Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Background:In the treatment of colorectal cancer,laparoscopic surgery has seen a significant amount of success.Reducing the risk of postoperative complications and improving patients’quality of life can be accomplished by appropriately employing pelvic peritoneal repair and sigmoid colostomy when appropriate.Objective:To compare fusion closure of pelvic peritoneum combined with extraperitoneal colostomy with non-closure of pelvic peritoneum combined with intraperitoneal colostomy in patients with low rectal cancer who had permanent colostomy.Methods:Low rectal cancer patients admitted to Hengshui People’s Hospital for permanent colostomy were evaluated.The participants were divided into two groups:an observation and a control group.All 30 cases in the observation group underwent pelvic peritoneum closure and extraperitoneal colostomy,while the other 30 cases in the control group underwent intraperitoneal colostomy.The C-reactive protein(CRP)levels of the participants in both groups were evaluated for 6 months to 2 years(24 h before,24 h after,48 h after,96 h after surgery).Results:Comparing the colostomy operative time,time to first passage of flatus postoperatively,time to first defecation postoperatively,length of hospital stay,laboratory indicators,stoma-related complications,colostomy function,etc.,the colostomy operative time significantly differed between the two groups(P<0.05);the observation group did considerably better than the control group in terms of stoma-related complications and bowel movement control 6 months after surgery(P<0.05);and although serum CRP levels increased in both groups 48 h after surgery,the difference was significant(P<0.05).Conclusion:Extraperitoneal colostomy can improve the quality of life of patients with permanent stoma and reduce the occurrence of stoma-related complications.Thus,this technique is worthy of promotion in clinical practice.

Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture

Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area,accompanied by massive hemoperitoneum,mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver,gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected. Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries,cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection,but the tumor recurred one month after operation. To our knowledge,the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.

Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum

Colorectal cancer(CRC) is the third most common cancer and the fourth most common cause of cancerrelated death worldwide. Besides the lymphatic and haematogenous routes of dissemination,CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity,which ultimately leads to peritoneal carcinomatosis(PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However,this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements,involving several well-defined steps,together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor,gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum,subsequently invade the subperitoneal space,where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript,we review current data regarding the molecular mechanisms underlying the development of colorectal PC,with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread.

Inhibitory effect of genistein on MMP-2 and MMP-9 expression through suppressing NF-κB activity in peritoneum of murine model of endometriosis

Objective:To analyze the inhibitory effect of genistein on matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) through inhibition of nuclear factor-kappa B (NF-κB ) activation.Methods: A total of 36 female mice were divided into six groups (n=6 in each group): control group (untreated mice), endometriosis mice group, and endometriosis mice groups administered with genistein at different doses (1.30 mg/day;1.95 mg/day;2.60 mg/day;and 3.25 mg/day). The genistein treatment was performed for 14 d. The expressions of NF-κB , MMP-2 and MMP-9 on the endometriosis lesions were analyzed by the immunohistochemical technique.Results: The activity of NF-κB in the endometriosis group increased significantly than that of the control group (P<0.05). The expression of MMP-2 or MMP-9 in the endometriosis group increased significantly than that of the control group (P<0.05). Administration of genistein at different doses was capable of significantly reducing the activity of NF-κB compared to that of the endometriosis group (P<0.05), reaching the level comparable to that of the control group at the third highest dose (P>0.05). The four doses of genistein administration were capable of significantly reducing the expression of MMP-2 compared to that of the endometriosis group (P<0.05), reaching an expression comparable to that of the control group for the highest dose (P>0.05). Administration of genistein at different doses was capable of significantly reducing the expression of MMP-9 compared to that of the endometriosis group (P<0.05), reaching the level comparable to that of the control group at the highest dose (P>0.05). Conclusions:Genistein suppresses the expression of MMP-2 and MMP-9 through suppressing NF-κB activity in the peritoneum of murine model of endometriosis.

Caval replacement with parietal peritoneum tube graft for septic thrombophlebitis after hepatectomy: A case report

BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.

