Male sexual function after laparoscopic total mesorectal excision

Aim The aim of this prospective study was to clarify the frequency of male sexual dysfunction after laparoscopic total mesorectal excision (LTME) and to examine the relationship between pelvic autonomic nerve (PAN) preservation status and functional outcomes. Method Candidates for LTME were included in this study. PAN preservation status after LTME was examined in detail by video review. Patients completed a functional questionnaire (the International Index of Erectile Function) before and 3, 6 and 12 months after the operation. Results Twenty‐six patients who underwent LTME were assessable. Detailed video reviews identified inadvertent PAN damage during surgery. PAN injury was observed in 11 cases (41%), including eight cases (32%) of inadvertent PAN damage (incomplete preservation group). There was a trend toward increasing inadvertent PAN injury rate in patients with high body mass index and large tumours. The results from all patients who underwent LTME showed no deterioration in total International Index of Erectile Function or its domain scores 12 months after surgery. In the incomplete preservation group, these scores temporarily decreased (3 and 6 months after surgery), but such deterioration was not observed in the complete preservation group. Most of the 12 patients with potentially active erectile function before the operation recovered this function, and only one patient (7%) with PAN injury was still judged as inactive 12 months after surgery. Conclusion The proportion of patients with sexual dysfunction after LTME is low. With the enhanced visibility of the laparoscope, inadvertent PAN injury was detected in a significant number of cases and associated with transient deterioration of sexual function.     

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。     

Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer

Background  Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not. Methods  The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision. Results  Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03). Conclusions  Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery. Presented orally at the 8th National Endoscopic Laparoscopic Surgery Congress, Antalya, Turkey, 1–4 July 2007.     

单吻合器法腹腔镜全直肠系膜切除术与开腹手术的对照研究

目的比较单吻合器法腹腔镜全直肠系膜切除术(TME)与开腹TME的临床效果。 方法回顾性对比分析2014年1月至2015年1月解放军海军安庆医院普通外科收治的39例行TME患者的临床资料,其中单吻合器法腹腔镜TME患者15例(腹腔镜组),行开腹TME患者24例(开腹组)。 结果两组患者均顺利完成手术,腹腔镜组的术后肛门排气时间、术中出血量、疼痛评分[(2.7±0.8)d、(45.7±24.6)ml、(2.3±0.9)分]明显低于开腹组[(4.4±1.2)d、(121.7±137.3)ml、(6.4±1.5)分],差异有统计学意义(P<0.05)。腹腔镜组的住院费用、清扫淋巴结数量、术后住院时间[(26 187.1±7 484.6)元、(9.9±5.6)枚、(14.6±4.6)d]与开腹组[(22 466.2±4 972.8)元、(9.0±4.8)枚、(16.2±4.8)d] 比较,差异无统计学意义(P>0.05);腹腔镜组的手术时间(252.3±54.2)min比开腹组(147.3±41.3)min长,差异有统计学意义(P<0.05)。 结论单吻合器法腹腔镜TME具有安全、微创、经济等优势,能够取得与开腹手术同样的肿瘤根治性效果,在经济欠发达地区很有实用价值。     

Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer

Background With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Because of its high operating cost, however, robotic surgery should be reserved to procedures in which the technology can be of maximum benefit, usually when precise dissections in confined spaces are required. Because conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the DaVinci robotic system in laparoscopic low anterior resections for cancer of the rectum. Methods Between November 2004 and May 2005 robotic-assisted low anterior resection with total mesorectal excision was performed on six consecutive patients with rectal cancer. These cases were compared with six consecutive low anterior resections performed with conventional laparoscopic techniques by the same surgeon. Results There were no conversions in either group. Operative and pathological data, complications, and hospital stay were similar in the two groups. Robotic operations appeared to cause less strain for the surgeon. Conclusions Robotic-assisted laparoscopic low anterior resection for rectal cancer is feasible in experienced hands. This technique may facilitate minimally invasive radical rectal surgery. Presented, in part, at the 14th International Congress of the Society of Laparoendoscopic Surgeons, September 14–17, 2005 San Diego, California.     

单吻合器法腹腔镜全直肠系膜切除术的临床应用研究

目的:探讨直肠癌患者行免切割闭合器单吻合器法腹腔镜全直肠系膜切除术(total mesorectal excision,TME)的可行性及临床疗效。方法:回顾分析2009年1月至2011年12月为9例直肠癌患者使用免切割闭合器单吻合器法行腹腔镜全直肠系膜切除术的临床资料。结果:9例均顺利完成腹腔镜手术,无一例中转开腹及脏器损伤。术中、术后病理检查提示残端无肿瘤细胞残留。手术时间180～305 min,平均(243.9±43.4)min;术中出血量30～100 ml,平均(51.1±20.0)ml;淋巴结清扫数量5～12枚,平均(7.9±2.7)枚;术后住院10～17 d,平均(13.4±1.9)d;胃肠功能恢复时间平均(44.0±12.3)h,无吻合口漏及吻合口出血。术后随访3～20个月,无局部复发及远处转移。结论:免切割闭合器单吻合器法行腹腔镜全直肠系膜切除术治疗早中期直肠癌是安全、可行的,可降低医疗费用。     

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。     

Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis

Background

Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME.

Materials and methods

Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated.

