasion were related to the prognosis (P<0.050). The tumors located in the upper part of the stomach and the serosal infiltration indicated poor prognosis. However, neither of them can be used as independent factor to evaluate the poor prognosis of GNENs patients (P>0.050). Conclusions GNENs has nonspecific clinical manifestation. Radical surgery and endoscopic resection are the main treatment methods, but the influence factors of prognosis in GNENs patients need further study.