Abstract:Objective:To study the surgical treatment principles of obstructive colorectal cancer. Methods: The clinical data of 108 cases of obstructive colorectal cancer treated in our hospital in recent 10 years were retrospectively analysed. Of 30 cases of right hemicolon cancer ,28 cases received primary hemicolectomy and anastomosis,1 underwere conversative operation,and 1 received non-operative treatment.In 78 patients with left hemicolon or rectal cancer,56 underwent primary resection ( primary and secondary anastomosis were performed on 32 and 24 cases, respectively), and 11 received two-stage resection;nonresectable cancer underwent by-pass procedures in 6 cases,and non-operative treatment in 5. Results:Most obstructive colorectal cancer were moderate or poor differentiated adenocarcinoma (65 cases) and in Dukes C or D stages(59 cases) .Postoperative complications rate was 27.3%(26 cases,46 times),most were infective complications(35/46) including 4 cases of anastomotic leakage. Eight cases died during perioperative period. The 5-year survavil rate in operative and nonoperative cases was 28.4% and 0% respectively(P<0.01) ;and in cases underwent primary or secondary tumor resection was 33.3% and 9.0% respectively（P<0.05）. The 5-year survival rate in cases underwent primary tumor resection. with one- or two-stage anastomosis was no significant difference(P>0.05). Conclusions:The surgical treatment principles for patients with obstructive colorectal cancer is to remove the tumor and relief the obstruction by one-stage operation individually if possible.But one-or two-stage anastomosis after tumor resection seems to be no influence on the patients prognosis.

Abstract:Objective:
To explore the operative methods and the effect of ano- reserving operations for lower rectal carcinoma (LRC) .Methods: Retrospective analysis was made on the clinical and pathological data of 206 LRC cases. Results:Of the 206 cases, 61 cases underwent Miles operation, 145 received ano-reserving procedures (ARP). In the 145 cases treated with ARP, postoperative anastomostic leakage occurred in 16 cases (11.0%),and anus stenosis in 13 cases (9.0%). All the complications were cured by non-operative treatment. There was no operative death in this series. The postoperative 5-year survival rate in Miles operation was 62.3%, in ano-reserving procedures was 67.2%( P>0.05). Conclusions:The choice of Miles opereration or ARP in the treatment of LRC is mainly according to patients condition. However, if a radical treatment can be assured. ARP is the best choice for LRC.

Abstract:Objective:
To evaluate the clinical value of "ligature anastomosis of the colon and anal canal" for middle-lower rectal cancer (M-LRC). Methods: Restrospective analysis of the clinical data of 113 patients with M-L RC treated by "ligature anastomoseof the colon and anal canal" with sustaining tube made by our self in recent seven years were made. Results: Fifteen patients(13.2%) had postoperative complications.There was no death in this series.One hundred and eight patients were followed-up for 3 months to 8 years postoperatively. One hundred and one patients (93.5%) renewed anal function in 8 months to 1 year.Eight patients (7.4%)had local recurrence within 1 year postoperatively;15 patients (13.8%) had local recurrence 5 years after operation. Conclusions :"Ligature anastomosis of the colon and anal canal" after resection of the cancer in the treatment of M-LRC has successful effect in preserving anus. This operation is simple and less complications . It can be used nationwide.

Abstract:Objective:
To investigate if the prognosis of young patients with colorectal cancer (CRC) is influenced by their familial predisposition. Methods:The patients with CRC under 40 years old, underwent operation, had pathological diagnosis , family survey, followed up etc were selected into this research. According to familial predisposition they were divided into two groups: group A (with familial predisposition) and group B (without familial predisposition). Results:Among the 44 patients twelve were in group A, thirty-two in group B. The 5-year survival rate in group A and B was 83.30%(10/12) and 59.38%(19/32) respectively,the difference was significant between the two groups(χ2=5.64,P<0.05). The cases of well differentiated cancer and poorly differentiated cancer in group A and B were 8, 4 and 19,13 respectively. Adjusted for histopothology difference, the standard 5-year survival rate in group A and B was 84.09%(37/44)and 59.09%(26/44)respectively(χ2=6.68,P<0.05). Patients in Dukes stage A ,B and C were 3, 14 and 18. Adjusted for Dukes classification difference,the 5-year survival rate in group A and B was 88.64%(39/44) and 63.64%(28/44) respectively (χ2=6.58,P<0.05). Conclusions:The prognosis of young patients with CRC may be influenced by their familial predisposition. It is necessary to collect more cases of young patients in HNPCC families for further study and to compare them with sporadic cases to evaluate the prognosis of goung patients with CRC correctly.

