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Cong JC, Zhang H, Chen CS. [Clinical significance of intersphincteric resection related anatomy effect on surgical safety]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:562-566. [PMID: 37583010 DOI: 10.3760/cma.j.cn441530-20230308-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
The anatomical studies of intersphincteric resection (ISR) have made remarkable progress in recent years. The anatomy of internal, external sphincter and hiatal ligament has been further understood. In this paper, the generation and functional mechanism of ISR related anatomy are described from the embryonic development process, and then the influence of hiatal ligament and internal sphincter on ISR surgery is analyzed respectively according to the anatomical characteristics. Finally, the correlation analysis of anatomical factors on the common problems of mucosal bleeding and instrument anastomosis in ISR is carried out. The objective of this paper is to improve the safety of ISR surgery by providing detailed anatomical explanations.
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Affiliation(s)
- J C Cong
- Ward of Colorectal Tumor, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - H Zhang
- Ward of Colorectal Tumor, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - C S Chen
- Ward of Colorectal Tumor, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Cong JC, Cui MM, Liu DS, Zhang H, Chen CS. [Evaluation of anorectal function after transanal total mesorectal excision and discussion of related problems]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:1024-1027. [PMID: 34823304 DOI: 10.3760/cma.j.cn441530-20200824-00496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cong JC, Chen CS, Zhang H. [Recognition of surgical anatomy for intersphincteric resection]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:598-603. [PMID: 34289544 DOI: 10.3760/cma.j.cn.441530-20201102-00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intersphincteric resection (ISR) involves the anatomy of hiatal ligament, internal and external sphincter and conjoined longitudinal muscle. The hiatal ligament is actually a branch of the longitudinal muscle of rectum, shown as an uneven ring attached to the levator ani muscle. The internal sphincter is the end of the circular muscle of rectum which begins at the level of hiatal ligament formation. The distance from the upper boundary of internal sphincter to dentate line is significantly different among individuals. Although there is adipose tissue in the space between the internal and external sphincters, no evidence of mesentery structure in the anal canal is found as in the rectum. The conjoined longitudinal muscle is the remaining branch of the longitudinal muscle, whose return passes through the external sphincter and ends at the anococcygeal ligament/coccyx after reaching the anal margin. The synergistic action of conjoined longitudinal muscle and the hiatal ligament participates in the defecation process. The individualized difference of ISR-related anatomy affects the operation, especially the anastomosis.
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Affiliation(s)
- J C Cong
- Colorectal Tumor Surgical Ward, Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - C S Chen
- Colorectal Tumor Surgical Ward, Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - H Zhang
- Colorectal Tumor Surgical Ward, Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
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Xia ZX, Cong JC, Zhang H. Rectoseminal vesicle fistula after radical surgery for rectal cancer: Four case reports and a literature review. World J Clin Cases 2020; 8:5645-5656. [PMID: 33344556 PMCID: PMC7716322 DOI: 10.12998/wjcc.v8.i22.5645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A rectoseminal vesicle fistula (RSVF) is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage (AL). Limited literature documenting this rare complication is available. We report four such cases and review the literature to investigate the etiology, clinical manifestations, and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder.
CASE SUMMARY Four cases of RSVF were presented and summarized, and a further 12 cases selected from the literature were discussed. The main clinical symptoms in these patients were pneumaturia, fever, scrotal swelling and pain, anal pain, orchitis, diarrhea, dysuria, epididymitis and fecaluria. Imaging methods such as pelvic X-ray, computed tomography (CT), sinus radiography, barium enema and other techniques confirmed the diagnosis. CT was the imaging modality of choice. In cases presenting with reduced levels of AL, minimal surrounding inflammation, and controlled infection, the RSVF was conservatively treated by urethral catheterization, antibiotics administration and parenteral nutrition. In cases of severe RSVF, incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula.
CONCLUSION This study provides an extensive analysis of RSVF, and outlines, summarizes and examines the causes, clinical manifestations, diagnostic procedures and treatment options, in order to prevent misdiagnosis and treatment errors.
