40例中下段直肠癌行直肠全系膜切除术（TME）的临床观察

目的：回顾性分析比较传统术式与TME在直肠癌术后对局部复发、排尿功能和性功能的影响。方法：2005-2009年我院40例行TME治疗中下段直肠癌,其中男性16例,女性24例,同期观察40例行传统术式治疗中下段直肠癌,跟踪随访3年,局部复发以CT和肠镜结果为准,排尿功能以拔尿管时间和尿残留为指标,性功能以问卷形式进行调查。结果：病人术后随诊3年,局部复发率为5.0%,3年生存率92.5%,排尿障碍17.5%,勃起障碍25%。结论：TME治疗中下段直肠癌对降低局部复发,减少对排尿功能和性功能影响明显优于传统术式。     

基于TME的直肠癌保留植物神经根治术及其效果分析

目的:探讨基于全直肠系膜切除(TME)的中下段直肠癌保留植物神经根治术对局部复发率、生存率和术后生存质量的影响.方法:回顾性分析125例基于TME的中下段直肠癌保留植物神经根治术与60例未保留植物神经的根治术患者的5年生存率和局部复发率,及排尿功能和性功能.结果:无手术死亡病例.A组排尿功能障碍13例(占10.4%),性功能障碍20例(占16.0%);B组分别为35例(占58.3%)和41例(占68.3%);两组比较,P＜0.005.局部复发率:A组为8.8%(11/125),B组为16.7%(10/60),两组比较,P＞0.05.5年生存率:A组60.8%(76/125),B组46.7%(28/60).结论:保留植物神经的直肠癌全直肠系膜切除术,在不增加局部复发率和降低5年生存率的同时,可以减少病人排尿功能和性功能障碍的发生,提高病人术后的生存质量.     

保留盆腔自主神经的全直肠系膜切除术在男性直肠癌保肛术中的应用研究

背景与目的:中低位直肠癌根治术术后常出现严重的与自主神经损害有关的泌尿生殖功能障碍,全直肠系膜切除术(total mesorectal excision,TME)可使上述问题得到一定程度的改善,但排尿功能障碍和性功能障碍仍是术后比较常见的问题.本文旨在探讨保留盆腔自主神经(pelvic autonomic nerve preservation,PANP)的全直肠系膜切除术在男性直肠癌患者低位保肛术中的应用.方法:通过分析保留盆腔自主神经的全直肠系膜切除(TME+PANP组)和不保留自主神经的全直肠系膜切除(TME组)在男性直肠癌患者保肛手术中的应用,对两组患者术后的性功能、排尿功能、局部复发率和5年生存率进行比较.结果:TME组和TME+PANP组的局部复发率、5年生存率差异无统计学意义(P>0.05),PANP+TME组的性功能、排尿功能优于TME组,PANP手术分型与性功能、排尿功能呈正相关(P<0.05).结论:TME+PANP的直肠癌根治术既保证根治,又降低了排尿障碍和性功能障碍的发生率,PANP手术保留神经越完整,手术后排尿障碍、性功能障碍的发生率越低.     

低位直肠癌全直肠系膜切除手术中保留盆腔自主神经侧方淋巴结清扫的临床价值

摘 要：［目的］ 探讨低位直肠癌全直肠系膜切除（TME）手术中保留盆腔自主神经并行侧方淋巴结清扫的临床效果。［方法］ 对接受TME手术治疗的81例低位直肠癌患者的临床资料进行回顾性分析,根据术中是否保留盆腔自主神经并行侧方淋巴结清扫术分组。对照组患者接受单纯TME手术治疗,研究组患者TME手术中保留盆腔自主神经并行侧方淋巴结清扫。术后随访1~5年,对比两组患者在排尿障碍、男性性功能障碍、术后盆腔局部复发率、术后5年生存率等方面的差异。［结果］ 研究组侧方淋巴结转移阳性率2.56%,对照组为0;研究组术后盆腔局部复发率5.12%,5年生存率为87.36%;对照组则分别为11.90%和64.35%。上述3项指标两组之间比较差异均有统计学意义(P<0.05)。对照组和研究组患者排尿功能障碍发生率分别为28.57%和12.82%;术后男性性功能障碍发生率分别为92.86%和34.62%,两组比较差异均具统计学意义(P<0.05)。［结论］ 低位直肠癌TME手术中保留盆腔自主神经侧方淋巴结清扫可有效改善患者排尿障碍、男性性功能障碍,降低术后盆腔局部复发的发生,提高术后5年生存率。     