Abstract:Objective:To evaluate the relationship between the expression of EGF, EGFR and PCNA with the clinicopathological characteristics in human colorectal carcinoma. Methods :Immunohistochemistry was used to examine the expression of EGF, EGFR and PCNA in 50 specimens of colorectal carcinoma and 10 specimens of normal colorectal tissue. Results:In cancer specimens,the expression of EGF and EGFR were 76.07% and 84.15% respectively, but in normal colorectal tissue were no expression of EGF and EGFR (P<0.05) . The expression of PCNA in tumor tissue was （37.22±14.49）%; and in normal colorectal tissue was （15.12±3.21）% (P<0.05) . The expression of EGF, EGFR and PCNA was not correlated with the size and site of the tumor; however , the expression was significant correlated with the degree of differentiation, Dukes stages, metastasis and recurrence of the colorectal carcinoma. Conclusions :The results suggest that the expression of EGF, EGFR and PCNA is an useful tool for providing information about the malignant degree, prognosis, relapse of the tumor, and may be as a gaiding in postoperative chemotherapy selection for patients with colorectal carcinoma.

Abstract:Objective:
To study the role of MEK2/ERK signal transduction pathway in the development of colorectal cancer. Methods: (1)Western blot analysis was performed on cancerous tissues and adjacent colonic tissues in 45 patients with colorectal cancers.(2)Human colorectal cancer cell line SW480 was treated with MEK inhibitor,and then MTT assay was used to measure the SW480 cells proliferation;and the expression of MEK2, p-ERK and C-myc in SW480 cells were measured by western blot. Results:MEK2 protein level was increased in colorectal cancer compared with adjacent mucosa (P<0.05). The overexpression of MEK2 in cancerous tissue was related to the Dukes stage, differentiation and lymph nodes metastasis (P<0.05). There were significant correlation between MEK2 expression and clinicopalhological parameters such as tumor size, serosa invasion and distant metastasis. SW480 treated with MEK inhibitor PD98059 resulted in significant growth inhibition and downregulation of MEK2, p-ERK and C-myc.Conclusions:The increase of MEK2 may correlate with the invisive potention of colorectal cancer. Blocking MEK2/ERK signal transduction pathway could inhibit the growth of SW480 cells.

Abstract:Objective:
To investigate the mutation of endothelin-B receptor(EDNRB) gene in sporadic Hirschsprung′s disease in Chinese population, to study the relationship between EDNRB gene and the pathogenesis of HD. Methods:Genomic DNA was extracted from HD bowel tissues removed by surgery in 34 sporadic HD patients. Exon 3, 4, 6 of EDNRB gene of EDN-3 gene were amplified by polymerase chain reaction (PCR) and analyzed by single strand conformation polymorphism (SSCP). Results : EDNRB mutations were detected in 2 of the 13 short-segment HDs,one′s mutant was in the exon 3, the another was in the exon 6. No mutations were detected in the ordinary or long-segment HD. Conclusions:The mutations of EDNRB gene were detected in the short-segment HD of sporadic HD in Chinese population. The results suggest that the EDNRB gene plays an important role in the pathogenesis of HD.