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Affiliation(s)
- Zhi-Xiu Xia
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Chun Cong
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Hong Zhang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Cong JC, Chen CS, Ma MX, Xia ZX, Liu DS, Zhang FY. Laparoscopic intersphincteric resection for low rectal cancer: comparison of stapled and manual coloanal anastomosis. Colorectal Dis 2014; 16:353-8. [PMID: 24460588 DOI: 10.1111/codi.12573] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/04/2013] [Indexed: 01/07/2023]
Abstract
AIM The study aim was to analyse the safety and feasibility of laparoscopic intersphincteric resection with stapled coloanal anastomosis for low rectal cancer. METHOD Between March 2009 and August 2010, 22 patients underwent laparoscopic intersphincteric resection with a stapled coloanal anastomosis without a diverting ileostomy. The results were compared retrospectively with hand-sewn coloanal anastomoses performed between January 2001 and May 2009, which included 55 open and 38 laparoscopic intersphincteric resections. The morbidity comparison only included data relevant to the anastomosis. Function was compared using the Saito function questionnaire and the Wexner score and only involved data relevant to the laparoscopy. RESULTS The anastomotic complication rates were similar for fistula, bleeding and neorectal mucosal prolapse (P = 0.526, P = 0.653 and P = 0.411, respectively). Anastomotic leakage and stricture formation of the stapled coloanal anastomosis were significantly lower than those of the hand-sewn coloanal anastomosis (P = 0.037 and P = 0.028, respectively). There were no significant differences in the Saito function questionnaire and the Wexner score between the stapled and hand-sewn coloanal anastomotic groups (all P > 0.05). CONCLUSION Laparoscopic intersphincteric resection with a stapled coloanal anastomosis is technically feasible and is less likely to result in anastomotic leakage and stricture formation than a hand-sewn anastomosis.
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Affiliation(s)
- J C Cong
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
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Cong JC, Chen CS, Zhang H, Qiao L, Liu EQ. Partial longitudinal resection of the anorectum and sphincter for very low rectal adenocarcinoma: a surgical approach to avoid permanent colostomy. Colorectal Dis 2012; 14:697-704. [PMID: 21689354 DOI: 10.1111/j.1463-1318.2011.02686.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Abdominoperineal resection has been the standard procedure for low rectal cancer. The present study details a new technique, partial longitudinal resection of the anorectum and sphincter, and assesses the oncological and functional outcomes. METHOD Between January 2004 and April 2008, 12 patients underwent partial longitudinal resection of the anorectum and sphincter for low rectal cancer. All patients underwent a diverting ileostomy and received biofeedback training before stoma closure. Functional results were assessed by vector manometry, Wexner constipation score and Wexner incontinence score. The quality of life (QoL) was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). RESULTS There was no postoperative mortality and a R0 curative resection was confirmed in every case. Morbidity included anastomotic leakage in three patients, one of whom underwent reoperation, and stenosis in 11, which was successfully managed with dilatation. The patient who underwent reoperation was not included in the functional analysis. The 11 successful patients received biofeedback training for 1-4 months, and underwent ileostomy closure 6-12 months after surgery. No patient had severe faecal incontinence after stoma closure. The EORTC QLQ-C30 global health status and QoL scores at 12 months after stoma closure were 50.4 ± 24.3, similar to preoperation scores of 52.3 ± 25.6 (P = 0.927), and not significantly different to scores for the healthy control population of 63.4 ± 23.5 (P = 0.539). No patients developed local recurrence during the median observation period (35.5 months). One patient had distant metastases at 24 months, and underwent resection of the left liver. CONCLUSION Curability and acceptable anal function can be obtained by partial longitudinal resection of the anorectum and sphincter in patients with very low rectal cancers. This technique is recommended as an alternative to abdominoperineal resection in patients with external sphincter muscle invasion or tumours located below the dentate line.
