全直肠系膜切除术临床应用.docVIP

全直肠系膜切除术临床应用【摘要】 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2008年11月至2009年6月年以来164例全直肠系膜切除术的直肠癌患者的临床资料。结果 164例中无手术死亡病例,Miles术23例,141例保肛, 141例吻合器吻合,保肛成功率86.9% (141/164),术后吻合口瘘2例,1急诊行结肠造瘘术，1例1个月后改行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个月复发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。? 【关键词】 全直肠系膜切除术; 直肠癌; 手术; 疗效 Clinical application of tota mesorectal excision in rectal cancer CHEN Hong.Department of General Surgery Hulunbeier Hospital,Hulunbeier City,021008,China ? 【Abstract】 Objective To investigate the clinical application of the total mesorectal excision (TME) of rectal cancer.Methods The clinical data of 164 patients of rectal cancer who performed TME from November 2008 to June 2009 were analyzed retrospectively.Results All patients achieved successful operation.23 accepted Miles operation,141 accepted sphincter saving resection. Anastomats were used in 11 patients, sphincter saving rate was 86.9%.2 patients occurred postoperative anastomosis leakage,1 paitent acceped emergency operation of colostomy at first and Miles operation 1 month later. There was no case with presacral hemorrhage.1 case with short-term dysuria and another case with short-term fecal incontinence.1 recurrent case underwent the second operation byway of Miles 16 months after the operation. Conclusion TME can reduce the operative mortality and presacral hem orrhage in operation, prevent the local recurrence, and preserve the function of pelvic organ.? 【Key words】 Total mesorectal excision; Rectal cancer; Surgical operation; Effect ? 直肠癌是临床上常见的恶性肿瘤之一， 其发病率近年来有着迅猛增高的趋势 ，居消化道肿瘤第3位［1］多为中低位，手术切除为其主要手段。随着人们对生活质量要求的不断提高，低位直肠癌的外科治疗已从单纯追求手术的彻底性转向根治和生存质量兼顾。因此，外科手术既要做到尽可能地根治肿瘤，又要尽可能地保留肛门，维持盆腔脏器功能。为改善患者的生活质量，提高疗效。自上世纪80年代初Heald提出全直肠系膜切除术(total mesorectal exci-sion，TME)原则之后，直肠癌术后复发率明显降低。TME手术的效果已经得到公认［2］总结中科院肿瘤医院 164例应用TME技术的病例，探讨全直肠系膜切除术的临床应用。? 1 资料与方法? 1.1 一般资料 2008年11月至2009年6月，中科院肿瘤医院收治的164例直肠癌患者，男96例，女68例。年龄36~79岁，平均61.8岁。术前经腹盆CT