Abstract:Abstract:Objective:To evaluate the results of anal function and oncologic effect of intersphincteric resection (ISR) for very low rectal cancer
Methods :Sixteen patients who had ISR from March 1999 to March 2006 in our hosptal. After complete dissection of the rectum and mesorectum down to the pelvic floor, the internal sphincter was separated from the external sphincter and puborectalis and resected together with the rectum, then the coloanal anastomosis was performed. On postoperative day 7, the anal contraction function training was started; on week 4, biofeedback training was started; on week 2, chemotherapy was used for Dukes B，C stage, and on week 4 radiotherapy was used.
Results:There was no operative mortality, and no anastomotic leakage. Colonic mucosa prolapse developed in two patients, two developed late strictures of the coloanal anastomosis and one had wound problem. At followup of 3 months to 7 years, there were 2 deaths from liver metastasis and 1 death from lung metastasis; no patient developed local recurrence. According to Williams continence status level, acceptable postoperative anal function were obtained in 62.5%， 80.0%，and 84.6% of patients at 3，6, and 12 months respectively.
Conclusions:ISR is safe for selected patients with very low rectal tumor, operative morbidity is low, and the curability rate and anal functional results are satisfactory.

Abstract:Abstract:Objective To evaluate the operative indications and technique of combined total mesorectal excision （TME）with modified Bacon procedure for treatment of very low rectal cancer.
Methods Seventysix cases who was proven very low rectal cancer in which the distance between the anal verge and the lower margin of the tumor was 4-8 cm underwent combined abdominal and trans anal TME and modified Bacon procedure with use of selfmade anal retractor.
Results There was no operative mortality or anastomotic fistula, and in all cases the operation was successful. The followup was 1-5 years. Local postoperative recurrence developed in 5 cases（6.58%）in 1-2 years, and 2 cases had anastomotic stenosis. The 1,3, and 5year survival rate was 100%,80.83%, and 68.37%, respectively. Defecation was under satisfactory control 3~6 months after operation and restored to normal in 6 months.
Conclusions Combined TME and modified Bacon procedure is a safe and effective method for treatment of very low rectal cancer of Dukes stages A, B and C cases without distant metastasis.

Abstract:Abstract:Objective To discuss the significance and feasibility of multivisceral resection for latestage colorectal carcinoma with invasion of adjacent organs or liver metastasis.
Methods The clinical data of 32 cases which had multivisceral resection were reviewed and analyzed, especially regarding to the postoperative complications and 5year survival rate.
Results At time of diagnosis, 9 cases had liver metastasis and 23 cases had invasion of other adjacent organs. One of the 9 cases with combined liver resection was lost to followup, and 3 of other 8 cases have survived for 5 years; while 11 of the 23 cases with combined removal of adjacent organs have survived for 5years. Thus, the 5year survival rate of combined liver resection and removal of adjacent organs was 37.5%(3/8) and 47.83%(11/23), respectively. No fatal complications have occurred among these cases.
Conclusions Combined multivisceral resection for latestage colorectal carcinoma would improve the living quality and the 5year survival rate of the patients, and it should be aggresively offered for treatment of these patients.

Abstract:Abstract:Objective To investigate the clinical guiding significance of lymphoscintigraphy with ^99mTc-DX for radical lateral lymph node dissection with pelvic autonomic nerve preservation(PANP) in lower rectal cancer.
〖WTHZ〗Methods In 67 patients with pathologically proven lower rectal cancer,37MBq/0.8ml ^99mTc-DX was injected into submucosa of the rectum through rectal endoscopy. At 0.5h, 1h, 2h, 3h, 4h, 6h, 12h, and 24h after the injection, the patients underwent pelvic and lower abdominal lymphoscintigraphy. The operative method was determined according to the imaging results, and the results of lymphoscintigrams were correlated with postoperative lateral node histologic examination.
Results The scintigrams were postive in 37 cases, and all were unilateral. The positive patients underwent PANP. The image results were compared with histological lymph node examination in all patients operated upon for rectal cancer. Histologically, the cases in conformity were 26(70.3%), false positive in 11 cases(29.7%), and 2 of 30 false positive patients who demonstrated metastases to lateral node were operated by PANP, while the others underwent only PANP(type Ⅰ) without lateral lymph nodes dissection. The percentage of good sexual function of the two groups of cases after operation was 74.4% and 71.4% respentively. The percentages of mild dysuria and good function of urination were both 100%.
Conclusions Lymphoscintigraphy with ^99mTC-DX has particular guiding significance in selection of PANP for lower rectal cancer.

