Abstract:

Objective: To study the relationship between metastatic lymph nodes ratio (MLR) with stage Ⅲ colorectal cancer and its clinicopathological features as well as prognosis. Methods: According to the median number of MLR, 247 patients with stage Ⅲ colorectal cancer were divided into three groups that were low-ratio (≤0.21), middle-ratio (>0.21-0.42) and high-ratio (>0.42) group, respectively. The differences of clinicopathological factors and the 5-year overall survival rate among the groups were analyzed, and the related prognostic factors of the stage Ⅲ colorectal cancer were analyzed by using Cox proportional hazards model. Results: The MLR of 247 cases ranged between 0.02-1.00 with median of 0.21. Of the low-ratio group, the proportion of the well to moderately differentiated colorectal carcinoma was 57.9% (113/195), which was significantly higher than that of the poorly differentiated colorectal carcinoma (23.1%, 12/52) (P＜0.01), and the proportion of the patients who had at least 12 lymph nodes examined was 56.5% (95/168), which was significantly higher than that of the patients who had less than 12 lymph nodes examined (38.0%, 30/79) (P＜0.05). The 5-year survival rate of the low-ratio, middle-ratio and high-ratio group was 67.4%, 28.8% and 6.3%, respectively, and there was a significant difference in 5-year survival rate among the three groups (P＜0.05). The multivariate Cox regression model revealed that the MLR was an important factor for prognosis of stage Ⅲ colorectal cancer. Conclusions: MLR is an important parameter for determining the prognosis of stage Ⅲ colorectal cancer.

Abstract:

Objective: To determine the value of repeat liver resection for recurrent colorectal liver metastases. Methods: The clinical data of 43 patients with recurrent colorectal liver metastases undergoing repeat liver resection and 67 patients with recurrent colorectal liver metastases undergoing systemic chemotherapy were retrospectively analyzed. Results: The 1-, 3- and 5-year survival rate of the repeat liver resection group was 83.7%, 51.1% and 27.9%, respectively, and of the chemotherapy group was 65.7%, 20.6% and 3.0%, respectively (P＜0.05 or P＜0.01). In the repeat liver resection group, no operative death occurred and the incidence rate of complications was 32.6%. Univariate analysis suggested that the number of recurrent liver metastasis, condition of the surgical margin, CEA level, tumor size and degree of tumor differentiation were related to the prognosis. Multivariate regression analysis revealed that only the number of recurrent liver metastasis and tumor size were independent risk factors for predicting the prognosis. Conclusions: Repeat liver resection is a safe treatment for patients with recurrent colorectal liver metastases, and is especially suitable for those with a low hepatic tumor load (tumor size less than 5 cm and metastases number fewer than 3). Repeat hepatectomy can prolong the survival of selected patients with recurrent colorectal liver metastases.

Abstract:

Objective: To compare the efficacy of laparoscopic versus open surgery in the treatment of locally recurrent rectal cancer. Methods: The clinical data of 38 patients undergoing laparoscopic surgery and 70 patients undergoing open surgery after local recurrence of rectal cancer were retrospectively analyzed and compared. Results: There were no statistical differences in age, sex and clinical stage between the two groups (all P＞0.05) before operation. The intraoperative blood loss, postoperative analgesic dosage and rate of wound infection of the laparoscopic surgery group were significantly lower than those of the open surgery group (all P＜0.05). The overall incidence rate of postoperative complications of the laparoscopic group and the open surgery group was 23.7% and 32.9%, respectively, and this was significantly different (P＜0.05). Conclusions: Laparoscopic surgery for patients with locally recurrent rectal cancer is safe and effective, and is less invasive and has a faster recovery than open surgical procedures.