Results

Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME.

Conclusions

RTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC.     

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。     

腹腔镜全直肠系膜切除术治疗中低位直肠癌的Meta分析

目的系统评价腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌的临床疗效和安全性。方法检索1991--2012年公开发表的针对腹腔镜TME和开腹TME治疗中低位直肠癌疗效比较的随机对照研究,使用RevMan5．1软件对两种术式的疗效进行Meta分析。结果8篇文献被纳人分析,样本量共计863例中低位直肠癌患者,其中腹腔镜TME组428例,开腹TME组435例。合并分析结果显示,与开腹TME相比,腹腔镜TME可明显减少术中出血量（P〈0．01）,缩短术后肠道功能恢复时间（P〈0．01）及住院时间（P〈0．05）,降低术后出血（P〈0．05）及切口感染（P〈0．01）的发生率;而在手术时间、淋巴结清扫数目、术后吻合口瘘、肠梗阻及盆腔脓肿发生率方面。两种术式的差异无统计学意义（均P〉0．05）。结论腹腔镜TME能够达到与开腹TME相当的术中淋巴结清扫效果,而且能促进患者术后康复,降低术后切口感染和术后出血的发生率。     

腹腔镜全直肠系膜切除术治疗直肠癌短期疗效及并发症的临床研究(附32例报告)

目的:探讨腹腔镜全直肠系膜切除术(TME)治疗直肠癌的短期临床疗效及并发症的预防。方法:回顾分析2001年至2004年行腹腔镜全直肠系膜切除术的直肠癌32例临床资料。结果:除1例外均在腹腔镜下完成手术,保肛率为90.6％,总并发症发生率为21.8％,局部复发率为6.2％,无手术死亡、术后肝转移及远处转移。平均术后胃肠功能恢复时间1.5d,平均住院时间12.4d。结论:腹腔镜全直肠系膜切除术治疗直肠癌的短期临床疗效可靠。严格掌握手术适应证、中转开腹指征及TME手术原则,提高腹腔镜技术水平是降低并发症发生率,提高短期手术疗效的关键。     

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。     

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.     

腹腔镜直肠癌全直肠系膜切除术中无瘤技术的探讨

目的:探讨腹腔镜全直肠系膜切除术(total mesorectal excision,TME)的无瘤技术。方法:基于肿瘤根治性切除的概念、TME的原则及开腹手术的无瘤操作常规,评价腹腔镜TME手术全过程,总结应遵循的无瘤技术常规。结果:腹腔镜TME的无瘤技术包括:(1)防止穿刺孔漏气;(2)尽早吸尽腹水;(3)封闭浆膜面;(4)绑扎肠管;(5)优先处理肠系膜下血管并高位结扎;(6)沿正确平面锐性解剖;(7)非触碰技术;(8)充分游离直肠末段;(9)先冲洗肛管直肠后横断直肠;(10)保护标本取出口;(11)盆腔冲洗;(12)经套管释放气体。结论:腹腔镜TME同样应坚守肿瘤学原则,采用严格的无瘤操作技术,以保证肿瘤学的安全性。腹腔镜TME无瘤技术除与开腹TME原则相符外,还特别强调防止气腹烟囱效应和标本取出口的保护。     

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。     

低位直肠癌腹腔镜全直肠系膜切除术(附42例报告)

目的:探讨应用腹腔镜微创技术与常规开放手术施行全直肠系膜切除术(total m esorectal exc ision,TME)在手术切除的彻底性、功能性神经保护、近期并发症等方面的差异。方法:低位直肠癌患者89例,分为腹腔镜组与开放组,比较两组治疗结果的差别。结果:腹腔镜的放大效应和超声刀的应用,使腹腔镜组对解剖间隙的正确选择和手术径路更得心应手,能更好的辨认和保护盆腔自主神经,患者手术创伤小,出血少,康复快,并发症少。结论:腹腔镜TME较开放手术更规范化和标准化。     

腹腔镜下直肠癌全直肠系膜切除术

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 对38例直肠腺癌患者采用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,并对全组病例随访2年余。结果 38例患者手术顺利,无中转开腹,术后排便、排气时间平均为32h,术后平均住院天数为7．5d。术后随访至今,38例患者均无腹部穿刺口种植,其中2例出现局部复发(1例伴肝转移)。38例患者均无排尿困难,6例患者有性功能减退。结论 腹腔镜下行直肠癌全直肠系膜切除术手术既能有效降低术后局部复发率和保护盆腔自主神经功能,又具有微创优点,值得临床推广。     

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.     

超声刀在腹腔镜直肠全系膜切除术中的临床应用

目的探讨超声刀在腹腔镜直肠全系膜切除术（Total mesorectal excision，TME）的临床应用价值。方法我院自2004年8月～2007年5月。应用超声刀在腹腔镜下对33例直肠癌患者实施TME术。结果33例患者手术顺利，无中转开腹，手术时间115～320min，平均155min；术中出血10～100ml，平均50ml；术后1～2d恢复胃肠功能并下床活动。住院时间5—14d，平均8d。术中及术后无并发症发生。术后随访1月至3年，无复发。结论应用超声刀行腹腔镜TME术，保肛率高，创伤小，出血少，烟雾少。术后恢复快，是一极具应用前景的微创外科新技术。