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routine colonic endoscopic evaluation following resolution of acute diverticulitis:Is it necessary?

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World Journal of Gastroenterology 2014年第35期20卷 12509-12516页

作者： Amit K Agarwal Burzeen E Karanjawala Justin A Maykel Eric K Johnson scott r steele Department of Surgery University of Texas Health Science Center-Houston Department of Surgery University of Texas Health Science Center-Houston and Lyndon B.Johnson General Hospital University of Massachusetts Memorial Medical Center Colon rectal Surgery Department of SurgeryMadigan Army Medical Center

Diverticular disease incidence is increasing up to 65% by age 85 in industrialized nations,low fiber diets,and in younger and obese ***-five percent of patients with diverticulosis will develop acute *** imposes a significant burden on healthcare systems,resulting in greater than 300000 admissions per year with an estimated annual cost of $3 billion *** computed tomography(CT) is the diagnostic study of choice,with a sensitivity and specificity greater than 95%.Unfortunately,similar CT findings can be present in colonic neoplasia,especially when perforated or *** prompted professional societies such as the American Society of Colon rectal Surgeons to recommend patients undergo routine colonoscopy after an episode of acute diverticulitis to rule out ***,the data supporting routine colonoscopy after acute diverticulitis is sparse and based small cohort studies utilizing outdated *** any patient with an indication for a colonoscopy should undergo appropriate endoscopic evaluation,in the era of widespread use of high-resolution computed tomography,routine colonic endoscopic evaluation following resolution of acute uncomplicated diverticulitis poses additional costs,comes with inherent risks,and may require further *** this manuscript,we review the current data related to this recommendation.

关键词： Colonic evaluation Colonoscopy Diverticulitis Acute diverticulitis Colonic neoplasia Endoscopy

经肛全直肠系膜切除术治疗直肠癌的优点和局限

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中华胃肠外科杂志 2018年第3期21卷 250-258页

作者： Deborah S Keller scott r steele 楼征张卫哥伦比亚大学医学中心纽约长老会医院结直肠外科美国纽约10032 克利夫兰医学中心结直肠外科美国克利夫兰44195 不详

在美国，结直肠癌的发病率和死亡率分别位于恶性肿瘤的第4位和第2位，其中直肠癌约占结直肠癌的1/3。对于可切除直肠癌而言，全直肠系膜切除术（total mesorectal excision，TME）仍然是手术的金标准。但骨盆狭窄、新辅助治疗后肿瘤触... 详细信息

在美国，结直肠癌的发病率和死亡率分别位于恶性肿瘤的第4位和第2位，其中直肠癌约占结直肠癌的1/3。对于可切除直肠癌而言，全直肠系膜切除术（total mesorectal excision，TME）仍然是手术的金标准。但骨盆狭窄、新辅助治疗后肿瘤触摸不清、照明及术野显露困难、远切缘确定困难及吻合器无法放置等解剖、技术和患者方面的因素，会使开腹及腹腔镜TME手术困难。在此环境下，＂自下而上＂的TME手术——经肛全直肠系膜切除手术（taTME）应运而生。taTME手术结合了腹腔镜及机器人手术的微创化、高清内镜平台的可视化及功能化以及经肛经腹直肠癌TME手术的优势。2010—2013年期间，Lacy等研究者陆续系列报道了taTME手术的实施情况，将该术式推向了高潮。taTME手术采取改良截石位。手术分为腹部手术和会阴手术两个部分。腹部手术具体步骤可由术者偏好调整，但总体包括游离左侧结肠和脾曲、高位结扎肠系膜下血管和标准的TME手术。会阴部手术先在肿瘤远端采用荷包缝合封闭肠腔，在进行直肠冲洗后，放入操作平台，环形切开肠壁，＂自下而上＂沿直肠系膜无血管层面进行游离，直至与腹部组会合。标本可以经肛或经造口部位取出。可采取手工缝合或吻合器吻合完成消化道重建。taTME手术的优点和局限如下。1. taTME手术优点：taTME手术采用经肛进入盆腔的入路方式，即使在低位局部进展期直肠癌、肥胖、骨盆狭窄等操作难度大的手术中，依然可以获得满意的视野显露。同时，由于在肿瘤远端荷包缝合肠壁，故对肿瘤远端切缘的判断更加准确。taTME手术相对简便地完成远端直肠系膜的游离切除，可能更有利于确保手术标本切缘的安全性和淋巴清扫的彻底性，并能得到更高质量的TME手术切除标本，使直肠癌患者的生存获益。国际登记机构的结果显示，taTME术后系膜完整率为96%，环周切缘和远端切缘阳性率分别为2.4%和0.3%。与腹腔镜手术相比，taTME手术时间更短，术后并发症发生率更低。taTME术后吻合口漏发生率和病死率分别为6.7%和2.6%。2. taTME手术局限：尽管taTME手术有上述优点，现有研究也提示，taTME术后短期肿瘤学安全性满意，但这毕竟是一种新术式，尚缺乏长期随访结果，需要更大样本的对照试验来探究其临床、肿瘤学和功能学结果。此外，对于一个新术式，在实践中会遇见一些新的并发症。特别是＂自下而上＂的路径，要求外科医生从不同的视角重新认识原来的解剖结构，如直肠后间隙的游离、血管神经束的保护等。此外，也需要重视和预防术中输尿管损伤、盆壁自主神经损伤、骶前静脉损伤和术后盆腔脓肿的发生。上述损伤尤其容易发生在系膜或前列腺层面上，因此，对于有肿瘤史、盆腔放疗史、前列腺切除史或前列腺肥大的患者尤其需要谨慎。必须指出的是，梗阻性直肠肿瘤、急诊手术和T4期肿瘤是taTME的禁忌证。综上所述，taTME有利于骨盆狭窄的＂高难度＂低位直肠癌患者的手术切除和标本质量，但作为一种全新的术式，还需要进一步研究其临床、肿瘤学和功能学结果。

