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目的 本文旨在评估直肠系膜全切除(TME)对直肠根治性切除术后局部复发和长期生存的价值。方法 自1991年1月～1998年12月随机双盲地对746例行根治性切除的直肠癌患者,按传统根治切除为对照与直肠系膜全切除的操作要求分两组进行手术,A组(TME)405例,B组(对照组)341例,两组在肿瘤部位、大体类型、病理类型、细胞分化、临床病理分期方面并无明显的差异。A组中行保肛手术者865.25%,B组中仅54.25％,P<0.05。结果 全组手术死亡9例,死亡率0.97％,A组5例,B组4例。术后吻合口漏19例,发生率4.21％,A组8例,3.95％,B组11例,5.95％。全组病例91％获随访,随访时问2～9年,中位随访48.3个月,术后出现复发者47例,复发率6.3％,A组16例,3.95％.B组31例,9.09%,P<0.01,两组差异非常显著,全组根治术后总的5年生存率72.46%±3.84％(寿命法),A组78.58％±3.28％,B组67.86％±3.02％,P<0.OO5,两组差异非常显著。结论 按直肠系膜全切除术,原则行直肠根治性手术不但可明显降低术后局部复发率,并可显著提高根治性手术后的5年生存率,故这是一个确实应遵循的操作原则。
Purpose This paper aims to evaluate the value of total mesorectal excision (TME) for local recurrence and long-term survival after radical rectal resection. Methods From January 1991 to December 1998, 746 patients with radical resection of rectal cancer were randomly and double-blindly operated according to the requirements of traditional radical resection as control and total mesorectal excision. The patients in group A ( TME) 405 cases, B group (control group) 341 cases, the two groups in the tumor site, general type, pathological type, cell differentiation, clinical pathological staging no significant differences. In group A, 865.25% of the anus-preserving surgery were performed, while in group B only 54.25%, P <0.05. Results The whole group of 9 patients died of surgery, the mortality rate was 0.97%, 5 cases in group A, 4 cases in group B. Postoperative anastomotic leakage in 19 cases, the incidence rate of 4.21%, A group of 8 cases, 3.95%, B group 11 cases, 5.95%. Ninety-one percent of the patients were followed up for 2 to 9 years with a median follow-up of 48.3 months. There were 47 cases of recurrence after operation, with a recurrence rate of 6.3%, 16 cases in group A and 3.95% in group B. 31 cases in group B and 9.09 %, P <0.01. There was significant difference between the two groups. The overall 5-year survival rate was 72.46% ± 3.84% (life span) in group A, 78.58% ± 3.28% in group A, 67.86% ± 3.02% in group B, P <0.OO5, the difference between the two groups is very significant. Conclusion According to the principle of total mesorectal excision, the principle of radical rectal surgery not only can significantly reduce the local recurrence rate, and can significantly improve the 5-year survival rate after radical surgery, so this is a practical operating principle to be followed.