直肠癌手术TME技术500例的应用体会

Significance of TME technique in the open operations of rectal cancer

目的:总结全直肠系膜切除(TME)技术在直肠癌开放手术中的应用体会.方法:回顾性分析我科自1998-04/2006-10按照TME原则行直肠癌根治术的500例直肠癌患者的临床与随访资料.结果:无围手术期死亡,平均手术时间(165±30)min,平均术中失血(152±120)mL,保肛手术率68.6%(343例),术后吻合口漏12例(占保肛手术的3.5%),吻合口狭窄4例(占保肛手术的0.8%).术后3年随访示:盆腔内局部复发29例(5.8%),膀胱功能障碍率35例(7%),术后年因疾病进展死亡142例(28.4%),3年总生存率71.6%.结论:正确使用TME技术并与保肛、保留盆自主神经、扩大根治有机结合,可以提高直肠癌开放手术的疗效;严格规范手术操作,可减少TME保肛术后吻合口瘘、吻合口狭窄等并发症的发生.

AIM：To summarize our clinical experience of using TME technique in the open operations of rectal cancer.METHODS：We retrospectively analyzed the clinical and follow-up data of 204 cases of consecutive rectal cancer patients（1998-04/2006-10） who accepted radical excision under TME principle.RESULTS：There＇s no operation death.The average operation time is （165±29.5） min and average blood loss during operation is（152±120） mL.The sphincter-preserving operation was performed for 343 patients（68.6%）.In which,postoperative anastomotic leak and stoma stenosis occurred in 12 patients（3.5%） and 4 patients（0.8%） respectively.Two years follow-up data of the patients shows that there are 29 local recurrence（5.8%）,35 bladder dysfunction（7%） and 142 death for progressive disease.CONCLUSION：Cooperating with concepts of sphincter preservation,pelvic autonomic nerve preservation and extended resection,proper using of TME technique can improve the effect of open operation of rectal cancer.Strictly specification of operative procedure may reduce the morbidity of anastomotic leak and stoma stenosis postoperatively.