全直肠系膜切除术的应用体会

Application Experience of Total Mesorectal Excision in Rectal Cancer

目的探讨全直肠系膜切除术(TME)的合理实施及临床应用。方法回顾性分析2005年以来38例全直肠系膜切除术的直肠癌患者的临床资料。结果38例中无手术死亡病例,Mile术20例,18例保肛,11例吻合器吻合,保肛成功率44.7%(17/38),术后吻合口瘘1例,1月后改行Miles术。无骶前大出血病例,术后近期排尿困难1例,近期大便失禁1例。术后16月复发1例来院行再手术切除。结论全直肠系膜切除术(TME)的合理实施可使手术病死率、术中大出血发生率降低,复发率降低,可有效保存盆腔脏器功能。

Objective To explore the clinical application experience of the radial rectectomy with the total mesorectal excision （TME） in rectal cancer patients. Methods The clinical data of 38 cases with rectal cancer who performed TME from Jan 2005 to Dec 2008 were analyzed retrospectively. Results All cases achieved successful operation. 20 were done with Miles operation, 18 cases with retained anus operation. 11 cases were done by stapling device with a successful rate of 44.7%, 1 case with postop- erative leak of anastomosis underwent Miles operation 1 month later. There was no case with presacral hemorrhage, l case with short-term dysuria and another case with short-term fecal incontinence. 1 recurrent case underwent the second operation by way of Miles 16 months after the operation. Conclusion TME can reduce the operative mortality and presacral hemorrhage in operation, prevent the local recurrence, and preserve the function of pelvic organ.