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1.
Urol Clin North Am ; 48(1): 25-33, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218591

RESUMO

"Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."


Assuntos
Biópsia/métodos , Biópsia Guiada por Imagem/métodos , Próstata/patologia , Neoplasias da Próstata/patologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Biópsia/efeitos adversos , Biópsia/tendências , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/tendências , Imagem por Ressonância Magnética , Masculino , Períneo/cirurgia , Próstata/cirurgia , Neoplasias da Próstata/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Ultrassonografia
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1144-1148, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353267

RESUMO

Colorectal surgeons have focused on the lateral structure of rectum for a long time and lateral ligament is the common term to depict this structure. A better understanding of lateral rectal structure could be beneficial to performing the total mesorectum excision (TME) procedure and protecting patients' urinary, sexual and defecation function. The main controversies focus on two aspects: (1) Does the lateral ligament exist? (2) What dose it contain? Does the middle rectal artery exist? Up to now, anatomic studies have failed to reach consensus on the lateral rectal structure. However, surgeons do find the lateral rectal ligament during surgery and it may be the pathway for lateral lymph node metastasis in rectal cancer. The lateral rectal structure contains the middle rectal artery, nerve branches, lymphatics and adipose fibrous tissue around them. We summarize our clinical experience and conclude that the middle rectal artery appears in lateral ligament constantly but some of them are too small to be easily observed. Therefore, regarding the perspective of membrane anatomy, embryology and surgery, this structure may be more appropriate to be called the "lateral mesorectum". We propose this new term based on the previous literature and our own experience for the readers' reference.


Assuntos
Ligamentos/anatomia & histologia , Artéria Mesentérica Inferior/anatomia & histologia , Mesentério/anatomia & histologia , Neoplasias Retais , Reto/anatomia & histologia , Humanos , Ligamentos/irrigação sanguínea , Ligamentos/cirurgia , Linfonodos/anatomia & histologia , Linfonodos/cirurgia , Artéria Mesentérica Inferior/cirurgia , Mesentério/irrigação sanguínea , Mesentério/cirurgia , Pelve/anatomia & histologia , Pelve/cirurgia , Neoplasias Retais/cirurgia , Reto/irrigação sanguínea , Reto/cirurgia
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1149-1154, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353268

RESUMO

Anastomotic bleeding is a common complication after colorectal surgery, mainly manifesting as continuous or intermittent bloody stool. The risk factors for anastomotic bleeding mainly include suboptimal surgical skill, surgical methods (such as laparoscopic anastomosis), close distance between the tumor and the anal margin, benign colorectal diseases, anastomotic leakage after colorectal surgery, severe pelvic and abdominal infections, and the patient's own condition, etc. Anastomotic bleeding can be prevented by standardized operation and intraoperative endoscopic examination. Anastomotic bleeding is mostly a self-limited disease, which can be cured by conservative treatments such as fluid resuscitation, blood transfusion and endoscopic treatment. When serious anastomotic bleeding threatens the life of patients, surgical treatment should be taken into consideration decisively.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório , Hemorragia Gastrointestinal/prevenção & controle , Laparoscopia , Fístula Anastomótica/etiologia , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Laparoscopia/efeitos adversos , Reto/cirurgia , Fatores de Risco
4.
Can J Surg ; 63(5): E460-E467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107814

RESUMO

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols use evidence-based perioperative practices that reduce morbidity and length of stay and improve patient satisfaction. ERAS is considered standard of care; however, utilization remains low and substantial practice variation exists. The aim of this study was to pragmatically characterize variation in colorectal surgery practice and identify predictors of ERAS utilization. METHODS: A survey of general surgeons identified using the Ontario College of Physicians and Surgeons database was conducted. Information on basic demographic characteristics, utilization of ERAS and predictors of ERAS implementation was collected. Nine ERAS behaviours were analyzed. Multivariable analysis was used to determine effects of demographic, hospital and surgeon covariates on ERAS utilization. RESULTS: Seven hundred and ninety-seven general surgeons were invited to participate in the survey, and 235 general surgeons representing 84 Ontario hospitals responded (30% response rate). Surgeons practising in academic settings and in large community hospitals represented 30% and 47% of the respondents, respectively. A total of 20% of the respondents used all 9 ERAS behaviours consistently. Rates of diet advancement on postoperative day 0, intravenous fluid restriction and having catheter and line procedures were significantly higher among respondents who adhered to ERAS protocols than among those who did not (74% v. 54%, p = 0.004; 92% v. 80%, p = 0.01; and 91% v. 41%, p < 0.001, respectively). Respondents from academic settings reported practising nearly 1 more ERAS behaviour than those from small community hospitals (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.42 to 1.31, p < 0.001). Multivariable analysis demonstrated that colorectal fellowship training or exposure to ERAS during training did not significantly affect ERAS behaviour utilization (OR 0.32, 95% CI -0.31 to 0.94, p = 0.16; OR 0.28, 95% CI -0.26 to 0.82, p = 0.16, respectively). CONCLUSION: Substantial practice variation in colorectal surgery still exists. Individual ERAS principles are commonly followed; however, ERAS behaviours are not widely formalized into hospital protocols.


