Total mesorectal excision - The new golden standard of surgery for rectal cancer
Total mesorectal excision - The new golden standard of surgery for rectal cancer
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DOI：
10.3109/07853899709113698
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发表时间：
1997-04-01
影响因子：
4.4
通讯作者：
Enker, WE
中科院分区：
文献类型：
--
作者：
Enker, WE
直肠癌仍然是一个重大的世界性问题，目前，手术与局部疾病（透壁穿透或局部肠系膜淋巴结受累）患者的预后不良、永久性结肠造口术的可能性高以及局部复发率高有关，阳痿和膀胱功能障碍等功能改变仍然是传统手术令人痛苦的常见后果。在过去的二十年中，手术技术发生了根本性的变化，传统手术（沿不可定义的组织平面使用钝器技术进行）已经让位于沿可定义平面的锐性解剖，称为全直肠系膜切除术（TME）或完全环直肠系膜切除术（CCME）的技术可完整切除直肠及其周围直肠系膜的完整包，包封在脏骨盆筋膜内由于TME，5年生存率从45-50%上升到75%，局部复发率从30%下降到5-8%，中、低位直肠癌的括约肌保留率提高了至少20%，阳痿和膀胱功能障碍率从50-85%下降到15%或更低，直肠癌患者现在可以拥有良好的生活质量。预后、完整的图像和高质量的生活，将多学科放射治疗和化疗整合到接受 TME 或 CCME 治疗直肠癌的患者的护理中，目前正在进行临床试验。
Rectal cancer persists as a significant worldwide problem, Currently, surgery is associated with a poor prognosis, a high likelihood of permanent colostomy and a high rate of local recurrence in patients with regional disease (transmural penetration or involvement of regional mesenteric lymph nodes), Functional changes such as impotence and bladder dysfunction remain distressingly common consequences of conventional surgery. Over the past two decades, a fundamental change in operative technique has taken place, Conventional surgery (which is performed using blunt technique along undefinable tissue planes) has given way to sharp dissection along definable planes, The technique known as total mesorectal excision (TME) or complete circumferential mesorectal excision (CCME) produces the complete resection of an intact package of the rectum and its surrounding mesorectum, enveloped within the visceral pelvic fasia with uninvolved circumferential margins, As a result of TME, 5-year survival figures have risen from 45-50% to 75%, local recurrence rates have declined from 30% to 5-8%, sphincter preservation has risen by at least 20% for mid- and lower rectal cancers, and the rates of impotence and bladder dysfunction have declined from 50-85% to 15% or less, Patients with rectal cancer can now have a good prognosis, and intact image and high quality of life, The integration of multidisciplinary radiation therapy and chemotherapy into the care of patients undergoing TME or CCME for rectal cancer is presently under clinical trial.