Intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers

Objective:In the evolving era of minimal access surgery,low rectal cancers still pose a challenge to laparoscopic or robotic surgeons.Hence,at our institute we intended to demonstrate the oncological efficacy of intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers,performing the abdominal part of the procedure which includes rectal mobilization,laparoscopically.Methods:From February 2017 to March 2021,125 patients who had undergone intersphincteric resection and coloanal anastomosis via the perineal approach at Galaxy Care Laparoscopic Institute,Pune,were included in this study.Transabdominal mobilization of the rectum was performed laparoscopically.All patients had a diversion ileostomy and a pelvic drain.Patients were followed-up for a period of 18 months post-surgery.Data on clinical and oncological outcomes were collected and analysed.The pre-operative and post-operative Wexner incontinence scores were compared.Results:The mean time taken for surgery was 181.57±30.00 min.The mean blood loss was 119.76±42.53 mL.Most patients(103,82.4%)had their tumour at a distance of 1e2 cm from the anal verge.A loco-regional recurrence rate of 12.8%(16/125)was noted in our study.For the post-surgery Wexner score,74.4% of patients(93/125)had a score of 5 or less,depicting that three-quarters of the study population had satisfactory continence.Overall,81.6%of patients were satisfied with the functional results of surgery.Conclusion:Intersphincteric resection and coloanal anastomosis,with a 12.8%recurrence rate,can now be considered an oncological and technically feasible procedure with sphincter salvage and good continence.

Progressive Failure Analysis of Composite/Aluminum Riveted Joints Subjected to Pull-Through Loading

Out-of-plane mechanical properties of the riveted joints restrict the performance of the wing box assembly of airplane.It is necessary to investigate the pull-through performance of the composite/metal riveted joints in order to guide the riveting design and ensure the safety of the wing box assembly.The progressive failure mechanism of composite/aluminum riveted joint subjected to pull-through loading was investigated by experiments and finite element method.A progressive damage model based on the Hashin-type criteria and zero-thickness cohesive zone method was developed by VUMAT subroutine,which was validated by both open-hole tensile test and three-point bending test.Predicted load-displacement response,failure modes and damage propagation were analysed and compared with the results of the pull-through tests.There are 4 obvious characteristic stages on the load-displacement curve of the pull-through test and that of the finite element model:first load take-up stage,damage stage,second load take-up stage and failure stage.Relative error of stiffness,first load peak and second load peak between finite element method and experiments were 8.1%,-3.3%and 10.6%,respectively.It was found that the specimen was mainly broken by rivet-penetration fracture and delamination of plies of the composite laminate.And the material within the scope of the rivet head is more dangerous with more serious tensile damages than other regions,especially for 90°plies.This study proposes a numerical method for damage prediction and reveals the progressive failure mechanism of the hybrid material riveted joints subjected to the pull-through loading.

Development and Pull-through of Climate Science to Services in China

1. IntroductionThe impacts arising from climate change and climate variability pose major challenges to global and regional security and economic prosperity（UNFCCC,2015）.Some regions are more at risk than others, through heightened exposure to climatic hazards, and high vulnerability and exposure to such hazards. China, with its rapid economic development, large and growing population, and frequent occurrence of disasters associated with heavy rainfall, flooding, tropical cyclones,

Literature Review of the Frequency of Reoperations after One Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) has gained worldwide acceptance. However surgical success is often reported separately, while the necessity for true reoperation is difficult to establish. Aim: To evaluate the incidence of reoperations following TERPT procedure. The findings will be important in counseling and planning childcare for HD patients as well as providing a benchmark for single centers clinical results. Methods: A literature review of reported TERPT operations on children with HD between 1998 through 2011 was performed. Only planned TERPT operation reports were included. Information was collected with particular emphasis on reoperations and their reasons. Results: Out of 26 published articles 23 were included, reporting on 836 children, female/male ratio: 1/3.3, undergoing the TERPT procedure as the only operative intervention with described postoperative courses. The children comprised neonates, 3 years of age (12%). The average follow up was 18.5 (6 - 38) months. The resected bowel length mean was 20.5 cm. Forty-one reoperations were reported (4.9%), including 24 laparotomies, 8 laparoscopies, 6 colostomies and ileostomies in 3 children. Only 2 re-do TERPT were reported (0.2%). Seven patients were considered TERPT failures (0.8%) with 5 requiring diverting colostomies and additional transabdominal pull-through operations. Two myectomies were performed (0.2%). One child with aganglionosis underwent a Duhamel pull through. Two (0.2%) had serious damage to the urinary tract also one child with a vas deferens lesion was reoperated. Two bowel obstructions required adhesiolysis. Eight anastomotic dehiscences (0.9%) required surgery after reparation. One prolapse of the pulled through colon was reported. Six patients (0.7%) suffered anastomotic leaks. Anastomotic strictures rate was 2.8%, all repaired with anal dilatation. Conclusion: The review supports the low incidence of reported reoperations for the TERPT procedure.

