BACKGROUND:Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS:We report a case of...BACKGROUND:Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS:We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. RESULT:Reconstruction was successful with a duodeno-jejunostomy and protected by a nasoduodenal drain. CONCLUSION:The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.展开更多
AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from...AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.展开更多
BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically clos...BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis(LNM), between AC and DC-Ⅱ.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-Ⅱ who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.RESULTS The patients with AC and DC-Ⅱ did not exhibit significant differences in 5-year overall survival(66.0% and 67.1%, respectively) and 5-year relapse-free survival(63.5% and 62.2%, respectively). Compared to the patients with DC-Ⅱ, the rate of preoperative biliary drainage was higher(P = 0.042) and the rates of digestive symptoms(P = 0.0158), ulcerative-type cancer(P < 0.0001), large tumor diameter(P < 0.0001), and advanced tumor stage(P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-Ⅱ,respectively, without significant difference(P = 0.23). The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py) were significantly higher in patients with DC-Ⅱ than in those with AC(metastasis to N-HE: 18.5% and 5% in patients with DC-Ⅱ and AC, respectively;P = 0.0432;metastasis to N-Py: 11.1% and 0% in patients with DC-Ⅱ and AC, respectively;P = 0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-Ⅱ than in those with AC.展开更多
Background Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary bo...Background Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up. Methods Twenty-two patients (22 eyes), who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. Localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages. Results After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities (BCVA) varied from 0.02-1.00, including 18 patients (81.82%) who had BCVA equal to or better than that before surgery. Fifteen patients (68.18%) had BCVA better than 0.3. Only two patients had intraocular pressure (lOP) of less than 10 mmHg and the other patients maintained normal lOP. Nine cases (40.91%) were given confirmed diagnosis of malignant melanoma, four (18.18%) of melanocytoma, six (27.27%) of nonpigmented ciliary epithelial adenoma, two (9.09%) of neurofibroma, and one (4.55%) of neurinoma. Twenty patients (90.91%) had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years after the operation. Conclusion For some ciliary body tumors, especially in the early stages, local excision is an effective and safe method to save the vision and the eyeball.展开更多
Background:With the increased usage of neoadjuvant chemoradiotherapy,improved surgical technique and stapling devices,sphincter-preserving resection has become more frequent for patients with rectal cancer.However,as ...Background:With the increased usage of neoadjuvant chemoradiotherapy,improved surgical technique and stapling devices,sphincter-preserving resection has become more frequent for patients with rectal cancer.However,as for locally advanced ultra-low rectal cancer,sphincter-preservation is still facing an enormous challenge.Objective:To introduce an NLT strategy of sphincter-preservation-neoadjuvant therapy(NT)followed by local excision(LE)and two-stage total mesorectal excision(TME)-into the treatment of locally advanced ultra-low rectal cancer(lesions with anal sphincter invasion).Methods:From October 2010 to October 2011,nine patients with locally advanced rectal cancer located less than 3 cm from the anal verge were treated by the NLT strategy.All patients had shown good clinical response to NT.The LE procedure was carried transanally 6-8 weeks after completion of the NT.TME was performed to dissect mesorectal lymph nodes 4-6 weeks after LE.Results:Of the nine patients,the lesion was assessed as T2 in two,T3 in five,and T4 in two before NT,and lymph node metastasis was detected in five patients.The median distance from the tumor to the anal verge was 2.5 cm(range:1-3 cm).The median follow-up was 27 months(range:24-34 months).No distant metastasis was detected.Only one patient(11.1%)developed local recurrence at 12 months post-operatively and then underwent abdomino-perineal resection.The remaining eight patients had preserved long-term continence and the median Wexner score at two years post-operation was 4(range:2-6).Conclusion:The new NLT strategy can achieve sphincter-preservation in some patients with ultra-low rectal cancer,with favorable oncological outcome and preservation of normal anal sphincter function.展开更多
