螺旋水刀在直肠癌全直肠系膜切除术中的应用

目的 探讨螺旋水刀在直肠癌全系膜切除术中应用的疗效。方法 将110例直肠癌手术患者分为两组，均行全直肠系膜切除术。一组术中应用螺旋水刀进行分离盆腔；另一组不使用螺旋水刀而使用电刀及常规方法分离盆腔。比较两组在手术时间、术中出血、吻合口漏、住院天数、术后局部复发率、暂时性排泄功能紊乱等方面的差别。结果 两组在术中所用时间、出血量、术后暂时性排尿功能紊乱发生率差异均有统计学意义（P〈0．05），而在住院天数、术后吻合口漏发生率、术后肿瘤局部复发率，差异无统计学意义（P〉0．05）。结论 应用螺旋水刀行直肠癌全直肠系膜切除术，分离术野清晰、出血少、不易损伤自主神经，尤其对于降低术后暂时性排尿功能紊乱方面有非常明显的效果。     

全直肠系膜切除术治疗直肠癌

由于低位直肠癌发病率高，常需永久性造口，且有较高的局部复发率及术后对性功能和泌尿功能的影响，因此直肠癌的治疗一直是困扰全球外科学界的重大问题。近二十年来，直肠癌的外科治疗发展迅速，特别是１９８２年Ｈｅａｌｄ等［１］提出全直肠系膜切除术（ｔｏｔａｌｍｅ...     

超声刀在开放直肠癌全直肠系膜切除术中的应用

超声刀（ultracision harmonic scalpel,UHS）最早被应用于腹腔镜手术中,近年来,因其在分离、止血方面的高效率表现而逐渐被引入到开放手术领域。2010年3月—2011年6月,笔者在中低位直肠癌全直肠系膜切除术（total mesorectal excision，TME）中应用超声刀，取得满意效果，报道如下。     

低位直肠癌全直肠系膜切除术和传统手术方法比较

全直肠系膜切除术（total mesorectal excision，TME）能降低直肠癌术后局部复发率，但也有人认为该手术手术时间长，并发症多。为此我们对TME和传统手术治疗直肠癌治疗效果进行对比，现报告如下。     

直肠癌全直肠系膜切除术

目的 比较全直肠系膜切除（ＴＭＥ）和传统手术方法对直肠癌术后局部复发及长期生存率的影响。方法 将１９９３年９月起采用ＴＭＥ术的直肠癌患１６８例与１９８１～１９９２年行传统切除方法的１２６例患进行比较,分析两组的临床病理参数。结果 手术后并发症发生率无差异,ＴＭＥ组２年复发率为４．６％,明显低于对照组的２０．６％（Ｐ＝０．００１）,２年及３年生存率ＴＭＥ组分别为８７．１％和８０．３％,对照组分别为７６．１％和６８．７％,ＴＭＥ组生存率高于对照组（Ｐ＝０．０１３）。ＴＭＥ技术、肿瘤的Ｄｕｋｅｓ分期,患的年龄、肿瘤距肛门的距离等因素中,只有ＴＭＥ是独立影响生存率的指标,ＴＭＥ、肿瘤的Ｄｕｋｅｓ分期是独立的影局部复发的指标,结论 对于距离肛门１２ｃｍ范围内的直肠癌,采用ＴＭＥ技术能有效地降低局部复发率及提高患生     

腹腔镜下直肠癌全直肠系膜切除术

直肠癌是消化道最常见的恶性肿瘤之一,外科手术是其主要治疗手段。直肠癌全直肠系膜切除术（total mesorectal excision,TME）在有效降低局部复发率的同时,还可提高患者的生存质量和生存率,目前TME被认为是直肠癌手术新的金标准[1-2]。     

全直肠系膜切除术在低位直肠癌中的应用

为探讨低位直肠癌全直肠系膜切除术（TME）在保肛、防止肿瘤局部复发中的作用,对行低位直肠癌TME43例患者的手术方法、疗效和并发症进行回顾性分析。结果显示,43例采用TME手术,术后无死亡病例,吻合口漏3例,无吻合口狭窄,术后局部复发3例,复发率为6．9％。结果表明,在低位直肠癌手术中应用TME可降低直肠癌局部复发率,不增加并发症。     

