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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1704_Библиотеки_им_академика_М_И_Перельмана
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292 Index
Functional bowel disorders, 209–243
anal manometry, 218–224
electromyography, 223
pudendal nerve terminal motor
latency, 219, 223–224
rectal compliance, 223
rectal sensation, 222–223
rectoanal inhibitory reflex, 222
test available, 218
vector volume manometry, 222
colonic transit studies, 236–239
endo-anal ultrasound, 224–236
faecal incontinence, 230–235
solitary rectal ulcer syndrome,
235–236
technique, 225–230
evacuatory proctography, 210–218
anal canal, 215
anorectal angle, 215–216
changes in rectal wall, 216–217
normal appearances, 215–218
pelvic-floor descent, 216
perineometry, 217–218
magnetic resonance imaging of
pelvis, 224
G
Gallbladder emptying, cholecystokinin
provocation test, 265
Gastric hereditary non-polyposis
colorectal cancer, 47
Gastrointestinal contrast series, in
pelvic surgery, 136
Gene therapy, in colorectal cancer, 204
Genetic risk assessment, screening,
colorectal cancer, 30
Giant condyloma, 123
Gracilis muscle, 160–164
flap harvesting, 161
nerve to, 161
Graciloplasty, dynamic, with faecal
incontinence, 252–253
Granulocyte macrophage-colony-
stimulating factor, 60
Gynaecologist, in pelvic surgery, 137
H
Haemorrhage, intraoperative, 139–143
postoperative pelvic packing,
142–143
presacral, 139–142
surgical control
iliac venous bleeding, 142
presacral haemorrhage, 141–142
Hamartomatous polyposis syndromes,
50–51
Cowden syndrome, 51
juvenile polyposis syndrome, 50–51
Peutz-Jeghers syndrome, 50
Hepatobiliary hereditary non-polyposis
colorectal cancer, 47
Hereditary non-polyposis colorectal
cancer, 45–50
age at diagnosis, cancer risk, 47
clinical features, diagnosis, 46–47
endometrial, 47
gastric, 47
genetics, 45–46
hepatobiliary, 47
management, 47–50
microsatellite instability, DNA, 46
ovarian, 47
screening, 31–33
small intestine, 47
urinary tract, 47
High fistulas, Crohn’s disease, 100–
101
History of symptomatology, 210
HIV infection
anal squamous intraepithelial lesions,
131
malignant anal-canal tumours, 119
HNPCC. See Hereditary non-polyposis
colorectal cancer
Humanised anti-tumour necrosis-factor
antibody, 60
I
Iliac venous bleeding, 142
Illuminated stents, 144
Imaging, preoperative, 136. See also
under specific imaging
modality
Immunosuppression, chronic,
malignant anal-canal tumours,
120
Immunotherapy, in colorectal cancer,
202–204. See also under specific
immunotherapeutic agent
Index 293
Incontinence, faecal, 244–261
anal-canal bulking agents, 254
artificial bowel sphincter, 251–252
biofeedback, 247–248
dynamic graciloplasty versus artificial
anal sphincter, 252–253
encirclement procedures, 249–250
endo-anal ultrasound, 230–235
medical management, pharmacology,
246–247
new techniques, 249–254
sacral nerve stimulation, 253–254
sphincter repair, 248–249
Infection, inoperable rectal cancer,
186–187
Inflammatory process, in pelvic surgery,
136
Infliximab
Crohn’s disease, 61, 66–68,
108–109
Inguinal lymphadenectomy, malignant
anal-canal tumours, 127
Inherited syndromes predisposing to
colorectal cancer
Inoperable rectal cancer, 171–190
bleeding, 186–187
chemoradiotherapy, 184–185
discharge, 186
infection, 186–187
pain management, 185–186
palliative treatments, 185–187
patient assessment, 171–173
radiological imaging, 173–174
surgical approaches, 177–185
abdominosacrectomy, 183–184
exenterative procedures, 182–183
intestinal obstruction, 178–179
resection, 179–180
surgical techniques, 180–182
