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目的探讨全直肠系膜切除术(TME)在低位直肠癌治疗中的应用。方法回顾总结106例行TME的低位直肠癌病例,分析疗效、局部复发和术后并发症。结果 106例平均失血50ml(30～100ml);手术时间2.5～4h,平均2.8h;术后发生吻合口瘘2例(1.9%),全组发生切口感染4例(3.8%)均合并糖尿病。无手术死亡病例。统计106例患者在半年内的排便情况显示,每日排便次数2～7次,平均3.8次。伴有便急、便频和便不尽感72例,排便不规则50例,偶有便失禁者3例。随访2.8～6年,平均4.2年。5年局部复发率6.7%(4/60)。统计3年生存率94.6%(87/92),5年生存率86.7%(52/60)。结论 TME治疗低位直肠癌可有效降低局部复发率,减少术后并发症,可提高患者生活质量和生存率,是治疗中、低位直肠癌的理想手术。
Objective To investigate the application of total mesorectal excision (TME) in the treatment of low rectal cancer. Methods We retrospectively reviewed 106 cases of low rectal cancer with TME, and analyzed the efficacy, local recurrence, and postoperative complications. Results The average blood loss of 106 patients was 50ml (30～100ml); the operation time was 2.5-4h, averaged 2.8h; postoperative anastomotic leakage occurred in 2 patients (1.9%), and the incision infection occurred in 4 patients (3.8%) all had diabetes. No operative deaths. Statistics of defecation in 106 patients within six months showed that the frequency of daily defecation was 2 to 7 times, an average of 3.8 times. With urgency, frequency and incontinence, there were 72 cases of impatience, 50 cases of irregular bowel movements, and 3 cases of occasional incontinence. Follow-up of 2.8 to 6 years, an average of 4.2 years. The 5-year local recurrence rate was 6.7% (4/60). The 3-year survival rate was 94.6% (87/92), and the 5-year survival rate was 86.7% (52/60). Conclusion TME treatment of low rectal cancer can effectively reduce the local recurrence rate, reduce postoperative complications, improve the quality of life and survival of patients. It is an ideal operation for the treatment of low rectal cancer.