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EN
Rectal prolapse is the partial or complete protrusion of the rectal wall into the anal canal. The most common etiology consists in the insufficiency of the diaphragm of the lesser pelvis and anal sphincter apparatus. Methods of surgical treatment involve perineal or abdominal approach surgical procedures. The aim of the study was to present the method of surgical rectal prolapse treatment, according to Mikulicz’s procedure by means of the perineal approach, based on our own experience and literature review. Material and methods. The study group comprised 16 patients, including 14 women and 2 men, aged between 38 and 82 years admitted to the department, due to rectal prolapse, during the period between 2000 and 2012. Nine female patients, aged between 68 and 82 years (mean age-76.3 years) with fullthickness rectal prolapse underwent surgery by means of Mikulicz’s method with levator muscle and external anal sphincter plasty. The most common comorbidities amongst patients operated by means of Mikulicz’s method included cardiovascular and metabolic diseases. Results. Mean hospitalization was 14.4 days (ranging between 12 and 17 days). Despite advanced age and poor general condition of the patients, complications during the perioperative period were not observed. Good early and late functional results were achieved. The degree of anal sphincter continence was determined 6-8 weeks after surgery showing significant improvement, as compared to results obtained prior to surgery. One case of recurrence consisting in mucosal prolapse was noted, being treated surgically by means of Whitehead’s method. Good treatment results were observed. Conclusion. Transperineal rectosigmoidectomy using Mikulicz’s method with levator muscle and external anal sphincter plasty seems to be an effective, minimally invasive and relatively safe procedure that does not require general anesthesia. It is recommended in case of patients with significant comorbidities and high surgical risk.
EN
INTRODUCTION: Colorectal cancer (CRC) is one of the most common cancers in the world, accounting for 10% of the annual global cancer incidence. This malignant neoplasm can remain asymptomatic for a long time and, despite medical advances, is too frequently diagnosed too late. The YKL-40 protein is a growth factor that stimulates endothelial cell migration, and plays a role in inflammation and neoplasia. The aim of the study was to assess the significance of YKL-40 as a biomarker in CRC and to determine the correlation between the serum YKL-40 levels in CRC patients and selected clinical and pathological parameters. MATERIAL AND METHODS: In a prospective study involving 133 patients over the age of 50, the serum YKL-40 protein level concentration was determined by the ELISA method. The patients were divided into two groups: 91 with CRC and 42 healthy. For the statistical analysis Student's t-test for independent data, the Mann-Whitney U test, and logistics regression were used. RESULTS: The YKL-40 serum concentration was significantly higher in the CRC patients (163 ± 36 μg/l) than the healthy patients (54 ± 20 μg/l; p < 0.0001). There was a statistically significant difference in the serum YKL-40 concentration between the early and intermediate stages of CRC. There was no correlation between the clinical parameters, i.e. sex, age and BMI and the serum YKL-40 protein concentration in the people with CRC. CONCLUSIONS: The YKL-40 protein seems to be a promising CRC biomarker. Its serum concentration is correlated with the stage of the cancer depending on the depth of the growth relative to the submucosa and may be a prognostic factor for an adverse prognosis of this cancer.
PL
WSTĘP: Rak jelita grubego (colorectal cancer – CRC) jest jednym z najczęstszych nowotworów na świecie – odpowiada za 10% rocznej globalnej zapadalności na raka. Przez długi czas może pozostać bezobjawowy i mimo postępu medycyny zbyt często zostaje zdiagnozowany za późno. Białko YKL-40 jest czynnikiem wzrostu stymulującym migrację komórek śródbłonka, odgrywającym rolę w stanach zapalnych oraz nowotworowych. Celem pracy była ocena znaczenia YKL-40 jako biomarkera w CRC oraz określenie powiązań stężeń YKL-40 w surowicy u chorych na CRC z wybranymi parametrami kliniczno-patologicznymi. MATERIAŁ I METODY: W badaniu prospektywnym, obejmującym 133 osoby powyżej 50 roku życia, oznaczono stężenie białka YKL-40 w surowicy metodą ELISA. Pacjentów podzielono na dwie grupy: 91 osób chorujących na CRC oraz 42 osoby zdrowe. W analizie statystycznej wykorzystano testy t-Studenta dla danych niezależnych, U Manna-Whitneya i regresję logistyczną. WYNIKI: Stężenie YKL-40 w surowicy było znacznie wyższe u chorych na CRC (163 ± 36 μg/l) niż u osób zdrowych (54 ± 20 μg/l; p < 0,0001). U osób z CRC nie wykazano zależności między parametrami klinicznymi, tj. płcią, wiekiem i wskaźnikiem masy ciała (body mass index – BMI), a stężeniem białka YKL-40 w surowicy. U chorych z CRC stężenie YKL-40 w surowicy statystycznie istotnie różniło się we wczesnym i średniozaawansowanym stadium nowotworowym. WNIOSKI: Białko YKL-40 wydaje się obiecującym biomarkerem CRC. Jego stężenie w surowicy jest skorelowane ze stopniem zaawansowania nowotworu zależnie od głębokości nacieku w stosunku do błony podśluzowej i może być czynnikiem rokowniczo niepomyślnym dla tego nowotworu.
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