Volume 18,Issue 4,2009 Table of Contents

1 The influential factors and clinical significance of metastatic lymph nodes ratio in gastric adenocarcinoma

WU Jugang , YU Jiwei , NI Xiaochun , LI Xiaoqiang , BIAN Bangjian , ZHANG Biao , GAO Youfu , JIANG Bojian

2009, 18(4):1-317. DOI: 10.7659/j.issn.1005-6947.2009.04.001

[Abstract](812) [HTML](0) [PDF 1.65 K](325)

Abstract:
Objective:To study the influential factors on metastatic lymph nodes ratio(MLR) and the relationships between MLR and prognosis.
Methods:The clinical data of 121 patients with gastric adenocarcinoma were analysed. The receiving operating characteristic curve (ROC curve) was used to determine the cutoff of MLR and the CK20 immunihistochemical staining was used to detect the lymph nodes micrometastasis.
Results:The area under the ROC curve of MLR to predict the death of patients at 3-year or 5-year postoperatively was 0.826±0.053 and 0.896±0.046, so MLR=30.95% and MLR=3.15% were selected as the cutoffs. Then the MLR was classified furthermore into three groups: MLR1(MLR<3.15%), MLR2(3.15%≤MLR≤30.95%) and MLR3(MLR>30.95%). The survival curve showed that the higher the MLR value the lower survival period after radical operation (P=0.000). COX model showed the MLR was an independent prognostic factor (P=0.000). The MLR also discriminated subsets of patients with different 5-year survivals the same N stage (P<0.05). The MLR proved to be 34.7%(242/697) by HE staining and 43.5%(303/697) by CK staining respectively (P=0.001). Thus, the detection of micrometastasis by CK staining changed the MLR significantly. The lymph vessel invasion and depth of invasion was significantly related to the MLR.
Conclusions:The area under the ROC curve of MLR in predicting the death of patients at 3-or 5-years postoperatively is very large, and it seems to be a good way to determine the group cutoff. Therefore, the MLR seems to be meaningful parameter in detecting the prognosis of gastric adenocarcinoma. The detection of lymph nodes micrometastasis could change the MLR significantly.

2 Clinical study on anatomic features of radical lymphadenectomy in laparoscopic surgery for distal gastric cancer

XU Jian , LIU Zhongcheng , ZHAO Qiqin , CHI Peihuan , TENG Shigang , JU Xuehong , JU Xiaohua

2009, 18(4):2-321. DOI: 10.7659/j.issn.1005-6947.2009.04.002

[Abstract](1199) [HTML](0) [PDF 881.00 Byte](479)

Abstract:
Objective:To study the anatomic features of radical lymphadenectomy in laparoscopic surgery for gastric cancer and find a proper approach for laparoscopic lymph nodes resection.Methods:Via 29 cases of laparoscopic radical resection of distal gastric cancer and 6 cadaver dissections,we obsered the anatomic mark point in laparoscopic vision, available anatomic space and the differences from open-operation.Results:Twenty-fire patients underwent laparoscopic radical gastrectomy, 4 patients had conversion to open surgery for tumor invasion or fixed lymph nodes. The number of harvested lymph nodes was 11~32.The potential space between mensentery and ligament. pancreas,middle colic vessel and left gastric vessel can be used as mark points for laparoscopic surgery for distal gastric cancer,due to their obvious and fixed site.
Conclusions:Lymphadenectomy in the right space by use of anatomic mark point in laparoscopic vision is safer and more standardized.Laparoscopic anatomic features can provide theoretical basis for laparoscopic surgery for gastric cancer.

3 Clinical value and significance of immunohistochemical staining and RT-PCR detected micrometastases of lymph nodes in patients with gastric cancer

LI Tao , WANG Yunhai , HE Tiehan , ZHANG Wenbing , CHEN Bing

2009, 18(4):3-325. DOI: 10.7659/j.issn.1005-6947.2009.04.003

[Abstract](769) [HTML](0) [PDF 882.00 Byte](335)

