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中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (04) : 403 -407. doi: 10.3877/cma.j.issn.2095-3224.2020.04.013

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综述

直肠癌术中直肠冲洗的研究进展
周世灿1, 胡军红1,()   
  1. 1. 475000 开封,河南大学淮河医院肛肠外科
  • 收稿日期:2020-02-08 出版日期:2020-08-25
  • 通信作者: 胡军红
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金(No. 320.2710.1836); 河南大学研究生"英才计划"(No. SYL18060141)

Research progress of rectal washout during the operation of rectal cancer

Shican Zhou1, Junhong Hu1,()   

  1. 1. Department of Anorectal Surgery, Huaihe Hospital of Henan University, Kaifeng 475000, China
  • Received:2020-02-08 Published:2020-08-25
  • Corresponding author: Junhong Hu
  • About author:
    Corresponding author: Hu Junhong, Email:
引用本文:

周世灿, 胡军红. 直肠癌术中直肠冲洗的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(04): 403-407.

Shican Zhou, Junhong Hu. Research progress of rectal washout during the operation of rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(04): 403-407.

诊疗的规范和技术的进步明显延长了直肠癌患者的生存时间,改善了其生活质量,但是,近10%的局部复发率依然是结直肠外科医生不得不面对和重视的问题。一旦出现局部复发,患者的生活质量和生存时间将会受到严重影响。如何降低术后局部复发率一直是临床医生关注的热点。术中直肠冲洗对减少肠腔内的肿瘤细胞具有积极作用,但能否降低术后局部复发率仍没有定论,本文将以此作为切入点进行讨论。

The standardized diagnosis and treatment and the progress of technology significantly prolong the survival time of rectal cancer patients and improving the quality of life, but nearly 10% of local recurrence rate is still the problem that colorectal cancer surgeons have to face and pay attention to, once the occurrence of local recurrence, the quality of life and survival time of patients will be seriously affected. How to reduce the postoperative local recurrence rate has been a focus of our attention. Intraoperative rectal washout has a positive effect on the reduction of tumor cells in the lumen, but whether it can reduce the local recurrence rate after surgery remains to be determined. This article will take this as a starting point for discussion.

