目的 探讨链霉菌抗生物素蛋白-过氧化物酶（SP）免疫组化染色检测胰岛素样生长因子-1（IGF-1）及组织P53蛋白的表达在结直肠腺癌中意义。方法 选取乌鲁木齐市中医医院2020年1月—2023年12月收治的169例结直肠腺癌患者为恶性组,另选取我院同期收治的169例良性结直肠肿瘤患者为良性组。取手术或活检病理组织应用SP免疫组化染色检测2组肿瘤组织IGF-1及P53蛋白表达水平,对比良性组与恶性组间差异,分析不同临床分期、淋巴结转移情况及组织分化程度患者的IGF-1水平、IGF-1mRNA及P53蛋白阳性率。结果 SP免疫组化染色检测IGF-1阳性率、P53蛋白阳性率,恶性组（72.78%、47.93%）均高于良性组（14.79%、6.51%）,对比差异有统计学意义（χ²=115.440、χ²=73.180,P<0.05）;Ⅳ期患者IGF-1阳性率（96.77%）及P53蛋白阳性率（77.42%）高于Ⅲ期（85.11%、63.83%）、Ⅱ期（62.69%、31.34%）及Ⅰ期患者（45.83%、25.00%）,对比差异有统计学意义（χ²=24.860,χ²=28.000,P<0.05）,各亚组两两比较差异无统计学意义（IGF-1阳性与阴性,Ⅰ期 vs Ⅲ期,χ²=12.110,P<0.001;Ⅰ期 vs Ⅳ期,χ²=16.060,P<0.001;Ⅱ期 vs Ⅲ期,χ²=6.880,P=0.009;P53蛋白阳性与阴性Ⅰ期 vs Ⅲ期,χ²=9.580,P<0.002;Ⅰ期 vs Ⅳ期,χ²=14.9990,P<0.001;Ⅱ期 vs Ⅲ期,χ²=11.790,P=0.001;）;有淋巴结转移患者IGF-1阳性率（85.71%）及P53蛋白阳性率（71.43%）高于无淋巴结转移患者（14.79%、40.94%）,对比差异有统计学意义（χ²=4.720、11.740,P<0.05）;低分化患者IGF-1阳性率（93.48%）及P53蛋白阳性率（71.74%）高于中分化患者（81.18%、54.12%）、高分化患者（52.63%、31.58%）,对比差异有统计学意义（χ²=21.250、13.510,P<0.05）。结论 SP免疫组化染色检测提示结直肠腺癌患者IGF-1、P53蛋白阳性率高于良性肿瘤患者,且临床分期高、淋巴结转移与肿瘤组织低分化者的IGF-1、P53蛋白阳性率高,因此IGF-1、P53有望成为结直肠腺癌诊治的重要检测指标。