Abstract:
Objective:To investigate the clinical value and significance of immunohistochemical(IHC) techniques and reverse transcriptase-polymerase chain reaction (RT-PCR) testing for detecting micrometastases of regional lymph nodes in patients with gastric cancer.
Methods:A total of 1 835 lymph nodes taken from 85 patients with average of 21.7 nodes per case were detected by IHC and RT-PCR assay to detect cytokeratin 20 markers. Clinicopathologic parameters and prognosis were compared between patients with and without micrometastases.
Results:The incidence of nodal micrometastases increased from 75.3% by hematoxylin-eosin (HE) staining to 83.5% and 90.6% respectively by immunostaining and RT-PCR in 85 patients with gastric cancer.The presence of micrometastases was closely correlated with Lauren classification and tumor depth, but was not correlated with tumor site and size. The re-stage rate was 18.8% and 37.6% respectively by immunostaining and RT-PCR. Eighty-two patients were followed up at an average time of 21.2 months. Lymph nodal micrometastases seemed to be a little prognostic value in patients with gastric cancer.
Conclusions:The present Results: indicate that immunohistochemical staining and RT-PCR assay are useful tools for the detection of micrometastases in the patients with gastric cancer,and may be used to improve the staging system for gastric cancer, and also serve as the basis for decision of therapautic regimen.

4 Study on resectability of advanced gastric cancer based on gastroscopic and CT examination

LI Jinghu , ZHANG Zhifeng , FAN Caiqing

2009, 18(4):4-329. DOI: 10.7659/j.issn.1005-6947.2009.04.004

[Abstract](1008) [HTML](0) [PDF 878.00 Byte](365)

Abstract:
Objective:To explore the use of gastroscopy and CT for staging and clinical guiding to the surgical therapy of advanced gastric cancer. Methods:The preoperative gastroscopic and CT classification and the Results: of operative classfication of 182 cases of advanced gastric carcinoma were compared. Results:The resection rate for low and undifferentiated adenocarcinoma and mucinous carcinoma on gastroscopic biopsy was low (64.1%),and the rate for diffuse infiltrative gastric carcinoma (6.7%) was significantly lower than that of mass tumor type (66.7%) and ulcerative type (61.8%). The total accuracy rate of CT staging was 91.21%. Sensitivity rate of CT diagnosis of perigastric invasion and/or metastasis was 72.22%. For lymph node staging the accuracy rate of CT was 74.2%, sensitivity rate was 74.1% and specificity rate was 74.3%. CT diagnosis of lymph node groups was blur. Conclusions:Gastroscopy has an unreplaceable role in the final diagnosis of advanced gastric cancer and has significance for gross tumor grading, histologic biopsy diagnosis can be as a guide to dicide the treatment modality of advanced gastric cancer. CT has high degree of value for accuracy of clinical staging, and diagnosis of invasion of adjacent organs and lymph node metastasis. CT is superior to gastroscopy for judgement of resectability. Therefore, preoperative CT is a valuable guide for surgical treatment of advanced gastric cancer.

5 The influence of CO2 pneumoperitoneum on the proliferation and metastasis of gastric cancer cells in abdominal cavity of nude mice

LI Jianxiong , SHI Yan , YU Peiwu , ZENG Dongzhu , HAO Yinxue , ZHAO Yongliang

2009, 18(4):5-333. DOI: 10.7659/j.issn.1005-6947.2009.04.005

[Abstract](711) [HTML](0) [PDF 905.00 Byte](336)

Abstract:
Objective:To observe the influence of CO2pnemumoperitoneum models on the growth and metastasis of seeded SGC-7901 cells in nude mice.
Methods:The SGC-7901 cells suspension was injected into the peritoneal cavity of 27 nude mice(2×106 cells/mouse), then the mice were randomly divided into three groups (9 cases per group).Control (A) group,the mice was laparotomy only;and CO2 pnemumoperitoneum was established with pressure 5 mmHg (group B) and 8 mmHg (group C), the treatment time was 1 h. The control group underwent a midline incision，which was closed after 1 h. Four weeks later, all of the nude mice were killed，and the number of macroscopic abdominal cavity nodules，the total body weight, the mean max diameters and distributing ranges of tumor mass were observed and measured.The rate of viscera (liver, spleen, peritoneum and mesentery) metastasis was also recorded in each group, and the HpamRNA expression in tumor tissue was measured by RT-PCR。
Results:The number of abdominal cavity nodules in each group was not significantly different (control group: 7.4±2.5, 5 mmHg group: 7.3±2.4, 8 mmHg group: 7.5±2.1. P＞0.05). also the total body weight, the mean max diameters and distributing ranges of metastasis showed no difference between each group（P＞0.05）. The HpamRNA expression in gastric cancer tissues showed no significant difference in each subgroup(P＞0.05).
Conclusions:CO2 pnemumoperitoneum do not accelerate the SGC-7901 cells growth invasion and metastasis in vivo，also it had no significant effect on HpamRNA expression.

