结直肠疾病英文优秀PPT.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Colorectal Cancer,Colon Ca incidence:105,500/US/yr,Colon Ca mortality:48,100/US/yr implies 45%colon Ca case mortality,Rectal Ca incidence:42,000/US/yr,Rectal Ca mortality:8,500/Us/yr,implies 21%rectal Ca case mortality,Epidemiology,2,3,Characteristics in china,Young,Lower location,ulceration,3,Ethiology,Dietary habits,Precancous diseases,Environment factors,Heredity factors,Other factors,4,Dietary habit,5,Heredity factors,Adenomatous polyposis syndromes(APS),Hereditary“Non-polyposis”Colon Cancer,(HNPCC,Lynch syndrome),Familial Adenomatous Polyposis(FAP),6,Other factors,7,Anatomy,8,Arterial supply of the colon,Ileocolic artery,Right colic artery,Meddle colic artery,Left colic artery,Sigmoid arteries,9,Venous drainage of the colon,Superior mesenteric vein,Inferior mesenteric vein,Splenic vein,Hepatic portal vein,10,Lymphatic drainage of the colon,Epicolic nodes,Paracolic nodes,Intermediate nodes,Central nodes,11,Ileocecal region,12,Arterial supply of the rectum,Superior rectal artery,Middle rectal artery,Inferior rectal artery,13,Venous drainage of the rectum,Internal hemorrhoidal plexus,External hemorrhoidal plexus,14,Rectal region,15,Model of colorectal carcinogenesis,（,90%,）,Nomal epithelium,Heperproliferative epithelium,Adenoma,Carcinoma,病理生理,Pathology,16,Morphology,Protrude type,Infiltrate type,Ulceration type,17,Pathology Cytology,Carcinome,Mucinous carcinomacarcinoide,Undifferentiated carcinoma,Squamous carcinoma,18,Route of metastasis,19,Route of metastasis,Infiltration direct,lymphatic metastasis,Hematogenous dissemination,Implantation metastasis,20,Liver Metastasis,21,Implantation metastasis,22,Classification of Pathology,Dukes stages,Dukes A,、,B,、,C,、,D,TNM stages,、,、,、,23,DUKES Classification,24,Dukes Stages,Stage A:limited to mucosa and submucosa 90%,Stage B:extends into muscularis or serosa 60-75%,Stage C:one positive node-69%six or more positive nodes,27%,Stage D:mets.to liver,bone,lung 5%,25,COLORECTAL CANCER SURVIVAL(Dukes Stages,5 y),26,Stage Classification,Stage 0,Tis,N0,M0,Stage I,T1,N0,M0 T2,N0,M0,Stage II,T3,N0,M0 T4,N0,M0,Stage III,Any T,N1,M0,Any T,N2,M0,Stage IV,Any T,Any N,M1,27,28,Clinical findings,Hematochezia(distinct from melena),Change in bowel habit:alternating constipation and diarrhea.,Obstipation to clinical lower bowel obstruction.,29,Anemia,Weight loss,Abdominal pain,FOBT,Mass,Fever,Anorexia,Location in right colon,30,Obstruction,Diarrhea,Location in left colon,Blood in feces,Constipation,31,Blood in stool,Change in normal bowel habits,Rectal examination,Cancer of rectum,32,Method of diagnosis,Digital examination,Fecal occult blood,Endoscope,anoscope,Flexible sigmoidoscope,Electrical Colonoscope,Air-contrast barium enema,CEA,others,CT,、,MRI,、,PET,33,Single contrast,Double contrast,Air-contrast barium enema,34,Endoscopes,35,Endoscopes,36,Colonoscopy,37,Colonoscopy,38,Colonoscopy,39,Colonoscopy,40,Rectal polyp,Rectal CA,CT ScanRectal tumor,41,Treatment,The main method is the operation,42,Operation of clolon,Right hemicolectomy,Transverse colon resection,Left hemicolectomy,Sigmoide resection,43,Right hemicolectomy,Ileo-transversal anastomose,Cecum,Ascending colon,Hepatic flexure of colon,Terminal ileum 15cm,Greater omentum,Transverse colon,LN of right gastroepiploic artery,44,Transverse colectomy,Ascendo-descending colon anastomose,Hepatic flexure of colon,Splenic flexure of colon,Transverse colon,Greater omentum,Mesocolon,LN of gastrocolic ligament,45,Radical correction of descending colon,Transversorectal anastomose,Splenic flexure of colon,Descending colo,Sigmoid colon,Parts of greater omentum,Mesocolon,46,Radical correction of sigmoid colon,Descendorectal anastomose,Parts of descending colon,Sigmoid colon,Superior extremity of rectum,Mesocolon of sigmoid,47,Operation of rectum,Transanus Local resection,(APR)-Miles,(LAR)-Dixon,Parks,Reforming Bacon,Hartmann,Post-cavitas pelvis cleare,Entire cavitas pelvis cleare,48,Radical correction of rectum,Dixon,location 5cm dentate line,Incisal margin 3cm,49,Abdominal Perineal Resection(Miles),Indication,location 5cm,Extent,50,Post-cavitas pelvis cleare,male female,51,Radical correction of rectum,Parks,Reforming Bacon,Hartmann,52,Complication,Hemorrhage anterosacrum,Ureter injury,Bladder injury,Urine retention,Sexual disturbance,Stomal leak,53,Chemotherapy,Method,systemic chemotherapy,regional chemotherapy,Medicin,5-FU,、,CF,54,Systemic Chemotherapy,55,Regional hepatic chemotherapy,56,Chemoport,57,Radiotherapy,External radiotherapy,Internal radiotherapy,58,New adjuvant therapy,Sandwich,Chemotherapy,+,Radiotherapy,operation,Chemotherapy,+,Radiotherapy,59,Treatment indication,STAGE 0,Local excision with clear margins,Large lesion not amenable to local excision,STAGE 1,Wide surgical resection and anastomosis,60,Treatment indication,STAGE 2,Wide surgical resection and anastomosis,Systemic or regional chemotherapy,Radiation therapy,Biologic therapy,61,Treatment indication,STAGE 3,Surgical resection and anastomosis,Pre/Postoperative chemotherapy,5-FU/leucovorin 6 M,5FU/levamisol 12M,Postoperative radiation therapy,Biological therapy,Alone or combination,62,Treatment indication,STAGE 4,Surgical resection/anastomosis or bypass,Surgical resection of isolated metastases,Chemotherapy,Biologic therapy,Radiation therapy,63,Postoperative follow up,CEA,Colonoscopy,Ultrasonography,Computer Tomography,Trans-Rectal UltraSound,64,Polyps of colon,Incidence in the general population is 1.6-12%,Incidence in people over 70 may be as high as 40%,Polyps are classified as neoplastic or nonneoplastic,Most polyps are asymptomatic-requiring ten years to double their diameter,Polyps may grow large enough to cause symptoms,65,Adenomatous polyps,Tubular adenoma75%5%,Tubulovillous 15%22%,Villousadenoma10%40%,TYPE PREVALENCE%MALIGNANT,66,Adenomatous polyps,Tend to grow slowly and continuously,They may be sessile,or pedunculated,67,Adenomatous polyps,Treatment,Removal of all polyps is recommended,Careful histologic assessment is mandatory for proper management,Resection either endoscopically or by open techniques,Follow-up,Regular checkups are recommended since 40%will have reoccurrence(F/U 6m-1year),68,Multiple Polyposis Syndromes,Familial adenomatous polyposis,Gardners syndrome,Turcots syndrome,69,Familial adenomatous polyposis,70,Thank you,71,