Abstract:Abstract:Objective To study the causes of local recurrence, and diagnosis and treatment outcome of recurrent colorectal cancer.
〖WTHZ〗Methods The clinical data of 60 patients with recurrent colorectal cancer treated during 10 years in our hospital were analyzed retrospectively.
Results Among the 60 cases, 40 cases (66.7% ) had recurrence within 2 years after operation. Recurrence in anastomotic stoma, perineum, abdominal incision occurred and in the abdominal cavity and pelvic cavity in 15, 10,7 and 20 cases respectively, and liver metastases were found in 8 cases. All patients underwent reoperation including curative surgery for 38 patients and palliative operation for 22 patients. After radical reoperation the 1,3, and 5yearsurvival rate was 93.6%, 48.8%, and 36.3%, respectively, and after palliative reoperation was 54.5%, 0%, and 0%, respectively.
Conclusions Emphasizing the application of notumor touch technique, resection of adequate amount of bowel, performing complete lymphadenectomy and removal of micrometastatic lesions are the major measures to prevent recurrence of rectal cancer after operation. Integrative therapy regimens，of which surgical treatment is the major component，should be considered according to the location of recurrence and the clinical staging of the recurrent cases.

Abstract:Abstract:Objective To investigate the effect of phenylacetate (PA), a differentiation induce agent, on cell cycle and proliferation in colorectal carcinoma HCT-8 cell line.
Methods HCT-8 cells were grown in the presence of PA (1.0, 2.0, 3.0, 4.0, and 5.0mmol/L) for 24h, 48h and 72h, respectively. The cellular proliferation inhibitory ratio was evaluated by MTT assay. The different phases of the cell cycle were analyzed using flow cytometer.
Results HCT-8 cells were treated by 1.0-5.0 mmol/L PA for 24-72 h. With the increase of concentration of PA or the prolongation of the treatment time, the proliferation inhibitory ratio of the tumour cells increased notably by 5.1%-24.3% when treated for 24h, 16.7%-72.3% when treated for 48 h, and 30.2%-93.4% when treated for 72 h, respectively. When HCT8 cells were treated with 5.0 mmol/L PA for 72h, cell cycle analysis with flow cytometry showed that the percentage of HCT8 cells in G0/G₁ phase reduced significantly and S phase was relatively increased(P＜0.05).
Conclusions PA can arrest G₁ cell cycle and inhibit cell proliferation.

Abstract:Abstract:Objective To investigate the expression of T lymphoma invasion and metastasis inducing factor 1(Tiam 1) in gastric cancer cells and analyse the correlation between Tiam 1 and the invasive and migratory potential of gastric cancer cells in vitro and in vivo.
Methods Two subpopulations lesser(ML) and higher(MH) adhesive subgroup were separated from human gastric cancer cell line MKN45(M0) by laminin adhesion method in vitro. RTPCR and ELISA were applied to detect the expression of Tiam 1 mRNA and protein in M0, ML and MH cells. The invasive and migratory potential of M0, ML and MH cells in vitro and in vivo were observed by Boyden chamber and by inoculation into nude mice and, simultaneously, correlation between the expression of Tiam 1 and the invasive and migratory potential of gastric cancer cells was analysed.
Results The invasive and migratory potential of MH cells in vitro (24.33±8.02, 52.00±14.53) and the lung metastatic rate of MH cells in nudemice (4/5 = 80%) was much higher than that of M0 cells (11.67±3.79, 26.00±9.54, 2/5 = 40%, RV = 0.759±0.047, RD = 0.911±0.104) and ML cells (9.67±3.06, 23.67±8.50, 1/5 = 20%, RV = 0.743±0.039, RD = 0.892±0.101) (P< 0.05), 〖JP3〗as well as the expression of Tiam 1 mRNA (RV = 0.855±0.051) and protein (RD = 1.262±0.165) in MH cells were much higher than those in MO and ML cells (P< 0.05),

Abstract:Abstract:Objective To establish a method for amplification of immature dendritic cells(DC) from murine bone marrow in vitro and investigate correlations between maturation degree of DC and varying dosages of granulocytemacrophagecolony stimulating factor (GMCSF).
Methods Dendritic cells from murine bone marrow were cultured with different dosages of rm GMCSF. The suspension cells were examined with scanning electronic microscope,and the nonsensitized T lymphocyte proliferation was observed by mixed lymphocyte reaction.
Results DC cultured in lower dosage of rmGMCSF (GMlow DC) exhibited typical characteristics of DC, and had immature characteristics in cell phenotype and cell functions with high expression of CD11c and low expression of CD80,CD86 and MHC II on the surface of the cells.The ability of GmlowDC to stimulate the proliferation of nonsensitized T lymphocyte in vitro was weaker than that of GmhighDC.
Conclusions The methods of immature DCs culturing establised by allthors was feasible. The dosage of rm GMCSF has a direct relationship with the maturation degree of DC.