6 Study on the expression of VHL, HIF-1α and its mRNA and their relationship to microvessel counts(MV) in benign and malignant lesions of stomach

ZHOU Jiapeng , YANG Zhulin , ZHOU Jianping , LIU Dongcai , SU Goushun , YUANG Lianwen , REN Feng

2009, 18(4):6-339. DOI: 10.7659/j.issn.1005-6947.2009.04.006

[Abstract](1276) [HTML](0) [PDF 1.13 K](318)

Abstract:
Objective:To study the protein and mRNA expressions of von Hipple-Lintau gene protein(VHL)，hypoxia inducible factor-1 alpha (HIF-1α) and MV counts in the benign and malignant lesions of stomach and their clinicopathological significances.
Methods:EnVisonTM immunohistochemistry was used for detecting the expression of VHL and HIF-1α and MV counts and in situ hybridization was used for assaying the expression levels of VHLmRNA and HIF-1amRNA in conventional paraffin-embedded sections from the specimens of gastric cancer (n=49), peritumoral tissues(n=20), lymph metastassis (n=36), and different types of benign lesions(n=80).
Results:The positive expression rate of VHL protein and mRNA was significantly lower in gastric cancer, than that in peritumoral tissues and different types of benign lesions (P<0.05 or P<0.01),but experssion of HIF-1α protein and mRNA was the opposite (P<0.05 or P<0.01）.The means of MV counts were significantly higher in gastric cancer than those in peritumoral tissues and different types of benign lesions(P<0.01).The negative cases of VHL protein and mRNA expression and/or positive cases of HIF-1α protein and mRNA expression in benign lesions and peritumoral tissues showed mild-to severely-atypical hyperplasia of muscous epithelia. No difference was found between the primary foci and metastatic foci of lymph node on the expressive levels of VHL HIF-1α protein and mRNA and MV counts (P>0.05).In gastric cancer the positive rates of HIF-1α protein and mRNA and the means MV counts were significantly lower in histologic grade Ⅱ,infiltrating depth T1+T2,no-metastasis of lymph node or distant organs than those in histologic grade Ⅲ+Ⅳ, infiltrating depth T3+T4, metastasis of lymph mode or distant organ, (P<0.05 or P<0.01）, but the positive rate of VHL protein and mRNA was opposite to that of HIF-1α protein and mRNA (P<0.05). A high unconsistence was found between the expressive levels of VHL protein and HIF-1α protein and mRNA in gastric cancer tissues (χVHL=14.66，P<0.01，χVHLmRNA=6.74, P<0.05). The means of MV counts were significantly higher in the negative cases of VHL protein and mRNA or the positive ones of HIF-1α protein and mRNA than those in the positive cases of VHL protein and mRNA or the negative ones of HIF-1α protein and mRNA in gastric cancer tissues (P<0.01).
Conclusions:The expression levels of VHL and HIF-1α and mRNA might be important biological markers for reflecting the carcinogenesis, progression, biological behaviors and prognosis of gastric cancer. They might exert a negative regulated effect on the carcinogenesis and progression of gastric cancer.VHL might have inhibitive effects and HIF-1α and might have promotive effects on angiogenesis of gastric cancer.

7 Comparison of chemosensitivity in gastrointestinal cancers lymph node metastases and the primary tumors in vitro

TAN Bibo , LU Hongmei , HAN Jie , LU Bonan , LU Bingrong , GENG Wei , ZHAO Jianhui

2009, 18(4):7-342. DOI: 10.7659/j.issn.1005-6947.2009.04.007

[Abstract](718) [HTML](0) [PDF 874.00 Byte](371)

