不同节段直肠癌T分期的多模态1.5T MRI评估与病理对照研究

目的探讨分析多模态1.5T磁共振成像(MRI)对不同节段直肠癌T分期的评估价值。方法选取我院2018年6月至2023年3月收治的经肠镜下活检确诊的160例直肠癌患者作为研究对象,所有患者术前均进行多模态1.5T MRI检查,并接受全直肠系膜切除术(TME)治疗及术后病理分析,以病理结果为金指标,分析1.5T MRI对直肠癌T分期的评估价值;依据肠镜测量的肿瘤距肛门距离将全部患者分为低位直肠癌、中位直肠癌、高位直肠癌,分析多模态1.5T MRI检查对不同节段直肠癌T分期的评估价值及效能分析。结果1.5T MRI分期的评估准确率为89.38%;MRI T_(1)分期的准确率、敏感性、特异性、阳性预测值及阴性预测值分别为98.75%、94.74%、100.00%、100.00%、98.39%;T2分期的各项评估结果分别为91.25%、86.49%、92.68%、78.05%、95.80%;T3分期的各项评估结果分别为90.63%、75.61%、95.80%、86.11%、91.94%;T4分期的各项评估结果分别为100.00%、100.00%、97.48%、93.62%、100.00%;1.5T MRI低位及中位直肠癌T_(1)分期的准确率、特异性及阳性预测值最高,T4分期的敏感性及阴性预测值最高;高位直肠癌T_(1)分期的的评估准确率、敏感性、特异性及阴性预测值,T4分期的敏感性及阴性预测值最高;且三个阶段其他T分期的各项效能分析均较高。结论1.5T MRI评估效果显著,且对于直肠癌患者T分期的各项效能指标评估分析参考价值都较高,有更为准确的评估结果,值得临床上使用推广。

NOSESⅡ式与常规腹腔镜中位直肠癌根治术疗效对比

目的通过与常规腹腔镜手术临床疗效对比探究NOSESⅡ式在中位直肠癌根治术中的应用价值,探讨NOSESⅡ式在腹腔镜中位直肠癌根治术中安全性及有效性。方法回顾性分析2013年8月至2018年11月于哈尔滨医科大学附属第二医院结直肠肿瘤外科就诊的直肠癌患者141例,其中腹部无辅助切口手术患者55例,腹腔镜手术患者86例。比较两组的手术时间、术中出血量、术后排气时间、进食时间、住院时长、并发症、预后等差异。结果共有NOSESⅡ式组47例、常规腹腔镜组47例成功配对,两组手术时长、术中出血量、淋巴结清扫、及术后肛门功能评价差异无统计学意义(P>0.05)。与常规腹腔镜组相比,NOSESⅡ式组术后总并发症发生率较低(6.4%vs.21.3%,χ^(2)=6.085,P=0.036);术后排气时间明显短于常规腹腔镜组(38 h vs.48 h,t=-2.639,P=0.008);术后进食时间也明显短于常规腹腔镜组(59 h vs.84 h,t=-3.330,P=0.001);在术后总住院时长上也较腹腔镜组明显缩短[12(6~18)vs.12(9~30),t=-1.460,P=0.004];术后患者疼痛评分第一日(t=-4.463,P<0.001)、第三日(t=-4.975,P<0.001)、第五日(t=-5.706,P<0.001)镇痛药物的使用明显低于腹腔镜组(t=-4.325,P<0.001);此外,在生存分析方面,两组患者术后无疾病生存时间(DFS)和总生存时间差异均无统计学意义(P>0.05)。结论NOSESⅡ式作为一种安全有效的直肠癌根治手术方式,在确保完成手术根治直肠癌的治疗效果前提下,并不增加手术风险,并且在降低手术后总并发症、缩短术后排气时间、进食时间、术后住院时长,术后减痛等方面较常规腹腔镜手术具有明显优势。

腹腔镜直肠全系膜切除术应用于中、低位直肠癌治疗中的临床效果分析

目的分析腹腔镜直肠全系膜切除术应用于中、低位直肠癌治疗中的临床效果和安全性。方法 60例中、低位直肠癌患者,按照手术方式不同分为观察组及对照组,每组30例。观察组选择腹腔镜直肠全系膜切除术,对照组实施传统开腹直肠癌全系膜切除术。对比两组手术相关指标、术后并发症发生率、局部复发或转移发生率及疗效。结果观察组手术时间长于对照组,术后通气时间、住院时间、切口长度短于对照组,术中出血量少于对照组,差异具有统计学意义(P<0.05);两组淋巴结清扫数对比差异无统计学意义(P>0.05)。观察组术后并发症发生率为16.7%低于对照组的43.3%,差异具有统计学意义(P<0.05);两组局部复发或转移率对比差异无统计学意义(P>0.05)。观察组总有效率90.0%高于对照组的66.7%,差异有统计学意义(P<0.05)。结论对于中、低位直肠癌患者而言,应用腹腔镜直肠癌手术展开治疗的效果较好,具有安全性高、术后并发症少的优势,因此建议临床深入研究和广泛应用。

直肠全系膜切除在低中位直肠癌根治术中的应用及疗效分析

目的探讨直肠全系膜切除术（TME）在低中位直肠癌根治术中应用的独特价值。方法在对487例低中位直肠癌患者施行根治术中，采用直肠全系膜切除，充分利用闭合器，吻合器进行吻合，并随访观察手术效果和术后生活质量，5年存活率。结果487例患者均达理想疗效。结论在低中位直肠癌根治术中，笔者采用直肠全系膜切除术，降低了术后并发症的发生率，提高了患者术后的生活质量水平及5年生存率。