Literature Review of the Outcome after One-Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) is frequently used worldwide. In order to give the families realistic expectations and to plan the medical care for the years after TERPT, the long term outcome is of great importance. Aim: To collect information on the long term outcome reported after one stage TERPT procedure for HD in children 0 - 15 years. Method: A literature review on the outcome of planned TERPT from 2005 through 2012 was carried out. Information was collected on the number of daily stools a few months postoperatively, incontinence and constipation and the measures taken to deal with these. Results: The reports are few and prospective studies were missing. The results show an initial high frequency of daily stools, 12% had later abnormal stool patterns, 21% had fecal incontinence and 10% had problems with constipation. Conclusion: In order to compare the long term outcome, it would be desirable to have uniform regular reports on the daily frequency of passed stools, incontinence and constipation during the first years after TERPT. Such knowledge would be of importance for the information given to the guardians of children with HD preoperatively to TERPT and in the planning of the future care. The findings can, furthermore, provide a benchmark for the outcome from a single centre.

澳门路环岛灌丛群落的特征

初步分析了澳门路环岛灌丛群落的种类组成及种群的多度、频度、重要值及外貌,结果表明:群落植物种类丰富,种属组成分散,具有典型的南亚热带区系特点。广东蒲桃、豺皮樟、亮叶柃、桃金娘等在群落中占明显优势,但本区灌丛群落均匀性偏低。具有较高丰富度的种类仅占很少部分,可能与乔木缺乏和种群竞争有关。群落的外貌主要是由小型和中型落叶草质及常绿革质、全缘单叶的高位芽植物所决定的。在分析灌丛群落特征的基础上,对其生态保护提出了建议。

澳门路氹湿地芦苇氮磷含量的季节变化

为探讨芦苇(Phragmitescommunis)的生长规律及其在湿地生态系统中的作用,对澳门路氹湿地芦苇氮磷含量变化进行了6次调查。结果表明:芦苇地上部分和地下茎的氮、磷含量都在秋冬达到最大值,在春夏达到最低值,其中叶氮、磷含量最高值分别为37·5和4·0g·kg-1,最低值为28·0和3·5g·kg-1;茎中部氮、磷含量最高值分别为14·1和2·0g·kg-1,最低值为11·5和1·6g·kg-1;地下茎氮、磷含量最高值分别为10·2和0·9g·kg-1,最低值为6·6和0·8g·kg-1。各季节芦苇不同部位的氮、磷含量大小顺序均为叶>地上茎>地下茎。氮、磷没有在芦苇体不同器官或部位之间发生转移。

澳门路氹湿地植物与盨?

湿地保育是近年来国际社会和科学家关注的热点。通过实地调查发现澳门路湿地有52种植物,对他们的组成、多度、生境等特点进行了分析,结果表明:湿地中草本植物种类居多,生境以稍离岸的种类居多,外来种占有较大比例,这与湿地面积较小,形成历史短和经贸的往来繁多有关。路湿地作为澳门最大的一块湿地,其丰富的生物多样性,并为世界极度濒危候鸟黑脸琵鹭的栖息地,已受到当地政府与社会的关注。

3D腹腔镜在超低位直肠癌保肛手术中的应用

目的探讨3D腹腔镜下超低位直肠癌根治术中结肠肛管吻合术(3D腹腔镜改良Parks手术)保肛的治疗效果。方法回顾性分析2014年3月至2015年12月期间36例采用3D腹腔镜改良Parks手术患者的临床资料。评估其术后并发症以及肛门控粪、排尿和性功能状况。结果全组患者随访6~24个月。术后出现吻合口瘘2例,吻合口狭窄3例,发生肝转移1例,无局部复发病例。术后6个月、1年和2年对排粪情况满意者分别占63.9%(23/36)、85.7%(24/28)和85.0%(17/20)。术后1个月排尿功能障碍发生率为13.9%(5/36);男性患者术后1个月勃起功能障碍发生率为28.5%(6/21),射精功能障碍发生率为33.3%(7/21)。女性患者术后1个月对性生活满意者占66.6%(10/15)。结论 3D腹腔镜在改良Parks手术中可以提高超低位直肠癌患者的保肛率,且术后控便功能、排尿及性功能满意。