Objective Exploring the significance of immunohistochemical staining with streptavidin-perosidase（SP）to detect the expression of insulin-like growth factor-1（IGF-1）and tissue P53 in colorectal adenocarcinoma．Methods A total of 169 patients with colorectal adenocarcinoma admitted to a hospital from January 2020 to December 2023 were selected and divided into the malignant group．Other 169 patients with benign colorectal tumors admitted to a hospital during the same period were selected and divided into the benign group．SP immunohistochemistry staining was used to detect and compare the expression levels of IGF-1 and P53 proteins in two groups of tumor tissues obtained in surgery or biopsy．And the IGF-1 levels,IGF-1 mRNA,and P53 positivity rates in patients with different clinical stages,lymph node metastasis,and tissue differentiation levels were compared．Results There was a significant difference in the positive rates of IGF-1mRNA and P53 detected by SP immunohistochemistry staining,and malignant group（72.78%,47.93%）were higher than the benign group（14.79%,6.51%）,which were statistically significant（χ²=115.440,73.180,P<0.05）．The positive rates of IGF-1 and P53 were 96.77% and 77.42% in stage IV,which were higher than those in Stage III（85.11%,63.83%）,II（62.69%,31.34%）and I（45.83%,25.00%）,the differences were statistically significant（χ²=24.860,28.000,P<0.05）．The expression levels of IGF-1 and P53 in colorectal adenocarcinoma patients with different lymph node metastases showed significant differences,the positive rates of IGF-1（85.71%）and P53（71.43%）in patients with lymph node metastasis were higher than those without lymph node metastasis（14.79%,40.94%）,and the differences were statistically significant（χ²=4.720,11.740,P<0.05）．There were significant differences in the expression levels of IGF-1 and P53 among patients with colorectal adenocarcinoma of different degrees of differentiation,the positive rates of IGF-1（93.48%）and P53（71.74%）were significantly higher than those of moderately differentiated（81.18%,54.12%）and well differentiated（52.63%,31.58%）,and the differences were statistically significant（χ²=21.250,13.510,P<0.05）．Conclusion sThrough SP immunohistochemical staining,it was found that the positivity rates of IGF-1 and P53 in colorectal adenocarcinoma patients were higher than those in benign tumor patients,and those with high the clinical stage,lymph node metastasis,and low differentiation of tumor tissue,had higher the positivity rates of IGF-1 and P53．Therefore,IGF-1 and P53 are expected to become important monitoring indicators for the diagnosis and treatment of colorectal adenocarcinoma．

直肠癌是全球常见的消化道恶性肿瘤之一,准确的影像学评估对直肠癌的诊断和治疗决策至关重要。在各种影像学检查中,磁共振成像已逐渐成为直肠癌不可或缺的检查手段,其中酰胺质子转移加权（APTw）成像是当前直肠癌磁共振成像中的一种极具发展前景的成像技术,其是通过检测病灶中内源性可移动蛋白的酰胺质子与水质子之间的交换,可以更好地在分子水平评估直肠癌病灶的蛋白质浓度、pH值、温度和代谢状态等,在直肠癌中有极大的应用潜能,有助于实现精准医疗。本文主要综述APTw成像在直肠癌中的研究进展、发展前景及尚存在的问题。

Rectal cancer is one of the most common gastrointestinal malignancies worldwide, and accurate imaging evaluation is essential for the diagnosis and treatment of rectal cancer．In various imaging examinations, magnetic resonance imaging（MRI）has gradually become an indispensable means of rectal cancer, among which amide proton transfer-weighted（APTw）imaging is a promising imaging technology．APTw imaging is to detect the exchange between amide protons of endogenous mobile proteins in lesions and water quality particles, which can better assess the protein concentration, pH, temperature, and metabolic status of rectal cancer at the molecular level．It has great application potential in rectal cancer and contributes to precision medicine．This article mainly reviews the research progress, development prospect and remaining problems of APTw imaging in rectal cancer．

目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激（TOF）比值将试验组患者分为试验组A（TOF≤0.1）、试验组B（0.10.8）。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组（P<0.01）,空白对照组患者TOF比值高于其他组（P<0.01）;空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义（P>0.01）;试验组A患者肌松恢复指数低于其他组（P<0.01）,空白对照组患者肌松恢复指数高于其他组（P<0.01）。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积（FEV1）、用力肺活量（FVC）和FEV1/FVC比较差异无统计学意义（P>0.05）。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。

Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer．Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects．The patients were randomly divided into a blank control group and an experimental group using a random number table method．Then,combined with the train-of-four（TOF）ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A（TOF≤0.1）,experimental group B（0.10.8）．The residual muscle relaxation and lung function between groups were compared．Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups（P<0.01）,while the TOF ratio of patients in the blank control group was higher than that of other groups（P<0.01）．There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit（P>0.01）．The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups（P<0.01）,while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups（P<0.01）．There were no significant differences in force expiratory volume in one second（FEV1）,forced Vital capacity（FVC）and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation（P>0.05）．Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels．

