直肠癌TME与非TME手术临床分析  

Clinical reseach of the effect of TME and non-TME on the treatment of rectal cancer

作　　者：范恩学[1] 房学东[1] 孙海侠[1] 丁道亮 姜恩文 

机构地区：[1]吉林大学第一医院普通外科疾病诊疗中心,吉林长春130021 [2]吉林省集安市医院普通外科,吉林集安134200 [3]吉林省九台市第二医院普通外科,吉林九台130515

出　　处：《中国现代普通外科进展》2009年第10期875-878,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:通过大样本直肠癌全系膜切除术(TME)与传统手术的临床效果比较,探讨TME的应用价值。方法:同期入院手术的Dukes A、B、C期中低位直肠癌患者分为TME组(2394例)和非TME组(2185例),比较2组患者术后的复发率,存活率,吻合口瘘、性功能、泌尿功能、肛门功能障碍发生率,直肠系膜内淋巴结清除情况,判断TME的效果。结果:TME组在手术后复发率、3年及5年存活率、性功能及泌尿功能障碍方面明显优于非TME组,而在吻合口瘘、肛门功能障碍方面,TME组略高于非TME组(P>0.05)。在直肠系膜内的淋巴结清除方面,TME组检出的淋巴结阳性率为20%,非TME组直肠系膜未切除或切除不完整,且肠系膜内淋巴结未清除或清除不彻底。结论:TME能够降低直肠癌术后复发率、死亡率,与传统直肠癌手术比较,能够减少某些并发症。TME手术治疗直肠癌具有较大的应用前景。Objective：To compare the effect of total mesorectal excision（TME） with the traditional operation pattern.And to explore the application value of TME.Methods：The clinical data of 2 394 patients with rectal carcinoma recepted TME（TME group） was analysed retrospectively.And 2185 patients with rectal carcinoma underwent traditional operation（non-TME group） were assigned as control.The rate of relapse,survival,anastomatic leakage,sexual disfounction,urinary disfounction,anus disfounction and lymph node cleaning of mesentery of rectum were compared between the two groups.Results：The results of TME Group,such as reducing the relapse rate after surgery,3-year and 5-year survival rate,decreasing sexual disfounction and urinary disfunction were much better than those of non-TME group.As to the anastomotic fistula and anus dysfunction rate,TME group was slightly higher than the non-TME group,but there was no statistical significance.The lymph nodes positive detected rate of TME group was 20%,while the removal of mesorectal excision of non-TME group didn’t do the mesenteric lymph nodes cleaning or cleaned thorough enough.Conclusion：TME can reduce the rate of rectal cancer relapse,mortality and some of the complications of rectal cancer surgery.TME is prospective.

关 键 词：直肠肿瘤 直肠全系膜切除术 

分 类 号：R735.37[医药卫生—肿瘤]