Coexistence of tuberculous peritonitis and primary papillary serous carcinoma of the peritoneum:A case report and review of the literature

A major diagnostic challenge to the evaluation of an incomplete intestinal obstruction is to distinguish between infectious and malignant etiologies.We present a case of an elderly woman complaining of abdominal pain accompanied with nausea and vomiting,and failure to pass gas or stools.Anti-tuberculosis drugs were used to relieve her abdominal pain,and a needle biopsy of the peritoneal cavity showed evidence of primary papillary serous carcinoma of the peritoneum(PSCP). This is a rare description of tuberculosis in the setting of PSCP.This report illustrates the potential complex nature of malignancies,and emphasizes the need to consider coexistence of malignancy and infection in patients, especially in those with risk factors for malignancy who fail with antibiotic therapy.

The follow up of quality life after in terventional therapy of post-peritoneum metastatic tumors

Objective Increase therapeutic effective rat e of post-perineum malignant carcin oma and decrease side effects.Method Inject chemotherapy drugs such as 5-FU,DDP and /or IL-2into tumors at variant po ints induced by B-ultrasound.Result The general effective rate was 72.7%in 11patients,which is hig her than other therapies.Conclusion B-ultrasound interventional thera py is recommended in the treatment of post-peritoneum malig nant tumors.

The peritoneum of fish expresses a specific gene pattern

The peritoneum is mainly composed of mesothelial cells,fiber cells,and fibers,with many free cells that come from tissue capillaries.Siniperca chuatsi is a valuable fish commodity and important freshwater aquaculture species in China.With the increase in the scale of its breeding,bacterial and viral disease of the S.chuatsi has become increasingly rampant in recent years.This study analyzed the peritoneal gene expression profile using transcriptome technology for the first time.The results showed that 95,711 unigenes were expressed in the peritoneum with an average length of 920.72 bp.In addition to the housekeeping genes,the genes of extracellular matrix protein 1a(ecm1),Angiopoietin-related protein 4-like(angptl4)and cysteine-rich protein 1(crip1)were highly expressed genes in the peritoneum,and they are key factors in peritoneal development and the maintenance of morphology.Meanwhile,many immune genes were also expressed in the peritoneum,including beta-2-microglobulin(b2m),MHC II invariant chain(cd74),prostate stem cell antigen-like protein(psca),claudin(cldn),heat shock protein 90(hsp90),complement component 4(c4),radical S-adenosyl methionine domain-containing protein 2(rsad2),and cathepsin S(ctss).The RT-PCR results showed that different genes exhibited different expression profiles.The transcriptome data indicated that b2m,cldn,hsp90,c4,and rsad2 were highly expressed in the peritoneum.b2m,cd74,psca,c4,and ctss were highly expressed after embryonic hatching,whereas cldn,hsp90,and rsad2 were expressed at early embryonic stages.Quantitative PCR demonstrated that b2m,cd74,cldn,hsp90,c4,and ctss genes were highly expressed after immunostimulation.This study provides significant data for studying the morphological and functional diversity of fish peritoneum and lays a foundation for research on mandarin fish immunity.

Cross-linking porcine peritoneum by oxidized konjac glucomannan:a novel method to improve the properties of cardiovascular substitute material

The use of natural polysaccharide crosslinkers for decellularized matrices is an effective approach to prepare cardiovascular substitute materials.In this research,NalO_(4)was applied to oxidize konjac glucomannan to prepare the polysaccharide crosslinker oxidized konjac glucomannan(OKGM).The as-prepared crosslinker was then used to stabilize collagen-rich decellularized porcine peritoneum(DPP)to construct a cardiovascular substitute material(OKGM-fixed DPP).The results demonstrated that compared with GA-fixed DPP and GNP-fixed DPP,3.75%OKGM[1∶1.5(KGM∶NalO_(4))]-fixed DPP demonstrated suitable mechanical properties,as well as good hemocompatibility,excellent anti-calcification capability,and anti-enzymolysis in vitro.Furthermore,3.75%OKGM[1∶1.5(KGM∶NalO_(4))]-fixed DPP was suitable for vascular endothelial cell adhesion and rapid proliferation,and a single layer of endothelial cells was formed on the fifth day of culture.The in vivo experimental results also showed excellent histocompatibility.The current results demonstrted that OKGM was a novel polysaccharide cross-linking reagent for crosslinking natural tissues featured with rich collagen content,and 3.75%OKGM[1∶1.5(KGM∶NalO_(4))]-fixed DPP was a potential cardiovascular substitute material.

