Objective:To discuss the value of congenital hypertrophy retinal pigment epithelium(CHRPE) in diagnosis of familial adenomatous polyposis(FAP).Methods: Twenty-two FAP patients who have received treatment in our department(January 2001 to June 2003) and 10 patients with sporadic colorectal polys(as control group) were subjected to optical fundus examination.The incidence,morphological feature and distribution of CHRPE were analyzed.Results: Seventeen(81.8%) of the 22 FAP patients were found to have CHRPE in optical fundus.The lesions showed a bilateral and multiple(≥2) distribution along the peripheral vessels with oval pigmentation.One patient was found to have CHRPE in the control group.Conclusion: Optical fundus examination is a highly sensitive and specific adjuvant diagnosis for FAP.It is a safe and effective way for screening FAP in FAP family members.

Objective To study the effeciency of endoscopic balloon dilat ation(EBD) for benign structures of colorectal anastomosis. Methods Fifteen cas es with benign stenosis of colorectal anastomosis(BCAS) were treated with endosc opic balloon dilatation,of which sigmoidectomy was performed in one case,and ant erior resection was performed in 14 case;stapler was used in 13 case,and hand su tura was used in 2 cases.Diameters and lengths of strictures were ranging from 0 .2～ 0.7 cm and 0.5～ 2.0 cm respectively. Results Strictures of all 15 patients were dilated successfully.There were no complications in this series.Follow－ u p has been from 3～ 30 months without recurrence of symptoms. Conclusion EBD is safe,efficient and well tolerated,and should be considered as the first choice o f treatment of BCAS.

0.05). Conclusion The oral sodium phosphate preparation is superior to magnesium sulfate before colorectal surgery. Single-day preoperative bowel preparation with oral sodium phosphate is suitable for elective colorectal surgery.

)(0.05);) the same was true when ≥1.0 cm,but with statistical significance (P0.05).Conclusion: COX-2 may be a stimulative factor in the progression of FAP and may participate in adenoma formation and cancerization.Selective inhibition of COX-2 may be an effective strategy for preventing FAP.

Objective:To evaluate the short-and long-term outcomes of subtotal proctocolectomy for familial adenomatous polyposis(FAP).Methods: Twenty-one FAP patients who had undergone subtotal proctocolectomy during 1985-2000 in our department were followed up colonoscopically to observe whether there was any recurrence of polyps in postoperatively residual colon or/and rectum.Results: Adenomatous recurrence with variant degrees was detected in the residual colon or/and rectum in all 21 patients,the recurrence rate being 100%.Polypous growth was denser in the residual rectum than in the proximal residual colon.The adenomatous polyp in one patient cancerized 4 years after the initial operation.The cumulative occurrence of colorectal cancer was 4.8%.Conclusion: Subtotal proctocolectomy is a simple procedure for FAP with fewer complications,but there is a risk of polyps cancerization in the residual colon or/and rectum.

Familial adenomatous polyposis(FAP) is an autosomal dominantly inherited syndrome.It will inevitably(progress) to colorectal carcinoma if not handled properly.The extracolonic manifestations of FAP play important role in the clinical(diagnosis) and prognosis of FAP patients.This paper reviews the clinical characteristics of FAP and current progress in its research.

Desmoid tumor(DT),a rare benign tumor sometimes with local invasion,is more frequently seen in patients with familial adenomatous polyposis(FAP) than in the general public,which might be associated with surgical trauma,genetic predisposition and hormonal factors.Fifty percent of FAP-associated DTs are intra-abdominal,usually present as non-tender,slowly growing masses.The symptoms include abdominal pain,vomiting and diarrhea,etc.Mesenteric DT can cause obstruction and ischemia of intestine,hydronephrosis and fistula.Diagnosis can be made through biopsy or CT scanning.Surgery should be considered for the abdominal wall DTs and medicine is the first choice for mesenteric DTs.Surgery should be chosen with caution.

Objective To evaluate the safety and feasibility of natural orifice transluminal endoscopic surgery(NOTES)with current available techniques and endoscopic accessories.Methods Transgastric and transvaginal endoscopic abdominal cavity exploration were performed in 6 female pigs.A needle-knife and a ERCP scalpel were used to make an anterior gastric wall incision,and a dilating balloon to expand the passage,through which a therapeutic gastroscope was sent into the abdominal cavity to seek the target organ.Partial liver resection was performed in 2 cases.For incision closure,a clip was applied to the incision orifice or it was just given putting-aside therapy.One week later,the abdominal cavity was examined via vagina.Another week later,it was observed via other incision of the stomach.Four weeks after the operation,the pigs were sacrificed.Adhesion,injury to the organs and closure of the incision were evaluated.Results Transgastric procedures were performed 12 times and transvaginal procedures 6 times.Mean operation time via stomach was 33.4±10.9 min.and that via vagina WaS 10.1±2.5 min.All animals recovered and gained weight after the operation.The incision healed up with no obvious complications.Re-exploration showed adhesion of various degrees,no effusion,or injury to the organs were observed.Ketamine plus propofol achieved satisfactory anesthetic effect with no complications.One of the two animals which underwent liver partial resection died of disphragmatic muscle perforation.Hemarrhage occurred twice,both in the procedures via satisfied.One case developed abdominal abscess.Conclusion It Was feasible and safe to perform NOTES via transgastric and transvaginal approach to the abdominal cavity and liver resection.But development of NOTES specific instruments is essential to the procedure.

key of success.

Objective To investigate the diagnosis and treatment of idiopathic chronic colonic pseudo-obstruction(ICCPO). MethodsIn this study 69 patients admitted for “constipation” were finally found falling into one of the 4 groups: 11 cases of outlet obstructive constipation, 16 cases of slow transit constipation, 26 cases of mixed type, and 16 of ICCPO. ResultsThe main symptoms of these 16 ICCPO cases were intractable constipation, compared with that in other entities ICCPO tends to affect patients at younger age, with shorter clinical course, and often needs surgical intervention due to intractable bowel obstruction, usually total colectomy. ConclusionsICCPO, STC and mixed constipation are different clinical entities. The differentiation of ICCPO from other entities is sometimes very difficult especially when patients are suffering from acute onset of bowel obstruction.