therapeutic strategies, 174–177
chemotherapy, 175–176
intraoperative radiotherapy,
176–177
preoperative radiotherapy, 175
Interferon beta-1, 60
Interleukin 11, 60
Internal anal sphincterotomy,
demonstrated on anal scan,
234
Internal sphincter
disruption of, following manual anal
dilatation, 233
variation in thickness in, with age,
229, 230
International population screening, for
colorectal cancer, 29
Intestinal obstruction, inoperable rectal
cancer, 178–179
Intestinal reconstruction, in pelvic
surgery, 150–151
Intraoperative pelvic surgery problems,
135–153
benign proctectomy, 145–148
autonomic injury, 147
dissection of rectal stump, 145–147
collateral damage, 139–145
colorectal surgeon, 137
computed tomography, 136
consultant surgical personnel, 137
cystoscopy, 136
excisional problems, 145–150
excretion renogram, 136
gastrointestinal contrast series, 136
gynaecologist, 137
haemorrhage, 139–143
iliac venous, 142
postoperative pelvic packing,
142–143
presacral, 139–142
inflammatory process, 136
intestinal reconstruction, 150–151
intravenous pyelogram, 136
lower gastrointestinal endoscopy,
136
magnetic resonance imaging, 136
neoplastic process, 136
neurosurgeon, 137
pelvic examination under
anaesthetic, 136
perineal myocutaneous
reconstruction, 151–152
plastic surgeon, 137
positron emission tomography scan,
136
pouch of Douglas Mass, 147–148
preoperative planning, 135–139
reconstructive problems, 150–152
sacral excision, 148–150
294 Index
Intraoperative pelvic surgery problems,
(cont.):
staging computed tomography, chest,
abdomen, 136
transrectal ultrasound, 136
urogenital collateral damage,
143–145
colorectal cancer involvement,
urogenital tract, 143–145
protecting ureters, 143
urologist, 137
vascular surgeon, 137
Intraoperative radiotherapy, inoperable
rectal cancer, 176–177
Intravenous pyelogram, in pelvic
surgery, 136
Intussusception
defaecating proctogram identifying,
271
prolapse of, with external prolapse,
217
Irinotecan, in colorectal cancer,
195–197
J
Juvenile polyposis syndrome, 50–51
L
Large-cell keratinising tumour, anal
canal, 123
Large-cell nonkeratinising tumour, anal
canal, 123
Lateral spot films, patient sitting
upright, 212
Lloyd Davis position, with head down,
138
Low fistulas, Crohn’s disease, 98–100
Lower gastrointestinal endoscopy,
pelvic surgery, 136
Low-risk patients
management of, 9
rectal bleeding with, 14–15
screening of, 33–34
Lymphatic drainage
anus, 117
rectum, 117
Lymphocyte trafficking, 60
in Crohn’s disease, inhibition of,
72–74
M
Magnetic resonance imaging, 224
Crohn’s disease, 95–96
in pelvic surgery, 136
POD mass, 148
rectal-cancer recurrence, 136
Malignant anal-canal tumours, 115–134
adenocarcinoma, 123
anal gland adenocarcinoma, 123
anatomic features, 115–116
anorectal fistula, 123
basaloid tumour, 123
chemoradiation salvage after local
resection, 129
classification, 121–122
diagnosis, 120
epithelial, 123
evaluation, 129, 130–131
follow up, 130–131
histologic classification, 123
inguinal lymphadenectomy, 127
large-cell keratinising tumour, 123
large-cell nonkeratinising tumour, 123
local excision, 124–125
location, 121–122
malignant epithelial tumours, 123
Paget’s disease, 123
preoperative chemotherapy,
radiation, 125–127
presentation, physical findings,
116–117
rectal type adenocarcinoma, 123
recurrent disease, surgical salvage,
127–128
risk factors, 117–120
cervical cancer and, 118–119
chronic immunosuppression, 120
HIV infection, 119
smoking, 120
screening, 130–131
small-cell carcinoma, 123
squamous-cell carcinoma, 123
treatment, 122–127, 130–131
undifferentiated, 123