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Affiliation(s)
- J C Cong
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
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Shen MY, Chen CS, Cong JC, Wang JJ. Correlation of serum TNF-α with serum leptin and insulin resistance in patients with colorectal cancer. Shijie Huaren Xiaohua Zazhi 2011; 19:2597-2601. [DOI: 10.11569/wcjd.v19.i24.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship of serum TNF-α level with serum leptin and insulin resistance in patients with colorectal carcinoma.
METHODS: ELISA was used to detect serum levels of leptin and TNF-α in 100 patients with colorectal carcinoma and 80 normal controls. Fasting plasma glucose (FPG) and fasting serum insulin (FIns) were measured to calculate the homeostasis model assessment of insulin resistance (HOMA-IR). The clinicopathological features were also recorded and analyzed.
RESULTS: Serum TNF-α levels in patients with colorectal carcinoma were significantly higher than in normal controls (125.68 pg/L vs 53.57 pg/L, P < 0.05). There was a significant difference in serum TNF-α levels among patients with tumors of different stages (TNM) (P < 0.001). A significant correlation was noted among serum leptin, serum TNF-α and HOMA-IR in patients with colorectal carcinoma (P < 0.001).
CONCLUSION: Serum TNF-α levels in patients with colorectal carcinoma were significantly higher than in normal persons. Tumor stage is associated with serum TNF-α levels in patients with colorectal carcinoma. There is a significant correlation among serum TNF-α, HOMA-IR and serum leptin in patients with colorectal carcinoma.
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Huang Z, Shen MY, Wang JJ, Cong JC, Chen CS. Correlation of serum leptin with oncogene expression in colorectal cancer. Shijie Huaren Xiaohua Zazhi 2010; 18:1509-1513. [DOI: 10.11569/wcjd.v18.i14.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To search possible pathways via which leptin participates in colorectal carcinogenesis by analyzing the correlation between serum leptin and oncogene expression.
METHODS: Serum leptin and adiponectin levels were measured by avidin-biotin-peroxidase complex enzyme-linked immunosorbent assay (ABC-ELLSA) in 30 colorectal cancer patients and 24 normal controls. The expression of K-ras, P53, adenomatous polyposis coli (APC) and deleted in colorectal carcinoma (DCC) mRNAs in tumor samples was detected by reverse transcription-polymerase chain reaction (RT-PCR). The correlation between oncogene expression and serum leptin and adiponectin was then analyzed.
RESULTS: The level of serum leptin was significantly higher in APC-positive patients than in APC-negative ones (3.78 µg/L ± 1.85 µg/L vs 2.41 µg/L ± 2.53 µg/L, P < 0.05), and the relative expression level of APC mRNA increased with the increase in serum leptin levels (P < 0.05). No significant correlation was noted between serum leptin and the expression of K-ras, P53 and DCC mRNAs in colorectal cancer (all P > 0.05).
CONCLUSION: There is a significant correlation between serum leptin level and APC expression in colorectal cancer. No significant correlation is noted between serum leptin level and the expression of K-ras, P53 and DCC mRNAs in colorectal cancer.
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Xu K, Zhang H, Feng Y, Cong JC, Chen CS, Liu EQ. Comparison of the outcomes of preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer: an analysis of 248 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:736-740. [DOI: 10.11569/wcjd.v18.i7.736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy and safety of self-expanding metallic stents (SEMSs) and to compare the short- and long-term outcomes of preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer.
METHODS: Sixty-two patients who underwent SEMS insertion and 186 patients who underwent primary emergency surgery for left-sided colorectal cancer from 2000 to 2008 were retrospectively analyzed.
RESULTS: The SEMSs were placed successfully in 61 patients, of which 14.5% developed complications such as perforating and migration. Primary anastomosis rate was higher in patients undergoing stent insertion than in those undergoing emergency surgery (87.1% vs 34.4%, P = 0.001). The complication rate was higher in patients undergoing emergency surgery than in those undergoing stent insertion (47.3% vs 17.7%, P = 0.000). No significant difference was noted in the survival curve between the two groups (P = 0.497).
