全直肠系膜切除术分离技术的体会(附129例报告)

The Dissection Technique of Total Mesorectal Excision(A Report of 129 Cases)

目的探讨全直肠系膜切除术（total mesorectal excision，TME）中直肠及其系膜的分离技术。方法回顾性分析2000年4月～2006年10月间129例直肠癌行TME的临床资料。结果全部病例顺利完成手术，在对直肠及其系膜的分离中（不包括会阴部操作）平均出血40（10—350）ml，保留腹下神经98例，术后发生尿潴留8例，1月后恢复；吻合口漏1例，行横结肠造口后愈合；切口感染6例，经换药后愈合，全组无输尿管及骶前静脉丛损伤。115例平均随访3．5年，15例死亡，局部复发7例，远处转移16例，1、3、5年生存率分别为91．8％、82．5％和65．2％。结论术者必须熟悉盆腔解剖关系，完善的止血和如何使直肠前后间隙及侧韧带等得到最大程度的暴露是TME顺利进行的关键。

Objective To study the dissection technique of total mesoretal excision （TME）. Method 129 cases of rectal cancer underwent TME from April 2000 to October 2006 were retrospectively analyzed. Result All the procedures were conducted successfully, average blood loss was 40 ml during the dissection of rectal mesentery, the hypogastric nerves were preserved in 98 cases, urinary retention occurred in 8 cases and recovered 1 month later. Anastomotic leakage occurred in 1 case and healed after transverse colostomy. Wound infection in 6 cases and healed by dress changing. There was no ureter injury. There were 15 cases of death, 7 eases of recurrence and 16 cases of distal metastasis according to 3.5 years follow-up in 115 cases. The 1,3,5 year survival rate was 91.8% ,82.5% and 65.2% respectively. Conclusion Anatomical dissection, adequate exposure and hemostasis are critical factors for TME.