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Early Effect Following the Resection of IlealCecum and Right HemicolonAn Experimental Study

Objective To explore the early effect following resection of ilealcecum and right hemicolon. MethodsTwenty piglets were randomly divided into 2 groups, 10 in control group and experimental group respectively. The ilealcecum and right hemicolon for 50 cm each were resected in the experimental group. The two groups were fed the same food before and after the operation. Some indexes of two groups were monitored. Results①In the two groups, the body length change wasn’t significant (Pgt;0.05); but the body weight had descended markly in experimental group, compared with control group, since 3 weeks after operation (Plt;0.05). ②In experimental group, the ileal bacteria were increased from 104-107/ml before operation to 109-1011/ml at 6 weeks after operation (Plt;0.05). ③The enterohepatic circulation of biliac acid was affected during the early phase after resection. ④In experimental group, the stool became diluted within 6 weeks after operation. ⑤In the two groups, the Vitamin B12 was waved slightly within 6 weeks after operation (Pgt;0.05). The megaloblastic anemia was not appeared. ⑥The function of liver and the absorption of Na+, Cl-,K+ did not change significantly (Pgt;0.05). Conclusion The ileocecum and right hemicolon are very important for digestion and absorption, it should be retained or the ileocecal valve should be reconstructed if possible.

回盲部炎性假瘤12例報告

創傷性腹股溝疝囊內回盲部破裂的手術方法選擇（附 3 例報道）

目的 總結創傷性腹股溝疝囊內回盲部腸管破裂的治療經驗以供臨床參考。 方法 回顧性分析筆者所在醫院于 2000 年 1 月至 2016 年 12 月期間收治的 3 例創傷性腹股溝疝囊內回盲部腸管破裂患者的臨床資料。 結果 3 例患者均為男性，其中 1 例右腹股溝滑動性疝患者行回盲部切除、回腸升結腸端側吻合術；1 例右腹股溝斜疝患者行回腸末端破裂清創吻合術，附加盲腸回腸皮管造瘺以保留回盲瓣；1 例右腹股溝斜疝患者行改良的經盲腸回腸皮管造瘺術。2 例避免了切除回盲部的過度醫療之嫌。術后 3 例患者均一期治愈，無吻合口漏、修補口瘺、腹腔膿腫形成、切口感染等并發癥發生。術后 3 例患者均獲隨訪，隨訪時間 2～3 年，隨訪期間無一例疝復發。 結論 對創傷性腹股溝疝囊內回盲部腸管破裂患者，需根據損傷部位及損傷程度施行不同的手術。

Regional and extra-regional lymph node metastasis in right-sided colon cancer: a two-year real-world data analysis

Objective This real-world study aimed to clarify the patterns of regional and extra-regional lymph node metastasis to provide evidence for clinical decision-making and future research. MethodsA total of 123 patients who underwent laparoscopic right hemicolectomy with complete mesocolic excision (CME) at the Department of Gastrointestinal Surgery, Deyang People’s Hospital from September 2022 to May 2024 were included. Lymph nodes were dissected, classified, and analyzed according to the Japanese Society for Cancer of the Colon and Rectum Guidelines for Colorectal Cancer Treatment (7th edition). Clinicopathological data were analyzed. ResultsOverall lymph node metastasis rate: 42.3% (52/123). The metastasis rate of para-intestinal lymph nodes (N1) was 33.3% (41/123), intermediate lymph node (N2) was 10.6% (13/123), and central lymph node (N3) was 13.0% (16/123). Cecal cancer: ileocolic artery lymph node metastasis rate was 40.0% (10/25), right colic artery lymph node metastasis rate was 0 (0/6) and middle colic artery lymph node metastasis rate was 4.0% (1/25). Transverse colon cancer: ileocolic artery lymph node metastasis rate was 0 (0/18) and middle colic artery lymph node metastasis rate was 33.3% (6/18). Of 45 patients with infrapyloric lymph node dissection, only 1 (2.2%) patient with hepatic flexure cancer showed metastasis. The metastasis rate was 2.2% (1/45). No ileal lymph node metastasis was observed. N3 metastasis rate: 9.3% (8/86) in well/moderately differentiated tumors vs 21.6% (8/37) in poorly differentiated tumors (χ2=2.63, P=0.105). No N3 lymph node metastasis occurred in T1 and T2 tumors. T3 and T4 tumors exhibited N3 metastasis rates of 13.3% (13/98) and 21.4% (3/14), respectively (χ2=0.17, P=0.683). ConclusionsFor cancer of the ileocecal region, lymph node metastasis beside the colic middle artery almost never occurs. And for transverse colon cancer, no lymph node metastasis beside the ileocolic artery has been found. suggesting that when the tumor is located in these areas, excessive resection of the intestine is not necessary, and a right hemicolectomy with ileocecal preservation can be performed to better preserve organ function. For poorly differentiated cancers and right-sided colon cancers on T3 and T4 stages, the N3 lymph node metastasis rates are high (more than 20%), respectively, and D3 lymph node dissection is still recommended. The rate of extra-regional lymph node metastasis is extremely low, and routine dissection is not recommended.

回盲部結腸癌誤診為闌尾炎30例分析

【摘要】　目的　分析回盲部結腸癌誤診為闌尾炎的原因及如何避免誤診的方法。　方法　回顧性分析1998年1月－2010年10月誤診為闌尾炎的回盲部結腸癌患者30例的臨床資料。其中男24例，女6例；年齡14～78歲，平均56歲。30例患者均行手術治療，闌尾切除術中發現回盲部結腸癌28例而改行其他術式，其中一期右半結腸癌根治術12例，姑息性右半結腸切除術5例，回腸橫結腸短路術6例，二期手術5例；1例于闌尾切除術后15 d發現回盲部結腸癌，行右半結腸癌根治術；1例于闌尾切除術后6個月因腸梗阻明確診斷而再次手術，行右半結腸癌根治術。20例術后行全身靜脈聯合化學療法治療。　結果　術后發生切口感染6例，經局部換藥、抗感染及支持等治療后切口丙級愈合；其余切口均甲級愈合。術后無腸漏發生。住院時間12～68 d，平均18 d，住院期間無死亡者。所有患者術后病理檢查均證實為回盲部結腸腺癌，其中合并闌尾炎28例。20例獲隨訪，隨訪時間3個月～12年，平均5.6年。6例因無法切除病灶而行回腸橫結腸吻合短路手術，于術后6～15個月死亡；5例行姑息性右半結腸切除術，于術后9～27個月死亡；余9例隨訪2～12年無復發。同期收治回盲部結腸癌167例，誤診、漏診率為18%。　結論　回盲部結腸癌有時易誤診為闌尾炎，或并發闌尾炎時易漏診；應仔細詢問病史，全面了解和掌握患者的病情，完善必要的輔助檢查，不要盲目自信是防止誤診、漏診的關鍵。