CONCLUSION: Preoperative stent insertion is safe and effective in the treatment of obstructive left-sided colorectal cancer and may result in a higher primary anastomosis rate. Stent insertion does not seem to have a deleterious effect on prognosis.
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Abstract
A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h. The pain localized over the periumbilical area with radiation along the medial side of the thigh. Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately, her family refused surgery because of her worsening condition. On the third evening after admission, the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy. Bowel resection and an end-ileostomy were performed. She recovered well despite of the complication of multiple organ dysfunction syndrome. Literature is reviewed, and the pathogenesis, clinical manifestation, imaging features and treatment are discussed.
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Abstract
AIM: To evaluate the quality of life and local recurrence for rectal cancer which under vent posterior pelvic exenteration (PPE) with anal sphincter preservation.
METHODS: Sixty cases with rectal cancer invading female reproductive system underwent PPE with anal sphincter preservation (SP group) or colon stoma (CS group) respectively. Thirty cases with low anterior resection rectal cancer were selected as control group (LAR group).Wexner scoring systems and vectorial manometry were used to compare the quality of life between the SP group and LAR group, and compare the 2-year local recurrence rate and survival rate between the SP group and CS group.
RESULTS: Three months after surgery, the Wexner score of SP group was higher than that of the LAR group (10.1 vs 6.1, P < 0.05), but there were no significant difference in score 1 year after surgery between two groups (P > 0.05), and the results of vectorial manometry between two groups also showed no significant difference (P > 0.05). The local recurrence rate and survival rate were 20% and 83.3% for SP group, 23.3% and 80% for CS group with no significant difference observed (both P > 0.05).
CONCLUSION: The quality of life after posterior pelvic exenteration with anal sphincter preservation could reach the level of low anterior resection, and the local recurrence rate and survival rate were similar with colon stoma operation.
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Ma J, Feng Y, Cong JC, Liu EQ. Influence of anastomosis level on defection and life quality of patients underwent sphincter preservation for rectal cancer. Shijie Huaren Xiaohua Zazhi 2009; 17:221-224. [DOI: 10.11569/wcjd.v17.i2.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the influence of anastomosis level on defection and quality of life in low rectal cancer using a questionnaire and anus-rectal manometry.
METHODS: We selected 160 patients who were divided into 3 groups according to the distance between anastomosis and dentate line (A: 0-1.0 cm, B: 1.0-2.0 cm, C: 2.0-3.0 cm), who received evaluation with Wexner scoring systems at 3 months and at 1 year after operation, using FIQL questionnaire for quality of life and anus-rectal vectorial manometry 1 year after operation. The normal controls were 30 healthy people without anus-rectal disease and disordered defecation.
RESULTS: Lower anastomosis level meant higher Wexner scores (10.1 vs 6.1 vs 4.1, P < 0.05) at 3 mo after operation. After 1 year of adaptation and functional exercise, the scores of three groups decreased obviously (10.1 vs 5.7, 6.1 vs 3.1, 6.1 vs2.9, all P < 0.05). However, compared with B group and C group, A group still had significantly higher scores (5.7 vs 3.1, 2.9,P < 0.05), but no differences were detected between B group and C group. As for quality of life satisfaction, three groups of patients showed no significant differences in life-style, psychological coping/behavior, depression/self-feelings and embarrassing 1 year after operation.
CONCLUSION: For the low anterior resection of rectal cancer surgery, the lower of the position of anastomosis, the worse of the function and the quality of life. For the distance between stoma and dentate line less than 1 cm, the long-term survival quality of life has also declined markedly.
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Zhang H, Chen CS, Cong JC, Qiao L, Hasegawa T, Takashima S. Clinicopathological characteristics of advanced colorectal cancer 30 mm or smaller in diameter. Chin Med Sci J 2007; 22:98-103. [PMID: 17763581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter. METHODS Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D. RESULTS The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases. CONCLUSIONS Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.
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Affiliation(s)
- Hong Zhang
- Department of General Surgery, the Second Affiliated Hospital of China Medical University, Shenyang 110004.
