直肠癌经肛全直肠系膜切除标本移除方式探讨  

Discussion on specimen extraction method in transanal total mesorectal excision for rectal cancer

作　　者：刘鼎盛[1] 张宏[1] LIU Dingsheng;ZHANG Hong(Department of General Surgery,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院普通外科结直肠肿瘤外科,辽宁沈阳110004

出　　处：《中国实用外科杂志》2022年第11期1316-1320,共5页Chinese Journal of Practical Surgery

基　　金：辽宁省民生科技计划项目(No.2021JH2/10300053)。

摘　　要：经肛全直肠系膜切除(taTME)手术的提出颠覆了传统的自上而下的直肠游离方式,自下而上游离解决了困难骨盆直肠末端游离和远端切缘无法确认的难题。目前关于taTME手术的研究多集中于手术技术和局部解剖、并发症预防及处理、肿瘤学疗效等方面。对于切除标本是经肛门移除还是经腹部辅助切口移除这一技术细节,并未给予足够重视。移除标本的过程与taTME的很多不良术后结局密切相关。根据笔者中心150余例taTME手术的经验,经肛门移除标本可减少术后切口部位感染及切口疝,疼痛更轻,美容效果更佳。但也存在导致系膜完整性破坏,损伤边缘血管,近端肠管切除不足,第2站淋巴结清扫不完全,术后肛门功能不良等不足。应结合术前MRI测量肿瘤直径、肛提肌夹角、直肠系膜面积,术中评估肛门括约肌张力、近端肠管长度,综合判断是否适合经肛门移除标本。The development of transanal total mesorectal excision(taTME)overturned the traditional top-down rectal dissociation mode.The bottom-up dissociation mode solved the difficult problem of distal pelvic rectum dissociation,and the distal resection margin cannot be confirmed.At present,the research on taTME mainly focuses on the surgical technique and local anatomy,the prevention and treatment of complications,and the oncological effect.Not enough attention had been paid to the technical details of whether the resected specimen was taken out through the anus or through the abdominal auxiliary incision.The process of specimen extraction was closely related to various adverse postoperative outcomes of taTME.Based on the experience of more than 150 cases of taTME in a single center,specimen extraction through the anus has the advantages of reducing surgical site infection and incisional hernias,less pain,and better cosmetic effect.However,it also possessed some shortcomings,such as the destruction of the integrity of the mesentery,the damage of the marginal vessels,the insufficient resection of the proximal bowel,the incomplete dissection of the lymph node at the second station,and the poor anal function after the operation.Therefore,it should be comprehensively judged whether it is suitable to take samples through anus by combining the measurement of tumor diameter,angle of levator ani muscle,area of mesorectum under MRI before the operation,and the evaluation of anal sphincter tension and proximal intestinal tube length during operation.

关 键 词：直肠癌 经肛全直肠系膜切除 标本移除 磁共振成像 

分 类 号：R6[医药卫生—外科学]