阑尾切除术中发现右位乙状结肠解剖变异1例

1 病例报告患者男,44岁。因转移性右下腹痛诊断急性阑尾炎而于2003—07—14 11:00在硬膜外麻醉下行阑尾切除术。取右下腹麦氏切口,于右髂窝找到'升结肠',沿结肠带向下寻找回盲部。

结肠解剖与大肠癌的临床诊断

大肠癌是世界上发病率比较高的癌症之一，手术治疗是根治大肠癌的主要手段。但由于手术治疗还有许多不尽人意之处，世界各国的医务人员正在研究各种早期诊断和辅助治疗结肠癌的方法。本文就近来一些早期诊断方法和辅助治疗的手段，进行客观和有参考价值的评述。

Racial differences in the anatomical distribution of colorectal cancer:a study of differences between American and Chinese patients

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental).METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery.RESULTS: The anatomical subsite distribution of tumor,age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P＜0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P＜0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (＞80 years).No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P＜0.001).CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time.Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

Gene profiles between non-invasive and invasive colon cancer using laser microdissection and polypeptide analysis

AIM: To explore the expression of differential gene expression profiles of target cell between non-invasive submucosal and invasive advanced tumor in colon carcinoma using laser microdissection (LMD) in combination with polypeptide analysis. METHODS: Normal colon tissue samples from 20 healthy individuals and 30 cancer tissue samples from early non-invasive colon cancer cells were obtained. The cells from these samples were used LMD independently after P27-based amplification. aRNA from advanced colon cancer cells and metastatic cancer cells of 40 cases were applied to LMD and polypeptide analysis, semiquantitative reverse transcribed polymerase chain reaction (RT-PCR) and immunohistochemical assays were used to verify the results of microarray and further identify differentially expressed genes in non-invasive early stages of colon cancer. RESULTS: Five gene expressions were changed in colon carcinoma cells compared with that of controls. Of the five genes, three genes were downregulated and two were upregulated in invasive submucosal colon carcinoma compared with non-invasive cases. The results were confirmed at the level of aRNA and gene expression. Five genes were further identified as differentially expressed genes in the majority ofcases (> 50%, 25/40) in progression of colon cancer, and their expression patterns of which were similar to tumor suppressor genes or oncogenes. CONCLUSION: This study suggested that combined use of polypeptide analysis might identify early expression profiles of five differential genes associated with the invasion of colon cancer. These results reveal that this gene may be a marker of submucosal invasion in early colon cancer.

Application of a wire-guided side-viewing duodenoscope in total esophagectomy with colonic interposition

Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay treatment for bile duct disease. The procedure is difficult per se, especially when a side-viewing duodenoscope is used, and when the patient has altered anatomical features, such as colonic interposition. Currently, there is no consensus on the standard approach for therapeutic ERCP in patients with total esophagectomy and colonic interposition. We describe a novel treatment design that involves the use of a side-viewing duodenoscope to perform therapeutic ERCP in patients with total esophagectomy and colonic interposition. A gastroscope was initially introduced into the interposed colon and a radio-opaque standard guidewire was advanced to a distance beyond the papilla of Vater, before the gastroscope was withdrawn. A sideviewing duodenoscope was then introduced along the guidewire under fluoroscopic guidance. After cannulation into the papilla of Vater, endoscopic retrograde chol-angiography (ERC) revealed a filling defect (maximum diameter: 15 cm) at the distal portion of the common bile duct (CBD). This defect was determined to be a stone, which was successfully retrieved by a Dormia basket after complete sphincterotomy. With this treatment design, it is possible to perform therapeutic ERCP in patients with colonic interposition, thereby precluding the need for percutaneous drainage or surgery.

Automatic anatomical classification of colonoscopic images using deep convolutional neural networks

Background:A colonoscopy can detect colorectal diseases,including cancers,polyps,and inflammatory bowel diseases.A computer-aided diagnosis(CAD)system using deep convolutional neural networks(CNNs)that can recognize anatomical locations during a colonoscopy could efficiently assist practitioners.We aimed to construct a CAD system using a CNN to distinguish colorectal images from parts of the cecum,ascending colon,transverse colon,descending colon,sigmoid colon,and rectum.Method:We constructed a CNN by training of 9,995 colonoscopy images and tested its performance by 5,121 independent colonoscopy images that were categorized according to seven anatomical locations:the terminal ileum,the cecum,ascending colon to transverse colon,descending colon to sigmoid colon,the rectum,the anus,and indistinguishable parts.We examined images taken during total colonoscopy performed between January 2017 and November 2017 at a single center.We evaluated the concordance between the diagnosis by endoscopists and those by the CNN.The main outcomes of the study were the sensitivity and specificity of the CNN for the anatomical categorization of colonoscopy images.Results:The constructed CNN recognized anatomical locations of colonoscopy images with the following areas under the curves:0.979 for the terminal ileum;0.940 for the cecum;0.875 for ascending colon to transverse colon;0.846 for descending colon to sigmoid colon;0.835 for the rectum;and 0.992 for the anus.During the test process,the CNN system correctly recognized 66.6%of images.Conclusion:We constructed the new CNN system with clinically relevant performance for recognizing anatomical locations of colonoscopy images,which is the first step in constructing a CAD system that will support us during colonoscopy and provide an assurance of the quality of the colonoscopy procedure.