目的 调查与分析儿童结直肠息肉的临床特征及腹腔镜联合结肠镜下手术对其的治疗效果。方法 选择2019年2月—2021年10月在郑州大学附属儿童医院诊治的98例结直肠息肉患儿,记录患儿的临床特征,根据患儿的手术方法分为腹腔镜组（腹腔镜联合结肠镜下手术治疗,n=40）与结肠镜组（采用结肠镜手术治疗,n=58）,对比不同手术方法的治疗效果、并发症发生率、疼痛视觉模拟评分法（VAS）评分、息肉复发与再手术率。结果 98例患儿中,息肉部位为直肠44例、横直肠38例、其他16例;息肉最大直径（1.65±0.24）cm;息肉单发83例、多发15例。腹腔镜组的围手术期指标比结肠镜组改善（P<0.05）。腹腔镜组术后7 d的感染、出血、肠穿孔、肠梗阻等并发症发生率为5.00%,低于结肠镜组的17.24%（P<0.05）。腹腔镜组术后1个月的总有效率为97.50%,高于结肠镜组的82.76%（P<0.05）。腹腔镜组术后1、3、7 d的疼痛VAS评分低于结肠镜组（P<0.05）。所有患儿术后随访1年,联合的息肉复发率与再次手术率为5.00%、2.50%,均低于结肠镜组的18.97%、13.79%（P<0.05）。结论 儿童结直肠息肉主要位于直肠、横直肠,多为单发,腹腔镜联合结肠镜下手术治疗能促进患儿康复,提高总体治疗效果,也能缓解患儿疼痛,减少并发症的发生,降低随访息肉复发率与再次手术率。

Objective To investigate and analyze the clinical features of children with colorectal polyps and the efficacy of laparoscopic surgery combined with colonoscopy. Methods A total of 98 children with colorectal polyps diagnosed and treated in our hospital from February 2019 to October 2021 were selected as subjects of this study. The clinical characteristics of all children were recorded,and they were divided into the laparoscopic group(laparoscopic surgery combined with colonoscopy,n=40)and the colonoscopy group(colonoscopy,n=58)according to the differences in surgical methods. The therapeutic effect,complication rate,VAS pain score,polyp recurrence and reoperation rate of different surgical methods were compared. Results Among the 98 children,the polyps of 44 cases were in rectum,38 cases in transverse rectum and 16 cases in other sites. The maximum diameter of polyp was(1. 65±0. 24)cm. Polyps were solitary in 83 cases and multiple in 15 cases. The perioperative indexes in the laparoscopic group were significantly improved compared with those in the colonoscopy group(P<0. 05). The incidence of postoperative complications such as infection,bleeding,intestinal perforation and intestinal obstruction was 5. 00% in the laparoscopy group,which was significantly lower than 17. 24% in the colonoscopy group(P<0. 05). The total effective rate of laparoscopic group was 97. 50% one month after operation,which was significantly higher than that of colonoscopy group(82. 76%,P<0. 05). The VAS pain score of the laparoscopic surgery group was significantly lower than that of the colonoscopy group at 1,3 and 7 days after surgery(P<0. 05). After 1 year of follow-up,the combined polyp recurrence rate and reoperation rate were 5. 00% and 2. 50%,which were significantly reduced compared with 18. 97% and 13. 79% in colonoscopy group(P<0. 05). Conclusions The main sites of colorectal polyps in children are rectum and transverse rectum,and most of them are solitary. Laparoscopic and colonoscopic surgery for colorectal polyps in children can promote the recovery of children,improve the overall treatment effect of patients,relieve the pain of children,reduce the occurrence of complications,and reduce the recurrence rate and reoperation rate of follow-up polyps in children.