Abstract:
Objective:To investigate the different chemosensitivity of lymph node metastases compared to the primary tumor in gastrointestinal cancers.
Methods:In vitro MTT colorimetric assay was performed on surgical specimens of primary tumors(PTs) and lymph node metastases(LNMs) form 40 gastrointestinal cancer patients. The Results: were then compared with response to 9 antitumor drugs.
Results:There was significantly different chemosensitivity to antitumor drugs between PTs and LNMs. The inhibition rates of tumor cells in LNMs for HCPT, L-OHP and CDDP were lower than those in PTs (all P<0.05); whereas the inhibition rate of tumor cell in LNMs for eADM, VP-16,and THP were higher than those in PTs (all P<0.05); howevre the chemosensitivity for 5-FU and PTX was equivalent in the two groups(all P>0.05). There was a significantly positive correlation between the inhibition rates of PTs and LNMs for 5-FU, HCPT, L-OHP and THP(r=0.4142~0.5712, all P<0.05).
Conclusions:Heterogeneity of chemosensitivity to antitumor drugs is present in LNMs and PTs of gastric and colorectal cancers. The chemosensitivity of primary gastrointestinal cancer in the histoculture drugs does not give a good indication of the chemosensitivity of metastatic lesions.

8 The effect of enhancement chemotherapy sensitivity by combining SiRNA recombinant expression vector targeting survivin gene with 5-Fu on human colon cancer cells

CAI Ming， WANG Guobin， TAO Kaixiong， CAI Changxue

2009, 18(4):8-347. DOI: 10.7659/j.issn.1005-6947.2009.04.008

[Abstract](727) [HTML](0) [PDF 988.00 Byte](369)

Abstract:
Objective:To construct SiRNA recombinant expression vector targeting survivin gene and study its effect on inhibition of proliferation of human colon cancer cells and enhancement of chemotherapy sensitivity.
Methods:SiRNA recombinant expression vector targeting survivin gene was constructed and transfected into human colon cancer cells.The effect of SiRNA recombinant expression vector was detected by RT-PCR and western blot. Enhancement of chemotherapy sensitivity was observed by MTT reduction assay and flow cytometry.
Results:SiRNA recombinant expression vector targeting survivin gene was constructed successfully confirmed by restriction endonuclease and sequence analysis, and its inhibition ratio on survivin mRNA and protein levels was 36.33％ and 44.65％, respectively. It could enhance the inhibitory effect of 5-Fu on growth of colon cancer cells.
Conclusions:The SiRNA recombinant expression vector targeting survivin gene can effectively inhibit the expression of survivin gene. It also can synergetically enhance the chemotherapy sensitivity and apoptosis induction of 5-Fu on human colon cancer cells.

9 The target effect of 5-flourocytosine combined thermotherapy on liver metastasis of colon cancer in nude mice

LI Chengjin , ZHANG Baoming , WANG Lie , TU Xiaohuang

2009, 18(4):9-352. DOI: 10.7659/j.issn.1005-6947.2009.04.009

[Abstract](1111) [HTML](0) [PDF 1.64 K](342)

Abstract:
Objective:To investigate the target effect of cytosine deaminase genetherapy combined thermochemotherapy on liver metastasis of colon cancer in nude mice.
Methods:Plasmid G1CEACDNa were transferred into the human colon cancer LoVo cells by liposomes method. The models of liver metastasis of colon cancer were established by injected LoVo-CEACD into peritonum in 45 BALB/C nude mice, then which were randomly divided into three groups: The control (C) group; the prodrug therapy (PDT) group and the prodrug thermochemotherapy (PDTCT group) and 42 ℃ sodium chloride，38 ℃ 5-FC and 42 ℃ 5-FC were injected into the abdominal cavity ［500 mg/（kg·d）,for 21 d］, respectively. After natural death of all mice, their life span, rate of liver metastasis and number of liver metastasis nodules were surveyed and compared among the three groups. The levels of the expression of target gene were detected by RT-PCR in carcinoma tissue, normal liver, stomach，lung，pancreas，small intestine and large intestine tissues. Pathological features were observed. Apoptotic index (AI) of tumor cells were analyzed in every group respectively.
Results:The CD gene was detected in the tumor tissues，but not in tissues of normal liver, stomach，lung，pancreas，small intestine and large intestine. In C,PDT and PDTCT group, the life span was （25.80±3.65）,（34.27±4.08） and （41.87±3.91）d respectively; the rate of liver metastasis was 100.0%(15/15),40.0%(6/15) and 13.3%(2/15), respectively; the number of liver metastasis nodules was（2.93±1.16）,（0.80±1.01） and （0.20±0.56）, respectively; and AI of tumor cells was 4.59%,9.87%,17.4%, respectively. The life span of PDT and PDTCT guoup was significantly longer than that of group (P＜0.05);the rate of liver matastasis and AI of tumor cells were obvious differences between the 3 groups.
Conclusions:The CEA tissue-specific CD/5-FC system has an obvious target suppression on liver metastasis of colon cancer cell LoVo in nude mice.

