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| 1 | Endoscopy and polyps-diagnostic and therapeutic advances in management显示文摘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. | Scott R Steele Eric K Johnson Bradley Champagne Brad Davis Sang Lee David Rivadeneira Howard Ross Dana A Hayden Justin A Maykel | 2013 | World Journal of Gastroenterology2013，19，27： | 16 |
| 2 | 经肛全直肠系膜切除术治疗直肠癌的优点和局限显示文摘在美国,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。 | Deborah S Keller Scott R Steele 楼征 张卫 | 2018 | 中华胃肠外科杂志2018，21，3： | 16 |
| 3 | Operative considerations for rectovaginal fistulas显示文摘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. | Kevin R Kniery Eric K Johnson Scott R Steele | 2015 | World Journal of Gastrointestinal Surgery2015，7，8： | 7 |
| 4 | Clostridium difficile Enteritis after Colectomy显示文摘 | Causey M Wayne Spencer Michael P Steele Scott R | 2009 | The American Surgeon2009，，12： | 2 |
| 5 | Gearlike rolling motion mediated by commensurate contact: carbon nanotubes on HOPG 显示文摘 | Falvo M R Steele J Taylor Ⅱ R M | 2000 | Phys Rev B2000，62，10： | 1 |
| 6 | Wheat classification using image analysis and crush-force parameters 显示文摘 | ZayasI Martin C R Steele J L | 1996 | Trans of the ASAE1996，39，： | 1 |
| 7 | 显示文摘 | Rylander P N Steele D R | 1969 | Tetrahedron Lett1969，，20： | 1 |
| 8 | Simple isolation of functional RNA from woody stems of gymnosperms显示文摘 | Lewinsohn E Steele C L Croteau R | 1994 | Plant Mol Biol Reptr1994，12，： | 1 |
| 9 | Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016):A multicentre,randomised trial显示文摘 | Sebag-Montefiore D Stephens RJ Steele R | 2009 | Lancet2009，373，9666： | 1 |
| 10 | High transmission Enhanced Faraday Rotation in One-dimensional Photonic Crystals with Defects显示文摘 | STEEL M J LEVY M OSGOOD R M | 2000 | IEEE Photon Technol Lett2000，12，： | 1 |
| 11 | A predictive model of rectal tumor response to preoperative radiotherapy using classification and regression tree methods显示文摘 | ZLOBEC I STEELE R NIGAM N | 2005 | Clinical Cancer Research2005，11，： | 1 |
| 12 | Examining the consequences of exposure to racism for the executive functioning of Black students 显示文摘 | BAIRN A STEELE R J | 2010 | J Experimental Soc Psychol2010，46，： | 1 |
| 13 | Distinct functional role of hepatitis C virus core protein on NF-KB regulation is linked to genomic variation显示文摘 | Ray R B Meyer K Steele R | 2002 | Virus Rearch2002，87，： | 1 |
| 14 | Introducing microcells into macrocellular networks:a case study显示文摘 | R Coombs R Steele | 1999 | IEEE Transactions on Communications1999，47，4： | 1 |
| 15 | A review and meta-analysis of research on the relationship between behavioral intentions and employee turnover 显示文摘 | Steel R P Ovalle N K | 1994 | Journal of Applied Psychology1994，69，： | 1 |
| 16 | A three-dimensional nonlinear active co- chlear model analyzed by the WKB-numerie method 显示文摘 | Lim K M Steele C R | 2002 | Hear Res2002，170，12： | 1 |
| 17 | Current clinical immunother- apy targets in advanced nonsmall cell lung cancer(NSCLC)显示文摘 | McCarthy F Roshani R Steele J | 2013 | J Leukoc Biol2013，94，6： | 1 |
| 18 | A randomized trial of\snonoperative treatment for perforated peptic ulcer显示文摘 | Croft T J Park K G Steele R J | 1989 | N Engl J Med1989，320，15： | 1 |
| 19 | Effect of the plane of surgery a-chieved on local recurrence in patients with operable rectal cancer:a prospective study using data from the MRC CR07 and NCIC-CTGC016 randomised clinical trial 显示文摘 | Quirke P Steele R Monson J | 2009 | Lancet2009，373，9666： | 1 |
| 20 | Pyrophoric nature of iron sulfides 显示文摘 | WALKER R STEEL A D | 1996 | Industrial & Engineering Chemistry Research1996，35，5： | 1 |
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