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Evolution of transanal total mesorectal excision for rectal cancer:From top to bottom 被引量:20
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作者 Sameh Hany Emile F Borja de Lacy +4 位作者 Deborah Susan Keller Beatriz Martin-Perez Sadir Alrawi Antonio M Lacy Manish Chand 《World Journal of Gastrointestinal Surgery》 SCIE CAS 2018年第3期28-39,共12页
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and ... The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME. 展开更多
关键词 Rectal cancer total mesorectal excision transanal total mesorectal excision transanal total mesorectal excision Sphincter sparing surgery Colorectal surgery
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Transanal total mesorectal excision: Myths and reality 被引量:5
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作者 Nicolas C Buchs Marta Penna +1 位作者 Alexander L Bloemendaal Roel Hompes 《World Journal of Clinical Oncology》 CAS 2016年第5期337-339,共3页
Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the ... Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the limits of standard low anterior resection. TaTME might help to decrease the conversion rate especially in difficult patients, and to improve the pathological results, while preserving the urogenital function. Evaluation of data from large registries and randomized studies should help to draw firmer conclusions. Beyond these technical considerations, the next challenge seems to be clearly the safe introduction of this approach, motivating the development of dedicated courses. 展开更多
关键词 transanal total mesorectal excision Bottom up TAMIS LAPAROSCOPY Robotic Outcomes RECTAL cancer
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Simple instruments facilitating achievement of transanal total mesorectal excision in male patients 被引量:1
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作者 Chang Xu Hua-Yu Song +3 位作者 Shao-Liang Han Shi-Chang Ni Hu-Xiang Zhang Chun-Gen Xing 《World Journal of Gastroenterology》 SCIE CAS 2017年第31期5798-5808,共11页
AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with ... AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors. 展开更多
关键词 Rectal neoplasm total mesorectal excision transanal approach Intersphincteric resection Longterm outcome Local recurrence
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Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer:Importance of appropriate patient selection 被引量:2
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作者 Pratik Bhattacharya Ishaan Patel +2 位作者 Noureen Fazili Shahab Hajibandeh Shahin Hajibandeh 《World Journal of Gastrointestinal Surgery》 SCIE 2022年第12期1397-1410,共14页
