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Diagnostic efficacy of whole-body diffusion-weighted imaging in the detection of tumour recurrence and metastasis by comparison with 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography or computed tomography in patients with gastrointestinal cancer

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Gastroenterology Report 2015年第2期3卷 128-135页

作者： Jiaying Gong Wuteng Cao Zhanwen Zhang Yanhong Deng Liang Kang Pan Zhu Zhengjun Liu Zhiyang Zhou department of Radiology The Sixth Affiliated Hospital(The Gastrointestinal&Anal Hospital)of Sun Yat-sen UniversityGuangzhouChina department of Nuclear Medicine The Sixth Affiliated Hospital(The Gastrointestinal&Anal Hospital)of Sun Yat-sen UniversityGuangzhouChina department of Oncology The Sixth Affiliated Hospital(The Gastrointestinal&Anal Hospital)of Sun Yat-sen UniversityGuangzhouChina department of Colorectal surgery The Sixth Affiliated Hospital(The Gastrointestinal&Anal Hospital)of Sun Yat-sen UniversityGuangzhouChina

Objective:The primary aim of this study was to assess the efficacy of whole-body diffusion-weighted imaging(WB-DWI)in detecting tumour recurrence and metastasis of gastrointestinal cancers by comparison with 18F-2-fluoro-2-deoxy-Dglucose positron emission tomography or computed tomography(18F-FDG-PET/CT).A secondary aim was to evaluate the change of apparent diffusion coefficient(ADC)value between metastases and normal ***:Twenty-eight previously confirmed gastrointestinal cancer patients with suspected tumour recurrence or metastasis were ***-DWI and PET/CT images were evaluated by two radiologists and a nuclear medicine *** between WB-DWI and PET/CT for detective efficacy was compared using kappa ***,diagnostic accuracy,sensitivity,specificity,negative predictive value(NPV),and positive predictive value(PPV)were also statistically *** values between metastatic and normal tissues were ***:There was no statistically significant difference(P>0.05)in the overall diagnostic performances of PET/CT(accuracy 98.9%;sensitivity 95.2%;specificity 99.8%;PPV 98.9%;NPV 98.9%)and WB-DWI(accuracy 95.9%;sensitivity 81.7%;specificity 99.1%;PPV 95.0%;NPV 96.1%).WB-DWI showed agreement with PET/CT(j=0.877)for detecting recurrence and distant metastases.A statistically significant difference in ADC value was observed between tissues of normal healthy volunteers and metastases in lymph nodes,liver and bones(P<0.05).Conclusions:WB-DWI is reliable in detecting tumour recurrence and metastasis of colorectal cancer and offers the same diagnostic performance as 18F-PET/CT without ionizing *** quantitative value of ADC provides extra information to determine cancer metastasis.

关键词： whole-body diffusion-weighted imaging(WB-DWI) 18F-FDG-PET/CT apparent diffusion coefficient(ADC) colorectal cancer recurrence metastasis

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Neoadjuvant therapy followed by local excision and two-stage total mesorectal excision:a new strategy for sphincter preservation in locally advanced ultra-low rectal cancer

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Gastroenterology Report 2014年第1期2卷 37-43页

作者： Ting Wang Jianping Wang Yanhong Deng Xiaojian Wu Lei Wang department of Colorectal surgery The Sixth Affiliated Hospital(The Gastrointestinal&Anal Hospital)of Sun Yat-sen UniversityGuangzhouChina department of Oncology The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina

Background:With the increased usage of neoadjuvant chemoradiotherapy,improved surgical technique and stapling devices,sphincter-preserving resection has become more frequent for patients with rectal ***,as for locally advanced ultra-low rectal cancer,sphincter-preservation is still facing an enormous ***:To introduce an NLT strategy of sphincter-preservation-neoadjuvant therapy(NT)followed by local excision(LE)and two-stage total mesorectal excision(TME)-into the treatment of locally advanced ultra-low rectal cancer(lesions with anal sphincter invasion).Methods:From October 2010 to October 2011,nine patients with locally advanced rectal cancer located less than 3 cm from the anal verge were treated by the NLT *** patients had shown good clinical response to *** LE procedure was carried transanally 6-8 weeks after completion of the *** was performed to dissect mesorectal lymph nodes 4-6 weeks after ***:Of the nine patients,the lesion was assessed as T2 in two,T3 in five,and T4 in two before NT,and lymph node metastasis was detected in five *** median distance from the tumor to the anal verge was 2.5 cm(range:1-3 cm).The median follow-up was 27 months(range:24-34 months).No distant metastasis was *** one patient(11.1%)developed local recurrence at 12 months post-operatively and then underwent abdomino-perineal *** remaining eight patients had preserved long-term continence and the median Wexner score at two years post-operation was 4(range:2-6).Conclusion:The new NLT strategy can achieve sphincter-preservation in some patients with ultra-low rectal cancer,with favorable oncological outcome and preservation of normal anal sphincter function.

关键词： rectal cancer sphincter-preservation neoadjuvant therapy local excision total mesorectal excision

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Metabolic disorders of fatty acids and fatty acid amides associated with human gastric cancer morbidity

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Chinese Medical Journal 2012年第5期125卷 757-763页

作者： SONG Hu PENG Jun-sheng YAO Dong-sheng LIU Da-ling YANG Zu-li DU Yan-ping XIANG Jun department of gastrointestinal surgery Xuzhou Central Hospital（Affiliated Hospital of Medical College of Southeast University）Xuzhou Jiangsu 221009 China department of gastrointestinal surge% sixth affiliated hospital（gaslrointestinal ＆ anal hospital） Sun Yat-sen University GuangzhouGuangdong 510655 China National Engineering Research Center of Genetic Medicine Ji NanUniversity Guangzhou Guangdong 510632 China

Background Gastric cancer （GC） is one of the most common types of cancer in the world. A change in the metabolism of lipids in tumor cells could lead to the pathogenesis of cancer. In this study, we investigated fat... 详细信息

关键词： gastric cancer fatty acids amides metabolic disorders

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A simple taurocholate-induced model of severe acute pancreatitis in rats

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World Journal of Gastroenterology 2009年第45期15卷 5732-5739页

作者： Zhong-Hui Liu Jun-Sheng Peng Chu-Jun Li Zu-Li Yang Jun Xiang Hu Song Xiao-Bing Wu Jun-Rong Chen De-Chang Diao department of gastrointestinal surgery the Sixth Affiliated Hospital of Sun Yat-sen University 26 Yuanchun Erheng Road Guangzhou 510655 Guangdong Province China department of Gastroenterology the Sixth Affiliated Hospital (Gastrointestinal & Anal Hospital) of Sun Yat-sen University 26 Yuanchun Erheng Road Guangzhou 510655 Guangdong Province China

AIM: To investigate gut barrier damage and intestinal bacteria translocation in severe acute pancreatitis (SAP), a simple rat model of SAP was induced and ***: Pancreatitis was induced by uniformly distributed injection of 3.8% Na taurocholate (1 mL/kg) beneath the pancreatic capsule. Rats in the control group were injected with normal saline in the identical location. RESULTS: Serum amylase, plasma endotoxin, intestinal permeability, and pancreatitis pathology scores were all markedly higher in the pancreatitis group than in the control group (P < 0.01). The bacterial infection rate was signif icantly higher in the SAP group than in the control group (P < 0.01), observed in parallel by both bacterial culture and real-time polymerase chain reaction. Acute damage of the pancreas was observed histologically in SAP rats, showing interstitial edema, leukocyte infiltration, acinar cell necrosis and hemorrhage. The microstructure of the intestinal mucosa of SAP ratsappeared to be destroyed with loose, shortened microvilli and rupture of the intercellular junction, as shown by electron microscopy. CONCLUSION: Significant gut barrier damage and intestinal bacterial translocation were def initely observed with few potential study confounders in this SAP rat model, suggesting that it may be an appropriate animal model for study of gut barrier damage and bacterial translocation in SAP.

