保留邓氏筋膜全直肠系膜切除术(iTME)中国专家共识(2021版)  

Chinese consensus on Denonvilliers'fascia preserving total mesorectal excision(iTME)(2021 version)

作　　者：无 卫洪波[2] 魏波[2] 方佳峰[2] 汪建平 王锡山[4] 兰平 叶颖江[5] 张忠涛[6] 

机构地区：[1]中国医师协会结直肠肿瘤专业委员会微创解剖学组,中国性学会结直肠肛门功能外科分会 [2]中山大学附属第三医院 [3]中山大学附属第六医院 [4]中国医学科学院肿瘤医院 [5]北京大学人民医院 [6]首都医科大学北京友谊医院

出　　处：《中华胃肠外科杂志》2021年第6期467-472,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：1982年,英国Heald教授提出了全直肠系膜切除(TME)的理念。TME的实施显著降低了直肠癌术后局部复发率,从而成为中低位直肠癌手术的金标准。然而,TME术后泌尿生殖功能障碍发生率居高不下,其中排尿功能障碍发生率达30%~60%,性功能障碍发生率高达50%~70%。近年来,大量研究表明,TME术中切除邓氏筋膜是导致直肠癌术后排尿及性功能障碍的重要原因。因此,保留邓氏筋膜的TME(iTME)得到了越来越多学者的支持。在国内外相关研究基础上,中国医师协会结直肠肿瘤专业委员会微创解剖学组和中国性学会结直肠肛门功能外科分会组织相关专家,针对iTME的若干问题,结合临床实践进行讨论和投票提出推荐建议,最终制定了本专家共识。本共识的制定,旨在提高手术医生对直肠癌术中保留邓氏筋膜价值的认识和功能保护的意识,明确iTME的适应证和禁忌证,规范iTME手术操作流程,以达到降低直肠癌术后排尿和性功能障碍发生率、改善患者生活质量的目的。本共识证据等级和推荐级别采用证据质量和推荐强度分级系统(GRADE)进行判定,通过专家投票和Delphi法确定共识内容。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.

关 键 词：直肠肿瘤 保留邓氏筋膜的全直肠系膜切除术 排尿功能障碍 勃起功能障碍 射精功能障碍 专家共识 

分 类 号：R735.37[医药卫生—肿瘤]