Security Assurance for One-stage Resection of Left Colon Cancer with Acute Obstruction—Thorough and Prompt Enteral Decompression without Contamination

Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.

Comparison of Clinicopathological and Survival Features of Right and Left Colon Cancers: Experience of the Medical Oncology Department of Fez

Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) have different epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. The objective of our study is to compare right-sided colon cancers and left-sided colon cancers regarding clinicopathological and survival characteristics. This is a retrospective study of 664 patients with colon cancer treated at the medical oncology department of Fez over a period from December 2009 to September 2020. Rectosigmoid, descending colon, and splenic flexure tumors were considered left-sided colon cancers, whereas ascending colon tumors were considered right-sided colon cancers. The Kaplan Meier method was used to estimate median survival. The study included 664 patients (female, 47%) having colon cancer with a median age of 60 years (23 - 83). Of the patients, 78.5% (n = 519) had LCC and 19.36 % (n = 128) had RCC. The rate of patients aged ≥ 65 years and the rate of patients with a family history of colon cancer was higher in the LCC patients. The proportion of poorly differentiated adenocarcinomas represented 3%, of which 63% had cancer of the right colon. There was a significantly higher proportion of higher T stage (T3-4: 62% vs 38%) in right sided tumors as compared to left sided tumors. The rate of metastatic patients was 64.1% in the RCC group and 43% in the LCC group. The median follow-up period was 14 months in the RCC group and 19 months in the LCC group with higher median overall survival in the LCC group (32 vs 21 months). We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage associated with a median overall survival better in left colon cancer.

Right and Left Colon Cancer: Clinico-Pathological Features and Treatment Results (South Egypt Cancer Institute Experience)

Background: Colon cancer (CC) ranks as the third most common cancer worldwide and is considered the second leading cause of cancer death. Recently, many international studies have made the observation that right and left colon cancer have many significant differences regarding clinico-pathological characteristics and primary tumor location has a crucial impact on treatment outcomes and overall survival. Our study was conducted to verify the presence of significant differences between right and left colon cancer. Patients and Methods: This study is a retrospective cohort study which aimed at comparing right and left colon cancer as regards clinico-pathological data and treatment results among patients with colon cancer receiving treatment at South Egypt Cancer Institute (SECI) during the period from 1/2008 to 12/2018. A sample size of 160 cases of colon cancer patients (80 diagnosed as right colon cancer and 80 diagnosed as left colon cancer) was randomly selected from our South Egypt Cancer Institute (SECI)’s tumor registry. Statistical analysis was done using SPSS program version 20. Difference was considered statistically significant at P-value < 0.05. Survival curves were conducted using the Kaplan-Meier methods and were compared with the log-rank test. Results: Right colon cancer occurred at an older age and was more commonly presented with abdominal pain while left colon cancer was more commonly presented with bleeding manifestations. More cases of the right side underwent curative surgeries whereas more palliative surgeries were performed to left-sided cases. Left sided cases were associated with a more advanced stage at diagnosis while right-sided cases were associated with a better response to first-line chemotherapy. More cases of the left side died due to metastatic disease. On the other hand, our findings demonstrated no differences between both sides regarding gender predilection, risk factors, sites of metastases, number of metastatic organs, histo-pathological examination and grading, response to second- or third-line chemotherapy, chemotherapy toxicity (hematological or non-hematological), overall survival, progression-free survival, or disease-free survival. Conclusion: Primary tumor location of colon cancer has a significant effect on clinico-pathological characteristics and treatment outcomes.