BACKGROUND Achieving a clear resection margins for low rectal cancer is technically challenging.Transanal approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the... BACKGROUND Achieving a clear resection margins for low rectal cancer is technically challenging.Transanal approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the laparoscopic approach in treating low rectal cancers.However,previous meta-analyses have included mixed population with mid and low rectal tumours when comparing both approaches which has made the interpretation of the real differences between two approaches in treating low rectal cancer difficult.AIM To investigate the outcomes of transanal TME(TaTME)and laparoscopic TME(LaTME)in patients with low rectal cancer.METHODS A comprehensive systematic review of comparative studies was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.Intraoperative and postoperative complications,anastomotic leak,R0 resection,completeness of mesorectal excision,circumferential resection margin(CRM),distal resection margin(DRM),harvested lymph nodes,and operation time were the investigated outcome measures.RESULTS We included twelve comparative studies enrolling 969 patients comparing TaTME(n=969)and LaTME(n=476)in patients with low rectal tumours.TaTME was associated with significantly lower risk of postoperative complications(OR:0.74,P=0.04),anastomotic leak(OR:0.59,P=0.02),and conversion to an open procedure(OR:0.29,P=0.002)in comparison with LaTME.Moreover,the rate of R0 resection was significantly higher in the TaTME group(OR:1.96,P=0.03).Nevertheless,TaTME and LaTME were comparable in terms of rate of intraoperative complications(OR:1.87;P=0.23),completeness of mesoractal excision(OR:1.57,P=0.15),harvested lymph nodes(MD:-0.05,P=0.96),DRM(MD:-0.94;P=0.17),CRM(MD:1.08,P=0.17),positive CRM(OR:0.64,P=0.11)and procedure time(MD:-6.99 min,P=0.45).CONCLUSION Our findings indicated that for low rectal tumours,TaTME is associated with better clinical and short term oncological outcomes compared to LaTME.More randomised controlled trials are required to confirm these findings and to evaluate long term oncological and functional outcomes. 展开更多
关键词 total mesorectal excision LAPAROSCOPIC transanal Rectal cancer
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Robotic transanal total mesorectal excision:Is the future now? 被引量:2
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作者 Juan Carlos Sebastián-Tomás Aleix Martínez-Pérez +3 位作者 Elías Martínez-López Nicola de'Angelis Marcos Gómez Ruiz Eduardo García-Granero 《World Journal of Gastrointestinal Surgery》 SCIE 2021年第8期834-847,共14页
Total mesorectal excision(TME)is the standard surgical treatment for the curative radical resection of rectal cancers.Minimally invasive TME has been gaining ground favored by the continuous technological advancements... Total mesorectal excision(TME)is the standard surgical treatment for the curative radical resection of rectal cancers.Minimally invasive TME has been gaining ground favored by the continuous technological advancements.New procedures,such as transanal TME(TaTME),have been introduced to overcome some technical limitations,especially in low rectal tumors,obese patients,and/or narrow pelvis.The earliest TaTME reports showed promising results when compared with the conventional laparoscopic TME.However,recent publications raised concerns regarding the high rates of anastomotic leaks or local recurrences observed in national series.Robotic TaTME(R-TaTME)has been proposed as a novel technique incorporating the potential benefits of a perineal dissection