目的 探讨手辅助腹腔镜技术在直肠癌根治术中的疗效.方法 对90例直肠癌患者资料进行回顾性分析,根据手术选择分为研究组(手辅助腹腔镜治疗,n=40)和对照组(传统开腹手术治疗,n=50).比较两组患者临床特征、手术时间、失血量、术后并发症、住院费用、住院时间、R0切除率、淋巴结检出个数、保肛率、3年局部复发率、3年无复发生存率和3年生存率.结果 研究组术中失血量和住院时间均低于对照组,手术时间和住院费用均高于对照组,差异均具有统计学意义(均P<0.01).研究组和对照组在淋巴结检出个数、R0切除率、保肛率、3年局部复发率、3年无复发生存率、3年总生存率、术后排便异常发生率和术后并发症发生率方面比较,差异均无统计学意义(均P>0.05).结论 与传统开腹手术比较,采用手辅助腹腔镜切除手术治疗直肠癌患者,具有创伤小、出血少和住院时间短等优点,且能够获得与传统开腹手术相同的预后,是可选择的外科技术.

The situation of prevention of non-neonatal tetanus in China is severe. Strengthening the active immunization with tetanus toxoid vaccine (TTCV) is the key to prevent the non-neonatal tetanus. Through the detection of tetanus antibody (TAB), the immune status of individual can be determined, so as to implement the active immunization of TTCV correctly. The research on TAB detection technology is stagnant in aboard, but still in a development process in China since there is a realistic demand for TAB detection. This review collects relatively limited data of TAB detection technology in China, and summarizes the techniques such as mice toxin neutralization test (MTNT), indirect hemagglutination assay (IHA), double agar gel immune diffusion test (Rubin method), enzyme-linked immunosorbent assay (ELISA) and colloidal gold (CG), in order to provide a comprehensive basis for domestic TAB detection. The TAB detection technology in China has not yet achieved international recognition due to the lack of comparative study of domestic and international institutions and reference reagents. The special domestic situation of tetanus prevention makes the research of TAB detection technology have a certain practical significance, and rapid detection reagents such as ELISA and CG method have a certain application value in China.

目的 通过文献分析了解动物和人咬伤患者发生破伤风的情况.方法 检索中国知网数据库、万方数据库、维普数据库和MEDLINE、Web of Science、EMBASE数据库,中文检索词为动物咬伤、动物致伤、犬咬伤、蛇咬伤和破伤风,英文检索词为dog bite、snake bite、cat bite、human bite和tetanus,检索时间1889年1月—2019年12月.采用Excel表整理资料,总结动物和人咬伤患者发生破伤风的特征.结果 共检索到46篇文献,其中21篇明确记录了动物和人咬伤患者并发破伤风,包括中文文献8篇、英文文献13篇;共31例患者,其中中国13例、尼日利亚9例、印度3例、日本2例、津巴布韦1例、爱尔兰2例、泰国1例;1例人咬伤部位为舌头,1例狮子咬伤部位为颈部及四肢,1例无明显伤口,其余28例均为四肢;3例为人咬伤,7例为犬咬伤,18例为蛇咬伤,1例为猫咬伤,1例为狮子咬伤;6例咬伤前注射了破伤风疫苗,2例咬伤后注射了破伤风抗毒素,死亡7例.结论 动物和人咬伤是破伤风发生的高风险因素,破伤风类毒素主动免疫不足是主要发病原因.动物和人咬伤需要加强破伤风的防治.

Human vaccine is the most effective tool to prevent infectious diseases. At present, there are dozens of vaccines that can prevent dozens of infectious diseases. Vaccines for human use include vaccines that do not contain living micro-organisms (inactivated vaccines, toxoid vaccines, component vaccines), and vaccines that contain living micro-organisms (live attenuated vaccines and vector vaccines). The research and development of human vaccine includes clinical trial, process development and test method research, and the production process of human vaccine is very important for the preparation of high-quality and reliable vaccine. In this paper, the development of human vaccines, the production process and the characteristics of various human vaccines are reviewed.

以手术为主的综合治疗是目前局部进展期直肠癌的治疗方案.由于术前同步放化疗能够改善肿瘤的局部控制,近年来也已广泛应用于临床.术前放化疗不仅能使肿瘤退缩,增加保留肛门括约肌的机会;也能使局部复发率显著下降.