Abstract:Abstract:Objective To investigate the relationship of expression of cyclooxygenase2(COX2) and vascular endothelial growth factor (VEGF) with the growth pattern,malignant degree,metastasis and prognosis of gastrointestinal stromal tumor(GIST).
Methods The expression of COX2 and VEGF was examined with immunohistochemistry from paraffinembedded tissue sections of 54 patients with GIST, and special attention was given to analyze the relationship between COX2、VEGF expressions and clinicopathologic factors of the neoplasm.
Results The expression of COX2 and VEGF was significantly higher in malignant GIST than in benign and potentially malignant GIST (P<0.05).A significant positive correlation was found between COX2 and VEGF（r=0.6667）.Meantime, the expression of COX2 and VEGF was significantly associated with pattern of tumor growth, tumor size and central necrosis(P<0.05). Furthermore, the 5year postoperative survival rates of patients with high expressions of COX2 and VEGF were significantly lower than those of patients with low expressions of the two markers ( P<0.01).
Conclusions Expression of COX2 and VEGF in GIST is closely related to tumor growth, invasion and metastasis. COX2 and VEGF can be used as objective parameters to judge the characteristics, malignant degree, metastasis and prognosis of GIST.

Abstract:Abstract:Objective To study the expression and significance of caveolin1 protein and mRNA in liver cancers and paracancer liver tissues.
Methods The expressions of caveolin1 protein and mRNA were detected by immunohistochemistry and in situ hybridization in 10 cases of normal liver tissue, and 50 cases of liver cancer and paracancer liver tissue.
Results Caveolin1 protein and mRNA were mainly expressed in vascular endothelial cells in hepatocellular carcinomas(HCC). The expression intensities of caveolin1 protein and mRNA were not related to differentiation degree of HCCs. In paracancer liver tissues, the positive signal of caveolin1 protein and mRNA was localized at sinusoidal endothelial cells, hepatic stellate cells, vascular endothelial cells and proliferative bile duct epithelial cells The hepatocytes in liver cirrhosis and paracancer tissues with atypical hyperplasia overexpressed caveolin1 protein and mRNA. Cancer cells and vascular endothelial cells in cholangiocellular carcinomas all over-expressed caveolin1 protein and mRNA. The expression intensities of caveolin1 protein and mRNA in cholangiocellular carcinomas were significantly higher than those in HCCs. The expression intensities of caveolin1 protein and mRNA in patients with HBsAg and AFP positive HCC were obviously lower than those in patients with HBsAg and AFP negative HCC.
Conclusions The weak or deleted expression of caveolin1 protein and mRNA in HCCs may be an important reason for the high degree of malignancy, rapid growth rate and frequent occurrence of metastasis in contrast to cholangiocellular carcinoma. Detection of caveolin1 expression may be one of the useful indexes for differentiation of HCC from cholangiocellular carcinoma.

Abstract:Abstract:Objective To evaluate the clinical significance of the intraoperative detection of peritoneal micrometastases of gastric cancer.
Methods In selected 50 cases of gastric cancer in which no obvious peritoneal metastasis was found preoperatively or during laparotomy, Douglas′s pouch peritoneal biopsy was undertaken intraoperatively,then HE and CK20 immunohistochemistry staining of the specimens was performed. The expression of CK20 mRNA in peritoneal irrigation fluid was also determined by RTPCR.
Results HE staining of all cases was negative.The positive rate of CK20 immunohistochemistry staining was 24.0％(12/50),and 36.0％(18/50) with RTPCR method.The positive rate of CK20 mRNA was significantly related with the histological type, the depth of invasion and the number of lymph node metastasis (P<0.05).The 3year survival rate of patients with positive and negative expression of CK20 mRNA was 22.2％ and 62.5％ respectively (P<0.01).
Conclusions The detection of CK20 mRNA expression by RTPCR is a sensitive method for determining peritoneal micrometastases in gastric cancer. It may provide evidence for the correct staging, adjuvant chemotherapy and estimation of prognosis of gastric cancer.