together with precise control of the distal margins,and also offers all those advantages provided by the robotic technology in terms of improved precision and dexterity.Encouraging short-term results have been reported for R-TaTME,but further studies are needed to assess the real role of the new technique in the long-term oncological or functional outcomes.The present review aims to provide a general overview of R-TaTME by analyzing the body of the available literature,with a special focus on the potential benefits,harms,and future perspectives for this novel approach. 展开更多
关键词 Rectal cancer Minimally-invasive surgery ROBOTICS total mesorectal excision transanal approach Natural orifice surgery
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Real-time in vivo distal margin selection using confocal laser endomicroscopy in transanal total mesorectal excision for rectal cancer
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作者 Jie Tan Hong-Li Ji +7 位作者 Yao-Wen Hu Zhi-Ming Li Bao-Xiong Zhuang Hai-Jun Deng Ya-Nan Wang Ji-XiangZheng Wei Jiang Jun Yan 《World Journal of Gastrointestinal Surgery》 SCIE 2022年第12期1375-1386,共12页
BACKGROUND Transanal total mesorectal excision(TaTME)allows patients with ultralow rectal cancer to be treated with sphincter-saving surgery.However,accurate delineation of the distal resection margin(DRM),which is es... BACKGROUND Transanal total mesorectal excision(TaTME)allows patients with ultralow rectal cancer to be treated with sphincter-saving surgery.However,accurate delineation of the distal resection margin(DRM),which is essential to achieve R0 resection for low rectal cancer in TaTME,is technically demanding.AIM To assess the feasibility of optical biopsy using probe-based confocal laser endomicroscopy(pCLE)to select the DRM during TaTME for low rectal cancer.METHODS A total of 43 consecutive patients who were diagnosed with low rectal cancer and scheduled for TaTME were prospectively enrolled from January 2019 to January 2021.pCLE was used to determine the distal edge of the tumor as well as the DRM during surgery.The final pathological report was used as the gold standard.The diagnostic accuracy of pCLE examination was calculated.RESULTS A total of 86 pCLE videos of 43 patients were included in the analyses.The sensitivity,specificity and accuracy of real-time pCLE examination were 90.00%[95%confidence interval(CI):76.34%-97.21%],86.96%(95%CI:73.74%-95.06%)and 88.37%(95%CI:79.65%-94.28%),respectively.The accuracy of blinded pCLE reinterpretation was 86.05%(95%CI:76.89%-92.58%).Furthermore,our results show satisfactory interobserver agreement(κ=0.767,standard error=0.069)for the detection of cancer tissue by pCLE.There were no positive DRMs(≤1 mm)in this study.The median DRM was 7 mm[interquartile range(IQR)=5-10 mm].The median Wexner score was 5(IQR=3-6)at 6 mo after stoma closure.CONCLUSION Real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer(clinical trial registration number:NCT04016948). 展开更多
关键词 transanal total mesorectal excision Probe-based confocal laser endomicroscopy Optical biopsy Distal resection margin Low rectal cancer