[1]
李兴旺, 胡军红. 直肠癌术后前切除综合征的研究进展[J/CD]. 中华结直肠疾病电子杂志, 2019, 8(2): 170-175.
[2]
陈锦程, 高惠荣. 直肠癌术后局部复发的原因及对策[J]. 浙江临床医学, 2007, 9(2): 277-278.
[3]
Mccall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer[J]. Int J Colorectal Dis, 1995, 10(3): 126-132.
[4]
曾焕虹, 傅卫, 孙涛, 等. 腹腔镜直肠癌根治术后患者的长期生存及其影响因素[J]. 中华普通外科杂志, 2018, 33(1): 25-29.
[5]
Moriya Y, Akasu T, Fujita S, et al. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer[J]. Surg Oncol Clin N Am, 2005, 14(2): 225-238.
[6]
Zhou C, Ren Y, Li J, et al. Systematic review and meta-analysis of rectal washout on risk of local recurrence for cancer[J]. J Surg Res, 2014, 189(1):7-16.
[7]
尤慧明. 低位直肠癌保肛手术中直肠冲洗治疗对预后的影响分析[J]. 基层医学论坛, 2015, 19(35): 4932-4933.
[8]
张琦玥, 赵欣辉, 孟泉辛. 低位直肠癌保肛手术中直肠冲洗治疗对预后的影响分析[J]. 中国医药指南, 2016, 14(25): 53-54.
[9]
王颢, 谢忠士, 任明杨, 等. 经肛全直肠系膜切除手术技术[J].中华胃肠外科杂志, 2019, 22(3): 242-245.
[10]
Terzi C, Unek T, Sağol O, et al. Is rectal washout necessary in anterior resection for rectal cancer? A prospective clinical study[J]. World J Surg, 2006, 30(2): 233-241.
[11]
Matsuda A, Kishi T, Musso G, et al. The effect of intraoperative rectal washout on local recurrence after rectal cancer surgery: a meta-analysis[J]. Ann Surg Oncol, 2013, 20(3): 856-863.
[12]
Charles R. Cancer infection and cancer recurrence: a danger to avoid in cancer operations[J]. Lancet, 1907, 170(4393): 1311-1316.
[13]
Goligher JC, Dukes CE, Bussey HJR. Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid[J]. Br J Surg, 1951, 39(155): 199-211.
[14]
Gertsch P, Baer HU, Kraft R, et al. Malignant cells are collected on circular staplers[J]. Dis Colon Rectum, 1992, 35(3): 238-241.
[15]
Rosenberg IL, Russell CW, Giles GR. Cell viability studies on the exfoliated colonic cancer cell[J]. Br J Surg, 1978, 65(3): 188-190.
[16]
Umpleby HC, Fermor B, Symes MO, et al. Viability of exfoliated colorectal carcinoma cells[J]. Br J Surg, 1984, 71(9): 659-663.
[17]
Skipper D, Cooper AJ, Marston JE, et al. Exfoliated cells and in vitro growth in colorectal cancer[J]. Br J Surg, 1987, 74(11): 1049-1052.
[18]
Symes MO, Fermor B, Umpleby HC, et al. Cells exfoliated from colorectal cancers can proliferate in immune deprived mice[J]. Br J Surg, 1984, 50(3): 423-425.
[19]
Fermor B, Umpleby HC, Lever JV, et al. Proliferative and metastatic potential of exfoliated colorectal cancer cells[J]. J Natl Cancer Inst, 1986, 76(2): 347-349.
[20]
葛翠翠. 结直肠癌肠腔脱落肿瘤细胞的检测及相关因素分析和临床意义[D].镇江: 江苏大学, 2017.
[21]
Vermeulen L, Melo FDSE, Richel DJ, et al. The developing cancer stem-cell model: clinical challenges and opportunities[J]. Lancet Oncology, 2012, 13(2): e83-e89.
[22]
张东兴, 颜登国. 结肠癌干细胞蛋白表达及生物学特性:培养与筛选分析[J].中国组织工程研究, 2015, 19(45): 7286-7291.
[23]
Kimura A, Koga S, Kudoh H, et al. Peritoneal mesothelial cell injury factors in rat cancerous ascites[J]. Cancer Research, 1985, 45(9): 4330-4333.
[24]
Xiao R, Zhao Y, Wang LJ, et al. Effects of Roundabout 5 on adhesion, invasion and potential motility of human tongue carcinoma Tb cells[J]. Chin Med J, 2011, 124(15): 2367-2371.
[25]
Simillis C, Mistry K, Prabhudesai A. Intraoperative rectal washout in rectal cancer surgery: A survey of current practice in the UK[J]. Int J Surg, 2013, 11(9): 993-997.
[26]
Monson JRT, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised)[J]. Dis Colon Rectum, 2013, 56(5): 535-550.
[27]
Sayfan J, Averbuch F, Koltun L, et al. Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer[J]. Dis Colon Rectum, 2000, 43(12): 1710-1712.
[28]
Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence?[J]. Dis Colon Rectum, 2004, 47(3): 291-296.
[29]
Constantinides VA, Cheetham D, Nicholls RJ, et al. Is rectal washout effective for preventing localized recurrence after anterior resection for rectal cancer?[J]. Dis Colon Rectum, 2008, 51(9): 1339-1344.
