The technique of intestinal stoma formation plays a critical role in determining postoperative recovery and long-term quality of life for patients with low rectal cancer, making its appropriate application a vital component of surgical treatment. This article systematically reviews the characteristics of mainstream stoma techniques, such as protective ileostomy and colostomy, with a particular focus on modified approaches—including stoma creation without a supporting rod, self-closing protective stoma, and extraperitoneal tunnel stoma—that aim to lower complication rates. It also assesses the potential applications and technical challenges associated with these modifications. The article further addresses current clinical debates concerning stoma indications and the optimal timing for stoma reversal. Finally, in line with ongoing trends toward minimally invasive and precision surgery, the article looks ahead to the potential role of innovative technologies—for instance, biodegradable stents and transanal drainage—in the future management of stomas. The overarching objective is to offer an evidence-based reference to support the development of individualized clinical treatment strategies.

This study aims to evaluate the postoperative safety, long-term survival, and postoperative peritoneal metastases (PPM) rate associated with laparoscopic surgery (LS) for T4 colon cancer. After propensity score matching, there were 68 patients in each of the LS and Open surgery groups. The primary outcomes were the 3-year OS, DFS, and PPM rates. After matching, 68 patients in each of the groups. The LS group had a higher cumulative 3-year peritoneal metastasis rate (19.8

目的 调查某岛礁医院手术情况,分析其外科疾病分布及手术特点,针对性加强岛礁医院外科住院医师的培养,提高业务水平.方法 回顾性分析某岛礁医院 2018 年 7 月至 2021 年 10 月所有手术患者资料,并参考《疾病和健康有关问题的国际统计分类》(第十次修订本)对诊断进行系统分类.结果 2018 年 7 月至 2021 年 10 月该院共进行 75 人次手术,其中74.7％为急诊手术.共检出 6 类系统疾病,前 3 位分别为消化系统疾病 46.7％(35/75),损伤、中毒和外因的某些其他后果36.0％(27/75),良性肿瘤 6.7％(5/75).手术患者共涉及 9 个专科,前 3 位分别为普通外科 46.7％(35/75)、创伤骨科 28.0％(21/75)、整形外科 13.3％(10/75).在 15 种术式中,占比最高的前 3 位为阑尾切除术 36％(27/75)、清创缝合术 14.7％(11/75)、肌腱修补术 9.3％(7/75).结论 根据岛礁医院手术情况分析,目前地方住院医师规范化培训内容与岛礁实际需求存在一定差异,建议从实际需求出发对岛礁外科住院医师进行针对性强化培训,采用"基于案例式"教学、"基于问题式"教学、模拟手术培训等形式,贴近实战,磨砺其现代化战伤救治本领,进一步提高岛礁医院卫勤保障能力.

Neoadjuvant therapy has been widely applied in the treatment of rectal cancer, which can shrink tumor size, lower tumor staging and improve the prognosis. It has been the standard preoperative treatment for patients with locally advanced rectal cancer. The efficacy of neoadjuvant therapy for rectal cancer patients varies between individuals, and the results of tumor regression are obviously different. Some patients with good tumor regression even achieve pathological complete response (pCR). Tumor regression is of great significance for the selection of surgical regimes and the determination of distal resection margin. However, few studies focus on tumor regression patterns. Controversies on the safe distance of distal resection margin after neoadjuvant treatment still exist. Therefore, based on the current research progress, this review summarized the main tumor regression patterns after neoadjuvant therapy for rectal cancer, and classified them into three types: tumor shrinkage, tumor fragmentation, and mucin pool formation. And macroscopic regression and microscopic regression of tumors were compared to describe the phenomenon of non-synchronous regression. Then, the safety of non-surgical treatment for patients with clinical complete response (cCR) was analyzed to elaborate the necessity of surgical treatment. Finally, the review studied the safe surgical resection range to explore the safe distance of distal resection margin.