Expression of cyclin-dependent kinase 9 is positively correlated with the autophagy level in colon cancer

BACKGROUND Cyclin-dependent kinase 9(CDK9)expression and autophagy in colorectal cancer(CRC)tissues has not been widely studied.CDK9,a key regulator of transcription,may influence the occurrence and progression of CRC.The expression of auto-phagy-related genes BECN1 and drug resistance factor ABCG2 may also play a role in CRC.Under normal physiological conditions,autophagy can inhibit tumorigenesis,but once a tumor forms,autophagy may promote tumor growth.Therefore,understanding the relationship between autophagy and cancer,partic-ularly how autophagy promotes tumor growth after its formation,is a key motivation for this research.AIM To investigate the relationship between CDK9 expression and autophagy in CRC,assess differences in autophagy between left and right colon cancer,and analyze the associations of autophagy-related genes with clinical features and prognosis.METHODS We collected tumor tissues and paracarcinoma tissues from colon cancer patients with liver metastasis to observe the level of autophagy in tissues with high levels of CDK9 and low levels of CDK9.We also collected primary tissue from left and right colon cancer patients with liver metastasis to compare the autophagy levels and the expression of BECN1 and ABCG2 in the tumor and paracarcinoma tissues.RESULTS The incidence of autophagy and the expression of BECN1 and ABCG2 were different in left and right colon cancer,and autophagy might be involved in the occurrence of chemotherapy resistance.Further analysis of the rela-tionship between the expression of autophagy-related genes CDK9,ABCG2,and BECN1 and the clinical features and prognosis of colorectal cancer showed that the high expression of CDK9 indicated a poor prognosis in colorectal cancer.CONCLUSION This study laid the foundation for further research on the combination of CDK9 inhibitors and autophagy inhibitors in the treatment of patients with CRC.

Different treatment strategies and molecular features between right-sided and left-sided colon cancers

The colon is derived from the embryological midgut and hindgut separately,with the right colon and left colon having different features with regards to both anatomical and physiological characteristics.Cancers located in the right and left colon are referred to as right colon cancer(RCC) and left colon cancer(LCC),respectively,based on their apparent anatomical positions.Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC,but molecular features also vary between them,not to mention the distinguishing clinical manifestations.Disease-free survival after radical surgery of both RCC and LCC are similar.In the treatment of RCC,the benefit gained from adjuvant FOLFIRI chemotherapy is superior,or at least similar,to LCC,but inferior to LCC if FOLFOX regimen is applied.On the other hand,metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting.For KRAS wild-type cancers,LCC benefits more from cetuximab treatment than RCC.Moreover,advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC.Significant varieties exist at the molecular level between RCC and LCC,which may serve as the cause of all apparent differences.With respect to carcinogenesis mechanisms,RCC is associated with known gene types,such as MMR,KRAS,BRAF,and mi RNA-31,while LCC is associated with CIN,p53,NRAS,mi RNA-146 a,mi RNA-147 b,and mi RNA-1288.Regarding protein expression,RCC is related to GNAS,NQO1,telomerase activity,P-PDH,and annexin A10,while LCC is related to Topo I,TS,and EGFR.In addition,separated pathways dominate progressionto relapse in RCC and LCC.Therefore,RCC and LCC should be regarded as two heterogeneous entities,with this heterogeneity being used to stratify patients in order for them to have the optimal,current,and novel therapeutic strategies in clinical practice.Additional research is needed to uncover further differences between RCC and LCC.

Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: meta-analysis with systematic review of the literature

AIM To investigate by meta-analytic study and systematic review, advantages of colonic stent placement in comparison with emergency surgery.METHODS We conducted an extensive literature search by PubMed, Google Scholar, Embase and the Cochrane Libraries. We searched for all the papers in English published till February 2016, by applying combinations of the following terms: Obstructive colon cancer, colon cancer in emergency, colorectal stenting, emergency surgery for colorectal cancer, guidelines for obstructive colorectal cancer, stenting vs emergency surgery in the treatment of obstructive colorectal cancer, selfexpanding metallic stents, stenting as bridge to surgery. The study was designed following the PrismaStatement. By our search, we identified 452 studies, and 57 potentially relevant studies in full-text were reviewed by 2 investigators; ultimately, 9 randomized controlled trials were considered for meta-analysis and all the others were considered for systematic review.RESULTS In the meta-analysis, by comparing colonic stenting(CS) as bridge to surgery and emergency surgery, the pooled analysis showed no significant difference between the two techniques in terms of mortality [odds ratio(oR) = 0.91], morbidity(oR = 2.38) or permanent stoma rate(oR = 1.67); primary anastomosis was more frequent in the stent group(oR = 0.45; P = 0.004) and stoma creation was more frequent in the emergency surgery group(oR = 2.36; P = 0.002). No statistical difference was found in disease-free survival and overall survival. The pooled analysis showed a significant difference between the colonic stent and emergency surgery groups(oR = 0.37), with a significantly higher 1-year recurrence rate in the stent group(P = 0.007).CONCLUSION CS improves primary anastomosis rate with significantly high 1-year follow-up recurrence and no statistical difference in terms of disease-free survival and overall survival.

