提高我国中低位直肠癌外科手术疗效的思考  

Improving the surgical treatment of mid-low rectal cancer in China

作　　者：周总光[1] 王存[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,四川成都610041

出　　处：《中国实用外科杂志》2014年第9期802-803,816,共3页Chinese Journal of Practical Surgery

摘　　要：WHO 2012年公布了全世界结直肠癌(CRC)新发与死亡病例最多的前20个国家,我国排在第一位。中低位直肠癌位于腹膜反折下盆腔盲区,存在淋巴回流、内脏神经分布、解剖毗邻关系复杂的特殊性,外科手术根治技术难度大、要求高。近年,全直肠系膜切除(TME)已进入美国国家综合癌症网络(NCCN)直肠癌诊治指南;腹腔镜TME技术因其显著的微创优势逐渐成为我国中低位直肠癌的主流技术,并在各级医院开展。然而,现状令人担忧:各自为阵,习惯经验主导;缺乏基于临床试验证据支撑的中低位直肠癌质量控制标准、技术规范及操作指南导向;技术风险增大,并发症、病死率及复发率呈上升趋势;医疗投诉、纠纷及事故增多。所以,中低位直肠癌临床实践应由经验向循证转化;建立中低位直肠癌关键技术规范及质量控制评价标准,成为我国直肠癌疗效提高所面临亟待解决的问题。According to annual statistics of the WHO（World Health Organization） in 2012,the new cases and deaths of colorectal cancer（CRC） in China both ranked first worldwide.Mid-low rectal cancer locates deeply in the pelvis below peritoneal reflection,with distinct lymphatic drainage,nerve distribution and anatomical neighborhood. Therefore,surgery of the area is always challenging and demands great background. The generalization of total mesorectal excision（TME） and the gradual dominance of laparoscopic TME due tominimized invasiveness of the procedure were witnessed in thepast twenty years. However,experience leading practice isstill a serious domestic problem. Currently,lack of high levelclinical trial and evidence-based technical guidance shouldmainly be responsible for the considerably high incidence of complication,recurrence and mortality rate. Thus,it is urgentto establish the technical standard and quality control system to improve the overall therapeutic level in China.

关 键 词：中低位直肠癌 全直肠系膜切除 微创技术 循证医学 

分 类 号：R6[医药卫生—外科学]