中、低位直肠癌外科治疗保留患者排便功能的可行性探讨

目的:比较保肛手术与Miles手术疗效,探讨其对患者排便功能和生活质量的影响。方法:回顾性分析1991/1998收治的75例中、低位直肠癌病例,手术治疗的方法以及预后。结果:28例行前切除根治术超低位吻合。20例以吻合器行低位端端吻合,绒毛状腺瘤恶变2例行局部切除术,2例行结肠拉出术,均成功保留了肛门。23例患者行Miles手术。保肛率69.33%。经随访,保肛组局部复发4例(4/52),占7.69%,5年生存率为73.07%(38/52),Miles手术组局部复发率为2例(2/23),占8.69%,5年生存率为69.56%(16/23)。结论:低位直肠癌中选择部分病例实施保肛手术是可行的,5年生存率和局部复发率与Miles手术无差异。

中位直肠癌术后吻合口狭窄临床分析

目的：探讨中位直肠癌术后吻合口狭窄的原因及治疗。方法：对铁岭市中心医院近10年来30例中位直肠癌吻合口狭窄患者的临床资料进行回顾性分析，分析吻合口狭窄的原因，预防措施以及治疗方法。结果：30例患者中20例经非手术治疗治愈，10例经手术治疗。结论：中位直肠癌术后吻合口狭窄是多因素作用的结果。术中术后避免各种导致狭窄的因素尤为重要。

经肛切除标本的直肠癌腔镜手术临床应用价值探讨

目的探讨腹部无辅助切口经肛切除标本的中位直肠癌腹腔镜手术的可行性及临床应用价值。方法回顾分析2013—06—01—2014—1008哈尔滨医科大学附属第二医院结直肠肿瘤外科，接受腹部无切口腹腔镜下经直肠拖出肛门外切除标本的直肠肿瘤根治术治疗的8例患者的临床资料，观察手术时间、术中出血量、淋巴结个数、术后恢复及并发症情况。结果8例患者手术均成功，其中男5例，女3例；年龄41～75岁，平均年龄（59．3±11．5）岁；体质量指数（22．1±2．3）kg／m2；肿瘤距离肛缘6～10cm，平均距离（7．75±1．49）cm。平均手术时间（187．75±29．77）min；平均术中出血量（34．88±9．13）mL；术后首次肛门排气时间为6～55h，平均排气时间（41．3±16．0）h。8例患者中TNM分期Ⅰ期3例，Ⅱ期5例；肿瘤直径2．0～4．5cm，平均直径（3．66±0．79）cm；清除淋巴结12～26枚，平均数目16．4枚，无阳性病例。术后患者疼痛轻微，疼痛程度评估表（visual analogue score，VAS）疼痛评分2．38±1．30，术后无功能障碍，无并发症发生。结论腹部无辅助切口经肛切除标本的中位直肠癌腹腔镜手术安全可行，值得推广应用。

Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People＇s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS： Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients （12.5%）, and was significantly associated with family history （Х^2= 3.929, P = 0.047）, high CEA level （Х^2 = 4.964, P = 0.026）, cancerous perforation （Х^2 = 8.503, P = 0.004）, tumor differentiation （Х^2 = 9.315, P = 0.009） and vessel cancerous emboli （Х^2 = 11.879, P = 0.001）. In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age （Х^2 = 0.506, P = 0.477）, gender （Х^2 = 0.102, Z2 = 0.749）, tumor diameter （Х^2 = 0.421, P = 0.516）,tumor infiltration （Х^2 = 5.052, P = 0.168）, depth of tumor invasion （Х^2 = 4.588, P = 0.101）, lymph node metastases （Х^2 = 3.688, P = 0.055） and TNM staging system （Х^2 = 3.765, P = 0.152）. The local recurrence rate of middle and lower rectal carcinoma was 33.3% （4/12） in patients with positive circumferential resection margin and 6.8% （3/44） in those with negative circumferential resection margin. There was a significant difference between the two groups （Х^2 = 6.061, P = 0.014）. Local recurrence of rectal carcinoma occurred in 6 of 36 patients （16.7%） with mesorectal metastasis, and in 1 of 20 patients （5.0%） without mesorectal metastasis. However, there was no significant difference between the two groups （Х^2 = 1.600, P = 0.206）. CONCLUSION： Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.

Bevacizumab as a second- or later-line of treatment for metastatic colorectal cancer

AIM: To determine the efficacy of bevacizumab in patients with metastatic colorectal cancer (MCRC) who have failed prior chemotherapy without bevacizumab. METHODS: Between March 2002 and June 2010, 40 patients in South Korea with MCRC who were treated with bevacizumab plus chemotherapy as a second or later-line treatment were analyzed retrospectively for their overall response rate (ORR), overall survival (OS), and progression-free survival (PFS). The tumor responses were assessed using the RECIST (Response Evaluation Criteria in Solid Tumors) guidelines. RESULTS: All of the patients had progressed under prior chemotherapy without bevacizumab. Three patients (7.5%) exhibited an ORR, twenty one patients (52.5%) exhibited stable disease (SD), and fifteen patients (37.5%) exhibited disease progression. The median duration of the OS and PFS were 14.0 and 6.13 mo respectively. The median OSs were 16.60, 14.07 and 13.00 mo for second-line, third-line and fourth- or later-line treatments, respectively. The median PFSs were 7.23, 7.30 and 3.87 mo for the second-line, third-line and fourth- or later-line treatments, respectively. CONCLUSION: In patients with MCRC, bevacizumab combined chemotherapy may be beneficial during second- or later-line treatment.