目的 探討中低位直腸癌經全系膜切除（TME）并雙吻合器吻合術后吻合口的局部效果。方法 選取我院2004年3月至2008年6月期間收治的142例行TME并雙吻合器吻合術的中低位直腸癌患者的臨床資料進行回顧性分析。結果 所有病例手術操作均順利，術中無死亡。術后無吻合口漏等嚴重并發癥發生。吻合口狹窄發生率為6.3%（9/142）。術后24個月時局部復發率為7.6%（8/105）。結論 在中低位直腸癌治療中只要合理選擇病例、嚴格規范術中操作、術后積極觀察處理，TME并雙吻合器吻合術可以有效降低吻合口并發癥的發生。
目的 探討國產單吻合器在低位直腸癌保肛手術中的臨床應用效果。方法 結合相關文獻回顧性分析2003年1月至2007年12月期間我院收治的128例低位直腸癌中行直腸全系膜切除（TME）且應用國產管狀吻合器及荷包鉗進行手術的91例患者的資料。結果 全組無手術死亡病例，保肛均獲成功，保肛率為71.09%（91/128），術后病理檢查腫瘤遠端切緣無癌殘留。未發生吻合口出血及狹窄； 1例（1.10%）發生吻合口漏，經保守治療后痊愈； 無大便失禁發生。全組獲隨訪1～5年，平均3.8年，局部復發6例（6.59%）； 總的1年生存率為97.80%（89/91），3年生存率為80.00%（72/90），5年生存率為68.97%（60/87）。結論 TME聯合國產管狀吻合器及荷包鉗應用于低位直腸癌根治術，可提高保肛率，操作簡單安全，療效滿意。
ObjectiveTo investigate the value of postoperative CT examination for evaluation of local complications in patients with low rectal carcinoma after total mesorectal excision with anal sphincter preservation. MethodsThe patients with low rectal carcinoma who received total mesorectal excision (TME) with anal sphincter preservation were examined using contrastenhanced CT in one year period from May 2009 to May 2010. Particular attention was paid to the presence of anastomotic leakage, local recurrence and status of lymph nodes. ResultsTotal of 82 patients (52 men, 30 women； mean age 57.8 years old； range 25.74 years old) were included in the study. Over a mean 10-month follow-up， 8 cases （9.8%） had clinically or surgically confirmed anastomotic leak, 6 cases （7.3%） had local recurrence around the anastomotic site， and 4 cases （4.9%） showed pelvic and distant metastatic lymphadenopathy. ConclusionPostoperative CT examination, including baseline and follow-up CT studies, is very useful for diagnosing anastomotic leakage, local tumor recurrence and lymphadenopathy.
ObjectiveTo investigate the effect of pelvic autonomic nerve preservation (PANP) with total mesorectal excision (TME) on sexual and urinary function in male rectal cancer patients. MethodsClinical data of eightyfour patients with rectal cancer from January 2008 to October 2010 in our hospital were analyzed. According to different operative techniques, all the patients were divided into two groups: PANP+TME group (n=41) and TME group (n=43). The sexual dysfunction, urination disorder rate, and local recurrence rate after operation of patients between two groups were compared. ResultsErectile dysfunction rate of patients in TME+PANP group and TME group was 29.3% (12/41) and 76.7% (33/43), ejaculation disorder rate was 26.8% (11/41) and 79.1% (34/43), and urination dysfunction rate was 24.4% (10/41) and 79.1% (34/43), respectively. The rate of sexual and urinary dysfunction of patients in TME+PANP group was significantly lower than that in TME group (Plt;0.05). Local recurrence rate of patients in TME+PANP group (9.8%, 4/41) was similar to that in TME group (11.6%, 5/43)， Pgt;0.05. ConclusionPANP based on TME can reduce effectively the rate of sexual and urinary dysfunction in male rectal cancer patients, which does not increase the local recurrence rate after operation.
Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision (TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library, and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted, and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.
ObjectiveTo compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision (R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision (L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus ［(3.28±1.64) d vs. (6.01±2.77) d, P<0.001］, the time to the first postoperative oral fluid intake ［(4.46±1.62) d vs. (6.28±2.74) d, P<0.001） and the length of hospital stay ［（11.20±5.80）d vs. (14.72±6.90) d, P=0.023］ of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention (2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group ［(175.06±110.77) mL vs. (123.91±99.61) mL, P=0.031, ）. The operative time, number of lymph nodes harvested and distal margin were similar intergroup（P>0.05）. The total cost was higher in the R-TME than in the L-TME group ［(85 623.91±13 310.50) CNY vs. (67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. ConclusionsCompared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.