Abstract:

Objective: To compare the clinical efficacy of using ultrasonic scalpel (US) versus monopolar electroscalpel (MES) in open radical operation for colorectal cancer. Methods: Sixty-two patients with colorectal cancer admitted to our hospital during the same period of time were randomly assigned to undergo radical operation by using either US (30 cases) or MES (32 cases) approach and then the effectiveness of the two approaches was compared. Results: The mean incision length of US group and MES group were (6±2) cm, (15±4) cm; and the mean operative blood loss were (50±6) mL, (150±30) mL, respectively, both of the indexes had significant differences (both P＜0.05). The mean operation time and the mean number of lymphoid node dissected of US group and control group were (130±25) min, (145±30) min, and 13±6, 12±5 respectively, and both of the indexes had no significant difference (both P＞0.05). The time for use of postoperative analgesics, anal gas passage and hospital stay, and the mean postoperative drainage volume of the US group were all better then those of the MES group (all P＜0.05). No significant difference was noted between the two groups in incidence of postoperative complications (all P＞0.05). Conclusions: The use of US in open radical resection for colorectal cancer is better than that of MES, because it has the advantages of minimal trauma and quick recovery after surgeny.

Abstract:

Objective: To assess the effectiveness of three tubes for lavage, drainage and decompression on prevention of anastomotic leakage after total mesorectal excision (TME) for rectal cancer. Methods: Three hundred and thirty-two consecutive patients, who underwent TME for rectal cancer in the research institute of general surgery of Fuzhou general hospital of Nanjing military command, were randomly assigned into group A and B with 166 cases each. Patients of group A received the self-designed three tubes for lavage and drainage, while those of group B received the conventional drainage, and the drainage tubes were placed 5-cm above the rectal anastomotic stoma in all patients. The alterations in anorectal pressure and the incidence of anastomotic leakage of the two groups were observed. Results: The anorectal pressure reached the maximum level at the fourth postoperative day. No anastomotic leakage occurred in group A, while 11 cases in group B (6.62%, 11/166) developed anastomotic leakages that mostly occurred at the fourth postoperative day, and this showed a significant difference between the two groups (χ2=11.389，P=0.001). In group B, 9 cases of anastomotic leakage were cured by nonsurgical treatment and the other 2 cases resolved by proximal bypass enterostomy. No perioperative death occurred in the two groups. Conclusions: The three tubes for lavage, drainage and decompression are effective in prevention of anastomotic leakage after TME for rectal cancer.

Abstract:

Objective: To investigate the prognostic factors of patients with liver metastases from colorectal cancer. Methods: The clinicopathological data of 71 patients with liver metastasis from colorectal cancer admitted to our hospital during the past 5 years were retrospectively analyzed. Ten clinical factors of the patients that included gender, age, the size, location, and number of liver metastatic tumors, time interval between primary diagnosis and detection of liver metastasis, the differentiation level of primary tumor, presence of lymph node and extrahepatic metastasis, and the methods of treatment of liver metastases were selected to conduct univariate and multivariate Cox regression analysis. Interaction analyses were also performed between the significant related factors. Results: Of the 71 patients, the average survival time was (16.5±5.3) months and the 3-year survival rate was 12.7%. The univariate analysis suggested that seven factors were related to prognosis, which included the size, location, and number of liver metastatic tumors, the differentiation level of primary tumor, presence or absence of lymph node and extrahepatic metastasis, and the methods of treatment of liver metastases, and they all had significant differences compared with their corresponding groups (χ2=11.279, 9.600, 8.076, 17.376, 19.817, 24.310, 32.267; P＜0.05). Multivariate analysis revealed that the differentiation level of primary tumor (RR=1.671, 95%CI 1.236-2.345, P=0.026), lymph node metastasis (RR=1.658, 95%CI 1.214-2.286, P=0.010), extrahepatic metastasis (RR=2.586, 95%CI 1.758-6.326, P=0.000) and the methods of treatment of liver metastasis (RR=6.846, 95%CI 3.624-13.032, P=0.000) were closely related to the prognosis of colorectal liver metastases. Conclusions: The differentiation level of primary tumor, lymph node and extrahepatic metastasis, and the methods of treatment of liver metastases were independent prognostic factors for colorectal liver metastases.

