RESUMO
RESUMEN Introducción: el cáncer colorrectal se desarrolla a partir de lesiones precursoras a nivel del colon, recto y ano, siendo responsable del 16,9 % de todas las muertes por cáncer y en los hombres es la tercera neoplasia maligna más común a nivel mundial. Objetivo: caracterizar a los pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá Paraguay en el periodo entre 2015 y 2018. Metodología: estudio observacional descriptivo, retrospectivo de corte transversal. Se utilizaron fichas de pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá Paraguay en el periodo entre 2015 y 2018. Resultados: del total de las 26 fichas de pacientes revisadas, el 70 % fue de sexo masculino y el rango etario más común fue entre 60 - 71 años (52 %); el tipo histológico de cáncer más frecuente fue el adenocarcinoma moderadamente diferenciado 78 %, el estadio más común fue adenocarcinoma de tipo II A (clasificación de la American Joint Committe on Cancer (AJCC-TNM) 65 %, presentó metástasis a distancia 3,81 % y la ubicación de cáncer más frecuente fue el recto 34,78 %. El motivo de consulta más frecuente fue hemorragia 70 %, la complicación más común fue la dehiscencia y no hubo óbitos. Conclusión: el mayor porcentaje de pacientes pertenece al sexo masculino y al grupo etario de mayores a 60 años, fue frecuente el adenocarcinoma moderadamente diferenciado y el estadio más común de tipo II A, la ubicación más frecuente fue el recto y motivo de consulta fue hemorragia (rectorragia)., por lo cual se deberían implementar medidas para la prevención de esta patología.
ABSTRACT Introduction: colorectal cancer develops from precursor lesions in the colon, rectum and anus, being responsible for 16,9 % of all deaths from cancer and in men it is the third most common malignant neoplasm worldwide. Objective: to characterize postoperative colorectal cancer patients of the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018. Methodology: descriptive, retrospective, cross-sectional observational study. Cards of postoperative colorectal cancer patients from the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018 were used. Results: of the total of the 26 patient files reviewed, 70 % were male and the most common age range was between 60 - 71 years (52 %); the most frequent histological type of cancer was moderately differentiated adenocarcinoma 78 %, the most common stage was adenocarcinoma type II A (classification of the American Joint Committee on Cancer (AJCC-TNM) 65 %, present distant metastases 3,81 % and the most frequent location of cancer was the rectum 34,78 % .The most frequent reason for consultation was hemorrhage 70 %, the most common complication was dehiscence and there were no deaths. Conclusion: the highest percentage of patients belongs to the male sex and to the age group over 60 years old, moderately differentiated adenocarcinoma was frequent and the most common stage was type II A, the most frequent location was the rectum and the reason for consultation was hemorrhage (rectorrhagia), for which measures must be implemented to prevent this pathology.
RESUMO
RACIONAL: Ao longo do tempo, estudou-se a escolha da colostomia perineal como a forma de se evitar a colostomia abdominal após cirurgia de amputação abdominoperineal. A colostomia perineal associada a um mecanismo frenador das fezes vem sendo estudada há vários anos com resultados satisfatórios. OBJETIVO: Investigação, em cães, da valvuloplastia cólica aplicada à amputação abdominoperineal do reto mais colostomia perineal e a discussão dos resultados obtidos na avaliação clínica e histopatológica. MATERIAL E MÉTODOS: O modelo experimental desta pesquisa foi desenvolvido no cólon de cães. Foram operados 65 animais, dos quais 10 constituíram o grupo-piloto, 15 o grupo-controle e os 40 demais foram separados em três grupos. O grupo 1 para observação de 10 dias; o grupo 2 em pós-operatório de 20 dias; e o grupo 3 de 30 dias. Os cães foram submetidos a amputação abdominoperineal parcial do reto com colostomia perineal associada à seromiotomia circunferencial, extramucosa em cólon esquerdo (exceto nos dos grupos-controle). RESULTADOS: Através de acompanhamento e estudo post-mortem, foi possível verificar fezes sólidas a montante das válvulas, evidenciando-se o eficiente mecanismo frenador das mesmas. A análise histológica das válvulas mostrou neoproliferação conjuntiva com fibrose em toda a área seccionada da serosa e das camadas musculares, separando-as. Evidenciou-se um anel fibroso com diminuição do lúmen intestinal, em resposta à cicatrização da serosa e muscular invertidas pela sutura, levando à formação da "válvula artificial". O processo inflamatório fibrosante reparativo ocorreu em todas as válvulas, associado a reações do tipo corpo estranho e à estenose parcial do lúmen intestinal. CONCLUSÃO: Conclui-se que a seromiotomia circunferencial produz um anel fibroso que facilita a estase fecal em colo esquerdo.
BACKGROUND: Throughout time, perineal colostomy in abdominoperineal resection, as a way to avoid abdominal colostomy, was studied. Perineal colostomy associated with a slowing down mechanism for stool transit has been studied for many years with satisfactory results. AIM: The investigation of a colic valvoplasty in dogs which have undergone an abdominoperineal resection plus perineal colostomy, and the discussion of the results achieved in clinic and histopathologic analysis are the objective of this study. MATERIAL AND METHODS: The experimental model of this research studied the colon of dogs. Sixty five animals were operated and divided in five groups: 10 animals in the pilot group, 15 animals in control group and 40 animals in 3 other groups of observation with 10, 20 and 30 days of postoperative care. The dogs underwent a rectal partial abdominoperineal resection with perineal colostomy associated to a circumferential extramucosal seromiotomy of the left colon (except in the control group). RESULTS: Through postoperative and post-mortem observation it was possible to verify solid stool before the valves showing the efficiency of the mechanism in slowing it down. The histological analysis of the valves showed connective growth with fibrosis in the whole incised serous and muscular layers, separating them. A fibrous ring diminished the colon lumen in response to the artificial valve created by the scar that appeared in the inverted suture of the serous and muscular layers. The inflammatory fibrous repair process occurred in all valves, associated to foreign body type reactions and to partial stricture of the colon lumen. CONCLUSION: The circumferential seromiotomy produces a fibrous ring that provides stool retention on the descending colon.