全直肠系膜切除术在直肠癌治疗中的作用

目的探讨直肠癌全直肠系膜切除术(TME)的临床应用价值。方法对65例中下段直肠癌行TME,分析术后局部复发率、术后并发症、直肠系膜肿瘤残留情况。结果65例直肠癌局部复发率为7.7%(5/65),术后吻合口漏的发生率为6.2%(4/65),5例术后短期内有泌尿生殖功能障碍,无骶前大出血,术后病检报告系膜内有癌巢存在的有35例(54%)。结论TME是治疗中下段直肠癌必须遵循的原则,能明显降低局部复发率及术后并发症,提高保肛手术率。     

腹腔镜直肠癌全直肠系膜切除术的临床应用

目的：探讨腹腔镜全直肠系膜切除术的临床应用。方法：回顾分析13例腹腔镜直肠全系膜切除术患者的临床资料。结果：13例均用腹腔镜完成手术,手术时间150-240min,平均165min,术中平均出血150ml。术后均无严重并发症发生,随访0.5-5年,无一例肿瘤复发,穿刺部位及造瘘口均无肿瘤种植。结论：腹腔镜全直肠系膜切除术具有较高的实用价值,在严格掌握手术适应证、不断提高手术技巧的基础上,腹腔镜直肠癌全直肠系膜切除术是可行的。     

全直肠系膜切除术治疗直肠癌——附168例报告

目的探讨全直肠系膜切除术在预防直肠癌术后局部复发中的作用，以及同该操作相关的一些并发症。方法回顾性分析168例直肠癌的临床资料。结果全组无手术死亡，术后随访1～36月，局部复发6例(3．6％)，术后吻合口漏13例(10．7％)，多数保肛患者出现便频、便急等症状。结论全直肠系膜切除术能有效降低直肠癌术后局部复发率，提高保肛率，但存在吻合口漏，控便功能等问题需进一步解决。     

直肠癌全直肠系膜切除术107例临床分析

目的探讨直肠癌全直肠系膜切除法在直肠癌中的应用。方法回顾性分析107例直肠癌患者行全直肠系膜切除的临床资料。本组病例行Miles术式18例;Dixon术式89例,其中76例使用吻合器吻合。结果全组术中出血100-150ml,术中术后均无输血。术后发生吻合口瘘3例,占2.8%。性功能障碍1例,占0.93%。排尿功能障碍1例,占0.93%。术口感染12例,占11.21%。随访6-42个月,局部复发率4.67%（5/107）。结论直肠癌全直肠系膜切除术,对提高直肠癌术后患者生存质量和生活质量确有裨益。     

腹腔镜下直肠癌全直肠系膜切除手术

目的 探讨腹腔镜下直肠癌全直肠系膜切除(total mesorectal excision，TME)手术的可行性。方法 自2000年3月至2003年11月共行腹腔镜下直肠癌TME手术67例，其中直肠癌前切除术(anterior resection，AR)45例，直肠癌腹会阴联合切除术(abdominal pelineal resection，APR)22例。结果 本组67例患者按TME原则采用腹腔镜完成直肠癌手术，术中出血量10～50ml，手术时间2.5～5．0h，无术中死亡，术后持续胃肠减压时间8～24h，平均术后24～48h开始进食水，术后1～3d下床活动，术后1～5d开始排便。术后住院时间7～10d。术后随访时间3～43个月，2例患者局部复发，2例患者肝转移；术后因局部复发和肝转移各死亡1例，失访3例；有19例术后不足1年的患者，未发现转移及复发。结论 只要有较好的开腹TME手术经验和腹腔镜操作技能，腹腔镜下直肠癌TME手术是可行的。     

腹腔镜直肠癌全直肠系膜切除术90列报告

目的 评价腹腔镜全直肠系膜切除术的临床疗效.方法 回顾分析2007年4月至2012年4月90例腹腔镜全直肠系膜切除术患者的临床资料.结果 82例用腹腔镜完成手术,手术时间180 ～ 260 min,平均205 min,术中平均出血150 ml,清除淋巴结总数平均为15个.术后均无严重并发症发生,随访1～4年,无肿瘤复发,穿刺部位及造瘘口均无肿瘤种植.结论 腹腔镜全直肠系膜切除术具有较高的实用价值,在严格掌握手术适应证、不断提高手术技巧的基础上,腹腔镜直肠癌全直肠系膜切除术是可行的.     