Assuntos
Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada/normas , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Reto/cirurgia , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Protocolos Clínicos/normas , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Comunitários/normas , Hospitais Comunitários/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ontário , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Padrões de Prática Médica/normas , Padrão de Cuidado , Cirurgiões/normas , Inquéritos e Questionários/estatística & dados numéricos
5.
Can J Surg ; 63(5): E475-E482, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107818

RESUMO

BACKGROUND: American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS: We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS: Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION: Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Doenças Retais/cirurgia , Carga de Trabalho/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colo/cirurgia , Doenças do Colo/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Novo Brunswick/epidemiologia , Razão de Chances , Complicações Pós-Operatórias/etiologia , Doenças Retais/mortalidade , Reto/cirurgia , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
6.
Arq Bras Cir Dig ; 33(2): e1504, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844877

RESUMO

BACKGROUND: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option for treating patients with haemorrhoidal disease. However, there is still controversy with regard to its efficacy for more advanced grades. AIM: To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades. METHOD: Seven hundred and five consecutive patients with Goligher's grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres. Six well-trained and experienced surgeons operated on the patients. Average follow-up was 21 months (12-48). RESULTS: Intraoperative complications were observed in 1.1% of cases, including four cases of haematoma, two of laceration of the mucosa, and two of bleeding. All of these were controlled by means of haemostatic suturing. In relation to postoperative complications, the most common of these were as follows: transitory tenesmus (21.4%); pain (7.2%); mucosal or haemorrhoidal prolapse (6.4%); residual skin tag (5.6%); faecal impaction (3.2%); haemorrhoidal thrombosis (2.8%); bleeding (2.1%); anal fissure (0.7%); and anal abscess (0.3%). Most of the complications were treated conservatively, and only 7.5% (53/705) required some type of surgical approach. There was no mortality or any severe complications. The recurrence of prolapse and bleeding was greater in patients with grade IV haemorrhoidal disease than in those with grade III and II (26.54% and 7.96% vs. 2.31% and 0.92% vs. 2.5% and 1.25%), respectively. CONCLUSION: The THD-M method is safe and effective for haemorrhoidal disease grades II and III with low rates of surgical complications. However, for grade IV hemorrhoids, it is associated with higher recurrence of prolapse and bleeding. So, THD-M method should not be considered as an effective option for the treatment of grade IV hemorrhoids.


Assuntos
Canal Anal/irrigação sanguínea , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Hemorroidas/cirurgia , Reto/irrigação sanguínea , Canal Anal/cirurgia , Artérias , Brasil , Hemorroidectomia , Hemorroidas/classificação , Humanos , Ligadura/métodos , Reto/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
7.
Nat Commun ; 11(1): 4308, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32855399

RESUMO

Distant metastasis (DM) is the main cause of treatment failure in locally advanced rectal cancer. Adjuvant chemotherapy is usually used for distant control. However, not all patients can benefit from adjuvant chemotherapy, and particularly, some patients may even get worse outcomes after the treatment. We develop and validate an MRI-based radiomic signature (RS) for prediction of DM within a multicenter dataset. The RS is proved to be an independent prognostic factor as it not only demonstrates good accuracy for discriminating patients into high and low risk of DM in all the four cohorts, but also outperforms clinical models. Within the stratified analysis, good chemotherapy efficacy is observed for patients with pN2 disease and low RS, whereas poor chemotherapy efficacy is detected in patients with pT1-2 or pN0 disease and high RS. The RS may help individualized treatment planning to select patients who may benefit from adjuvant chemotherapy for distant control.