目的 评估基于NRS2002系统的多学科营养支持对直肠癌放化疗患者的作用。方法 选取2017年2月—2020年2月我院收治的96例直肠癌放化疗患者作为研究对象,根据入院建档顺序不同分2组,每组48例,对照组接受常规护理,观察组接受基于NRS2002系统的多学科营养支持。比较2组干预前后主观全面评定法(PG-SGA)评分、营养指标[前白蛋白(prealbumin, PA)、血清白蛋白(serum albumin, SA)、转铁蛋白(transferrin, TF)]、癌因性疲乏、生存质量(FLIC评分)。结果 干预后观察组营养状况优于对照组(P＜0.05);干预后观察组SA、PA、TF高于对照组(P＜0.05);干预后观察组癌因性疲乏低于对照组(P＜0.05);干预后观察组生存质量FLIC各维度评分高于对照组(P＜0.05)。结论 基于NRS2002系统的多学科营养支持有助于改善直肠癌放化疗患者营养状态,减轻癌因性疲乏,提升生存质量水平。

Objective To evaluate the efficacy of multidisciplinary nutritional support through NRS2002 system on patients undergoing radiotherapy and chemotherapy with rectal cancer. Methods From February 2017 to February 2020, 96 cases of rectal cancer patients undergoing radiotherapy and chemotherapy in our hospital were selected as the research objects, which were divided into two groups according to the order of filing, 48 cases in each group. The control group received routine nursing, and the observation group received multidisciplinary nutritional support through NRS2002 system. The PG-SGA score, nutritional indexes [prealbumin (PA), serum albumin (SA), transferrin (TF)], cancer-related fatigue and quality of life (FLIC score) were compared between two groups before and after intervention. Results After the intervention, the nutritional status of the observation group was better than that of the control group (P<0.05). The SA, PA, TF of the observation group were higher than those of the control group (P<0.05). The cancer-related fatigue of the observation group was lower than that of the control group (P<0.05), and the FLIC score of the observation group was higher than that of the control group (P<0.05). Conclusion Multidisciplinary nutritional support through NRS2002 system was helpful to improve nutritional status of patients, reduce cancer-related fatigue and improve quality of life of patients with rectal cancer undergoing radiotherapy and chemotherapy.

目的 分析疼痛护理对直肠癌癌痛患者不良情绪及爆发性疼痛的影响。方法 选取2020年4月—2020年6月我院收治的68例直肠癌癌痛患者作为研究对象,通过随机分组的方式将患者分为2组,对照组使用常规临床护理模式,观察组使用疼痛护理模式,对比2组患者的癌痛程度、不良情绪及爆发性疼痛的发生率。结果 2组患者在接受不同护理模式后,SF-MPQ评分相较于护理前出现了下降(P＜0.05),其中观察组的评分与对照组比较下降(P＜0.05),但护理前2组比较并无差异(P＞0.05);2组患者在接受不同护理模式后,功能维度评分和总体健康评分相较于护理前出现了上升(P＜0.05),且与对照组比较观察组得分升高(P＜0.05),2组患者在接受不同护理模式后,症状维度评分相较于护理前降低(P＜0.05),且与对照组比较观察组的评分下降(P＜0.05);服药依从率对比结果显示,观察组(94.12%)的依从性优于对照组(61.76%),组间比较有差异(P＜0.05);爆发性疼痛对比结果显示,观察组(8.82%)低于对照组(47.06%),组间比较有差异(P＜0.05)。结论 疼痛护理可以有效应用于直肠癌癌痛患者的护理中,其不仅可以减轻患者的癌痛程度,还有利于调节患者的不良情绪,降低患者的爆发性疼痛发生率,宜广泛应用及推广。

Objective To analyze the influence of pain nursing on the negative mood and explosive pain of patients with rectal cancer pain. Methods A total of 68 patients with colorectal cancer pain in June 2020 were included as research objects, and divided into two groups by randomized grouping.Routine clinical care was applied on the control group, pain nursing was applied on the observation group.The incidence of cancer pain, negative emotions and explosive pain in both groups of patients were compared. Results After applying different care plans, two groups of patients had a significant decrease in the SF-MPQ score (P<0.05), in which the score of the observation group was significantly lower than the control group (P<0.05), however, there were no significant differences before nursing (P>0.05). Two groups of patients were significantly improving in function scoring and the overall health scoring after receiving different care modes (P<0.05), and the observation group was significantly higher than the control group (P<0.05). The symptom dimension scores were significantly lower than before accepting different care modes (P<0.05), and the control group was significantly higher (P<0.05). The comparative results of the medicinal compliance of observation group (94.12%) were better than the control group (61.76%,P<0.05); outbreak pain comparative results showed the observation group (8.82%) was significantly lower than that of the control group (47.06%,P<0.05). Conclusion Pain nursing can be effectively used in the nursing of patients with rectal cancer pain.It can not only reduce the degree of cancer pain, but also help regulate the patient's negative mood and reduce the incidence of explosive pain.It should be widely used and promoted.

