腹腔镜TME与开腹TME治疗直肠癌近期疗效和并发症比较

目的对比分析腹腔镜下全直肠系膜切除术（TME）与开腹TME治疗直肠癌的近期疗效及并发症。方法回顾性分析32例腹腔镜TME（A组）和36例开腹TME（B组）治疗直肠癌患者的临床资料,比较两组手术近期疗效及术后并发症发生率。结果 A组和B组手术时间分别为（195.6±32.8）、（155.2±35.7）min,术中出血量分别为（154.6±91.4）、（302.1±217.3）ml,术后肠道功能恢复时间分别为（32.8±6.8）、（74.2±10.1）h,住院时间分别为（11.8±2.0）、（14.6±2.8）d（P均〈0.05）。术后并发症发生率A组为9.38%,B组为30.56%（P〈0.05）。结论腹腔镜TME治疗直肠癌安全、可行,近期疗效优于开腹手术。     

Distribution of lymph nodes in the mesorectum: how deep is TME necessary?

BACKGROUND: Standardization of total mesorectal excision (TME) had a great impact on decreasing local recurrence rates for the treatment of rectal cancer. However, exact numbers and distribution of lymph nodes (LN) along the mesorectum remains controversial with some studies suggesting that few LNs are present in the distal third of the mesorectum. METHODS: Eighteen fresh cadavers without a history of rectal cancer were studied. The rectum was removed by TME and then was divided into right lateral, posterior and left lateral sides, which were further subdivided into 3 levels (upper, middle and lower). A pathologist determined the number and sizes of the LNs in each of the nine areas, b linded to their anatomical origin. RESULTS: Overall, the mesorectum had a mean of 5.7 LNs (SD=3.7) and on average each LN had a maximum diameter of 3.0 mm (SD=2.7). There was no association between the mean number or size of LNs with gender, BMI, or age. There was a significantly higher prevalence of LNs in the posterior location (2.8 per mesorectum) than in the two lateral locations (0.8 and 1.2 per mesorectum; p=0.02). The distribution of LNs in the three levels of the rectum was not significant. CONCLUSIONS: The distribution of LNs reinforces the fact that TME should always include the distal third of the mesorectum. Care must be taken to not violate the posterior aspect of the mesorectum.     

Is there a difference between a chief of cardiology and a chief of medicine?

The job of Chief of Medicine demands considerably more administrative effort than the Chief of Cardiology. However, one can still maintain a significant presence in cardiology as a Chief of Medicine. Each job has its own merits, joys, and irritations.     

直肠癌TME和ELAPE手术质量控制

解剖层面明确、手术质量可控制是手术进步的重要体现。在直肠癌的手术的发展上,全直肠系膜切除术（TME）和肛提肌外腹会阴联合切除术（ELAPE）属于手术质量控制的里程碑式手术。TME手术目前是中低位直肠癌的标准术式,要求直肠和直肠系膜作为一个解剖单位整体切除;ELAPE手术在减少传统腹会阴联合切除时存在"外科腰"方面（可能导致环周切缘阳性）可能具有一定价值。外科医师要做到手术质量控制,需要做好包括术前多学科专家组（MDT）评估、术中手术技术质控、术后标本质量病理学评估在内的一整套直肠癌手术质量控制体系。本文从上述三个方面对两种术式的手术质量控制进行论述。     

152例TME术式疗效探讨

中、低位直肠癌手术切除、保留肛门者 ,术后有良好的生活质量 ,但肿瘤局部复发率高 ( 2 0 %～ 3 7% )。 1997～ 1998年我院为 15 2例中、低位直肠癌患者实施全直肠系膜切除术(TME) ,效果满意。报告如下。资料与方法 :本组男 10 9例 ,女 43例 ;年龄 3 2～ 81岁 ,中位数年龄 5 9 5岁。 15 2例均实施TME手术。Dukes分期 :A期 2 2例 ,B期 5 1例 ,C期 79例。另选 1996～ 1997年收治的161例中、低直肠癌患者为对照组 ,该组实施非TME手术 (即不按TME原则进行手术 ) ,男 112例 ,女 49例 ;年龄 2 8～ 79岁 ,中位数年龄 5 7 5岁。Dukes分期A期…     

TME治疗直肠癌100例疗效观察

采用全系膜切除术（TME）治疗直肠癌100例,无手术死亡者,术后发生吻合瘘8例（8%）,术后2 a内复发9例（9%）。认为TME治疗直肠癌,肿瘤局部复发率低,效果满意。     

TME术治疗直肠癌15例疗效分析

近年来-直肠癌的手术治疗虽然取得较成熟的经验．但患者生存率无明显提高,其主要原因是直肠癌根治性切除后局部复发率较高。2002～2004年,我院采用全直肠系膜切除、保留肛门低位吻合(TME)手术治疗直肠癌患者15例,并与既往采用传统术式的患者进行对比分析。现报告如下。     

腹腔镜TME治疗中低位直肠癌疗效观察

目的观察腹腔镜全直肠系膜切除术(TME)治疗中低位直肠癌的疗效。方法 198例中低位直肠癌患者,随机分为腹腔镜组93例和传统开腹组105例。分别采用腹腔镜和传统开腹手术方法进行TME。结果两组患者切除标本长度、清扫淋巴结数量、肠管远切缘距离相比P>0.05。两组所有标本远切缘病理学检查均为阴性。腹腔镜组合传统开腹组完整TME切除+近完整TME切除率分别为92.5%和91.7%。腔镜组复发率和总生存率分别是5.6%和93.3%,而开腹组分别为7.3%、94.8%,两组相比P>0.05。结论腹腔镜TME治疗中低位直肠癌疗效与开腹手术相似。     

Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire

A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped “SafeSept” trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the “SafeSept” guidewire, when advanced into the left atrium, becomes atraumatic.