关键词：全直肠系膜切除术结直肠癌新辅助治疗术后吻合口漏 TME手术并发症发生率直肠癌患者腹腔镜手术

Endoscopy and polyps-diagnostic and therapeutic advances in management

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World Journal of Gastroenterology 2013年第27期19卷 4277-4288页

作者： scott r steele Eric K Johnson Bradley Champagne Brad Davis Sang Lee David rivadeneira Howard ross Dana A Hayden Justin A Maykel Department of Surgery Madigan Army Medical CenterMadigan Health SystemTacoma Division of Colon and rectal Surgery Case Western Reserve Medical Center Department of Surgery University of Cincinnati Division of Colon and rectal Surgery Weill Cornell Medical College Department of Surgery Huntington Hospital/North Shore-LIJ Health System Department of Surgery Riverview Plaza Riverview Medical CenterRed Bank Department of Surgery Loyola University Health System Division of Colon and rectal Surgery University of Massachusetts Memorial Medical Center

Despite multiple efforts aimed at early detection through screening, colon cancer remains the third leading cause of cancer-related deaths in the United States, with an estimated 51000 deaths during 2013 alone. The goal remains to identify and remove benign neoplastic polyps prior to becoming invasive cancers. Polypoid lesions of the colon vary widely from hyperplastic, hamartomatous and inflammatory to neoplastic adenomatous growths. Although these lesions are all benign, they are common, with up to one-quarter of patients over 60 years old will develop pre-malignant adenomatous polyps. Colonoscopy is the most effective screening tool to detect polyps and colon cancer, although several studies have demonstrated missed polyp rates from 6%-29%, largely due to variations in polyp size. This number can be as high as 40%, even with advanced (> 1 cm) adenomas. Other factors including sub-optimal bowel preparation, experience of the endoscopist, and patient anatomical variations all affect the detection rate. Additional challenges in decision-making exist when dealing with more advanced, and typically larger, polyps that have traditionally required formal resection. In this brief review, we will explore the recent advances in polyp detection and therapeutic options.

