摘要:

&NA;In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long‐term survivors, 71 remain disease‐free through the last follow‐up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1‐cm margin, and 17 of whom had a greater than 1‐cm margin. Eighty‐one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primarycarcinoma. The disease‐free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five‐year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five‐year disease‐free survivors are also present in each of these subsets. It is concluded that five‐year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;An animal study was done to evaluate the safety of a sutureless colorectal anastomosis in irradiated bowel. Forty mongrel dogs received preoperative radiation with 5000 rads and then underwent a low anterior resection and anastomosis using either the EEA‐31™stapling device, a two‐layer handsewn technique, or the biofragmentable anastomotic ring (BAR) 31‐1.5 mm and BAR 31‐2.0 mm devices. The anastomoses were then evaluated for early and late anastomotic healing and leaks. The results show four radiographic (three clinical) leaks (P<.05) in the BAR 31‐1.5 mm group and one radiographic leak in the handsewn group. No leaks were detected in the EEA or BAR 31‐2.0 mm groups. Results indicate that all three techniques can be done safely with this dose of radiation, and gap size (1.5 mmvs.2.0 mm) is of critical importance when performing a BAR anastomosis in irradiated bowel.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;A retrospective review was undertaken to determine factors important in predicting functional results following the ileal reservoir and ileoanal anastomosis procedure. One hundred seventy‐nine patients underwent ileal reservoir and ileoanal anastomosis at the University of Toronto between December 1981 and January 1987. One hundred sixty‐three patients had ulcerative colitis, 11 had familial adenomatous polyposis, and five had Crohn's disease. A J‐reservoir was constructed in 72 patients and an S‐reservoir in 107 patients. Functional results were assessed in 102 patients who had had their loop ileostomies closed for more than one year. The most significant technical complications were anal anastomotic leaks (10 percent), reservoir anastomotic leaks (3.9 percent), anal anastomotic stricture (7.8 percent), late fistula‐inano (2.8 percent), small‐bowel obstruction (19 percent), and loop ileostomy complications (23 percent). Overweight males and patients with operative blood loss greater than 1000 cc developed anal stricture more frequently (P<.005). Patients who had a stapled J‐reservoir had a higher rate of reservoir leak. The average number of bowel movements reported by patients for 24 hours was 6.2±3.1. Only ten (9.8 percent) patients had to intubate their reservoir to empty it. Urgency was experienced by 24 patients and soilage at night by 23 (22.5 percent) and during the day by 18 (17.6 percent). Seven patients (6.8 percent) were incontinent during the night and only one during the day. Pouchitis was reported in 16 patients (15.7 percent). Patients with anal anastomotic stricture had more urgency and pouchitis, and had to intubate their reservoir more frequently (P<.05). No other factors analyzed affected technical or functional results.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small‐bowel damage. Animal experiments demonstrated tolerance to high‐dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow‐up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh‐related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;This report presents experience with a safe and effective form of treatment for anal fistulas that involve a significant portion of the sphincter mechanism. The technique includes removal of the involved crypt, closure of the internal opening with a sliding endorectal flap, and counter drainage of the fistula tract. This series includes eight patients treated over a five‐year period with a follow‐up of up to five years. This limited series had no complications and one case of early recurrence. Most of these patients had had previous failed attempts at correction of the fistula. The main advantage of this mode of treatment is preservation of the integrity of the sphincter muscle, thus avoiding the high risk of incontinence that is inherent especially with anteriorly located fistulas in females. It is proposed that, because it does not transect the sphincter anteriorly, this technique is safer than the placement of setons, as has been previously advised for management of anterior fistulas. The different treatment techniques for anal fistulas, including complications, recurrence rates, surgical techniques, and indications for types of management are reviewed.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;In a controlled, randomized study the effect of penicillin and streptomycin on postoperative septic complications in colorectal surgery (penicillin, 2 ml, IU, intramuscularly, three times daily for a period of six days and concomitantly streptomycin, 0.5 gm, intramuscularly, two times daily for a period of four days) was compared with the effect of cefotaxime, 2 gm, intravenously, three times on the day of surgery. One hundred patients completed the study: 48 were treated with penicillin and streptomycin (Group 1) and 52 with cefotaxime (Group 2). Wound infection occurred in one patient (2.1 percent) in Group 1, but not in Group 2 (0%, N.S.). Rupture of the wound occurred in one patient in each group (2.1 percentvs. 