结直肠癌英文教学课件.ppt

* (2) With Acute Obstruction In Ascending Colon: ● Well status: 右半结肠切除+回肠-横结肠吻合术 ● Poor status: 盲肠造瘘，然后二次切除 * In Descending Colon ● 首先横结肠造瘘解除梗阻 ● 然后在充分肠道准备下手术切除 * Chemotherapy Basic agent: 5-FU ● FOLFOX6方案：5-FU + CF+奥沙利铂 ● MAYO方案： 5-FU + CF ● XELOX方案：卡培他滨+奥沙利铂 * CARCINOMA OF RECTUM * ● More than colon carcinoma (1.5:1) ● 60%~75% in lower rectum ● 10%~15% < 30 year old ETIOLOGICAL CHARACTERISTIC * (1) Direct Invasion to: wall of bowel, adjacent organ, such as: womb, prostate, bladder, seminalis, vagina, ureter … … SPREAD & METASTASIS * 腹主动脉旁淋巴结 (2) Lymphatic Spread 肠系膜下动脉旁淋巴结 直肠上动脉旁淋巴结 (A) 高位肿瘤向高处转移 * (B) 低位肿瘤向上方或者侧方转移 (C) 齿状线周围的肿瘤向上方、侧方 或者腹股沟淋巴结转移 * (3) Hematogenous Spread ● Through portal vein to liver ● About 10%~15% of patients with liver metastasis ● Through iliac vein to lung bone, or brain * (4) Implantation Metastasis ● Implantation metastasis occur in upper rectal cancer occasionally * CLINICAL FEATURES ● 直肠刺激症状: 便意频数; 里急后重；排便习惯改变 ● 肠腔狭窄症状: 便条形状改变或不完全梗阻 ● 癌肿破溃感染症状: 血便或粘液脓血便 * ● 浸润到前列腺或者膀胱： 尿频、尿急、尿痛或者排尿不尽感 ● 浸润到骶神经: 持续性骶前区疼痛 … ● 肝转移: 腹水、黄疸、贫血、水肿 … * DIAGNOSIS (1) 大便潜血试验（Test for occult blood）: used as primary test for high risk people (2) 直肠指诊（Rectal Touch）: the most important test for diagnosis (3) 结肠镜检（Endoscopy）: for diagnosis and biopsy, about 5%~10% of cases were multiple tumor * (4) 影像学检查 ● 结肠钡剂造影：评价有无多发瘤及定位 ● 腹部B超: 评价有无肝脏及腹腔淋巴结转移 ● 腔内超声: 评价中低位癌肿肠壁浸润深度 ● MRI检查：评价中低位癌肿肠壁浸润深度 ● CT 造影: 评价有无肝脏、腹腔淋巴结转移 及盆腔内的浸润情况 ● PET-CT: 评价有无远处转移及估测预后 * (5) OTHERS: ● 腹股沟淋巴结活检, ● 阴道内诊或者腹部双合诊 ● 膀胱镜检查 * TREATMENT （一）手术治疗： The most important radical treatment for rectal carcinoma * (1) 局部切除 Local Resection: suitable for early stage, with a small size, located in mucosa ● 经肛门局部切除术 ● 骶后径路局部切除术 * （2）腹会阴联合直肠癌根治术 既往—金标准手术 Miles operation： the mostly used radical operation for lower rectal carcinoma * Dixon Operation: suitable for t