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Perioperative Treatments for the Aged People with Obstructive Colorectal Cancer

摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.

大肠癌治疗的进展

自1833年Reybard第一个为乙状结肠癌成功地施行切除手术以来，外科手术一直是结、直肠癌的首选治疗手段，对此，人们并无置疑。然而从手术的内涵和方式方法上经历了巨大的变化，最根本的变化是人们的观念和目标发生了变化。由于癌肿的致命性，因此，手术的目标是“根除癌肿、挽救生命”。手术的方法从单纯的局部肿瘤切除、肠段切除、根治性肠切除到扩大根治术，最后认识到手术能力的限度和扩大手术带来的创伤和并发症，“付出”与“得益”间的不平衡，从而接受并统一了根治性切除的方法。当然，对问题始终会有不同的认识，因此，还有一小部分的外科医师在为扩大根治术进行争辩，但这已经不是发展的主流了。因为随着科技的发展，人们对大肠癌解剖、病理、诊断、治疗手段、器械设备等方面的深入了解和发展，以及随着经济的发展，对生活水平和生活质量要求的提高，手术目标已从单一的“根除癌肿”变为“既要根除癌肿又要保存功能”，从原来追求“生命”变为“生命+生存质量”的双重目标，而这一概念和目标已成了当前外科手术发展的主流。至于那些为扩大根治手术争辩的理由之一就是除了手术以外，似乎放疗、化疗对大肠癌都是无效的，那么手术就成了挽救患者生命的唯一希望和可以采用的手段。然而，近年来放疗与化疗的进展已达到从双重目标来发挥其作用，下面扼要介绍这些进展。1外科手术在治疗低位直肠癌中的变化

CLINICAL STUDY OF GASTRIN IN SURUM AND TISSUES OF LARGE INTESTINE CARCINOMA

Gastrin(G) concentration in fasting blood, cancer tissues and its adjacent mucosas sampled from fourty-three patients with large intestine carcinoma (LIC) were measured. The results showed fasting G levels in patients with LIC were significantly higher than those in the normal surum controls (Ｐ＜0.05),and dropped to normal value after resection of the cancers. Surum G levels were correlated with cell differentiations of the cancer.The cancer tissues and its adjacent mucosas contained higher levels of G than the normal mucosas (Ｐ＜0.05). The results provided a laboratory evidence that the growth of LIC in vivo were regulated by G and G level might be an indicative parameter for selection of patients with LIC to be treated with hormone therapy and the study of biological character of LIC.

Molecular Switch of T Cell Factor-4 in Carcinogenesis of Colorectal Cancer

Objective　To investigate the role of T cell factor-4 (TCF-4) in the carcinogenesis of colorectal cancer. Methods　Relevant references about TCF-4 and the carcinogenesis of colorectal cancer, which were published recently domestic and abroad, were collected and reviewed. Results　For TCF-4 gene, multiple isoforms are generated by way of alternative splicing, which encode different proteins. TCF-4 protein is sequence-specific DNA binding protein and is incapable of activating or repressing transcription independently, but it can interact with distinct partners to lead to different effects through multiple domains. Conclusion　TCF-4 might be viewed as nuclear vehicles targeting other auxiliary proteins to a specific set of promoters and functions as molecular switch during the carcinogenesis of colorectal cancer.

Study on the Expression of bcl2 and bax Gene in Cancerous Tissue and Transitional Mucosa in Colorectal Cancer

ObjectiveTo study the expression of apoptosissuppressing gene (bcl2) and apoptosispromoting gene (bax) in colorectal cancerous tissue and transitional mucosas. MethodsColorectal cancerous tissue, transitional mucosas (3 cm from the cancerous tissue) and normal tissue were taken respectively in thirtyone cases. Immunohistochemical technique SP method was used to detect the expression in those tissues. ResultsThe positive expression rate of bcl2 protein in cancerous tissue and transitional mucosa were 64.5%and 60.0% respectively and significantly higher than that in normal tissue (P＜0.05). The positive expression rate of bcl2 protein in normal tissue was 35.0%. The positive expression rate of bax protein in cancerous tissue and transitional mucosa were 45.2%and 45.0% respectively and significantly lower than that in normal mucosa (P＜0.05). The positive expression rate of bax protein in normal tissue was 60.0%. There was no obvious difference in the positive rate of bax and bcl2 protein between cancerous tissue and transitional mucosa (Pgt;0.05). The expression rate of bax and bcl2 protein in colorectal cancer was irrelative to clinical pathological gradation and clinical stage (Pgt;0.05). ConclusionThere is over expression of bcl2 protein and low expression of bax protein in colorectal cancer and transitional mucosa. bcl2 protein and bax protein can affect the generation of colorectal cancer by participating in the regulation of apoptosis. But it is irrelative to clinical pathological gradation and clinical stage. Transitional mucosas should be viewed as precancerous lesion and resected during operation.