基于TME的直肠癌保留植物神经根治术及其效果分析

目的：探讨基于全直肠系膜切除（TME）的中下段直肠癌保留植物神经根治术对局部复发率、生存率和术后生存质量的影响。方法：回顾性分析125例基于TME的中下段直肠癌保留植物神经根治术与60例未保留植物神经的根治术患者的5年生存率和局部复发率，及排尿功能和性功能。结果：无手术死亡病例。A组排尿功能障碍13例（占10．4％），性功能障碍20例（占16．0％）；B组分别为35例（占58．3％）和41例（占68．3％）；两组比较，P〈0．005。局部复发率：A组为8．8％（11／125），B组为16．7％（10／60），两组比较，P〉0．05。5年生存率：A组60．8％（76／125），B组46．7％（28／60）。结论：保留植物神经的直肠癌全直肠系膜切除术，在不增加局部复发率和降低5年生存率的同时，可以减少病人排尿功能和性功能障碍的发生，提高病人术后的生存质量。     

腹腔镜与传统开放术式在低位直肠癌根治术中的比较研究

[目的]总结腹腔镜与传统开放术式在低位直肠癌根治术中的手术方法和效果。[方法]回顾性分析53例行腹腔镜下低位直肠癌根治术的患者的临床资料,总结手术操作经验,同时期50例行传统前入路开放低位直肠癌根治术患者作为对照,比较两组并发症以及术后生存等情况。[结果]腹腔镜组53例患者均成功完成腔镜下手术,其中49例完成Dixon手术,4例术中发现远端切缘肿瘤细胞阳性改行Miles式;开放手术组11例改行Miles式。101例患者获随访,随访时间为17~25个月,平均21个月。腹腔镜组术后出现排尿功能障碍4例,性功能障碍1例;开放手术组出现排尿障碍13例,性功能障碍5例,经过保守治疗后均好转。共5例出现吻合口瘘。3例患者出现切口疝,2例出现复发。[结论]腹腔镜下低位直肠癌根治术相比较传统开放前入路直肠癌根治术是安全可靠的,能减少对盆腔神经的损伤,提高患者术后生存质量,在低位保肛等方面有独到优势。     

腹腔镜直肠全系膜切除治疗中下段直肠癌临床疗效的探讨

目的:探讨腹腔镜直肠全系膜切除(TME)治疗中下段直肠癌的临床疗效.方法:选择我院外科行腹腔镜直肠全系膜切除治疗中下段直肠癌患者61例为腹腔镜TME组,与行开腹手术治疗的中下段直肠癌患者50例进行对照分析.结果:腹腔镜TME组手术时间明显较开腹手术组长(P＜0.05),而切口长度、术中出血量、VSA评分、术后肛门排气时间及围手术期并发症发生率比较,腹腔镜TME组均明显优于开腹手术组(P＜0.05);两组标本的上、下切缘均为阴性,标本长度和清除淋巴结的数目比较差异无统计学意义,P＞0.05;腹腔镜TME组性功能、泌尿功能障碍发生率明显低于开腹手术组(P＜0.05),而两组术后随访死亡、复发和转移比较差异无统计学意义,P＞0.05.结论:腹腔镜直肠全系膜切除治疗中下段直肠癌手术是安全、可行的,不但能到达传统开腹手术相同的肿瘤根治远期疗效,且具有微创优势.     

全直肠系膜切除术治疗中低位直肠癌48例分析

目的 评价全直肠系膜切除(TME)对中低位直肠癌根治术后局部复发率及生存率的影响.方法 回顾性分析2001年1月-2006年6月共48例行TME治疗中低位直肠癌患者的临床资料.结果 2例发生吻合口瘘.术后随访6个月-3年,盆腔复发3例.60岁以下男性病人中,性功能较术前有所减弱,但基本正常,尿失禁及排尿困难等症状术后部分存在,随时间的延长(6个月-1年)均逐渐恢复.结论 中低位直肠癌实施TME后,局部复发率明显降低,保肛率及3年生存率明显提高,术后性生活和膀胱功能恢复较好,提高了病人术后长期的存活率和生存质量.     

