Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.