直肠系膜切除在直肠癌前切除术中的应用

Application of anterior resection of rectal carcinoma with mesorectal excision

目的:探讨直肠系膜切除在直肠癌前切除术中的临床应用。方法:回顾分析2000年10月～2003年10月行前切除术的226例直肠癌患者的临床疗效,其中低位直肠癌行全直肠系膜切除术(TME),而高位直肠癌行部分直肠系膜切除术(PME,达到距肿瘤4～5cm的直肠系膜切缘)。对比分析TME和PME术中、术后各项指标,吻合口瘘、局部复发和生存期的差别。结果:肿瘤距肛门平均9.4cm,TME在64.2%的患者中施行,这些患者的平均手术时间更长,出血量更多,住院时间更长(P<0.05)。TME、PME的手术死亡率、并发症发生率、5年局部复发率和5年肿瘤相关生存率均无显著性差异(均P>0.05)。吻合口瘘在TME和PME中发生率分别为9.7%和1.2%,存在显著性差异(P<0.05)。结论:前切除术并直肠系膜切除术是一种安全的术式,能在大多数直肠癌患者中应用。TME同PME相比较,手术方式更加复杂,吻合口瘘发生率更高,在近端直肠癌中行PME达到了足够的直肠系膜清扫。中低位直肠癌中行TME的局部复发率和生存期同高位直肠癌行PME的相近。

Objective：To investigate the operative results of anterior resection with mesorectal excision of rectal cancer.Methods：Anterior resection of primary rectal cancer was performed in 226 patients from October 2000 to October 2003.Patients with mid and distal rectal cancer were treated with total mesorectal excision （TME）while partial mesorectal excision（PME）was performed in those with more proximal tumors.Clinic data on the postoperative results,oncological outcomes,anastomotic leakage,local recurrence and survival of the patients were reviewed.The differences between patients with TME and PME were analyzed.Results：The median distance of the tumor was 9.4cm from the anal verge.TME was performed in 145 patients （64.2%）.Significantly longer average operating time,more blood loss, and a longer hospital stay were found in patients with TME. The operative mortality and morbidity rates were 1.9%,1.6% and 20%,18% respectively,and there were no significant differences between those of TME and PME.Anastomotic leak occurred in 9.7% and 1.2% of patients with TME and PME,respectively（P〈0.05）.The 5-year actuarial local recurrence rate and 5-year cancer-specific survival was 10.3%,6.2% and 79.3%,69.1% respectively,and there were no significant differences between those of TME and PME.Conclusion：Anterior resection with mesorectal excision is a safe option and can be performed in the majority of patients with rectal cancer.The procedure of TME is more complex and has a higher leakage rate than that of PME which can provide adequate mesorectal clearance in proximal rectal cancer.By performing TME in patients,the local control and survival of these patients are similar to those of patients with PME.