中下段直肠癌TME术的质量控制与微转移检测

直肠癌是常见的恶性肿瘤,发病率较高,其中中下段直肠癌约占70%-87.3%,常需永久性造口,并且有较高的局部复发率及术后对性功能、泌尿功能及排便功能的影响,会给病人在肉体上、精神上和生活上带来不便和苦恼。近年来,随着人们对于直肠系膜的认识及直肠癌淋巴引流及局部转移规律的认识,Heald于1982年提出TME概念,TME手术大大降低了局部复发率,提高了生存率和保肛率,性功能及排尿功能障碍减少,目前已成为中下段直肠癌的标准术式[1]。但是TME手术在不同组织或不同的术者中术后局部复发率及远期生存率有很大差别。一项研究表明,对施行人员标准…     

保留盆腔自主神经对男性中低位直肠癌患者术后排尿排便和性功能的影响

目的 探讨在男性中低位直肠癌保肛术中保留盆腔自主神经(PANP)对排尿、排便及性功能的影响.方法 回顾性分析我院在2001年1月至2004年12月间施行的123例男性中低位直肠癌保肛手术病例,其中采用PANP治疗66例,采用传统直肠癌根治术(TRER)治疗57例.对比两组患者的3年生存率、局部复发率、排尿功能、肛门功能和性功能.结果 PANP组和TRER组患者3年生存率和局部复发率差异无统计学意义(P>0.05);两组患者的肛门功能差异无统计学意义(P>0.05);PANP组排尿功能、勃起功能和射精功能均优于TRER组,差异有统计学意义(P<0.05).结论 保留盆腔自主神经的直晒癌根治术可以降低排尿障碍、性功能障碍和射精功能障碍的发生率,提高了患者的术后生活质量,值得临床推广应用.     

直肠癌根治术后患者排尿和性功能的变化

Objective:To investigate the changes in sexual function and urinary function following rectal cancer resection in male patients.Methods:48 male patients with rectal cancer under 65 years old were included in the study and postoperative sexual function and urinary function were investigated through questionnaires and telephone interviews following resection of rectal cancer and the results were analyzed retrospectively.Results:The overall sexual dysfunction rate was 58.33%.The overall urinary dysfunction rate was 56.25%.No statistically significant differences in the incidences of sexual dysfunction and urinary dysfunction were found in the comparison between participants under 50 and above 50 years old,between those who received Mile's operation and Dixon's operation,and among those at different tumor stages respectively.Conclusion:The incidences of sexual dysfunction and urinary dysfunction in male patients following resection of rectal cancer are high.The age,ways of surgical management and stages of tumor are not apparently contributed to these complications.     

Three-dimensional versus two-dimensional laparoscopic surgery for rectal cancer: better promote postoperative sexual and urinary function of a propensity-matched study

Laparoscopic total mesorectal excision (TME) with autonomic nerve preservation (ANP) is a common procedure for rectal cancer (RC), associated with a high prevalence of postoperative urogenital and anorectal dysfunctions. Compared to 2D laparoscopy, 3D laparoscopy provides better depth perception of the surgical field and hand-eye coordination to achieve better outcomes. We compared the performance of 2D and 3D laparoscopy on preserving urogenital and anorectal function in TME+ANP surgery for rectal cancer using propensity-score matching. Data were collected from consecutive male patients who underwent 3D or 2D laparoscopic TME+ANP for primary RC at our institution between March 2012 and December 2020. The primary outcome was sexual and urinary function 1 year after surgery. A total of 450 male patients were eligible. After 1:1 matching, 146 cases were included in each group for analysis. One year after surgery, the prevalence of sexual dysfunction (International Index of Erectile Function score <26) was 8.22% in the 3D laparoscopic group and 44.52% in the 2D laparoscopic group, respectively (P=0.000) and a significant difference in the incidence of urinary retention was observed (n=3 and 24, respectively (P=0.000)). Moreover, blood loss, operative time, duration of hospital stay, and the time to first flatus in the 3D laparoscopic group were significantly less than in the 2D laparoscopic group. In conclusion, 3D laparoscopic TME is associated with lower incidences of postoperative sexual and urinary dysfunction than 2D laparoscopic TME for rectal cancer in male patients.     

