结直肠疾病英文.ppt

Colorectal Cancer,Colon Ca incidence: 105,500/US/yr Colon Ca mortality: 48,100/US/yr implies 45% colon Ca case mortality Rectal Ca incidence: 42,000/US/yr Rectal Ca mortality: 8,500/Us/yr implies 21% rectal Ca case mortality,Epidemiology,3Characteristics in china,Young,Lower location,ulceration,Ethiology,Dietary habits Precancous diseases Environment factors Heredity factors Other factors,Dietary habit,Heredity factors,Adenomatous polyposis syndromes (APS) Hereditary “Non-polyposis” Colon Cancer (HNPCC, Lynch syndrome) Familial Adenomatous Polyposis (FAP),Other factors,Anatomy,Arterial supply of the colon,Ileocolic artery Right colic artery Meddle colic artery Left colic artery Sigmoid arteries,Venous drainage of the colon,Superior mesenteric vein Inferior mesenteric vein Splenic vein Hepatic portal vein,Lymphatic drainage of the colon,Epicolic nodes Paracolic nodes Intermediate nodes Central nodes,Ileocecal region,Arterial supply of the rectum,Superior rectal artery Middle rectal artery Inferior rectal artery,Venous drainage of the rectum,Internal hemorrhoidal plexus External hemorrhoidal plexus,Rectal region,Model of colorectal carcinogenesis（90%） Nomal epithelium Heperproliferative epithelium Adenoma Carcinoma,病理生理,Pathology,Morphology,Protrude type Infiltrate type Ulceration type,Pathology Cytology,Carcinome Mucinous carcinoma carcinoide Undifferentiated carcinoma Squamous carcinoma,Route of metastasis,Route of metastasis,Infiltration direct lymphatic metastasis Hematogenous dissemination Implantation metastasis,Liver Metastasis,Implantation metastasis,Classification of Pathology,Dukes stages Dukes A、B、C、D TNM stages 、,DUKES Classification,Dukes Stages,Stage A: limited to mucosa and submucosa 90% Stage B: extends into muscularis or serosa 60-75% Stage C: one positive node - 69% six or more positive nodes, 27% Stage D: mets. to liver, bone, lung 5%,COLORECTAL CANCER SURVIVAL (Dukes Stages, 5 y),Stage Classification,Stage 0 Tis, N0, M0 Stage I T1, N0, M0 T2, N0, M0 Stage II T3, N0, M0 T4, N0, M0 Stage IIIAny T, N1, M0 Any T, N2, M0 Stage IV Any T, Any N, M1,Clinical findings,Hematochezia (distinct from melena) Change in bowel habit: alternating constipation and diarrhea. Obstipation to clinical lower bowel obstruction.,Anemia,Weight loss,Abdominal pain,FOBT,Mass,Fever,Anorexia,Location in right colon,Obstruction,Diarrhea,Location in left colon,Blood in feces,Constipation,Blood in stool,Change in normal bowel habits,Rectal examination,Cancer of rectum,Method of diagnosis,Digital examination Fecal occult blood Endoscope anoscope Flexible sigmoidoscope Electrical Colonoscope Air-contrast barium enema CEA othersCT、MRI、PET,Single contrast,Double contrast,Air-contrast barium enema,Endoscopes,Endoscopes,Colonoscopy,Colonoscopy,Colonoscopy,Colonoscopy,Rectal polyp,Rectal CA,CT ScanRectal tumor,Treatment,The main method is the operation,Operation of clolon,Right hemicolectomy Transverse colon resection Left hemicolectomy Sigmoide resection,Right hemicolectomy,Ileo-transversal anastomose Cecum Ascending colon Hepatic flexure of colon Terminal ileum 15cm Greater omentum Transverse colon LN of right gastroepiploic artery,Transverse colectomy,Ascendo-descending colon anastomose Hepatic flexure of colon Splenic flexure of colon Transverse colon Greater omentum Mesocolon LN of gastrocolic ligament,Radical correction of descending colon,Transversorectal anastomose Splenic flexure of colon Descending colo Sigmoid colon Parts of greater omentum Mesocolon,Radical correction of sigmoid colon,Descendorectal anastomose Parts of descending colon Sigmoid colon Superior extremity of rectum Mesocolon of sigmoid,Operation of rectum,Transanus Local resection (APR)-Miles (LAR)-Dixon Parks Reforming Bacon Hartmann Post-cavitas pelvis cleare Entire cavitas pelvis cleare,Radical correction of rectum,Dixon location 5cm dentate line Incisal margin 3cm,Abdominal Perineal Resection(Miles),Indication location 5cm Extent,Post-cavitas pelvis cleare,male female,Radical correction of rectum,Parks Reforming Bacon Hartmann,Complication,Hemorrhage anterosacrum Ureter injury Bladder injury Urine retention Sexual disturbance Stomal leak,Chemotherapy,Method systemic chemotherapy regional chemotherapy Medicin 5-FU、CF,Systemic Chemotherapy,Regional hepatic chemotherapy,Chemoport,Radiotherapy,External radiotherapy Internal radiotherapy,New adjuvant therapy,Sandwich,Chemotherapy + Radiotherapy,operation,Chemotherapy + Radiotherapy,Treatment indication,STAGE 0 Local excision with clear margins Large lesion not amenable to local excision STAGE 1 Wide surgical resection and anastomosis,Treatment indication,STAGE 2 Wide surgical resection and anastomosis Systemic or regional chemotherapy Radiation therapy Biologic therapy,Treatment indication,STAGE 3 Surgical resection and anastomosis Pre/Postoperative chemotherapy 5-FU/leucovorin 6 M 5FU/levamisol 12M Postoperative radiation therapy Biological therapy Alone or combination,Treatment indication,STAGE 4 Surgical resection/anastomosis or bypass Surgical resection of isolated metastases Chemotherapy Biologic therapy Radiation therapy,Postoperative follow up,CEA Colonoscopy Ultrasonography Computer Tomography Trans-Rectal UltraSound,Polyps of colon,Incidence in the general population is 1.6-12% Incidence in people over 70 may be as high as 40% Polyps are classified as neoplastic or nonneoplastic Most polyps are asymptomatic-requiring ten years to double their diameter Polyps may grow large enough to cause symptoms,Adenomatous