A novel time-frequency domain interference excision technique is proposed. The technique is based on adaptive biorthogonal local discrete cosine trans form (BLDCT). It uses a redundant library of biorthogonal local d...A novel time-frequency domain interference excision technique is proposed. The technique is based on adaptive biorthogonal local discrete cosine trans form (BLDCT). It uses a redundant library of biorthogonal local discrete cosine bases and an efficient concave cost function to match the transform basis to the interfering signal. The main advantage of the algorithm over conventional trans form domain excision algorithms is that the basis functions are not fixed but ca n be adapted to the time-frequency structure of the interfering signal. It is w e ll suited to transform domain compression and suppression of various types of in terference. Compared to the discrete wavelet transform (DWT) that provides logar ithmic division of the frequency bands, the adaptive BLDCT can provide more flex ible frequency resolution. Thus it is more insensitive to variations of jamming frequency. Simulation results demonstrate the improved bit error rate (BER) perf ormance and the increased robustness of the receiver.展开更多
BACKGROUND Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases.Abdominoperineal resection was regarded as the radical procedure for disease control.Nevertheless,it ...BACKGROUND Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases.Abdominoperineal resection was regarded as the radical procedure for disease control.Nevertheless,it led to more postoperative complications than sphincter-sparing wide local excision(WLE)and reduced the patient’s quality of life(QOL)owing to creation of colostomy.Therefore,in this study,WLE,radiotherapy(RT),and a second WLE were conducted on a patient who had been diagnosed with localized rectal melanoma.CASE SUMMARY The patient was a 79-year-old woman who had been experiencing anal pain and bloody stool for 1 mo.Colonoscopy,magnetic resonance imaging,positron emission tomography–computed tomography,and histological analysis of tissue biopsy using the histological markers Melan-A(+),S-100(+),and Ki-67(+,50%)lead to the diagnosis of localized rectal melanoma.The patient had initially undergone WLE to resolve problem of anal bleeding,followed by RT to treat the residual lesion with partial response.Subsequently,the residual lesion was removed with margin-free resection by the second WLE.The patient’s postoperative course was smooth and uneventful.During the 2-year follow-up,no local recurrence was observed.Additionally,a good functional outcome and improved QOL were reported.CONCLUSION Combining WLE,RT,and repeat WLE is proposed as a viable alternative for treating rectal melanoma accompanied by bleeding symptoms that cannot be completely resected at the beginning.展开更多
BACKGROUND Transduodenal local excision is an alternative treatment approach for benign ampullary tumors.However,this procedure has technical difficulties,especially during reconstruction of the pancreaticobiliary duc...BACKGROUND Transduodenal local excision is an alternative treatment approach for benign ampullary tumors.However,this procedure has technical difficulties,especially during reconstruction of the pancreaticobiliary ducts.An operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification,illumination,and stereoscopic view.The application of an operating microscope in transduodenal excision of ampullary tumors has not been reported.CASE SUMMARY A 55-year-old woman was admitted for investigation of recurrent upper abdominal pain.Physical examination and laboratory tests found no abnormalities.Imaging identified a large mass in the descending part of the duodenum.Esophagogastroduodenoscopy revealed a 3.5-cm-sized villous growth over the major duodenal papilla.Pathology of the endoscopic biopsy indicated a villous adenoma with low-grade dysplasia.Microscopic transduodenal excision of the ampullary tumor was performed.The final pathological diagnosis was villous-tubular adenoma with low-grade dysplasia.The patient was discharged on postoperative day 12 after an uneventful recovery.Endoscopic retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor recurrence.The patient is continuing follow-up at our clinic and remains well.CONCLUSION Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.展开更多
AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with ...AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.展开更多
AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advan...AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.展开更多
