There are four major principle _'s treatments in the radical operation of rectal cancer

There are four major principle _'s treatments in the radical operation of rectal cancer
The large intestine cancer is one of the increased year by year malignant tumour in our country. It have illness coming on position come, watch, 60% lie in rectum by about, because of special dissection, physiology, pathology and biological characteristic of rectum, its surgical treatment has certain particularity too. Some question scholars among them have already made the common understanding, but some problems still have a difference opinion too. Discuss extensively, to unifying the views of these questions, there are important meanings to standardize the treatment of rectal cancer.
The expert thinks rectal cancer is like other cancers, its surgical treatment should radically treat the skill, and the radical cure skill of rectal cancer should include the question of four following respects.
1 fully excises and sends the cooking stove originally
Must send it originally to the cooking stove to excise completely while carrying on the operation like other tumours. Because rectal cancer lies in the narrow and small cavum pelvis, with the prostate, bladder (men) Or uterus, vagina adjacent, tumour too big, when being relatively late, very easy to infringe organ these by the intersection of disease and issuing. The actual conditions of the necessary foundation patient, try hard to choose to jointly excise at this moment, can obtain good curative effect. One large hospital has carried on the whole pelvis organ and excised the skill in soaking 27 cases of rectal cancer of other organs, the survival rate of 5 years after the operation reaches 40.9%. Otherwise only send the cooking stove and condone and excise the meaning not big originally. In addition, connect anal canal and rectum with under the rectum, how protect anus, how master the intersection of tumour and the intersection of bottom flange and normal excision range of intestines, also an important problem. A ideal protecting the anus operation may have minimum recurring and good arranging and accusing of the informal function. If you want to satisfy the former, should excise enough intestines; Want, satisfy the latter, should keep, mention the intersection of anus and skin, wait and defecate about structure integrality. On the contrary, do not consider these, has only kept the continuity absolutely not ideal protecting the anus operation of the intestine. Then how many normal intestines are excised under bottom flange of tumour on earth, it is unlikely to cause the recurring of the postoperative identical mouth? The excision length that a lot of people's research indicates to carry the anal canal far in tumour influences the important factor that recur. According to some research of scholar, point out rectal cancer have soak the phenomenon while being reverse in the wall. The research uses rectum intestines and surrounding tissue as the great method to slice. A lot of scholars' research was pointed out in the seventies of the 20th century: Carried the intestines and should excise 5cm far, had already become one of the principles of protecting anus operation at that time in rectal cancer. But the research in recent years shows, though store in reverse the wall and soak, actually rare, it and take place more in above lymphatic vessel blockage when,last 3cm. So they advocate carrying the intestines and excising 3cm far. One large hospital carried on research to the reverse distance soaked in the rectal cancer wall at the beginning of the eighties, result indicate, have 50% patient exist, soak while being reverse only, it soaks the distance to be 2.4cm equally, reach 4.4cm, soak while being reverse and its pathologic type, intensity of splitting up and soak intensity,etc., have something to do around most far person. So expert advocate, excise 3cm, carry intestines far in general cases too, special type person (low to split up the intersection of gland and cancer and the intersection of mucus and the intersection of gland and cancer,etc.) Still need Damien 5cm, and more early case can excise 2cm. Could fully excise and send the cooking stove originally in this way, it is unlikely to cause the recurring of the postoperative identical mouth. A few scholars study and point out through detailed pathology too at home: Protect the anus operation as to rectal cancer, it is unsafe to cut reason under traditional 2~3cm. It excises to be should not competent to protect the intersection of anus and operation behind the 3cm, should walk perineum of belly excise skill jointly. Though identical device, especially wide application of a pair of identical technology at present, the expert must follow this principle too, otherwise apt to cause the recurring of the identical mouth, cause and protect the failure of anus operation, let alone the quality of surviving. One large hospital has treated the case of recuring of 207 cases of postoperative part, 71 among them have identical mouths to recur, it is analyzed that its reason is mostly played and cut the end to excise insufficiently. So it is the principle that rectal cancer must be followed to fully excise and send the cooking stove originally while radically treating the skill.
