Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
目的 探讨闭孔疝的诊断和治疗方法。方法 回顾性分析了我院2001年10月至2009年8月期间收治并经手术证实的8例闭孔疝患者的临床资料。结果 8例均为女性，其中7例是老年、体弱的多产妇，1例是已婚年轻女性。平均年龄74.6岁（46～85岁），平均体重为39.1 kg（34～43 kg），平均生育5胎（1～10胎）。8例患者中5例术前经CT检查确诊而行手术治疗，3例由外院转入者在行急诊剖腹探查术中确诊。7例行坏死小肠切除吻合术，1例行嵌頓小肠复位术。 术后4例出现并发症：1例肺炎、1例切口感染、1例低蛋白水肿、1例为酸中毒和低血钾（死亡）。7例痊愈出院，1例死亡。结论 闭孔疝缺乏特异性表现，对年老体弱的经产妇出现腹痛、呕吐和股部疼痛应想到闭孔疝的可能；CT检查能提高闭孔疝的诊断率。准确的诊断和及时的手术干预是改善闭孔疝患者预后的关键。
Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
Objective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hospital of Sichuan University from November 2006 to June 2007 was retrospectively study, and the application situation and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patients were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of 10.61 items. According to correlation analysis, positive correlation existed among lung function and blood type ( r =0.161, P =0.001), tumor marker ( r =0.118, P =0.014), chest X-ray ( r =0.113, P =0.018), routine electrocardiogram ( r =0.198, P =0.000) , while lung function and immune and stress reaction exhibit a negative correlation ( r =-0.106, P = 0.027) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r =0.151, P =0.001) as well as endorectal ultrasound ( r =0.330, P =0.000). Using univariate analysis, the influence of tumor location ( P =0.012) and operative method ( P =0.004) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm-related examination and important organs function detection. And three levels of preoperative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpful to consummate preoperative evaluation and improve medical quality.
Objective To determine the relationships between the preoperative and postoperative Glasgow prognostic score (GPS) and short-term prognosis in colorectal cancer. Methods Patients pathologically verified colorectal cancer were prospectively enrolled at West China Hospital of Sichuan University from April 2009 to June 2009. C-reactive protein (CRP) and albumin (Alb) were examined on the third day before operation and the first day after operation. We calculated the value of GPS and analyzed the relationships between GPS and short-term prognosis. Results This study enrolled 38 patients. Preoperative GPS was significantly related with pathological M stage (P=0.007) and TNM stage (P=0.013), and was not related with T stage and N stage (Pgt;0.05). Postoperative GPS was not related with pathological T, M, N and TNM stages (Pgt;0.05). Moreover, there was no relationship between GPS and postoperative quality of life or complications (Pgt;0.05). Conclusions Preoperative GPS correlates with pathologically M stages and TNM stages. Systematic inflammatory response maybe not the determinant factor for the short-term prognosis of patients with colorectal cancer.
Objective To summarize the research progress of preoperative staging diagnosis for gastric cancer. Methods Both the domestic and international literatures involving the preoperative staging diagnosis of gastric cancer in recent years were collected and reviewed. Results Transabdominal ultrosonography, EUS, CT, MRI, PET and diagnostic laparoscopy could provide objective evidences, and enhanced the accuracy of preoperative staging diagnosis for gastric cancer. Conclusion With the development of examination methods, the assessment of preoperative staging diagnosis of gastric cancer has been improved, and operation strategy can be made according to the correct preoperative staging.