Malignant fibrous histiocytoma, which is composed of spindle-shaped cells arranged in a pleomorphic and storiform pattern, is rarely found in the colorectum. Although complete surgical excision remains the main stem o...Malignant fibrous histiocytoma, which is composed of spindle-shaped cells arranged in a pleomorphic and storiform pattern, is rarely found in the colorectum. Although complete surgical excision remains the main stem of therapy, an optimal treatment strategy according to the stage has not been elucidated. We report a case of a 63-year-old woman with an ulcerative lesion in the anorectal junction and a final diagnosis of malignant fibrous histiocytoma. We introduced an access for transanal local excision and adjuvant radiotherapy because the patient refused abdominoperineal resection. No local recurrences or distant metastases were observed 15 mo after the operation. To our knowledge, this is the first case reported in the English literature of a malignant fibrous histiocytoma treated with the transana local excision and adjuvant radiotherapy. This report showed that this approach is selectively reserved for early-stage malignant fibrous histiocytoma and for those patients who refuse radical surgery because of the risk in a permanent colostomy.展开更多
目的:探讨应用腔镜直线切割吻合器(endoscopic linear cutters, ENDOPATH)行经肛门局部切除术治疗T_(1)期中低位直肠癌的疗效和安全性。方法:回顾性分析2011年01月至2017年12月我院收治的92例T_(1)期中低位直肠癌患者的临床资料。根据...目的:探讨应用腔镜直线切割吻合器(endoscopic linear cutters, ENDOPATH)行经肛门局部切除术治疗T_(1)期中低位直肠癌的疗效和安全性。方法:回顾性分析2011年01月至2017年12月我院收治的92例T_(1)期中低位直肠癌患者的临床资料。根据手术方式分为经肛门局部切除术组(TAE组)与直肠癌传统根治术组(根治术组)。TAE组使用腔镜直线切割吻合器行经肛门全层局部切除术,共39例;根治术组按全直肠系膜切除原则行传统根治术,共53例(包括16例Miles手术和37例Dixon手术)。对两组患者的一般资料、术中及术后相关指标及预后情况进行比较。结果:TAE组和根治术组患者在性别、年龄、肿瘤病理分型、肿瘤大小、距肛缘距离方面对比分析,无显著性差异(P>0.05),两组资料有可比性。两组患者在手术时间[(TAE组:(37.74±10.66)min,根治术组:(117.66±41.78)min]、术后住院时间[TAE组:(6.85±1.06)天,根治术组:(10.70±1.72)天]、术中出血量[TAE组:(30.21±2.97)mL,根治术组:(78.96±12.65)mL]、术后并发症发生率(TAE组:2.56%,根治术组:43.39%)方面差异均有统计学意义(P<0.01)。两组患者的3年无病生存率均为100.00%,两组患者3年内均无复发,相比较无统计学差异(P> 0.05)。两组患者的生存质量评分[TAE组:(90.31±3.82)分,根治术组:(71.59±6.33)分]差异有统计学意义(P<0.01)。结论:与传统根治术相比,应用腔镜直线切割吻合器对T1期中低位直肠癌行经肛门局部切除术同样安全有效。应用腔镜直线切割吻合器行经肛门局部切除术创伤小、并发症少、恢复快,患者术后生活质量等方面明显优于根治术。应用腔镜直线切割吻合器行经肛门局部切除术可作为早期无淋巴转移的中低位直肠癌患者优先选择的一种术式。展开更多
文摘BACKGROUND:Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS:We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. RESULT:Reconstruction was successful with a duodeno-jejunostomy and protected by a nasoduodenal drain. CONCLUSION:The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.
文摘AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.
文摘BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis(LNM), between AC and DC-Ⅱ.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-Ⅱ who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.RESULTS The patients with AC and DC-Ⅱ did not exhibit significant differences in 5-year overall survival(66.0% and 67.1%, respectively) and 5-year relapse-free survival(63.5% and 62.2%, respectively). Compared to the patients with DC-Ⅱ, the rate of preoperative biliary drainage was higher(P = 0.042) and the rates of digestive symptoms(P = 0.0158), ulcerative-type cancer(P < 0.0001), large tumor diameter(P < 0.0001), and advanced tumor stage(P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-Ⅱ,respectively, without significant difference(P = 0.23). The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py) were significantly higher in patients with DC-Ⅱ than in those with AC(metastasis to N-HE: 18.5% and 5% in patients with DC-Ⅱ and AC, respectively;P = 0.0432;metastasis to N-Py: 11.1% and 0% in patients with DC-Ⅱ and AC, respectively;P = 0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-Ⅱ than in those with AC.
基金This work was supported by the grants from the National Natural Science Foundation of China (No. 30571988), the Beijing Natural Science Foundation (No. 7072019), and the Capital Medical Development Foundation (No. 2002-2018).
文摘Background Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up. Methods Twenty-two patients (22 eyes), who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. Localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages. Results After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities (BCVA) varied from 0.02-1.00, including 18 patients (81.82%) who had BCVA equal to or better than that before surgery. Fifteen patients (68.18%) had BCVA better than 0.3. Only two patients had intraocular pressure (lOP) of less than 10 mmHg and the other patients maintained normal lOP. Nine cases (40.91%) were given confirmed diagnosis of malignant melanoma, four (18.18%) of melanocytoma, six (27.27%) of nonpigmented ciliary epithelial adenoma, two (9.09%) of neurofibroma, and one (4.55%) of neurinoma. Twenty patients (90.91%) had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years after the operation. Conclusion For some ciliary body tumors, especially in the early stages, local excision is an effective and safe method to save the vision and the eyeball.