光谱CT显示左结肠动脉的最佳虚拟单能量

目的:探讨双层探测器光谱CT显示左结肠动脉(LCA)的最佳虚拟单能量,旨在为腹腔镜直肠癌根治术前评估LCA提供帮助。方法:回顾性分析在本院行腹部CT血管成像(CTA)扫描的100例患者的影像学资料,将动脉期原始图像重组成混合能量图像以及基于能谱的间隔10 keV的40~70 keV的单能量图像。对5组图像LCA的CT值、信噪比(SNR)、对比噪声比(CNR)、图像噪声以及图像质量评分进行比较。结果:40~70 keV组单能量图像LCA的CT值、噪声、CNR、SNR随着能级的升高呈递减趋势。常规混合能量图像组及40~70 keV单能量图像组两两比较,各组间CT值、SNR、CNR、噪声差异有统计学意义(P<0.05)。40 keV组图像LCA的CT值、CNR、SNR均高于其他组,噪声低于常规混合能量图像组。两名影像科医师图像质量主观评价的一致性良好(0.40≤Kappa值<0.75),各组间图像主观评分差异均有统计学意义(P均<0.001)。40 keV组图像主观评分最高,40~70 keV组单能量图像质量均高于常规混合能量图像。结论:40 keV为显示LCA的最佳虚拟单能量,显示血管清晰、边缘锐利,能更清晰显示LCA及其解剖变异,利于外科医生腹腔镜直肠癌根治术的顺利进行。

场景式扶镜法在头侧中间入路3D腹腔镜左半结肠游离中的应用体会

目的:探讨头侧中间入路3D腹腔镜直肠癌手术中应用场景式扶镜法游离左半结肠的可行性。方法:以手术图片描述场景式头侧中间入路3D腹腔镜左半结肠游离扶镜技术的关键要点。将2020年4月至2022年5月采用场景式扶镜技术行头侧中间入路3D腹腔镜直肠癌左半结肠游离的41例患者归入场景组,将2019年1月至2020年3月采用传统扶镜法的37例患者归入传统组,对比分析两组左半结肠游离时间、术中出血量等。结果:场景组与传统组左半结肠游时间差异有统计学意义[(60.9±13.3)min vs.(70.1±13.9)min,P<0.05],术中出血量[(35.0±13.6)mL vs.(39.2±13.6)mL]、淋巴结清扫数量[(11.9±4.9)枚vs.(12.9±4.4)枚]、术后住院时间[(7.7±3.4)d vs.(8.0±4.3)d]、术后并发症(5 vs.4)差异无统计学意义(P>0.05)。两组术后随访6~12个月,均无局部复发或转移。结论:相较传统扶镜法,头侧中间入路3D腹腔镜直肠癌手术中应用场景式扶镜法游离左半结肠可明显缩短手术时间,术者操作更加流畅。