体外丝线牵拉辅助两孔腹腔镜内环缝合在治疗内环口皱褶冗厚斜疝中的应用

目的探讨体外丝线牵拉辅助两孔腹腔镜内环缝扎治疗内环皱褶冗厚斜疝的安全性、可行性。方法2019年10月~2023年2月,322例斜疝患儿接受两孔法腹腔镜内环缝扎,其中186例(292侧)内环皱褶冗厚患儿采用体外丝线牵拉法辅助。在腹腔镜监视下,针持持针经内环口外下缘入腹膜,于腹膜后间隙走行至精索血管外侧缘出针;于精索血管外侧缘进针,体外轻轻牵拉线尾,腹腔镜下见进针点附近后腹膜间隙增大,缝针顺势在后腹膜间隙跨越精索血管表面。相同方法牵拉和展开折叠在输精管-髂外血管间隙的腹膜皱褶,增大后腹膜间隙,缝针继续在后腹膜间隙贴近髂血管表面跨越Doom三角区冗厚的腹膜组织。相同方法于腹膜外间隙跨越输精管表面。继续直视下缝合内环口内侧壁和上壁腹膜组织,于最初进针处出针和打结,闭合内环口。结果292侧体外丝线牵拉冗厚腹膜后,缝针能顺利跨越精索血管、Doom三角区以及输精管表面。80例单侧手术时间(18.5±3.2)min,106例双侧手术时间(32.6±5.3)min。均无术中并发症发生,均在术后6 h内出院。122例术后随访3~18个月(平均8.5月),未出现切口感染、医源性隐睾或睾丸萎缩等并发症,无复发疝、鞘膜积液。结论对于内环皱褶冗厚的儿童斜疝,体外丝线牵拉法可有效展开冗厚的后腹膜,降低两孔法腹腔镜内环口缝扎时缝针跨越精索血管、Doom三角区以及输精管表面的难度,具有安全性、可行性。

微粒口腔黏膜代阴道成形术临床应用效果评价

目的探讨微粒口腔黏膜代阴道成形术的临床应用效果。方法回顾性分析2013年2月-2024年1月甘肃省妇幼保健院收治的149例生殖道畸形(MRKH综合征和阴道闭锁)需要行阴道成形术的患者临床资料。按照手术方式不同分为口腔黏膜代阴道成形术组(n=95)、腹膜代阴道成形术组(n=31),及生物补片代阴道成形术组(n=23),比较手术相关指标、人工阴道相关指标、性生活指标,评价微粒口腔黏膜代阴道成形术的临床应用效果。结果口腔黏膜组及生物补片组在手术时间、出血量方面显著优于腹膜组(P<0.05)。在住院费用上,生物补片组明显高于另外两组,口腔黏膜组花费最低(P<0.05)。术后阴道长度口腔黏膜组及生物补片组优于腹膜组(P<0.05)。阴道弹性、阴道pH值、性满意度、并发症率等指标3组间差异无统计学意义。结论口腔黏膜代阴道成形术简单、微创、无痛。符合患者隐私需求,效果满意,医疗费用低,性价比高,具有临床应用价值。

单钩针下压式勾线疝囊高位结扎术治疗儿童腹股沟斜疝的体会

目的探讨全腹膜外疝囊高位结扎术中采用单钩针下压式勾线治疗儿童腹股沟斜疝的体会。方法回顾性分析2018年5月至2019年5月西安市儿童医院收治的腹股沟斜疝患儿419例。其中男370例,女49例,最小年龄8个月,最大年龄15岁,平均年龄3岁6个月;左侧160例,右侧220例,双侧39例。在全腹膜外疝囊高位结扎术中采用单钩针下压式勾线,记录手术时间和后腹膜的完整性。结果女孩单侧手术时间为(4.0±1.0)min,双侧为(6.0±1.2)min;男孩单侧手术时间为(6.0±1.0)min,双侧为(9.0±1.5)min。术中均未出现多次钩挂腹膜的手术过程和后腹膜撕裂等并发症,术后随访均无并发腹膜裂孔疝继发肠坏死情况。结论单钩针全腹膜外疝囊高位结扎术治疗儿童腹股沟斜疝手术中采用下压式勾线,能有效地减少腹膜外勾线时反复勾线和避免钩挂腹膜所引起的后腹膜撕裂等并发症,值得临床借鉴推广。

