Zhonghua Wei Chang Wai Ke Za Zhi. 2021 Jun 25;24(6):467-472. doi: 10.3760/cma.j.cn.441530-20210407-00147.
In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.
1982年,R. J. 希尔德教授提出了全直肠系膜切除术(TME),这是直肠癌手术的一个里程碑式进展。TME的理念显著降低了中低位直肠癌(MLRC)的局部复发率,从而成为MLRC手术的金标准。然而,TME术后泌尿生殖功能障碍的发生率仍然很高,其中排尿功能障碍达30%-60%,性功能障碍达50%-70%。近年来,研究表明,TME术中切除Denonvilliers筋膜(DVF)是术后排尿和性功能障碍的重要原因。因此,保留DVF的全直肠系膜切除术(iTME)已得到越来越多外科专家的认可。基于现有文献和临床实践,我们组织专家进行讨论和投票,针对iTME的几个问题提出建议,最终形成本专家共识。本共识的制定旨在提高外科医生对TME手术中DVF价值及功能保护的认识,明确iTME的适应证和禁忌证,规范iTME的操作流程,以减少术后排尿和性功能障碍,提高MLRC患者的生活质量。本共识的证据水平和推荐意见采用分级推荐、评估、制定与评价(GRADE)方法确定,共识内容通过专家投票和德尔菲法确定。