10 Expression of heat shock protein 90β in colon carcinoma tissues and cells and its relationship to chemoresistance

ZHU Qin , HU Yu , GONG Liansheng , ZHANG Yangde

2009, 18(4):10-357. DOI: 10.7659/j.issn.1005-6947.2009.04.010

[Abstract](787) [HTML](0) [PDF 1.05 K](329)

Abstract:
Objective:To explore the expression of heat shock protein 90β(HSP90β) in colon carcinoma tissues and HCT-8 cell line, and to investigate the relationship of HCT-8 cells to chemoresistance.
Methods:The expression of HSP90 β in colon carcinoma tissues was detected by immunohistochemistry and the relationship of HSP90β expression with the Dukes stage and pathological grade was analyzed, The medium effective concentration (IC50) of vincristine (VCR) to colon cancer parent cells HCT-8 and drug resistance cells HCT-8/VCR was detected by MTT method. The expression difference of HSP90βmRNA in of HCT-8 cells and HCT-8/VCR cells was detected by RT-PCR to investigate its relationship to the chemoresistance.
Results:The positive expression rate of HSP90 β was higher in colon carcinoma tissues (41.67%) than non-cancerous colon tissues (16.67%) (P<0.05). The expression level of HSP90β was related to tumor differentiation grade (r=-0.8825, P<0.05), and was not related to Dukes stage (P>0.05). The drug resistance of HCT-8/VCR cell line to VCR was significantly higher than that of HCT-8 cell line (P<0.05). The content of HSP90βmRNA in drug resistance cells（0.955±0.03）was obviously higher than that in parent cells（0.835±0.029）（P<0.01）.
Conclusions:The expression level of HSP90 β in colon carcinoma is enhanced, which may be related to malignant transformation and chemoresistance,and might serve as a new therapeutic target for improving chemotherapy sensitivity of colon carcinoma.

11 Experimental study of Kupffer cell transfected with a recombinant adenoviral vector expressing interleukin 12 on proliferation of LoVo human colorectal cancer cells

GAO Quangen , LI Zhimin , QIU Jianping , SHEN Genhai , YUAN Jianmao , WAN Linlin

2009, 18(4):11-361. DOI: 10.7659/j.issn.1005-6947.2009.04.011

[Abstract](857) [HTML](0) [PDF 1.41 K](334)

Abstract:
Objective:To explore the effect of Kupffer Cells (KC) transfected with a recombinant adenoviral vector expressing interleukin 12 (IL-12) on human colorectal cancer LoVo cells.
Methods:ELISA method was used to detect quantitatively the level of IL-12 of Kupffer cells transfected with Adv-mIL-12. KC,KC-adv-EGFP and KC-Adr-mlL-12 with LoVo cells were cultured in different plates. The cells viability and the supernatants′ VEGF were measured by MTT assay and VEGF ELISA kit；different supernatants groups of LoVo cells were harvested and differences of apoptosis were analyzed using FCM.
Results:A high level of secretion of IL-12 was detected in the adv-mIL-12-transfected KC［(564.29±31.24)pg/mL 24 h］. The MTT assay and ELISA test showed that the inhibition ratio of LoVo cells was higher in the experimental group compared with 2 control groups（P＜0.05）；the FCM showed that more apoptosis cells were detected in the the experimental group(21%).
Conclusions:KC-Adv-mIL-12 can inhibit the proliferation and metastasis of LoVo cells.

