直肠癌行全直肠系膜切除术分离技术的探讨：附112例报告

Dissection technique of total mesorectal excision： a report of 112 cases

目的探讨直肠癌行全直肠系膜切除术（TME）中直肠及其系膜的分离技术。方法回顾性分析2000年1月至2008年8月112例直肠癌患者行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（45±32）ml，保留腹下神经96例，术后发生尿潴留6例，1个月后恢复；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。112例平均随访（3．7±1．1）年，14例死亡，局部复发6例，远处转移15例，1、3、5年生存率分别为92．0％（103／112）、84．8％（95／112）、66．1％（74／112）。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 mesorectal excision （TME）. Method One hundred and twelve cases of rectal cancer underwent TIME from January 2000 to August 2008 were retrospectively analyzed. Results All the procedures were conducted successfully, average blood loss was （45 ：1： 32） ml during the dissection of rectal mesentery, the hypogastric nerves were preserved in 96 cases, urinary retention occurred in 6 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 14 cases of death, 6 cases of recurrence and 15 eases of distal metastasis according to（ 3.7 ± 1.1 ） years follow-up in 112 cases. The survival rate of 1,3,5 years was 92.0%（ 103/1 12）, 84.8%（95/112）,66.1%（74/112） respectively. Conclusion Anatomical dissection adequate exposure and hemostasis are critical factors for TME.