Abstract:

Objective: To investigate the clinical diagnostic value of CT virtual colonoscopy (CTVC) in preoperative determination of the nature and localization of colorectal cancer. Methods: The imaging and clinical data of 51 patients with colorectal cancer undergoing preoperative CTVC and colonoscopic examination as well as surgical treatment were retrospectively analyzed. Results: The whole group of 51 patients were confirmed to have colorectal cancer by surgical biopsy and pathological examination. After surgical confirmation, the detection rate of CTVC and colonoscopy was 100% and 92.0%, respectively. Localization accuracy of CTVC was 100%, while that of colonoscopy was 93.6%. The coincidence rate of clinical staging by preoperative CTVC was 94.1%. Conclusions: CTVC is a non-invasive method that can determine the extent of extra-intestinal invasion and metastasis, inspect the proximal bowel wall in cases with severe luminal stricture and comprehensively define the nature and position of the tumor. Furthermore, it is complementary to colonoscopy, and is of great importance in clinical staging of colorectal cancer and selection of the operative procedure.

Abstract:

Objective: To study the clinical characteristics of growth hormone (GH)-secreting pituitary adenoma with concomitant colorectal cancer. Methods: The clinical and pathological data of 8 patients with GH-secreting pituitary adenoma and concomitant colorectal cancer admitted from 2006 to 2011 were retrospectively analyzed. Results: There were 6 male and 2 female patients, and the median age was 59 (48-69) years. The history of acromegaly caused by pituitary tumor of the patients ranged from 10 to 30 years. Two patients had undergone treatment for pituitary adenoma. The serum levels of hormones were detected and MRI/CT examinations were performed before surgery. All patients were diagnosed as having colorectal cancer by colonoscopic biopsy and all underwent radical operation for colorectal cancer. The clinical stages of the tumor were Dukes B and C. Adjuvant chemotherapy was given in all patients after surgery. The postoperative complications included pulmonary infection, hypertension, hyperglycemia, hypokalemia, etc., which were all resolved by symptomatic treatments. No anastomotic fistula or abdominal infection occurred. One case was self-discharged from hospital against advice (and then was lost to follow-up). The other 7 cases were followed up for 2 to 44 months and all were alive. Conclusions: For patients with GH-secreting pituitary adenoma and concomitant colorectal cancer, the comprehensive treatments for colorectal cancer shoud be adopted first, and later the pituitary adenoma is treated according to the patient’s situation.

Abstract:

Objective: To investigate the inhibitory effect of the combined treatment with oxaliplatin (LOHP) and low molecular weight citrus pectin (LCP) on the proliferation of human colon cancer cell line HCT116 and its mechanism. Methods: The effect of LOHP alone and LOHP combined with LCP on the proliferation of HCT116 cells was determined by MTT assay. The apoptosis rate and cell cycle of HCT116 cells after the above two treatments were detected by Flow cytometry (FACS), and the changes of procaspase-3, -8, -9 and poly (ADP-ribose) polymerase (PARP) of the cells after treatments were analyzed by Western blot. Results: Both treatments had inhibitory effect on the proliferation of HCT116 cells, and the combination of LOHP and LCP exerted stronger inhibitory effect than LOHP alone treatment (P＜0.05). FACS analysis showed that both treatments increased the apoptosis rate of HCT116 cells, and the apoptosis rate of the combined treatment was significantly higher than that of the LOHP alone treatment (P＜0.01). Both treatments decreased the G0/G1 phase and increased G2/M phase of the cells, while the G2/M phase ratio of the combined treatment was increased more significantly higher than that of the LOHP alone treatment (P＜0.05). The expressions of procaspase-3, -9, and PARP protein were all down-regulated after both treatments, and those down-regulations after the combined treatment were more obvious compared with those after LOHP alone treatment. The expression of procaspase-8 showed no obvious difference after the two treatments. Conclusions: LCP can increase the inhibitory effect of LOHP on proliferation of human colonic cancer cell line HCT116, and this effect may be related to modulation of the cell cycle and activation of mitochondria aboptosis pathway.