Whether patients with asymptomatic primary tumors and unresectable metastases of colorectal cancer (CRC) should undergo primary tumor resection (PTR) remains controversial. This study aims to determine the appropriateness of PTR for these individuals by evaluating a number of outcome measures. A systematic literature search was performed. Outcome measures included overall survival, emergency surgery rates, incidence of postoperative complications, time to initiate chemotherapy, conversion rates, and chemotherapy-related toxicities. Patients who received PTR in addition to chemotherapy had a better overall survival rate than those who only received chemotherapy (HR = 0.62, 95

[Objectives] To analyze the clinical and pathological characteristics of colorectal cancer in organ transplant recipients and provide references for clinical diagnosis and treatment. [Methods] Retrospective analysis of 7 organ transplant recipients confirmed with colorectal adenocarcinoma who underwent radical surgery at the Department of Colorectal Surgery of the First Affiliated Hospital of Naval Medical University from September 2002 to September 2021 was performed. Clinical and pathological characteristics of colorectal cancer in organ transplant recipients were summarized and analyzed. [Results] The initial symptoms were hematochezia in 3 cases, abdominal pain in 1 case, diarrhea in 1 case, abdominal distension and vomiting in 1 case, and abnormal colonoscopy in 1 case. The preoperative serum levels of CEA were 1.61 to 123.20 ng/mL, the median serum CEA level was 5.12 (1.76, 10.28) ng/mL; the preoperative serum levels of CA199 were 4.79 to 184.96 U/mL, and the median serum CA199 level was 18.59 (9.37, 135.60) U/mL. Three patients had normal preoperative serum CEA, and five had normal preoperative serum CA199. The tumor was located in the ascending colon in 1 case, descending colon in 1 case, sigmoid colon in 1 case, rectosigmoid junction in 1 case, and rectum in 3 cases. Among them, 3 cases at stage Ⅲ, 3 cases at stage Ⅱ, and 1 case at stageⅠ;3 cases were poorly differentiated, 1 case was moderately to poorly differentiated, and 3 cases were moderately differentiated; The tumor occupied less than the entire intestinal circumference in 2 cases and the entire intestinal circumference in 5 cases. [Conclusion] Colorectal cancer in organ transplant recipients tends to occur within five years, and the tumor is usually located in the rectum, with most patients diagnosed with locally advanced stage. Therefore, for individuals who have undergone organ transplantation, it is recommended to strengthen early diagnosis and treatment of colorectal cancer to improve prognosis.

The pelvic cavity is a monolithic structure whose integrity plays an important role in the pelvic organ function. Currently, pelvic floor peritoneum reconstruction (PFPR) is rarely performed during laparoscopic surgery for middle and low rectal cancer patients. This study evaluated the effect of PFPR using barbed wire during laparoscopic surgery on the postoperative defecation function in middle and low rectal cancer patients. This was a retrospective study involving a total of 252 middle and low rectal cancer patients who had been subjected to laparoscopic-assisted anterior resection of rectal cancer at Shanghai Changhai Hospital from March 2018 to April 2020. The Wexner and low anterior resection syndrome (LARS) scores were used to evaluate the postoperative defecation function among patients. A Wexner score ≥ 8 and LARS score ≥ 30 were considered to indicate major defecation dysfunction. A total of 229 patients (52 patients subjected to PFPR) were followed up, and the Wexner and LARS scores were recorded. The follow-up rate was 90.87%, the mean follow-up time was 22.88 ± 6.93 months, the stoma rate was 64.29%, the ileostomy reduction surgical rate was 90.74%, and the stoma duration was 7.64 ± 2.94 months. Regarding the assessment of postoperative defecation dysfunction using the Wexner score, a multivariate analysis revealed that a long operation time (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.984–0.999, p = 0.026) and radiotherapy (OR, 0.352; 95% CI, 0.156–0.797, p = 0.012) were independent risk factors for major defecation dysfunction, while a high tumor location (OR, 1.318; 95% CI, 1.151–1.657, p = 0.001) and PFPR (OR, 4.770; 95% CI, 1.435–15.857, p = 0.011) were independent protective factors for major defecation dysfunction. Regarding the assessment of the postoperative defecation function using the LARS score, a multivariate analysis revealed that a high tumor location (OR, 1.293; 95% CI, 1.125–1.486, p < 0.001) and PFPR (OR, 3.010; 95% CI, 1.345–6.738, p = 0.007) were independent protective factors for major defecation dysfunction. A subgroup analysis showed that the postoperative Wexner score (3.13 ± 2.79 vs. 4.71 ± 3.45 p = 0.003) and LARS score (21.77 ± 8.62 vs. 25.14 ± 8.78 p = 0.015) were lower for patients with PFPR than for patients without PFPR. Regarding patients with low rectal cancer, those with PFPR had a lower LARS score than those without it (23.62 ± 8.94 vs. 28.40 ± 7.90, p = 0.022), but there was no significant difference in the Wexner score between the groups. A total of 9.76% of patients with PFPR and 48.89% of those without PFPR showed an intestinal accumulation in the sacral front (p < 0.001). PFPR and a high tumor location are protective factors for postoperative defecation dysfunction in middle and low rectal cancer patients. PFPR can be routinely performed during laparoscopic surgery.