基金This study was supported by the Programme of Introducing Talents of Discipline to Universities(No.B12003)National Natural Science Foundation of China(No.81101669)。
文摘Background:With the increased usage of neoadjuvant chemoradiotherapy,improved surgical technique and stapling devices,sphincter-preserving resection has become more frequent for patients with rectal cancer.However,as for locally advanced ultra-low rectal cancer,sphincter-preservation is still facing an enormous challenge.Objective:To introduce an NLT strategy of sphincter-preservation-neoadjuvant therapy(NT)followed by local excision(LE)and two-stage total mesorectal excision(TME)-into the treatment of locally advanced ultra-low rectal cancer(lesions with anal sphincter invasion).Methods:From October 2010 to October 2011,nine patients with locally advanced rectal cancer located less than 3 cm from the anal verge were treated by the NLT strategy.All patients had shown good clinical response to NT.The LE procedure was carried transanally 6-8 weeks after completion of the NT.TME was performed to dissect mesorectal lymph nodes 4-6 weeks after LE.Results:Of the nine patients,the lesion was assessed as T2 in two,T3 in five,and T4 in two before NT,and lymph node metastasis was detected in five patients.The median distance from the tumor to the anal verge was 2.5 cm(range:1-3 cm).The median follow-up was 27 months(range:24-34 months).No distant metastasis was detected.Only one patient(11.1%)developed local recurrence at 12 months post-operatively and then underwent abdomino-perineal resection.The remaining eight patients had preserved long-term continence and the median Wexner score at two years post-operation was 4(range:2-6).Conclusion:The new NLT strategy can achieve sphincter-preservation in some patients with ultra-low rectal cancer,with favorable oncological outcome and preservation of normal anal sphincter function.
基金Project supported by the National Natural Science Foundation of China(Grant No.6017201860372007)
文摘A novel time-frequency domain interference excision technique is proposed. The technique is based on adaptive biorthogonal local discrete cosine trans form (BLDCT). It uses a redundant library of biorthogonal local discrete cosine bases and an efficient concave cost function to match the transform basis to the interfering signal. The main advantage of the algorithm over conventional trans form domain excision algorithms is that the basis functions are not fixed but ca n be adapted to the time-frequency structure of the interfering signal. It is w e ll suited to transform domain compression and suppression of various types of in terference. Compared to the discrete wavelet transform (DWT) that provides logar ithmic division of the frequency bands, the adaptive BLDCT can provide more flex ible frequency resolution. Thus it is more insensitive to variations of jamming frequency. Simulation results demonstrate the improved bit error rate (BER) perf ormance and the increased robustness of the receiver.
文摘BACKGROUND Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases.Abdominoperineal resection was regarded as the radical procedure for disease control.Nevertheless,it led to more postoperative complications than sphincter-sparing wide local excision(WLE)and reduced the patient’s quality of life(QOL)owing to creation of colostomy.Therefore,in this study,WLE,radiotherapy(RT),and a second WLE were conducted on a patient who had been diagnosed with localized rectal melanoma.CASE SUMMARY The patient was a 79-year-old woman who had been experiencing anal pain and bloody stool for 1 mo.Colonoscopy,magnetic resonance imaging,positron emission tomography–computed tomography,and histological analysis of tissue biopsy using the histological markers Melan-A(+),S-100(+),and Ki-67(+,50%)lead to the diagnosis of localized rectal melanoma.The patient had initially undergone WLE to resolve problem of anal bleeding,followed by RT to treat the residual lesion with partial response.Subsequently,the residual lesion was removed with margin-free resection by the second WLE.The patient’s postoperative course was smooth and uneventful.During the 2-year follow-up,no local recurrence was observed.Additionally,a good functional outcome and improved QOL were reported.CONCLUSION Combining WLE,RT,and repeat WLE is proposed as a viable alternative for treating rectal melanoma accompanied by bleeding symptoms that cannot be completely resected at the beginning.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LQ19H100004.