经肛门全直肠系膜切除和腹腔镜全直肠系膜切除对直肠癌的疗效对比

目的分析比较经肛门全直肠系膜切除（TaTME）与腹腔镜全直肠系膜切除（LaTME）在中低位直肠癌治疗中的疗效及预后。 方法选择东营市东营区人民医院2015年2月至2016年2月收治的64例择期行全直肠系膜切除术（TME）的中低位直肠癌患者,随机分为TaTME组与LaTME组,各32例。观察并比较两组患者的手术时间、术中出血量、标本完整率、环周切缘（CRM）阳性率、远端切缘（DRM）阴性率、淋巴结清扫数目、保肛率、中转开放手术率、术中及术后并发症、术后住院时间、局部复发率、远处转移率、2年总体生存率（OS）各指标间的差异。 结果TaTME组患者的术中出血量、中转开放手术率、手术时间、标本完整率、CRM阳性率、保肛率、术后住院时间、尿潴留发生率均显著优于LaTME组（均P<0.05）。患者均获随访2~24个月,TaTME组中位生存时间为23.9个月,局部复发率、转移率分别为6.2%（2/32）、3.1%（1/32）。LaTME组中位生存时间为19.7个月,局部复发率、转移率均为3.1%（1/32）。两组术后复发率、转移率比较,差异无统计学意义（χ²=0.350、0.516,P=0.554、0.472）。TaTME组与LaTME组1年OS分别为100.00%、93.75%,2年OS分别为96.87%、81.25%。两组1年OS比较,差异无统计学意义（χ²=0.516,P=0.472）,TaTME组的2年OS显著高于LaTME组患者（χ²=4.402,P=0.036）。 结论与LaTME术相比,TaTME术治疗中低位直肠癌具有较高的安全性和有效性,且术后并发症较少,术后住院时间短,可以改善患者预后。     

Robotic total mesorectal excision for the treatment of rectal cancer

Robotic techniques have been developed to facilitate endoscopic surgery and to overcome its disadvantages. Thus, we performed robotic total mesorectal excison (TME) in a patient with rectal cancer, using the da Vinci^® Surgical System. To our knowledge, this is the first robotic low anterior resection, based on standard TME principles, with pelvic autonomic nerve preservation. In conclusion, this robotic system is an excellent instrument for performing the standard TME procedure in rectal cancer patients.     

腹腔镜和开腹直肠癌全系膜切除的对照研究

目的:探讨腹腔镜下行直肠癌全直肠系膜切除根治术的临床效果。方法:24例直肠癌患者分为两组。腹腔镜组:采用全直肠系膜切除(LCR)12例。采用经腹腔镜下联合应用超声刀循盆筋膜壁层和脏层的间隙行锐性游离全直肠系膜,切除一个不间断的直肠整体标本。开腹组:12例,采用常规开腹手术。比较两组围手术期的状况、肿瘤切除的彻底性、肠旁淋巴结清扫数量。结果:两组切除标本的直肠系膜均完整,腹腔镜组中无中转开腹,腹腔镜组与开腹组淋巴结数分别为7．9±0．7个与8,1±0．9个(P >0．05);远端直肠均无癌残留;腹腔镜组手术后肠功能恢复早[(45±4．5)h VS(79±11．6)h,P>0.05], 手术中出血量少[(185±41)ml VS(380±48)ml,P<0．01]。结论:经腹腔镜行全直肠系膜切除术 (TME)手术是行之有效的,具有创伤小,恢复快等忧点。     

