Objective To introduce a new anus preserving operation for low rectal cancer-ultralow anterior resection and colorectal/coloanal anastomosis by using supporting-bundling up method.Methods The clinical data of 310 patients who underwent anus preserving operation by supporting-bundling up method for low rectal cancer were retrospectively reviewed.Results The mean distance of tumor from the anal verge was 4.7?1.2cm;the TNM stage was stage Ⅰin 40 cases,stage Ⅱ30 cases,stage Ⅲ109 cases and stage Ⅳ 31 cases.the mean distance of the anastomosis from the anal verge was 2cm(1-4cm).the occurrence rate of postoperative anastomosis leak was 2.3%,the rate of excellent anal sphincter control was 82.25%.The 5-year local recurcence rate was 5.8%.Conclusions Ultralow anterior resection and colorectal/coloanal anastomosis by supporting-bundling up method may be one of the best anus preserving operations for low rectal cancer.It is a safe and feasible operation,and the long-term outcome is excellent.

Objective To evaluate the influence of anus-preserved procedures on life quality of patients with low rectal carcinoma.Methods One hundred and forth cases with low rectal carcinoma who underwent double stapling technique(DST) (n =64) or support binding procedure(SBP) (n =50) were selected as our subjects.Patients in both group were undergone total mesorectal excision (TME) to sever mesorectum.Anal Function was assessed by Xu Zhongfa Anal-Function's criterion after operation.All patients were performed a 5 years follow-up.Results The 5-years survival rate and local recurrence rate were 65.63％ (37/64),20.03％ (13/64) respectively in DST group,and 76.0％ (38/50),6.0％ (3/50) in SBP group.The differences were significant (P =0.049,0.032).The postoperative general occurrence rate of dysuria,dysporia and sexual disorder in the DST group were 31.25％ (20/64),17.19％ (11/64) and 45.31％ (29/64) respectively,higher than those of SBP group(14.00％ (7/50),4.00％ (2/50) and 26.00％ (13/50) ;P =0.037,0.045,0.034).Conclusion Both DST and SBP therapy are proved to be effective in terms of anus-preserved treatment for low rectal cacinoma.5-year survival rate is similar in the two groups,while the survival quality is better in SBP group than in DST group.

ObjectiveTo evaluate the indication, the operation pattern and therapeutic effect of the ano-saving surgery in low rectal carcinoma. MethodsAccording to anorectal finger-examination, IRUS,and CT, 94 out the 161 rectal cancer patients were selected to have ano-saving surgery from August 1993 to December 1994.Excreting function, 5-year survival rate and local recurrence rate of the various operation were compared. ResultsThe perfomed rate of ano-saving operation in low rectal cancer was 58.4%. Among them, low anastomosis was done in 6 cases, ultra-low anastomosis in 48 cases,Park′s operation in 25 cases,and Bacon operation in15 . The death rate was 2.1%(2 cases).Incidence of anastomotic leakage after the surgery was 3.2%(3 cases), and only 13 cases had anastomotic narrowing(13.8%) within 1 year. The successful rates of excreting function after the surgery were respectively as follows: low anastomosis 100%, ultra-low anastomosis 97.9%,Park′s surgery 88.0%,and Bacon surgery 53.3%. The 5 year survival rates and the local recurrence rates were respectively,as follows: low anastomosis 83.3% and 0; ultra-low anastomosis 79.2% and 4.2%; Park′s 64.0% and 12.0%; and Bacon 66.7% and 13.3%,respectively. ConclusionsUltra-low colo rectum anastomosis becomes the main operative pattern to preserve anal sphincter in low rectal cancer.There is no difference in the 5-year survival rate and the excreting function among low, ultra-low anastomosis and Park′s operation, but the low and ultra-low colo-rectum anastomosis were obviously better than that of Bacon and Miles operation.The local recurrence rates of low and ultra-low colon-rectum anastomosis are lower than that of Miles′.There is no difference in the 5-year survival rate and local recurrence rate between Park′s, Bacon and Miles operation.

ObjectiveTo evaluate a new coloanal anastomosis preserving dentate line and anal sphincter. Methods After total mesorectal excision in 87 patients with low rectal carcinoma, the rectum no more than 1cm above the dentate line was preserved. The rectal mucosa was stripped and the dentate line was saved, then a sustaining anastomotic tube was fixed into the proximal colon, and the colon was pulled down and anastomosed with the remnant rectum 0.5cm above the dentate line. Results The ultralow coloanal anastomosis with anal sphincter preservation was accomplished. No perioperative death and anastomotic leakage occurred. The patients were followed up for 2 to 6 months and the follow-up rate was 89%. There was no anastomotic recurrence. Soft tissue recurrence in pelvic cavity was found in 3 cases, lymph node recurrence in obturator space recurrence in 2 cases and liver metastasis in 6 cases. Anastomotic stenosis was found in 6 cases 12 months later. The defecation function returned to normal six months after operation. Conclusions The sustaining banding method in the ultralow coloanal anastomosis with anal sphincter preservation is a safe and reliable surgical procedure.

Objective To evaluate a surgical procedure of low/ultralow colo-rectal(anal) anastomoses with sustaining bonding method after total mesorectal excision (TME) for lower rectal cancer. Methods After TME in 346 cases of lower rectal carcinoma, a sustaining anastomotic tube was inserted into the proximal colon, then the remnant was ligated and sutured. The rectal remnant no less than 1cm was preserved by colo-rectal anastomoses of modified Welch operation,while the rectal remnant no more than 1cm were preserved by colo-anal anastomoses with anal sphincter preservation. Results There was no perioperative mortality. Anastomotic leakage developed in 4 cases (1.2%), and anastomotic stenosis in 10 (2.9%). Postoperative 5 year survival and recurrence was 78.6%, 6.3% respectively. The defecation function was satisfactory in 82.6% cases. Conclusions Low/ultra-low colo-rectal(anal) anastomoses with sustaining bonding method after TME is safe and effective for lower rectal cancer.