文摘BACKGROUND Transduodenal local excision is an alternative treatment approach for benign ampullary tumors.However,this procedure has technical difficulties,especially during reconstruction of the pancreaticobiliary ducts.An operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification,illumination,and stereoscopic view.The application of an operating microscope in transduodenal excision of ampullary tumors has not been reported.CASE SUMMARY A 55-year-old woman was admitted for investigation of recurrent upper abdominal pain.Physical examination and laboratory tests found no abnormalities.Imaging identified a large mass in the descending part of the duodenum.Esophagogastroduodenoscopy revealed a 3.5-cm-sized villous growth over the major duodenal papilla.Pathology of the endoscopic biopsy indicated a villous adenoma with low-grade dysplasia.Microscopic transduodenal excision of the ampullary tumor was performed.The final pathological diagnosis was villous-tubular adenoma with low-grade dysplasia.The patient was discharged on postoperative day 12 after an uneventful recovery.Endoscopic retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor recurrence.The patient is continuing follow-up at our clinic and remains well.CONCLUSION Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.
基金Supported by(in part)Wenzhou Science and Technology Project,No.Y20160044Suzhou Key Medical Center,No.LCZX201505+2 种基金Soochow Development of Science and Technology Projects,No.SZS201618Chinese Natural Science Foundation,No.81672970Second Affiliated Hospital of Soochow University Preponderant Clinic Discipline Group Project,No.XKQ2015007
文摘AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.
文摘AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.
文摘Malignant fibrous histiocytoma, which is composed of spindle-shaped cells arranged in a pleomorphic and storiform pattern, is rarely found in the colorectum. Although complete surgical excision remains the main stem of therapy, an optimal treatment strategy according to the stage has not been elucidated. We report a case of a 63-year-old woman with an ulcerative lesion in the anorectal junction and a final diagnosis of malignant fibrous histiocytoma. We introduced an access for transanal local excision and adjuvant radiotherapy because the patient refused abdominoperineal resection. No local recurrences or distant metastases were observed 15 mo after the operation. To our knowledge, this is the first case reported in the English literature of a malignant fibrous histiocytoma treated with the transana local excision and adjuvant radiotherapy. This report showed that this approach is selectively reserved for early-stage malignant fibrous histiocytoma and for those patients who refuse radical surgery because of the risk in a permanent colostomy.
文摘目的:探讨应用腔镜直线切割吻合器(endoscopic linear cutters, ENDOPATH)行经肛门局部切除术治疗T_(1)期中低位直肠癌的疗效和安全性。方法:回顾性分析2011年01月至2017年12月我院收治的92例T_(1)期中低位直肠癌患者的临床资料。根据手术方式分为经肛门局部切除术组(TAE组)与直肠癌传统根治术组(根治术组)。TAE组使用腔镜直线切割吻合器行经肛门全层局部切除术,共39例;根治术组按全直肠系膜切除原则行传统根治术,共53例(包括16例Miles手术和37例Dixon手术)。对两组患者的一般资料、术中及术后相关指标及预后情况进行比较。结果:TAE组和根治术组患者在性别、年龄、肿瘤病理分型、肿瘤大小、距肛缘距离方面对比分析,无显著性差异(P>0.05),两组资料有可比性。两组患者在手术时间[(TAE组:(37.74±10.66)min,根治术组:(117.66±41.78)min]、术后住院时间[TAE组:(6.85±1.06)天,根治术组:(10.70±1.72)天]、术中出血量[TAE组:(30.21±2.97)mL,根治术组:(78.96±12.65)mL]、术后并发症发生率(TAE组:2.56%,根治术组:43.39%)方面差异均有统计学意义(P<0.01)。两组患者的3年无病生存率均为100.00%,两组患者3年内均无复发,相比较无统计学差异(P> 0.05)。两组患者的生存质量评分[TAE组:(90.31±3.82)分,根治术组:(71.59±6.33)分]差异有统计学意义(P<0.01)。结论:与传统根治术相比,应用腔镜直线切割吻合器对T1期中低位直肠癌行经肛门局部切除术同样安全有效。应用腔镜直线切割吻合器行经肛门局部切除术创伤小、并发症少、恢复快,患者术后生活质量等方面明显优于根治术。应用腔镜直线切割吻合器行经肛门局部切除术可作为早期无淋巴转移的中低位直肠癌患者优先选择的一种术式。