[30]
Zhang XM, Bi JJ, Wang Z, et al. Analysis of outcomes of intra-operative rectal washout in patients with rectal cancer during anterior resection[J]. Med Oncol, 2013, 30(1): 386.
[31]
Kodeda K, Holmberg E, Jörgren F, et al. Rectal washout and local recurrence of cancer after anterior resection[J]. Br J Surg, 2010, 97(10): 1589-1597.
[32]
Rondelli F, Trastulli S, Cirocchi R, et al. Rectal washout and local recurrence in rectal resection for cancer: a meta-analysis[J]. Colorectal Disease, 2012, 14(11): 1313-1321.
[33]
Church J, Gibbs P, Chao M, et al. Optimizing the outcome for patients with rectal cancer[J]. Dis Colon Rectum, 2003, 46(3): 389-402.
[34]
王君辅, 谢勇, 胡林, 等. 直肠癌根治术中不同类型冲洗液选择对术后复发影响的荟萃分析[J]. 实用医学杂志, 2013, 18(29): 3065-3069.
[35]
Gelister JS, Harrison RA, Boulos PB. The efficacy of agents employed to prevent anastomotic recurrence in colorectal carcinoma[J]. Ann R Coll Surg Engl, 1985, 67(4): 267.
[36]
Basha G, Penninckx F, Yap P. Influence of blood components and faeces on the vitro cancericidal activity of povidone-iodine[J]. Br J Surg, 1998, 85(4): 534-537.
[37]
Tsunoda A, Shibusawa M, Kamiyama G, et al. Iodine absorption after intraoperative bowel irrigation with povidone-iodine[J]. Dis Colon Rectum, 2000, 43(8): 1127-1132.
[38]
Mariani PP, Pelt JFV, Ectors N, et al. Rectal washout with cytotoxic solution can be extended to the whole colon[J]. Br J Surg, 2003, 89(12): 1540-1544.
[39]
Banich FE, Mendak SJ, Intraoperative colonic irrigation with povidone iodine. An effective method of wound sepsis prevention[J]. Dis Colon Rectum, 1989, 32(3): 219-222.
[40]
王锡山. 中国NOSES面临的挑战与展望[J/CD]. 中华结直肠疾病电子杂志, 2018, 7(1): 2-7.
[41]
王锡山. 经自然腔道取标本手术和经自然腔道内镜手术及经肛全直肠系膜切除术的应用前景与挑战[J]. 中华胃肠外科杂志, 2018, 21(8): 856-861.
[42]
倪春华, 黄平, 戴青松, 等. 尼龙扎带阻断技术在腹腔镜直肠癌保肛术中的应用[J]. 江苏医药, 2018, 44(11): 1268-1271.
[43]
García-Granero E, Flor-Lorente B, García-Botello S, et al. The occlusive tourniquet: a simple method for rectal stump washout during open and laparoscopic surgery[J]. Dis Colon Rectum, 2008, 51(10): 1580-1582.
[44]
Hamada M, Nishioka Y, Kurose Y, et al. New laparoscopic double-stapling technique[J]. Dis Colon Rectum, 50(12): 2247-2251.
[45]
Nakayama S, Hasegawa S, Hida K, et al. Obtaining secure stapling of a double stapling anastomosis[J]. J Surg Res, 2014, 193(2): 652-657.
[46]
吴作友, 黄平, 陈启, 等. 胸腔镜卵圆钳在腹腔镜直肠癌前切除术经肛门肠腔冲洗中的应用[J]. 江苏医药, 2019, 45(1): 100-101.
[47]
邢俊杰, 张辰新, 杨晓虹, 等. 腹部无切口经直肠取出标本的腹腔镜乙状结肠癌根治术与传统腹腔镜手术近期效果比较[J]. 中华胃肠外科杂志, 2017, 20(6): 665-670.
[48]
傅传刚, 周主青, 韩俊毅, 等. 中高位直肠癌和乙状结肠癌腹腔镜经直肠标本取出手术的保护措施[J]. 中华胃肠外科杂志, 2017, 20(10): 1151-1155.
[49]
宗华, 潘凯, 夏利刚, 等. 腹腔镜直肠癌根治术中肠腔脱落肿瘤细胞的临床研究[J]. 腹腔镜外科杂志, 2009, 14(2): 41-43.
[50]
Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of " rectal washout "[J]. Dis Colon Rectum, 2004, 47(10): 1706-1710.
[51]
Dafnis G, Nordstrom M. Evaluation of the presence of intraluminal cancer cells following rectal washout in rectal cancer surgery[J]. Tech Coloproctol, 2013, 17(4): 363-369.
[52]
Fukuda I, Kameyama M, Imaoka S, et al. Prevention of local recurrence after sphincter-saving resection for rectal cancer[J]. Gan To Kagaku Ryoho, 1991, 18(11): 1965-1967.
[53]
Shinto E, Mochizuki H, Tamakuma S. Improvement of anastomotic recurrence rate of rectal cancer by intraoperative anal side rectal lavage[J]. Nippon Daicho Komonbyo Gakkai Zasshi, 1996, 49(5): 399-404.
[54]
Zhou C, Ren Y, Li J, et al. Association between irrigation fluids, washout volumes and risk of local recurrence of anterior resection for rectal cancer: a meta-analysis of 427 cases and 492 controls[J]. PloS One, 2014, 9(5): e95699.
[55]
中华医学会外科学分会腹腔镜与内镜外科学组. 腹腔镜结直肠癌根治术操作指南(2018版)[J]. 中华消化外科杂志, 2018, 17(9): 877-885.
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