Abstract:

Objective: To investigate the expressions of the hypoxia marker carbonic anhydrases-IX (CA-IX) in the relevant tissues of the patients with rectal cancer and its effect on the growth of rectal cancer cells in vitro, as well as its role in the tumorigenesis and metastasis of rectal cancer. Methods: The expressions of CA-IX in normal rectal tissues, rectal adenoma, original tumor tissues of rectal cancer, mesorectums and liver metastases were examined by Western blot analysis. The effect of carbonic anhydrases inhibitor acetazolamide on the proliferation of rectal cancer cells in vitro was measured by MTT assay. All the results were analyzed to assess the clinical significance of CA-IX as a tumor marker or metastasis indicator of rectal cancer. Results: The positive rate of CA-IX of the primary tumor tissues of rectal cancer (74.2%) was significantly higher than that of rectal adenoma (16.7%) (P＜0.05), and there was no CA-IX expression in the normal rectal tissues. The expressions of CA-IX in rectal cancer and mesorectal tissues were unrelated to gender, tumor size, differentiation level, clinical stage and liver metastasis of the patients (all P＞0.05). The expression rate of CA-IX in the primary tumor tissues of the N0 patients (5.5%) was lower than that of the N1 (66.7%) and N2 (64.5%) patients (both P＜0.05). The expression rate of CA-IX in mesorectum of the N0 patients (85.5%) was higher than that of N1 (26.2%) and N2 (29.0%) patients (both P＜0.05). Acetazolamide significantly enhanced the ability of 5-fluorouracil of different concentrations to kill the rectal cancer cells in vitro (P＜0.05). Conclusions: CA-IX can accelerate the proliferation of rectal cancer cells and may probably play an important role in the occurrence and development of rectal cancer. It can be used as a tumor marker, but not metastasis indicator of rectal cancer.

Abstract:

Objective: To study the expression of tumor-infiltrating lymphocytes (TIL) and their prognostic roles in colorectal cancer. Methods: The colorectal cancer specimens from the patients who had been operated in our hospital over a past 16-year period were collected, with 30 cases of either survival time≥5 years or ≤3 years.Immunohistochemical staining and flow cytometry were used to detect the expression of tumor-infiltrating CD4 and CD8 T lymphocyte, and the relations of their expressions with clinicopathological features and prognosis were analyzed. Results: The expression rate of CD4 and CD8 in colorectal cancer tissues was 28.3% (17/60) and 41.6%(25/60)by immunohistochemical staining, respectively. The expression levels of CD4 and CD8 in cancer nests were significantly lower than those in interstitial tissue (both P＜0.05).The expression of CD4 and CD8 in tumor tissue was irrelevant to gender,age,lymph node metastasis and differentiation degree of tumor, and was correlated with tumor Dukes stage and outcome of the patients. The expression rates of CD4 and CD8 in the patients with Dukes stage A+B cancer were both higher than those in the patients with Dukes stage C+D cancer, and the expression rates of CD4 and CD8 in the patients with survival time ≥5years were both significantly higher than those of the patients with survival time ≤3 years(both P＜0.05). Flow cytometry analysis showed that the CD4/CD8 ratio of tumor-infiltrating lymphocytes was related to the Dukes stage and outcome of the patients (P＜0.05). Conclusions: Tumor-infiltrating CD4 and CD8 T lymphocyte can be used as the prognosis factors for patients with colorectal cancer, and low infiltration of TIL in tumor regions predicts a poor prognosis.