Manometry, anal, 218–224
electromyography, 223
pudendal nerve terminal motor
latency, 219, 223–224
rectal compliance, 223
Index 295
rectal sensation, 222–223
rectoanal inhibitory reflex, 222
resting anal pressure, 220
test available, 218
vector volume manometry, 222
6-mercaptopurine
in Crohn’s disease, 63, 108
Mechanistically novel cytotoxics, in
colorectal cancer, 195–198
Megabowel, constipation and
surgical management, 277–280
Megacolon, management of, 280
Megarectum, management of, 280
Mental, physical consequences,
excisional pelvic surgery, 137
Mercaptopurine, in Crohn’s disease, 63,
108
Methotrexate, in Crohn’s disease, 61, 76
evidence for efficacy, 76
future questions, 78
side-effect profile, 77
Metronidazole, Crohn’s disease,
107–108
Microparticle diets, in Crohn’s disease,
83–84
Microsatellite instability, DNA,
hereditary non-polyposis
colorectal cancer, 46
Midrectal intussusception, defaecating
proctogram identifying, 271
Moderate-risk groups, screening, 33
Multidisciplinary approach, in
screening for colorectal cancer,
34
Multiple colorectal adenomas,
macroscopic appearance of
colon, 41
N
National population screening, for
colorectal cancer, 29
Nephrostomy tube, renal pelvis, 174
Neurosurgeon, in pelvic surgery, 137
Normal caliber colon/rectum, severe
constipation and, surgical
management, 263–280
Normal colonic transit study
abnormal proctogram, surgical
management, 268–275
anismus, 273–275
intussusception/internal prolapse,
270–272
rectocele, 272–273
solitary rectal ulcer syndrome, 275
normal proctogram, surgical
management, 276–277
Nutritional therapies, in Crohn’s
disease, 78–79
O
Omentum, 164–166
flap, 165
Oncologist, role in colorectal cancer
treatment, 191–208
adjuvant chemotherapy, 198–201
chemotherapy, 191–200
5-fluorouracil, 192–195
biomodulation, with other agents,
193–194
gene therapy, 204
immunotherapy, 202–204
mechanistically novel cytotoxics,
195–198
irinotecan, 195–197
oxaliplatin, 198
modulation of, 194–195
new approaches to treatment,
202–204
radiotherapy, 201–202
recombinant virus vaccines, 204–
205
Onerecpt, 60
in Crohn’s disease, 69–70
Oral scintigraphic segmental transit
study, 239
Ovarian hereditary non-polyposis
colorectal cancer, 47
Oxaliplatin, in colorectal cancer, 198
P
Packing, pelvic, postoperative, 142–143
Paget’s disease, anal canal, 123
Pain management, inoperable rectal
cancer, 185–186
Palliative treatments, inoperable rectal
cancer, 185–187
Patient evacuating, with completion
film, full straining, 214
296 Index
Pelvic examination under anaesthetic,
in pelvic surgery, 136
Pelvic floor
descent, 216
functional reconstruction of, 154–170
loss, 168–169
repair, appearance of, 163
Pelvic surgery
after radiotherapy, 169
benign proctectomy, 145–148
autonomic injury, 147
dissection of rectal stump, 145–147
collateral damage, 139–145
colorectal surgeon, 137
computed tomography, 136
constipation, 262–285
consultant surgical personnel, 137
cystoscopy, 136
excisional problems, 137, 145–150
excretion renogram, 136
gastrointestinal contrast series, 136
gynaecologist, 137
haemorrhage, 139–143
iliac venous bleeding, surgical
control, 142
inflammatory process-, 136
intestinal reconstruction, 150–151
intraoperative problems, 135–153
intravenous pyelogram, 136
lower gastrointestinal endoscopy, 136
magnetic resonance imaging, 136
neoplastic process, 136
neurosurgeon, 137
packing, postoperative, 142–143
pelvic examination under
anaesthetic, 136
perineal myocutaneous
reconstruction, 151–152
plastic surgeon, 137
positron emission tomography scan,
136
pouch of Douglas Mass, 147–148
preoperative planning, 135–139
presacral haemorrhage, 139–142
reconstructive problems, 150–152
sacral excision, 148–150
staging computed tomography, chest,
abdomen, 136
transrectal ultrasound, 136
urogenital collateral damage,
143–145
colorectal cancer involvement,
urogenital tract, 143–145
protecting ureters, 143
urologist, 137
vascular surgeon, 137
Pelvis, magnetic resonance imaging,
224
Perianal Crohn’s disease, 93–114. See
also Crohn’s disease
abscess, management of, 96–98
advancement flaps, 102–103
anal fissures, skin tags, management
of, 97–98
anorectal stricture, 105–106
classification of, 94–95
defunctioning, 101–102
endo-anal ultrasound, 95–96
high fistulas, 100–101
initial assessment, 95–96
low fistulas, 98–100
magnetic resonance imaging, 95–96
malignant change and, 106–107
manifestations of, 93
medical management, 107–109
azathioprine, 108
ciprofloxacin, 107–108
infliximab, 108–109
6-mercaptopurine, 108
metronidazole, 107–108
natural history of, 94
proctocolectomy in, 106
proximal resection, 102
setons, 100–101
sexual function, 106
treatment, 96–107
vaginal fistula, 103–105
Perianal symptoms, rectal bleeding
and, 10
Perineal myocutaneous reconstruction,
in pelvic surgery, 151–152
Perineal proctectomy, 167–168
Perineometry, 217–218
Perineum
functional reconstruction of, 154–
170
repair after extended skin loss,
removal, 166–167
Index 297
Personnel, in colorectal pelvic case,
planning, 137
Peutz-Jeghers syndrome, 50
Plastic surgeon, in pelvic surgery, 137
Pooled analysis, individual patient data
for survival, 192
Positron emission tomography scan, in
pelvic surgery, 136
Postoperative pelvic packing, 142–143
Pouch of Douglas mass, 147–148
Pre-chemoradiation therapy, 121
Predictive value of rectal bleeding, 4
Preoperative radiotherapy, inoperable
rectal cancer, 175
Presacral chordoma, 149
Presacral haemorrhage, 139–142
in pelvic surgery, 139–141
Pressures in incontinent patient, 221
Prevalence of rectal bleeding, 2–4
Probiotics, in Crohn’s disease, 83
Proctectomy
benign, 145–148
perineal, 167–168
Proctocolectomy, Crohn’s disease, 106
Proctogram
cystogram, urinary bladder, 269
normal, with rectal bleeding, 5–7
small stump, 146
Proctography, squeeze assessment
during, 213
Proximal resection, Crohn’s disease,
102
Pudendal nerve terminal motor
latency, 219, 223–224
Q
QUASAR 1 study, schematic
representation of, 200
R
Radiolabeled scintigraphy scan,
demonstrating delay at splenic
flexure, 267
Radiolucent commode, for
proctographic assessment, 211
Radiotherapy
in colorectal cancer, 201–202
intraoperative, inoperable rectal
cancer, 176–177
preoperative, inoperable rectal
cancer, 175
surgery after, 169
Recombinant virus vaccines, in
colorectal cancer, 204–205
Reconstructive problems, in pelvic
surgery, 150–152
Record of symptomatology, 210
Rectal bleeding
age, symptom profiles, 10
cancer risk in community, in primary
care, 9–12
change in bowel habit, 10, 12
characteristics of, 10–12
dark red bleeding, 10–11
delays in treatment, 6
diagnostic value of, 12
earlier diagnosis of colorectal cancer,
survival, 6–7
earlier symptomatic diagnosis, 7
for identification of cancer, 1–21
incidence rates, 3
with low risk of cancer, 14–15
management, 12–14
manifestation of, 11
normal colonic transit study, normal
proctogram, 5–7
palpable rectal mass, 11–12
paradigm governing management of,
changing, 8–9
perianal symptoms, 10
predictive value of, 4, 7, 11
prevalence of, 2–4
recurrent, 14
referral of patients for investigation,
4–5
risk of cancer, vs. risk of
investigation, 7–9
symptom patterns of, 10
Rectal cancer, inoperable, 171–190