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Zhang H, Cong JC, Chen CS, Qiao L, Feng Y, Liu EQ. Pre- and post-operative sequential changes of serum P53 antibody, carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with colorectal cancer. Shijie Huaren Xiaohua Zazhi 2006; 14:2897-2900. [DOI: 10.11569/wcjd.v14.i29.2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of sequential change of pre- and post-operative serum P53 antibodies, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in patients with colorectal cancer.
METHODS: A total of 132 patients with colorectal cancer and 36 ones with benign lesions (as controls) were included in this prospective study. The blood samples were collected 1 h before operation and 30 d postoperatively. The presence of serum P53 antibody was determined by enzyme-linked immunosorbent assay (ELISA). The levels of serum CEA and CA19-9 were detected using radioimmunoassay (RIA).
RESULTS: The positive rate of serum P53 antibodies in patients with colorectal cancer were significantly higher than that in ones with benign disease (χ2 = 18.11, P < 0.0001). Thirty-nine (74%) of P53 seropositive patients showed negative conversion 1 mo after operation, including 3 cases (33%) in palliative surgery group and 36 cases (82%) in radical operation group (χ2 = 9.04, P = 0.0026). Thirteen (54%) of CEA seropositive patients showed negative conversion 1 mo after operation, including 2 cases (18%) in palliative surgery group and 11 cases (85%) in radical operation group (χ2 = 10.60, P = 0.0011). Seven (41%) of CA19-9 seropositive patients showed negative conversion 1 mo after operation, including 2 cases (20%) in palliative surgery group and 5 cases (71%) in radical operation group (χ2 = 4.50, P = 0.034).
CONCLUSION: Monitoring of sequential changes of pre- and post-operative serum P53 antibodies, CEA and CA19-9 in patients with colorectal cancer can help to evaluate responses to treatment, judge prognosis and guide the comprehensive treatment after operation.
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Cong JC, Zhang H, Chen CS, Liu EQ. Biofeedback therapy can improve the anal sphincter function in patients with intersphincteric resection for low rectal cancer. Shijie Huaren Xiaohua Zazhi 2006; 14:2566-2570. [DOI: 10.11569/wcjd.v14.i25.2566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy of biofeedback therapy in the patients received intersphincteric resection for very low rectal cancer.
METHODS: From 1999 to 2006, a total of 16 patients underwent intersphincteric resection, and all of them received biofeedback treatments. Therapeutic responses were evaluated with Vaizey, Wexner scoring systems and vectorial manometry.
RESULTS: After biofeedback treatments, the Vaizey and Wexner scores were markedly decreased as compared with those before treatments (6.4 vs 8.6, P < 0.001; 5.4 vs 7.2, P < 0.001); the maximal contraction pressure (mmHg) and contraction vector volume [cm×(mmHg)2] were significantly increased (205.6 ± 44.5 vs 143.6 ± 46.5, P < 0.001; 50 664.6 ± 8040.1 vs 13 337.0 ± 7491.1, P < 0.001); the asymmetric index as the resting or contracting of sphincter was dramatically down-regulated (46.8 ± 7.5 vs 58.3 ± 7.4, P < 0.001; 29.9 ± 6.7 vs 38.3 ± 7.2, P < 0.001); at last, the positive rate of rectoanal reflex was also increased from 6.3% to 31.3%.
CONCLUSION: The maximal pressure and vector volume are deficient in patients after intersphincteric resection, while biofeedback therapy can partly improve the anal sphincter function.
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Abstract
Colon lipoma is remarkably rare in clinical practice. We reported a case of ascending colon lipoma in an 83-year-old woman. She was asymptomatic with a lipoma of 35 mm×30 mm×24 mm in size which was found by routine colonoscopy. Right hemicolectomy was performed uneventfully. The diagnosis was made by histological examination. Reviewing the literature and combining with our experience, we discussed the clinical features, diagnosis and treatment of this uncommon disease.
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Affiliation(s)
- Hong Zhang
- Department of General Surgery, The Second Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
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