Parks手术在低位直肠癌术中的保肛作用

目的 探讨Parks手术在低位直肠癌术中的保肛作用及一些相关问题。方法 回顾分析自1991年5月至2004年6月共33例Parks手术病人的临床资料。结果 全组手术进程顺利,术后并发吻合口漏和吻合口出血各1例。按Parks制定的标准,本组病人术后肛门功能优良率为89.2％,肿瘤术后局部复发率为6.2％,3年存活率为87.5％,5年存活率为65.4％。结论 Parks手术应为低位直肠癌保肛手术的首选术式。

肥胖对直肠/肛管恶性肿瘤患者行结肛吻合术后近期疗效的影响

目的探讨肥胖是否会影响直肠/肛管恶性肿瘤患者行结肛吻合术后的近期疗效.方法回顾性纳入2008年1月至2010年6月,在四川大学华西医院胃肠外科中心结直肠外科专业组接受结肛吻合术并符合本研究条件直肠/肛管恶性肿瘤患者共185例,根据患者的体重指数分组,将BMI值为(18.5～24.9)kg/m2的患者定义为A组,BMI≥25 kg/m2的患者定义为B组,比较2组的手术安全性和术后恢复指标.结果从术后恢复指标看,2组在住院时间、排气时间、排便时间、进食时间和下床活动时间上差异无统计学意义(P=0.079,0.356,0.367,0.700,0.923);2组在拔引流管时间、拔胃管时间、拔尿管时间上差异均无统计学意义(P=0.624,0.084,0.080);2组术后并发症总发生率差异无统计学的意义(P=0.067),但2组肛周感染的发生率差异有统计学意义(P=0.013),其余并发症包括吻合口瘘、切口感染等的发生率差异均无统计学意义.结论结肛吻合术治疗肥胖直肠/肛管癌患者能够取得良好的近期恢复效果;于肥胖直肠/肛管恶性肿瘤患者结肛吻合术后应加强肛周护理.

结肠肛管吻合治疗低位直肠癌(附23例报告)

23例低位直肠癌病人行结肠肛管吻合术(CAA),目的旨在评价CAA安全性、有效性及功能结果.肿瘤距肛门缘≤8cm20例(87％).7例(30％)属C期.切除肛侧断端无瘤边缘>2cm,23例均未作结肠造瘘,无手术死亡.吻合口漏3例(13％).21例功能评价,18例(85％)术后1年有良好自制力.23例随访生存率3年71.61％;5年63.65％.盆腔复发17％,无吻合口发.本文结果强调直肠低位肿瘤常规Miles术或未必明智,而CAA法能保留肛门自控能力乃为最佳选择.

单吻合器双荷包吻合法在腹腔镜下低位直肠癌前切除术中的应用

目的:评估单吻合器双荷包吻合法在腹腔镜下低位直肠癌前切除术中应用的有效性和安全性。方法:103例直肠癌患者,男56例,女47例,肿瘤下缘距离肛缘3~5 cm且病理学确诊为直肠腺癌,均接受腹腔镜下低位直肠癌前切除术,术中采用单吻合器双荷包吻合(A组)56例,采用全手工缝合(B组)47例。比较两组患者术中术后的情况。结果:两组患者均顺利完成手术,无中转开腹,无术中或术后死亡病例。A、B组清扫淋巴结数分别为(15.8±6.4)、(15.3±7.2)枚,吻合口距肛缘距离分别为(2.1±1.4)、(2.2±1.7)cm,差异均无统计学意义(P>0.05)。两组手术时间、术中出血量、行保护性回肠造瘘患者比例、吻合口瘘和吻合口出血发生率、首次排气时间、直肠刺激征发生率比较,差异均无统计学意义(P>0.05)。A组吻合口狭窄发生率为1.8%,B组为17.0%,A组低于B组(P<0.05)。结论:单吻合器双荷包吻合法是一种安全、可行且有优势的腹腔镜下低位直肠癌前切除术中结肛吻合方法。

单纯经肛门直肠及内括约肌切除术治疗先天性巨结肠的探讨(附101例报告)

