Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
目的 探讨肠外瘘并腹腔感染的诊治。方法 回顾性分析我院2002年1月至2007年12月期间收治的86例肠外瘘并腹腔感染患者的临床资料。结果 所有肠瘘多在术后1~2周发生，经口服或引流管注入60%泛影葡胺60～100 ml造影后明确诊断，均行腹腔引流液细菌培养，加强抗感染。20例患者行腹腔冲洗引流，62例在B型超声定位下穿刺引流，4例急诊行剖腹冲洗引流，其中2例行降结肠造瘘。2例合并糖尿病的患者因全身感染严重且反复发作，出现多器官功能衰竭，分别于术后第15 天和第28 天死亡。其余84例住院治疗时间平均12 d，均顺利出院。结论 对肠外瘘并腹腔感染的患者，早期彻底的腹腔冲洗及有效的腹腔和脓肿引流，是控制感染、治愈肠外瘘的关键。
Objective To analyze surgical treatment and clinicopathologic features of remnant gastric cancer,and to recognize the strategies of treatment. Methods The clinical data of 26 cases patients with remnant gastric cancer diagnosed by endoscopy and pathological examination and underwent surgical treatment were retrospectively analyzed in our hospital between January 2004 and March 2011.In this study,14 cases of remnant gastric cancer from benign disease （RGCB） and 12 cases of remnant gastric cancer after stomach cancer operation （RGCC） were included.The clinical findings,Helicobacter pylori （HP） infection,surgical methods, histopathological features,and prognosis were analyzed.Results The patients developed a carcinoma in the gastric remnant about 15-44 years after operation for benign disease （median 26.3 years） and about 1-10.5 years after gastric cancer operation （median 4 years）,and there was significant differences of the two groups（P＜0.05）.HP infection of the gastric remnant was found in 73.1%（19/26） patients,and infection rate of patients was 71.4%（10/14） in RGCB and 75.0%（9/12） in RGCC, but there was no statistical different in two groups （P＞0.05）.All 26 patients underwent surgical procedure,and the rate of radical resection was 46.2% （12/26）, which was 57.1% （8/14） in RGCB and 33.3% （4/12） in RGCC respectively,there was no statistical different （P＞0.05）.Among the 12 cases underwent radical resection, the highest lymphatic metastasis rate was in No.3 group （83.3%， 10/12）,which came in second in lymph node of mesojejunum or splenic hilum （33.3%， 4/12）.Postoperative pathological staging was as follows：stageⅠin 3 cases, stageⅡ in 2 cases, stage Ⅲ in 14 cases and stage Ⅳ in 7 cases. In 18 patients underwent tumor excision,the metastasis of lymph node occurred in 13 cases （72.2%）,and the pancreas,transverse colon,or spleen were invaded in 13 cases according to histopathological results. Meanwhile,peritoneal metastasis were founded in 8 cases patients,and the peritoneal metastasis rate of patients with RGCB （14.3%；2/14） was significantly lower than that with RGCC （50.0%， 6/12）, P＜0.05.The overall one-year survival rate and three-year survival rate was 54.5% and 38.5%,respectively, and the survival time was 2-61 months （median 12 months）.Survival analysis indicated that pathological stage and radical resection were significant prognostic factors for patients with remnant gastric cancer（P＜0.01）,and radical resection was an independent prognostic factor （P＜0.05）,while age,gender,disease of first operation, degree of differentiation and HP infection were not （P＞0.05）. Conclusions Early detection and standard radical resection are the key factor to improve the prognosis of patients with remnant gastric cancer and laparoscopic exploration may minimize unnecessary injures of surgery.Because of the different clinical characteristics,strategy of treatment for RGCC and RGCB shall be discriminatory.
Objective To study the safety and feasibility of modified laparoscopic Dixon surgery for rectal cancer. Methods In the procedure of modified laparoscopic Dixon surgery, the rectum with tumor was pulled out and cut and colon-rectum anastomosis was performed through anus. The clinical data of patients with rectal cancer between modified laparoscopic Dixon surgery (laparoscopy group) and open Dixon surgery (open group) were compared and analysed prospectively. The clinical data included operative time, volume of bleeding, number of lymph node dissection, volume of abdominal drainage, time to bowel gas passage, hospital stay and relative complications, such as anastomotic leakage, ureteral injury, dysuria and fecal incontinence. Results Fifty-eight cases were selected in this study between September 2007 and July 2008, including 25 laparoscopic surgery in laparoscopy group and 33 open surgery in open group. Patient’s data on gender, age, distance between tumor and anus edge, tumor diameter, tumor pathologic type and Dukes stage were similar between two groups by statistic analysis (Pgt;0.05). All the operations were performed successfully. Two cases experienced anastomotic leakage in laparoscopy group, while 1 case experienced anastomotic leakage in open group. All these patients got recovered by conservative treatment at last. No other complications were experienced, such as ureteral injury, dysuria, fecal incontinence, and so on. There were no significant differences in term of operative time, volume of bleeding and number of lymph node dissection between two groups (Pgt;0.05). The volume of abdominal drainage was less while the time to bowel gas passage and hospital stay were shorter in laparoscopy group than those in open group (P＜0.05). Conclusion This study reveals that it is safe and feasible to perform modified laparoscopic Dixon surgery for rectal cancer, and it presents the character of minimal invasion.