BACKGROUND: The occurrence of sexual and urinary dysfunction is higher in patients who have received rectal cancer surgeries. This could most likely be correlated with the age of the patients and the approach applied in the operation. Therefore, how to preserve the sexual and urinary functions has become a hot point in this field.OBJECTIVE: This study was designed to investigate the influence of differences in age and therapeutical approach on the sexual and urinary function in patients with rectal cancer.DESIGN: Investigation study on patients.SETTING: General Surgery Department, the 309 Clinical Division, General Hospital of Chinese PLA.PARTICIPANTS: Some male patients with rectal cancer hospitalized in the General Surgery Department, the 309 Clinical Division, General Hospital of Chinese PLA were involved from January 1999 to October 2000. All of the 79eligible patients had received a radical surgery for rectal cancer by the time of study. Their sexual and urinary function before surgery were normal and an over-2-year follow-up after surgery was conducted on each of them. The two groups, which were classified into two groups according to surgical ap-proaches they received, contained comparable quantity of sampling and age distributions, which prompts the validity of the comparison.METHODS: By distributing follow-up letters, outpatient inquiries and phone call investigations; the follow-up was conducted to evaluate the sexual functions in these patients, including their penile erection and ejaculation. The erectile function was assessed according to the International Index of Erectile Function Questionnaire-5 (IIEF-5). The assessment on ejaculation was based on whether the patients had a sexual climax and whether they can ejaculate. The definition of urinary function consisted of both short-term and long-term urinary functions.MAIN OUTCOME MEASURES: The sexual desire, erectile function, ejaculation and the urinary function in patients within different age brackets.RESULTS: After Miles operation, 81% patients developed sexual dysfunction, 46% got short-term urinary dysfunction(19/41) and 5 % (2/41) had long-term urinary dysfunction. While after Dixon operation, 55% patients had sexual dysfunction, 29% (11/38) had short-term urinary dysfunction, and none of the patients had long-term urinary dysfunction. The difference between the outcomes of the two operations was significant( P ＜ 0. 05) .Sexual dysfunction occurred at a rate of 38% in the less-than-40 age bracket, 60% in the 40-to-59 age bracket, and 96% in the over-60 age bracket. The overall differences between different pairs of age brackets were significantly ( P ＜ 0. 05 ).CONCLUSION: There is a high rate of postoperative sexual and urinary dysfunction in male population. The age of patients and the approach adopted in the surgery are directly correlated with the rate of dysfunction. An autonomic nerve-preserving radical operation for rectal cancer can reduce the occurrence of sexual and urinary dysfunction effectively.

Objective To investigate the effect of preoperative regional intra-arterial chemotherapy on apoptosis and apoptosis-regulating genes in advanced breast cancer.Methods 56 patients were divided into 2 groups:Preoperative regional intra-arterial chemotherapy group(treatment group,28 cases)and non-preoperative chemotherapy group(control group,28 cases).Apoptotic cells were examined by TUNEL and bcl-2 expression,and bax was detected by immunohistochemical techniques.Results Apoptotic index(AI)of breast cancer in the treatment group was 8.74%,while that of the control group was 4.65%.The bcl-2 expression in treatment group was 0.68?0.06,while in control group was 2.24?0.36.Expression of bax in treatment group was 0.72?0.06,while in control group was 0.38?0.04(P

