Fifteen patients with rectal carcinoid tumors were treated from 1975 to 1991. Before admision, nine patients (60%) had been misdiagnosed as polyps ,hemorrhoids or proctitis. Diagnosis may be delayed because of failure to recognize their charasteristics and by the negligeuce of doing digital examination or proctoscopy. Some aspects of the management of these tumors remain controversial. However, present-day treatment programs call for radical cancer resections only for lesions 2cm in diameter or larger, and local resections for all others. In reviewing this series of cases and other studies, we advocate that both the size of the lesion and the depth of tumor invasion should be taken as the criteria of surgical managements. If the tumor is 2cm in diameter, or smaller than that, local resection can be performed, but whenever the nuscularis propria is invaded, radical resection should be performed. Radical resection is bly indicated for tumors larger than 2cm.
【Abstract】Objective To discuss the clinical significance of postoperative application of gastrointestinal decompression after anastomosis of lower digestive tract. Methods Three hundred and sixty-eight patients undergoing excision and anastomosis of lower digestive tract were divided into two groups: the group with postoperative gastrointestinal decompression and the group without it. The clinical therapeutic outcomes and incidences of complications were compared between the two groups. Results The volume of gastric juice in the decompression group was about 200 ml every day after operation. Both groups had a smaller abdomenal circumference before operation than after operation （P＜0.001）. No difference in the time of first passage of gas from anus and defecation after operation was found between the two groups. The incidence of complications in the decompression group was obviously higher than that of non-decompression group (28.0% vs. 8.2%, P＜0.001); the incidence of pharyngolaryngitis of the former was up to 23.1%. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion The present study shows that application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce the gastrointestinal tract pressure and has no obvious effect on prevention from postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial for the recovery of patients without gastrointestinal decompression.
2.6 术式原则2.6.1 前入路——前切除术2.6.1.1 手术指征 位于齿状线以上且肛门扩约肌未受累的直肠癌均可实施各类前切除术……
1背景早在1987年英国爱丁堡皇家医院就开始着手研究快速的治疗流程分类系统给心肌梗塞的患者所带来的时间经济效益，就此对快速流程的研究正式拉开了序幕。到了20世纪90年代初，欧洲部分医院的急诊科首先从科室角度开始迅速推广快速流程； 同时涉及麻醉方面的流程效率改革和创新逐步兴起。20世纪90年代末麻醉专业从门诊麻醉模式、手术及麻醉前干预上，开始逐步提升快速流程的综合管理能力。正是在20世纪90年代末，快速流程的理念被正式提出，在当时它还有一个名称叫做多模式康复流程。这种理念随之在欧美国家流行起来，大量的临床实践不断在进行。1994年，美国Engelman等就提出了冠状动脉旁路“fast-track recovery”的概念，并建立了一套相应的快速康复程序，通过实践发现其的确能够加快患者的术后康复、缩短住院时间。至此快速流程作为一项高效的临床运作模式被正式纳入临床具体病种的应用中。从2001年至今，心脏外科及结直肠外科的快速流程已趋于成熟，并已成功地渗透到外科领域的多个环节……
2.6.2.2 经骶直肠癌局部切除术（trans-sacrococcygeal resection,TSR）(1)ＴＳＲ手术指征①肿瘤部位: 部位是选择TSR 的决定性因素之一,原则上腹膜返折以下的早期直肠癌均可通过TSR 完成,但理想部位是距齿状线4～6 cm 的直肠癌,切口可直达病灶,在咬除尾骨后游离直肠范围较小,得以轻松显露接近腹膜返折甚至距肛缘8～10 cm 的直肠中段肿瘤。②肿瘤方位: TSR 最适合的还是直肠后壁或后侧壁病变,前壁或前侧壁肿瘤的直肠游离要做到界面层次清晰则需要术者具备相当的经验。③肿瘤大小: 无论瘤体大小(瘤体直径＜3 cm),肿瘤基底直径应＜2 cm,尤其是浅溃疡型肿瘤,还要考虑到直肠壶腹的宽窄大小。④肿瘤形态: TSR仅适合于息肉隆起型或扁平隆起型病变,也包括浅溃疡型癌。⑤肿瘤浸润深度: 肠腔内窥镜超声检查理应成为术前分期的常规检测手段和临床指南,临床上通过仔细检查肿瘤基底活动度来判断其浸润..............
３ 整体流程图……