Abstract:Objective:
To determine the serum gastrin level, the expression of gastrin in colorectal carcinoma cells and observe the ultrastructure of gastrin secretory granule in colorectal carcinoma cells,in order to explore the relationship between gastrin and clinical behavior of colorectal carcinoma. Methods:The serum gastrin and gastrin expression in colorectal carcinoma tissues of the 53 cases were examined by using radio-immunity analysis(RIA), immunohistochemistry and immunoelectron microscopic technique. Results:Compared with control group,the preoperative level of serum gastrin in colorectal group was significantly increased, especially in well-differentiation adenocarcinoma . In the tissue of colorectal carcinoma, the gastrin expression rate was 56.6%. The expression rate of well-differentiated adenocaroinoma was higher than that in moderate and poor differentiation adenocarcinoma. Immunoelectron microscopy showed that the granules of protein A-gold (PAG) could be seen in different electro-density secretion granules in carcinoma cells, in intercellular space and on the surface of membrane of microvillus.Conclusions:The level of serum gastrin and the expression of gastrin in cancer tissues in colorectal carcinoma patients are increased. The colorectal carcinoma cells may synthesize and secrete gastrin themselves, which may be correlated with clinical behavior of colorectal carcinoma.

Abstract:Objective:
To investigate the effect of recombinant human endostatin (rhES) on the growth of transplanted gastric cancer in nude mices. Methods :At the 20 day after tumor transplantation, twelve Balb/c-nu/nu mice were randomly divided into two groups:(1)Control group: 0.9% NS 0.1ml was injected around the tumor,once a day for 10 days; (2)experimental group: rhES 2mg/kg was inpected around the tumor once a day for 10 days. The tumors bulk were measured every five days until five days after injection. VEGF, bFGF,PDGF,VEGF-c, VEGFR-3， FⅧAg, PCNA, bcl-2 and apoptosis index were examined. The tumor inhibition rate(TIR) and tumor condensing rate (TCR) were calculated. The difference of AI , tumor bulk and MVD between the 2 groups were assessed. Results :The difference of the tumor bulk between the two group was no statistical significance before injection, but at the time of 15 days after begining of the injection, the difference was significant(P =0.0001); and in the experimental group the tumor bulk was also decreased significantly after treatment(P=0.0015). MVD, VEGF, bFGF, PDGF， VEGF-c，VEGFR-3 and bcl-2 expressed lower in experimental group than those in control group; PCNA expression was the same in the 2 groups. AI increased significant in experimental group compared with in control group (P =0.0000). In experimental group,the TIR was 91.2%,TCR 53.5%,and HE staining presented more necrotic areas.Conclusions :rhES can inhibit angiogenesis of the tumor and promote tumor cell apoptosis, so that can inhibit the growth of tumor.

Abstract:Objective: To study the significance of expression of hypoxia-inducible factor 1 alpha(HIF-1α) in gastric mucosal diseases. Methods:Using tissue chip technique to creat tissue chip in 120 cases of vary gastric mucosal disease,and using S-P immunohistochemical methods to detect the expressions of HIF-1α in these tissue chips. Results:The positive rates of HIF-1α was 28.3% in 120 tissue chips of gastric mucosal diseases. The positive rates of HIF-1α was 0, 10.0%, 40.0% and 63.3% in chronic superficial gastritis, chronic atrophic gastritis with intestinal metaplasia, chronic atrophic gastritis with dysplasia and intestinal type gastric cancer, respectively. The positive rates of HIF-1α of intestinal type gastric cancer and chronic atrophic gastritis with dysplasia were significantly higher than that in chronic superficial gastritis and chronic atrophic gastritis with intestinal metaplasia(P<0.05). Conclusions:The results demonstrate that HIF-1α is a good marker of gastric precancerous lesion. It is feasible to use of tissue chip for a rapid screen of massive tissue specimens clinically,and it is a high efficacy,economic and accurate method for delecting gastric precancerous lesion.

Abstract:Objective:
To study the clinical characteristic and the surgical treatment of the patients with familial adenomatous polyposis(FAP). Methods: Retrospective analysis was made on the clinical feature and operative procedures of 28 patients with FAP in our hospital in recent 14 years. Of the 28 patients, 20 patients had familial history, 6 had cancerization. Results:All the patients received operation, ileal pouch- anal anastomosis(IPAA) were performed on 25 cases(89.29%) , 3 cases underwent other operations. No severe complications had taken place postoperatively. All the patients received non-steroid anti-inflammatory drugs(NSAIDs) or tamoxifen treatment. All the patients were followed-up for 2-14 years, 4 patients died(14.29%) during follow-up period. Life quality and bowel function after operation were good in the aliving patients. No polyp in ileum pouch was seen. Conclusions:Surgical treatment is the main methods for FAP, it can prevent bowel polyp carceration. Use of NSAIDs or tamoxifen as an adjuvant treatment of FAP is useful in the prevention of FAP recurrence.