Assuntos
Antineoplásicos/uso terapêutico , Nomogramas , Protectomia , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Adulto , Idoso , Quimioterapia Adjuvante/estatística & dados numéricos , Conjuntos de Dados como Assunto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/prevenção & controle , Estadiamento de Neoplasias , Planejamento de Assistência ao Paciente , Seleção de Pacientes , Radioterapia Adjuvante/estatística & dados numéricos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 438-444, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842421

RESUMO

Presacral recurrent rectal cancer which involves the presacral fascia and/or sacral bone is one subtype of locally recurrent rectal cancer. Presacral recurrent rectal cancer is fixed posteriorly to the pelvis due to presacral fascial and/or sacral bone involvement, which makes treatment difficult. There is lack of standardized diagnosis, treatment and surgical methods of presacral recurrent rectal cancer. The purpose of this expert consensus is to improve the understanding of this condition among Chinese specialists, and to help standardizing the diagnosis and therapeutic strategies for presacral recurrent rectal cancer. There are 17 statements on diagnosis (clinical symptoms, imaging, endoscopy, tumor marker detection and pathological biopsy), treatment (radiotherapy, chemotherapy and surgery), follow-up and prognosis for presacral recurrent rectal cancer. It is emphasized that radical surgery with the evaluation of multidisciplinary team (MDT) is the core method for the treatment. The choice of surgical approach should be based on the anatomic characteristics of presacral recurrence. The controversial issues in this consensus requires to further high-quality clinical research.


Assuntos
Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/terapia , Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia , China , Consenso , Humanos , Reto/cirurgia , Sacro/cirurgia
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 445-450, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842422

RESUMO

Presacral recurrent rectal cancer (PRRC) which involves the presacral fascia or/and sacral bone is one of the classification of locally recurrent rectal cancer. Presacral fascia or/and sacral bone involvement and posterior fixation make treatment difficult. In recent years, there are many researches on the diagnosis, surgical treatment and surgical methods of PRRC. The major therapeutic principle of PRRC is to perform radical resection with combined therapy under the evaluation of the multidisciplinary team (MDT). Among the surgical methods, abdominal resection or abdominoperineal resection, sacrectomy and abdominosacral resection are the common surgical methods for the treatment of PRRC. Recent articles revealed that limited sacrectomy could also result in good efficacy, provided strict indications for this procedure. With the development of minimally invasive technology, the application of laparoscopic technology in PRRC has been increasingly emphasized. In summary, the surgical principle of PRRC has shifted from solely pursuring radical resection to obtaining good efficacy as well as reduced morbidity with individualized management. In this article, the research progress of surgical methods of presacral recurrent rectal cancer in recent years are reviewed in order to provide reference to clinical diagnosis and treatment.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Reto/cirurgia , Sacro/cirurgia , Humanos , Protectomia , Resultado do Tratamento
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 480-485, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842428

RESUMO

Objective: To identify the factors associated with successful transrectal specimen extraction after laparoscopic rectal cancer resection. Methods: A retrospective case-control study was conducted. Clinical data of rectal cancer patients who did or did not successfully undergo transrectal specimen extraction in Shanghai East Hospital between January 2017 and December 2017 were retrieved through the rectal cancer database of Shanghai East Hospital. Case inclusion criteria: (1) tumor size ≤7 cm by pelvic MRI; (2) body mass index (BMI)≤ 30 kg/m(2); (3) no history of neoadjuvant chemoradiotherapy; (4) no anal stenosis. Clinical data including age, gender, BMI, tumor obstruction, distance from tumor to anal verge, history of abdominal operation, maximal diameter of tumor and width of mesorectum in the anteroposterior dimension measured by pelvic MRI, etc. were collected. The χ(2) test was used to perform univariate analysis. Multivariate logistic regression was used to identify factors affecting transrectal specimen extraction. Results: A total of 208 patients were included in the analysis. Of 208 patients, 132 were men and 76 were women; mean age was (63±11) years old and median tumor size was 3.8 (IQR, 3.0 to 5.0) cm. Sixty-six (31.7%) patients completed transrectal specimen extraction successfully. Univariate analysis showed that patients who completed transrectal specimen extraction were more likely to have a lower BMI (χ(2)=7.420, P=0.006), be free from malignant obstruction (χ(2)=8.972, P=0.003), have a shorter distance from tumor to the anal verge (<5.0 cm) (χ(2)=14.960, P<0.001), a smaller tumor size (≤5.0 cm) (χ(2)=18.495, P<0.001) and a thinner mesorectum in the anteroposterior dimension (≤6.0 cm) (χ(2)=34.612, P<0.001) than those who failed to perform transrectal specimen extraction. Gender, age or history of abdominal operation were not associated with the successful extraction (all P>0.05). Multivariate analysis revealed that BMI ≤25.0 kg/m(2) (OR=2.32, 95% CI: 1.06 to 5.06, P=0.034), free from malignant obstruction (OR=3.01, 95% CI: 1.82 to 6.69, P<0.001), the distance from tumor to the anal verge <5.0 cm (OR=3.73, 95% CI: 1.22 to 11.43, P=0.021), tumor size ≤ 5.0 cm (OR=4.43, 95% CI: 1.39 to 14.09, P=0.012), and the anteroposterior width of mesorectum ≤ 6.0 cm (OR=4.30, 95% CI: 2.02 to 9.18, P<0.001) were independent protective factors for successful transrectal specimen extraction. Conclusion: Preoperative assessment of BMI, malignant obstruction, distance from tumor to the anal verge, tumor size and anteroposterior width of mesorectum is beneficial to choose appropriate patients with rectal cancer to undergo transrectal specimen extraction.