Abstract:

Objective: To investigate the expression of survivin in the peripheral blood of the patients with colon cancer and its relations with recurrence and metastasis of colon cancer. Methods: The expression of survivin mRNA in peripheral blood of patients with colon cancer was detected by combined use of reverse transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay (RT-PCR-ELISA), and the relations between its expression and the clinicopathological features were analyzed. Fifty-one patients were followed up for 36 months to analyze the relevance of the time to metastasis and relapse with the expression of survivin mRNA. Results: The expression rate of survivin mRNA in the peripheral blood of the 95 patients with colon cancer was 36.8% (35 cases). The expression rate of survivin mRNA for well to moderately differentiated cancer and poorly differentiated to undifferentiated cancer was 31.0% and 45.0%, respectively. The expression rate of the patients with tumor penetrating the serosa was 44.0%, which was higher than that of the patients with only the involvement of submucosa and muscularis (20.0%) (P＜0.05). The expression rate of the patients with lymph node metastases was 47.5%, which was higher than that of the patients without lymph node metastasis (19.4%) (P＜0.05). The follow-up study showed that the incidence of metastasis and relapse of the patients with survivin positive expression (47.3%) was higher than that of the patients with survivin negative expression (16.6%). The results demonstrated that expression of surviving mRNA in the peripheral blood was associated with the degree of tumor differentiation, depth of infiltration, lymph node metastasis and clinical stages, but was irrelevant to the tumor site. Conclusions: The patients with surviving positive expression in the peripheral blood are prone to metastasis and relapse. The expression of survivin in the peripheral blood may be an indicator for evaluating the biological behaviors and prognosis of colon cancer.

Abstract:

Objective: To study the expression of tumor-associated glycoprotein 72 (TAG72) and glucose-regulated protein 94 (GRP94) and their clinicopathological significances in benign and malignant lesions of the stomach. Methods: The conventional paraffin-embedded sections were prepared from the surgical resected or gastroscopic biopsy specimens that included 49 cases of gastric cancer tissues, 20 cases of peritumoral tissues, 36 cases of metastastic foci in lymph nodes and 80 cases of benign lesions of different types. Immunohistochemical staining was performed to determine the expression level of TAG72 and GRP94. Results: The positive rates of TAG72 and GRP94 expression in gastric cancer were significantly higher than those in peritumoral tissues and different types of benign lesions (P＜0.05 or P＜0.01). The peritumoral tissues and benign lesions with positive expression of TAG72 and/or GRP94 all showed mild to severe degrees atypical hyperplasia of mucosal epithelia. The positive rates of TAG72 and GRP94 expression showed no significant differences between the primary foci and the corresponding metastatic foci in lymph nodes (both P＞0.05). The positive rates of TAG72 and GRP94 expression in the cases of tumor invasion depth T1+T2 and no metastasis to regional lymph nodes or distant organs were significantly lower than those of invasion depth T3+T4, metastasis of regional lymph nodes or distant organs (P＜0.05 or P＜0.01). The positive rates of TAG72 and GRP94 expression in the cases of histological grade II and N1 lymph nodes involvement were lower than those of histological grade III+IV and N2+N3 lymph nodes involvement, but both had no significant difference (both P＞0.05). Conclusions: The expression level of TAG72 and/or GRP94 may play a promoting role in the occurrence, development and biological behaviors of gastric cancer, and the positive expression of TAG72 and/or GRP94 in gastric cancer patients predicts a poor prognosis.

