A patient’s account: six months of blood in the stool more and more serious My surname is Yu, this year has been 59 years old, usually very strong body, even the cold is rarely there. But from June and July last year, I found blood in the stool, and at first I thought it was an attack of hemorrhoids, so I didn’t take it seriously, but slowly the blood in the stool became more and more serious, and the number of stools was also increasing. At the beginning of this year, I had to get up 2-3 times in the latter half of the night to have a bowel movement, and every time I had blood in my stool, and I lost weight, weighing only 90 pounds for a 1.72 meter person. I think nowadays the incidence of this cancer and that cancer is very high, my symptoms are not too much like hemorrhoid attack, I have been busy for most of my life, almost to the retirement age, soon I can enjoy my old age, in case it is cancer or early treatment is better, so I found the gastrointestinal surgery expert Xie Song, director to see. The doctor diagnosed: four tumors in the large intestine at the same time In early January, rarely go to the hospital, accompanied by family members, to see the hospital specialist clinic, Xie Song, director of the examination found a cauliflower-like mass 5 cm from the anus, the preliminary diagnosis of rectal cancer. After hearing this news, Uncle Yu and his family were very anxious and hoped that the doctor would immediately arrange for hospitalization so that the diagnosis could be confirmed as soon as possible and early surgery could be performed. After he was hospitalized, Director Xie Song immediately arranged for him to have a colonoscopy, which revealed that in addition to a cancerous mass in the lower rectum, there were three other tumors in the sigmoid colon at 20 cm from the anus, the descending colon at 55 cm, and the descending colon at 70 cm, with diameters of about 1.5 cm, 1 cm, and 3 cm, respectively; the specimens were taken for pathological examination, and it was confirmed that the four lesions were: mesorectal The specimens were taken and pathological examination was performed. Director Xie Song said: colorectal cancer is one of the most common malignant tumors of the gastrointestinal tract. The early stage of rectal cancer is often manifested as blood in the stool, so it is easily misdiagnosed as hemorrhoids. At present, radical surgical resection is the main and preferred method for the treatment of colorectal cancer. However, it is rare to have four tumors in the colon at the same time like Uncle Yu, so we need to determine the treatment plan after comprehensive evaluation. Treatment plan: one surgery to cure four tumors After Uncle Yu was confirmed to have four intestinal tumors, Director Xie Song carefully analyzed the abdominal CT and 3D reconstruction pictures and thought that the tumors were relatively limited and there were no liver or lung metastases, so the surgery should be able to achieve radical resection. In order to achieve radical resection of the tumor, about 1 meter of large intestine (the left half of the colon and the whole rectum) needed to be removed, which involved the whole left half of the abdomen and pelvis, and was more traumatic. However, Uncle Yu’s body is thin and his nutritional status is poor, whether he can tolerate the surgery needs further evaluation. In addition, considering that there is a tumor in the lower rectum, which is only 5 cm away from the anus, to improve the patient’s quality of life, it is necessary to perform a precise low “anal preservation” surgery, that is, after the tumor is removed, the transverse colon of the upper abdomen should be pulled to the anal opening for intestinal anastomosis, which is a very difficult operation. After consideration, Director Xie decided to perform “left hemicolectomy + low rectal cancer radical surgery” for Uncle Yu, that is, to complete two major operations under one anesthesia. After the surgical plan was decided, Director Xie Song led the treatment team to conduct a comprehensive assessment of the nutritional status and function of important organs of Uncle Yu, and to provide effective nutritional support to correct anemia and hypoproteinemia so that the body would have enough energy to tolerate the surgery. At the same time of nutritional support, the surgical team started the intense preoperative examination and preparation, combined with CT and barium enema examination, and performed accurate imaging localization of the four large intestinal tumors. After completing all preoperative preparations, Uncle Yu was admitted to the operating room in the morning of January 17. After general anesthesia, Director Xie Song started the main surgery. Under the shadowless lamp, Director Xie Song carefully cut open the abdominal cavity of Mr. Yu, carefully dissected and then skillfully freed the left half of the transverse colon, descending colon, sigmoid colon and rectum, and cleared the lymphatic fatty tissue around the mesentery and pelvic vessels, and then removed the 1-meter-long intestinal tube containing 4 tumors completely. The transverse colon in the upper abdomen was freed again, and the severed end was pulled to the anal opening for anastomosis with the rectum, and the operation was successfully completed after checking that the rectal anastomosis was good and the intestine was restored to be open. The whole operation lasted for 3 and a half hours, and the surgical process was very smooth, with minimal bleeding and no blood transfusion. After the operation, Uncle Yu woke up from anesthesia and was sent to the ward. Although his surgery was very traumatic, he recovered quickly after the surgery and passed the “hurdles” of intestinal bleeding, intestinal leakage, wound infection and anastomotic stenosis. Director Xie Song commented after the operation that the scope of radical resection of colorectal cancer should include not only the removal of tumor, but also the two end segments of the intestine, adjacent organs that have been invaded, surrounding tissues that may be infiltrated and lymph nodes. In order to improve the patient’s survival quality, we performed a low-level “anus-preserving” operation after resecting the 1-meter-long intestinal canal during the operation. However, since the proximal section of the intestinal canal was 30 cm away from the rectal section at the anal opening, anastomosis of the two sections could easily produce tension, and once tension existed, there was a risk of very serious intestinal leakage after surgery. Therefore, the difficulty of the operation is imaginable. Director Xie also said: In addition to the difficulty of intestinal anastomosis, the rectal tumor of Uncle Yu is only 5 cm from the anus, and the “anal preservation” surgery should be performed in the lowest position of the pelvis, with a small field of vision and narrow operating space, so it is extremely difficult to separate and anastomose, therefore, doctors without good surgical skills will choose to remove the anus and perform “artificial anus”. The good thing is that we have rich experience in this area, and the technique of low-level “anal preservation” surgery for rectal cancer that is 5 cm or even lower from the anus is very mature. It should be said that Uncle Yu’s surgery was very successful and his post-operative recovery was also very smooth, and he is now receiving standardized chemotherapy.