Objective To explore the etiology,diagnosis and treatment of postsurgical gastroparesis syndrome(PGS)after radical gastrectomy for gastric carcinoma.Methods The data of 585 patients who had undergone radical gastrectomy for gastric carcinoma were retrospectively studied.The diagnosis was established with fiberoptic gastroscopy and biopsy before operation in all the patients,and radical subtotal gastrectomy was performed,with antero-colonic Billroth's Ⅱ anastomosis of the remnant stomach and jejunum.Results PGS occurred in 24 patients(age 46-81,mean 58.6 years)among 585 patients,the prevalence was 4.1%.In all the 24 patients,PGS occurred at the period when liquid diet was changed to semifluid diet,with the symptoms of epigastric fullness,nausea,vomiting and intractable hiccup.The vomitus contained large amount of gastric contents and a small amount of bile.The quantity of gastrointestinal decompression was 800-2000 ml/d.Upper gastrointestinal radiography using 38% meglucamine diatrizoate was performed in all the 24 patients,the contrast agent was taken orally or through gastric tube.It showed that the remnant stomach was atonic,gastric peristalsis was weak or absent,and evacuation of contrast agent was delayed.The anastomosis stoma was patent.Gastroscopy was performed in 18 patients,and a large amount of residual gastric content and anatomotic edema of anastomosis stoma were found.Howener,the gastroscope could be introenced into the duodenum or jejunal efferent loop through anastomotic stoma without difficulty,and no signs of mechanical obstruction were found.All the 18 patients were cured within10-38 days by conservative treatment.Conclusion The main causes of PGS may be the loss of gastrointestinal motility and anastomotic edema,while the risk factors may include old age,malnutrition,water-electrolyte imbalance,and peritoneal infection.Gastrointestinal radiography and gastroscopy are important diagnostic methods,and the patients can be cured by conservative treatment.

Objective To evaluate the effects of indigenous staplers on anus-preservation,and postoperative target chemotherapy to prevent local recurrence and distant metastasis of low-situated rectal cancer.Methods 284 patients with low-situated rectal cancer hospitalized during Jan.1990 to Dec.2004 in the Second Affiliated Hospital of PLA General Hospital were treated surgically with indigenous staplers for anus-preservation,interoperative implantation of iliac artery pump and postoperative target infusion chemotherapy.They were followed up for 2~8 years.The clinical data including the result of anus-preservation,local recurrence rate,distant metastasis rate and long-term survival rate were retrospectively analyzed.Results All the 284 patients received anus-preservation operation with successful result.Among them 282 cases(99.3%) undervent the operation once,and the remaining two(0.7%) were operated on twice with success.Control of defecation was good in 247 cases(87.0%),anastomotic fistula occurred in 2 cases(0.7%),stanosis of anastomosis occurred in 1 case(0.4%),and bleeding from anastomotic site occurred in 1 case(0.4%).The follow-up data were completely collected from 236 cases(83.1%).The 1-,3-,5-year local recurrence was found in 2 cases(0.8%),6 cases(2.5%) and 8 cases(3.2%),respectively.The 1-,3-,5-year distant metastasis was found in 11 cases(4.7%),22 cases(9.3%) and 10 cases(4.3%),respectively.The 1-,3-,5-year overall survival rate were 97.0%(229/236),86.0%(203/236) and 65.3%(154/236),respectively.Conclusion The use of indigenous staplers is safe and dependable in operation for anus-preservation in low-situated rectal cancer.Postoperative target chemotherapy may decrease the local recurrence rate and distant metastasis rate,and raise the long-term survival rate as well.

Objective To investigate the feasibility of breast conserving surgery after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer.Methods Forty-six patients,suffering from Ⅱ and Ⅲ stage breast cancer admitted to 309 Hospital of PLA from Jun.2003 to Dec.2008,and received breast conserving surgery after neoadjuvant chemotherapy,were followed-up.Chemotherapy protocol included intravenous injection of epirubicin 60mg/m2 on day 1 and continuous intravenous infusion of paclitaxel 150 mg/m2 for 3 hours on day 2.The neoadjuvant chemotherapy was repeated every 21 days for 2-4 cycles.Patients eligible for breast conserving therapy received quadrantectomy or wide excision of tumor plus axillary lymph node resection.Evidence of local recurrence and distant metastasis and breast contour were followed up after surgery.Results After neoadjuvant chemotherapy,9 patients showed complete clinical response(CR),37 patients showed partial response(PR).Post-operative pathological examination showed that there were varied degrees of apomorphosis and necrosis of tumor cells,interstitial edema,fibrous hyperplasia,and inflammatory cell infiltration,among them pathological remission was found in 4 cases.The patients were followed up for 8 to 70 months with a mean of 58 months,local recurrence was found in 4 cases distant metastasis was found in 3 patients,and 2 of them died.Assessment of breast contour was carried out in 31 cases 1 year after breast conserving therapy,and excellent results were obtained in 6 cases,good in 18 cases and poor in 7 cases.Conclusions It is safe for patients with Ⅱ-Ⅲ stage breast cancer to receive preoperatively treatment with neoadjuvant chemotherapy.Routine operation,postoperative irradiation and chemotherapy and systemic support are the keys to achieve satisfactory result of breast conserving therapy.