1.9 percent, N.S.). Insufficiency of the anastomosis occurred in four patients in Group 1 (8.3 percent) and in one patient in Group 2 (1.9 percent). It is concluded that short‐term prophylaxis with cefotaxime is as effective as long‐term prophylaxis with penicillin and streptomycin.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;In a prospective, randomized control trial, 152 consecutive patients requiring emergency or complicated colorectal surgery were allocated either to two doses of cefotetan or to five‐day cover with gentamicin, and a single dose of metronidazole. Twenty‐one patients received 6 gm of cefotetan before prolongation of prothrombin time dictated a change in the dose regimen such that all remaining patients (N=55) received only 4 gm of cefotetan. The groups were well matched for diagnosis and surgical procedure. Rates of postoperative infection did not differ significantly between the groups, with wound infection rates occurring in 17 of 75 patients receiving gentamicin and metronidazole (22.7 percent) compared with ten of 75 receiving cefotetan (13 percent). Although wound infection rates were lower in the cefotetan group, the incidence of intra‐abdominal abscess was similar in both groups. Eight patients receiving cefotetan developed intra‐abdominal abscesses (11 percent), compared with seven receiving gentamicin and metronidazole (9 percent). Prolongation of prothrombin time in excess of 13 seconds occurred in six patients receiving cefotetan compared with no patients receiving gentamicin and metronidazole. None of these patients developed clinical bleeding, however.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The clinical, laboratory, and pathologic data of 310 patients who had curative resections were prospectively collected and analyzed in a multiple step wise regression model. Although several factors (i.e., venous invasion) were of importance in univariate analysis, the following conclusions reflect the outcome and relative importance of the regression analysis only. Blood loss as an initial symptom and duration of symptoms were associated with a better prognosis. Location of the primary tumor, age, and sex did not appear to have prognostic value. Observations during operation such as palpable lymph nodes, fixity to adjacent organs, and tumor spill were related to a diminished tumor‐free survival. Laboratory data (hemoglobin, leukocytes, ESR, GGTP, SGOT, SGPT, LDH, total protein, CEA) were tested for their potential prognostic values. Only a preoperative low protein level or an elevated CEA level were associated with an increased risk of death due to recurrent tumor. The histopathologic features (stage and grade), with the exception of venous invasion, were of relative importance in the determination of prognosis. The aforementioned variables can be included in a prognostic index on the base of which high‐risk groups suitable for adjuvant studies can be identified.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Iron stores as estimated by serum ferritin concentration were studied in 40 patients subjected to colon surgery in reference to postoperative complications and restoration of iron stores, as well as to dietary and supplementary iron. The results showed that empty iron stores are common in patients subjected to colon surgery; 40 percent of the patients had a total loss before the operation. Preoperatively empty iron stores were associated (P<.01) with an increased risk of postoperative complications that were not explained by other nutritional parameters. Surgery of the colon did not affect serum ferritin concentration or iron stores acutely or long‐term. Intake of dietary iron was determined by food recording for seven days in all patients and was compared to 40 controls. The preoperative hemorrhagia and lower daily intake of dietary iron (8±3 mg) in the patients than in the controls (14±4 mg) may explain the empty iron stores. However, patients with normal iron stores also had low amounts of dietary iron (9±3 mg). In 12 patients with empty iron stores the effects of ferrous sulfate (80 mg Fe++) three times daily for six weeks were studied. The patients responded well to the therapy. It is concluded that preoperatively empty iron stores are common in patients subjected to colon surgery, and that this raises the risk of postoperative complications. Colon operations are not followed by acute or long‐term changes in serum ferritin concentration or iron stores. The restoration of iron is achieved by oral iron therapy.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Angiography using Prostaglandin El®was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG‐S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG‐S2, abnormality up to vasa recta; 3) AG‐S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG‐S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID