目的:探讨急诊肠镜下止血治疗结直肠机械吻合术后早期吻合口出血的疗效。方法:回顾分析2007年12月—2012年10月接受急诊肠镜下止血治疗的15例结直肠机械吻合术后早期吻合口出血患者的临床资料。结果:15例患者中行直肠前切除术(Dixon术)...目的:探讨急诊肠镜下止血治疗结直肠机械吻合术后早期吻合口出血的疗效。方法:回顾分析2007年12月—2012年10月接受急诊肠镜下止血治疗的15例结直肠机械吻合术后早期吻合口出血患者的临床资料。结果:15例患者中行直肠前切除术(Dixon术)后10例,右半结肠切除术后1例,吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)后4例。15例患者发生出血时间为术后6 h^7 d,出血量100~1000 mL。急诊肠镜下发现吻合口出血灶后,2例采取电凝联合硬化剂注射止血,3例采取电凝止血,9例采取金属夹夹闭止血,1例采取金属夹夹闭联合电凝止血。所有患者均一次性止血成功,未见再次出血。结论:急诊肠镜下止血治疗结直肠机械吻合术后早期吻合口出血具有操作简单、安全、有效的优点,值得在临床推广。展开更多
Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal ...Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy(Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.展开更多
目的:观察经自然腔道取标本在直肠癌患者腹腔镜根治术中的应用效果。方法:选取2018年1月至2020年12月该院收治的80例直肠癌患者进行前瞻性研究,按随机数字表法分为对照组和观察组各40例。对照组采用常规腹腔镜根治术治疗,观察组采用腹...目的:观察经自然腔道取标本在直肠癌患者腹腔镜根治术中的应用效果。方法:选取2018年1月至2020年12月该院收治的80例直肠癌患者进行前瞻性研究,按随机数字表法分为对照组和观察组各40例。对照组采用常规腹腔镜根治术治疗,观察组采用腹腔镜根治术中经自然腔道取标本结直肠吻合术治疗。比较两组手术相关指标(手术时间、术中出血量、淋巴结清扫数量、标本完整度、环周切缘阳性)水平、术后康复指标(肠道功能恢复时间、住院时间及术后疼痛)水平、肿瘤细胞播散种植阳性率、复发率和并发症发生率。结果:两组术中出血量、淋巴结清扫数量、标本完整度、环周切缘阳性率比较,差异均无统计学意义(P>0.05);观察组手术时间长于对照组,差异有统计学意义(P<0.05);观察组肠道功能恢复时间、住院时间均短于对照组,差异有统计学意义(P<0.05);两组术后24、48 h VAS评分比较,差异均无统计学意义(P>0.05);两组吻合前、吻合后、手术结束前的肿瘤细胞播散种植阳性率比较,差异均无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05);观察组术后1年复发率低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜根治术中经自然腔道取标本应用于直肠癌患者结直肠吻合术可降低术后1年复发率,缩短肠道功能恢复时间和住院时间的效果优于常规腹腔镜根治术,但需延长手术时间。展开更多
Colorectal anastomosis after extended left colectomies may result difficult, and, sometimes, impossible due to the shortness of the vascular pedicles and the distance between the two ends. Total colectomy with ileo-re...Colorectal anastomosis after extended left colectomies may result difficult, and, sometimes, impossible due to the shortness of the vascular pedicles and the distance between the two ends. Total colectomy with ileo-rectal or ileo-anal anastomosis with sacrifice of healthy colon and ileocaecal valve is usually preferred to overcome this problem. In this manuscript we describe the stepby-step surgical technique of retroileal transmesenteric colorectal anastomosis which can be used as a salvage technique for both open and laparoscopic surgeries. We also discuss the advantages and disadvantages of this approach compared to other techniques. We believe that the widespread of laparoscopic colorectal surgery as well as the raising volume of metachronous colorectal resections will revive this vintage overlooked approach.展开更多
Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low ^(18)F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT ly...Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low ^(18)F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT lymphoma is a rare entity that contributes to 1.6% of all MALT lymphomas and < 0.2% of large intestinal malignancies. The case reported herein firstly revealed stage Ⅱ MALT lymphoma with unexpected higher ^(18)F-FDG avidity of 18.9 arising at the colorectal anastomosis in a patient with a surgical history for sigmoid adenocarcinoma, which was strongly suspected as local recurrence before histopathological and immunohistochemical examinations. After accurate diagnosis, the patient received four cycles of standard R-CVP regimen (rituximab, cyclophosphamide, vincristine and prednisone), combined target therapy and chemotherapy, instead of radiotherapy recommended by National Comprehensive Cancer Network guidelines. He tolerated the treatment well and reached complete remission.展开更多