Abstract:

Objective: To screen out the genes related to peritoneal metastasis from gastric cancer, so as to provide clues to the underlying mechanisms of peritoneal metastasis of gastric cancer. Methods: The models of subcutaneously transplanted human gastric cancer in nude mice were established using SGC-7901 cell line. After three subcutaneous passages of the original xenograft through mice, the small dissected pieces of solid tumor were introduced into the stomach wall of nude mice. Tumor tissues from the original transplant sites and metastases were collected. Gene chip technology was used to determine the differentially expressed genes between the original tumor and metastasis, and then RT-PCR was performed to validate the result of the gene chip analysis. Results: Fifteen orthotopic transplant nude mice with gastric cancer were established, of which, the tumor formation rate in stomach wall was 100% (15/15) and the incidence of peritoneal metastases was 40% (6/15). There were 192 up-regulated genes and 139 down-regulated genes as shown by gene chip hybridization analysis. The highly expressed regenerating gene IV (Reg IV) was tested by RT-PCR and the result was consistent with that of the gene chip analysis. Conclusions: There are differentially expressed genes between the primary tumor and metastases of gastric cancer, some of which may possibly play an important role in peritoneal metastasis of gastric cancer.

Abstract:

Objective: To investigate the expression of Bmi-1 (B-cell specific moloney leukemia virus insertion site 1) in gastric cancer tissues and its relation with the clinicopathological factors of gastric cancer. Methods: RT-PCR and Western blot analysis were performed to detect the expression of Bmi-1 in 44 cases of gastric cancer tissues and their adjacent normal tissues. Results: The positive rate of Bmi-1 mRNA expression in gastric cancer tissues was 72.73%, which was significantly higher than that in the adjacent normal tissues (14.3%) (P＜0.05), and the expression of Bmi-1 protein in gastric cancer tissues was also significantly higher than that in adjacent normal tissues (P＜0.05). The expression of Bmi-1 in patients with lymph node and distant metastases was significantly higher than that in patients without lymph node and distant metastases (P＜0.05). The expression of Bmi-1 was irrelevant to the sex, age, tumor size or degree of tumor differentiation of the patients, because no significant differences between the groups divided according to these four factors were obtained (P>0.05). Conclusions: The elevated expression of Bmi-1 may possibly be involved in the occurrence, invasion and metastasis of gastric cancer.

Abstract:

Objective: To investigate the alterations of serum sexual homones level, and the expression and distribution of estrogen receptor β (ERβ) in the colon of rats with slow transit constipation (STC). Methods: Chemiluminescence, immunohistochemistry and Western blot technique were carried out to detect the serum level of sexual homones and determine the distribution and expression of ERβ in the colons of the STC rats and normal control rats, respectively. Results: Chemiluminescence showed that all the serum levels of follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), progesterone (P) and testosterone (Testo) of rats with STC had no differences compared with those of the control rats (all P＞0.05). Immunohistochemical staining showed that the ERβ proteins were distributed mainly in myenteric nerve plexus and submucous nerve plexus of the rats′colons, and the expression level of ERβ of the STC rat was markedly lower than that of the normal rat. Western blot analysis also revealed that the expression level of ERβ protein of STC rats was deceased compared with that of the normal rats and this had a significant difference (P＜0.01). Conclusions: The expression level of ERβ in the colon of the STC rats is reduced, which may probably be associated with the pathogenesis of STC.

Abstract:

Objective: To study the clinical features, diagnosis and management of primary jejuno-ileal carcinoma and to analyze its main prognostic factors. Methods: The clinical, pathological and follow-up data of 14 patients with primary jejuno-ileal carcinoma, admitted to our hospital from January 2000 to January 2008, were retrospectively analyzed. Results: Carcinoma of the jejunum and ileum occurred in both men and women, and the ratio of men to women in our data was 1∶6. The main clinical symptoms of the patients comprised abdominal pain, abdominal distension, hematochezia, anemia, abdominal mass and intestinal obstruction. Of the patients, 9 cases had jejunal carcinoma and 5 cases had ileal carcinoma. Thirteen cases underwent tumor resection, of which 5 cases received 2- to 6-cycle of postoperative chemotherapy. One case, who had liver metastases and ascites, only underwent biopsy and subsequent supportive therapy. Of the whole group, the preoperative diagnotic rate was less than 50% and the 3-year survival rate was 50%. The better chance of survival of the patients after surgery was associated with better differentiated tumor type, less involvement of lymph nodes, and lesions distant from the ligament of Treitz, and vice versa. Conclusions: The preoperative dagnosis of carcinoma of the jejunam and ileum is difficult and requires the B-ultrasounic, CT and endoscopic examinations. Surgical resection is still the main treatment method of this disease and the patients may have a better chance of survival after surgery.