鲫腹膜分布、组织学及光照对其影响研究

腹膜在脊椎动物中普遍存在,由间皮细胞构成,通过结缔组织的支持作用形成的一层膜状组织,具有润滑、支持和保护等功能。鱼类有腹膜且分布有色素细胞,本研究选取常见经济鱼类鲫(Carassius auratus)为实验对象,采用组织学方法研究其腹膜分布及色素细胞形态特征,并探究光照条件对鲫腹膜色素细胞的影响。结果显示:(1)鲫腹膜呈黑色,腹腔腹壁内侧、心腹隔膜靠近腹腔一侧有明显分布,腹腔腹壁内侧黑色腹膜在腹腔上方延伸包裹性腺后相连覆于鳔下侧。(2)鲫腹膜黑色素细胞为黑色的树突状细胞。(3)鲫腹腔腹壁内侧腹膜的石蜡组织切片显示黑色素细胞连续分布形成黑色色素带,细胞核椭圆形、呈蓝紫色;扫描电镜下腹膜组织凹凸不平,由嵴组成多角形的网状结构;透射电镜下黑色素细胞有细胞核和黑素小体,黑素小体分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四个时期。(4)不同光照影响鲫腹腔腹壁内侧腹膜黑色素细胞的形态,光照组黑色素细胞胞体变大、分支变粗,呈色变深;黑暗组黑色素细胞胞体变小、分支变细长。本研究为鱼类腹膜系统研究提供理论参考。

输卵管和腹膜结核的MRI表现特征分析

目的探讨输卵管和腹膜结核的MRI表现特征。方法选21例经病理和实验室检查证实的输卵管和腹膜结核(TB)患者和27例卵巢癌(EOC)累及输卵管伴腹膜转移患者的临床和MRI及PET/CT表现进行比较分析,对病变形态、T1WI、T2WI和弥散加权成像(DWI)信号特点、表观弥散系数(ADC)值及强化特征进行分析研究。结果21例TB患者中,16例输卵管TB为单侧性(左侧9例,右侧7例),5例为双侧性。病变输卵管10例呈棒状,12例呈腊肠状S或L形,4例呈肿块状。病变输卵管于T1WI上呈略高信号,T2WI上呈软组织中等信号,DWI上呈高信号,ADC值测量范围为0.75-1.02×10-3mm2/s。结核性输卵管病变大小从0.7×2.2cm到1.5×4.5cm。TB性腹膜的厚度范围为1.6mm-3.2mm,呈薄层均匀平滑无结节增厚。结论输卵管呈管状、S/L形等非肿块样改变,在T1WI呈略高信号和腹膜呈薄层均匀性增厚并明显强化是输卵管和腹膜结核的特征表现。

术前血清CA125和腹水对胰腺癌腹膜转移诊断价值

目的 探讨术前血清肿瘤标志物CA125和腹水与胰腺癌腹膜转移之间的关联性,为胰腺癌腹膜转移的早期诊断提供依据。方法 选取2018年1月—2021年12月在我院因胰腺癌腹膜转移行外科手术的病人24例,无腹膜转移的胰腺癌病人89例。收集病人的CA125及腹水状态等指标,分析其与腹膜转移的关系。结果 有无腹膜转移的胰腺癌病人的分化程度、CA199、CA125及腹水状态的差别有统计学意义(χ^(2)=6.43~9.54,P<0.05)。CA125(OR=1.189,95%CI=1.040~1.358)及腹水(OR=1.037,95%CI=0.806~1.225)为胰腺癌腹膜转移的独立危险因素。CA125+腹水诊断胰腺癌腹膜转移的受试者工作特征曲线下面积(0.953)大于CA125(0.941)和腹水(0.859)单独诊断(Z=3.950、4.158,P<0.001)。结论 CA125及腹水是胰腺癌腹膜转移的独立危险因素,二者联合检测可提高胰腺癌腹膜转移的诊断准确性。

腹腔镜直肠癌腹会阴联合切除术后盆底腹膜重建技术的研究进展

探讨低位直肠癌经腹会阴联合切除术后盆底腹膜重建的方法及意义。通过检索直肠癌术后盆底结构重建技术及盆底腹膜重建相关文献,复习直肠癌盆底重建技术发现,直肠癌腹腔镜腹会阴联合切除术后关闭盆底腹膜是有必要的,虽然增加了外科医师的手术难度,但可减少盆腔及会阴区域感染、肠粘连、肠梗阻及放射性肠炎发生率,提高患者生活质量。该文对盆底结构重建方法及盆底腹膜重建的方法及优缺点进行了综述。