关键词： Acute pancreatitis Bacterial translocation Inflammation Real-time polymerase chain reaction

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Transanal vs laparoscopic total mesorectal excision for rectal cancer:a multicenter randomized phase III clinical trial(TaLaR trial)protocol

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Gastroenterology Report 2021年第1期9卷 71-76,I0002页

作者： Liang Kang Ziwei Zeng Shuangling Luo Hong Zhang Quan Wang Mingyang Ren Miao Wu Weidong Tong Qing Xu Yi Xiao Aiwen Wu Yuan-Guang Chen Bo Feng Zhanlong Shen Liang Huang Xingwei Zhang Minhua Zheng Jian-Ping Wang department of Colorectal surgery The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China Guangdong Institute of Gastroenterology The Sixth Affiliated Hospital of Sun Yatsen UniversityGuangzhouGuangdongP.R.China Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China department of Colorectal surgery Shengjing Hospital of China Medical UniversityShenyangLiaoningP.R.China department of gastrointestinal surgery The First Hospital of Jilin UniversityChangchunJilinP.R.China department of gastrointestinal surgery The Affiliated Nanchong Central Hospital of North Sichuan Medical CollegeNanchongSichuanP.R.China department of gastrointestinal surgery The Second People’s Hospital of YibinYibinSichuanP.R.China department of General surgery Daping HospitalArmy Medical universityChongqingP.R.China department of gastrointestinal surgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiP.R.China department of General surgery Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingP.R.China department of gastrointestinal surgery Peking University Cancer HospitalBeijingP.R.China department of gastrointestinal surgery The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongP.R.China Ruijin hospital Shanghai Jiaotong University School of Medicine ShanghaiP.R.China department of gastrointestinal surgery Peking University People’s HospitalBeijingP.R.China

Background:Total mesorectum excision(TME)is considered the standard surgical procedure for rectal-cancer *** TME(taTME)is a new procedure to treat low rectal *** published studies have proven that taTME can provide a better-quality resected specimen in low-rectal-cancer patients in comparison to the transabdominal procedure,yet long-term outcomes must be *** designed this non-inferiority trial(TaLaR trial)to compare short-term and long-term outcomes between taTME and laparoscopic TME(lapTME)for rectal ***:The TaLaR trial is a phase III open-labeled multicenter randomized-controlled *** who are diagnosed with rectal cancer with no more than T3N2 stage,and with the tumor location below the peritoneal reflection by magnetic resonance imaging scan,digital rectal examination,or colonoscopy,qualify for this *** calculating,a total of 1,114 patients(557 per group)will be randomly allocated to either the taTME or the lapTME *** endpoints are the 3-year disease-free survival(DFS)rate and the 5-year overall survival(OS)*** endpoints include specimen quality,perioperative results,pelvic and anal function,and quality of ***:The TaLaR trial is expected to clarify whether taTME can achieve comparable oncological outcomes,as well as improve specimen quality and recovery conditions in rectal-cancer patients compared with lapTME.

关键词： transanal total mesorectal excision total mesorectal excision laparoscopic rectal cancer surgery

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Association of perioperative blood pressure with long-term survival in rectal cancer patients

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Chinese Journal of Cancer 2016年第6期35卷 20-29页

作者： Hui-Chuan Yu Yan-Xin Luo Hui Peng Xiao-Lin Wang Zi-Huan Yang Mei-Jin Huang Liang Kang Lei Wang Jian-Ping Wang department of Colon and Rectum surgery The Sixth Affiliated Hospital(Guangdong Gastrointestinal and Anal Hospital)Sun Yat-sen UniversityGuangzhouGuangdong 510655PRChina Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital)Sun Yat-sen UniversityGuangzhouGuangdong 510665PRChina