Objective To study the influence of clinicopathologic characteristics and surgical treatment of gastric cancer on patients' survival rate.Methods From Apr.1994 to Aug.2005, the data of 759 gastric cancer patients concerning surgical treatment, pathological diagnosis and outcome were collected. Retrospective analysis of the results was made, 3-year and 5-year survival rates were calculated by Kaplan-Meier curve method, univariate analysis was done through Log-rank and multiple factors comparison through Cox regression analysis, and follow-up duration was 4-131 months.Results Single factor analysis indicated that age,tumor location,diameter of tumor, Borrmann type, type of histology, TNM stage, depth of infiltration, lymph node metastasis, liver metastasis, peritoneal dissemination, blood of transfusion during operation, extent of the radical cure of the tumor and excision techniques were significantly influential factors for the prognosis of patients. Cox regression analysis showed that tumor location, diameter of tumor,depth of infiltration, lymph node metastasis,liver metastasis, TNM stage, peritoneal dissemination, blood transfusion during operation, extend of the radical cure of the tumor and excision techniques were independent factors influencing the postoperative survival rate.Conclusion Independent factors influencing the postoperative survival rate include tumor location, diameter of tumor, lymph node metastasis, infiltration depth of the tumor, pathological classification, liver metastasis, peritoneal dissemination, and TNM stage, extent of the radical cure of the tumor, lymphanodectomy techniques and blood transfusion during operation are also important factors.

Objective To explore selective criteria of sphincter preservation operation(SPO) for middle to low third rectal cancer,and analyze clinicopathologic parameters resulting in the selective criteria.Methods Two hundred and seventy-nine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively.One hundred and eighty-seven rectal tumours were located in 5-10 cm from anus,92 rectal tumours in below 5 cm from anus.Among them 127 cases were treated by abdominal-perineal resection(APR),and 152 cases were treated by SPO in which there were 130 Dixon operations,12 Bacon operations,and 10 Parks operations.Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically.Results Gender,age,size,tumor types,site of tumor,degree of differentiation,infiltrated circumference of intestine,and lymph node metastasis,depth of invasion and Dukes stages were not significantly different between APR and SPO groups.SPO performed rate was 54.48% in all.SPO was performed in 48 lower third rectal cancer cases(52.17%,48/92).Regional recurrence rate was 6.81%(19/279).Middle survival time was((65.00?6.87))months and 5-year survival rate was 63.51% in SPO group.Middle survival time was((52.23?5.63)) months and 5-year survival rate was 52.50% in APR group.Chi-Suqare was 18.14 by Log-rank test(P=0.054 1).Conclusion There is no statistically difference in survival rate between APR and SPO groups.

Objective To establish the model of pancreatoduodenal allotransplantation in pigs with enteric drainage (ED) and portal venous drainage (PVD). Methods Forty-six hybrid landraces were divided into two groups (donor and recipient groups) randomly, for pancreatoduodenal allotransplantation. Donors were perfused via abdomial aorta without clamping the portal venous outflow with UW solution after heparinization. Whole pancreatoduodenal graft was harvested with segments of abdomial aorta and portal vein and shaped under cold UW solution. Then, the end-to-end anastomosis was performed with the donor iliac artery bifurcation “Y” graft to the recipient superior mesenteric arteries and celiac artery. Furthermore, type Ⅰdiabete model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Meanwhile, the end-to-side anastomosis was performed with the donor common iliac artery bifurcation “Y” graft to the recipient abdomial aorta and the side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of blood glucose, insulin and glucagon in blood were measured before and during the operation and 1, 3, 5, 7 d after operation. Results Twenty-three cases of pancreatoduodenal allotranplantations were performed on pigs. One died from complication of anesthesia. Success rate of operation was 95.7%.Complications of operation happened in 2 cases in which one was phlebothrombosis, incidence 4.5% and the other was duodenojejunal anastomotic leak, incidence 4.5%. The level of blood glucose increased within 30 min and recovered on the 2nd day after removal of pancreas. The levels of insulin and glucagon decreased within 30 min and recovered on the 2nd day after removal of pancreas. Rejection curred at the 1st day and reached the worst level on the 9th day after transplantation without the change of insulin and glucagon in blood and clinical symptoms of rejection. Conclusion Pancreatoduodenal transplantation in pigs can treat type Ⅰ diabete. ED and PVD can keep the function of endocrine in normal. The techni- que of duodenal transplantation with ED and PVD may pave the way for the further development of pancreas transplantation in clinic.

We summarized and evaluated the radical effect and feasibility of the ano-saving operation for low rectal carcinoma by reviewing literature in recent years about the operative indication, the excision dimension, total mesorectum excision, selection of operative mode, 5-year survival rate and follow-up of the anal saving operation in low rectal carcinoma.The main points are as follows: (1)The operative indication of ano-saving operation is done according to the location,invasion depth and pelvic lymphatic metastasis of low rectal carcinoma.(2)The preoperative digital anal examination,rectal intraluminal ultrasound,pelvic CT and MRI can direct the selection of operative indication.(3)The operation of low rectal carcinoma should adhere to total mesorectum excision,but the lateral lymphadenectomy is necessary.(4)The wtra low resection is the major operative mode for low rectal carcionoma.(5)We should simultaneously perform the ano-saving operation through treating and preventing hepatic metastasis.The ano-saving operation can not only have radical treatment effect,but also improve the quality of life in patients with low rectal carcinoma.

Objective To study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. Methods According to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. Results Retained spleen had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.