Assuntos
Cirurgia Endoscópica por Orifício Natural , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Idoso , Estudos de Casos e Controles , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proctoscopia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
13.
J Gastrointest Cancer ; 51(3): 800-804, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32656628

RESUMO

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Neoplasias Retais/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Betacoronavirus/isolamento & purificação , Quimioterapia Adjuvante/normas , Tomada de Decisão Clínica , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Controle de Infecções/normas , Irã (Geográfico)/epidemiologia , Oncologia/métodos , Terapia Neoadjuvante/normas , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Protectomia/normas , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia
14.
Updates Surg ; 72(3): 793-800, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32632764

RESUMO

According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.


Assuntos
Quimiorradioterapia Adjuvante , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Linfonodos/patologia , Metástase Linfática/patologia , Metástase Linfática/terapia , Terapia Neoadjuvante , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 634-642, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683822

RESUMO

There has been an upsurge of the theory of membrane anatomy in China, but it is still in the initial stage of establishing preliminary framework. The concept of fasciae in membrane anatomy actually refers to the fasciae constituting the particular plane or the 'holy plane'. Therefore, the membrane anatomy can't simply be defined as the anatomical relationship among fascia. The application of the membrane anatomy is also not just to pursue the avascular plane in the surgical field. Nowadays, nonstandard anatomical terms and diversification of views impede the development of the theory of the membrane anatomy. Fasciae occur in embryonic stage, undergo a series of changes in rotation and fusion, and lose the original features, which bring difficulties in understanding the anatomy of fasciae. In this paper, we restore the origin and continuity of fasciae related to the colorectal surgery by cadaveric study, surgical observation and literature review. Taking the TME for example, we also discuss the core content about the fasciae and plane related to 'mesenteric envelope' and complete mesorectal excision. From the perspective of the fasciae integrity, we illustrate the definitions of important anatomical structure and standardized the terminology of fasciae. To study the origin and architecture of fasciae in the view of embryology, integrity and continuity will contribute to establish the standard theoretical system of membrane anatomy.


Assuntos
Fáscia/anatomia & histologia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Cadáver , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fáscia/irrigação sanguínea , Fáscia/embriologia , Humanos , Mesentério/irrigação sanguínea , Mesentério/embriologia , Reto/cirurgia , Membrana Serosa/anatomia & histologia , Membrana Serosa/irrigação sanguínea , Membrana Serosa/cirurgia
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 666-669, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683828

RESUMO

Total mesorectal excision (TME) has been advocated as the golden standard of mid-low rectal cancer surgery for nearly 30 years. However, the complication of postoperative urinary and sexual dysfunctions due to intraoperative nerve injury has yet to be improved. Based on the concept of membrane anatomy, we carried out a systematic study on the important membrane anatomical structure anterior to the rectum--Denonvilliers' fascia. From multiple aspects including anatomy, physiology, histochemistry and surgical practice, we verified the importance of Denonvilliers' fascia for TME surgery in prevention of intraoperative nerve injury and postoperative urogenital dysfunction. Moreover, based on anatomical study of the surgical marker line of Denonvilliers' fascia (Wei's line) and surgical plane, we proved that total mesorectal excision with preservation of Denonvilliers' fascia (iTME) was feasible and practical. Therefore, we conducted a large multicentric randomized controlled trial (RCT). The mid-term result demonstrated that compared with traditional TME surgery, iTME was more effective in reducing the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer, without sacrifice of short-term tumor radical outcome. We believe that the final RCT result of iTME, based on membrane anatomy, will provide solid evidence for the update of concepts of rectal cancer surgery.