老年人腹腔镜直肠癌根治术中保留左结肠动脉安全及疗效的Meta分析

目的:系统评价老年人腹腔镜直肠癌根治术中保留左结肠动脉是否安全有效。方法:检索PubMed、EMBase、Cochrane图书馆、Web of Science、万方、VIP、CNKI等数据库,文献检索从建库至2023年6月。对纳入文献进行质量评价和数据提取,应用stata16.0软件进行Meta分析。结果:纳入了11篇文献,共1138例患者,其中保留左结肠动脉(LCA)组571例,不保留LCA组567例。与对照组相比,保留LCA组住院时间(WMD=-0.844,95%CI=-1.064~-0.624,P<0.05)、吻合口瘘的发生率(RR=0.274,95%CI=0.149~0.504,P<0.05)、IMA根部淋巴结清扫数目(WMD=-0.264,95%CI=-0.365~-0.163,P<0.05)、术后排气时间(WMD=-0.364,95%CI=-0.669~-0.058,P<0.05)均优于不保留组,但手术时间(WMD=9.518,95%CI=4.568~14.468,P<0.05)与术中出血率高于不保留LCA组(RR=3.239,95%CI=1.901~4.578),P<0.05);对于切口感染率(RR=1.022,95%CI=0.411,2.545,P=0.962)、总淋巴结的清扫数目(WMD=0.226,95%CI=-0.714~1.167,P=0.637)、肠梗阻发生率(RR=0.708,95%CI=0.262~1.915,P=0.497)复发率(RR=1.183,95%CI=0.265~5.278,P=0.826)、吻合口出血率(RR=0.979,95%CI=0.468~2.048,P=0.956)、尿潴留发生率(RR=0.633,95%CI=0.363~1.104,P=0.107)无显著差异。结论:保留左结肠动脉在住院时间、IMA根部淋巴结清扫数目、吻合口瘘发生率会优于不保留组;手术时间、术中出血率、术后排气时间却高于不保留LCA组;切口感染发生率及复发率等指标无差异。

双侧入路腹腔镜下中低位直肠癌根治术保留左结肠动脉的治疗效果研究

目的比较双侧入路与传统入路腹腔镜下中低位直肠癌(MLRC)根治术保留左结肠动脉的临床治疗效果。方法回顾性分析2021年2月至2024年2月于广东省茂名农垦医院实施腹腔镜下MLRC根治术保留左结肠动脉的82例患者临床资料,按照手术入路方式分为双侧入路组(n=45)和传统入路组(n=37)。比较两组患者的临床指标(术中出血量、手术时间、吻合时间、淋巴结清扫总数目、术后疼痛评分、排气时间及住院时间)和术后并发症发生情况。结果双侧入路组患者术中出血量、手术时间、吻合时间、淋巴结清扫总数目、术后疼痛评分、排气时间及住院时间分别为(78.64±8.16)mL、(153.07±20.84)min、(27.10±3.04)min、(18.26±1.60)枚、(3.32±0.63)分、(2.39±0.49)d、(8.74±1.62)d,与传统入路组的(76.53±8.40)mL、(148.01±22.15)min、(25.95±3.19)min、(18.80±1.42)枚、(3.05±0.67)分、(2.28±0.46)d、(9.17±1.63)d比较,差异均无统计学意义(P>0.05);双侧入路组患者术后并发症发生率为2.22%,明显低于对照组的16.22%,差异有统计学意义(P<0.05)。结论双侧入路腹腔镜下MLRC根治术保留左结肠动脉患者的临床治疗效果与传统入路相似,但双侧入路能够显著降低术后并发症的发生风险。

全直肠系膜切除术中保留左结肠动脉在直肠癌患者中的应用效果

目的:观察全直肠系膜切除术(TME)中保留左结肠动脉(LCA)在直肠癌患者中的应用效果。方法:回顾性分析2019—2022年该院收治的106例直肠癌患者的临床资料,根据术中是否保留LCA将其分为对照组(n=56)和研究组(n=50),两组均行TME治疗。对照组术中不保留LCA,研究组术中保留LCA,比较两组围术期指标(手术时间、术中出血量、淋巴结清扫数目、首次排气时间、首次进食时间、术后住院时间)水平,手术前后T细胞亚群指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、肛肠功能指标[肛肠静息压(ARP)、直肠肛管抑制反射阈值(AIRT)、高压区长度(HPZ)]水平,以及并发症发生率。结果:两组手术时间、术中出血量、淋巴结清扫数目比较,差异均无统计学意义(P>0.05);研究组首次排气时间、首次进食时间、术后住院时间均短于对照组,差异有统计学意义(P<0.05);术后3、5 d,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);术后1、2周,两组ARP、HPZ水平均低于术前,但研究组高于对照组,两组AIRT水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为6.00%(3/50),低于对照组的25.00%(14/56),差异有统计学意义(P<0.05)。结论:TME术中保留LCA治疗直肠癌患者,可促进患者康复,改善免疫功能和肛肠功能,降低并发症发生率,效果优于TME术中不保留LCA治疗。

