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。

Surgical quality control of TME and ELAPE procedure for rectal cancer

Clear anatomical plane and surgical quality control are crucial points of operation development. In the history of rectal cancer surgery, total mesorectal excision (TME) and extralevator abodminoperineal excision (ELAPE) are two milestone style operations. TME has become the standard procedure of middle-low rectal cancer, ELAPE play an important role in decreasing the ″surgical waist″ (it might lead to circumferential resection margin positive) produced in conventional abdominoperienal excision procedure. The surgical quality control should include three aspects as followed: sufficient preoperative evaluation by multidisciplinary team (MDT), surgical technique quality control, postoperative pathological evaluation. The surgical quality control of two procedures was discoursed based on above three aspects