外科手术一直以来是结直肠癌的主要治疗手段.随着科学技术的进步和分子生物学的发展,结直肠癌的诊断和围手术期的综合治疗均出现了巨大的观念上的改变,使结直肠癌的综合治疗水平有了较大的提高,长期生存得到显著改善.其中,外科手术技术的进步,使结直肠癌的手术从开腹手术发展到了微创手术,后者又派生出许多新的手术技术.毫无疑问,微创外科的时代已经到来,近年来发展起来的单孔技术、NOSE手术及机器人手术等的发展,使结直肠癌的手术技术发生了根本性的变化.应当看到,在微创时代的到来之际,结直肠癌的开腹手术率在下降;特别是在我国,县级以上的医院大多开展了微创手术,在微创手术日渐普及的背景下,传统的开腹手术在结直癌治疗中的作用是否受到了挑战?开腹手术是否会被完全替代?开腹手术是否已经过时了?笔者就上述问题发表自己的观点.

The process of multidisciplinary team (MDT)treatment of a rectal cancer patient with primary lung ade-nocarcinoma was described.Left supraclavicular lymph node metastasis was discovered by clinical examination,and the bi-opsy of the lymph node indicated poorly differentiated lung adenocarcinoma.After MDT discussion,the patient received chemotherapy combined with targeted therapy(gefitinib 250 mg,once per day+capecitabine 1 500 mg,twice per day).On the basis of intensive therapy of lung adenocarcinoma,the patient received radical resection of rectal carcinoma,and is regu-larly followed up in the department of thoracic surgery.The diagnosis and treatment process of this case suggested that MDT discussion was crucial to improving the survival of patients with combined rectal cancer and lung adenocarcinoma.The treatment goal should be dynamically adjusted according to the tolerance and treatment response of patients who initially cannot tolerate surgery.MDT should be standardized and specialized to achieve the maximal benefits of patients.

术前新辅助治疗已经成为直肠癌、 尤其是中低位进展期直肠癌的规范化治疗模式. 术前新辅助治疗通常包括术前长程放化疗、 术前短程放疗和术前化疗联合放化疗. 不论何种新辅助治疗模式, 都可能获得一定的完全缓解率. 据报道,新辅助治疗后约有15%( 4% ~ 38%)的患者得到完全缓解.应当指出,完全缓解可分为临床完全缓解(clinical complete response,cCR) 和病理完全缓解(pathological complete response,pCR),前者指经过新辅助治疗后手术前临床上没有肿瘤残留的迹象, 而后者是手术后经过病理证实没有肿瘤残留. 临床医生希望通过cCR来判断pCR,但遗憾的是,这两者之间只有30% ~ 50%的符合率,大约只有36%的cCR患者为真正的pCR. 因此,提高cCR与pCR的符合率是当前面临的课题,目前通常以同时满足以下条件判断为cCR:(1)直肠指诊(digital rectal examination, DRE):不能触及肿瘤或仅可触及瘢痕;(2)结肠镜+活检:肿瘤消退, 活检 (-);(3) 磁共振成像 (magnetic resonance imaging,MRI)或腔内超声(transrectal ultrasonography,TRUS):正常肠壁或瘢痕、纤维化;(4)血清肿瘤标志物:完全正常;(5)无远处转移. 通常患者应在新辅助治疗结束后第5 ~8周进行评价,应当指出,这一标准仍存很多争议,比如是否应该加入PET-CT,是否应该进行局部切除.

目的 探讨中西方结直肠癌治疗及预后的差别.方法 对本中心的1 321例结直肠癌患者临床病例资料及随访数据进行分析,并与Surveillance,Epidemiology and End Resluts (SEER)数据库和European Cancer Registry(EUROCARE-4)数据库进行比较,研究中西方结直肠癌预后的差异.结果 1 321例接受结直肠癌切除手术患者5年总生存率为62.6％,高于中国平均水平(47.2％),与SEER数据库的64.7％和EUROCARE4的56.8％相似.各分期中,与SEER数据比较,人组数据虽然生存率较低,但分期方式受到新辅助治疗降期等因素影响,其差异不能说明预后更差.结论 本中心结直肠癌手术患者预后好于中国结直肠癌患者预后的平均水平,与西方国家结直肠癌患者预后相似.

人体大肠约有1.5米,分布在人体腹部的四周,起到吸收水分、形成粪便、储存粪便和排出粪便的作用.诱发大肠癌的因素有很多. 目前已确定的两个病因,第一是环境,第二是遗传 肿瘤的发生通常跟环境和遗传都有关系.比如一个人先天有肺癌的遗传基因,后天又去抽烟,再加上没有养成一个良好的生活习惯,那他患肺癌的概率就要大大高于常人.有人会问,为什么有的人抽了很多年的烟也没得肺癌?可能因为这个人本身就没有肺癌的遗传基因.那人们能否提前知道身体内是否有某种癌症的基因呢?这个很难,人类现在对人体的了解还没有达到这个境界,所以我们很难了解自己容易罹患哪种癌症.

目的探讨错配修复蛋白h MLH1、h MSH2和h MSH6在散发性结直肠癌（SCRC）中的表达情况及其与SCRC临床病理参数之间的关系。方法选取空军总医院普通外科和北京大学肿瘤医院结直肠外科2008年3月至2012年3月期间收治的SCRC患者263例,所有病例均经组织学证实且术前均未接受放化疗。采用免疫组织化学SP法检测263例SCRC患者肿瘤组织中h MLH1、h MSH2、h MSH6蛋白表达缺失情况,并分析其表达缺失与患者临床病理参数的关系。结果 263例SCRC患者肿瘤组织中h MLH1蛋白表达缺失率为13.3%（35/263）,h MSH2蛋白表达缺失率为12.2%（32/263）,h MSH6蛋白表达缺失率为28.9%（76/263）,h MLH1/h MSH2表达共同缺失率为3.4%（9/263）,h MLH1/h MSH6表达共同缺失率为10.2%（27/263）,h MSH2/h MSH6表达共同缺失率为6.8%（18/263）,h MLH1/h MSH2/h MSH6表达共同缺失率为3.4%（9/263）。h MSH1蛋白表达缺失率在高分化腺癌组织中明显高于中分化腺癌和低分化、黏液腺癌（P＜0.01）;h MSH2蛋白表达缺失率在直径＞5 cm的肿瘤组织中明显高于直径≤5 cm的肿瘤组织（P＜0.05）;h MSH6蛋白表达缺失率在男性患者中明显高于女性患者（P＜0.01）,且在淋巴结转移少的肿瘤组织中明显高于淋巴结转移较多的肿瘤组织（P＜0.01）。结论 h MLH1、h MSH2、h MSH6在SCRC中的表达缺失并不少见,且其表达缺失与SCRC患者临床病理参数的关系也明显不同于林奇综合征。因此,h MLH1、h MSH2、h MSH6在SCRC发生、发展中的作用可能也有别于林奇综合征。

Objective To investigate the expression and clinical significance of mismatch repair proteins hMLH1, hMSH2 and hMSH6 in sporadic colorectal carcinoma (SCRC). Methods Two hundred and ninety patients with SCRC were studied, who underwent surgery in the Department of General Surgery, the Air Force General Hospital and the Department of Colorectal Surgery, Beijing Cancer Hospital from March 2008 to December 2012. Immunohistochemistry was used to detect hMLH1, hMSH2 and hMSH6 expression in tumor tissues. The relationship between expression and clinicopathological data was analyzed retrospectively. Results The absent expression rates of hMLH1, hMSH2 and hMSH6 only in tumor tis-sues were 13.4% (39/290), 12.1% (35/290) and 29.0% (84/290), respectively. The absent expression rates of hMLH1 and hMSH2, hMLH1 and hMSH6, hMSH2 and hMSH6, and hMLH1, hMSH2 and hMSH6 were 3.8% (11/290), 10.0% (29/290), 7.2% (21/290) and 3.4% (10/290), respectively. The absent expression rate of hMLH1 in highly differentiated adenocarcinoma tissues was obviously higher than that of moderatelyto poorly differentiated adenocarcinoma and mucous carcinomas tissues (P<0.01). In the tumor tissues less than 5 cm, the expression level of hMSH2 was obviously higher than that of more than 5 cm, so as hMSH6 (P<0.05). The expression rate of hMSH6 in female group was clearly higher than that of male group (P<0.01), and the expression rate of hMSH6 in high lymph node metastasis of tumor tissues was higher than that of low lymph node metastasis. Conclusions The absent expressions of hMLH1, hMSH2 and hMSH6 are common in SCRC, and the clinicopathological parameters of SCRC is obviously different from hereditary nonpolyposis colorectal cancer (HNPCC). Therefore, the biological effects, indicators for evaluation of degree of malignancy, individualized chemotherapy regimens and prognostic indicators may be different from those in HNPCC.

[目的]比较Ⅰ期直肠癌与新辅助治疗后降期为ypT1-2N0M0的cT3-4或N+的直肠癌患者5年总生存率的差异.[方法]回顾分析105例直肠癌根治术后病理分期为T1～2N0M0的直肠癌患者的临床病理资料及随访资料.按患者是否行新辅助治疗和辅助化疗分为3组.单纯手术组(A组):未经术前新辅助治疗,pT1～2N0M0的早期直肠癌患者(29例).新辅助降期化疗组(B1组):初始诊断为cT3-4或N+,术前行新辅助治疗后降期为ypT1-2N0M0,且术后行辅助化疗的直肠癌患者(54例).新辅助降期非化疗组(B2组):初始诊断为cT3～4或N+,术前行新辅助治疗后降期为ypT1～2N0M0,且术后未行辅助化疗的直肠癌患者(22例).对3组生存情况进行分析.[结果]新辅助治疗后降期为T1～2N0M0的直肠癌患者(B1+B2组)术后5年生存率为94.0％.单纯手术组(A组)患者术后5年生存率为91.0％,新辅助降期化疗组(B1组)为88.9％,新辅助降期非化疗组(B2组)为90.9％.单因素分析提示3组预后差异无统计学意义(P＞0.05).[结论]新辅助治疗后降期为T1-2N0M0的直肠癌患者无论是否行术后化疗都可获得与Ⅰ期直肠癌患者相同的预后.新辅助治疗后降期为T1～2N0M0直肠癌患者术后化疗并未能提高患者5年总生存率.

<正>根据全国第3次死因调查(2004—2005年)的结果,在我国结直肠癌发病率及死亡率均排在恶性肿瘤第5位[1],并呈现逐年上升的趋势,严重危害人民健康。因此不仅结直肠癌的临床诊治是目前的研究热点,该病所带来的心理问题同样引起了广大研究者的关注,其中死亡焦虑就是心理问题中的一个重要内容。死亡焦虑是一种病态的、不正常的、或持续的对死亡的恐惧。英国国家健康服务中心将死亡焦虑定义为当想到死亡的过

近年来,随着全直肠系膜切除术的普及和双吻合技术的广泛应用[1],使低位或超低位直肠癌保肛手术成为可能.但是,吻合器的应用同时也会带来一系列的并发症,其中吻合口出血是术后早期严重并发症之一.因此,在出血后能够做出正确的判断和处理是结直肠外科医生的重要任务之一.作者结合我院实施的270例直肠癌前切除资料作一回顾性分析.

患者男性,51岁.主诉"大便次数增多1个月余".患者自2010年10月开始无明显诱因出现大便次数增多,达6~8次/d,为不成形稀便,伴有里急后重,大便偶带鲜血,血与大便相混合,量不多.2010年11月上述症状加重,伴有发热,体温最高达39 ℃,尿中伴有大便流出,且体重下降15 kg,直肠指诊:距肛门4 cm前壁可触及隆起型肿物,约占整个肠周,无触痛,表面不平,活动差,肠腔明显狭窄,上极不能触及,指套少量血染.

<正>1简介1.1背景结直肠癌在美国已经成为癌症相关死亡的第二大病因。美国医师协会(American College of Physicians,ACP)通过对其他组织颁布的结直肠癌筛查指南进行评估,发表了自己的筛查指南[1],以期对临床医生有所帮助。目前,我们可以看到很多类似主题的指南,并且各个指南也存在分歧,有鉴于此,ACP认为与其再颁布新的指南加入战团,不如将现有的指南好好总结归纳。

<正>结直肠癌是消化道最常见的恶性肿瘤之一,目前,结直肠癌发病率和死亡率仍呈现上升趋势。外科治疗是结直肠癌的主要治疗手段。随着人们对结直肠的解剖、病理等方面的研究不断深入及先进医疗器械设备的相继应用,结直肠癌的外科治疗模式发生了根本性的变化。患者对根治

结直肠癌肝转移在外科临床非常多见.对于这类疾病,不同的学科有不同的认识.在一些综合医院,外科对这类患者往往会先切除可以切除的病灶,然后让患者到肿瘤专科医院或肿瘤科做化疗.许多直肠癌肝转移患者往返奔波于各类医院,最后得出的结果也不尽相同,让患者及家属不知所云,一头雾水.

OBJECTIVE:To investigate the occult lymph node metastasis in the middle and lower third rectal cancer after neoadjuvant radiotherapy.METHODS:From June 2003 to December 2006, 74 rectal cancer patients received neoadjuvant radiotherapy (30 Gy/10 f/2 w, CACA-CRC-001) and underwent total mesorectal excision (TME) two weeks later. Fat clearance technique was used in all the samples. Occult lymph node metastasis was detected in the mesorectum using the anti-CK antibody.RESULTS:In total 1883 retrieved lymph nodes, 172 metastasis lymph nodes were harvested by HE examination with the mean diameter [(4.9+/-2.6) mm] being larger than that (2.7+/-1.4) mm of the 1711 negative nodes (P<0.01). In HE negative nodes, occult metastasis was found in 40 lymph nodes (2.33%) from 24 patients. Most of these nodes were less than 5 mm (90.0%) with a mean diameter of (3.2+/-1.2)mm, smaller than those of HE-positive metastasis nodes (P<0.01). Occult metastasis was found in 23.1% (9/39) of HE-negative patients. Occult metastasis incidence was higher in patients with HE-positive nodes (42.8%,P<0.01). No correlation of lymph node occult metastasis with tumor differentiation, age, or surgical procedures was found. There was no significant difference in recurrence-free survival between ypN(0) patients with and without occult metastasis (P=0.157).CONCLUSION:It is not necessary to include occult lymph node metastasis in the TNM staging in patients with ypN(0) rectal cancer.