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Laparoscopic total mesorectal excision with natural orifice specimen extraction 被引量:14
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作者 Quan Wang Chao Wang +2 位作者 Dong-Hui Sun Punyaram Kharbuja Xue-Yuan Cao 《World Journal of Gastroenterology》 SCIE CAS 2013年第5期750-754,共5页
AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal c... AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications. 展开更多
关键词 Laparoscopic total mesorectal excision Natural orifice SPECIMEN EXTRACTION RECTUM cancer TRANSVAGINAL transanal
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Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer
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作者 Feng Lu Shu-Guang Tan +3 位作者 Juan Zuo Hai-Hua Jiang Jian-Hua Wang Yu-Ping Jiang 《World Journal of Gastrointestinal Surgery》 2025年第1期147-155,共9页
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be... BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC. 展开更多
关键词 Laparoscopic total mesorectal excision transanal total mesorectal excision Low-lying rectal cancer Quality of life Stress response
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Transanal vs laparoscopic total mesorectal excision for rectal cancer:a multicenter randomized phase III clinical trial(TaLaR trial)protocol 被引量:3
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作者 Liang Kang Ziwei Zeng +15 位作者 Shuangling Luo Hong Zhang Quan Wang Mingyang Ren Miao Wu Weidong Tong Qing Xu Yi Xiao Aiwen Wu Yuan-Guang Chen Bo Feng Zhanlong Shen Liang Huang Xingwei Zhang Minhua Zheng Jian-Ping Wang 《Gastroenterology Report》 SCIE EI 2021年第1期71-76,I0002,共7页
Background:Total mesorectum excision(TME)is considered the standard surgical procedure for rectal-cancer treatment.Transanal TME(taTME)is a new procedure to treat low rectal cancer.Some published studies have proven t... Background:Total mesorectum excision(TME)is considered the standard surgical procedure for rectal-cancer treatment.Transanal TME(taTME)is a new procedure to treat low rectal cancer.Some published studies have proven that taTME can provide a better-quality resected specimen in low-rectal-cancer patients in comparison to the transabdominal procedure,yet long-term outcomes must be investigated.We designed this non-inferiority trial(TaLaR trial)to compare short-term and long-term outcomes between taTME and laparoscopic TME(lapTME)for rectal cancer.Methods:The TaLaR trial is a phase III open-labeled multicenter randomized-controlled trial.Patients who are diagnosed with rectal cancer with no more than T3N2 stage,and with the tumor location below the peritoneal reflection by magnetic resonance imaging scan,digital rectal examination,or colonoscopy,qualify for this study.After calculating,a total of 1,114 patients(557 per group)will be randomly allocated to either the taTME or the lapTME group.Primary endpoints are the 3-year disease-free survival(DFS)rate and the 5-year overall survival(OS)rate.Secondary endpoints include specimen quality,perioperative results,pelvic and anal function,and quality of life.Discussion:The TaLaR trial is expected to clarify whether taTME can achieve comparable oncological outcomes,as well as improve specimen quality and recovery conditions in rectal-cancer patients compared with lapTME. 展开更多
