The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurren...The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery.However,standardized TME causes urogenital dysfunction in more than half of patients,thus lowering the quality of life of patients.Of note,pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction.The anatomy of the Denonvilliers’fascia(DVF)and its application in surgery have been investigated both nationally and internationally.Nevertheless,controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery.Currently,it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection.Herein,this study systematically describes the anatomy of DVF and its appli-cation in surgery,thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.展开更多
目的系统评价中低位直肠癌全直肠系膜切除手术中保留盆腔自主神经治疗的临床价值。方法使用Rev Man 5.4软件,检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统、Cochrane Library、Pub Med、EMbase数据库和Web of...目的系统评价中低位直肠癌全直肠系膜切除手术中保留盆腔自主神经治疗的临床价值。方法使用Rev Man 5.4软件,检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统、Cochrane Library、Pub Med、EMbase数据库和Web of Science数据库,筛选出全直肠系膜切除手术中保留盆腔自主神经治疗的中低位直肠癌的随机对照试验(RCT),检索期限为建库至2023年4月,采用Rev Man 5.4软件进行meta分析。结果最终纳入10篇RCTs,包括899例患者。结果显示:观察组术后勃起功能障碍发生率低于对照组[RR=0.46,95%CI(0.38~0.58),P<0.00001];观察组术后射精功能障碍发生率低于对照组[RR=0.54,95%CI(0.46~0.65),P<0.00001];观察组术后排尿功能影响低于对照组[RR=0.38,95%CI(0.29~0.51),P<0.00001];两组肿瘤复发率比较,差异无统计学意义[RR=0.82,95%CI(0.45~1.52),P=0.53]。结论在中低位直肠癌的手术治疗中,相较于传统直肠癌根治术,全直肠系膜切除术中保留盆腔自主神经虽未明显改善复发率,但可保护术后性功能和排尿功能,提高生活质量,具有临床价值。展开更多
基金the Key Project of the Qinghai Provincial Health Commission,No.2019-wjzd-06.
文摘The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery.However,standardized TME causes urogenital dysfunction in more than half of patients,thus lowering the quality of life of patients.Of note,pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction.The anatomy of the Denonvilliers’fascia(DVF)and its application in surgery have been investigated both nationally and internationally.Nevertheless,controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery.Currently,it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection.Herein,this study systematically describes the anatomy of DVF and its appli-cation in surgery,thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.
文摘目的系统评价中低位直肠癌全直肠系膜切除手术中保留盆腔自主神经治疗的临床价值。方法使用Rev Man 5.4软件,检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统、Cochrane Library、Pub Med、EMbase数据库和Web of Science数据库,筛选出全直肠系膜切除手术中保留盆腔自主神经治疗的中低位直肠癌的随机对照试验(RCT),检索期限为建库至2023年4月,采用Rev Man 5.4软件进行meta分析。结果最终纳入10篇RCTs,包括899例患者。结果显示:观察组术后勃起功能障碍发生率低于对照组[RR=0.46,95%CI(0.38~0.58),P<0.00001];观察组术后射精功能障碍发生率低于对照组[RR=0.54,95%CI(0.46~0.65),P<0.00001];观察组术后排尿功能影响低于对照组[RR=0.38,95%CI(0.29~0.51),P<0.00001];两组肿瘤复发率比较,差异无统计学意义[RR=0.82,95%CI(0.45~1.52),P=0.53]。结论在中低位直肠癌的手术治疗中,相较于传统直肠癌根治术,全直肠系膜切除术中保留盆腔自主神经虽未明显改善复发率,但可保护术后性功能和排尿功能,提高生活质量,具有临床价值。
