摘要:

&NA;The rectoanal inhibitory reflex plays an important role in the normal mechanisms of anorectal continence. Anterior resection abolishes the reflex, but whether it recovers, particularly after inverted stapled anastomosis, is not clear. Anal manometry was performed on patients undergoing low anterior resection for carcinoma. Maximum anal resting pressure and the rectoanal inhibitory reflex were assessed preoperatively and up to two years postoperatively. The reflex was present in 43 of 46 patients (93 percent) preoperatively, in 8 of 45 patients (18 percent) on the 10th postoperative day, and in 6 of 29 patients (21 percent) between six months and one year following surgery. Twenty patients were studied more than two years postoperatively, and in 17 (85 percent) the reflex was demonstrated. In the majority of low anterior resection patients, the rectoanal inhibitory reflex is abolished by surgery, remains absent throughout the first year, and has recovered by the end of the second postoperative year. This may be important in the recovery of anorectal function in these patients.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The field change is one hypothesis concerning the development of colorectal carcinoma. Removal of a carcinoma without its entire surrounding altered mucosa may result in the development of a recurrence. S44, a monoclonal antibody directed against statin, a nuclear protein expressed in nonproliferating cells in either a quiescent or senescent state, was used to determine the rate of cell growth in colorectal mucosa at different distances from carcinomas. The specimens of 18 patients undergoing resection of a colorectal carcinoma were immediately opened after operation, and strips of mucosa were taken at distances of 1 cm, 5 cm, and 10 cm from the carcinoma. For each location, 10 longitudinally oriented crypts were evaluated for statin‐positive cells identified by the presence of a dark brown peroxidase‐conjugated antibody reaction product. The average percentage of statin‐positive cells per crypt was significantly lower at a 1‐cm distance from the carcinoma compared with the mucosa located 5 and 10 cm from the carcinoma (20.89±4.33 at 1 cm, 32.41±5.27 at 5 cm, and 34.23±6.45 at 10 cm). None of the calculated parameters showed any significant difference between the 5‐cm and 10‐cm locations. The fact that the proliferation rate of the mucosal cells returns to the normal level at 5 cm from the margin of the carcinoma suggests that cells located within this distance still retain proliferative potential even though they are morphologically indistinguishable from their normal counterparts. We conclude that failure to remove this transitional, potentially proliferative mucosa may result in subsequent development of anastomotic or perianastomotic recurrences.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Fibrin adhesives have been advocated as a protective sealant in high‐risk colonic anastomoses to prevent leakage. To assess the effect of fibrin glue sealing on the healing ischemic anastomosis, we compared the healing of sutured colonic anastomoses in the rat, with and without fibrin adhesive (Groups IA and IB), and ischemic anastomoses with and without fibrin adhesive (Groups IIA and IIB). On days two, four, and seven, 10 animals in each group were sacrificed. Adhesion formation was scored, and thein situbursting pressure was measured. The collagen concentration and degradation were estimated by measuring hydroxyproline. Adhesion formation was more prominent in Groups IB, IIA, and IIB on day four only; abscesses were noted in the ischemic group in four rats. Anastomotic bursting pressure was significantly lower in sealed (IB) and ischemic anastomoses (IIA) than in normal anastomoses (IA) on day four. Sealing of ischemic anastomoses did not change bursting pressures on days two, four, and seven. The relative decrease of collagen in the sealed anastomoses is significantly higher on day four only. It is concluded that sealing of normal colonic anastomoses in the rat has a negative effect on wound healing. Ischemia at the anastomotic site results in weaker anastomotic strength on day four postoperatively. Also in ischemic anastomoses, fibrin sealant does not improve wound healing during the first seven days. Adhesion formation on ischemic intestinal anastomoses was not prevented by fibrin sealing.