Dayal Sanjeev, Battersby Nick, Cecil Tom
Department of Surgery & Peritoneal malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, RG24 9NA, UK.
J Gastrointest Surg. 2017 Jul;21(7):1166-1173. doi: 10.1007/s11605-017-3427-9. Epub 2017 Apr 25.
Surgery that produces an optimal total mesorectal excision (TME) resection specimen remains the cornerstone of curative rectal cancer management. In the modern era, despite the results of recent randomised trials, laparoscopic TME is a crucial technique in the TME surgery armamentarium. Laparoscopic surgery offers the benefit of magnified views that aid sharp and precise dissection. However operating in the confines of a narrow pelvis, particularly when the mesorectum is bulky, requires significant technical skill. This is compounded by limited angulation of laparoscopic instruments and staplers. The final challenge is to preserve the integrity of the mesorectum during delivery of the specimen. The principles of TME surgery, on which Bill Heald founded the Basingstoke Colorectal unit, can equally be applied to laparoscopic, transanal and robotic TME, but great care must be taken to preserve the key principle-that no steps are taken that have the potential to shed tumour cells or compromise the quality of the mesorectal specimen.
能够获得最佳全直肠系膜切除（TME）切除标本的手术仍然是直肠癌根治性治疗的基石。在现代，尽管近期随机试验取得了相应成果，但腹腔镜TME仍是TME手术手段中的一项关键技术。腹腔镜手术具有放大视野的优势，有助于进行精确的锐性解剖。然而，在狭窄骨盆的有限空间内操作，尤其是当直肠系膜体积较大时，需要高超的技术。腹腔镜器械和吻合器的角度受限使这一情况更加复杂。最后的挑战是在取出标本时保持直肠系膜的完整性。比尔·希尔德创建贝辛斯托克结直肠科所依据的TME手术原则，同样适用于腹腔镜、经肛门和机器人辅助TME，但必须格外小心以保留关键原则，即不采取任何可能导致肿瘤细胞脱落或影响直肠系膜标本质量的步骤。