Abstract:

Objective: To investigate the feasibility and efficacy of combination of gastric or colonic cancer resection with pancreaticoduodenectomy (en bloc PD) for locally advanced gastric or colonic cancer. Methods: The clinical data of 15 patients with locally advanced gastric or colonic carcinoma with pancreatic head and duodenum involvement undergoing en bloc PD between May 2004 to December 2010 were retrospectively analyzed, and included 12 cases of primary or recurrent gastric cancer and 3 cases of colonic cancer. Results: The median operating time was 6 h (4-12 h) and the median length of postoperative hospital stay was 21 d (7-63 d). The incidence rate of complications was 46.7% (7/15), reoperation rate was 6.7% (1/15) and mortality was 6.7% (1/15). The median survival time was 23 months and the 1-, 2- and 3-year cumulative survival rate was 62.2%, 44.4% and 22.2%, respectively. Conclusions: En bloc PD could be considered as one of the therapeutic options for locally advanced gastric or colonic cancer with pancreaticoduodenal involvement, and it may prolong the survival time of some these patients.

Abstract:

Objective: To investigate the manifestations, diagnosis and management of duodenal diverticulum. Methods: The clinical data of 105 patients with duodenal diverticulum admitted to our hospital during two years and seven months were retrospectively analyzed. Results: Of the patients, the most common symptom was abdominal pain (54 cases), followed by the symptoms of sour regurgitation, nausea and vomiting (21 cases). The patients were diagnosed mainly by endoscopic and radiographic examination of gastrointestinal tract. Sixty-eight patients received conservative treatment, one of whom underwent duodenal diverticulization operation (Billroth II gastrectomy and gastrojejunostomy) later due to repeated recurrence of symptoms. The other 37 cases received surgical treatment, of which, 22 cases complicated by biliary tract diseases underwent related operations, and 11 cases underwent duodenal diverticulization (5 cases) or diverticulectomy (6 cases) due to recurrent diverticulitis, and 4 cases underwent other procedures. No obvious discomfort was found in all the 105 patients during one year of follow-up. Conclusions: The most common symptom of duodenal diverticulum is abdominal pain, and duodenal diverticulum is discovered mainly by endoscopic and radiographic examination of gastrointestinal tract. Conservative management is suitable for the majority of duodenal diverticula, and the indications for surgery should be strictly controlled.

Abstract:

Objective: To compare the advantages and disadvantages of double-barrel terminal ileostomy and double-barrel transverse colostomy for temporary fecal diversion after anus-preserving surgery for rectal cancer. Methods: The clinical data of patients undergoing anus-preserving surgery for rectal cancer at our hospital were retrospectively analyzed. For temporary fecal diversion, 54 cases underwent double-barrel terminal ileostomy and 32 cases underwent double-barrel transverse colostomy. The general medical data and complications related to stoma and stoma closure of the patients between the two groups were compared. Results: No significant difference was noted between the two groups in terms of incidence of anastomotic leakage (P>0.05). The incidence of stoma-related complications of the double-barrel terminal ileostomy group (10.9%) was significantly lower than that of the double-barrel transverse colostomy group (37.5%) (P<0.05). The incidence of complications related to stoma closure of the double-barrel terminal ileostomy group (10.0%) was significantly lower than that of the double-barrel transverse colostomy group (32.0%) (P<0.05). Conclusions: Double-barrel terminal ileostomy is recommended to divert the fecal stream for those high-risk patients following anus-preserving surgery for rectal cancer.