Abstract:Abstract:Objective To explore the ideal mode of degestive tract reconstruction after total gastrectomy.
Methods One hundred and sixteen gastric cancer patients, who underwent one of two reconstruction procedures between Jan 1996 and May 2006, were retrospectively evaluated with regard to their digestive symptoms and nutritional status. The two procedures were double Braun anastomosis (double Braun) and PRouxenY reconstruction (PRy).
Results Follow up of the 2 groups, at one year after operation, showed the frequency of early satiety, reflux esophagitis and dumping syndrome in the double Braun group was 1(1.69%),3(5.08%), and 2(3.39%) cases, respectively, and in PRy group was 13(22.81%), 10(17.54%), and 8(14.04%) cases, respectively.Compared with PRy group, the frequency of reflux esophagitis in double Braun group was less (P＜0.05); and in doubl Braun group, patients had better food intake and lower rate of early satiety(P＜0.01), and rate of dumping syndrome was less (P＜0.05). But no difference was found in nutritional status(body weight and serum nutrition parameters) between the two groups(P＞0.05).
Conclusions Compared to PRy group, the postoperative quality of life was better and the subjective symptoms were fewer in patients of double Braun group. So authors considerate that after total gastrectomy double Braun anastomosis is a relatively ideal alimentary tract reconstruction method. Double Braun anastomosis is recommended as the method of choice for patients undergoing total gastrectomy.

Abstract:Abstract:Objective To investigate the procedure, imaging features and clinical significance of CT virtual gastroscopy(CTVG) in the diagnosis of gastric carcinoma using bitilted CT scanning.
Methods Thirty patients and ten normal volunteers had bitilted CT scan using helical CT(GE lightspeed 16 CT). The patients and yolunteers were given bubblemaking powder by mouth and placed in a supine position on the CT table. CTVG and MPR images were obtained using the virtual dissection and reform of GE.
Results The appearances of the inner lesion and normal wall of the stomach on CTVG were similar to those on fiberoptic gastroscopy. The CTVG and MPR features of gastric cancer were focal or diffuse mural thickening, soft tissue mass, stenosis of stomach, cancerous ulcer, infiltration to adjacent tissues, and lymph node and distant metastases. In comparison with fiberoptic gastroscopy (as the gold standard), CTVG showed a diagnostic accuracy of 92.5%，a sensitivity of 93.3%, a specificity of 90.0%, a positive prediction value of 96.7%, and a negative prediction value of 81.8%.
Conclusions CTVG is a safe, reliable, noninvasive method for demonstrating the structure of normal and abnormal stomach, and is a good complementory method to conventional fiberoptic gastroscopy.

Abstract:Abstract:Objective To investigate the diagnosis of primary duodenal carcinoma and its outcome after surgical treatment.
〖WTHZ〗Methods The clinical data of 85 patients with primary duodenal carcinoma treated operatively between 1997 and 2006 were analyzed retrospectively.
Results The correct diagnosis rate for endoscopy was 86.8%(66/ 76),for duodenography 84.3% (16/ 19),for ultrasound examination 28.2% (24/85) and for computerized tomography (CT) scanning 39.6% (21/53), respectively.All of the 85 patients received surgery including pancreaticoduodenectomy (PD) in 61 patients, duodenal segmental resection (SR) in 8, subtotal gastrectomy in 2 and bypass operation in 14.The 1,3, and 5 year survival rate of all patients was 84.4%，58.3%, and 31.9% respectively.The 1,3, and 5 year survival rates of patients receiving PD and SR were 100.0%，67.7%，41.6% and 100.0%, 60.0%, 0.0%,respectively. With univariate analysis, radical resection(PD and SR), infiltration and lymph node metastases were found to be significant factors associated with overall postoperative survival. With multivariate analysis, radical resection, lymph node metastases and depth of local tumor infiltration independently affected the overall postoperative survival.
Conclusions Duodenography and endoscopy can increase the rate of early diagnosis of primary duodenal carcinoma. Radical resection can improve the longterm survival of patients with primary duodenal carcinoma.

Abstract:摘要：
胃肠道间质瘤（GIST）是一种具有基因和分子特征性的肿瘤。胃肠道间叶源性肿瘤中最常见。GIST均具有生物学的侵袭行为，因此治疗原则应以手术切除为主，且必须遵循无瘤操作以及防止瘤体破溃的原则。 GIST常发生肝转移和腹膜转移，少有淋巴结转移，故除非术中发现有淋巴结转移，一般不常规行淋巴结清扫。其切除范围和术式应根据瘤体大小、解剖部位并结合对肿瘤恶性潜能的评估再作抉择。GIST对常规化疗和放疗不敏感，以格列卫为代表的分子靶向治疗是一种较好的辅助治疗。应强调指出：若拟行格列卫新辅助治疗或术中已有多处无法切除的转移灶而拟行术后化疗时方可考虑活检，但禁忌术前经皮穿刺活检，以免瘤体破溃酿成腹膜转移。

Abstract:摘要：
空肠造瘘术是肠内营养的重要手段之一，可维持患者的营养需求、改善其全身状况。随着医学技术的发展，空肠造瘘方法也迅速发展，但仍不可避免地存在很多并发症，如机械性梗阻、肠腔积气、感染、误吸、水电解质紊乱等。笔者主要将其归为机械性、感染性、代谢性和消化道并发症四个方面，并作一综述。