Objective To investigate the changes of rectoanal function after intersphincteric resection(ISR). Methods In this study,27 lower(3～5 cm from anal verge)rectal adenocarcinoma patients(T0-T2 determined by MRI and endoanal uhrasonography before surgery)undergoing intersphincteric resection between January2005 and January 2007 were followed up,their rectoanal function was assessed by rectoanal manometry 1 week preoperatively and 2 weeks,3 months,6 and 9 months postoperatively.The data were compared by using student t test and X2 test.Results For these 27 patients,within 3 months after surgery,the mean resting pressures(44±6)mm Hg to(19±3)mm Hg,maximum resting pressures(60±8)mm Hg to(33±4)mm Hg,squeezing pressures(180±19)mm Hg to(131±16)mm Hg and msximum tolerable volume(165±20)ml to(55±8)nd were decreased significantly(P＜0.05),and the rectoanal inhibitory reflexes(BAIR)were all absent;6 months after surgery,the resting pressures,squeezing pressures and maximum tolerable volume began to increase obviously,and 6 patients presented RAIR;3 months later the mean resting pressures,maximum resting pressures and squeezing pressures were(41±5)mm Hg,(57±8)mm Hg and(173±19)mm Hg respectively,close to the normal range(P＞0.05),though the maximum tolerable volume increased to(110±16)mi,still lower than the preoperative value(P=0.0153),11 patients restored BAIR.Conclusions The rectoanal function is injured obviously after intersphincteric resection within a short time period,but with time it was gradually restored.

Objective To evaluate surgical therapy for recurrent rectovaginal fistula.Methods In this study.two patients were treated by endorectal advancement flap repair and one patient was treated by vascular pedicled segment of small bowel.Results All patients were cured and followed up from 4 to 20 months.During the period of follow-up there was no recurrence.Conclusions The procedures and timing of operation are important factors for a successful repair.Both the endorectal advancement flap and patch of intestine provide an effective methods in repairing recurrent rectovaginal fistula.

ObjectiveTo modify the technique of whole small bowel transplantation in rats to improve the survival.MethodsOne hundred and six SD rats served as donors and recipients to establish a homogeneous and orthotopic model of small bowel transplantation without fistula.Anastomosis of aorta and vein was done with three- cuff technique,the vena mesenterica superior of recipient was done under a surgical microscope.End-to-end anastomosis was performed between donor proximal small intestine and receptor jejunum,and also between the remote and receptor ascending colon.Surviving more than 3 days after surgery was defined as the operation was successful.ResultsThe operation was successfully carried out in 48 cases with the survival rate of 90.6％ (48/53).The average warm ischemic time was 0 minute,and the average cold ischemic time was(30 ±2.48)min.The survival rate( ＞7 d) was 97.9％ (47/48).ConclusionsOn the basis of three-cuff technique,the survival of SBT was greatly improved.When the vena mesenterica superior of recipient was done under a surgical microscope,the surgical training time was shortened.

Objective To compare the application,safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery(TEM) and the conventional transanal excision(TAE).Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed.Results Age,sex,tumour size,blood loss,postoperative hospital stay were similar in the two groups(P＞0.05).The median distance from the anal verge was significantly higher in the TEM group ( TEM/TAE =7.0/5.0 cm,P ＜ 0.01 ).The operation time was significantly longer in the TEM group (TEM/TAE =70.00/30.00 min,P ＜ 0.01 ).There was no operation-related mortality in both groups (P ＞ 0.05 ).Two patients in the TEM group developed postoperative haemorrhage,and one patient developed pulmonary infection and retention of urine respectively.There were two secondary haemorrhage cases in the TAE group.On median follow-up of 30 months,there was 7.8％ recurrence rate in the TEM group,compared with 23.2％ the in TAE group.Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm.It has broader indication,and better theraputic effect than the conventional transanal excision.

Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique.Methods From January 2002 to March 2011,forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique.The clinical data of these patients were reviewed.The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score.Results During the median follow-up of 65 months,2 patients with malignant adenomatous polyps died,2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing,1 patient developed persistent anastomotic stricture needing surgical intervention,16 patients developed at least 1 episode of pouchitis.There was no incontinence in these patients,and the median functional Oresland score was 6,3 and 2 after 1 year,2.5 years and 5 years respectively.Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising,with no incontinence in our patients.