腹腔镜中低位直肠癌根治术保留盆自主神经的疗效分析

目的:探讨腹腔镜中低位直肠癌根治术经"Holy plane"间隙保留盆自主神经的疗效.方法:把实施了经"Holy plane"间隙保留盆自主神经中低位直肠癌根治术的69例老年男性患者分为两组.观察组采用腹腔镜手术,对照组采用常规开腹手术.两组均采用全直肠系膜切除术(total mesorectal excision,TME).对两组患者的手术时间,术中出血量、术后排尿功能、性功能,局部复发率及5年生存率进行回顾性总结和比较.结果:观察组手术时间明显延长,术中出血量明显少于对照组,两组患者术后排尿功能及性功能障碍的比较均无显著性差异,术后3年患者局部复发率及5年生存率比较无显著性差异.结论:腹腔镜经"Holy plane"间隙保留盆自主神经的中低位直肠癌根治术具有微创优势.在神经保护方面,可以达到与开腹手术相近的手术效果.二者在局部复发率及5年生存率上无明显差异.     

Function preservation in rectal cancer surgery

When total mesorectal excision (TME) is accurately performed, dysfunction, theoretically, does not occur. However, there are differences among individuals in the running patterns and the volumes of nerve fibers, and if obesity or a narrow pelvis is present, nerve identification is difficult. Currently, the rate of urinary dysfunction after rectal surgery ranges from 33% to 70%. Many factors other than nerve preservation play a role in minor incontinence. Male sexual function shows impotence rates ranging from 20% to 46%, while 20%–60% of potent patients are unable to ejaculate. In women, information on sexual function is not easily obtained, and there are more unknown aspects than in men. As urinary, sexual, and defecation dysfunction due to adjuvant radiotherapy have been reported to occur at a high frequency, the creation of a protocol that enables analysis of long-term functional outcome will be essential for future clinical trials. In the treatment of rectal cancer, surgeon-related factors are extremely important, not only in achieving local control but also in preserving function. This article reviews findings from recent studies investigating urinary, sexual, and defecation dysfunction after rectal cancer surgery and discusses questions to be studied in the future.     

应用全直肠系膜切除和保留植物神经的三腔清扫技术治疗中晚期直肠癌247例

 【摘要】　目的　分析应用全直肠系膜切除（TME）、保留植物神经（PANP）的三腔清扫（TSD）技术治疗中晚期直肠癌的效果。方法　247例中晚期直肠癌患者采用TME和（或）TSD技术行根治性切除。其中,185例（74.9 %）进行了PANP（P组）的直肠癌根治术治疗,其余患者由于怀疑侵犯植物神经丛而行植物神经非保留式（P-组）切除术,P组中行TME者139例（Pm组）,行TSD者46例（Ps组）。结果　247例患者中无手术死亡病例。Pm组在手术时间、手术操作难度等方面优于Ps组（P ＜0.05）。P组在术后泌尿和性功能上明显好于P-组（P <0.05）。P组与P-组、Pm组与Ps组在肛门直肠功能、2年生存率及远期复发率、转移率及生存期等方面差异均无统计学意义（均P >0.05）。结论　TME技术PANP对绝大多数中晚期直肠癌均是应该优先选择的术式,应争取行"三明治"疗法。TSD手术操作相对复杂。TME、TSD的术后生存率差异无统计学意义,术后生存期主要取决于癌肿的早期发现与干预。     

Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? : Results of a case-control study

Aims

Intraoperative neuromonitoring (IONM) aims to control nerve-sparing total mesorectal excision (TME) for rectal cancer in order to improve patients' functional outcome. This study was designed to compare the urogenital and anorectal functional outcome of TME with and without IONM of innervation to the bladder and the internal anal sphincter.