The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma

Background Although experience of laparoscopic treatment of rectal carcinoma has been reported, there is no evidence of its oncological safety because most procedures included partial mesorectal excision or abdominoperineal excision and quality of surgery is lacking. The aim of this study was to assess the oncological results of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma.Methods From 2000 to 2003, 144 patients underwent laparoscopic total mesorectal excision with low colorectal or coloanal anastomosis for mid and low rectal adenocarcinoma. There were 88 men and 56 women, with a median age of 65 years. The tumor was located at 5.5 cm (range 1–12) from the anal verge and was classified uT1T2 in 25 cases and uT3 in 119 cases. One hundred twenty patients received preoperative radiotherapy.Results Postoperative mortality and morbidity were 1% and 34% respectively. Conversion was 14% (n = 20). Macroscopic assessment of the specimen (n = 92) showed an intact mesorectum in 88% of the cases. The distal margin and the circumferential margin were safe in 98% and 94% of the cases, respectively. A complete microscopic excision, i.e., R0 resection, was achieved in 134 cases (93%). Pathological data were similar to those of an open match group. With a median follow-up of 18 months, there was no port-site recurrence and two patients had local recurrence (1.4%). The 3-year overall and disease- free survival rates were 89% and 77%, respectively.Conclusions A high quality of surgical excision can be achieved by the laparoscopic dissection, suggesting that this approach in treatment of rectal carcinoma is oncologically safe.     

Effect of rectal washout on local recurrence of rectal cancer in the era of total mesorectal excision: Meta-analysis

IntroductionPresence of intraluminal viable cancer cells implanting into the anastomosis has been proposed as a potential cause for developing local recurrence in patients undergoing anterior resection for rectal cancer. Rectal washout has been proposed as a method to prevent this from happening. There have been conflicting reports in literature regarding the effect of rectal washout on local recurrence. We aim to look at the role of rectal washout in preventing local recurrence of rectal cancer in patients undergoing total or tumor-specific mesorectal excision (TME).Materials and methodsA literature review of studies evaluating the role of rectal washout on rectal cancer local recurrence was performed using PubMed, Scopus, EMBASE and non-English language literature search using CiNii (Japanese) and CNKI (Chinese). Inclusion criteria were use of TME, comparison of rectal washout with no washout, and evaluation of local recurrence as outcome.ResultsFour studies were identified according to inclusion criteria. The meta-analysis showed a protective effect of rectal washout on local recurrence (OR 0.45 95% CI 0.45–0.75). However, one of the studies included had more than 90% weightage. Excluding this study from analysis showed no difference on local recurrence with rectal washout (OR 0.94, 95% CI 0.37–2.36).ConclusionThe effect of rectal washout on rectal cancer local recurrence in patients who undergo TME is questionable and needs to be evaluated further by prospective studies.     

Robotic total mesorectal excision for rectal cancer using four robotic arms

Background The da Vinci system is a newly developed device for colorectal surgery, therefore experience of its use for rectal cancer surgery is limited and there are no reports describing the use of four robotic arms with this system. The aim of this study is to evaluate the safety and feasibility of the four-arm da Vinci system for total mesorectal excision in rectal cancer patients. Methods Clinicopathologic data were prospectively collected on nine patients who underwent robotic total mesorectal excision using four robotic arms for the treatment of mid or low rectal cancer between November 2006 and Febuary 2007. Patient demographics, perioperative clinical outcomes, and pathology results with macroscopic grading (complete, nearly complete, incomplete) were evaluated. Results nine patients with mid or low rectal cancer underwent robotic total mesorectal excison using four robotic arms without serious complications. The mean length of hospital stay was 7.4 ± 1.3 days (range 5.0–10.0 days) and the mean operating time was 220.8 ± 49.4 min (range 153–315 min). Macroscopic grading of the specimen was complete in eight patients and nearly complete in one patient. There were no cases of conversion. Conclusion In the present study, we accomplished nine robot-assisted rectal resections safely and effectively.