结直肠疾病英文课件

ColorectalCancerColonCaincidence:105,500/US/yrColonCamortality:48,100/US/yrimplies~45%colonCacasemortalityRectalCaincidence:42,000/US/yrRectalCamortality:8,500/Us/yrimplies~21%rectalCacasemortalityEpidemiology3CharacteristicsinchinaYoungLowerlocationulcerationEthiologyDietaryhabitsPrecancousdiseasesEnvironmentfactorsHeredityfactorsOtherfactorsDietaryhabitHeredityfactorsAdenomatouspolyposissyndromes(APS)Hereditary“Non-polyposis”ColonCancer(HNPCC,Lynchsyndrome)FamilialAdenomatousPolyposis(FAP)OtherfactorsAnatomyArterialsupplyofthecolonIleocolicarteryRightcolicarteryMeddlecolicarteryLeftcolicarterySigmoidarteriesVenousdrainageofthecolonSuperiormesentericveinInferiormesentericveinSplenicveinHepaticportalveinLymphaticdrainageofthecolonEpicolicnodesParacolicnodesIntermediatenodesCentralnodesIleocecalregionArterialsupplyoftherectumSuperiorrectalarteryMiddlerectalarteryInferiorrectalarteryVenousdrainageoftherectumInternalhemorrhoidalplexusExternalhemorrhoidalplexusRectalregionModelofcolorectalcarcinogenesis（90%）

NomalepitheliumHeperproliferativeepitheliumAdenomaCarcinoma

病理生理PathologyMorphologyProtrudetype

InfiltratetypeUlcerationtypePathologyCytologyCarcinomeMucinouscarcinoma

carcinoideUndifferentiatedcarcinomaSquamouscarcinomaRouteofmetastasisRouteofmetastasisInfiltrationdirectlymphaticmetastasisHematogenousdisseminationImplantationmetastasis

LiverMetastasisImplantationmetastasisClassificationofPathologyDukesstagesDukesA、B、C、DTNMstagesⅠ、Ⅱ、Ⅲ、ⅣDUKESClassificationDukesStagesStageA:limitedtomucosaandsubmucosa90%StageB:extendsintomuscularisorserosa 60-75%StageC:onepositivenode-69%sixormorepositivenodes,27%StageD:mets.toliver,bone,lung5%COLORECTALCANCERSURVIVAL(DukesStages,5y)StageClassificationStage0＝Tis,N0,M0StageI＝T1,N0,M0T2,N0,M0StageII＝T3,N0,M0T4,N0,M0StageIII＝AnyT,N1,M0AnyT,N2,M0StageIV＝AnyT,AnyN,M1ClinicalfindingsHematochezia(distinctfrommelena)Changeinbowelhabit:alternating constipationanddiarrhea.Obstipationtoclinicallowerbowelobstruction.AnemiaWeightlossAbdominalpainFOBTMassFeverAnorexiaLocationinrightcolonObstructionDiarrheaLocationinleftcolonBloodinfecesConstipationBloodinstoolChangeinnormalbowelhabitsRectalexaminationCancerofrectumMethodofdiagnosisDigitalexaminationFecaloccultbloodEndoscopeanoscopeFlexiblesigmoidoscopeElectricalColonoscopeAir-contrastbariumenemaCEAothers－－CT、MRI、PETSinglecontrastDoublecontrastAir-contrastbariumenemaEndoscopesEndoscopesColonoscopyColonoscopyColonoscopyColonoscopyRectalpolypRectalCACTScan—RectaltumorTreatmentThemainmethodistheoperationOperationofclolon

Righthemicolectomy

Transversecolonresection

LefthemicolectomySigmoideresectionRighthemicolectomy

Ileo-transversalanastomoseCecumAscendingcolonHepaticflexureofcolonTerminalileum15cmGreateromentumTransversecolonLNofrightgastroepiploicarteryTransversecolectomyAscendo-descendingcolonanastomoseHepaticflexureofcolonSplenicflexureofcolonTransversecolonGreateromentumMesocolonLNofgastrocolicligamentRadicalcorrectionofdescendingcolonTransversorectalanastomoseSplenicflexureofcolonDescendingcoloSigmoidcolonPartsofgreateromentumMesocolonRadicalcorrectionofsigmoidcolonDescendorectalanastomosePartsofdescendingcolonSigmoidcolonSuperiorextremityofrectumMesocolonofsigmoidOperationofrectumTransanusLocalresection(APR)---Miles(LAR)----DixonParksReformingBaconHartmannPost-cavitaspelviscleareEntirecavitaspelviscleareRadicalcorrectionofrectumDixon

location>5cmdentatelineIncisalmargin>3cmAbdominalPerinealResection(Miles)Indicationlocation<5cmExtentPost-cavitaspelviscleare

malefemaleRadicalcorrectionofrectumParksReformingBaconHartmannComplicationHemorrhageanterosacrum

UreterinjuryBladderinjuryUrineretentionSexualdisturbanceStomalleakChemotherapyMethodsystemicchemotherapyregionalchemotherapyMedicin5-FU、CFSystemicChemotherapyRegionalhepaticchemotherapyChemoportRadiotherapyExternalradiotherapyInternalradiotherapyNewadjuvanttherapySandwichChemotherapy

+RadiotherapyoperationChemotherapy

+RadiotherapyTreatmentindicationSTAGE0LocalexcisionwithclearmarginsLargelesionnotamenabletolocalexcisionSTAGE1WidesurgicalresectionandanastomosisTreatmentindicationSTAGE2WidesurgicalresectionandanastomosisSystemicorregionalchemotherapyRadiationtherapyBiologictherapyTreatmentindicationTreatmentindicationSTAGE4Surgicalresection/anastomosisorbypassSurgicalresectionofisolatedmetastasesChemotherapyBiologictherapyRadiationtherapyPostoperativefollowupCEAColonoscopyUltrasonographyComputerTomographyTrans-RectalUltraSoundPolypsofcolonIncidenceinthegeneralpopulationis1.6-12%Incidenceinpeopleover70ma