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| 1 | 经肛全直肠系膜切除术治疗直肠癌的优点和局限显示文摘在美国,结直肠癌的发病率和死亡率分别位于恶性肿瘤的第4位和第2位,其中直肠癌约占结直肠癌的1/3。对于可切除直肠癌而言,全直肠系膜切除术(total mesorectal excision,TME)仍然是手术的金标准。但骨盆狭窄、新辅助治疗后肿瘤触摸不清、照明及术野显露困难、远切缘确定困难及吻合器无法放置等解剖、技术和患者方面的因素,会使开腹及腹腔镜TME手术困难。在此环境下,"自下而上"的TME手术——经肛全直肠系膜切除手术(taTME)应运而生。taTME手术结合了腹腔镜及机器人手术的微创化、高清内镜平台的可视化及功能化以及经肛经腹直肠癌TME手术的优势。2010—2013年期间,Lacy等研究者陆续系列报道了taTME手术的实施情况,将该术式推向了高潮。
taTME手术采取改良截石位。手术分为腹部手术和会阴手术两个部分。腹部手术具体步骤可由术者偏好调整,但总体包括游离左侧结肠和脾曲、高位结扎肠系膜下血管和标准的TME手术。会阴部手术先在肿瘤远端采用荷包缝合封闭肠腔,在进行直肠冲洗后,放入操作平台,环形切开肠壁,"自下而上"沿直肠系膜无血管层面进行游离,直至与腹部组会合。标本可以经肛或经造口部位取出。可采取手工缝合或吻合器吻合完成消化道重建。taTME手术的优点和局限如下。
1. taTME手术优点:taTME手术采用经肛进入盆腔的入路方式,即使在低位局部进展期直肠癌、肥胖、骨盆狭窄等操作难度大的手术中,依然可以获得满意的视野显露。同时,由于在肿瘤远端荷包缝合肠壁,故对肿瘤远端切缘的判断更加准确。taTME手术相对简便地完成远端直肠系膜的游离切除,可能更有利于确保手术标本切缘的安全性和淋巴清扫的彻底性,并能得到更高质量的TME手术切除标本,使直肠癌患者的生存获益。国际登记机构的结果显示,taTME术后系膜完整率为96%,环周切缘和远端切缘阳性率分别为2.4%和0.3%。与腹腔镜手术相比,taTME手术时间更短,术后并发症发生率更低。taTME术后吻合口漏发生率和病死率分别为6.7%和2.6%。
2. taTME手术局限:尽管taTME手术有上述优点,现有研究也提示,taTME术后短期肿瘤学安全性满意,但这毕竟是一种新术式,尚缺乏长期随访结果,需要更大样本的对照试验来探究其临床、肿瘤学和功能学结果。此外,对于一个新术式,在实践中会遇见一些新的并发症。特别是"自下而上"的路径,要求外科医生从不同的视角重新认识原来的解剖结构,如直肠后间隙的游离、血管神经束的保护等。此外,也需要重视和预防术中输尿管损伤、盆壁自主神经损伤、骶前静脉损伤和术后盆腔脓肿的发生。上述损伤尤其容易发生在系膜或前列腺层面上,因此,对于有肿瘤史、盆腔放疗史、前列腺切除史或前列腺肥大的患者尤其需要谨慎。必须指出的是,梗阻性直肠肿瘤、急诊手术和T4期肿瘤是taTME的禁忌证。
综上所述,taTME有利于骨盆狭窄的"高难度"低位直肠癌患者的手术切除和标本质量,但作为一种全新的术式,还需要进一步研究其临床、肿瘤学和功能学结果。 | Deborah S Keller Scott R Steele 楼征 张卫 | 2018 | 中华胃肠外科杂志2018，21，3： | 16 |
| 2 | Review of 500 single incision laparoscopic colorectalsurgery cases-Lessons learned显示文摘Single incision laparoscopic surgery(SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery. | Deborah S Keller Juan R Flores-Gonzalez Sergio Ibarra Eric M Haas | 2016 | World Journal of Gastroenterology2016，22，2： | 8 |
| 3 | Review of single incision laparoscopic surgery in colorectal surgery显示文摘As surgical techniques continue to move towards less invasive techniques,single incision laparoscopic surgery(SILS),a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery,was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis,postoperative pain,recovery time,and quality of life at the drawback of higher technical skill required. In this article,we review the history,describe the available technology and techniques,and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature. | Nisreen Madhoun Deborah S Keller Eric M Haas | 2015 | World Journal of Gastroenterology2015，21，38： | 8 |
| 4 | Probiotic metabolites from Bacillus coagulans GanedenBC30^(TM) support maturation of antigen-presenting cells in vitro显示文摘AIM:To study the effects of probiotic metabolites on maturation stage of antigen-presenting immune cells.METHODS:Ganeden Bacillus coagulans 30(GBC30) bacterial cultures in log phase were used to isolate the secreted metabolite(MET) fraction.A second fraction was made to generate a crude cell-wall-enriched fraction,by centrifugation and lysis,followed by washing.A preparation of MET was subjected to size exclusion centrifugation,generating three fractions:< 3 kDa,3-30 kDa,and 30-200 kDa and activities were tested in comparison to crude MET and cell wall in primary cultures of human peripheral blood mononuclear cell(PBMC) as a source of antigen-presenting mononuclear phagocytes.The maturation status of mononuclear phagocytes was evaluated by staining with monoclonal antibodies towards CD14,CD16,CD80 and CD86 and analyzed by flow cytometry.RESULTS:Treatment of PBMC with MET supported maturation of mononuclear phagocytes toward both macrophage and dendritic cell phenotypes.The biological activity unique to the metabolites included a reduction of CD14+ CD16+ pro-inflammatory cells,and this property was associated with the high molecular weight metabolite fraction.Changes were also seen for the dendritic cell maturation markers CD80 and CD86.On CD14dim cells,an increase in both CD80 and CD86 expression was seen,in contrast to a selective increase in CD86 expression on CD14bright cells.The co-expression of CD80 and CD86 indicates effective antigen presentation to T cells and support of T helper cell differentiation.The selective expression of CD86 in the absence of CD80 points to a role in generating T regulatory cells.CONCLUSION:The data show that a primary mechanism of action of GBC30 metabolites involves support of more mature phenotypes of antigen-presenting cells,important for immunological decision-making. | Kathleen F Benson Kimberlee A Redman Steve G Carter David Keller Sean Farmer John R Endres Gitte S Jensen | 2012 | World Journal of Gastroenterology2012，18，16： | 8 |
