A state-owned enterprise organs cadres Zhang Mo Chuan, forty years old, in the unit has a title called “boss”. The origin of this name is on the one hand because he works hard and never takes leave, plus he thinks he is physically strong, with a “light injury not on the line” energy, very much appreciated by the leadership. Another reason is that he has a surprising amount of alcohol and brisk personality, belonging to the kind of two to drink a catty of the main, so also popular with customers and colleagues. But Zhang himself has a small problem, drinking after the diarrhea, “hemorrhoids” also often attack, sometimes blood in the stool, and weight in the year also dropped a lot. But Zhang believes that liquor hurts the stomach, diarrhea is a very normal thing, after pulling the equivalent of the “toxins” are eliminated from the body, blood in the stool that is many years old, eat chili or drinking have, a few days on their own. The thin point of course does not matter, age is gradually older, as the saying goes, it is difficult to buy a thousand gold old to be thin, which is good.
Until one day in 2006, the old Zhang as usual after drinking, and feel as if to diarrhea, but this time how can not pull out, and the stomach is more and more pain, at first tolerable, the old Zhang thought to endure can pass, the next day still insist to work, and then the stomach distension is very strong, the pain has been sweating, body temperature also began to rise, in colleagues and leadership persuasion which came to the hospital The emergency treatment. When he arrived at the hospital, his body temperature had risen to 39.0 degrees Celsius, his white blood cells were 15.94×109/L (normal value 4-10×109/L), and he was also anemic. In order to clarify the cause of intestinal obstruction, the doctor suggested to perform abdominal CT, but the test results shocked everyone at once: Old Zhang had rectal cancer! Moreover, the cancer cells have already invaded the surrounding tissues, which means that the rectal cancer of old Zhang is likely to be in the middle and late stage. Normally, it takes about 18~24 months for rectal cancer to grow and infiltrate the intestinal wall for 1 week, and the time when Lao Zhang started to show symptoms such as blood in stool and weight loss does basically match with this time!
Although Zhang and his colleagues could hardly believe such a cruel reality, they knew in their hearts that the disease needed to be operated on quickly. But the doctors didn’t seem to be in a hurry. After placing a gastric tube in Lao Zhang, the doctors and the family informed him of his condition and suggested that he should be treated conservatively for the time being, and only if the obstructive symptoms worsened further would he need emergency surgery.
Why exactly is this? Because the main function of the colon is to absorb water and electrolytes, form, store and excrete feces. The tumor of Zhang was located in the sigmoid colon, and because of the very high bacterial content in feces, the emergency surgery could not complete the preparation work such as intestinal cleansing, so it was not possible to suture the healthy intestine directly after removing the tumor, and it was necessary to perform a temporary “artificial anus”, that is, to create an opening in the abdomen to collect feces, and to cover the stoma with a special bag to collect feces. The stoma is reoperated after 3 months to close it. If the obstruction is relieved by conservative treatment, the intestine can be anastomosed directly with adequate preparation, thus avoiding unnecessary secondary surgery.
The length of the colon is about 1.5m-2.0m, and according to its location from right to left, it is the ascending colon, transverse colon, descending colon, sigmoid colon, and rectum in order, and the rectum is the intestinal canal within 13-18cm from the anus.
Three-dimensional reconstruction of the colon, the upper part of the rectum was obviously narrowed.
It takes about 18 months for rectal cancer to grow and invade the intestinal wall for a week, and CT showed that the rectal cancer of Lao Zhang had invaded the surrounding normal tissues.
Fortunately, rectal cancer did not completely block the intestinal cavity, and after several days of conservative treatment, Lao Zhang’s bowel obstruction symptoms were relieved, and after careful bowel cleansing preparation, Lao Zhang underwent surgery. The name of the operation is called anterior rectal resection, which is performed all in the abdominal cavity. Since the lower edge of the tumor is far from the anus, the radical resection will not damage the function of the anal sphincter, so Lao Zhang’s anus can be preserved. If the tumor was located closer to the anus, the anus would need to be removed for a permanent stoma in order to ensure the radical nature of the tumor resection.
The surgeon enters the abdominal cavity through a longitudinal incision below the belly button, first examines the abdominal cavity thoroughly to clarify whether there are metastases, and at the same time decides again the scope of surgical resection and estimates the possible difficulties encountered in the operation. Rectal cancer can infiltrate and grow to the upper and lower ends of the intestinal canal, but in most patients, the distance of downward spread does not exceed 3 cm, so removing the intestinal canal 3 cm below the tumor can completely remove the tumor.
When removing the intestinal canal, the intestinal cavity at both ends of the tumor is usually tied with gauze tape to prevent the tumor from spreading in the intestinal cavity. The arteries, veins, fat and lymph nodes supplying the intestinal canal are in the mesentery, so complete removal of the mesentery also clears the lymph nodes that may metastasize.
The separation of the lower part of the intestinal canal is carried out in a special gap, in front of which are the seminal vesicle gland and the prostate gland, and in the posterior loose tissue gap there is the presacral venous plexus, because most of the veins penetrate from the bone holes on the sacrum, and after the injury their vertebral veins will retract into the intervertebral foramen bone, so it is difficult to clamp and stop the bleeding. Therefore, the large amount of bleeding may lead to hemorrhagic shock or even death within a short period of time, and therefore becomes one of the most dangerous complications in rectal cancer surgery. Although the rectal cancer of Lao Zhang had invaded this structure, fortunately, the surgeons adopted the correct hemostasis method in time during the operation and pressed the bleeding point with a titanium-nickel nail, which controlled the possible hemorrhage in just a few minutes.
Pattern of tumor invading the whole intestinal wall
Peritumor lymph nodes
After tumor removal, the upper and lower intestinal tubes need to be reanastomosed, which is usually done by using anastomosis. Anastomosis is an extension of the surgeon’s surgical technique, which can suture the intestinal tubes more evenly and firmly, and greatly shorten the operation time.
After the surgery, Zhang recovered very well, but after all, the tumor was found too late. Postoperative pathological examination confirmed that the intestinal canal had invaded the surrounding tissues, and most of the surrounding lymph nodes had metastasized. A lot of medical statistics show that tumor stage and prognosis are closely related, the five-year survival rate of stage I patients with early stage can be more than 90%, while stage IV patients have the worst prognosis, their five-year survival rate is only about 18%. After surgery, Zhang received various treatments such as chemotherapy, radiotherapy and biological immunotherapy. When I saw him a few days ago, although he looked a little thin and tired, he still said with confidence: I don’t have too high requirements now, and it does seem difficult to eliminate him completely, but I hope to live with my rectal cancer!
Schematic diagram of the anastomosis of the intestinal tube by anastomosis