基于TCGA研究左右半结肠癌基因表达差异及苦参-大血藤-半枝莲作用机制

【目的】探讨左半结肠癌与右半结肠癌的基因表达差异及大肠癌核心药对苦参-大血藤-半枝莲作用于左右半结肠癌的机制差异。【方法】下载134例左半结肠癌及194例右半结肠癌患者癌症基因组图谱(TCGA)的转录组数据,应用R软件实现2组差异基因分析及京都基因与基因组百科全书(KEGG)通路富集分析;通过BATMAN-TCM数据库获取苦参-大血藤-半枝莲药对的活性成分及靶点,基于左右半结肠癌差异基因,分别进行药对-左/右半结肠癌KEGG富集分析、蛋白质互作(PPI)网络构建,比较药对治疗左、右半结肠癌富集的生物信号通路差异及关键靶点差异。【结果】左半结肠癌与右半结肠癌相对于正常癌旁组织共同的差异表达基因共6051个,左半结肠癌特异性的差异表达基因共1958个,右半结肠癌特异性的差异表达基因共1739个;左半结肠癌特异性KEGG富集通路14条,右半结肠癌特异性KEGG富集通路23条。苦参-大血藤-半枝莲药对活性化合物共85个,对应的靶点合计469个,药对-左半结肠癌靶点富集于10条KEGG信号通路,关键靶点为DRD2、CACNA1C、HTR3A、COMT、TH,药对-右半结肠癌靶点富集于1条KEGG信号通路,核心靶点为HTR3A、DRD2、TH、AGT、GRIN2B。【结论】左半结肠癌与右半结肠癌存在基因表达差异:左半结肠癌与免疫功能异常、AMPK信号通路异常等机制有关,右半结肠癌与中性粒细胞外陷阱形成、酒精中毒、Hippo信号通路异常等机制有关。除调控细胞周期及必需氨基酸代谢等机制外,苦参-大血藤-半枝莲药对对调节左半结肠癌肠道内分泌功能、抑制右半结肠癌炎症反应具有特异性作用,亦可能对结肠癌患者具有情绪调控作用。

腹腔镜下直肠癌根治术中保留左结肠动脉治疗直肠癌的效果观察

目的:探讨腹腔镜下直肠癌根治术中保留左结肠动脉(LCA)对直肠癌患者手术相关指标及胃肠功能恢复的影响。方法:选择2020年1月—2023年1月莆田市第一医院150例直肠癌患者,根据是否保留LCA分为保留LCA组(75例)和不保留LCA组(75例)。比较两组手术相关指标及胃肠功能恢复情况。结果:两组术中出血量、手术时间、肠系膜下动脉(IMA)根部淋巴结清扫数目、淋巴结清扫总数、住院时间比较,差异均无统计学意义(P>0.05)。保留LCA组术后3 d的胃动素、胃泌素水平,术后3个月的胃肠道生活质量指数(GIQLI)量表评分均高于不保留LCA组,差异均有统计学意义(P<0.05)。保留LCA组术前、术后3 d的CD3^(+)、CD4^(+)、CD8^(+)与不保留LCA组比较,差异均无统计学意义(P>0.05)。保留LCA组并发症发生率低于不保留LCA组,差异有统计学意义(P<0.05)。结论:腹腔镜下直肠癌根治术中保留LCA对直肠癌患者手术相关指标、免疫功能无明显影响,但可以促进胃肠功能恢复,减少术后并发症。