| 5 | Phase formation in YAG powder synthesized by chemical methods 显示文摘 | SIM S M KELLER K A | 2000 | J Mater Sci2000，35，： | 2 |
| 6 | Texture description and segmentation through fractal geometry显示文摘 | Keller JM Chen S Crownover RM | 1989 | Computer Graphics Image Prooess1989，，45： | 2 |
| 7 | Novel biomarkers for patient stratification in colorectal cancer:A review of definitions,emerging concepts,and data显示文摘Colorectal cancer(CRC) treatment has become more personalised,incorporating a combination of the individual patient risk assessment,gene testing,and chemotherapy with surgery for optimal care.The improvement of staging with high-resolution imaging has allowed more selective treatments,optimising survival outcomes.The next step is to identify biomarkers that can inform clinicians of expected prognosis and offer the most beneficial treatment,while reducing unnecessary morbidity for the patient.The search for biomarkers in CRC has been of significant interest,with questions remaining on their impact and applicability.The study of biomarkers can be broadly divided into metabolic,molecular,micro RNA,epithelial-to-mesenchymal-transition(EMT),and imaging classes.Although numerous molecules have claimed to impact prognosis and treatment,their clinical application has been limited.Furthermore,routine testing of prognostic markers with no demonstrable influence on response to treatment is a questionable practice,as it increases cost and can adversely affect expectations of treatment.In this review we focus on recent developments and emerging biomarkers with potential utility for clinical translation in CRC.We examine and critically appraise novel imaging and molecular-based approaches; evaluate the promising array of micro RNAs,analyze metabolic profiles,and highlight key findings for biomarker potential in the EMT pathway. | Manish Chand Deborah S Keller Reza Mirnezami Marc Bullock Aneel Bhangu Brendan Moran Paris P Tekkis Gina Brown Alex Mirnezami Mariana Berho | 2018 | World Journal of Gastrointestinal Oncology2018，10，7： | 2 |
| 8 | Specificity of cardiac troponins Ⅰ and T in renal disease显示文摘 | Willging S Keller F Steinbach G | 1998 | Clin Chem Lab Med1998，36，： | 1 |
| 9 | Surgical and nonsurgical manage- ment of lumbar spinal stenosis: four - year outcomes from the Maine lumbar spine study显示文摘 | Atlas S J Keller RB Robson D | 2000 | Spine2000，25，： | 1 |
| 10 | Major depression and immunity in alcohol-dependent persons显示文摘 | Schleifer SJ Keller SE Czaja S | 2006 | Brain Behav Immun2006，20，1： | 1 |
| 11 | Copeptin improves early diagnosis of acute myocardial infarction显示文摘 | Keller T Tzikas S Zeller T | 2010 | J Am Coll Cardiol2010，55，19： | 1 |
| 12 | Communication strategies for brand extension: enhancing percerved fit by establishing explanatory 显示文摘 | Bridges S Lane Keller Sood S | 2000 | Journal of Advertising2000，29，1： | 1 |
| 13 | Inhibition of endothelin-1-mediated up-regulation of iNOS by bosentan ameliorates endotoxin-induced liver injury in cirrhosis 显示文摘 | Keller S Karaa A Paxian M | 2006 | Shock2006，25，3： | 1 |
| 14 | Storm wave reactivation of a submarine landslide显示文摘 | Prior D B Suhayda J N Lu N J Bomhold B D Keller G H Wiseman W J Wright L D Yang Z S | 1989 | Nature1989，341，： | 1 |
| 15 | Two-generation reproduction studies in Rats fed di-isodecyl phthalate显示文摘 | Hushka L J Waterman S J Keller L H | 2001 | Reprod Toxicol2001，15，2： | 1 |
| 16 | Configurational resonances in optical near-field microscopy:a rigorous point-dipole approach显示文摘 | Keller O Xiao M Bozhevolnyi S | 1993 | Surf Sci1993，280，1： | 1 |
| 17 | Surgical and nonsurgi cal management of lumber spinal stenosis:four-year outcomes from the maine lumbar spine study显示文摘 | Atlas S J Keller R B Robson D | 2000 | Spine2000，25，5： | 1 |
| 18 | Transjugular intrahepatic portosystemic shunt:present status,comparison with endoscopic therapy and shunt surgery,and future prospectives显示文摘 | J R(O)SCH M D FREDERCK S KELLER M D | 2001 | World J Surg2001，25，： | 1 |
| 19 | The national depressive and manic-depressive association consensus statement on the undertreatment of depression显示文摘 | HIRSCHFELD R M A KELLER M PANICO S | 1997 | JAMA1997，277，： | 1 |
| 20 | Activate caspase-1 is a regulator of unconventional protein secretion 显示文摘 | Keller M Andreas R Wemer S | 2008 | Cell2008，132，5： | 1 |
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