Clinical Analysis Of Total Mesorectal Excision On 72 Rectal Cancer Patients

rectal cancer is cancer located between colon sigmoideum- rectum juncture and denate line. It's frequent malig tumor in enteron,account for the second place among enteron cancer.The death rate is rising and account for the second place among cancer in western countries.The same in our country the death rate account for the fifth place.Surgery is the most important,effective means to treat rectal cancer.From 1970s because of recognizing the rule of lymphaden transfer in rectal cancer,the role of cavitas pelvis autonomic nerve and anatomic position,the progress in surgical technic,invention of equipment,the development of micro-trauma surgery,and because people have higher requirement about the effect after surgery and living quality classic redical resection of rectal cancer is impacted.Especially the mesorectum total resection used in clinic from recent 20 years,the treatment level of rectal cancer has been far advanced.ObjectiveCompare the effect of TME with that of traditional rectal cancer operation,research the prospect and value of TME.Methodsuse 72 lower rectal cancer patient in May 2001~May 2002 that are treated with TME operation compared with 63 patient in February 1998- February 2001that are treated with non- TME operation,in order to research the clinical value of TME on lower rectal cancer.1. follow-up visit:take telephone,letter,home visit,clinic service to recheck patient.2. TME operation:after open abdomen and decide to use radical excision,begin to eliminate peripheral nodes of inferior arteria mesenterica.Eliminate adip of inferior arteria mesenterica and inferior veinmesenterica.Cut splanchnoderm anadesma of cavitas lelvis near hypogastric nerve wall,Separate splanchnoderm anadesma of cavitas lelvis from parietal layer anadesma of cavitas lelvis and enter presacral space. Completely dissociate splanchnoderm anadesma,tumor intestinal section and mesoretum until levator ani muscle plane(notice not to damage nervi splanchnici pelvini and visceral plexuses.Cut rectum at the position 2~3cm from inferior border of cancer after complete dissociation.Dislodge tumor specimen and use abundant distilled water 5-FU mixed liquor to wash operating field and far-end rectum.Use stapler to make rectum,colon descendens end to end intestinal anastomosis.Put drainage tube at stoma rear.3. Handling main points: completely cut whole mesorectum and tumor,require not to tear up rectum deep fascia.Should cut 2cm intestine from tumor far-end and cut more than 5cm mesorectum from tumor far-end.Should protect autonomic nerve preservation,avoid ring clamp seperatiing,avoid dragging tumor.In order to improve rectal function and reduce defecation ,can make J-form colon sack.4. Statistical treatment:use SPSS12.0 software to handleResultsTME operation group obviously surpass non- TME operation group from following aspects: relapse rate after operation, survival rate of 3 years and 5 years,sexual function,uropoiesis functional disturbance and so on.While from the aspects of stoma fistula and anal functional disturbance, TME operation group a little surpass non- TME operation group,but no statistically significant.From the aspect that eliminate lymphaden of mesorectum, lymphaden positive rate detected by TME operation group is about 20% while traditional operation didn't cut mesorectum or didn't completely cut mesorectum and didn't eliminate lymphaden of mesorectum or didn't completely eliminate. Relapse rate are the best index to judge anyoperation,TME obviously more fit these standards.Conclusion :1. TME is a new operation means that base on modern anatomy,pathology and other subjects.It has vigorous anatomy and pathology basement.2. Practice prove:TME can degrade the relapse rate after operation and death rate.3. Compared with traditional operation,TME can reduce some complication of operation on rectal cancer.4. TME acting as a gradual widespread operation has greater prospect,it is"golden standard"in rectal cancer operation.