Background:Several studies suggested that hypertension is positively related to cancer incidence and *** this study,we investigated the association between perioperative blood pressure(BP) and long?term survival out?comes in patients with rectal ***:This study included a cohort of 358 patients with stages I–III rectal cancer who underwent a curative resection between June 2007 and June *** pre? and postoperative BPs were measured,by which patients were grouped(low BP:analysis showed that patients with high preoperative systolic BP had lower 3?year DFS(67.2% vs.82.1%,P = 0.041) and CSS rates(81.9% vs.94.8%,P = 0.003) than patients with low preoperative systolic BP,and the associations remained significant in the Cox multivariate analysis,with the adjusted hazard ratios equal to 1.97 [95% confidence interval(CI) = 1.08–3.60,P = 0.028] and 2.85(95% CI = 1.00–8.25,P = 0.050),***,in postoperative evaluation,patients with high systolic BP had significantly lower 3?year CSS rates than those with low systolic BP(78.3% vs.88.9%,P = 0.032) in univariate ***,high pre? and/or postoperative systolic BP presented as risk factors for CSS in the subgroups of patients who did not have a history of hypertension,with and/or without perioperative administration of antihypertensive ***:High preoperative systolic BP was an independent risk factor for both CSS and DFS rates,and high postoperative systolic BP was significantly associated with a low CSS rate in rectal cancer ***,our results suggest that rectal cancer patients may get survival benefit from BP control in perioperative ***,further studies should be conducted to determine the association between BP and CSS and targets of BP cont

关键词： Blood pressure Radical surgery Rectal cancer Cancer-specific survival

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Short-term and oncological outcomes of natural orifice specimen extraction surgery(NOSES)for colorectal cancer in China:a national database study of 5055 patients

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Science Bulletin 2022年第13期67卷 1331-1334,M0003页

作者： Xu Guan Xiyue Hu Zheng Jiang Ye Wei Donghui Sun Miao Wu Haitao Zhou Hongliang Yao Junmin Song Guiyu Wang Junhong Hu Mingyang Ren Qing Xu Jianchun Cai Jian Peng Dan Ma Yangchun Zheng Qingsi He Bo Jiang Zejun Wang Taiyuan Li Su Yan Luchuan Chen Tiegang Li Zhiguo Xiong Pan Chi Liang Kang Gang Yu Xiaodong Deng Hong Zhang Ming Xie Jianbao Wei Hongyan Gong Xuejun Sun Weidong Zang Yongmao Song Peng He Zhengqi Wen Chunxu Zhang Yusheng Wang Yinggang Chen Guangwei Xie Mingzhang Li Shaojun Yu Haiying Liu Min Pu Chuangang Fu Xishan Wang on behalf of China NOSES Alliance department of Colorectal surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China department of General surgery Zhongshan HospitalFudan UniversityShanghai 200032China department of gastrointestinal and anal surgery Jilin University First HospitalChangchun 130021China department of gastrointestinal surgery The Second People’s Hospital of YibinYibin 644000China department of gastrointestinal surgery The Second Xiangya HospitalCentral South UniversityChangsha 410011China department of Anorectal surgery First Affiliated HospitalZhengzhou UniversityZhengzhou 450052China department of Colorectal Cancer surgery The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150081China department of gastrointestinal surgery Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000China department of gastrointestinal surgery Renji HospitalShanghai JiaoTong University School of MedicineShanghai 200240China department of gastrointestinal surgery Zhongshan Hospital of Xiamen UniversityXiamen 361004China department of General surgery Xiangya HospitalCentral South UniversityChangsha 410008China department of General surgery Xinqiao HospitalThird Military Medical UniversityChongqing 400037China department of gastrointestinal surgery Sichuan Cancer HospitalChengdu 610041China department of General surgery Shandong University Qilu HospitalJinan 250012China department of Colorectal and anal surgery Shanxi Cancer HospitalTaiyuan 030013China department of gastrointestinal surgery The Affiliated Cancer Hospital of Guizhou Medical UniversityGuiyang 550008China department of General surgery The First Affiliated Hospital of Nanchang UniversityNanchang 330006China department of gastrointestinal surgery Qinghai University Affiliated HospitalXining 810012China department of gastrointestinal surgery Fujian Medical University Cancer HospitalFuzhou 350014China Depar

