With the common application of total mesorectal excision (TME) technique,the proportion of sphincterpreserving surgery for the mid-low rectal carcinoma is significantly increased.Anastomotic leakage after sphincter-preserving surgery is the most severe complication of rectal surgery,and it is the main reason which will lead to other complications and death.Many researches on the early diagnosis,prevention and treatment of anastomotic leakage are conducted by surgeons at home and abroad,and a further understanding of this complication is deeply realized.

Aim To investigate effects of 1,25-(OH)2D3 on the differentiation of MGC-803 cells.Methods MGC-803 cells were treated by 1,25-(OH)2D3(10-6、10-5、10-4 mmol?L-1),and the rate of growth suppression was evaluated by 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide(MTT) assay.Plate clone formation assay was carried out to detect the phenotypes of colony formation.FACS analysis was used to analyze the cell cycle.The activity of telomerase was examined by telomeric repeat amplification protocol(TRAP) PCR-silver staining.Results 1,25-(OH)2D3 showed significant inhibitory effect on growth of these gastric carcinoma cells at 24,48,72 and 96 h.Treated with 1,25-(OH)2D3 for 48 h,cell cycle showed G0/G1 phase arrest,and the activity of telomerase was inhibited significantly.The colony-forming rate was reduced drastically(P

Objective To explore the effect of psychological nursing on anxiety and depression and quality of life of patients with multi drug resistant pulmonary tuberculosis.Methods 58 patients with multi -drug resistant pulmonary tuberculosis were randomly divided into observation group and control group,29 cases in each group.The control group received routine nursing care,the observation group received psychological nursing on the basis of the control group.Before and after psychological nursing intervention,the self rating anxiety scale(SAS)and depression self rating scale(SDS),health survey(SF -36)score were observed,and the clinical curative effect and compliance of the two groups were observed.Results After psychological nursing intervention,the SAS and SDS scores of the observation group[(36.83 ±7.61)points and (40.07 ±5.49)points]were significantly lower than the control group [(44.07 ±9.16)points and (43.90 ±7.91)points],the differences were statistically significant(t =3.27,2.14,all P <0.05).The SF -36 scores showed that after psychological nursing intervention,the physiological function(PF), physiological functions(RP),general health(GH),vitality(VT),social function(SF),role emotional(RE),mental health(MH),the seven dimensions scores of the observation group were significantly higher than those in the control group,the differences were statistically significant(t =7.18,10.22,8.85,12.71,12.04,9.68,4.79,all P <0.05). The compliance of the observation group was 93.10%,which of the control group was 72.41%,the difference was significant(χ2 =4.35,P <0.05).The total effective rate of the observation group was 86.21%,which of the control group was 62.07%,the difference was statistically significant(χ2 =4.41,P <0.05).Conclusion The psychological nursing intervention can improve the anxiety and depression of patients with multi -drug resistant tuberculosis, improve the quality of life of patients,improve the treatment compliance of patients,and improve the clinical efficacy.

It has been reported that the conventional abdominoperineal excision has the disadvantages of higher rates of positive circumferential resection margin and intraoperative bowel perforation, which affect the prognosis. The technique of extralevator abdominoperineal excision proposed by Holm et al is used to overcome these disadvantages. But this new concept of abdominoperineal excision causes other new problems, such as increased complexity, major trauma and more complications. With further studies, the advanced knowledge about the indications, modifications and complications of this technique has been obtained by the domestic and overseas surgeons. This article reviews the characteristics of extralevator abdominoperineal excision and its indications, research progress and major associated complications.
Digestive System Surgical Procedures ; methods ; Humans ; Perineum ; surgery ; Prognosis ; Rectal Neoplasms ; surgery ; Rectum ; surgery

Currently, the safety and efficiency of laparoscopic surgery for rectal cancer have been confirmed by large amount of evidences. Laparoscopic surgery has been commonly applied in the treatment for low rectal cancer. Sphincter preservation is a highly concerning issue for patients and surgeons during rectal cancer surgery. Sphincter-preserving surgery should be based on the R0 resection. The article reviews the application of laparoscopic surgery for low rectal cancer and the choice of operations for sphincter-preserving surgery.
Anal Canal ; Digestive System Surgical Procedures ; Humans ; Laparoscopy ; Rectal Neoplasms ; Rectum ; Safety

Harmonic scalpel is an important instrument for laparoscopic surgery, and it can be used for dissection and hemostasis. During the procedure of laparoscopic surgery for colorectal tumor, surgeons can use Harmonic scalpel to identify the surgical plane around the mesorectum and mesocolon. We summarized technical points based on our own 15-year experiences of harmonic scalpel use in laparoscopic surgery for colorectal surgery, and extracts them into five words, which are 'shave, poke, cut, peel and push'. These skills are described in combination of the illustrations and videos in this article.
Colorectal Neoplasms ; surgery ; Digestive System Surgical Procedures ; instrumentation ; Humans ; Laparoscopy ; instrumentation ; Surgical Instruments

Laparoscopic total mesorectal excision (TME) has been commonly applied in the operation of mid-low rectal cancer, but the conventional laparoscopic TME has the disadvantages of major operative difficulty and long learning-curve, due to its limitations of 2-dimension vision and common laparoscopic instruments. Robotic surgical system with high-qualified 3-dimenstion vision and flexible Endo Wrist instruments can overcome those limitations of conventional laparoscopy, and is useful for the TME that demands deep pelvic operation and flexible dissection in the space of distal rectum. Robotic TME has the advantages of shorter learning curve and lower conversion rate, and it can even be performed by the surgeon with little laparoscopic experience. But according to the current studies, the superiority of robotic TME over laparoscopic TME can not be confirmed. To confirm the efficacy of robotic surgery, more high-level evidences are needed. Currently, the biggest obstacle for the widespread use of robotic surgical system is its high expense. But there is an obvious advantage that is the more comfortable feeling of surgeon while performing robotic surgical system, compared with performing laparoscopic operation, and it is helpful for long-time complicated operation. It is confirmative that robotic operation is the results of science and technology development, and it is the direction of future development. With the expiration of patent right of Da Vinci robotic system, there will be more kinds of robotic surgical systems which will lead to the much lower operation expense and the widespread use. The young surgeons should master the laparoscopic TME, which will help them master robotic TME technique quickly.

