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大肠癌的早期诊断
随着我国人口老龄化程度的提高,大肠癌的发病率明显增加.然而,到医院就诊的大肠癌患者中三分之二为中、晚期患者,他们的5年存活率不足50%.究其原因,早期大肠癌常无明显临床表现,不为患者所注意,随着病变的进展,疾病干扰了机体正常生理功能,才出现一系列症状和体征.大肠癌常见的临床表现是便血、脓血便、排便习惯改变、腹痛、腹部包块、腹水、肠梗阻、贫血等.
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KEYPOINTS1. The proximal small intestine (duodenum & jejunum) is the primary site of fluid absorption. It absorbs about 50% to 60% of any given fluid load. The colon or large intestine absorbs approximately 80 to 90% of the fluid it receives, but accounts for only about 15% of the total fluid load.
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自然人群普查在大肠癌早期诊断中的作用
自然人群普查、癌前疾病随访和遗传性大肠癌致病基因预测是大肠癌早期诊断的三个主要途径.如前一章所述,在这三个早诊途径中,自然人群普查是大肠癌早期诊断的主要方法.然而,即使是普查工作开始早,政府支持力度大的美国,全国的普查率也只占应普查人群的40%,为此,其它两种早诊途径也应予以关注.
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超声内镜下大肠黏膜下癌的高频声像特征
[ Objective] The aim of this study was to evaluate the role of miniprobe ultrasonography on colonoscope in the diagnosis of submucosal tumor of the large intestine and determine it's imaging characteristic. [ Methods] Thirty- five patients with submucosal tumors of the large intestine underwent miniprobe (Olympus UM -2R,12 MHz; UM -3R, 20 MHz) ultrasonography on colonoscope. The results were compared with pathological findings of specimens by biopsy and surgical resection. [ Results] Lipomas were visualized as hyperechoic homogeneous masses located in the submucosa with a distinct border. Leiomyomas were visualized as hypoechoic homogeneous mass originated from the muscularis propria. Leiomyosarcomas were shown with inhomogeneous echo and irregular border.Carcinoids waere presented as a submucosal hypoechoic mass with a homogenous echo and distinct border. Lymphangiomas were shown as submocosal hypoechoic masses with cystic septal structures. Malignant lymphomas displayed as hypoechoic mass from mucosa to muscularis propria, while pneumatosis cystoids intestinalis originated from submucosa with a special sonic shadow. One large leiomyoma was misdiagnosed as leiomyosarcoma. [ Conclusion ]Endoscopic miniprobe ultrasonography can provide precise information about the size, layer of origin, border and has a high accuracy in the diagnosis of submucosal tumor of the large intestine. Pre - operative miniprobe ultrasonography on colonoscope may play an important role in the choice of therapy for submucosal tumor of the large intestine.
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老年人大肠癌致急性肠梗阻的外科处理
大肠癌致急性肠梗阻是大肠癌晚期临床表现之一,亦是老年人肠梗阻常见原因。老年人大肠癌患者脏器代偿功能和机体免疫功能均下降,且多有全身其他严重疾病或肠梗阻本身引起的全身性严重病理生理变化,在临床处理中比较棘手。外科处理选择是否正确可直接影响预后。我院1980~2000年共收治老年人大肠癌致急性肠梗阻病例42例,现就其处理体会介绍如下。……