Through the qualitative study of peritoneal cavity free cancer cells of patients with gastric cancer, to evaluate the rational of exercising intraoperative no touch isolation technique, routine peritoneal and warm perfusion chemotherapy after the operation. 102 patients in PLA 309 Hospital with gastric cancer were included into the study. 100 ml peritoneal fluid were collected respectively before the investigation and before close peritoneal cavity,and rapidly sent for free cancer cells examination. Results: Before the investigation, the positive rate of free cancer cells is 36.3%, and the positive rate before close peritoneal cavity is 52.9%. The free cancer cells positive rate is concerned with tumor infiltration depth, serous membrane infection area and the type of the histopathology。Conclusions: Inside the peritoneal cavity of patients with gastric cancer, free cancer cells are able to survive and have a high degree of activity. Although all kinds of intraoperative no touch isolation technique are used, it still cannot be avoided that some cancer cells will exfoliate and slip into the peritoneal cavity. The wound stimulation during the operation will certainly increase the exfoliation. So, it is quite necessary in the course of operation to adopt no touch isolation technique and to use a great deal of normal saline to give peritoneal cavity lavage. And what's more important is, to give these patients who show positive in the free cancer cell examination perfusion chemotherapy after the operation.

To evaluate the effect of local resection plus axillary dissection in the treatment of early breast cancer, 112 cases of early breast cancer were divided into 2 groups: quadrant resection plus axillary dissection group(66 cases) and Halsted′s method group(46 cases).Their survival rate, local recurrence rate, metastasis rate,cosmetic effect of breast were observed for a prolonged period. The results showed that the 3,5,8 year survival rates in the first group were respectively 97 0%,87 9% and 71 2%. The 3,5,8 year survival rates in the second group were respectively 97 8%,80 5%,76 1%. The rate of local recurrence was 6 1% in the first group and 4 3% in the second group.The metastasis rate of the first group was 16 7%,and that of the second group was 21 6%.In 83 8% of patients in the first group,the breasts retained a satisfactory cosmetic form.It suggested that similar to the Halsted's method,the quadrant resection plus axillary dissection method is an ideal method to treat early breast cancer.

To evaluate the effect of intra arterial infusion chemotherapeutic medicine and immunizator in treatment of later gastro intestinal carcinoma, 86 cases suffering from irremovable gastro intestinal carcinoma were divided into treatment group(group A) and control group (group B). 46 cases in group A were treated with intra arterial chemo immunotherapy, 40 cases in group B were treated only with chemotherapy. Effective rates of group A and group B were 82 6% and 52 5% ( P

To evaluate the value of chemotherapy via portal vein pump implantation in preventing hepatic metastasis from colorectal cancer after a radical resestion. Patients after a radical resection were divided into two groups: the portal vein pump implantation chemotherapy group (Group A 32 cases), chemotherapy via peripheral vein(Grounp B 22 cases). The results showed that hepatic metastasis rate was 15 4% in group I and 36 4% in group 2. The survival rates of 1, 2, 3 years in group A were 98%, 83%, 61% respectively, while in group B they were 90%, 68%, 42%, respectively. The results suggested that portal vein pump chemotherapy was an effective treatment modality to prevent hepatic metastasis from colorectal cancer. Its clinical results were better than conventional chemotherapy via peripheral vein.

To study the treatment of peritoneal and hepatic recurrence of advanced gastric carcinoma after operation, 218 patients were divided into treatment group and control group.Treatment group: (hyperthemic peritoneal perfusion and intraarterial infusion chemotherapy)126 cases. Control group (peripleral veins): 92 cases. The peritoneal and hepatic recurrence and 3 year survival rate of each group were analyzed. The peritoneal and hepatic recurrence and 3 year survival rate in treatment group were 27%, 12 7% and 69 5%. and were 44 5%, 26 1% and 47 8% in control group. Hyperthermic peritoneal perfusion and intraarterial infusion chemotherapy are effective in control of the recurrence of advanced gastric cancer after operatin.