OBJECTIVETo introduce the diagnosis and the treatment of the long-segment bowel stenosis above the anastomosis and bowel obstruction caused by the radiation-induced pelvic wall and bowel fibrosis.

METHODSBetween January 2008 and June 2014, 468 patients with rectal carcinoma underwent sphincter-preserving operation after neoadjuvant chemoradiotherapy in Fujian Medical University Union Hospital. Among 241 patients without postoperative anastomotic leakage, anastomosis stenosis, local recurrence and small bowel obstruction, severe pelvic and bowel fibrosis with obstruction during follow-up was found in 14 patients(SFO group). Associated data of these 14 patients were retrospectively collected. Clinical and image characteristics, and treatment outcomes of these 14 patients were analyzed and compared to those of other 227 patients without fibrosis and obstruction (control group).

RESULTSCompared to control group, SFO group had lower BMI(19.7±2.3 vs. 22.5±3.2, P=0.000), higher ratio of male (92.9% vs. 63.9%, P=0.039) and smoking patients(78.6% vs. 32.2%, P=0.001), shorter preoperative distance from lower edge of tumor to anal verge [(4.9±0.7) cm vs. (5.7±1.4) cm, P=0.043), and longer time from the end of radiation to operation [(9.4±2.3) week vs. (8.1±1.7) week, P=0.024). The largest thickness of the bilateral obturator internus increased significantly after chemoradiotherapy (left side: P=0.030, right side: P=0.020) as compared to pre-chemoradiotherapy on MR image. Patients of SFO group received corresponding treatments according to the status of bowel stricture, and the outcomes were all satisfactory.

CONCLUSIONSReconstructed rectum stricture can be caused by the radiation-induced fibrosis of pelvic wall soft tissue and proximal colon. Severe stricture can be treated with corresponding methods to relieve symptoms.

OBJECTIVETo investigate the safety, feasibility, perioperational information and post-operational pathology of the modified abdominal operation of extralevator abdominoperineal excision (ELAPE), meaning transpelvic levator dissection under direct visualization.

METHODSFrom January 2010 to March 2013, 36 patients with rectal tumors(≤5 cm distance to anal verge) underwent extralevator abdominoperineal excision with transpelvic levator dissection by laparoscopic or open surgery, without position change during the perineal operation. The preliminary result of this modified technique was summarized.

RESULTSThe levator ani muscles of all the patients were successfully dissected with transpelvic levator dissection and the extent of levator dissection was determined individually according to its involvement. No position was changed during the perineal operation. No conversion to open approach in laparoscopic surgery group was observed, and only 1 case of rectum perforation occurred in open surgery group. The mean operation time was (220.9±36.8) min, and mean intraoperative blood loss was(121.6±99.7) ml. All the specimens had levator ani muscles attached to the mesorectum and positive rate of circumferential resection margin was 5.6%(2/36).

CONCLUSIONSTranspelvic levator dissection simplifies the procedure of ELAPE and achieves individualized dissection of levator. This technique is effective without position change during perineal operation, with shorter operation time and acceptable oncologic outcomes.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Pelvic Floor ; Perineum ; surgery ; Rectal Neoplasms ; surgery ; Rectum ; surgery

OBJECTIVETo investigate the influence of anastomotic leakage (AL) on long-term survival after resection for rectal cancer.

METHODSClinicopathological data of 653 rectal cancer cases confirmed by pathology and undergoing R0 resection for rectal cancer in our department from January 2007 to December 2011 were retrospectively analyzed. Anastomotic leakage was found in 40 cases (AL group) and not in the other 613 cases (non-AL group). After median 47 (1-91) months of follow-up, 5-year disease-free survival rate, distant metastasis rate and local recurrence rate were compared between the two groups. Risk factors affecting long-term prognosis were also analyzed.

RESULTSThe 5-year disease-free survival rate, 5-year distant metastasis rate, and 5-year local recurrence rate were 78.1%, 14.2% and 4.2% in the non-AL group, and 74.5%, 20.1% and 8.4% in the AL group respectively, and the differences were not statistically significant (P=0.808, P=0.965, P=0.309). Multivariate analysis showed that preoperative neoadjuvant radiochemotherapy, TNM staging, abnormal CA199, preoperative low level of albumin were independent prognostic factors of rectal cancer patients after R0 resection, while AL was not an independent factor of 5-year disease-free survival (P=0.910). Further multivariate analysis on 507 cases receiving postoperative adjuvant chemotherapy also revealed that AL was not an independent factor of 5-year disease-free survival (P>0.05). Percentage difference of patients finishing postoperative chemotherapy between the two groups was not statistically significant (79.4% vs. 76.3%, P=0.681).

CONCLUSIONAL is not an independent predictor of long-term survival for rectal cancer.

Anastomotic Leak ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Postoperative Period ; Prognosis ; Rectal Neoplasms ; pathology ; Retrospective Studies ; Survival Rate