关键词 transanal total mesorectal excision total mesorectal excision LAPAROSCOPIC rectal cancer SURGERY
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Transanal total mesorectal excision for rectal cancer:a multicentric cohort study 被引量:1
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作者 Liang Kang Yuan-Guang Chen +12 位作者 Hao Zhang Hong-Yu Zhang Guo-Le Lin Ying-Chi Yang Wen-Hao Chen Shuang-Ling Luo Ning Chen Wei-Dong Tong Zhan-Long Shen De-Hai Xiong Yi Xiao Zhong-Tao Zhang Jian-Ping Wang 《Gastroenterology Report》 SCIE EI 2020年第1期36-41,I0002,共7页
Background:Transanal total mesorectal excision(taTME)has recently emerged as a promising novel surgical procedure for rectal cancer.It is believed to hold the potential advantage of providing better access to mobilize... Background:Transanal total mesorectal excision(taTME)has recently emerged as a promising novel surgical procedure for rectal cancer.It is believed to hold the potential advantage of providing better access to mobilize the distal rectum and achieving better pathologic results.This study aimed to evaluate the feasibility of taTME for rectal cancer and summarize the preliminary experience in 10 Chinese hospitals.Methods:A total of 211 patients were enrolled in this study.Variables for evaluation of safety,feasibility,and oncologic outcomes were retrospectively collected and analysed.Results:The median distance between the tumor and the anal verge was 5.9cm(range,1.5–12 cm).The median operating time was 280 min(range,70–600 min)and the median estimated intra-operative blood loss was 50mL(range,10–1,500 mL).The overall rate of complication was 27.9%.Among the 211 patients,175(82.9%)had complete TME and 33(15.6%)had near complete TME.The circumferential resection margin was negative in 97.7%of patients.The patients were followed for a median of 35months(range,2–86months).There was 7.6%(16)mortality,6.2%(13)had local recurrence,and 12.8%(27)had systemic recurrence.Kaplan–Meier survival analysis showed that 1-,2-,and 3-year disease-free survival rates were 94.8%,89.3%,and 80.2%,respectively,and 1-,2-,and 3-year OS rates were 97.4%,95.7%,and 92.9%,respectively.Conclusions:Although limited by its retrospective nature,taTME was safe and feasible in selected patients.Future work with rigorous data recording is warranted. 展开更多
关键词 rectal cancer LAPAROSCOPIC transanal total mesorectal excision MULTICENTRIC
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Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer 被引量:19
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作者 Fang-Hai Han Li-Xin Hua +2 位作者 Zhi Zhao Jian-Hai Wu Wen-Hua Zhan 《World Journal of Gastroenterology》 SCIE CAS 2013年第43期7751-7757,共7页
AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergo... AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages. 展开更多
关键词 transanal specimen extraction Natural orifice specimen extraction Laparoscopic anterior resection Low/ultra-low anastomosis total mesorectal excision