Methods

A consecutive series of 150 patients with primary rectal cancer were analysed. Fifteen match pairs with open TME and combined urogenital and anorectal functional assessment at follow up were established identical regarding gender, tumour site, tumour stage, neoadjuvant radiotherapy and type of surgery. Urogenital and anorectal function was evaluated prospectively on the basis of self-administered standardized questionnaires, measurement of residual urine volume and longterm-catheterization rate.

Results

Newly developed urinary dysfunction after surgery was reported by 1 of 15 patients in the IONM group and by 6 of 15 in the control group (p = 0.031). Postoperative residual urine volume was significantly higher in the control group. At follow up impaired anorectal function was present in 1 of 15 patients undergoing TME with IONM and in 6 of 15 without IONM (p = 0.031). The IONM group showed a trend towards a lower rate of sexual dysfunction after surgery.

Conclusions

In this study TME with IONM was associated with significant lower rates of urinary and anorectal dysfunction. Prospective randomized trials are mandatory to evaluate the definite role of IONM in rectal cancer surgery.     

保留盆腔自主神经在男性直肠癌根治术中的应用

目的探讨保留盆腔自主神经直肠癌根治术对减少男性患者术后排尿功能障碍和性功能障碍的作用。方法采用病例对照法,分析56例直肠癌根治术中保留盆腔自主神经组和不保留组患者术后排尿和性功能障碍的发生率及局部复发率。结果排尿功能障碍总发生率为研究组25.00%(14/56),对照组为60.71%(34/56),两组比较差异有统计学意义(P<0.01)。研究组和对照组病人术后勃起功能障碍的发生率分别为26.79%和75.00%,射精功能障碍发生率分别为28.57%和69.64%,两组比较差异有统计学意义(P<0.01)。局部复发率分别为7.14%和8.93%,差异无统计学意义。结论保留盆腔自主神经的直肠癌根治术在不增加局部复发率的情况下,可以改善患者术后的性功能和排尿功能,提高患者术后的生活质量。     

Results after change of treatment policy for rectal cancer--report from a single hospital in China.

BACKGROUND: Great changes have occurred in the management of rectal cancer. This study presents the outcome of total mesorectal excision (TME) for rectal cancer in a single Chinese institution and evaluates TME's role in the comprehensive management of rectal cancer. METHODS: We reviewed the data of rectal cancer patients surgically treated by three colorectal surgeons from January 2000 to August 2004. Patients who received surgical resection for rectal cancer from January 1996 to December 1999, before the introduction of TME, were chosen as controls. Data regarding characteristics of patients and tumors, surgical procedures, postoperative complications, and results of follow-up were collected for analysis. RESULTS: Three hundred and seventy-seven patients with rectal cancer were enrolled in our study, with 175 patients in the TME group and 202 as controls. Mortality and morbidity rates were 1% and 14% in TME patients and 1% and 31% in controls, respectively. The TME group had a shorter operation time and hospital stay, and less bleeding, wound and urinary complications. The local recurrence (LR) rate was 6% and 12% in the TME and the control groups, respectively (P<0.05). With a median follow-up of 35 months, the actuarial 5-year survival rate was 66%. Consistent with the univariate analysis result, multivariate analysis demonstrated that TNM stage, tumor grade, age, and surgeons were independent prognostic factors. TME was not an independent prognostic factor for patients' survival. CONCLUSIONS: TME is a safe and efficient option in reducing LR. However, it is not an independent predictor for patients' survival. In addition to the standardized usage of TME, further knowledge on the molecular mechanism of cancer is needed.     

Function-preserving operation in rectal cancer

Function preservation in rectal cancer surgery consists of preservation of the anal function, the urinary function and the male sexual function. Low anterior resection (manual or instrumental), invagination technique and pull-through are selected as the sphincter saving operation for cancer of the upper and middle rectum. It is reported that more than 60% of rectal cancers are treated by these operations and that a favorable function are obtained. Autonomic nerves such as hypogastric, pelvic and pudendal nerves are anatomically preserved in Dukes A cancer to prevent the urinary and male sexual dysfunction. The post-operative disturbances of urination and male sexual potency decreased to 10% or less by the autonomic nerves preservation.