12 Impact of galectin-1 expression on LoVo cell apoptosis

TONG Huasheng , ZHANG Yali , JIANG Bo , SU Lei

2009, 18(4):12-365. DOI: 10.7659/j.issn.1005-6947.2009.04.012

[Abstract](913) [HTML](0) [PDF 1.33 K](322)

Abstract:
Objective:To observe the changes of LoVo cell growth by galectin-1.
Methods:Eukaryotic expression vector of galectin-1 was constructed and transfected into LoVo cells using lipofectamineRM 2000. Immunochemistry was employed to detect galectin-1 expresson. LoVo cell proliferation and apoptosis were observed.
Results:Galectin-1 eukaryotic expression vector pEGFP-C1/GAL1 was successfully constructed. Three cell clones, p-GAL1-LoVo and p-LoVo,transfected with pEGFP-C1/GAL1 and pEGFP-C1 correspondingly,and LoVo were cultured successfully. Galectin-1 expression downregulated Bcl-2 level only occurring in p-GAL1-LoVo cells. p-GAL1-LoVo cell proliferation was similar to p-LoVo and LoVo cells,but p-GAL1-LoVo cell apoptosis was increased (9.61±0.56)%,as compared with p-LoVo and LoVo cells,［(3.56±0.53)% and (3.46±0.46)% respectively］(P<0.001).
Conclusions:Galectin-1 induces cell apoptosis possibly by downregulating Bcl-2 expresson.

13 The expression and efffects of RSpo1 and β-catenin in intestinal epithelium with intestinal ischemia-reperfusion injury in mouse

YIN Gang， WU Chengtang， LEI Shangtong， WANG Yunxing

2009, 18(4):13-370. DOI: 10.7659/j.issn.1005-6947.2009.04.013

[Abstract](712) [HTML](0) [PDF 1.07 K](319)

Abstract:
Objective:To explore the expression and effects of RSp1 and β-catenin in the intestinal epithelium with intestinal ischemia-reperfusion injury (IIRI) in of mouse.
Methods:Fifty healthy male kunming mice were randomly divided into control group（n=10）and experimental group (n=40). All mice in control group were only subjected to laparotomy, while the other mice underwent 20 minutes of intestinal mesenteric artery occlusion followed by 6 hours (group A),12 hours(group B), 24 hours(group C) and 48 hours(group D) of reperfusion. RT-PCR was used to detect RSpo1 and β-catenin in small intestine in intestinal ischemia-reperfusion groups and in control group.
Results:The villous heights of intestinal in experimental groups were significantly lower than that in control group（P<0.05~0.01）.The varying trend of β-Catenin expression in experimental groups was the same as villous height,its expression was significantly weaker than that in control group（P<0.01），and increased gradually along with the reperfusion time. Compared with control group, RSpo1 expression decreased rapidly at 6h(P<0.05),then increased gradually at 12 h, reached the peak level at 24h(P<0.01)followed by rapid decrease and remained significantly lower than that in control group at 48h(P<0.05).
Conclusions:Intestinal ischemia-reperfusion injury may inhibit β-catenin and RSpo1 expression in early stage, but it increase in middle stage. Both of them may be related with the proliferation and differentiation of intestinal stem cells and role an important part in the process of repair after mucosal damage.

14 Clinical analysis of rectal cancer in patients younger than 40 years old

LIU Shengrong , DIAO Ping , ZOU Yonghao , SUN Zhenlong

2009, 18(4):14-375. DOI: 10.7659/j.issn.1005-6947.2009.04.014

[Abstract](666) [HTML](0) [PDF 896.00 Byte](326)

Abstract:
Objective:To investigate the clinicopathological characteristics, treatment Methods: and prognosis of rectal cancer in patients younger than 40 years old.
Methods: From Jan, 1998 to Dec, 2003, 325 treated rectal cancer patients with complete surgical records were divided into two groups: young patients group (younger than 40 years old) 49 patients, accounted for 15.1%; middle and old patients group (older than 40years old) 276 patients, accounted for 84.9%. The clinicopathological characteristics, treatment Methods: and follow-up data were compared.
Results:Among the younger patients, cancer in middle and lower segments of rectum accouned for 79.6%(39/49), infiltrative cancer accounted for 55.1%(27/49), mucous and low-differentiated cancer accounted for 83.7%(41/49), cancer invasion of serosa occurred in 87.8%(43/49), lymph node metastasis in 75.5%(37/49), Miles operation was performed in 65.3%(32/49) and Dixon operation in 34.7%(17/49). These characteristics differewed significantly from middle-aged and old patients. And the 5-year survival-rate in youn patient group was 32.7% and in middle and old patient proup was 60.9% respectively, (P＜0.01).
Conclusions:The clinicopathological characteristics and prognosis of rectal carcinoma in younger patients differs markedly from those of middle-aged and older patients, and therefore we should be more vigilant in order to discover,detect and treat the younger patient as early as possible.