外周血糖链抗原CA50及CA199在大肠癌中的应用价值

胆囊结石合并大肠癌10例漏诊原因分析

Nuclear Factor-κB and Colon Cancer

ObjectiveTo explore the relationship between nuclear factor κB (NFκB) and the occurrence, metastasis, and treatment of colon cancer. MethodsThe literature on the structure and the property of molecular biology of NFκB, the relationship between NFκB and apopotosis, malignant tumor and colon cancer were reviewed.ResultsNFκB had action of antiapopotosis. The occurrence of malignant tumor had close relation with the oncogene by NFκB, the metastasis of malignant tumor was that cell of cancer escaped the killing and supervising of immunity by NFκB. NFκB affected the occurrence and metastasis of colon cancer by regulating cmyc, Cox2, ICAM1.Conclusion NFκB has important action in the occurrence and metastasis of colon cancer. It will become a new target of treatment.

Expression and Significance of Cyclooxygenase-2 and Angiopoietin-2 in Colorectal Cancer

【Abstract】　Objective　To study the expressions of cyclooxygenase-2 (Cox-2) and angiopoietin-2 (Ang-2) in colorectal cancer tissues, cancer adjacent tissues and normal colorectal tissues, and the relationship between these expressions and the clinicopathologic features of colorectal cancer. Methods　Forty-five excised samples of colorectal adenocarcinoma were confirmed pathologically and 39 of them were of well or moderately differentiated and 6 of poorly differentiated. Lymph nodes metastasis developed in 30 patients. And 15 cases were in stage of A or B and the rest were in the stage of C or D according to the Dukes stage. Taken PBS as the negative control and the verified Cox-2 or Ang-2 positive sections as positive controls, this study detected the expressions of Cox-2 and Ang-2 protein in 45 colorectal cancer tissues, 45 cancer adjacent tissues and 15 normal colorectal tissues by using immunohistochemical SP technique method. Results　Cox-2 and Ang-2 were expressed in colorectal cancer tissues and cancer adjacent tissues, but were not expressed in normal colorectal tissues. In 45 colorectal cancer tissues, the positive expression rates of Cox-2 and Ang-2 were 80.0% and 66.7%; in 45 cancer adjacent tissues, the positive expression rates of Cox-2 and Ang-2 were 35.6% and 11.1%, respectively. The positive expression rates of both Cox-2 and Ang-2 in colorectal cancer tissues were significantly higher than those in cancer adjacent and normal colorectal tissues. There were close correlations between the expressions of Cox-2 and Ang-2 and some pathologic features, such as lymph node metastasis and Dukes stage; whereas there were no significant association between the expressions and gender, histological type and position of tumor. There was also a close correlation between the expressions of Cox-2 and Ang-2 themselves. Conclusion　Cox-2 and Ang-2 play an important role in the occurrence and development of colorectal cancer. The use of specific inhibitor of Cox-2 as a treatment for colorectal cancer may become feasible and necessary.

THE RELATIONSHIP BETWEEN GASTRIN AND c-myc， c-fos EXPRESSION IN COLORECTAL CANCEROUS TISSUE

Objective To study the relationship between gastrin and c-myc, c-fos expression in colorectal cancerous tissue and the mechanism of gastrin effect on colorectal cancer.Methods The gastrin and c-myc, c-fos expression in 48 cases of colorectal cancerous tissue and canceradjacent mucosa were detected with immunohistochemistry techniques.Results The positive rate of gastrin in colorectal cancerous tissue was 39.58%. The rate of the well differentiated adenocarcinoma was higher than that of the poorly differentiated and mucinous adenocarcinoma(P＜0.05). The positive rates of c-myc and c-fos in colorectal cancerous tissue were higher than those in canceradjacent and normal mucosa. The positive rate of c-myc and c-fos in the group with gastrin positive expression were 78.94% and 73.68%, higher than those in the group with negative gastrin expression(37.93% and 31.04%). Conclusion Some of colorectal cancer cells formed and secreted gastrin through autocrine. The increase of cmyc, c-fos etc oncogene expression probably stimulate the cancer cells proliferation.