文摘目的:探讨急诊肠镜下止血治疗结直肠机械吻合术后早期吻合口出血的疗效。方法:回顾分析2007年12月—2012年10月接受急诊肠镜下止血治疗的15例结直肠机械吻合术后早期吻合口出血患者的临床资料。结果:15例患者中行直肠前切除术(Dixon术)后10例,右半结肠切除术后1例,吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)后4例。15例患者发生出血时间为术后6 h^7 d,出血量100~1000 mL。急诊肠镜下发现吻合口出血灶后,2例采取电凝联合硬化剂注射止血,3例采取电凝止血,9例采取金属夹夹闭止血,1例采取金属夹夹闭联合电凝止血。所有患者均一次性止血成功,未见再次出血。结论:急诊肠镜下止血治疗结直肠机械吻合术后早期吻合口出血具有操作简单、安全、有效的优点,值得在临床推广。
文摘Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy(Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.
文摘目的:观察经自然腔道取标本在直肠癌患者腹腔镜根治术中的应用效果。方法:选取2018年1月至2020年12月该院收治的80例直肠癌患者进行前瞻性研究,按随机数字表法分为对照组和观察组各40例。对照组采用常规腹腔镜根治术治疗,观察组采用腹腔镜根治术中经自然腔道取标本结直肠吻合术治疗。比较两组手术相关指标(手术时间、术中出血量、淋巴结清扫数量、标本完整度、环周切缘阳性)水平、术后康复指标(肠道功能恢复时间、住院时间及术后疼痛)水平、肿瘤细胞播散种植阳性率、复发率和并发症发生率。结果:两组术中出血量、淋巴结清扫数量、标本完整度、环周切缘阳性率比较,差异均无统计学意义(P>0.05);观察组手术时间长于对照组,差异有统计学意义(P<0.05);观察组肠道功能恢复时间、住院时间均短于对照组,差异有统计学意义(P<0.05);两组术后24、48 h VAS评分比较,差异均无统计学意义(P>0.05);两组吻合前、吻合后、手术结束前的肿瘤细胞播散种植阳性率比较,差异均无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05);观察组术后1年复发率低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜根治术中经自然腔道取标本应用于直肠癌患者结直肠吻合术可降低术后1年复发率,缩短肠道功能恢复时间和住院时间的效果优于常规腹腔镜根治术,但需延长手术时间。
文摘Colorectal anastomosis after extended left colectomies may result difficult, and, sometimes, impossible due to the shortness of the vascular pedicles and the distance between the two ends. Total colectomy with ileo-rectal or ileo-anal anastomosis with sacrifice of healthy colon and ileocaecal valve is usually preferred to overcome this problem. In this manuscript we describe the stepby-step surgical technique of retroileal transmesenteric colorectal anastomosis which can be used as a salvage technique for both open and laparoscopic surgeries. We also discuss the advantages and disadvantages of this approach compared to other techniques. We believe that the widespread of laparoscopic colorectal surgery as well as the raising volume of metachronous colorectal resections will revive this vintage overlooked approach.
文摘Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low ^(18)F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT lymphoma is a rare entity that contributes to 1.6% of all MALT lymphomas and < 0.2% of large intestinal malignancies. The case reported herein firstly revealed stage Ⅱ MALT lymphoma with unexpected higher ^(18)F-FDG avidity of 18.9 arising at the colorectal anastomosis in a patient with a surgical history for sigmoid adenocarcinoma, which was strongly suspected as local recurrence before histopathological and immunohistochemical examinations. After accurate diagnosis, the patient received four cycles of standard R-CVP regimen (rituximab, cyclophosphamide, vincristine and prednisone), combined target therapy and chemotherapy, instead of radiotherapy recommended by National Comprehensive Cancer Network guidelines. He tolerated the treatment well and reached complete remission.