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Impact of technology on indications and limitations for transanal surgical removal of rectal neoplasms
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作者 Bikash Devaraj Andreas M Kaiser 《World Journal of Surgical Procedures》 2015年第1期1-13,共13页
Transanal surgery has and continues to be well accepted for local excision of benign rectal disease not amenable to endoscopic resection. More recently, there has been increasing interest in applying transanal surgery... Transanal surgery has and continues to be well accepted for local excision of benign rectal disease not amenable to endoscopic resection. More recently, there has been increasing interest in applying transanal surgery to local resection of early malignant disease. In addition, some groups have started utilizing a transanal route in order to accomplish total mesorectal excision(TME) for more advanced rectal malignancies. We aim to review the role of various transanal and endoscopic techniquesin the local resection of benign and malignant rectal disease based on published trial data. Preliminary data on the use of transanal platforms to accomplish TME will also be highlighted. For endoscopically unresectable rectal adenomas, transanal surgery remains a widely accepted method with minimal morbidity that avoids the downsides of a major abdomino-pelvic operation. Transanal endoscopic microsurgery and transanal minimally invasive surgery offer improved visualization and magnification, allowing for finer and more precise dissection of more proximal and larger rectal lesions without compromising patient outcome. Some studies have demonstrated efficacy in utilizing transanal platforms in the surgical management of early rectal malignancies in selected patients. There is an overall higher recurrence rate with transanal surgery with the concern that neither chemoradiation nor salvage surgery may compensate for previous approach and correct the inferior outcome. Application of transanal platforms to accomplish transanal TME in a natural orifice fashion are still in their infancy and currently should be considered experimental. The current data demonstrate that transanal surgery remains an excellent option in the surgical management of benign rectal disease. However, care should be used when selecting patients with malignant disease. The application of transanal platforms continues to evolve. While the new uses of transanal platforms in TME for more advanced rectal malignancy are exciting, it is important to remain cognizant and not sacrifice long term survival for short term decrease in morbidity and improved cosmesis. 展开更多
关键词 transanal SURGERY transanal ENDOSCOPIC MICROSURGERY ENDOSCOPIC mucosal resection transanal total mesorectal excision transanal MINIMALLY invasive SURGERY Robotic transanal SURGERY Local excision rectal neoplasms
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机器人辅助直肠癌根治术研究进展
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作者 史文 龚国杰 +1 位作者 高维鸽 祝利 《医学综述》 CAS 2024年第13期1558-1562,共5页
