全直肠系膜切除术引入对直肠癌治疗的影响。

Effect of the introduction of total mesorectal excision for the treatment of rectal cancer.

作者信息

Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald R J

机构信息

Surgical Department, Ullevaal Hospital, University of Oslo, Norway.

出版信息

Br J Surg. 1998 Apr;85(4):526-9. doi: 10.1046/j.1365-2168.1998.00601.x.

DOI:10.1046/j.1365-2168.1998.00601.x

PMID:9607540

Abstract

BACKGROUND

Total mesorectal excision (TME) has been reported to reduce local recurrence and improve survival rates in patients with rectal carcinoma. This paper reports the problems that have arisen with the introduction of this new surgical technique.

METHODS

This was a prospective study of two consecutive groups of patients: one who underwent TME (n = 76) and one who did not (non-TME, n = 76).

RESULTS

Postoperative mortality rate in the non-TME and TME group was 5 and 7 per cent respectively, and the rate of anastomotic failure was 8 and 16 per cent respectively. Anastomotic leaks in TME patients were located in the mid and lower rectum. TME patients with anastomotic failure had lower anastomoses and a longer duration of operation than non-TME patients. Intraoperative problems were encountered in 71 per cent of the failures. All TME patients who had a leak required reoperation compared with 25 per cent of non-TME patients. TME patients without postoperative complications stayed significantly longer in hospital than non-TME patients.

CONCLUSION

Anastomotic dehiscence increased after introduction of the TME technique but this improved with experience.

摘要

背景

据报道，全直肠系膜切除术（TME）可降低直肠癌患者的局部复发率并提高生存率。本文报告了这项新手术技术引入后出现的问题。

方法

这是一项对两组连续患者的前瞻性研究：一组接受TME手术（n = 76），另一组未接受（非TME，n = 76）。

结果

非TME组和TME组的术后死亡率分别为5%和7%，吻合失败率分别为8%和16%。TME患者的吻合口漏位于直肠中下段。发生吻合失败的TME患者的吻合位置更低，手术时间比非TME患者更长。71%的吻合失败患者术中出现问题。所有发生吻合口漏的TME患者均需再次手术，而非TME患者为25%。无术后并发症的TME患者住院时间明显长于非TME患者。