OBJECTIVETo investigate the reasonable proposal of prophylactic antibiotics use in selective colorectal operation.

METHODSOne hundred and sixty-five patients underwent colorectal surgery were randomized to Treatment 1 (55 cases), Treatment 2 (50 cases) and Control (60 cases) group. The Treatment 1 group was given oral MgSO4 solution at the night before operation, and Cefradine 2.0 g (I.V.) during the induction of anesthesia, continued with tow times of intravenous Cefradine 2.0 g and 0.5% Metronidazole 100 ml at an interval of 12 hours in 24 hours after the operation. The Treatment 2 group was given the same treatment as Treatment 1, but the antibiotics would not be withdrawn until 3-5 d after operation. On the basis of the treatment of Treatment 2 group, the Control group was given oral antibiotics 2-3 days before operation. Postoperative complications including surgical site infection, stoma leakage, dysbacteriosis, and WBC, body temperature, days of hospitalization and antibiotic expenses in the three groups were observed and compared.

RESULTSThere was no significant differences in surgical site infection, stoma leakage, WBC counting and its change, body temperature and hospital stay among the three groups (P > 0.05). The incidence rate of dysbacteriosis in Control group was significantly higher than that in Treatment 1 group (P < 0.05). The antibiotic expenses in the Treatment 1 group was significantly lower than those of the other two groups (P < 0.05).

CONCLUSIONSProphylactic antibiotic use during the induction of anesthesia and 24 hours after operation was reasonable in selective colorectal operation, it can prevent the surgical site infection effectively with good social-economic effects and fewer side effects.

Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; adverse effects ; Antibiotic Prophylaxis ; adverse effects ; methods ; Colorectal Surgery ; Female ; Humans ; Male ; Middle Aged ; Surgical Wound Infection ; prevention & control

OBJECTIVETo evaluate the accuracy and value of the placement of metallic clips during colonoscopy in the localization of colorectal cancer and incision selection.

METHODSA total of 30 patients received metallic clip placement by colonoscopy before operation. Abdominal plain film (supine and upright position) was taken and incision was determined by the projection of clips on the abdominal wall.

RESULTSThe inaccuracy rate of localization by colonoscopy was 30%(9/30). Colonoscopy combined with the placement of metallic clips achieved an accurate incision rate of 100% (30/30).

CONCLUSIONSThere is a considerable rate of inaccuracy for localization in colonic cancer by colonoscopy. Colonoscopy combined with placement of metallic clips should be considered in order to select a reasonable incision.

Adult ; Aged ; Aged, 80 and over ; Colon ; surgery ; Colonic Neoplasms ; surgery ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Surgical Instruments

OBJECTIVETo evaluate the integrity of the resected mesentery specimen after total mesorectal excision (TME) for low rectal cancer using methylene blue perfusion via the superior rectal artery.

METHODSTwenty patients with low rectal cancer were randomly divided into the methylene blue group (n=10) and the control group (n=10). All the patients received TME and macroscopic examination of the mesorectal surface was performed to evaluate the quality of the surgical specimen. The methylene blue was injected into the specimen postoperatively via superior rectal artery.

RESULTSThe mesorectal surface of all the specimens was intact on macroscopic examination. However, after methylene blue perfusion, 2 specimens were found to be incomplete. The number of lymph nodes in the methylene blue group were significantly larger (17.3+/-2.4 vs 12.4+/-5.4, P=0.016).

CONCLUSIONSIntegrity evaluation of TME specimen is necessary. Methylene blue perfusion is a convenient and effective method to identify subtle incompleteness of specimen and can improve the detection of lymph node.

Adult ; Aged ; Digestive System Surgical Procedures ; Female ; Humans ; Infusions, Intra-Arterial ; Male ; Mesenteric Artery, Inferior ; Mesentery ; pathology ; surgery ; Methylene Blue ; Middle Aged ; Postoperative Period ; Prognosis ; Rectal Neoplasms ; surgery ; Rectum ; blood supply

OBJECTIVETo explore the operation indication and safety of presacral tumor.

METHODSClinical data of 36 patients with presacral tumor from November 1990 to May 2006 treated in our hospital, in whom 23 patients underwent trans-sacral operation, were analyzed retrospectively.

RESULTSThe operation time was from 43 to 210 min (average 94 min). The volume of blood loss was from 30 to 2000 ml (average 350 ml). Hospital stay was from 8 to 16 days (average 10.7 days). There were 13 different pathology types of tumors in the 36 patients including 26.4% of malignancy. Complications of trans-sacral operation included 1 case of ureteral damage, 1 case of sacral wound hernia, 1 case of presacral abscess who was healed by sigmoid stoma and wound drainage.