Abstract:Objective:
To study the relevant factors of malignant change of colorectal adenoma. Methods: The clinical data of 276 cases of colorectal adenoma admitted in our hospital in recent 14 years were analyzed retrospectively . Results: Malignant change rate of the adenoma in the left colon was significantly higher than that in right colon(P<0.05);in the diameter of adenoma more than 2 cm was significantly higer than that in less than 1 cm( P<0.01);in villous adenoma was significantly higher than that in tubiform adenoma and mixed adenoma(P<0.01);in severe atypical hyperplastic adenoma was significantly higher than that in mild and moderate atypical hyperplatic adenoma(P<0.01);in multiple adenoma was significantly higher than that in single adenoma(P<0.05);in erosion and sessile adenoma were significantly higher than that in smooth and pedicle adenoma (P<0.01).Conclusions: The histological type, degree of atypical hyperplasia, the size, number, location of the adenoma and the patients age are the relevant risk factors of malignant chang factors of colonic adenoma.

Abstract:Objective:To investigate the earlier diagnostic methods and operative procedures of gastric remnant cancer. Methods:Clinicopathologic data of 19 cases of gastric remnant cancer were retrospectively analysed,and the diagnostic value of the gastroscopy and barium meal was compared.Influencing the prognosis of gastric remnant cancer treated by different operations according to the situation seen during operation were observed. Results:The diagnostic rate of gastroscopy and barium meal was 78.9% and 47.4%, respectively.All the 5 cases who underwent radical remnant gastrectomy sarvived≥3 years postoperatively.Two of the 3 cases who underwent palliative remnant gastrectomy survived 2 years and 1 alived 1.5 years postoperatively. In 6 cases of gastrojejunostomy, 4 cases died within half year, 2 cases died 12.5 and 14 months postoperatively. Conclusions:The diagnostic value of gastroscopy takes advantage over barium meal examination. The patients who treated by radical remnant gastrectomy have better prognosis.

Abstract:Objective:
To study the relationship between the type of histopathology and prognosis of contained mucous adenocarcinoma(CMAC) of stomach and its clinical significance. Methods: Eighty-seven cases of CMAC of stomach were observed by means of pathomorphology, histochemistry, immunohistochemistry and follow up etc. Results : The malignant behavior of the cancer was significant difference according to the nature and quantity of the CAMC and the primary pathological type of the cancer.The clinical type in simple mucous carcinoma was mainly Borrmann type I;in tubular papilla mucous adenocarcinoma was mainly Borrmman type II; in signet-ring cell mucous carcinoma was mainly Borrmman type IV,and in mixed cell mucous carcinoma was mainly Borrmman type III. There was significant difference in the lymphatic metastasis and survival rate between the 4 groups. Conclusions :Correct differentiation of the pathological type of contained mucous adenocarcinoma of stomach is important for guading the treatment and predicting the prognosis.Cathepsin D expression can help for understanding the biological behavior of CMAC of the stomach.

Abstract:Objective:
To ivestigate the clinical feature and therapeutic ways of the gastroduodenal ulcer perforation(GDUP) in aged patients.Methods:The clinical data of 58 GDUP patients with age more than 60 gears treated in recently tweenty yesas in our hospital were analysed retrospectively. Results:Among the 58 patients,56 patients underwent operation,46cured and 12 died.Of the 12 patients,dead of cardiorespiratory function failture in 5 ; septic shock in 4 ;and renal failturl in 3 .Conclusions:Aged patients with GDUP would be operated as early as possible.Repair of the performed ulcer plus modified vagotomy is a better choice.