机器人辅助手术(RAS)系统是一种新型操作系统,因其机械臂稳定性高、视野高清放大、手腕部灵活操作等特征在直肠癌根治术中广泛应用,主要包括机器人辅助经腹直肠癌根治术、机器人辅助经肛直肠癌根治术、机器人辅助经自然腔道直肠癌根治... 机器人辅助手术(RAS)系统是一种新型操作系统,因其机械臂稳定性高、视野高清放大、手腕部灵活操作等特征在直肠癌根治术中广泛应用,主要包括机器人辅助经腹直肠癌根治术、机器人辅助经肛直肠癌根治术、机器人辅助经自然腔道直肠癌根治术、机器人荧光系统(吲哚菁绿)辅助。机械臂操作的灵活性大大提高了经腹和经肛直肠癌手术的短期疗效,RAS的荧光模式可充分且直观地识别肠管血供情况,有效减少吻合口瘘的发生,因此RAS有望成为直肠癌根治术的新一代经典治疗方案之一。 展开更多
关键词 直肠癌 机器人辅助手术 经肛全直肠系膜切除术
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经肛全直肠系膜切除术治疗直肠癌的效果及对胃肠功能的影响
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作者 杨方武 罗炜 +1 位作者 陈钦伟 杨峰 《中国医学创新》 CAS 2024年第11期57-61,共5页
目的:探究经肛全直肠系膜切除术(ta TME)治疗直肠癌的效果。方法:选择2021年4月—2023年4月在枣庄市立医院治疗的直肠癌患者94例,应用随机数字表法将其分为对照组[予以全直肠系膜切除术(TME)]及观察组(予以taTME),各47例。对比两组术中... 目的:探究经肛全直肠系膜切除术(ta TME)治疗直肠癌的效果。方法:选择2021年4月—2023年4月在枣庄市立医院治疗的直肠癌患者94例,应用随机数字表法将其分为对照组[予以全直肠系膜切除术(TME)]及观察组(予以taTME),各47例。对比两组术中临床指标、术后临床指标、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]、胃肠功能[胃动素(MOT)、胃泌素(GAS)、碱性成纤维细胞生长因子(BFGF)]、肛门功能[肛管最大收缩压(AMSP)、肛管静息压(ARP)、直肠最大耐受量(RMTV)]、并发症发生率。结果:观察组手术时间长于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);两组淋巴结清扫数量比较,差异无统计学意义(P>0.05)。观察组排气时间、进食时间、排便时间、肠鸣音恢复时间均早于对照组,差异均有统计学意义(P<0.05)。术前,两组炎症因子水平比较,差异均无统计学意义(P>0.05);术后,两组TNF-α、IL-6、CRP均升高,但观察组均低于对照组,差异均有统计学意义(P<0.05)。术前,两组胃肠功能指标比较,差异无统计学意义(P>0.05);术后,两组MOT、GAS、BFGF均降低,观察组均高于对照组,差异均有统计学意义(P<0.05)。术前,两组肛门功能指标比较,差异无统计学意义(P>0.05);术后,两组AMSP、ARP、RMTV均降低,观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:直肠癌患者选择taTME治疗,能够减轻炎症反应,对肛门功能、胃肠功能的影响较小,且可降低并发症发生率。 展开更多
关键词 经肛全直肠系膜切除术 直肠癌 胃肠功能
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腹腔镜辅助经肛全系膜切除术后低位前切除综合征的发生及影响因素相关研究
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作者 梁小辉 彭博 +4 位作者 练绮雯 李子一 刘鑫斌 钟晓华 张喆 《中国医学工程》 2024年第6期46-51,共6页
目的探讨分析腹腔镜辅助经肛全系膜切除术(TaTME)后低位前切除综合征的发生及影响因素,为今后改善TaTME治疗直肠癌患者的排便功能提供依据。方法选取2019年1月至2023年1月惠州市中心人民医院胃肠外科收治的62例行腹腔镜TaTME中低位直肠... 目的探讨分析腹腔镜辅助经肛全系膜切除术(TaTME)后低位前切除综合征的发生及影响因素,为今后改善TaTME治疗直肠癌患者的排便功能提供依据。方法选取2019年1月至2023年1月惠州市中心人民医院胃肠外科收治的62例行腹腔镜TaTME中低位直肠癌患者,术后3个月、6个月依据直肠癌低位前切除综合征(LARS)量表评分分为LARS组和FLARS组,分别分析术后3个月、6个月发生LARS的影响因素(单因素、多因素回归分析)。结果术后3个月LARS发生率为66.13%,显著高于术后6个月(41.94%)(P<0.05)。术后3个月单因素和多因素分析均显示:LARS发生的独立危险因素为肿瘤直径、术前放化疗率及吻合口距肛缘距离;术后6个月单因素和多因素分析均显示:LARS发生的独立危险因素为术前放化疗率、吻合口距肛缘距离。结论TaTME治疗中低位直肠癌患者,术后3个月LARS发生率显著高于术后6个月,患者术后康复训练和疾病恢复密切相关,TaTME术后发生LARS的独立危险因素为同步放化疗、术后吻合口距肛缘距离(<2cm)、肿瘤直径(≥5cm),在手术过程需要引起注意,加以干预,降低术后LARS发生率,改善患者排便功能。 展开更多
关键词 腹腔镜辅助经肛全系膜切除术 低位前切除综合征 中低位直肠癌 影响因素
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机器人手术系统在经肛腔镜外科体系中的应用进展
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作者 牛森 张烨 +1 位作者 李增耀(综述) 王彤(审校) 《医学研究与战创伤救治》 CAS 北大核心 2024年第3期310-315,共6页
近年来,机器人手术系统在国内外经肛腔镜外科体系中日益发展成熟,凭借着高度符合人体工程力学、3D高清视野、Endowrist^(TM)技术允许7个自由度的转腕以及震颤消除功能等优势,被认为是腹腔镜辅助经肛门微创手术的宝贵替代平台。然而,机... 近年来,机器人手术系统在国内外经肛腔镜外科体系中日益发展成熟,凭借着高度符合人体工程力学、3D高清视野、Endowrist^(TM)技术允许7个自由度的转腕以及震颤消除功能等优势,被认为是腹腔镜辅助经肛门微创手术的宝贵替代平台。然而,机器人手术系统也存在手术时间长,成本高,缺乏长期循证医学数据等争议。目前研究报道,各种新型机器人辅助经肛门微创手术已经成功用于复杂直肠肿瘤局部切除,经肛门全直肠系膜切除,直肠瘘修复等手术。在未来,机器人手术系统的技术更新将极大拓展经肛腔镜外科体系的施展空间。文章主要就机器人辅助经肛门微创手术的发展、在国内外的应用进展以及存在的争议问题进行综述。 展开更多
关键词 经肛门微创手术 机器人手术系统 直肠肿瘤 经肛门全直肠系膜切除
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Lap-TaTME在拟行保肛手术的低位直肠癌患者中的应用效果分析
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作者 许振彬 林志高 林世安 《中外医学研究》 2024年第31期26-29,共4页