Objective To evaluate the specificity,sensitivity and accuracy of miniature probe combined with radial scanning endoscopic ultrasonography(EUS)in preoperative TN staging of rectal cancer,and to assess its value in the choice of therapeutic strategy.Methods A total of 60 patients with rectal cancer received EUS assessment before surgery.Diagnosis was made according to TNM standard and compared with those of MRI and postoperative pathological examination.The reference value of EUS for therapy selection was studied.Results According to EUS staging,there were 4 cases of TI,18 T2,30 T3 and 8 T4,among which 7 cases were over-staged and 4 others were under-staged.MRI staging showed 1 case of T1,18 T2,30 T3 and 10 T4,among which 14 were over-staged and 3 others were under-staged.The total accuracy of EUS in T staging and N staging was 81.67%(49/60)and 78.33%,respectively,with the sensitivity and specificity at 71.43%and 91.03%,respectively.Accuracy of MRI for T staging and N staging were 71.67%(43/60)and 83.33%,respectively,with the sensitivity and specificity as 85.71%and 86.96%.Conclusion EUS with combination of miniature probe and radial scanning is effective in preoperative TN staging of rectal cancer with easy manipulation and less pain.

Objective To study the clinical topography of lateral ligament of the rectum in the relation to surgical procedures in rectal carcinoma. Method Twenty-three pelvises(12 males,11 females)harvested from embalmed cadavers were studied by topographic dissection. Results The lateral rectal ligamem were identiffed bilaterally in all cadavers between the rectum and visceral fascia.Unilateral middle rectal arteries was found in 8 cadavers and bilateral arteries was found in 2 cadavers.The rectal branches from the pelvic plexus were uniformly constant structure within lateral ligament of the rectum.Conclusion The lateral rectal ligament is located between rectum and visceral fascia.The cleavage between visceral fascia and pelvic plexus is the appropriate plane for lateral rectal dissection of rectal cancers.

Objective To study the pelvic fascia related to pelvic autonomic nerve and detect the anatomical localization of pelvic autonomic nerve by marker in adult male.Methods Twelve pelvises of adult male harvested from cadavers were studied by dissection.Results Hypogastric nerve was embedded in the posterior leaf of the visceral pelvic fascia.Pelvic plexus was situated between vesicohypogastric fascia and visceral fascia.Pelvic nerve branch of seminal vesicle and prostate was located at the anterolateral part of Denonvilliers fascia.Sacral promontory,ureter,junction of Denonvilliers fascia,visceral fascia and seminal vesicle could be regarded as anatomical markers for pelvic autonomic nerve.Conclusion The anatomical characteristics of pelvic autonomic nerve can be used for protecting and isolating pelvic autonomic nerve in total mesorectal excision of adult male.

Objective To evaluate the long-term therapeutic results of intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection (ISR),and the clinical data were analyzed retrospectively.There were 39 males,21 females and their average age was 55 years old (range from 30 to 77 years old).The inferior border of the tumor were from 28 to 50 mm to the edge of anus,averaging 42 mm.Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively.After a median follow-up period of 49 months (range from 18 to 90 months),local and distant recurrence were observed in 6 and 4 patients respectively.Five-year overall survival rate and disease-free survival rate were 88.3％ and 83.3％ respectively.The mean stool frequency were (3.8 ± 1.3) times in each day based on data from 53 patients,and the stool control function of 73.6％ of all patients was preserved satisfactorily according to Kirwan classification.Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.

OBJECTIVETo identify genetic abnormalities in primary pancreatic carcinoma in humans.

METHODSComparative genomic hybridization (CGH) was used to investigate genomic imbalances in 27 cases of pancreatic carcinomas. Multiple deletions and gains were observed in all tumor specimens.

RESULTSLosses affecting chromosomes 9p, 17p, 4q and 6p and gains involving 8q, 7q, 3q and 1q were commonly observed.

CONCLUSIONSThere are multiple regions of chromosomes with changes copy number in pancreatic carcinoma. The altered chromosomal regions may contain several candidate genes which are involved in the development and progress of pancreatic carcinogenesis.

Adult ; Aged ; Chromosome Aberrations ; Chromosome Disorders ; Female ; Humans ; Male ; Middle Aged ; Nucleic Acid Hybridization ; Pancreatic Neoplasms ; genetics