关键词： Polyps Endoscopy Colonoscopy Endoscopic submucosal dissection Endoscopic mucosal resection Quality Combined endoscopic-laparoscopic resection Combined laparoscopic-endoscopic resection Combined endoscopic-laparoscopic surgery

An NSQIP evaluation of practice patterns and outcomes following surgery for anorectal abscess and fistula in patients with and without Crohn’s disease

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Gastroenterology report 2013年第1期1卷 58-63页

作者： Marlin Wayne Causey Daniel Nelson Eric K.Johnson Justin Maykel Brad Davis David E.rivadeneira Brad Champagne scott r.steele Department of Surgery Madigan Army Medical SystemMadigan Health SystemTacomaWA 98431USA

Background:Patients with Crohn’s disease(CD)are believed to have more aggressive anorectal abscess and fistula *** assessed the types of procedures performed and perioperative complications associated with the surgical management of anorectal abscess and fistula disease in patients with and without ***:The American College of Surgeons National Surgical Quality Improvement Program database(ACS-NSQIP,2005-2010)was used to calculate 30-day outcomes using regression modeling,accounting for demographics,comorbidities and surgical ***-9 codes for anorectal abscess or fistula were used for initial *** were then stratified,based on the presence or absence of underlying *** procedures included incision and drainage of abscesses,fistulotomy and seton *** fistulas were considered simple,while all others were classified as complex(-vaginal,-urethral and-vesical).results:A total of 7,218 patients(mean age 45 years;64%male)met inclusion criteria,with underlying CD in 345(4.8%).CD patients were more likely to have a seton placed(9.9 vs 8.2%,Proids(15.4 vs 4.3%,Prty-seven percent of CD patients underwent local procedures,while 46%had a proctectomy and8%underwent *** was more common in those without underlying CD(16 vs 11%,Prall complication rate after local treatment was 4.9%,with no difference between patients with and without CD(7.7 vs 4.9%,P=0.144).This was not affected by fistula type-simple(7.9 vs 3.9%,P=0.194)vs complex(33 vs 7.1%,P=0.21)—or when stratified by wound(3.8 vs 2.4%;P=0.26)or systemic complications(3.8 vs 2.5%;P=0.53).Yet,complications following emergency procedures were higher in patients with CD(21.4 vs 5.9%,P=0.047).Factors significantly associated with increased complications were Crohn’s disease(Or=8.2),lack of functional independence(Or=2.0),pre-operative weight loss(Or=2.6)and pre-operative acute renal failure(Or=5.6).Steroids were al

关键词： National Surgical Quality Improvement Program(NSQIP) Crohn’s disease anorectal diseases anorectal abscess fistula-in-ano

Operative considerations for rectovaginal fistulas

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World Journal of Gastrointestinal Surgery 2015年第8期7卷 133-137页

作者： Kevin r Kniery Eric K Johnson scott r steele Department of Surgery Division of Colorectal SurgeryMadigan Army Medical Center

To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas(rVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of rVFs. rVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas.

关键词： rectovaginal fistulas Anovaginal fistulas

美国结直肠外科医师协会2019版藏毛窦诊治临床实践指南

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结直肠肛门外科 2019年第4期25卷 363-374页

作者： Eric K.Johnson,M.D. Jon D.Vogel,M.D. Michelle L.Cowan,M.D. Daniel L.Feingold,M.D. scott r.steele,M.D.,M.B.A. 杜涛张振宇冷株赟傅传刚 Uniformed Services University of the Health Sciences Cleveland Clinic Foundation Department of Surgery University of Colorado Department of Surgery New York Presbyterian Hospital Columbia University Department of Colon and rectal Surgery Cleveland Clinic Foundation 同济大学附属东方医院胃肠肛肠外科

美国结直肠外科医师协会(The American Society of Colon and rectal Surgeons,ASCrS)于2019年2月公布了最新的藏毛窦诊治临床实践指南。指南是由国际知名结直肠外科专家组成的临床实践指南委员会修订,对藏毛窦的一些争议进行了汇总和... 详细信息

美国结直肠外科医师协会(The American Society of Colon and rectal Surgeons,ASCrS)于2019年2月公布了最新的藏毛窦诊治临床实践指南。指南是由国际知名结直肠外科专家组成的临床实践指南委员会修订,对藏毛窦的一些争议进行了汇总和分析。

关键词：藏毛窦治疗指南美国结直肠外科医师协会循证医学

美国结直肠外科医师协会2019版肠道准备在择期结直肠手术中的应用临床实践指南

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结直肠肛门外科 2019年第4期25卷 375-380页

