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Методички онкология / 5 курс / САРС / 4 колоректальный.doc
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In justification of the diagnosis draws attention to the stage of the disease, clinical group, location and spread of tumor.

A differential diagnosis of benign tumors and precancerous diseases of the colon. Formulated a final diagnosis.

Radical treatment is the only operation. In cancer, blind, ascending colon and hepatic angle performed right hemicolectomy. When the tumor in the left half of the colon is left-sided hemicolectomy. Carcinoma of transverse colon and sigmoid colon resection shows, retreating 5 - 6 cm from the edge of the visible tumor. Radiation therapy is not effective. Chemotherapy as palliative method used in inoperable tumors, and after conventionally radical and palliative operations. Often prescribed: 5-fluorouracil, mitomycin, adriablastyn.

Patients after surgery for cancer of the colon tovtsoyi should be under constant supervision of the conduct of their endoscopy, ultrasound and laboratory tests (determination of REE).

In patients with colon cancer after radical surgery quickly recovers full performance. During the examination of performance should take into account the stage of the process, the tumor, the nature of the treatment as well as profession, age and sex of the patient.

P'yaterichne survival of patients with colon cancer after radical surgery reaches 50-60%, while the first and second stages of 80%.

Marked association of rectal cancer with the nature of power. Foods with a high content of protein and fat is favorable for the emergence of this disease.

The upper limit of the rectum corresponds to a height of 15 cm from the edge of the anal opening. In the rectum are three divisions: nyzhnoampulyarnyy (5 cm) serednoampulyarnyy (5 - 10 cm), verhnoampulyarnyy.

The most frequent symptom PKK - the presence of abnormal discharge. Admixture of blood in the stool that appears before or during defecation defecation, observed in 75-90% of patients. Bleeding associated with destruktyrnymy processes. Other abnormal discharge (mucus, pus) also appear in the decay of the tumor and the presence of inflammation, which is typical for the later stages.

Another group of symptoms - constipation, change in the form of feces, trains stool (tenesmus) - associated with bowel dysfunction.

Pain in rectal tumors depend on a number of reasons. Recurrent abdominal pain pereymysti indicate intestinal obstruction. Constant pain can be the result of local distribution process. Intestinal obstruction occurs in 30% of patients

Finger research rectum is mandatory and indispensable method for diagnosing PKK. Great importance sigmoidoscopy and irihoskopiya.

Discussion of additional examination methods, rationale and preliminary clinical diagnoses made ​​in navchaniy room in the absence of the patient.

In justification of the diagnosis draws attention to the stage of the disease, clinical group, location and spread of tumor.

A differential diagnosis of benign tumors and precancerous diseases of the colon. Formulated a final diagnosis.

To treat the PKK used for surgery, radiotherapy and cytotoxic methods. The method of operation depends on the tumor in the rectum.

1)               intraperitoneal (anterior) resection of the rectum is performed by placing the tumor distance of 12 cm from the anal opening;

2)               Abdominal-perineal extirpation of the rectum (Operation Kenyu-Miles) - when the tumor below 6 - 7 cm from the back passage opening.

3)               Abdominal-anal resection of the rectum - tumors located at a distance of 7 - 12 cm from the anal opening.

4)               Operation Hartmann - in the presence of contraindications for applying intraperitoneal anastomosis.

Radiation treatment is a palliative method in the local spread of the tumor or in the presence of contraindications to surgery.

Chemotherapy is ineffective. Sometimes used in inoperable patients in advanced stages of 5-fluorouracil, or ftorafur. More effective polychemotherapy (5-fluorouracil, mitomycin C, adriablastyn).

Five-year survival of patients with CRC is 50-60%, and in the early stages of 70-80%.

About 50% of patients with rectal cancer throughout life after surgery with artificial vidhidnyk. This impede somatic and psychological rehabilitation. Therefore, expanding indications for organ preservation is one of the ways rehabilitation of such patients. After extirpation of the rectum with the formation of artificial vidhidnyka patients with debilshoho recognized disabled (II disability group) and only occasionally returning to previous work not related to physical activity.

Literature

Summary:

Bilynsky BT Oncology. Lviv, 1998.

Bilynsky BT Oncology. Lviv, 1992.

Peterson BE CANCER. Moscow: Medicine, 1980.

Slynchak SM CANCER. Kiev, 1989.

Trapeznikov NN CANCER. Moscow: Medicine, 1981.

Lecture material.

Further Reading:

Alexandrov NN, Lыtkyn NI, Petrov VP and others Neotlozhnaya Surgery at rake colon. Minsk.: Belarus. 1,980 g. - 330 p.

Hanychkyn GA Cancer colon. Moscow: Medicine, 1970. - 223 p.

Sneshko LI Prevention retsydyvov metostazov cancer and colon. Leningrad: Medicine, 1976 g.

Senyutovych RV Operations for rectal cancer. Volume I-III. Chernivtsi, 1996. - 360 p.

Alexander VI Cancer a straight intestine. Moscow: Medicine, 1977.

 

 

Quiz:

Rate of a ROC. Value of the nature of power.

Precancerous diseases. Methods for cancer prevention.

Forms growth and localization of tumors. Patterns of metastasis.

Separation on stage.

Symptoms of cancer of the left and right half of the colon.

The main clinical variants ROCK.

Diagnosis ROCK. Value of radiological and endoscopic examination.

Treatment (radical and palliative). The volume of surgery depending on the tumor.

Tactics in disease incidence of cancer is complicated by an acute intestinal obstruction. Palliative surgery.

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