结直肠疾病英文课件.ppt

ColorectalCancer ColonCaincidence 105 500 US yrColonCamortality 48 100 US yrimplies 45 colonCacasemortalityRectalCaincidence 42 000 US yrRectalCamortality 8 500 Us yrimplies 21 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 Stage0 Tis N0 M0StageI T1 N0 M0T2 N0 M0StageII T3 N0 M0T4 N0 M0StageIII AnyT N1 M0AnyT N2 M0StageIV AnyT 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 contrastbariumenemaCEAothers CT MRI PET Singlecontrast Doublecontrast Air contrastbariumenema Endoscopes Endoscopes Colonoscopy Colonoscopy Colonoscopy Colonoscopy Rectalpolyp RectalCA CTScan Rectaltumor Treatment Themainmethodistheoperation Operationofclolon RighthemicolectomyTransversecolonresectionLefthemicolectomySigmoideresection Righthemicolectomy Ileo transversalanastomoseCecumAscendingcolonHepaticflexureofcolonTerminalileum15cmGreateromentumTransversecolonLNofrightgastroepiploicartery Transversecolectomy Ascendo descendingcolonanastomoseHepaticflexureofcolonSplenicflexureofcolonTransversecolonGreateromentumMesocolonLNofgastrocolicligament Radicalcorrectionofdescendingcolon TransversorectalanastomoseSplenicflexureofcolonDescendingcoloSigmoidcolonPartsofgreateromentumMesocolon Radicalcorrectionofsigmoidcolon DescendorectalanastomosePartsofdescendingcolonSigmoidcolonSuperiorextremityofrectumMesocolonofsigmoid Operationofrectum TransanusLocalresection APR Miles LAR DixonParksReformingBaconHartmannPost cavitaspelviscleareEntirecavitaspelviscleare Radicalcorrectionofrectum Dixonlocation 5cmdentatelineIncisalmargin 3cm AbdominalPerinealResection Miles Indicationlocation 5cmExtent 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