目的 探讨单纯经肛门直肠黏膜及内括约肌切除术治疗新生儿及儿童先天性巨结肠的效果. 方法 本组101例,在齿状线水平将直肠黏膜与肛管皮肤交界处环形切开,切开略大于直肠1/2周径的前壁肌层至黏膜下层,沿黏膜下层向上分离;后壁沿直肠纵肌向上分离,前后壁共同分离直达腹膜反折水平进入腹腔,切除大部分内括约肌及直肠后壁肌鞘行巨结肠根治术. 结果 101例均手术顺利,手术时间45～190 min,平均90 min.术中出血＜10 ml,无术后尿潴留,无伤口感染、肛门回缩及肛门狭窄.术后肠炎发生率2.3%(2/86),污粪的发生率由术后2个月的27%(22/82)下降至术后6个月的4%(3/82).78例肛门直肠测压,手术后1、2、3、6个月肛管静息压力比手术前明显减低(P＜0.05). 结论 经肛门内括约肌及直肠后壁肌鞘切除治疗巨结肠安全易行,可有效预防术后并发症的发生,同样适合在基层医院推广应用.

结肠肛管粘膜吻合术治疗低位直肠癌42例报道

目的:探讨低位直肠癌保肛手术方法和疗效。方法:采用经腹经肛门切除中、下段直肠癌,经肛门行结肠、肛管粘膜吻合术治疗距齿线2～5cm的42例低位直肠癌。结果:全组无死亡、无吻合口瘘、吻合口狭窄发生,术后随访1～11年,术后局部复发率7.1%。5年生存率85.7%,半年后肛门排便功能基本恢复正常。结论:结肠肛管粘膜吻合术是低位直肠癌合理、安全的术式。

直肠癌低前位切除结肠J型贮袋吻合术对肛门功能的影响

目的 评价直肠癌低前切除结肠J型贮袋吻合术对肛门功能的影响.方法 对2008年3月至2010年3月行直肠前切除术治疗的50例中低位直肠癌随机分为结肠J型贮袋吻合组25例,结肠直肠直接吻合组25例,比较两组的手术情况和术后6个月、12个月肛门功能情况.结果 两组均无死亡、吻合口瘘和狭窄;直接吻合组术后肝转移1例,袋吻合组术后便秘2例;术后6个月和12月时随访患者肛门功能改善显著优于直接吻合组（P〈0.05）.结论 对于中低位直肠癌行直肠前切除术时选择结肠J型贮袋术可以明显改善患者术后近期的肛门功能.

拖出式结肠肛管吻合术的改进和应用

目的 :介绍拖出式保肛术的改进经验 ,探讨改进术式的临床价值。方法 :对 1987年 5月～ 2 0 0 0年 12月间 488例患者的治疗过程及结果进行回顾分析。结果 :全组无手术死亡 ;手术总并发症发生率为 14.18% ;术后肛门功能满意。结论 :拖出式保肛术的改进 ,显著改善了术后排便节制 ,确保肿瘤切除的彻底性 ,提高了手术的安全性。这一手术值得我们进一步研究和推广应用。

低位直肠癌保肛术的分析(附15例病例分析)

目的探讨低位直肠癌术中的保肛作用及一些相关问题。方法回顾性分析我院1998年3月～2004年12月共15例低位直肠癌行结肠肛管吻合术的临床资料。结果全组手术进程顺利,术后肛门功能恢复良好,肿瘤术后局部复发率为15.7%,3年存活率为71.3%,5年存活率为52.7%。结论结肠肛管吻合术作为保肛手术的一种术式可用于低位直肠瘤病人。

改良结肠肛管吻合术治疗低位直肠癌

目的 探讨改良结肠肛管吻合术在低位直肠癌治疗中的价值。方法 回顾分析 37例低位直肠癌的术后并发症及疗效。结果 术后发生吻合口瘘 2例 ,吻合口狭窄 9例 ,无手术死亡和肛门失禁 ;盆腔复发 5例。结论 改良结肠肛管吻合术在保留肛门功能的同时 ,避免了预防性横结肠造口 。

低位直肠癌改良Parks术的应用研究(附33例报告)

目的 总结1990年1至1998年10月间经腹低位直肠癌切除、结肠肛管吻合术33例,探讨提高手术成功率,减少并发症的方法.方法 回顾性分析33例低位直肠癌经腹切除术,采用结肠肛管吻合术的方式及疗效,并对Parks进行改进研究.结果 33例采用经腹直肠癌切除、结肠肛管吻合术,其中根治切除32例,占96.97%,无手术死亡病例,吻合口瘘2例,占6.06%,无吻合口狭窄,随访6～84个月,盆腔复发2例,无吻合口复发病例,手术近期肛门控制稀便功能欠佳,3～6个月随访肛门功能良好.结论 低位直肠癌在保证根治的前提下,只要肛管直肠括约肌环完整,可采用该术式,手术安全,并发症发生率低,是一种理想的保肛术式.