经自然腔道取标本手术(NOSES)通过无切口理念与常规手术器械的结合,表现出极佳的微创效果,并带给患者全新的就医感受.目前,尽管NOSES已广泛用于结直肠肿瘤治疗,大量研究也表明相比常规腹腔镜手术,NOSES具有恢复快、创伤小、疼痛轻等优势... 详细信息

经自然腔道取标本手术(NOSES)通过无切口理念与常规手术器械的结合,表现出极佳的微创效果,并带给患者全新的就医感受.目前,尽管NOSES已广泛用于结直肠肿瘤治疗,大量研究也表明相比常规腹腔镜手术,NOSES具有恢复快、创伤小、疼痛轻等优势,但绝大多数研究均为小样本、单中心回顾性研究.本研究旨在通过分析我国5055例结直肠肿瘤NOSES患者数据,进一步探讨NOSES的短期疗效与预后.研究对象中,经直肠NOSES占整体比例的90.3%,经阴道NOSES占9.7%.NOSES术后短期并发症发生率为14.1%,吻合口瘘发生率为4.9%,腹盆腔感染率为1.9%.患者3年总生存率为93.2%,无病生存率为82.2%,局部复发率为3.6%.研究结果提示NOSES具有较好的安全性与可行性,为其应用于结直肠肿瘤治疗提供了证据.

关键词：结直肠肿瘤肿瘤学并发症发生率无病生存率吻合口瘘回顾性研究总生存率经直肠

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Phosphorylated NFS1 weakens oxaliplatin-based chemosensitivity of colorectal cancer by preventing PANoptosis

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Signal Transduction and Targeted Therapy 2022年第3期7卷 918-933页

作者： Jin-Fei Lin Pei-Shan Hu Yi-Yu Wang Yue-Tao Tan Kai Yu Kun Liao Qi-Nian Wu Ting Li Qi Meng Jun-Zhong Lin Ze-Xian Liu Heng-Ying Pu Huai-Qiang Ju Rui-Hua Xu Miao-Zhen Qiu department of Medical Oncology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University510060 GuangzhouP.R.China Research Unit of Precision Diagnosis and Treatment for gastrointestinal Cancer Chinese Academy of Medical Sciences510060 GuangzhouP.R.China Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease The Sixth Affiliated Hospital(Guangdong Gastrointestinal and Anal Hospital)Sun Yat-sen University510655 GuangzhouP.R.China department of Pathology Sun Yat-sen University Cancer Center510060 GuangzhouP.R.China department of Gastroenterology and Urology Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of MedicineCentral South University410013 ChangshaP.R.China department of Colorectal surgery Sun Yat-sen University Cancer Center510060 GuangzhouP.R.China

Metabolic enzymes have an indispensable role in metabolic reprogramming,and their aberrant expression or activity has been associated with ***,targeting metabolic enzymes remains an attractive approach for treating tu... 详细信息

关键词： colorectal attractive Metabolic

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International guideline on natural orifice specimen extraction surgery(NOSES)for colorectal cancer(2023 version)

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Holistic Integrative Oncology 2023年第1期2卷 93-100页

