中国实用外科杂志

中国实用外科杂志

• 外科质量控制 • 上一篇    下一篇

直肠癌手术质量控制

叶颖江，申占龙，王    杉   

  1. 北京大学人民医院胃肠外科，北京100044
  • 出版日期:2016-01-01 发布日期:2015-12-31

  • Online:2016-01-01 Published:2015-12-31

摘要：

全直肠系膜切除（total mesorectal excision，TME）的提出，使外科分离的解剖学标志明确、外科平面清晰，是直肠癌手术质量控制的里程碑。在大量循证医学证据的基础上，手术质量可评估指标和体系不断建立和明确，已经逐步形成了包括：（1）术前多学科专家组（MDT）评估。准确的细化的术前影像学评估分期，使手术方式选择更个体化，使手术质量得到控制成为可能。（2）质量可控制的手术过程。以TME和肛提肌外腹会阴切除术（ELAPE）为代表，明确的手术操作平面和解剖学界标，减少神经血管副损伤，保护器官功能为其共同特点。（3）术后标本质量病理学评估。环周切缘（CRM）阳性和标本质量评分是术后评估手术质量的重要指标。

关键词: 直肠癌, 手术, 质量控制, 多学科专家组

Abstract:

Quality control in the surgery of rectal cancer        YE Ying-jiang, SHEN Zhan-long, WANG Shan. Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
Corresponding auther: YE Ying-jiang,E-mail:yeyingjiang@
pkuph.edu.cn
Abstract    TME (total mesorectal excision) procedure making the anatomical landmark and plane definitive has become the mile stone in the quality-controlled surgery of rectal cancer. The system of quality-controlled surgery is being established and cleared based on the accumulating evidences. It includes following aspects: a. preoperative evaluation by MDT (Multidisciplinary team). Precise preoperative imaging staging for tumors makes the surgical options tailored and quality-controlled; b. quality-controlled surgical procedures，such as TME and extralevator APE approaches,  show the common characteristics, which bring the dissecting plane and landmark clear, make the injury of vessels and nervous decreased and the organic function protected; c. postoperative pathological assessment. CRM (circumferential resection margin) and specimen quality score are the critical parameters to evaluate the surgical quality after operation.

Key words: rectal cancer, surgery, quality controll, multidisciplinary team