【Abstract】ObjectiveTo study the distal intramural spread of rectal carcinoma, and provide evidence for modification of rectal carcinoma surgery. MethodsSixty patients with rectal carcinoma admitted to the first affiliated hospital of Chongqing university of medical science from November 2001 to October 2002 were included. The specimens were extended to its original size and shape by the fat clearing method. Mesenteric lymph nodes were dissected by using transillumination to examine metastases histologically, then a lymph nodes map was produced which including the site of the primary lesion, the vascular distribution, and the sites of dissected nodes. The specimen below the distal margin of the tumor was cut continuously with 0.5 cm interval then sectioned for histopathological examination. ResultsTumor spread to the distal intramural was observed in 11 of 60 patients (18.3%) with the range within 1.5 cm, of which less than 0.5 cm in 5 case, 5 cm to 1.0 cm in 2 cases, 1.0 cm to 1.5 cm in 4 cases. The tumor invasion was correlated with gross type, histological type and infiltrative depth, but not with sex, age, location of the tumor, size of the tumor, lymph nodes metastases and Dukes stage. Conclusion The range of distal mural excision should exceed 1.5 cm to tumor margin in radical surgery for rectal carcinoma. This rule should be emphasized for patients with poor cell differentiation and deep infiltration.
目的 觀察鹽酸氨基葡萄糖對Pilon骨折的輔助治療作用。 方法 2007年6月－2010年9月，將43例接受手術治療的Pilon骨折患者隨機分成兩組，A組術后口服鹽酸氨基葡萄糖，B組作為對照組（僅服用安慰劑）。A組21例患者，平均年齡（35.7± 8.0）歲，B組22例患者，平均年齡（36.7 ± 7.1）歲。兩組患者年齡、性別、骨折分型及手術時機相比較，無統計學差異（P＞0.05）。定期隨診（術后6、12、18個月），根據美國足與踝關節協會踝與后足功能評分（AOFAS）評分系統對患者進行功能評分，進行前瞻、對照、雙盲研究。 結果 術后6、12、18個月，A組患者的AOFAS評分均明顯高于B組，差異有統計學意義（t=2.530，2.856，2.881；P=0.015，0.007，0.006）；術后18個月，A組臨床療效優良率為95.2%，B組優良率為72.3%，差異有統計學意義（χ2=3.995，P=0.046）。A組2例患者分別發生輕度頭暈及惡心，無嚴重不良反應發生。 結論 鹽酸氨基葡萄糖輔助治療Pilon骨折可改善踝關節功能，減少創傷性骨關節炎的發生。