目的 使用分层应变技术评价以mFOLFOX6化疗的结直肠癌患者左心室功能的变化。方法 收集30例病理确诊为结直肠癌患者,各位患者均采用mFOLFOX6(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗方案,以自身对照做研究,分别于化疗前、化疗中期、化疗后期行心脏超声检查,获取常规参数,并采集左心室心尖四腔、三腔、两腔切面、短轴二尖瓣、乳头肌、心尖切面的三维动态图像,获取左心室的心肌心内膜下、中层、心外膜下心肌的纵向应变(GLSendo、GLSmid、GLSepi)及左心室心肌心内膜下、中层、心外膜下圆周应变(GCSendo、GCSmid、GCSepi)的数值,计算△GLS(△GLS=GLSendo-GLSepi),△GCS(△GCS=GCSendo-GCSepi),并比较这些数值的绝对值在化疗前后的变化。结果 无论化疗前还是化疗后,各层心肌均有跨壁梯度的存在。与化疗前相比:化疗后各层心肌应变参数的绝对值均降低,GLSendo和GCSendo、ΔGLS下降更为显著(P<0.05),其中,GLSendo的ROC曲线下面积为0.766,P<0.001,选25.3%为诊断界点,灵敏度为83.3%,特异度为70%;ΔGLS的ROC曲线下面积为0.749,P<0.001,选4.1%为诊断界点,灵敏度为76.7%,特异度为73.3%。结论 心肌分层应变技术有助于早期发现mFOLFOX6致结直肠癌患者左心室各层心肌功能的变化,GLSendo、ΔGLS是该技术中较为敏感的指标。

Objective To evaluate the changes of left ventricular function in patients with colorectal cancer treated with mFOLFOX6 using layer-specific strain analysis. Methods The data of 30 patients with pathologically diagnosed with colorectal cancer were collected. All patients were treated with mFOLFOX6 (5-fluorouracil+oxaliplatin+calcium leucovorin) chemotherapy. The self-control study was carried out before, during, and after chemotherapy, and cardiac ultrasound was performed to obtain conventional parameters, and three-dimensional dynamic images of the left ventricular apex four-chamber, three-chamber, two-chamber section, short-axis mitral valve, papillary muscle, and apical sectionare were acquired. The longitudinal strain of the three layer of myocardium (GLSendo、GLSmid、GLSepi) and the circumferential strain of myocardium (GCSendo、GCSmid、GCSepi) were collected, and △GLS (△GLS=GLSendo-GLSepi), △GCS (△GCS=GCSendo-GCSepi) were calculated, and the absolute values of these indexes before and after chemotherapy were compared. Results No matter before or after chemotherapy, there was a transmural gradient in each layer of myocardium. Compared with those before chemotherapy, the absolute values of myocardial strain parameters of each layer were reduced after chemotherapy, and GLSendo and GCSendo and ΔGLS decreased more significantly (P<0.05),while the area under the ROC curve of GLSendo was 0.766, P<0.001.Selecting 25.3% as the diagnostic boundary, the sensitivity was 83.3%, and the specificity was 70%.The area under the ROC curve of ΔGLS was 0.749, P<0.001. Selecting 4.1% as the diagnostic boundary, the sensitivity was 76.7%, and the specificity was 73.3%. Conclusions The myocardial layer-specific strain analysis is helpful for early detection of changes in the myocardial function of the left ventricle, which caused by mFOLFOX6 in patients with colorectal cancer. GLSendo and ΔGLS are sensitive indicators in this technique.