Assuntos
Fáscia/anatomia & histologia , Mesentério/cirurgia , Protectomia/efeitos adversos , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Humanos , Masculino , Mesentério/anatomia & histologia , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Peritônio/anatomia & histologia , Reto/anatomia & histologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Doenças Urológicas/etiologia , Doenças Urológicas/prevenção & controle
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 670-675, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683829

RESUMO

The introduction of total mesorectal excision and wider use of laparoscopic surgery pushed the field of colorectal surgery into an era of interfasical dissection. The Japanese suggestion of fascial arrangement of the trunk in a multilaminar, symmetrical and parallel way helps in better understanding of fascial relationship and interfascial planes surrounding the colon and the rectum. However, different interpretations of the multilayer retroperitoneal fascial relationship, complexity of fascial structures within the pelvis and dense adhesion between two apposed fasciae at special points make it still challenging for the surgeon to decide on the precise interfascial plane for colorectal mobilization. Small vessels on fasica propria of the rectum and various retroperitoneal fascia, especially ureterohypogastric fascia show distinctive features. The root of small vessels on fascia propria of the rectum helps to identify the anterolateral and posterolateral interfascial plane in the middle and low rectum. The longitudinal trajectory of small vessel on ureterohypogastric fascia and scarcity interfascial vascular communication between mesocolic and retroperitoneal fascia help the surgeon to find and stay in the interfacial plane during colorectal mobilization. More knowledge of fascial and interfascial plane will certainly help achieve better mesocolic mesorectal integrity and reduce the risk of injuries to autonomic nerves. More anatomical, histological and embryological studies are warranted with respect to relationship between small vessels and fasciae.


Assuntos
Neoplasias do Colo/cirurgia , Fáscia/anatomia & histologia , Mesentério/cirurgia , Neoplasias Retais/cirurgia , Colectomia/efeitos adversos , Colectomia/métodos , Colo/anatomia & histologia , Colo/cirurgia , Dissecação , Fáscia/irrigação sanguínea , Humanos , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Peritônio/anatomia & histologia , Peritônio/irrigação sanguínea , Peritônio/cirurgia , Protectomia/efeitos adversos , Protectomia/métodos , Reto/anatomia & histologia , Reto/cirurgia
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 689-694, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683831

RESUMO

Objective: To observe the anatomical architecture of rectosacral fascia and discuss the best plan for accurate peri-rectal dissection in laparoscopic/robotic total mesorectal resection (TME). Methods: A descriptive cohort study was carried out. A total of 127 patients with rectal cancer who underwent TME in the Department of Colorectal Surgery at the affiliated Union hospital of Fujian Medical University were included, patients' demographics with their pathological details and operation videos were collected for analysis. Another 20 high-definition images of post-TME surgical specimens were collected from our digital database. A total of 28 cadaveric models were examined at the Laboratory of Clinical Applied Anatomy, Fujian Medical University, to observe the anatomical details of rectosacral fascia. Results: (1) Anatomical observation showed that the pre-hypogastric fascia attaches to the proper fascia of the mesorectum in a horizontal arc posteriorly, forming the rectosacral fascia. If this fusion couldn't be identified and appropriately transected during posterior space dissection, it would be easy to destroy the proper fascia and dissect through the mesorectum resulting in residual mesorectum tissue. After the fascia transaction, the proper fascia of the mesorectum is still intact distally. The upper part of rectosacral fascia bilaterally re-separated again into the proper fascia and pre-hypogastric fascia. The pre-hypogastric fascia acts as a "fascia barrier" when dissecting the lateral space constantly from posterior to anterior. The right attachment of the rectosacral fascia was gradually transected. The pelvic plexus from the right S2-S4 was covered by the pre-hypogastric fascia which is considered the outer side layer of rectosacral fascia laterally. It was observed that the fascia continued with the anterior layer of the Denonvilliers' fascia, which has been transected during anterior space dissection. The proper fascia, which is the inner side layer of rectosacral fascia laterally, was still intact. The edge of the right rectosacral fascia attachment ran obliquely from the back and upward into the front direction. The left extension was similar to the right. (2) Cadaveric specimens: at the level of the lower edge of S4 vertebral body, the pre-hypogastric fascia fused with the proper fascia to form the rectosacral fascia. The right attachment margin of the rectosacral fascia was cut off step by step. The attachment margin of the rectosacral fascia went from the back and upward to the front downward direction. The right edge of rectosacral fascia attachment continued with the anterior layer of the Denonvilliers' fascia at the pre-rectal space and attached to the pre-hypogastric fascia laterally. The pelvic plexus sends out many tiny rectal branches on the anterolateral side, which pass through the transitional area between pre-hypogastric fascia and the anterior layer of the Denonvilliers' fascia to innervate the rectum. (3) TME specimens observation: the posterior attachment of rectosacral fascia was curved around the mesorectum with bilateral oblique attachments. The mesorectum was covered by fusion fascia below the posterior and bilateral attachment margin while it was covered only by the proper fascia above it. Conclusion: according to the morphological characteristics of rectosacral fascia, the rectosacral fascia should be dissected at the level of S4 vertebral body posterior to the rectum in an arc, shape and then enter the superior-levator space. Before dissecting the bilateral spaces, the anterior space of the rectum should be dissected first. The anterior layer of the Denonvilliers' fascia should be cut off into an inverted "U" shape, and then the lateral space should be dissected from anterior to posterior. Finally, the lateral attachment of rectosacral fascia was transected to ensure the integrity of the mesorectum without damaging the pelvic plexus branches and NVB.


Assuntos
Fáscia/anatomia & histologia , Fasciotomia/métodos , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Cadáver , Estudos de Coortes , Dissecação , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Reto/anatomia & histologia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos , Sacro
19.
BMC Surg ; 20(1): 166, 2020 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-32711482

RESUMO

BACKGROUND: Anastomotic leakage (AL) is one of the most severe early complications after rectal cancer surgery. Many studies and meta-analysis results show that the indentation of transanal drainage tubes (TDT) can prevent and reduce the incidence of AL. However, the size and material of drainage tubes are rarely reported. Herein, we compare the effect of three kinds of TDT and analyze the use of TDT material and size to prevent AL, which may better prevent the occurrence of AL. METHODS: The clinical data of 182 patients who underwent laparoscopic anterior resection of rectal cancer were retrospectively analyzed between January 2016 and March 2019. According to the types of indwelling TDT after the operation, they were divided into Fr32 silicone tubes (81 cases), Fr24 silicone tubes (54 cases), Fr24 latex tubes (47 cases). The first drainage, exhaust, defecation, abdominal distension and anastomotic leakage of the patients with three different types of TDT were compared. RESULTS: There was no significant difference in the degree of first exhaust, abdominal distension and anastomotic leakage among three different types of TDT; the time of first drainage and defecation of the Fr32 silicone tube was significantly earlier than that of Fr24 silicone tube and Fr24 latex tube. CONCLUSION: The drainage effect of the Fr32 silicone tube is better than that of Fr24 silicone tube and Fr24 latex tube after anterior resection for rectal cancer, Fr32 silicone may better prevent the occurrence of AL, but randomized controlled studies are needed.


Assuntos
Fístula Anastomótica/prevenção & controle , Drenagem/instrumentação , Protectomia/métodos , Neoplasias Retais , Canal Anal/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Estudos Retrospectivos
20.
Zhonghua Wai Ke Za Zhi ; 58(8): 596-599, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727189

RESUMO

Radical resection is one of the most important treatment for rectal cancer, which requires not only removal of adequate bowel and mesorectum around the tumor, but also thorough lymphadenectomy. Besides, postoperative complications are surgeons' concerns as well. According to different ways to manage inferior mesenteric artery, procedures could be divided into two groups: inferior mesenteric artery (IMA) high ligation and low ligation, which lead to various outcomes of the extent of lymph nodes dissection, survival, preservation of intestinal blood supply, incidence of anastomotic leakage, and postoperative functions including defecation function, urinary function and sexual function. Author believes that for those patients with clinical stage T1, low ligation and D2 lymph nodes dissection could be considered. However, for patients with locally advanced carcinomas (clinical stage T2+or N+), especially suspicious metastasis of lymph nodes around IMA root, high ligation and D3 lymph node dissection is suggested to ensure en bloc resection. As for those patients with high risks for compromised intestinal blood supply, preservation of left colic artery plus D3 lymph nodes dissection might be a feasible way. Intraoperative indocyanine green fluorescent imaging might play a role in quality control of lymphadenectomy.


Assuntos
Artéria Mesentérica Inferior/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Colo/irrigação sanguínea , Colo/cirurgia , Humanos , Ligadura/métodos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Mesentério/irrigação sanguínea , Mesentério/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/irrigação sanguínea , Reto/irrigação sanguínea , Reto/cirurgia
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