含奥沙利铂的一线化疗对左右半结肠癌的临床效果对比研究

目的比较含奥沙利铂的一线化疗对左半结肠癌和右半结肠癌的临床疗效。方法选取2020年1月至2024年1月于上海大学附属第二医院就诊的结肠癌患者120例,根据肿瘤所在位置将其分为左半结肠癌组(60例)和右半结肠癌组(60例)。两组患者均给予含奥沙利铂的一线化疗方案治疗2个周期,比较两组患者的疾病控制率、血清肿瘤标志物、血清炎症因子、癌因性症状评分、生存质量和不良反应发生率。结果治疗后,左半结肠癌组患者的疾病控制率显著优于右半结肠癌组(χ^(2)=22.224,P<0.001);左半结肠癌组患者的血清癌胚抗原、糖类抗原125、糖类抗原153、C反应蛋白、白细胞介素-6水平均显著低于右半结肠癌组(P<0.05);左半结肠癌组患者的癌因性疼痛评分、癌因性疲乏评分均显著低于右半结肠癌组(P<0.05);左半结肠癌组患者的生存质量优于右半结肠癌组(P<0.05)。结论含奥沙利铂的一线化疗对左半结肠癌患者的近期疗效更好,肿瘤进展控制良好,患者的临床症状得以改善,生存质量得以提高。

全腹腔镜顺蠕动侧侧吻合在左半结肠癌根治术中的临床疗效观察

目的探讨全腹腔镜顺蠕动侧侧吻合(Overlap)在左半结肠癌(LCC)根治术中的临床疗效。方法选取2021年6月至2023年6月徐州医科大学附属医院收治的LCC病人87例。根据消化道重建技术分为观察组42例,采用全腹腔镜Overlap吻合术;对照组45例,采用传统体外吻合术。比较两组手术时长、辅助切口长度、术中出血量、术后首次肛门排气时间以及术后住院时长。比较两组肠道屏障功能指标(谷氨酰胺、二胺氧化酶、D-乳酸)、炎症指标(超敏C反应蛋白、降钙素原)、数字等级量表(NRS)疼痛程度评分、并发症发生率等。结果两组手术时间、出血量以及术后住院时长比较,差异无统计学意义(P>0.05)。观察组辅助切口长度短于对照组[(5.1±0.8)cm比(6.9±1.5)cm,P<0.001]、术后首次肛门排气时间早于对照组[(1.3±0.5)d比(2.3±0.6)d,P<0.001]。术前,两组血清谷氨酰胺、二胺氧化酶、D-乳酸、超敏C反应蛋白及降钙素原水平比较,差异无统计学意义(P>0.05)。术后第7天,两组二胺氧化酶、D-乳酸、超敏C反应蛋白及降钙素原水平相比于术前均升高,观察组病二胺氧化酶[(2.4±0.3)U/mL比(3.1±0.4)U/mL,P<0.001]、D-乳酸[(3.4±0.5)mg/L比(4.1±0.7)mg/L,P<0.001]、超敏C反应蛋白[(13.25±2.64)mg/L比(18.28±3.78)mg/L,P<0.001]及降钙素原水平[(0.25±0.12)μg/L比(0.39±0.15)μg/L,P<0.001]普遍低于对照组;血清谷氨酰胺水平低于术前,观察组高于对照组[(547.8±40.6)μmol/L比(518.4±35.3)μmol/L,P<0.001]。术后疼痛程度评分显示,观察组在术后第1、3、7天的疼痛程度显著低于对照组(P<0.05)。此外,观察组在术后首月的并发症发生率也低于对照组(P<0.05)。结论全腹腔镜Overlap吻合术在降低手术创伤、加快胃肠功能恢复及降低并发症风险方面相较于传统手术具有显著优势,这对于减少病人住院时间和促进术后恢复极为重要。

