Advances in colonic manometry in adults with colonic motility disorders / 中华胃肠外科杂志

In recent years, colonic manometry has been gradually introduced into clinical practice. It helps clinicians to gain a better understanding of the physiology and pathophysiology of colonic contractile activity in healthy adults and patients with colonic dysfunction. More and more patterns of colonic motility are being discovered with the help of colonic manometry. However, the clinical significance of these findings still needs to be further investigated. This review enhances our understanding of colonic motility and the current state of development and application of colonic manometry, as well as the limitations, future directions and potential of the technique in assessing the impact of treatment on colonic motility patterns, by analyzing and summarizing the literature related to colonic manometry.

Clinicopathological features and risk factors of neuroendocrine tumors in 256 patients / 天津医药

Objective To investigate the epidemiology, clinical manifestations, diagnosis, treatment and prognosis of neuroendocrine tumors (NETs). Methods Medical records of 265 patients with neuroendocrine tumors diagnosed and treated in our hospital from January 2006 to August 2015 were collected and retrospectively reviewed in this study. The clinicopathological data including gender, age of onset, initial symptoms, primary site, pathological conditions, diagnosis, treatment, prognosis and follow up were analyzed. Results The gender ratio M/F of the 265 cases was 160:105 (1.5:1), with mean age of (55.8±2.7) years, and the high incidence was in age of 55-65 years. The tumors were located in the colon and rectum (127 cases, 47.9％), lung (59 cases, 22.3％), stomach (21 cases, 7.8％), appendix (15 cases, 5.7％), small intestine (especially in the duodenum and pancreas, 10 cases, 3.8％), mammary gland (11 cases, 4.2％), neck (10 cases, 3.8％) and unknown primary site (12 cases, 4.5％). Patients with different tumor sites showed different symptoms. Patients with colorectal tumors mainly manifested as changes in bowel habits, such as diarrhea, constipation and blood in stool. The main manifestation of patients with primary pulmonary symptoms was cough or bloody sputum. The patients with tumors at stomach, appendix or small intestine showed many discomfort, such as abdominal pain and abdominal distention. Among the 265 cases, 186 patients were diagnosed as phase G1 (70.2％), 54 patients were diagnosed as phase G2 (20.4％) and 25 patients were diagnosed as phase G3 (9.4％). Immunohistochemistry showed that synaptophysin (Syn) was positive in 228 cases (86.4％), chromaffin A (CgA) was positive in 102 cases (38.5％), and C56 was positive in 74 cases (27.9％). A total of 232 patients were treated with surgery (87.5％), 28 patients received radiotherapy or chemotherapy treatment (10.6％) and 5 patients were not treated. One hundred and ninety-eight patients were followed up at least 1 time, and the follow-up rate was 74.7％. The median follow-up time was 38 months. No tumor related death was found in patients with phase G1 during the follow-up, 6 cases of tumor associated death were found in patients with phase G2 and 19 cases of cancer related death were found in patients with phase G3. Metastasis was found in all 23 patients with tumor related death. The survival rate of patients with neuroendocrine tumor (G1+G2) was significantly higher than that of patients with neuroendocrine carcinoma (G3, Log rankχ2=13.774,P<0.01). Conclusion The males have a higher incidence rate of NETs than females. Patients with different tumor sites showed different symptoms. The most common primary sites of NETs are the digestive tract, especially in patients with colorectal cancer. The more late the pathological stage, the worse the prognosis.

Efficacy of Cranial Electrotherapy Stimulation Combined with Biofeedback Therapy in Patients with Functional Constipation

BACKGROUND/AIMS: A large number of studies have shown that function constipation (FC) has an extremely high incidence of mental and psychological disorders. Cranial electrotherapy stimulation (CES) was applied to the treatment of psychological disorders such as anxiety and depression. We explored the effects of CES combined with biofeedback therapy (BFT) on the psychological state, clinical symptoms, and anorectal function in patients with FC. METHODS: A total of 74 patients with FC were randomly divided into 2 groups. The control group received BFT. CES combined with BFT was carried out in the experiment group. All patients were assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Wexner constipation score at baseline and the end of each course. Anorectal manometry and balloon expulsion tests were performed before and after treatment. RESULTS: After treatment, the participants in the experiment group had significantly lower score SAS, SDS, and Wexner constipation scores than the control group (all P < 0.05). The number of successful expulsion in the experiment group was larger than the control group (P = 0.016). CONCLUSIONS: CES combined with BFT was effective in improving the psychological status of anxiety, depression, and bowel symptoms in patients with FC.