结直肠癌是最常见的消化道恶性肿瘤之一,严重威胁着患者的身体健康.外科手术是治疗结直肠癌的有效方法.目前,微创手术因创伤小、恢复快等优点,成为许多患者的首选.传统腹腔镜手术在技术上存在一定的难度,它需要外科医生拥有丰富的腹腔镜操作经验.而达芬奇机器人拥有高清的3D镜头、灵活的机械臂以及更符合人体工程学的操作方式,在设计上优于腹腔镜.但多项研究结果显示,机器人结直肠手术的围手术期结果、远期结果与传统腹腔镜相比未见明显优势,而费用却明显增加.目前,机器人结直肠手术已被证实是安全可行的,其便于进行体内肠吻合,并可以缩短学习曲线.达芬奇机器人可在手术空间狭小、解剖复杂的盆腔内操作.在面对内脏肥胖、骨盆狭窄、低位肿瘤等病例时,它的视觉系统也有助于辨识解剖层次,更好的保留盆腔自主神经,可能会促进泌尿与性功能的术后恢复.随着各领域的新技术不断发展和融合,以及外科医生机器人手术经验的积累,相信机器人手术在未来会拥有更广阔的应用前景.

This study intends to assess miRNA-326’s effect on the immune-inflammatory microenvironment and its mechanism in gastric cancer (GC). GC adjacent tissues and tumor tissues were collected to analyze inflammatory factors by immunohistochemistry and ELISA, Est-1 and miRNA-326 level by Western blot or PCR, Th17 cells by flow cytometry. CD4+ T cells were transfected with Est-1 inhibitor, Est-1 mimics, or miR-326 mimics followed by measurement of Th17 differentiation-related genes via gene chips and inflammatory factor release. Inflammatory factors in serum of GC patients were significantly increased and miR-326 was upregulated with decreased Est-1 and unbalanced Th17/Treg cell ratio. miR-326 targeted Est-1 to inhibit its expression. After transfection with Est-1 inhibitor, Th17 differentiation-related genes were upregulated. After transfection with miR-326 mimics, Est-1 level was reduced and inflammation was enhanced with maturation of Th17 cells. In conclusion, miRNA-326 induces Th17 cell differentiation by targeting Est-1, thereby promoting the release of inflammatory factors and inducing immune inflammatory microenvironment.

降结肠旋转不良(persistent descending mesoco?lon, PDM)是一种先天性疾病, 1960年由Morgen?stern[1]首次报道.胚胎发育过程中,肠管以肠系膜上动脉为中心发生旋转,旋转结束后,在胎儿发育第5个月降结肠及系膜与左侧、后腹膜融合并固定,如果在发育过程中由于各种原因导致降结肠及系膜没有完成上述融合和固定,则发生PDM[2].对于PDM患者,降结肠往往移向腹腔中线位置,甚至乙状结肠位移于右下腹,因此,PDM又被称为右位乙状结肠.由于其存在广泛的粘连和异常的血管分布,在PDM患者接受腹腔镜降结肠癌、乙状结肠癌和直肠癌手术时,术者进行精准的粘连分离和正确的系膜裁剪,对于减少术中不必要的脾曲游离和术后吻合口并发症具有关键意义.笔者根据文献报道并结合临床实践体会对PDM手术策略进行总结分析,以供结直肠外科同道参考.