TME在中低位直肠癌治疗中作用.docVIP

TME在中低位直肠癌治疗中作用[摘要] 目的：探讨全直肠系膜切除术（total mesorector excision,TME）在中、低位直肠癌治疗中的临床应用价值。方法：对83例行全直肠系膜切除术的中、低位直肠癌病例进行回顾性总结，分析其疗效、术后局部复发率和术后并发症。结果：围手术期无死亡病例；5年生存率77.1%（64/83）；局部复发率6.02%（5/83）；术后吻合口漏和吻合口狭窄的发生率分别是6.02%（5/83）和4.81%（4/83）。结论：TME是治疗中、低位直肠癌必须遵循的原则，其可有效降低局部复发率，减少术后并发症，并能提高患者生活质量和生存率。 [关键词] 中低位直肠癌；全直肠系膜切除术；术后并发症 [中图分类号] R735[文献标识码]B [文章编号]1673-7210（2008）01（a）-053-02 Clinical value of total mesorectal excision in treating middle and low rectal cancer LIU Bo,FU Jian-cheng,HUA Xiao,WANG Xue-min,MENG Yong-qiang (Department of General Surgery,Hulunbeier People?s Hospital, Hulunbeier021008,China) [Abstract]Objective:To discuss the clinical significance of total mesorectal excision inmiddle and low rectal cancer.Methods: The clinical data of 83 cases with middle and low rectal cancer treated by TME were analyzed retrospectively including the therapeutic effect,the postoperative local recurrent rate and complications. Results:Perioperative death rate was 0; 5-year survival rate was 77.1%(64/83); local recurrence rate was 6.02%(5/83); postoperative anastomotic leakage rate was 6.02%（5/83）,and the rate of anastomotic constriction was 4.81%（4/83）. Conclusion: TME is the principle that must be followed in the treatment of middle and low rectal cancer.It can effectively decrease local recurrent rate and postoperative complications,and improve postoperative quality of life and survival rate. [Key words]Middle and low rectal cancer; Total mesorectal excision; Postoperative complications Heald在1982年首先提出直肠癌全系膜切除（total mesorector excision，TME）能明显降低直肠癌术后的局部复发率。现在，TME作为直肠癌手术的“金标准”[1,2]正被越来越多的人接受。我院1997年6月～2002年6月应用TME原则治疗中低位直肠癌共83例，现报道如下： 1 资料与方法 1.1 一般资料 本组83例中低位直肠癌患者中，男52例，女31例，年龄32～89岁，平均年龄57岁。肿瘤病灶下缘距齿状线距离：2～5 cm者46例，5.1～9.0 cm者37例。术后标本病理检查：切除边缘的远近端均未见肿瘤细胞浸润。术后病理组织学分类：高、中分化腺癌56例，低分化腺癌17例，黏液腺癌7例，印戒细胞癌3例。Dukes分期：A期5例，B期53例，C期25例。全部病例术前均未做辅助放疗和化疗。 1.2 手术方法 手术采用截石位，左旁正中切口入腹，全部病例均采用TME原则，直视下用剪刀或电刀沿直肠后的盆腔筋膜的脏壁层之间进行，分离时将直肠向前上方提拉有利于暴露覆盖直肠系膜的脏层筋膜，保证直肠