CONCLUSIONTrans-sacral resection of low presacral tumor is safe and effective with less trauma, less bleeding and quick recovery.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pelvic Neoplasms ; surgery ; Retrospective Studies ; Sacrum ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the efficacy and safety of colonoscopy-guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction.

METHODSClinical data of 42 patients (24 males and 18 females with a mean age of 64.3 years) undergoing colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between January 2010 and June 2012 were reviewed retrospectively.

RESULTSThe obstruction was located in the rectum (n=19), sigmoid (n=9), descending colon (n=8), splenic flexure (n=1), hepatic flexure (n=3), and ascending colon (n=2). Technical success was achieved in all the 42 patients (100%). The mean time of operation was (11.8±10.4) min (range 1.1-51.0 min). No serious procedure-related complication occurred. Minor bleeding occurred in 3 cases (7.1%). One patient died on the second day after surgery because of heart failure.

CONCLUSIONSColonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe with shorter operative time.

Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms ; complications ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents

OBJECTIVETo investigate the emergency therapeutic strategy for sigmoid vovulus in the elderly.

METHODSClinical data of 14 elderly patients with sigmoid vovulus were analyzed retrospectively.

RESULTSThe mean age was(79.1±7.2) years(range, 70-93), and 11 patients (78.6%) were male. Emergency decompression and restoration with colonoscopy was performed in all the patients with a success rate of 100%. No patient required emergent surgery. Four patients(28.6%) recurred and they were managed well by repeat colonoscopic restoration.

CONCLUSIONEmergency colonoscopic restoration is the first treatment of choice for sigmoid vovulus in the elderly because it is safe and effective, and can be performed repeatedly.

Aged ; Aged, 80 and over ; Colon, Sigmoid ; surgery ; Colonoscopy ; Decompression, Surgical ; Emergencies ; Female ; Humans ; Intestinal Volvulus ; surgery ; Male ; Recurrence ; Retrospective Studies

OBJECTIVETo investigate the limiting effect of pelvic diameters on the technical difficulty of total mesorectal excision(TME) for rectal cancer by computed tomography pelvimetry.

METHODSFrom January 2009 to January 2011, 69 patients with rectal cancer underwent TME in the Department of Proctology at the Changhai Hospital in Shanghai. There were 55 males and 14 females. Using three dimensional reconstruction software, pelvic dimensions of rectal cancer patients were measured based on pelvic MDCT thin-slice computed tomography. All the patients were measured for 15 pelvic parameters, including the length of pelvic inlet, the length of pubic symphysis, the interspinous distance, the distance from sacral promontory to tip of coccyx, etc. All the procedures were open surgery, including anterior resection(n=19), low anterior resection and ileostomy(n=29) and abdominal perineal resection(n=21). Duration of the operation and blood loss at surgery were recorded as evaluation indicators of the technical difficulty of total mesorectal excision. By univariate analysis significant pelvic parameters were selected. Multiple regression analysis was used to investigate the relationship between pelvic parameters and blood loss or duration of operation.

RESULTSThe mean operative time was(139.9±32.4) min and the mean intraoperative blood loss was (228.8±150.6) ml. Multivariate analysis showed that the interspinous distance, the length of pelvic inlet, the distance from sacral promontory to the tip of coccyx were the main factors affecting the operation time, and that the length of pubic symphysis and the distance from sacral promontory to the tip of coccyx were the main factors affecting the amount of blood loss (all P<0.05). Among the 3 procedures, the multivariate analysis for low anterior resection appeared to be most valuable, in which operative time was associated with the distance from sacral promontory to the tip of coccyx and the interspinous distance (adjusted coefficient of determination of the regression equation, Rc(2)=0.460, P=0.003). Factors associated with intraoperative blood loss were the length of pelvic inlet, the distance from sacral promontory to the tip of coccyx, and the sacrum-pubis angle(Rc(2)=0.358, P=0.022). Comprehensive analysis of the measurement parameters showed that the ratio between the length of pelvic inlet and the distance from sacral promontory to the tip of coccyx was associated with the operative time and blood loss. This ratio was significantly higher in female patients than that in males. In females with a ratio greater than 1, the operative time was significantly shorter(P=0.050), and the intraoperative blood loss was significantly less in males with a ratio greater than 0.9(P=0.021).

CONCLUSIONSOperative time and intraoperative blood loss for total mesorectal excision are more favorable in patients with a wide and shadow pelvis. Surgical difficulty is increased in deep and narrow pelvis or those with major sacrum curvature. The difficulty of total mesorectal excision procedure can be predicted by measuring the length of pelvic inlet and the distance from sacral promontory to the tip of coccyx.

Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Mesentery ; diagnostic imaging ; surgery ; Middle Aged ; Pelvis ; diagnostic imaging ; Rectal Neoplasms ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; methods

OBJECTIVETo investigate the diagnosis and surgical management of adult Hirschsprung's disease.

METHODSClinical data of 15 patients with adult Hirschsprung's disease were reviewed retrospectively from June 1992 to June 2004.

RESULTSPatients age ranged from 17 to 54 years old. The main manifestations included long-term (ranged from 9.5 month to 50 years) constipation and abdominal distention. Acute abdominal pain occurred in six patients, but no sign of de hydration and malnutrition occurred in all patients. Bowel stenosis and dilation could be examined by barium enema. Soave procedure was performed in 3 patients, subtotal colectomy with coloanal anastomosis was performed in twelve patients. The function of defecation was improved in all patients after operation.

CONCLUSIONSThe diagnosis of adult Hirschsprung's disease mainly depends on the history of constipation from infant and barium enema. Subtotal colectomy with coloanal anastomosis is an effective and safe operative procedure.

Adolescent ; Adult ; Female ; Hirschsprung Disease ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate the safety and efficacy of surgical treatment for recurrent colorectal carcinoma in the elderly.

METHODSThe clinical and follow up data of 24 elderly patients with recurrent colorectal carcinoma who were treated between January 2000 and June 2009 at the Changhai hospital of the Second Military Medical University were analyzed retrospectively.

RESULTSAmong the 24 patients there were 14 men and 10 women. The mean age of the patients was 76.9 ± 5.3 years. The local recurrence was found in 15 patients. In 9 patients, both distant metastases and local recurrence were found. A total of 24 patients received operation, including radical resection in 15 patients and palliative resection in 8 patients. One patient had laparotomy only because of diffuse metastases in the abdomen and involvement of the duodenum and common bile duct.The patient received stent placement in the common bile duct and chemotherapy after the surgery. Postoperative complication occurred in 7(29.2%) patients, which included ileus(n=1), pulmonary infection(n=1), urinary infection(n=1), wound infection(n=2), wound dehiscence(n=1), and wound fat liquefaction(n=1). There were no perioperative deaths. The median survival time was 6 months in the entire cohort. The median survival time was 33 months in patients undergoing radical resection, and the 1-, 3-, and 5-year survival rate was 71.4%, 28.6%, and 14.3%. The median survival time was 3 months in patients who underwent palliative resection, and the 1-year survival rate was 0. The difference between the two groups was statistically significant(P<0.01).

CONCLUSIONOutcomes are acceptable after radical resection for elderly patients with recurrent colorectal cancer if careful preoperative evaluation and perioperative management are performed.

Aged ; Aged, 80 and over ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Prognosis ; Retrospective Studies ; Survival Rate

italic>Dendrobium officinale Kimura et Migo is a rare Chinese herbal medicine, while Dendrobium crepidatum Lindl is a local medicine in Yunnan, both of which have the function of nourishing yin and stomach. To reveal the differences in chemical composition between the two species, ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometry (UPLC-Q-TOF-MS/MS) was used to analyze the chemical composition of stems and leaves of D. officinale and D. crepidatum. Principal component analysis (PCA) and partial least squares discriminant analysis (OPLS-DA) were used to determine the differences in metabolites between species and parts of Dendrobium. Fifty-eight chemical compounds were identified in the two species. Analysis indicated that the side ring of alkaloids connected with nitrogen was readily cleaved during analysis. The results of PCA analysis showed that the stems and leaves of D. officinale and D. crepidatum could be easily differentiated, and the chemical constituents of D. officinale and D. crepidatum were significantly different. OPLS-DA analysis showed that there were 16 metabolite differences between the stems and 22 differences in metabolites between the leaves of D. officinale and D. crepidatum. The main metabolite differences in components between the two Dendrobium species were dendrocrepidine B, dendrocrepidine C and dendrocrepine. There were 14 differences in metabolites between the stems and leaves of D. crepidatum. In conclusion, the chemical compositions of D. officinale and D. crepidatum are quite different; the small molecular compounds of D. officinale are mainly terpenoids and flavonoids, and the content of alkaloids is low. There is no significant difference between stem and leaf. In contrast, D. crepidatum is mainly composed of alkaloids and terpenoids, with crepidamine and dendrocrepine as its unique components, and there are great differences in the components between stems and leaves. This study provides a theoretical basis for the development and utilization of Dendrobium resources.