Disease of the colon and rectum.ppt

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1、Disease of the colon and rectumGeneral surgery of second Xianya hospital,Center South University Zhou JianpingCommon diseasesColorectal neoplasmsFissure in anoAnorectal suppurationFistula in anohemorrhoidsSurgical anatomyAscending coloncecumHepatic flexuretransversedescendingSplenic flexuresigmoidSu

2、perior mesentericInferior mesentericrectumCarcinoma of the colon,rectum,and anusIntroduction:increasing,152000 new cases,57000 die/annually in U.S.A.Rectum and sigmoid are frequent areaPrognosis is better than other digestive tract carcinomaetiologyPolyps:neoplastic polyps,familial adenomatous polyp

3、osisDietary factorsSchistosomiasisUlcerative colitisNeoplastic polypsTubular adenoma Tubulovillous adenomaVillous adenomapolypsEndoscopic viewpathologyEarly stage carcinoma:lesion located in mucous membrane,no lymph metastasisGrowing of polyply and unpolyplyAdvanced stageMassiveStenosisulceraivemass

4、ivestenosisulcerativeMicroscope observationAdenocarcinomaMucous carcinomaUndifferentiated carcinomaClassification and stagingBroders classification:grade grade grade gradeDukes stagingA:located in mucous membrane,no L.M.B:beyond mucous membrane,no L.M.C:lymph metastasisD:distant metastasisSpread and

5、 metastasisDirect extensionLymph metastasis Hematogenous meastasisImplantation metastasisClinical featuresSemi-right colonic carcinoma:Abdominal massAnemiaGeneral symptomSemi-left colonic carcinomaObstructive symptomChange in bowel habitsRectal carcinomaRectal irritant symptomStenosis sympyomLocal i

6、nfection and rupturediagnosisEarly screening:Change of bowel habitsBowel bleedingProgressive anemia and weight lossAbdominal massDigital examinationPositionsMethodsattentionsPalpable lesionsHemorrhoidsFistula in ano Rectal polypsAnorectal carcinomaendoscopyRigid endoscopySigmoidoscopy or colonoscopy

7、Advantages and problemsAttentions and complicationsObservation with colonoscopyReport:Mass5 cm12 cm above anal ringTransverse neoplasmRectal carcinomaBarium enemaAdvantages and problemsPathologic diagnosis It is very important for rectal cancerOther diagnosis testUltrasonograpyComputed tomographic t

8、est CEAPET-CTtreatmentSurgical proceduresBowel preparationCommon proceduresSemi-right colon resectionSemi-left colon resectionSigmoid colon resectionMiles procedureDixon procedureHartmann proceureAurgical anatomy and physiologyDentate lineAnorectal sphincter ringPeri-anorectal spaceFissure in anoFis

9、sure triadClinic featureTreatment:nonoperation,operationAnorectal abcessPerianalIschiorectalsupralevatorFistula in anoEtiologyClinic findingsClassification:intersphincteric,transsphincteric,suprasphincteric,extrasphinctericmanagementOperation:ResectionExcidingstrangulation of sutureResection of fist

10、ulahemorrhoidsInternal hemorrhoidsExternal hemorrhoidsclassification of hemorrhoidsFirst degree:painless bleeding,Second degree:protrusion with defecation with spontaneous reduction,bleedingThird degree:protrusion,spontaneous or with bowel movement,requiring manual reduction,bleedingFourth degree:permanently prolapsed,irreducible,bleedingClinic findingsBleeding of defecationProtrusionPainfulitchingmanagementNonsurgical:better local hygiene;better dietary habits;medication to keep stool formed but soft;rubber-band ligation.Hemorrhoidectomy:PPH手术过程PPH手术前后比较照片提供照片提供上海长海医院肛肠科上海长海医院肛肠科 傅传刚傅传刚 教授教授