全直肠系膜切除术联合保留左结肠动脉术治疗直肠癌的临床疗效

目的探究全直肠系膜切除术(TME)联合保留左结肠动脉(LCA)术治疗直肠癌患者的临床疗效。方法回顾性分析2020年4月至2021年5月潜江市中心医院收治的97例直肠癌患者的临床资料,按照肠系膜下左结肠血管处理方式不同分为甲组(n=49)与乙组(n=48)。两组均实行TME术,甲组术中保留LCA,乙组术中不保留LCA,比较两组手术情况、术后恢复情况、尿流动力学指标、随访结果及并发症发生率。结果两组手术时间、出血量、淋巴清扫数比较差异无统计学意义;甲组首次排气、排便、拔除引流管时间及住院时间均短于乙组,差异有统计学意义(P<0.05);术后14d,两组最大尿流率(Qmax)均慢于术前,最大膀胱逼尿肌收缩压(MDP)低于术前,残余尿量(RUV)均高于术前,但甲组Qmax快于乙组,MDP高于乙组,RUV低于乙组,差异有统计学意义(P<0.05);两组复发率、肠系膜下动脉(IMA)根部淋巴结转移发生率比较差异无统计学意义;甲组并发症发生率为6.51%,低于乙组的21.74%,差异有统计学意义(P<0.05)。结论与TME术中不保留LCA比较,TME术中保留LCA治疗直肠癌效果确切,对患者膀胱功能的影响较小,可减少术后并发症的发生,促进术后恢复,且不会增加疾病复发及IMA根部淋巴结转移的发生。

术中低位结扎保留左结肠动脉对腹腔镜直肠癌前切除术患者的影响

目的:研究术中保留左结肠动脉对腹腔镜直肠癌切除术患者的影响。方法:选择2020年1月—2022年1月重庆市黔江区中医院收治的60例直肠癌患者作为研究对象,以随机数表法将患者分为试验组与对照组,各30例。两组均行腹腔镜直肠癌前切除术治疗,试验组术中低位结扎保留左结肠动脉,对照组术中高位结扎且不保留左结肠动脉。比较两组手术相关指标、术后相关指标、并发症及低位前切除综合征(low anterior resection syndrome,LARS)。结果:60例患者均顺利完成手术,无中转开腹者,住院期间无术后死亡病例。两组手术时间、术中出血量、腹腔引流量、肿瘤近端切缘距离、肿瘤远端切缘距离、淋巴结清扫情况、腹腔管引流时间、插置尿管时间、住院时间及术后吻合口瘘、吻合口狭窄、吻合口出血发生率比较,差异无统计学意义(P>0.05)。试验组术后肠鸣音恢复时间、术后肛门排气时间短于对照组,差异有统计学意义(P<0.05)。试验组住院期间、随访1年LARS发生率低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜直肠癌前切除术中低位结扎保留左结肠动脉,对手术相关指标及术后吻合口相关并发症影响较小,但有利于术后胃肠功能恢复,还能减少LARS发生。

肠道支架置入联合腹腔镜手术应用于梗阻性左半结肠癌治疗的临床价值分析

目的分析肠道支架置入联合腹腔镜手术应用于梗阻性左半结肠癌治疗的临床价值。方法随机选取2018年8月—2023年4月上海杨思医院100例梗阻性左半结肠癌患者为研究对象,采用随机对照试验设计,在计算机随机数字生成下将患者分为两组,观察组(n=50)为肠道支架置入联合腹腔镜手术治疗,对照组(n=50)为传统治疗。比较两组患者手术时间、出血量、术后进食时间、住院时间、切口感染率、腹腔感染率、血清肿瘤标志物水平以及Ⅰ期手术吻合成功率。结果两组患者手术时间[(183.19±22.31)min vs(182.46±32.74)min]比较,差异无统计学意义(P>0.05)。观察组术中出血量(67.75±23.13)mL低于对照组的(211.36±11.81)mL,差异有统计学意义(t=39.101,P<0.05)。观察组术后住院时间及术后进食时间均短于对照组,差异有统计学意义(P均<0.05)。术后,观察组甲胎蛋白、癌胚抗原均低于对照组,差异有统计学意义(P均<0.05)。观察组一期手术吻合成功率高于对照组,感染总发生率均低于对照组,差异有统计学意义(P均<0.05)。结论梗阻性左半结肠癌患者采用肠道支架置入联合腹腔镜手术治疗效果较为理想,术后恢复较快,且感染发生率较低,可有效提高一期吻合术的成功率。