目的 探讨应用三管引流法在防治直肠癌前切除术后吻合口漏中的疗效。方法 选取在我科2018年4月—2020年3月接受腹腔镜或者开腹直肠癌前切除术患者186例,将患者随机分为两组,研究组(三管引流法)96例,对照组(常规引流法)90例,进行对比研究。比较两组患者术后吻合口漏及恢复情况。结果 研究组患者吻合口漏发生率、非计划手术率、回肠造口率低于对照组(P＜0.05),吻合口漏患者中,研究组体温恢复正常时间、C反应蛋白(CRP)恢复正常时间及住院时间均少于对照组,差异均有统计学意义(P＜0.05)。结论 应用三管引流法,可预防直肠癌前切除术后吻合口漏,通过非手术治疗避免非计划二次手术,缩短吻合口漏患者恢复时间,显示更好的临床疗效。

Objective To explore and evaluate the clinical application value of three-tube drainage for the treatment of anastomotic leakage after low anterior resection for rectal cancer. Methods We retrospectively analyzed a total of 186 rectal cancer patients after low anterior resection for rectal cancer in our hospital from April 2018 to March 2020. According to the difference of prevention to anastomotic leakage, these patients were divided into two groups randomly that 90 cases used conventional drainage as control group, and 96 cases used three-tube drainage as study group. Postoperative recovery and anastomotic leakage were compared between these two groups. Results The rate of anastomotic leakage, ileostomy and unplanned reoperation of study group were lower than those of control group (P＜0.05).The times returned to normal of body temperature and C-reactive protein (CRP), the average length of stay in hospital of study group were shorter than those of control group respectively (P＜0.05). Conclusion The application of three-tube drainage may prevent anastomotic leakage and unplanned reoperation after low anterior resection for rectal cancer and shorten postoperative recovery time, to reveal better clinical effects.

目的 观察结直肠癌患者使用联合药物FOLFOX化疗前后左心室应变参数的变化。方法 选取健康人30例作为正常组,收集病理确诊为结直肠癌并采用FOLFOX(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗的患者30例,以自身对照做研究,分别在化疗前、化疗1个周期后、化疗6个周期后、化疗12个周期后48 h内完成心脏超声检查,采集左心室的动态图像,获取常规参数:LVEDd、LVEDs、IVSd、LVPWd、LVEDV、LVESV、LVEF、LVFS;三维参数:SPI、SV、CO、LVEDMass、LVESMass、GAS、GRS、GLS、GCS,并比较化疗前后这些数值的变化。结果 正常组与各化疗组相比对,LVEDd、LVEDs、IVSd、LVPWd、LVPW、LVESV、SPI的变化均无统计学意义(P>0.05);LVEF、LVFS、SV、CO在化疗中、后期出现了降低,差异有统计学意义(P<0.05),HR、LVEDMass、LVESMass略升高,差异有统计学意义(P<0.05);化疗后GLS及GAS较化疗前明显减低(P<0.05),其中GAS的ROC曲线下面积为0.883,P<0.001,选30%为诊断界点,灵敏度为86.7%,特异度为80%;GLS的ROC曲线下面积为0.888,P<0.001,选19%为诊断界点,灵敏度为73.3%,特异度为90.0%。结论 三维斑点追踪技术能够早期发现FOLFOX致结直肠癌患者左心室功能的变化,其中LVGLS、LVGAS是有力的观测指标。

