Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision (TME) in treating mid-low rectal cancer. Methods From March 2005 to July 2008, 74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected. The data of clinicopathologic parameters were analyzed. Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer. No operative death occurred in this group. No case was converted to open procedure. The mean operation time was 187 min. The mean operative blood loss was 90 ml. The mean postoperative hospital stay was 10 d. Bowel function was restored on 46 h after operation on average. The mean distance between tumor and the section edge was 3.1 cm. The average number of lymph node dissection was 19.7. The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge. The follow-up times were 2-44 months, average 25 months. The incidence of complications was 9.5%. No tumor cell port site implantation or distant metastasis happened. One case was pelvic recurrence， no patient was dead.Conclusion Laparoscopic TME is a feasible, safe and minimally invasive technique for the patients with mid-low rectal cancer, achieving the principles of TME.
Objective To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer. Methods In total of132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n=65） and air leak＋methylene blue solution leak test group （n=67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper endof bowel， then injecting 500 mL distilled water to pelvic， and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus， and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened， and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum， 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected， observing the location where the methylene blue solutionleaking out and repaired it. Results Three cases （4.62%） of anastomotic leakage were found during operation in air leak test group， and 9 cases （13.85%） were found after operation. Of the 9 cases， 5 cases were cured with placement of adeq-uate drainage and symptomatic treatment， 3 cases were cured with anal patch， and 1 case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage， 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene bluesolution leak test group， but no one suffered anastomotic leakage after operation. Compared with air test group， detectionrate of anastomotic leakage during operation was higher （P＜0.05）， and incidence rate of anastomotic leakage after opera-tion was lower in air leak＋methylene blue solution leak test group （P＜0.05）. Conclusions Large anastomotic leakage can be found by using air leak test， and small and hidden leakage can be found by using methylene blue solution leak test， combination method of the two experiments is better. Repair can be performed effectively under direct vision.
目的 探讨腹腔镜全直肠系膜切除术盆腔自主神经保留的可行性及对术后性功能的影响。方法 对我院2004年2月至2006年5月期间21例中低位直肠癌患者施行腹腔镜全直肠系膜切除保留盆腔自主神经手术，调查了解患者术后性功能情况。结果 21例患者性功能均存在,绝大多数(18例)患者勃起功能良好。结论 腹腔镜下全直肠系膜切除术保留盆腔自主神经是可行的，患者性功能恢复满意。
Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.
ObjectiveTo summarize the functional outcomes of transanal total mesorectal excision (TaTME).MethodThe literatures about functional outcomes and existing problems secondary to TaTME in China and abroad were collected to make a review.ResultsNeither the TaTME or the laparoscopic TME (LTME) had few serious impact on the quality of life of patients. At present, only a few studies were involved in the postoperative sexual function, and no definite conclusion could be drawn. From the current data only, the TaTME had few serious impact on the sexual function and it didn’t show some advantages as compared with the LTME. The urinary and defecation functions showed no obvious differences between the TaTME and the LTME, which of the patients after the TaTME might be impaired to some extent. The defecation disorders mainly occurred in 1—6 months after the TaTME, but it would recover to a certain extent as time went on.ConclusionsAlthough TaTME has more advantages in protecting pelvic autonomic nerves, there is no obvious difference in postoperative organ function as compared with LTME surgery at present. Multi-center, large sample size, and long-term follow-up studies are still needed to validate long-term results.
Objective To introduce the total mesorectal excision (TME)under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10.3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis.Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.
After more than 10 years of development, transanal total mesorectal excision (taTME) has played an important role in anus-preserving surgery for low rectal cancer. Existing studies have shown that taTME is not significantly different from traditional laparoscopy in the short-term and long-term efficacy of the treatment of low rectal cancer, and that taTME has potential advantages in postoperative functional recovery. With the maturity of taTME technology, transanal endoscopic approach has gradually been clinically applied to other rectal tumors, anastomotic stenosis, lateral lymph node dissection and other scenarios. Clinical practice shows that the transanal endoscopic approach can dissect pelvic tissues more accurately, greatly reduce the difficulty of surgery for complex pelvic diseases, improve the safety of surgery, and provide new ideas for clinical practice.
目的 探讨全直肠系膜切除术（total mesorectal excision,TME）在治疗中低位直肠癌中的技术操作与效果。方法 对47例应用TME技术治疗的中低位直肠癌患者的临床资料进行回顾性分析。结果 27例行低位前切除术，20例行腹会阴联合切除术（Miles术），全部病例均顺利完成手术并出院，平均出血量250 ml； 术后发生吻合口漏2例； 术后随访0.5～3年，局部复发5例，因肝转移死亡2例。结论 应用TME技术治疗中低位直肠癌有其适应证，术中须遵循其操作规范，同时应注意采取适当的措施预防吻合口漏。
Objective To observe the expressions of P53 and CD34 in rectal cancer and distal mucosa and to explore the safe distal margin of radical surgery for rectal cancer at molecular pathologic level. Methods Forty-five cases of rectal cancer were marked before operation， and then the cases were detected by PET/CT. P53 and CD34 expressions in rectal tissues were detected by immunohistochemistry technique. Results P53 expression and microvessel density (MVD) in rectal cancer were significantly higher than those in distal mucosa， which in distal mucosa were decreased along the anal direction. P53 and CD34 were still found in the normal rectal tissue. P53 expression and MVD were not significantly different between in more than 1.5 cm distal rectal mucosa and in normal rectal tissue. Besides MVD was related to size of tumor in rectal cancer and distal 0.5 cm rectal mucosa tissue, P53 and CD34 in rectal cancer and distal mucosa rectal tissue were not associated with tumor diameter, stage and differentiation of rectal cancer. Conclusion From the molecular pathologic view, the resection of 2.0 cm rectal distal tissue should be safe for excision of rectal cancer.
Objective To prospectively evaluate the health-related quality of life (HRQOL) outcomes in patients undergoing laparoscopic total mesorectal excision (LTME) with anal sphincter preservation (ASP) for low rectal cancers. Methods From June 2001 to March 2004, 125 patients undergoing LTME and 103 patients undergoing OTME were included in this study. The international standard questionnaires (QLQ-C30 and QLQ-CR38) were used to evaluate the conditions of patients at 3 periods after surgery respetively: 3-6 months, 12-18 months, gt;24 months. Results In contrast to OTME patients, the LTME ones showed significantly better physical function during 3-6 months after surgery, less micturition problems within 12-18 months, less male sexual problems and better sexual function during 12-18 months after surgery, with better sexual enjoyment after postoperative 24 months. Both groups showed significant improvement in most subscales from the first to the second assessment, and improvement in sexual enjoyment from the second to the third assessment. The sexual function, micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment, whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have bette postoperative HRQOL than patients undergoing OTME, with better physical function, micturition function, overall sexual and male sexual functions in short term, and better sexual enjoyment in the long term. The HRQOL of both LTME and OTME patients may be expected to improve over time, particularly in the first postoperative year.