目的:观察腹腔镜辅助经肛全直肠系膜切除术(Lap-TaTME)在拟行保肛手术的低位直肠癌患者中的应用效果。方法:选取2022年1月—2024年2月德化县医院收治的50例低位直肠癌拟行保肛手术患者。根据随机数表法将其分为对照组及研究组,各25例。... 目的:观察腹腔镜辅助经肛全直肠系膜切除术(Lap-TaTME)在拟行保肛手术的低位直肠癌患者中的应用效果。方法:选取2022年1月—2024年2月德化县医院收治的50例低位直肠癌拟行保肛手术患者。根据随机数表法将其分为对照组及研究组,各25例。对照组给予全直肠系膜切除术(TME),研究组给予Lap-TaTME。比较两组围手术期指标,恢复情况,术后3个月的肛门功能,手术中转率,肿瘤近期不良预后。结果:研究组术中出血量少于对照组,手术时间长于对照组,差异有统计学意义(P<0.05)。研究组切口愈合时间、住院时间均短于对照组,术后肛门排气时间、下床活动时间均显著早于对照组,差异有统计学意义(P<0.05)。术后3个月,研究组Wexner评分低于对照组,差异有统计学意义(P<0.05)。研究组手术中转率为8.00%(2/25),低于对照组的36.00%(9/25),差异有统计学意义(P<0.05)。两组近期不良预后发生率比较,差异无统计学意义(P>0.05)。结论:Lap-TaTME可减少低位直肠癌患者手术出血量,加快术后恢复,优化肛门功能,降低手术中转率。 展开更多
关键词 低位直肠癌 腹腔镜辅助经肛全直肠系膜切除术 手术中转率 近期预后
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“防治康”三结合策略在腹腔镜经肛门全直肠系膜切除术患者术后康复中的应用研究
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作者 秦燕 《中国医药科学》 2024年第5期145-148,共4页
目的探讨“防治康”三结合策略在腹腔镜经肛门全直肠系膜切除术(TaTME)患者术后康复中的应用研究。方法选取2020年12月至2022年12月在中山市人民医院肿瘤外科60例TaTME患者作为研究对象,按随机数表法分为结合策略组和传统康复组,每组各3... 目的探讨“防治康”三结合策略在腹腔镜经肛门全直肠系膜切除术(TaTME)患者术后康复中的应用研究。方法选取2020年12月至2022年12月在中山市人民医院肿瘤外科60例TaTME患者作为研究对象,按随机数表法分为结合策略组和传统康复组,每组各30例。传统康复组给予传统的康复指导及院后指导,结合策略组实施“防治康”三结合策略护理措施。观察比较两组患者护理效果,观察指标包括患者肛门功能状态、胃肠功能状态、运动能力情况、术后恢复质量和术后并发症情况。结果经干预后,结合策略组术后恢复质量评分高于传统康复组,术后住院时间少于传统康复组,差异有统计学意义(P<0.05);干预后,结合策略组术后下床活动时间、首次肛门排气时间少于传统康复组,差异有统计学意义(P<0.05);首次排便时间略少于传统康复组,差异无统计学意义(P>0.05);干预后,结合策略组术后并发症发生率低于传统康复组,差异有统计学意义(P<0.05)。结论“防治康”三结合策略能够有效提高TaTME患者术后恢复质量,降低术后住院时间,改善术后首次排气时间,值得临床推广应用。 展开更多
关键词 防治康 腹腔镜经肛门全直肠系膜切除术 术后康复 肛门功能状态 胃肠功能状态
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经肛全直肠系膜切除术治疗低位直肠癌的手术护理配合
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作者 黄春燕 邝永龙 方洁英 《智慧健康》 2024年第26期69-71,75,共4页
目的分析经肛全直肠系膜切除术(taTME)治疗低位直肠癌的手术护理配合效果。方法选取2020年4月—2023年11月本院收治的低位直肠癌患者32例为研究对象,随机将其分成对照组和观察组,各16例。对照组采取常规手术护理,观察组在护理前给予专... 目的分析经肛全直肠系膜切除术(taTME)治疗低位直肠癌的手术护理配合效果。方法选取2020年4月—2023年11月本院收治的低位直肠癌患者32例为研究对象,随机将其分成对照组和观察组,各16例。对照组采取常规手术护理,观察组在护理前给予专门的培训指导,并在整个围术期给予针对性的手术护理,落实医护、护护配合,比较两组的护理成效。结果观察组手术时间短于对照组,术中出血量低于对照组(P<0.05);两组平均住院日、术后平均住院时间、住院平均费用、疼痛评分、术后并发症发生率无显著差异(P>0.05);观察组患者与手术医生的满意度高于对照组(P<0.05)。结论对于低位直肠癌手术患者,给予手术护理配合,可提升疗效,能够促进患者康复,提高患者与医生对护理的满意度。 展开更多
关键词 低位直肠癌 经肛全直肠系膜切除术 手术 护理配合
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完全经肛全直肠系膜切除术联合括约肌间切除治疗超低位直肠癌 被引量:12
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作者 姚宏伟 陈宁 +1 位作者 张志鹏 张忠涛 《首都医科大学学报》 CAS 北大核心 2017年第6期790-794,共5页
目的探索应用完全经肛全直肠系膜切除(pure transanal total mesorectal excision,pure-TaTME)联合括约肌间切除(intersphincteric resection,ISR)治疗超低位直肠癌术式的安全性及可行性。方法经过术前肠镜、直肠腔内超声及盆腔磁共振(m... 目的探索应用完全经肛全直肠系膜切除(pure transanal total mesorectal excision,pure-TaTME)联合括约肌间切除(intersphincteric resection,ISR)治疗超低位直肠癌术式的安全性及可行性。方法经过术前肠镜、直肠腔内超声及盆腔磁共振(magnetic resonance imaging,MRI)等检查进行评估,筛选出本例超低位直肠癌患者,顺利施行pure-TaTME联合ISR手术:利用肛门牵开器充分显露肛管,直视下完成ISR手术。然后建立经肛手术路径,完全经肛完成pure-TaTME手术,并创建肠道的连续性。结果手术时间350 min,术中出血量200 mL。切除标本长约18 cm,远断端切缘1.0 cm,直肠系膜完整。术后病理报告为直肠高级别锯齿状腺瘤,局灶黏膜内癌变,远近断端及环周切缘阴性;检出淋巴结32枚,未见癌转移。病理分期为p T1N0M0。患者术后恢复满意,术后3d肠道功能恢复,开始进流食,术后第5天进半流食,无感染及吻合口瘘发生。至今随访24个月,大便控制功能良好,未见肿瘤复发转移。结论完全经肛全直肠系膜切除(pure-TaTME)联合括约肌间切除(ISR)治疗超低位直肠癌安全可行,这为低位甚至超低位直肠癌的外科治疗提供了一种可行性选择,但远期效果还需要更多病例进行临床研究来确定。 展开更多
关键词 超低位直肠癌 经肛全直肠系膜切除术 完全经肛全直肠系膜切除术 括约肌间切除术
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