作者： Zheng Liu Xu Guan Mingguang Zhang Xiyue Hu Ming Yang Junge Bai Jun Li Shaojun Yu Kefeng Ding Qingsi He Liang Kang Dan Ma Chuangang Fu Junhong Hu Ye Wei Donghui Sun Gang Yu Songbing He Changyou Wang Yanwei Gao Guiyu Wang Hongliang Yao Jian Peng Yangchun Zheng Bo Jiang Taiyuan Li Zhiguo Xiong Xuejun Sun Zhenning Wang William Meng William Tzu-Liang Chen Ming-Yin Shen John H.Marks Charles A.Ternent Darcy DShaw Jim SKhan Petr Tsarkov Inna Tulina Sergey Efetov Joaquim Manuel da Costa Pereira Fernanda Nogueira Ricardo Escalante Joel Leroy Avanish Saklani Audrius Dulskas Cuneyt Kayaalp Atsushi Nishimura Kay Uehara Woo-Yong Lee Sang-Hoo Kim Suk-Hwan Lee Xishan Wang Committee of Colorectal Cancer Society Chinese Anti-Cancer Association International NOSES Alliance department of Colorectal surgery National Cancer CenterNational Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100021China department of Colorectal surgery The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina department of General surgery Shandong University Qilu HospitalJinanShandongChina department of Colorectal surgery The Sixth Affiliated HospitalSun Yat-Sen UniversityGuangzhouChina department of General surgery Xinqiao HospitalThird Military Medical UniversityChongqingChina department of gastrointestinal surgery Shanghai East HospitalTongji University School of MedicineShanghaiChina department of Anorectal surgery First Affiliated HospitalZhengzhou UniversityZhengzhouHenanChina department of General surgery Zhongshan HospitalFudan UniversityShanghaiChina department of Gastric and Colorectal surgery Jilin University First HospitalChangchunChina department of General surgery Qilu Hospital(Qingdao)Cheeloo College of MedicineShandong UniversityJinanChina department of General surgery the First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina affiliated hospital of North China University of Science and Technology TangshanHebeiChina Inner Mongolia Autonomous Region People’s hospital HuhhotInner Mongolia Autonomous RegionChina department of Colorectal Cancer surgery the Second Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina department of General surgery The Second Xiangya HospitalCentral South UniversityChangshaHunanChina department of General surgery Xiangya HospitalCentral South UniversityChangshaChina department of gastrointestinal surgery Sichuan Cancer HospitalChengduChina department of Colorectal and anal surgery Shanxi Cancer HospitalTaiyuanShanxiChina department of General surgery The First Affiliated Hospital of Nanchang UniversityNanchangChina department of gastrointestinal surgery Hubei Provincial Cancer Hosp

Purpose In recent years,natural orifice specimen extraction surgery(NOSES)has gained widespread attention as an alternative *** the safety and feasibility of NOSES have been well documented,many questions remain open for *** aim of this guideline is to provide more evidence for the promotion of *** This guideline has been prepared by the CACA Committee of Colorectal Cancer Society and the International NOSES Alliance,based on the latest *** The guideline on NOSES for colorectal cancer include the definition,classification,technology requirement,indications,technical difficulties and clinical *** The guideline provides a full introduction of the theoretical and technical aspects of NOSES for colorectal cancer which will beneficial to development of NOSES.

关键词： Colorectal cancer Guideline Treatment surgery Holistic integrative medicine Natural orifice specimen extraction surgery

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Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

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World Journal of Gastroenterology 2012年第14期18卷 4994-5013页

作者： Antonio Bove Massimo Bellini Edda Battaglia Renato Bocchini Dario Gambaccini Vincenzo Bove Filippo Pucciani Donato Francesco Altomare Giuseppe Dodi Guido Sciaudone Ezio Falletto Vittorio Piloni Gastroenterology and Endoscopy Unit Department of GastroenterologyAORN "A.Cardarelli"80131 NaplesItaly gastrointestinal Unit Department of GastroenterologyUniversity of Pisa56100 PisaItaly Gastroenterology and Endoscopy Unit Cardinal Massaja Hospital14100 AstiItaly Gastroenterology Unit M.Bufalini Hospital47023 CesenaItaly department of Medical and Surgical Critical Care University of Florence50141 FlorenceItaly department of Emergency and Organ Transplantation University of Bari70124 BariItaly department of Oncological and Surgical Sciences University of Padua35126 PaduaItaly Division of General and Geriatric surgery Second University of Naples80131 NaplesItaly sixth Division of University surgery Department of General SurgerySan Giovanni Battista Hospital10126 TurinItaly Diagnostic Imaging Centre "N.Aliotta" Villa Silvia-SenigalliaI-60100 AnconaItaly

The second part of the Consensus Statement of the Italian Association of hospital Gastroenterologists and Italian Society of Colo-Rectal surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.

关键词： Laxatives Prokinetics Biofeedback Pelvicfloor rehabilitation Outlet obstruction Stapled trans-anal rectal resection Delorme operation Colectomy Pelvic organ prolapse Mesh

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