目的:探讨青年人大肠癌临床表现、病理特点。方法:回顾性分析四川省成都市第五人民医院普外科1997年7月至2007年12月收治的23例35岁以下青年大肠癌患者临床资料。结果:23例青年大肠癌患者平均年龄24.5岁,男女比例为2.8∶1;病变部位以直肠多见,组织学分型以低分化腺癌与印戒细胞癌最多;Dukes分期:A期1例,B期3例,C期13例,D期6例。结论:青年大肠癌表现为病理分化程度低、Dukes分期晚,更具进展性。提高认识及早期行肠镜检查有助于早期诊断。
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.
ObjectiveTo evaluate the significance and effect for surgery of Dukes D stage colorectal carcinoma. MethodsEightytwo cases of Dukes D stage colorectal carcinoma who underwent surgery from 1991 to 1998 were analyzed retrospectively. ResultsTwentyone patients experienced extended resections,29 patients palliative resection, 19 patients sideside anastomosis and 13 patients laparotomy and biopsy of the tumor. Patients with extended resections had significantly long survival time, quality of life in these patients were excellent in 71.4%, good in 23.8%, and fair in 4.8%; whereas quality of life in the group with palliative resections were excellent in 62.1%, good in 17.2%, fair in 13.8%, and poor in 6.9%. The other two groups had a bad postoperative effect, short survival time and poor quality of life. ConclusionIf the patients with Dukes D stage colorectal carcinoma have operative indications,surgical therapy should be actively performed and the postoperative survival rate and quality of life can be improved.
【Abstract】 Objective To investigate the effect of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthase, on the growth of colorectal cancer xenografts in vivo and on tumor-associated neovascularization. Methods Twenty BALB/c nude mice were randomly divided into control group and study group equally. Human colorectal cancer cell line SL174T was inoculated subcutaneously into nude mice to form transplantation tumors. Saline 0.2 ml was intragastric-administrated to mice in control group and L-NAME （4 mg toties guoties) was administrated orally to mice in study group three times per week for four weeks. The changes of tumors in both groups were recorded and the microvessel density (MVD) was also measured by immunohistochemistry assay. Results L-NAME significantly inhibited the growth of colorectal cancer xenografts in nude mice. The weight of transplantation tumor reduced with the inhibitory rate of 41.36%, and the inhibitory rate of tumor volume was 43.48% in study group. MVD in the study group and control group were 14.83±2.10 and 21.04±3.11, respectively, which showed that the former was significantly lower than that of the control group （P＜0.05）. Conclusion L-NAME may inhibit the growth of colorectal cancer via the suppression of tumor neovascularization.
【Abstract】ObjectiveTo study the expressions of matrix metalloproteinase 2 (MMP2) and carbohydrate antigen 50 (CA50) in colorectal carcinoma, cancer-adjacent mucosa （2 cm from the nether edge of tumor）, cancerdistant mucosa （5 cm from the nether edge of tumor） and normal colorectal mucosa, and to elucidate their effects on the development of colorectal carcinoma. MethodsThe expressions of MMP2 and CA50 were detected immunohistochemically in 40 cases of colorectal carcinoma, cancer-adjacent mucosa, cancer-distant mucosa and 10 cases of normal colorectal mucosa. Results①The expression intensity and positive rates of MMP-2 and CA50 increased significantly in turn by normal mucosa, cancer-distant mucosa, cancer-adjacent mucosa and colorectal carcinoma. ②The expression of MMP2 was correlated with CA50 in colorectal carcinoma. ③The expression of CA50 in colorectal carcinoma was closely associated with tumor differentiation, and the expression of MMP2 in colorectal carcinoma was closely associated with differentiation and Dukes stages as well. ConclusionOver expression of MMP2 facilitates the malignant progress of colorectal carcinoma; CA50 is a reliable marker of malignance in colorectal carcinoma; CA50 and MMP2 may have synergetic effects on the development of colorectal carcinoma.
Objective To determine whether tumor angiogenesis correlates with progression of colorectal carcinoma. Methods Microvessel counts (MVC) of 102 specimens resected from patients with colorectal carcinoma were investigated by immunohistological staining with a monocolonal antibody against FⅧ RAg, the mean number of microvessels in three areas of highest vascular density were counted under 200 times magnification microscope. Correlation of MVC with various clinicopathologic factors, and prognosis was studied. Results MVC was increased with Dukes stage, the MVC of patients with advanced stage disease was significantly higher than that of early stage patients (P＜0.01). MVC was significantly higher in tumors with lymph node metastasis and liver metastasis (P＜0.01) than in those without such metastasis. The recurrence rate after curative resection in hypervascular group (MVC≥14, 60.4%) was significantly higher (P＜0.01) than that in the hypovascular group (MVC＜14,26.5%).Moreover, the prognosis of patients with a high MVC was significantly poorer than that of those with a low MVC (P＜0.01). Conclusion Angiogenesis within colorectal cancer is an indicator of tumor behavior and may identify patients at higher risk for recurrence and poorer prognosis.
The oncogene ras p21 expression and DNA content in 46 cases of colorectal tumor were analysed quantitatively with flow cytometry and cyto-immunofluorescence staining technique. The results showed that the positive rate of ras p21 expression was 65.7% and the rate of DNA aneuploid was 74.3% in colorectal carcinomas. Ras p21 expression was higher in colorectal adenocarcinomas than that of the adenomas and normal mucosa. DNA ploid and proliferative index had some association with ras p21 expresssion. Detection of ras p21 expression and DNA content in tumors may be helpful in predicting the outcome of colorectal cancer patients.
Gastrin(G) concentration in fasting blood, cancer tissues and its adjacent mucosas sampled from fourty-three patients with large intestine carcinoma (LIC) were measured. The results showed fasting G levels in patients with LIC were significantly higher than those in the normal surum controls (Ｐ＜0.05),and dropped to normal value after resection of the cancers. Surum G levels were correlated with cell differentiations of the cancer.The cancer tissues and its adjacent mucosas contained higher levels of G than the normal mucosas (Ｐ＜0.05). The results provided a laboratory evidence that the growth of LIC in vivo were regulated by G and G level might be an indicative parameter for selection of patients with LIC to be treated with hormone therapy and the study of biological character of LIC.