作者： John Migaly,M.D. Andrea C.Bafford,M.D. Todd D.Francone,M.D.,M.P.H. Wolfgang B.Gaertner,M.D.,M.Sc. Cagla Eskicioglu,M.D.,M.Sc.,F.r.C.S.C. Liliana Bordeianou,M.D.,M.P.H. Daniel L.Feingold,M.D. scott r.steele,M.D.,M.B.A. 刘孟承王恺京杜涛傅传刚 Department of Surgery Duke University School of Medicine Department of Surgery University of Maryland Medical Center Department of Surgery Massachusetts General Hospital Division of Colorectal Surgery University of Minnesota Health Department of Surgery Michael G.DeGroote School of Medicine McMaster University Department of Surgery Columbia University Irving Medical Center Department of Colorectal Surgery Cleveland Clinic Cleveland Ohio 同济大学附属东方医院胃肠肛肠外科

美国结直肠外科医师协会(The American Society of Colon and rectal Surgeons,ASCrS)于2019年1月公布了最新的肠道准备在择期结直肠手术中的应用临床实践指南。该指南是由国际知名结直肠外科专家组成的临床实践指南委员会修订,对肠道... 详细信息

美国结直肠外科医师协会(The American Society of Colon and rectal Surgeons,ASCrS)于2019年1月公布了最新的肠道准备在择期结直肠手术中的应用临床实践指南。该指南是由国际知名结直肠外科专家组成的临床实践指南委员会修订,对肠道准备的一些争议进行了汇总和分析。

关键词：结直肠手术肠道准备治疗指南美国结直肠外科医师协会循证医学

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肛裂临床诊治指南（第三次修订）

中华胃肠外科杂志 2013年第7期16卷 689-690页

作者： Farshid Araghizadeh ~ robin Boushey Sridhar Chalasani George Chang robert Cima Gary Dunn Daniel Feingold Philip Fleshner Daniel Geisler Jill Genua Sharon Gregorcyk Daniel Herzig Andreas Kaiser ravin Kumar David Larson Steven Mills John Monson P. Terry Phang Feza remzi David rivadeneira Howard ross Peter Senatore Elin Sigurdson Thomas Stahl scott steele scott Strong Charles Tement Judith Trudel Madhulika Varnna Martin Weiser 丁义江(译) 皇甫少华(译) 丁曙晴(译) 美国结直肠外科医师协会不详

“美国结直肠外科医师协会（American Societyof Colonandrectal ***）”（协会）致力于推进结直肠和肛门疾病的相关理论以及预防和诊疗水平的提高，给患者提供优质的医疗服务。“标准委员会”由协会中在结直肠外科方面有显著专长的成... 详细信息

“美国结直肠外科医师协会（American Societyof Colonandrectal ***）”（协会）致力于推进结直肠和肛门疾病的相关理论以及预防和诊疗水平的提高，给患者提供优质的医疗服务。“标准委员会”由协会中在结直肠外科方面有显著专长的成员组成。该委员会的建立是为了引领国际结直肠和肛门疾病诊治的发展，以建立具有循证医学证据的临床诊疗指南。指南是涵盖性的，非指令性的，目的是为临床决策提供信息，而非具体的治疗方法。指南适用于所有相关的医护人员以及希望得到相应指南中疾病的相关诊治信息的患者。

关键词：诊治指南临床决策结直肠外科修订肛裂医师协会肛门疾病循证医学证据

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受伤的地球之肺

环球科学 2023年第14期 36-39页

作者：斯科特·达特菲尔德不详

世界自然基金会(WWF)在2021年1月发布了一份关于全球毁林问题的报告,重点指出了24个“毁林前线”,也就是大片森林被砍伐的地方。该报告提到,过去13年,全球已有4300万公顷的森林被砍伐殆尽。WWF英国首席执行官塔尼娅斯蒂尔(Tanya steele)... 详细信息

世界自然基金会(WWF)在2021年1月发布了一份关于全球毁林问题的报告,重点指出了24个“毁林前线”,也就是大片森林被砍伐的地方。该报告提到,过去13年,全球已有4300万公顷的森林被砍伐殆尽。WWF英国首席执行官塔尼娅斯蒂尔(Tanya steele)说:“自然环境每况愈下,全球气候也在发生危险的变化。保护像亚马孙这样珍贵的森林,是应对这场全球危机的重要方式之一。”

关键词：首席执行官毁林全球危机全球气候斯蒂尔亚马孙地球之肺