2 cleans the lymph node rationally
It is one of the diffusion routes with main rectal cancer that it is shifted that lymphocytic, if it is unreasonable to clean the lymph node, will influence survival rate. To what rational surgery did one large hospital treated rectal cancer at the beginning of the eighties, carried on the research in many aspects, how to clean the lymph node according to its lymphocytic transformation law among them, it is the focal point that an expert studies to expand and radically treat the skill at once. Through the work of more than 20 years, finish more than 3000 operations of rectal cancer, make its survival rate obviously raise, about 65% arrived from improvement of about 50% before the eighties in survival rate in 5. But expand the question of radically treating the skill in doing, the domestic people having a common goal have been putting forward the objection. Especially the application of the peritoneoscope is launched in recent years, this one disputes becoming fiercer. As 14% and 10% the second, 3 station shifting rate above according to result of study of expert, observe result from recent morphology ', the 3rd stop shifting rate of side is also 10%) ,From the long-term survival rate situation (survival rate is obviously raised compared with case before the eighties) Come to look, it is essential to expand the lymph node and clean. The expert's observation result still shows at the same time, the enlargement which the people having a common goal worry about radically treats amalgamation disease (bleed more, the ureter was damaged, the vein bled and the pelvis plant nerve is damaged etc. before the sacral bone) apt to appear of skill in recent years Except that the nerve of plant is damaged, have not increased; And plant nerve damage urinate and sexual dysfunction that cause, radically treat skill, receive certain improvement through keep the intersection of pelvis and the intersection of plant and functional enlargement of nerve. So expert think expand, effect a radical cure skill, have sure advantages in the treatment of rectal cancer, has not increased complication, it is an ideal operation to improving survival rate. About expand lymph node, clean, dispute that side cleans especially fierce especially, the Japanese scholar proposed since the seventies after the side lymph node was cleaned, nearly the whole Japanese scholar advocated this skill type so far, their result of study indicates the shifting rate of lymph node of side is thought the side lymph node to clean, obviously improve survival rate about 5%- 20%, especially it is more significant to return to the peritoneum, roll over the following cancer. Contrary to it, the scholar of America and Europe thinks the side transformation rate not high, only about 2%, think person who shifts side develop into the intersection of whole body and disease of already often, belong to later period, even clean the lymph node, the result is not good. The scholar even having it thinks occidentals relatively fat, clean the difficulty. All this kind, they do not maintain the side lymph node is cleaned. Some results of study of large hospital show: The side transformation rate mainly concentrates on closing hole and internal carotid artery about 10%; The side shifts and mainly returns to the peritoneum, rolls over the following cancers, the side transformation relates to a lot of clinical pathological factors. Japanese scholar, American-European scholar and result of study of the auspicious professor of my king cloud of the seventies of the fifties pointed out in the twenties of last century: Rectum store side, down drainage route of three sides in outside the wall upwards, "Don't damage the intersection of muscle and the intersection of wall and layer and dirty layer of membrane in front of the sacral bone, expert think, go on free among two floors, will not damage the membrane of muscle easily, on the contrary, if pathological change is relatively late, have already infringed the membrane of muscle, have to excise some muscle membrane sometimes, it is unable to guarantee its integrality at this moment. If pathological change is more serious, unable to walk and radically treat the skill, talk about guaranteeing the integrality of the membrane of muscle just loses the meaning. The third of its main point " The rectum should be the excision level of the membrane lower than the bottom flange 5cm of tumour " ,Heald,et al. thinks it is a distance of infiltration in the membrane that the distance of infiltration in the enteric wall is considerably less than far, so the majority maintains that excises the normal intestines 1cm of bottom flange of tumour, will have 4cm intestines not to have blood that will be supported when being expert at TME like this, so He
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