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1、Colonic-anal diseasesGeneral surgery of second Xianya hospital, Center South University 结直肠肿瘤(结直肠肿瘤(colorectal neoplasmacolorectal neoplasma)肛裂肛裂(anal fissure(anal fissure)肛管直肠周围脓肿肛管直肠周围脓肿(anorectal (anorectal abscess)abscess)肛瘘肛瘘(anal fistula) (anal fistula) 痔疮痔疮(hemorrhoids)(hemorrhoids)结直肠癌(colon
2、ic-rectal carcinoma)概论(introduction)国内外流行病学趋势及特点国内外流行病学趋势及特点:1.上升性;2.以直肠乙状结肠为多发;3.预后相对较好。发病现状中国每年新发癌症病例约350万,因癌症死亡约250万。全国每6分钟就有1人被确诊为癌症,每天有8550人成为癌症患者,每7到8人中就有一例死于癌症。据非官方数据资料,中国大陆癌症村约达459个病因发达国家中,30%的癌症是由于饮食或营养,16%烟草,8%感染,5%职业暴露,2%环境污染,39%其他原因。而在我国,有学者夸张的说“80%到90%以上的癌症可能由于环境因素引起”病因学基础病因学基础(etiology
3、)(etiology)1.息肉(polypus):腺瘤性息肉、结肠息肉病等2.饮食(diet):高蛋白,高脂肪,低纤维素饮食3.血吸虫病(Schistomiasis):是血吸虫肉芽肿.4.溃疡性结肠炎(ulcerative colitis)腺瘤性息肉腺瘤性息肉(polyps)(polyps):管状腺瘤(adenoma)绒毛管状腺瘤绒毛状腺瘤(villous adenoma)7病理病理 (pathology)早期早期(early stage)是指癌局限于结直肠粘膜层及粘膜下层,一般无淋巴结转移。息肉状生长型、非息肉状生长型。进展期进展期(advanced stage)肿块型(massive)狭窄
4、型(stenosis)溃疡型(ulcerative)镜下观察:(microscope Ob.)腺癌 (adenocarcinoma)粘液癌 (mucous carcinoma)未分化癌(undifferentiated carcinoma)肿瘤分级和分期肿瘤分级和分期(classification and (classification and stage)stage)Broders method:低恶性;:中恶性; :高恶性;:未分化; Dukes stagesDukes stages:A:局限于粘膜,无淋巴结转移;B:浸润到粘膜外,但无淋结转移;C:癌肿已出现淋巴结转移;D:已出现远处转移
5、.扩散与转移:扩散与转移:(spread and metastasis)直接浸润(direct extension)淋巴转移(lymph metastasis)血行扩散(hematogenous metastasis)种植转移(implantation metastasis)临床表现临床表现(clinical findings)右半结肠癌的表现(semi-right colonic carcinoma)腹部肿块(abdomen masses)贫血(anemia)全身症状(general symptom)左半结肠癌的表现(semi-left colon carcinoma)肠梗阻(obstruc
6、tion)排便习惯与粪便性状改变 (alterations in bowel habits and feces)直肠癌的表现(manifestations of rectal carcinoma)直肠刺激症状(irritant symptom)癌肿破溃感染症状 (rupture and infection of masses)肠壁狭窄症状(stenosis symptom)诊断诊断(diagnosis) 早期诊断(early diagnosis)排便习惯与粪便性状改变者(alteration of bowel habits and feces)进行性贫血、体重减轻(progressive an
7、emia and weight loss)腹部肿块(abdomen masses)直肠指检(digital rectal examination)体位(position)方法(method)注意事项(attention)直肠指检发现的常见问题痔疮(hemorrhoids)肛瘘(anal fistula)直肠息肉(rectal polypus)肛管直肠癌(anorectal carcinoma)内窥镜(endoscope)硬质镜(rigid endoscope )纤维镜(fibroscope)优点及存在问题 (advantages and problem)注意事项及并发症 (attention
8、and complication)镜检报告(fibroscopic report)距肛门12cm可见一直径约5cm的肿块,肿块表面溃烂、渗血、呈菜花状。镜检报告(fibroscopic report)横结肠中段可见环形肿块、狭窄,内镜不能通过,观察肿块全貌欠佳,肿块表面充血、溃烂、渗血。镜检报告(fibroscopic report)距肛门10cm见粘膜肿块向腔内突出,表面糜烂坏死、成分叶状、累及1/3肠腔。钡灌肠(barium enema)优点(advantages)存在问题(problem)病理检查(pathologic inspect )对直肠癌尤为重要 (it is very impo
9、rtant for rectum carcinoma)其它检查(other inspects)B-USCTCEA治疗(treatment)以手术为主的综合治疗肠道准备(preparation of bowel)常见的手术方法(common procedure)右半结肠切除(semi-rihgt colon resection)左半结肠切除(semi-left colon resection)乙状结肠切除(sigmoid colon resection)Miles procedureDixon procedureHartmann procedure直肠肛管解剖生理复习齿线及意义(dental l
10、ine )肛管直肠环(anorectal sphincteric ring)肛管直肠周围间隙 (para-anorectal space)肛裂(anal fissure)肛裂三联征(fissure triad) 临床表现(clinic findings)治疗:非手术、手术(therapy:operation 肛周脓肿(perianal abscess)肛周皮下脓肿坐骨直肠间隙脓肿骨盆直肠间隙脓肿肛瘘(anal fistual)肛瘘的成因与病原菌临床表现(clinic findings)单纯肛瘘与复杂肛瘘高位肛瘘与低位肛瘘肛瘘的治疗方法切除切开挂线疗法痔疮(hemorrhoids)外痔(internal hemorrhoids)内痔(external hemorrhoids)内痔的分期期:排便时出血,痔块不脱出期:排便时痔块脱出,可自行 回纳期:排便时痔块脱出后需用手 回纳期:痔块脱出不能用手回纳临床表现(clinic findings)便血痔块脱出疼痛瘙痒非手术治疗(conservative therapy)通便局部清洁局部消炎对症处理外科治疗注射治疗(injection therapy)电子/激光治疗手术治疗(surgery therapy)