15 Clinical analysis of right colon cancer complicated with acute appendicitis: a report of 51 cases

XU Keqin , HE Jianjun

2009, 18(4):15-378. DOI: 10.7659/j.issn.1005-6947.2009.04.015

[Abstract](988) [HTML](0) [PDF 869.00 Byte](314)

Abstract:
Objective:To summarize our experience in the diagnosis and treatment of right hemicolon carcinoma combined with acute appendicitis.
Methods:A respective analysis of clinical data of 51 cases of right colon cancer complicated with acute appendicitis and confirmed by surgical operation and pathology was made.
Results:In 2400 cases of right colon cancer, 51 cases(2.1%) complicated with appendicitis. There were medical complications in 39 cases (76.5%).The diagnosis before operation was made in 13 cases (25.5%),and diagnosis of colon cancer was missed in 38 cases (74.5%).Colon adenocarcinoma was found in 40 cases,mucous adenocarcinoma 7 cases (13.7%),undifferentiated carcinoma 4 cases (7.8%); and Dukes B, C, D stages were in 2 cases (3.9%), 29 cases (56.9%) and 20 cases (39.2%) respectively.The simple appendicitis, suppurative appendicitis, gangrenous appendicitis and phlegnomous appendicitis was found in 28 cases (54.9%),11 cases (21.6%),8 cases (15.7%)and 4 cases (7.8%) respectively.3-5-year survival was 95.2%, 40.0%, respectively.
Conclusions:Occurrence rate of right colon cancer combined with appendicitis is low, but misdiagnosis rate is high, and 5-year survival rate is low.Middle and old age patients with appendicitis and accompanied with emaciation,anemia,digestive symptoms and right lower abdominal mass should have appropriate examination to avoid missing the diagnosis of right colon cancer.

16 Diagnosis and therapy of Crohn′s disease: a report of 30 cases

YANG Hua , XIAO Gang

2009, 18(4):16-382. DOI: 10.7659/j.issn.1005-6947.2009.04.016

[Abstract](737) [HTML](0) [PDF 885.00 Byte](286)

Abstract:
Objective:To investigate the diagnosis and therapy of Crohn′s disease(CD).
Methods:The clinical data of 30 cases of pathologically proven CD from 1992 to 2005 were analyzed, 26 cases were followed up. Results:Among the 30 patients with CD, 13 (43.3%) diagmosed by endoscopy and biopsy. and17 cases（57.7%） were diagnosed by operation and pathology Before operation, 6 cases were diagnosed as acute abdomen,4 cases as ileus,3 cases as massive hemorrhage of gastrointestinal tract,2 cases as colorectal cancer, 1 case as intestinal fistula and 1 case as head mass of pancreas.Of the 26 cases followed up cases,15 cases accepted operation with 5 cases of recurrence; 21 cases have taken drugs,and the total effective rate was 73.1%.
Conclusions:CD is a chronic relapsing disease and is difficult to diagnose.The majority of patients undergo operation due to misdiagnosis or complications.CD is prone to relapse postoperatively, quality of life is poor, and one must heighten awareness of these patients, make early diagnosis,directed therapy, and intensify follow up.

17 The surgery treatment of Crohn′s disease

TAN Xingguo , YANG Zhulin , JIANG Jiarui , ZHOU Jun , LI Minchen

2009, 18(4):17-385. DOI: 10.7659/j.issn.1005-6947.2009.04.017

[Abstract](581) [HTML](0) [PDF 867.00 Byte](306)

Abstract:
Objective:To explore the diagnosis and treatment of Crohn′s disease.
Methods:We retrospectively analysed the clinical data，treatment and the follow-up result of 31 patients with Crohn′s disease.
Results:The clinical manifestations of Crohn′s disease were variable, and preoperative diagnosis was made in only 9 cases in this group.In 12 cases with intestinal fiberscopy, there were only 5 cases correctly diagnosed.The 31 cases all had one or two operations, postoperative complications occurred in 7 cases, 1 case died,and 5 cases relapsed.
Conclusions:The diagnostic rate of CD was low and the misdiagnostic rate was high before the operation.Doctors can determine accurately this disease based on the findings during operation.The treatment is by selecting a reasonable method of operation and systemic medication.

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Volume 18,Issue 4,2009 Table of Contents

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