Morphological changes of the peritoneum in peritoneal dialysis patients

Background Long-term peritoneal dialysis (PD) requires that the peritoneal membrane remain effective for dialysis. Research directed toward human peritoneal morphology and structure is limited. The present study was performed to investigate morphological changes of the human peritoneal membrane during PD and to elucidate the possible mechanisms of its functional deterioration. Methods A total of 32 peritoneal biopsies were performed in normal subjects (n=10),uremic nondialysis patients (n=12) at the time of catheter insertion,and PD patients (n=10) at the time of catheter removal or reinsertion or at the time of renal transplantation. Peritoneal morphology was examined by light microscopy,scanning electron microscopy,and transmission electron microscopy. Results The peritoneal membrane in normal subjects consisted of a monolayer of mesothelial cells on a basement membrane and a layer of connective tissue containing cells,blood vessels,and lymphatic vessels. Mesothelial cells were polygonal,often elongated,and had numerous microvilli on their luminal surface. There were lots of oval or roundish pinocytotic vesicles in the cytoplasm of the mesothelial cells. The peritoneal morphology of uremic nondialysis patients was similar to that of normal subjects. However,significant abnormalities of the peritoneal membrane were observed in PD patients,and the changes were found to be progressive. Microvilli were the first site of damage which involved microvilli shortening,a gradual reduction in their number,and,eventually,the total disappearance of microvilli. Mesothelial cells then detached from the basement membrane, disappearing completely in some cases. In the end,the peritoneal membrane consisted only of submesothelial connective tissue without any cells.Conclusions PD can modify peritoneal morphology and structure. The morphological change is progressive and may be one of the important causes of peritoneal failure. Peritoneal biopsies can provide lots of valuable information about the effects of PD. Studying the relationship between peritoneal structure and its function proved very useful for understanding the physiopathology of the peritoneum during PD.

Expression of aquaporin-1 in the human peritoneum and the effect of peritoneal dialysis on its expression

Objective To investigate the expression of aquaporin-1 (AQP1) in the human peritoneum and to evaluate the effect of peritoneal dialysis (PD) on its expression.Methods Peritoneal biopsies were obtained from normal subjects (n =10), uremic nondialysis patients (n = 12) at catheter insertion and PD patients ( n = 10) at the time of catheter removal, reinsertion or renal transplantation. Western blot, immuno-histochemical staining and reverse transcript-polymerase chain reaction ( RT-PCR) techniques were used to investigate AQP1 expression.Results All peritoneal samples expressed AQP1 at both mRNA and protein levels. Western blot revealed a major band at 28 kD as well as more diffuse bands between 35 and 50 kD. The 28 kD band represents the nonglycosylated form of the protein while the 35 - 50 kD bands correspond to glycosylated AQP1. Immunohistochemical staining found the positive deposits were distributed in the mesothelial cells, endothelial cells of capillaries, venules and small veins, whereas no signal was detected in the arterioles. Semi-quantitative analysis showed that AQP1 expression was remarkably stable in all samples, whatever their origin (P>0. 05).Conclusions Our findings suggested that AQP1 is the molecular counterpart of an ultra small pore during PD. Secondly, the peritoneal mesothelial cell might also be involved in peritoneal transcellular water transport. As regards whether or not the structural or distributional alterations of AQP1 in the peritoneum may be more obviously expressed during PD, further study is needed.

幼儿腹膜原发支持-间质细胞瘤1例

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腹膜外途径腹腔镜修补膀胱直肠瘘5例报道

本文回顾性分析了我院采用经腹膜外途径腹腔镜治疗的5例膀胱直肠瘘患者,采用了经腹膜外途径切除膀胱和直肠瘘口,并分开缝合,两瘘口间填塞带血管蒂大网膜,同期行乙状结肠造口。5例患者手术时间100~130 min(平均115 min),术中出血20~50 ml(平均32 ml)。术后6个月将乙状结肠还纳。随访1年无尿瘘复发,无其他并发症。