Risk factors associated with stress ulcer bleeding in postoperative rectal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the influence factor of stress ulcer bleeding(SUB) in postoperative rectal cancer patients.</p><p><b>METHODS</b>Clinical data of rectal cancer patients undergoing operation in our hospital were analyzed retrospectively. Patients were divided into case group and control group according to the postoperative occurrence of SUB. Univariate analysis combined with multivariate analysis were used to evaluate the influence factors.</p><p><b>RESULTS</b>Chronic diseases incidence of case group was higher than that of control group. Except for renal failure, the incidence of postoperative complications of case group was higher than that of control group. Univariate analysis revealed that age, chronic disease, preoperative, and postoperative complications had statistical significant differences(P<0.05). Multivariate analysis identified that age(OR=2.893, 95%CI:1.118-5.543), drinking history(OR=3.839, 95%CI:1.012-6.654), preoperative chronic disease(OR=4.646, 95%CI:1.872-8.892), intraoperative bleeding volume(OR=5.129, 95%CI:2.829-9.328), occurrence of severe complications after surgery(OR=6.576, 95%CI:4.539-13.278), postoperative application of glucocorticoid(OR=2.978, 95%CI:1.013-4.512), preoperative application of non-steroidal anti-inflammatory drugs(OR=2.126, 95%CI:1.287-7.636) were risk factors for SUB in rectal cancer patients after operation. Postoperative prophylactic use antacids(OR=0.102, 95%CI:0.017-0.196) was protective factor for SUB patients.</p><p><b>CONCLUSION</b>Effective measures should be taken for high-risk patients, in order to improve the prognosis of patients.</p>

Experience of laparoscopic total mesorectal excision for middle or low rectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the feasibility and safety of laparoscopic surgery for middle or low rectal cancer.</p><p><b>METHODS</b>83 patients with middle or low rectal cancer received laparoscopic surgery and 85 patients received conventional open surgery. The cutting edge of specimens and number of lymph nodes were analyzed retrospectively.</p><p><b>RESULTS</b>The mean distance between resected margin and the tumor was 3.21 +/- 1.25 cm in laparoscopic operation group, while it was 1.15 +/- 1.11 cm in the open surgery group (P = 0.001). The mean number of disected lymph nodes was 12.53 +/- 1.88 in the laparoscopic operation group and 10.85 +/- 1.81 in the open operation group (P = 0.01). The incidence of postoperative complications was 12.0% in the laparoscopic operation group and 23.5% in the open operation group (P = 0.026). The mean time of food intake and using analgesics after surgery were 2.43 +/- 1.06 days and 2.53 +/- 1.01 days, respectively, in the laparoscopic operation group, while the corresponding figures were 3.67 +/- 1.13 days and 4.55 +/- 1.78 days, respectively, in the open operation group (P = 0.005, P = 0.008).</p><p><b>CONCLUSION</b>Laparoscopic surgery is a safe and effective procedure for middle or low rectal cancer, with less postoperative complications and better recovery after treatment.</p>

Efficacy of postoperative chemoradiation for stage III low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of postoperative chemoradiation for stage III low rectal cancer.</p><p><b>METHODS</b>A total of 132 patients with stage III low rectal cancer, including 69 males and 63 females, were identified and divided into two groups: group A received chemoradiation while group B underwent chemotherapy alone.</p><p><b>RESULTS</b>Eighteen patients developed local recurrence after five years of follow-up, with 6 cases(8.3%) in group A and 12(22.2%) in group B(P<0.05). In patients with distant metastasis(n=65), 37(47.4%) were in group A and 28(51.9%) in group B, and the difference was not statistically significant(P>0.05). The 5-year survival rates for group A and group B were 47.4% and 29.6%, respectively(P<0.05). Radiation proctitis was found in 6 cases in group A.</p><p><b>CONCLUSIONS</b>Postoperative chemoradiation can reduce local recurrence rate and improve 5-year survival compared to chemotherapy alone. However, it has little effect on the distant metastasis. Postoperative chemoradiation is safe and effective for low rectal cancer.</p>