目的 探讨溃疡性结肠炎(ulcerative colitis,UC)病人行全结直肠切除-回肠储袋肛管吻合术(total proctocolectomy with ileal pouch-anal anastomosis,TPC-IPAA)术后排便功能情况与长期生活质量,初步分析其影响因素,为制定有效的措施、改善其生活质量提供依据.方法 回顾性收集2008年2月至2017年12月期间于上海交通大学医学院附属新华医院接受TPC-IPAA的UC病人的临床资料与术后随访信息,通过克利夫兰生活质量评分量表(Cleveland Global Quality of Life,CGQL)评估病人术后远期生活质量,采用Wexner和Vaizey评分法评估术后排便功能.基于术后CGQL评分提高50％,以及Wexner/Vaizey评分均值为截断值,分别将病人不同分组统计,进一步分析TPC-IPAA术后排便功能与生活质量的影响因素.结果 ①治疗及随访情况:研究共纳入61例病人,中位随访时间为85.7个月(IQR 45.2-105.8个月),TPC-IPAA术后CG-QL评分较术前显著提高(0.732±0.148比0.420±0.173,P＜0.001).②TPC-IPAA术后并发症发生情况:共发生早期储袋手术相关并发症31例次(储袋术后30 d内发生),其中肠梗阻8例次(25.8％),储袋及吻合口出血8例次(25.8％),切口感染8例次(25.8％),储袋相关瘘发生共有3例次(8.7％).发生远期并发症35例次,以储袋炎、肠梗阻较为常见.储袋失败3例(8.6％).③TPC-IPAA术后排便功能与生活质量影响因素分析:术后早期并发症(OR:3.50;95％CI:1.078～11.361)、手术时年龄(OR:0.950;95％CI:0.908～0.995)是影响长期生活质量的独立危险因素.术后早期并发症与储袋术后排便功能相关(P=0.031).结论 TPC-IPAA治疗重度(难治性)UC安全有效,早期并发症的发生与储袋病人远期生活质量有关.选择微创精细的手术操作,合理规避防治储袋手术早期并发症,有助于进一步提高UC病人术后的排便功能与远期生活质量.
Objective:To explore the feasibility and effect of laparoscopic radical gastrectomy for gastric cancer.Methods:Among the 26 cases of gastric cancer,21 cases received radical distal gastrectomy,and 5 cases received total gastrectomy.Results:All cases underwent laparoscopic radical gastrectomy successfully.In radical distal gastrectomy group,the operating time was(189.3±36.5)min,the volume of blood loss was(140.3±33.4)ml,the number of resected lymph nodes was 18.8±5.6,and the time for gastrointestinal function recovery was(3.8±1.4)days.Conclusion:Laparoscopic radical gastrectomy is a feasible,safe and minimally invasive treatment and can achieve the same outcome as the open operation.
Objective To investigate the skills of laparoscopic splenectomy(LS).Methods The clinical data of 29 patients subject to LS were retrospectively analyzed.Results LS was performed successfully on 28 cases,and one case was converted to abdominal operation.The operative time was 130-380 min(mean 180 min),the intraoperative blood loss was 80-2000 ml(mean 600 ml),and the postoperative hospital stay was 2-12 days(mean 7 days).Conclusion The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing LS.
Objective To discuss the diagnosis and treatment of Mirizzi syndrome.Methods The clinical data of 26 cases of Mirizzi syndrome were retrospectively analyzed and a summary to its diagnosis and treatment was made.Results All patients were treated surgically.By using Csendes standard,15 cases were classified into pattern Ⅰ,7 into pattern Ⅱ,3 into pattern Ⅲ and 1 into pattern Ⅳ.During a follow-up period of 6 months to 2 years,25 cases were cured,and 1 case restored well.Conclusion Mirizzi syndrome is a particular type of chronic calculous cholecystitis complications,and its preoperative diagnosis is difficult.Different surgical procedures can achieve good results according to the classification of Csendes standard.
Objective To investigate the expression of CDX2 and NF-κB P65 protein in gastric signet-ring cell carcinoma.Methods By using the adjacent gastric mucosa and gastric intestinal metaplasia as the control,the expression of CDX2 and NF-κB P65 was detected in gastric signet-ring cell carcinoma by immunohistochemistry.Results CDX2 was not expressed in normal gastric mucosa.There was significantly higher CDX2 expression in gastric signet-ring cell carcinoma,but the expression level was lower than in intestinal metaplasia.NF-κB P65 in gastric signet-ring cell carcinoma was significantly higher than in the adjacent gastric mucosa.The expression of CDX2 and NF-κB P65 had a correlation with the invasive depth of tumor.Conclusion CDX2 and NF-κB P65 are the molecular markers in gastric signet-ring cell carcinoma.
Objective:To investigate the effectiveness of stent installation with the help of endoscopic retrograde cholangiopancreatography(ERCP)for iatrogenic bile duct stenosis.Methods:Forty-nine patients were treated by stent installation with the help of ERCP.Liver function(ALT,total bilirubin,prothrombin time)was tested on the day 1,4,7 and 11 after treatment.Flow cytometry was used to count leukocytes.Hospital stay,clinical curative rate and recurrence rate were monitored.Results:Forty-two patients were cured and the curative rate was 85.7 %.The number of leukocytes,ALT level,total bilirubin and prothrombin were also significantly decreased.There were significant differences between the first day and the seventh day after operation(P0.05).However,there were no obvious differences between the seventh day and the eleventh day after operation(P0.05).The 1-,3-and 5-year recurrent rate after operation was 8.2 %,12.2 % and 20.4 % respectively.The restoration time of liver function was(14.5±1.9)days,the hospital stay was(9.8±1.3)days.There was significant difference in hospital stay,mean restoration time of liver function and recurrent rate after operation between the patients with the diameter beyond 3 mm and those with the diameter below 3 mm(P0.05).Conclusion:The stent installation with the help of ERCP was a good choice to improve the long-term curative effectiveness of iatrogenic bile duct stenosis,especially to bile duct stenosis in which the diameter was beyond 3 mm.As soon as mechanism was concerned,conserving the integrity of structure and function of Oddi sphincter perhaps played an important role.
Objective To assess the perioperative safety and survival impact of portal vein resection and reconstruction(PVRR)in advanced hilar cholangiocarcinoma.Methods From Jan.2003 to Dec.2009,10 patients with hilar cholangiocarcinoma were subjected to radical resection combined simultaneously with hepatectomy and/or PVRR in our centre.The clinical data were retrospectively analyzed.Results Of 10 cases receiving PVRR,6 accepted R0 resection,and 4 R1 resection.Two of 4 cases receiving partial exsection of portal vein wall were identified without histologically-positive tumor invasion to the portal vein.Among 6 cases undergoing main portal vein resection and anastomosis,4 patients received combined hemihepatectomy and caudate lobectomy,and 2 received hepatic artery resection.The postoperative complications included bile leakage in 3 cases and hepatic artery thrombosis in 1 case.No patient suffered from portal vein thrombosis or stricture,liver function failure and alimentary tract hemorrhage.No patients died preoperatively,and average hospital stay was(32.5±15.7)days.Of 6 cases between 2003 and 2008,one survived over 1 year,2 over 3 years.Three out of 4 cases performed in 2009 were followed up yet.Conclusion Combined PVRR with hemihepatectomy and caudate lobectomy for hilar cholangiocarcinoma did not increase perioperative mortality and morbidity.
Objective:To investigate the clinical features and treatment experience of stromal tumors of small intestine.Methods:A retrospective analysis was performed on the clinical data of 13 patients with stromal tumors of small intestine confirmed surgically from Jun.1997 to Oct.2009.Results:All the patients were treated surgically.Two cases received imatinib treatment after operation.All the patients were followed up for 6 months to 12 years.One patient recurred,and now was still alive after second surgery.Two cases receiving imatinib treatment obtained remission,and the remaining were still alive without recurrence.Conclusion:The prognosis of patients with intestinal stromal tumor was good,but unexplained gastrointestinal bleeding and abdominal pain should be intervened early with special examinations or surgical exploration in order to avoid misdiagnosis.Imatinib has a good effect in advanced intestinal stromal tumors.
Objective To summary the experience of diagnosis and treatment of 40 patients with traumatic intestinal rupture.Methods The clinical data of 40 patients with traumatic intestinal rupture from June 2007 to June 2010 were retrospectively analyzed.Results All 40 cases of traumatic small bowel rupture were diagnosed surgically.Thirty cases were subjected to simple repair and 10 cases to partial intestine resection.All 40 cases were cured and there were no deaths.Three cases were complicated with incisional infection and 3 with adhesive un-complete intestinal obstruction.Conclusion In treating traumatic small bowel rupture,it is recommended to make an overall evaluation,carefully observe the disease conditions of the patients with suspicious abdominal organ damage and repeatedly perform examinations.Once the diagnosis is made,surgical operation is done as early as possible.
Objective To discuss the lymph-node metastasis features of patients younger than 40 years with gastric carcinoma and try to explain the relationship between their prognosis and age.Methods We reviewed the pathologic data of 159 patients with gastric carcinoma from January 1988 to December 2008.The patients were divided into the young(age≤40 years)group(n=31)and the old(age40 years)group(n=128).The pathological characteristics were compared between the two groups.Results Twenty-six patients(83.9 %)had lymph-node metastasis in young patient group,and 80 patients(62.5 %)had lymph-node metastasis in old group.There was significant difference in the number of lymph-node metastasis,the ratio of lymph-node metastasis and the lymph-node metastasis rate in N2,N3 stage between ≤40 years group and 40 years group.The median survival time of young and elderly patients was 27 months and 33 months respectively(P0.05).The median survival time of young and elderly patients after radical resection was 34 months and 36 months respectively with the difference being not significant(P0.05).Conclusion The pathological characteristics of young patients with gastric carcinoma were identified:the more number of lymph-node metastasis and the higher ratio of lymph-node metastasis were strongly correlated with poor prognosis.Earlier diagnosis and standard D2,D3 lymph-node dissection are keys to improve the prognosis.
Objective To explore the impact of restrictive fluid administration on the incidence of post-operative complications under multi-disciplinary team.Methods From December 2007 to May 2008,the patients diagnosed definitely as colorectal cancer were analyzed retrospectively.The clinical effects on post-operative complications were studied and the differences between restrictive fluid regimen and standard fluid regimen were compared.Results There was statistically significant difference in overall incidence of post-operative complications between the two groups(P0.05).The incidences of pulmonary infection,intestinal obstruction and urinary retention in restrictive fluid group was lower than that in standard fluid group.There was significant difference in levels of ALB,GLB,glucose,Ag,calcium,magnesium between two groups(P0.05 or P0.01).In standard group,the average levels of ALB and calcium was lower than lower limit of the normal range,and the average levels of glucose were higher than the normal upper limit.Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery and play a certain role in the postoperative rehabilitation of the special populations like diabetic patients.
Objective To evaluate the applied value of double stapling technique in the sphincter-preserving surgery in middle and low rectal cancer.Methods Double stapling technique was applied in the sphincter-preserving surgery for 62 cases of middle and low rectal cancer from Jan.2006 to Dec.2009.Results There was no operative deaths,anastomotic leakage or constriction.There were 4 cases(6.5%) of local recurrence during the follow-up period of 8-60 months,including 1 case of Dukes B,and 3 cases of Dukes C.Postoperative defecation dysfunction to varying degrees occurred.Conclusion The application of double stapling technique improves the success rate of the sphincter-preserving surgery in middle and low rectal cancer and reduces the recurrence of anastomotic leakage and anastomotic constriction.
Objective To explore the application of laparoscopic common bile duct exploration in the elderly patients with cholelithiasis.Methods The clinical data of 103 elderly patients with cholelithiasis who underwent laparoscopic common bile duct exploration from July 2003 to July 2009 were analyzed retrospectively.Results All 103 elderly patients were safe during perioperative period after active pre-operative management on the accompanied diseases.Direct common bile duct exploration was performed on 93 patients,transcystic common bile duct exploration on 6 patients,and 4 patients were converted to laparotomy.Twenty-two patients received T-tube drainage,and 39 patients suffered bile leakage among 77 patients subject to primary suture.No post-operative bile duct stenosis and remanent stone occurred in primary suture cases.Conclusion Laparoscopic common bile duct exploration was safe and effective in dealing with elderly patients with cholelithiasis.
Objective To compare the clinical effects between the patients who accepted the simplified fast-track(SFT) intestinal preparation and the traditional intestinal preparation(TAD) before low/ultra-low anterior resection.Methods Patients scheduled for elective rectal surgery from January to April 2008 were randomized into two groups: 47 patients in SFT group,and 47 patients in TAD group.The perioperative indexes of these patients wer compared.Results In TAD group,the cleaning degree of intestinal canal was better than in SFT group(P0.01).In SFT group,gastric tube and plasma drainage tube plucking time,vent and defecation time,postoperative intake were earlier than in TAD group.There was no significant difference in urinary canal plucking time,the duration of postoperative hospitalization and complications between two groups(P0.05).Conclusion SFT intestinal preparation is a feasible management model for low/ultra-low anterior resection of rectal cancer.In comparison to TAD,SFT intestinal preparation is safer in operative and postoperative periods.