bleeding, 186–187
chemoradiotherapy, 184–185
discharge, 186
infection, 186–187
pain management, 185–186
palliative treatments, 185–187
patient assessment, 171–173
radiological imaging, 173–174
surgical approaches, 177–185
298 Index
Rectal cancer, inoperable, (cont.):
abdominosacrectomy, 183–184
exenterative procedures, 182–
183
intestinal obstruction, 178–179
resection, 179–180
surgical techniques, 180–182
therapeutic strategies, 174–177
chemotherapy, 175–176
intraoperative radiotherapy,
176–177
preoperative radiotherapy, 175
Rectal stump, dissection of, 145–147
Rectal tumour, fistulating anteriorly
into bladder in male, 178
Rectal type adenocarcinoma, anal
canal, 123
Rectal wall, changes in, 216–217
Rectoanal inhibitory reflex, 222
Rectocele, 216
defaecating protogram
demonstrating, 272
intussusception, coexisting, 218
Rectus abdominis muscle, 158–160
Recurrent rectal bleeding, 14
Recurrent rectal tumour, extending to
pelvic side wall, 173
Red, dark, bleeding, 10–11
Referral, alternative methods for, 14
Resection, in inoperable rectal cancer,
179–180
Resources, colorectal pelvic case, 137
Risk of cancer, risk of investigation,
compared, 7–9
S
Sacral excision, in pelvic surgery,
148–150
Sacral nerve stimulation, with faecal
incontinence, 253–254
Screening for colorectal cancer, 22–36
cost effectiveness of, 28
ethical dilemmas in population
screening, 28–29
familial adenomatous polyposis,
30–31
future of, 29–30
genetic risk assessment, colorectal
cancer, 30
hereditary non-polyposis colorectal
cancer, 31–33
high-risk groups, 30–33
individuals screened, 26–28
international population screening,
29
low-risk group, 33–34
moderate-risk group, 33
multidisciplinary approach, 34
national population screening, 29
population screening, 29
test(s), 23–26
Setons, Crohn’s disease, 100–101
Sexual function, Crohn’s disease, 106
Small intestine, hereditary non-
polyposis colorectal cancer, 47
Small-cell carcinoma, anal canal, 123
Smoking, malignant anal-canal
tumours, 120
Solitary rectal ulcer syndrome, 235–236
Sphincter disruption, following anal
trauma, 235
Sphincter repair, with faecal
incontinence, 248–249
Split skin graft, 166
Squamous-cell carcinoma, 123
anal canal, 123
Squeeze assessment
maximal pressure, 221
during proctography, 213
Staging computed tomography, chest,
abdomen, 136
Staging of rectal cancer, 172
Straining, without evacuation, 213
Surgery. See Pelvic surgery
Surveillance protocols, for family
history of colorectal cancer,
43
T
Thalidomide, 60, 70
Three-dimensional imaging, anal canal,
231
Total parental nutrition, in Crohn’s
disease, 79–80
Transducer, protected by plastic cone,
226
Transrectal ultrasound, in pelvic
surgery, 136
Index 299
Tumour-necrosis-factor receptor fusion
protein, 60
Tumour-necrosis-factor-binding protein
CNI-1493, 60
U
Ulcerative colitis, chronic,
predisposition to, 53
Ultrasound, endo-anal, 224–236
faecal incontinence, 230–235
solitary rectal ulcer syndrome,
235–236
technique, instrumentation, 225–230
Undifferentiated carcinoma, anal canal,
123
Urinary bladder, proctogram,
cystogram, 269
Urinary tract, hereditary non-polyposis
colorectal cancer, 47
Urogenital collateral damage, in pelvic
surgery, 143–145
colorectal cancer involvement,
urogenital tract, 143–145
protecting ureters, 143
Urologist, in pelvic surgery, 137
V
Vaginal fistula, Crohn’s disease,
103–105
Vaginal repair, partial, 167
Vascular surgeon, in pelvic surgery,
137
Vector volume manometry, 222
Verrucous carcinoma, 123
W
WHO classification of, carcinoma of
anus, 123–124
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