Objective To observe the changes of left ventricular strain parameters in patients with colorectal cancer before and after combined chemotherapy with FOLFOX. Methods 30 healthy people were selected as normal group, and 30 patients with pathologically diagnosed colorectal cancer and FOLFOX (5-fluorouracil +oxaliplatin+calcium leucovorin) chemotherapy were collected. Before, after 1 cycle of chemotherapy, after 6 cycles of chemotherapy, and within 48 hours after 12 cycles of chemotherapy, cardiac ultrasound examination was performed, and dynamic images of the left ventricle were collected to obtain conventional parameters: LVEDd, LVEDs, IVSd, LVPWd, LVEDV, LVESV, LVEF, LVFS; three-dimensional parameters: SPI, SV, CO, LVEDMass, LVESMass, GAS, GRS, GLS, GCS, and the changes of these values before and after chemotherapy were compared. Results Compared with the chemotherapy group, the normal group had no statistically significant changes in LVEDd, LVEDs, IVSd, LVPWd, LVPW, LVESV, and SPI (P>0.05); LVEF, LVFS, SV, CO were in the middle and late stages of chemotherapy. There was a decrease, the difference was statistically significant (P<0.05), HR, LVEDMass, LVEESMass were slightly increased, the difference was statistically significant (P<0.05); LGS and GAS after chemotherapy were significantly lower than before chemotherapy (P<0.05), the area under the ROC curve of GAS is 0.883, P=0.000, 30% is selected as the diagnostic boundary, the sensitivity is 86.7%, and the specificity is 80%; the area under the ROC curve of GLS is 0.888, P=0.000, 19% as a diagnostic boundary, the sensitivity is 73.3% and the specificity is 90.0%. Conclusion Three-dimensional speckle tracking technology can detect the changes of left ventricular function in patients with colorectal cancer caused by FOLFOX in early stage, of which LVLGS and LVGAS are powerful observation indicators.

目的 探讨内镜黏膜下剥离术(ESD)治疗结直肠高级别上皮内瘤变(HGIN)的安全性及临床疗效。方法 回顾性分析2016年1月—2019年6月在南方医科大学附属小榄医院经肠镜活检诊断为结直肠HGIN并接受ESD治疗的56例患者的临床资料,记录每例病变的术后病理、整块切除率、治愈性切除率、手术并发症和随诊结果。结果 病灶平均直径为(2.28±0.76) cm。53例经ESD术完整切除,3例术中改用内镜下黏膜分片切除术切除,整块切除率为94.64％ (53/56)。术后病理51例HGIN,2例HGIN伴黏膜内癌,2例浸润性癌,术前活检与术后病理总符合率为92.86%(52/56),治愈性切除率为96.43%(54/56)。术中出血发生率为89.29%(50/56),术后迟发性出血发生率为3.57%(2/56)。术中穿孔发生率为5.36%(3/56),无术后迟发性穿孔病例。中位随访期为17个月,期间共1例患者复发。结论 ESD术治疗结直肠HGIN安全有效,但需警惕浸润性癌的可能。ESD术具有较高的术中出血和穿孔的风险,术者需具备熟练的操作技术及处理手术并发症的经验。

Objective To investigate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for colorectal high-grade intraepithelial neoplasia (HGIN). Methods Data of 29 patients diagnosed as colorectal HGIN and underwent endoscopic submucosal dissection (ESD) from January 2016 to June 2019 were retrospectively analyzed. Postoperative pathology, total en bloc resection rate, curative resection rate, complication and follow-up results were recorded. Results The mean diameter of the lesions was (2.28±0.76) cm. A total of 53 cases were successfully treated by ESD, 3 cases were changed using endoscopy piecemeal mucosal resection, the en bloc resection rate was 94.64% (53/56). Postoperative diagnosis confirmed 52 cases of HGIN, 2 cases of HGIN with intra-mucosal cancers and 2 case of invasive cancer,the overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 92.86% (52/56), the curative resection rate was 96.43% (54/56). The incidence of intro-operative bleeding and postoperative delayed bleeding was 89.29% (50/56) and 3.57% (2/56) respectively. The incidence of intro-operative perforation was 5.36% (3/56) and no delayed perforation occurred. The median follow-up period was 17 months and one case recurred. Conclusion ESD is a safe and effective treatment for colorectal HGIN, but invasive cancer must be cautioned. ESD has high risk of intro-operative bleeding and perforation, therefore, the surgeon must have skilled operation and treatment experience for complications.