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;To determine the safety of intersecting staple lines, 22 pigs were operated upon with a functional end‐to‐end enteroanastomosis 40 cm distal to the ligament of Treitz using linear stapling devices. The procedure was repeated on the colon, where a colocolostomy was created. The blood flow at intersecting staple lines and single‐row staple lines for each anastomosis was studied with the reference organ method 24 hours after the first operation. The purpose was to evaluate whether there is a reduction in blood flow at the site of intersecting staple lines, causing an increased risk for anastomotic leakage. The reduction in mean blood flow in crossing compared with noncrossing staple lines was 6 percent (−5‐17 percent) for small bowel anastomoses and 7 percent (−6‐19 percent) for colonic anastomoses. An equivalence test showed that, if a reduction in blood flow exists between crossing and noncrossing staple lines, it is most likely less than 30 percent(P<0.001) for both small bowel and colonic anastomoses. This experimental study demonstrates that intersecting staple lines in small bowel and colonic anastomoses do not reduce anastomotic blood flow to a dangerous level.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Some patients with rectal cancer who undergo exenterative surgery may require radiation therapy as an adjuvant treatment for recurrent or residual disease. A common devastating side effect of this treatment modality is radiation enteritis, a radiation‐induced small bowel injury. Hence, the prevention of such a complication is essential for both the surgeon and the radiation oncologist. A new surgical method using the posterior rectus sheath and peritoneum to partition the abdominal cavity at the level of the umbilicus to the sacral promontory seems to accomplish this purpose, keeping the small bowel away from the pelvic cavity. After removal of the rectal lesion [eight abdominoperineal resections (APRs), nine Hartmann's procedures, and one low anterior resection (LAR)] in 18 patients with rectal cancer, this new surgical procedure was performed. One of the patients had an early postoperative intestinal obstruction, and all but one of the patients received postoperative adjuvant radiation therapy. In addition, a small bowel series was performed before the radiation therapy and six months and one year after surgery. Upon examination, most of these patients still had their small bowel kept intact in the abdominal cavity. During the follow‐up period of 10 months to 2 years with an average of 18 months, two late complications of intestinal obstruction were noted. Exploratory laparotomy of these two patients revealed radiation enteritis of the small bowel. Therefore, the failure rate of the following procedure is 12 percent, since 2 of the 17 patients received small bowel injury. Although the follow‐up period for this surgical method is short, the results have encouraged us to continue the use of this procedure on advanced rectal cancer patients who require postoperative radiation therapy.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;This study explores the role of sutures and the healing colonic wound in experimental carcinogenesis. One hundred sixty rats underwent surgery with colotomy and repair using silk, steel, or Vicryl®(Ethicon, Somerville, NJ) sutures or a sutureless technique. Forty rats had a sham procedure. All animals received azoxymethane for 12 weeks at a dose of 10 mg/kg/week. Half the rats commenced carcinogen before surgery, and half commenced it eight weeks after surgery. Animals with anastomotic tumors were found in 46 percent of the sham group(P<0.05cf.sutured), 41 percent of the sutureless group(P<0.02cf.sutured), and 68 percent of the sutured group. The corresponding figures for anastomotic carcinoma were 9 percent(P<0.001cf.sutured), 22 percent, and 38 percent. No significant differences in tumor yield were noted among the different sutures. However, several differences were noted between the two carcinogen models. In those animals that received surgery first, there was a higher incidence of anastomotic tumors(P<0.002) and cancers(P<0.0001) in the sutured and sutureless groups, and those tumors that occurred in the sutured group were considerably larger than in those that had carcinogen first (15.9 mmcf.4.9 mm;P<0.0001). Overall, all sutures seem to enhance anastomotic tumor formation, and we would suggest that a sutureless anastomosis may diminish this risk.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The laparoscopic vascular stapler facilitates bidirectional stapling and division of the pelvic attachments and hepatic veins.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Attempting proctoscopic placement of a rectosigmoid stent is proposed as a first step in treating obstructing rectosigmoid neoplasms. If stent placement is successful, elective colon resection can be performed following treatment of any coexisting medical problems that would complicate an emergency colon resection and after routine mechanical bowel preparation.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID