结直肠疾病英文课件.ppt

ColorectalCancer,ColonCaincidence:105,500/US/yrColonCamortality:48,100/US/yrimplies45%colonCacasemortalityRectalCaincidence:42,000/US/yrRectalCamortality:8,500/Us/yrimplies21%rectalCacasemortality,Epidemiology,3Characteristicsinchina,Young,Lowerlocation,ulceration,Ethiology,DietaryhabitsPrecancousdiseasesEnvironmentfactorsHeredityfactorsOtherfactors,Dietaryhabit,Heredityfactors,Adenomatouspolyposissyndromes(APS)Hereditary“Non-polyposis”ColonCancer(HNPCC,Lynchsyndrome)FamilialAdenomatousPolyposis(FAP),Otherfactors,Anatomy,Arterialsupplyofthecolon,IleocolicarteryRightcolicarteryMeddlecolicarteryLeftcolicarterySigmoidarteries,Venousdrainageofthecolon,SuperiormesentericveinInferiormesentericveinSplenicveinHepaticportalvein,Lymphaticdrainageofthecolon,EpicolicnodesParacolicnodesIntermediatenodesCentralnodes,Ileocecalregion,Arterialsupplyoftherectum,SuperiorrectalarteryMiddlerectalarteryInferiorrectalartery,Venousdrainageoftherectum,InternalhemorrhoidalplexusExternalhemorrhoidalplexus,Rectalregion,Modelofcolorectalcarcinogenesis（90%）NomalepitheliumHeperproliferativeepitheliumAdenomaCarcinoma,病理生理,Pathology,Morphology,ProtrudetypeInfiltratetypeUlcerationtype,PathologyCytology,CarcinomeMucinouscarcinomacarcinoideUndifferentiatedcarcinomaSquamouscarcinoma,Routeofmetastasis,Routeofmetastasis,InfiltrationdirectlymphaticmetastasisHematogenousdisseminationImplantationmetastasis,LiverMetastasis,Implantationmetastasis,ClassificationofPathology,DukesstagesDukesA、B、C、DTNMstages、,DUKESClassification,DukesStages,StageA:limitedtomucosaandsubmucosa90%StageB:extendsintomuscularisorserosa60-75%StageC:onepositivenode-69%sixormorepositivenodes,27%StageD:mets.toliver,bone,lung5%,COLORECTALCANCERSURVIVAL(DukesStages,5y),StageClassification,Stage0Tis,N0,M0StageIT1,N0,M0T2,N0,M0StageIIT3,N0,M0T4,N0,M0StageIIIAnyT,N1,M0AnyT,N2,M0StageIVAnyT,AnyN,M1,Clinicalfindings,Hematochezia(distinctfrommelena)Changeinbowelhabit:alternatingconstipationanddiarrhea.Obstipationtoclinicallowerbowelobstruction.,Anemia,Weightloss,Abdominalpain,FOBT,Mass,Fever,Anorexia,Locationinrightcolon,Obstruction,Diarrhea,Locationinleftcolon,Bloodinfeces,Constipation,Bloodinstool,Changeinnormalbowelhabits,Rectalexamination,Cancerofrectum,Methodofdiagnosis,DigitalexaminationFecaloccultbloodEndoscopeanoscopeFlexiblesigmoidoscopeElectricalColonoscopeAir-contrastbariumenemaCEAothersCT、MRI、PET,Singlecontrast,Doublecontrast,Air-contrastbariumenema,Endoscopes,Endoscopes,Colonoscopy,Colonoscopy,Colonoscopy,Colonoscopy,Rectalpolyp,RectalCA,CTScanRectaltumor,Treatment,Themainmethodistheoperation,Operationofclolon,RighthemicolectomyTransversecolonresectionLefthemicolectomySigmoideresection,Righthemicolectomy,Ileo-transversalanastomoseCecumAscendingcolonHepaticflexureofcolonTerminalileum15cmGreateromentumTransversecolonLNofrightgastroepiploicartery,Transversecolectomy,Ascendo-descendingcolonanastomoseHepaticflexureofcolonSplenicflexureofcolonTransversecolonGreateromentumMesocolonLNofgastrocolicligament,Radicalcorrectionofdescendingcolon,TransversorectalanastomoseSplenicflexureofcolonDescendingcoloSigmoidcolonPartsofgreateromentumMesocolon,Radicalcorrectionofsigmoidcolon,DescendorectalanastomosePartsofdescendingcolonSigmoidcolonSuperiorextremityofrectumMesocolonofsigmoid,Operationofrectum,TransanusLocalresection(APR)-Miles(LAR)-DixonParksReformingBaconHartmannPost-cavitaspelviscleareEntirecavitaspelviscleare,Radicalcorrectionofrectum,Dixonlocation5cmdentatelineIncisalmargin3cm,AbdominalPerinealResection(Miles),Indicationlocation5cmExtent,Post-cavitaspelviscleare,malefemale,Radicalcorrectionofrectum,ParksReformingBaconHartmann,Complication,HemorrhageanterosacrumUreterinjuryBladderinjuryUrineretentionSexualdisturbanceStomalleak,Chemotherapy,MethodsystemicchemotherapyregionalchemotherapyMedicin5-FU、CF,SystemicChemotherapy,Regionalhepaticchemotherapy,Chemoport,Radiotherapy,ExternalradiotherapyInternalradiotherapy,Newadjuvanttherapy,Sandwich,Chemotherapy+Radiotherapy,operation,Chemotherapy+Radiotherapy,Treatmentindication,STAGE0LocalexcisionwithclearmarginsLargelesionnotamenabletolocalexcisionSTAGE1Widesurgicalresectionandanastomosis,Treatmentindication,STAGE2WidesurgicalresectionandanastomosisSystemicorregionalchemotherapyRadiationtherapyBiologictherapy,Treatmentindication,STAGE3SurgicalresectionandanastomosisPre/Postoperativechemotherapy5-FU/leucovorin6M5FU/levamisol12MPostoperativeradiationtherapyBiologicaltherapyAloneorcombination,Treatmentindication,STAGE4Surgicalresection/anastomosisorbypassSurgicalresectionofisolatedmetastasesChemotherapyBiologictherapyRadiationtherapy,Postoperativefollowup,CEAColonoscopyUltrasonographyComputerTomographyTrans-RectalUltraSound,Polypsofcolon,Incidenceinthegeneralpopulationis1.6-12%Incidenceinpeopleover70maybeashighas40%PolypsareclassifiedasneoplasticornonneoplasticMostpolypsareasymptomatic-requiringtenyearstodoubletheirdiameterPolypsmaygrowlargeenoughtocausesymptoms,Adenomatouspolyps,Tubularadenoma75%5%Tubulovillous15%22%Villousadenoma10%40%,TYPEPREVALENCE%MALIGNANT,Adenomatouspolyps,TendtogrowslowlyandcontinuouslyTheymaybesessile,orpedunculated,Adenomatouspolyps,TreatmentRemovalofallpolypsisrecommendedCarefulhistologicassessmentismandato