Objective To investigate the clinical features of easily misdiagnosed and mistreated digestive system involved Behcet disease in clinic work,then improve clinic level of diagnosis and treatment.Methods In 19 cases of misdiagnosed and mistreated digestive system involved Behcet disease,their age of onset,course of disease,clinical symptoms,involved digestive system,auxiliary examination and operation were analyzed.Results Average course of misdiagnosed and mistreated digestive system involved Behcet disease was very long[(10.2±7.5) years],clinical extra-digestive system complaint was significantly earlier than digestive system complaint[(10.5±9.2) years vs(3.5±5.8) years,respectively,P0.01].During the course of diagnosis and treatment,7 cases were misdiagnosed as acute appendicitis,6 cases as intestinal tuberculosis,2 cases as esophagitis,2 cases as superficial gastritis and gastric ulcer,and 2 cases as intestinal infection.Conclusion Digestive tract complaints were multiple and occurred lately in digestive system involved Behcet disease that was easily misdiagnosed and mistreated.
Objective To study the feasibility,method and clinical value of the laparoscopy in radical resection for colorectal cancer.MethodsThe clinical data of 18 cases of colorectal cancer subject to laparoscopic operation were analyzed retrospectively.ResultsEighteen patients received laparoscopic operation,and 2 of them were converted to abdominal operation.No death occurred.No postoperative complications such as leakage and stricture occurred.All patients were followed up for 4-30 months.No one had tracar site implantation.ConclusionLaparoscopy in radical resection for colorectal cancer possesses less trauma,rapid postoperative recovery and better eosmetie results.
Objective To investigate the clinically applied value of terminal ileostomy in low rectal cancer operation.Methods We retrospectively analyzed clinical data of 16 cases of rectal cancer,who accepted low anterior resection plus terminal ileostomy to prevent and cure anastomotic leakage.Results All the 16 cases accepted primary resection and anastomosis plus terminal ileostomy,and no stomal leak was observed.Two month later,the patients accepted second-stage colostomy apothesis.Three cases showed low rectum anastomotic stenosis before the apothesis detected by direct rectum examination and enteroscopy,and were cured by balloon dilatation.All the patients were reduced successfully,and no complication was observed.Conclusion Terminal ileostomy was a simple surgical procedure with less complication,and could prevent and treat stomal leak after rectal cancer operation effectively,especially in the old patients with multiple concomitant diseases.
Objective To explore the causes of obscure lower gastrointestinal hemorrhage(OLGIH) and diagnostic strategies.MethodsThe clinical data of OLGIH in 33 patients were retrospectively analyzed.ResultsThe causes of OLGIH were as follows:small bowel tumor(9 cases),diverticulosis(4 cases),mesenteric venous thrombosis(2 cases),mesenteric artery embolization(3 cases),nonocclusive mesenteric ischemia(4 cases),Crohn disease(4 cases),ulcerative colitis(5 cases),intestinal tuberculosis(1 case),small bowel vein phlebectasia(1 case).Diagnoses were confirmed by re-examination of colonoscope or barium clysis again in 8 cases,64-slice spiral CT scanning and contrast-enhanced scanning in 16 cases,DSA in 2 cases,small bowel air-barium double contrast examination in 4 cases,laparoscope in 2 cases,and exploratory laparotomy in 1 case.ConclusionFor detecting the cause of OLGIH,re-examination of colonoscope or barium clysis is an important choice.64-slice spiral CT scanning is the most effective way among no-invasive detections.DSA and laparoscope are important ways.
Objective To investigate the causes of recurrent colorectal cancer and surgical therapy.Methods From Jan.2000 to Jan.2010,26 inpatients with recurrent colon cancer receiving reoperation were analyzed retrospectively.Results The time from the first operation to recurrence was 10 months to 11 years(mean 28 months).There were 17 cases of recurrence within 2 years after operation(65.4 %),7 cases from 2 to 5 years,2 cases over 5 years.Re-resection was performed on 20 cases(76.9 %),including radical resection(15 cases)and palliative resection(5 cases).The survival time of radical resection and palliative resection was 1 to 5 years and 10 to 28 months respectively.Conclusion Colon cancer recurrence occurred more than 2 years after surgery.On local recurrence,active surgery is recommended if distant metastasis is excluded.
Objective To explore the effect of surgical treatment on simultaneous liver metastasis from colon cancer.Methods The clinical data of 67 cases of simultaneous liver metastasis from colon cancer subject to surgical treatment from Jan.2003 to Dec.2007 in our hospital were analyzed.Results Thirteen patients with multiple liver metastases underwent resection of primary tumor and portal vein pump implantation,and the remaining 54 cases were treated with simultaneous resection of primary tumor and liver metastases.The 1-,2-and 3-year survival rate of all 67 patients was 91.0 %(61/67),71.6 %(48/67),40.3 %(27/67) respectively.The shortest survival time was 8 months and the longest survival time was 57 months with the median survival time being 30.2 months.Conclusion Simultaneous resection of colon cancer primary tumor and liver metastases,supplemented with local and systemic chemotherapy,can achieve satisfactory results.
