约10%~30%的新发结直肠癌患者会出现急性肠梗阻,传统急诊手术治疗存在术后并发症高、死亡率高、生存质量低等不足。肠道支架置入联合限期手术作为一种新型治疗策略,展现出显著优势。肠道支架可迅速解除梗阻,改善患者症状,降低手术风险,为肿瘤微创切除创造条件,同时为新辅助化疗提供可能,但其潜在并发症如出血、移位、再梗阻及肠穿孔等也不容忽视,且长期安全性及对肿瘤结局的影响尚不明确。文章综述了肠道支架治疗梗阻性结直肠癌的治疗现状、争议及研究进展,旨在为临床研究和实践提供参考依据。
Approximately 10% to 30% of patients with newly diagnosed colorectal cancer present with acute intestinal obstruction.Traditional emergency surgical intervention is characterized by high rates of postoperative complications,elevated mortality,and diminished quality of life.Combined stent and curative elective surgery(CSCES)has emerged as a novel therapeutic strategy,exhibiting significant clinical benefits.Intestinal stenting can rapidly alleviate obstruction,thereby improving patient symptoms,reducing surgical risks,and facilitating minimally invasive tumor resection.Additionally,it provides an opportunity for neoadjuvant chemotherapy.However,potential complications,including bleeding,stent migration,recurrent obstruction,and intestinal perforation,must be carefully considered.Moreover,the long-term safety and impact on oncologic outcomes remain to be elucidated.This review aims to provide a comprehensive overview of the current status,controversies,and recent advancements in the use of intestinal stents for the treatment of obstructive colorectal cancer,with the goalof informing clinical research and practice.
通过筛查和早期发现,可以降低结直肠癌(CRC)的发病率,有效切除肿瘤病变可以降低CRC的病死率。虽然对CRC的危险因素、发病机制和前体病变的了解已经取得进展,但最近年轻人群CRC发病率升高,原因尚不清楚。在过去十年中,出现了多种侵入性、半侵入性和非侵入性筛查方式。目前对结肠镜检查质量的重视提高了筛查的有效性,人工智能等影像新技术在肿瘤检测中的作用正在迅速显现。而且,CRC有效干预措施,如保肛治疗新术式、靶向治疗及免疫治疗领域的新进展,被证明可以提高CRC患者的生存率。该文旨在总结目前国内外CRC筛查方式和指南的证据,并综述CRC治疗领域的进展。
The incidence of colorectal cancer(CRC)can be reduced through screening and early detection.Effective resection of tumor lesions reduces mortality from CRC.Although progress has been made in understanding the risk factors,pathogenesis and precursor lesions of CRC,the reasons for the recent increase in the incidence of CRC in young adults are largely unknown.A variety of invasive,semi-invasive and non-invasive screening modalities have emerged in the last decade.The current emphasis on the quality of colonoscopy has improved the effectiveness of screening,and the role of new imaging technologies such as artificial intelligence in tumor detection is rapidly emerging.Moreover,there are effective interventions for CRC,such as new surgical modalities for anal preservation therapy,and new advances in the field of targeted therapy and immunotherapy,which have been shown to improve the survival rate of CRC.The aim of this article is to summarize the current evidence on CRC screening modalities and guidelines both nationally and internationally,and to provide an overview of advances in the field of CRC treatment.
大便失禁是肛肠外科常见疾病,可导致患者生活质量下降,并引起一系列社会心理问题,其发病率随着年龄增加明显上升。肛门括约肌复合体损伤是大便失禁的最常见原因。目前的治疗方式包括保守治疗和手术治疗,但治疗效果仍不理想,尤其是长期治疗效果较差。最近,许多临床前和临床研究对大便失禁的干细胞疗法进行了探索,作为一种新的治疗方式,干细胞疗法有望彻底治愈大便失禁。本文就干细胞疗法治疗大便失禁的动物模型、损伤和修复机制、疗效等方面进行综述。
Fecal incontinence is a common anorectal surgical condition that can lead to decreased quality of life and a range of psychosocial problems in patients, and its incidence increases significantly with age. Damage to the anal sphincter complex is the most common cause of fecal incontinence. Current treatment modalities include conservative and surgical treatment, but treatment outcomes remain suboptimal, especially in the long term. Recently, many preclinical and clinical studies have explored stem cell therapy for fecal incontinence as a new treatment modality that holds promise for a complete cure of fecal incontinence. This paper presents a review of animal models, mechanisms of injury and repair, and efficacy of stem cell therapy for fecal incontinence.