贝伐珠单抗联合FOLFIRI方案治疗微卫星稳定型晚期复发左、右半结直肠癌的疗效对比

目的探讨应用贝伐珠单抗联合FOLFIRI方案治疗微卫星稳定(MSS)型晚期复发左、右半结直肠癌的疗效差异。方法回顾性分析徐州医科大学附属医院2018年9月—2021年12月收治的58例一线应用贝伐珠单抗联合FOLFIRI方案治疗的MSS型晚期复发左、右半结直肠癌患者的临床资料,比较MSS型左、右半结直肠癌患者的临床特征、总生存时间(OS)、无进展生存时间(PFS)、疾病控制率(DCR)、客观缓解率(ORR)及1、2年生存率。结果MSS型晚期右半结肠癌患者合并不完全肠梗阻所占比例更高(P<0.05),MSS型晚期右半结肠癌患者较左半结直肠癌患者更易合并贫血及体重下降>5 kg(均P<0.05),肿瘤最大直径≥5 cm的右半结肠癌患者所占比例较左半结直肠癌患者高(P<0.05);左半结直肠癌患者中男性患者占比小于右半结肠癌患者(P<0.05)。2组治疗后癌胚抗原(CEA)和糖类抗原199(CA199)较治疗前明显下降(均P<0.05)。右半结肠癌组发生肝转移患者所占比例高于左半结直肠癌组(P<0.05)。左半结直肠癌组与右半结肠癌组ORR分别为14.8%和29.0%(P<0.05),DCR分别为74.1%和87.1%,差异无统计学意义(P>0.05)。左半结直肠癌组的1、2年生存率分别为92.6%、81.4%,右半结肠癌组分别为83.8%、61.3%,差异有统计学意义(P<0.05)。左半结直肠癌组的中位PFS长于右半结肠癌组(13.7个月vs 10.1个月,P<0.05),左半结直肠癌组的中位OS也明显长于右半结肠癌组(35.3个月vs 27.2个月,P<0.05),预后相对较好。结论应用贝伐珠单抗联合FOLFIRI方案治疗MSS型晚期复发结直肠癌患者,左、右半结直肠癌患者的临床特征、转移部位及生存状况存在差异。

腹腔镜左半结肠癌根治术中采用IMA-CMA技术对淋巴结清扫的影响分析

目的 探讨腹腔镜左半结肠癌根治术中采用肠系膜下动脉优先解剖联合完全内侧入路(Priority Anatomy of the Inferior Mesenteric Artery Combined with Complete Medial Approach,IMA-CMA)技术对淋巴结清扫的影响。方法 回顾性选取2019年5月-2023年5月南平第一医院治疗的81例腹腔镜左半结肠癌根治术患者的临床资料,根据手术方法不同分为IMA-CMA组和对照组,其中IMA-CMA组44例,对照组37例。对照组采用传统入路技术,IMA-CMA组采用IMA-CMA技术,比较两组患者的手术相关指标、淋巴结清扫情况、术后肠功能恢复情况、并发症发生情况及复发率和转移率。结果 同对照组相比较,IMA-CMA组手术时间较短,术中出血量较低,253组淋巴结清扫数目较多,差异有统计学意义(P均<0.05)。同对照组相比较,IMA-CMA组腹痛腹胀持续时间、术后排便时间及术后排气时间均较短,差异有统计学意义(P均<0.05)。IMA-CMA组并发症发生率为4.55%,低于对照组的18.92%,差异有统计学意义(χ^(2)=4.204,P<0.05)。术后1年,IMA-CMA组和对照组复发率、转移率比较,差异无统计学意义(P均>0.05)。结论 腹腔镜左半结肠癌根治术中采用IMA-CMA技术能够缩短手术时间,减少术中出血量,对淋巴结的清扫情况更佳,且可以改善术后肠功能恢复情况及并发症发生情况,不增加复发和转移风险。