高级搜索

局部进展期直肠癌手术治疗的研究前沿及相关热点问题

郑民华, 马君俊, 赵轩

郑民华, 马君俊, 赵轩. 局部进展期直肠癌手术治疗的研究前沿及相关热点问题[J]. 肿瘤防治研究, 2022, 49(5): 379-383. DOI: 10.3971/j.issn.1000-8578.2022.21.1404
引用本文: 郑民华, 马君俊, 赵轩. 局部进展期直肠癌手术治疗的研究前沿及相关热点问题[J]. 肿瘤防治研究, 2022, 49(5): 379-383. DOI: 10.3971/j.issn.1000-8578.2022.21.1404
ZHENG Minhua, MA Junjun, ZHAO Xuan. Research Improvements and Related Hot Issues of Surgical Treatment on Locally Advanced Rectal Cancer[J]. Cancer Research on Prevention and Treatment, 2022, 49(5): 379-383. DOI: 10.3971/j.issn.1000-8578.2022.21.1404
Citation: ZHENG Minhua, MA Junjun, ZHAO Xuan. Research Improvements and Related Hot Issues of Surgical Treatment on Locally Advanced Rectal Cancer[J]. Cancer Research on Prevention and Treatment, 2022, 49(5): 379-383. DOI: 10.3971/j.issn.1000-8578.2022.21.1404

局部进展期直肠癌手术治疗的研究前沿及相关热点问题

详细信息
    作者简介:

    郑民华  主任医师,二级教授,博士研究生导师,上海交通大学医学院附属瑞金医院普外科主任,外科教研室主任,兼胃肠外科主任及上海市微创外科临床医学中心主任。担任中华医学会外科学分会常委、中华医学会外科学分会腹腔镜与内镜外科学组组长、中国抗癌协会腔镜与机器人外科专委会副主任委员、中国医师协会外科医师分会微创外科医师委员会副主委、中国医学装备协会腔镜与微创技术分会会长等学术团体职务。从事胃肠道肿瘤微创外科治疗的临床研究,成功开展了多项国际腹腔镜手术,包括我国首例腹腔镜下乙状结肠癌根治术、首例腹腔镜胰十二指肠切除术、世界首例腹腔镜同期胃癌结肠癌切除术等,并牵头制定国际及国内的相关操作指南与规范。主编、参编学术专著10余部,发表学术论文200余篇。以第一完成人获教育部科学技术进步奖一等奖、上海市科技进步奖一等奖等,负责国家863计划、国家重点研发计划、国家自然科学基金等多项课题。获全国先进工作者、全国五一劳动奖章、国家卫健委有突出贡献中青年专家、上海市十佳医生等荣誉称号,享国务院特殊津贴
    郑民华(1963-),男,博士,主任医师,主要从事胃肠恶性肿瘤的综合治疗及胃肠道疾病的腹腔镜微创治疗

  • 中图分类号: R735.3+7

Research Improvements and Related Hot Issues of Surgical Treatment on Locally Advanced Rectal Cancer

  • 摘要:

    手术切除是局部进展期直肠癌治疗中的主要环节之一。随着全直肠系膜切除原则及腹腔镜微创技术的不断普及和深入,手术治疗的相关研究现已进入高位平台期。本文基于目前的研究前沿,对直肠癌手术治疗的热点进行概述,主要包括减少戳孔、经自然孔道取出标本、机器人手术、高清/3D/荧光手术,并进一步探索手术入路及手术关键技术。如今在强调循证医学的环境下,结直肠外科医师应适应时代变化,积极吸纳科学前沿理念及技术并与手术设备和器械相结合,同时积极开展严谨的、有创新性的大规模前瞻性临床研究。

     

    Abstract:

    Surgical resection is one of the main steps in the treatment of locally advanced rectal cancer. With the popularization of total mesorectal resection and laparoscopic minimally invasive techniques, related current research on surgical treatment has now entered a relatively high-level stage. In this article, we review the research frontiers of surgical treatment on rectal cancer, including reduction of trocars, specimen retrieval through natural orifices, robotic surgery, high definition/3D/indocyanine fluorescence green surgery, surgical approach and key surgery technology. Based on the current environment of evidence-based medicine, colorectal surgeons should adapt to the changes of the times, actively absorb cutting-edge scientific concepts and technologies and integrate them with surgical equipment and instruments, and carry out rigorous and innovative large-scale prospective clinical trials.

     

  • 肺癌是目前全球最常见的恶性肿瘤之一,其发病率和死亡率分别位居世界第二位和第一位[1],尤其在中国,其5年生存率仅有19.7%[2]。NSCLC根据组织结构异质性又分为鳞癌(LUSC)和腺癌(LUAD)[3]。目前,尽管NSCLC的治疗有了非常大的进步,但患者总体预后仍然较差,主要是多数患者确诊时已经是晚期且已发生转移,另一个重要原因则是手术切除后复发[4]。因此寻找新的治疗方法和治疗靶点来改善NSCLC患者预后仍然是目前亟待解决的关键问题。人类着丝粒蛋白F(CENPF)是叉头框蛋白M1(FOXM1)的已知靶点[5],研究表明,CENPF的表达与多种肿瘤的进展及预后显著相关[6-8],且CENPF在LUAD中的功能尚未完全阐明,为此本研究将探讨CENPF在LUAD中表达与患者临床预后及病理分期的关系,同时初步探讨其发挥功能的机制。

    LUAD组织芯片购自上海芯超生物科技有限公司(HLugA180Su07),样本剔除失访病例后共87例肺腺癌患者组织,其中男47例、女40例,平均年龄(63.8±8.72)岁,T1期患者16例、T2期患者46例、T3期患者20例、T4期患者5例;病理分级为Ⅰ级7例、Ⅱ级50例、Ⅲ级30例。

    肺腺癌NCI-H2126细胞(中国科学院上海细胞库)。DMEM培养基(美国Gibco公司)、胎牛血清(FBS)(美国Hyclone公司)。青霉素、链霉素(美国Hyclone公司)。CENPF慢病毒由吉凯基因公司设计生产。SDS-PAGE试剂(上海生工公司)。ACKR3/CXCR7、E-cadherin、N-cadherin及GAPDH抗体(武汉三鹰)。主要设备有生物安全柜、CO2培养箱、垂直电泳仪、化学发光成像系统、Tecan酶标仪等。

    SP法检测组织芯片中CENPF的表达。石蜡切片常规脱蜡至水,加0.01 mol/L枸橼酸缓冲液(pH6.0),高压锅进行抗原热修复,加3%H2O2室温避光孵育30 min,PBS洗涤3次。滴加10%的正常非免疫羊血清,37℃孵育60 min,PBS洗涤3次。滴加CENPF一抗工作液(1:100),4℃孵育过夜,PBS洗涤3次。滴加二抗工作液(稀释比例为1:500),37℃孵育60 min,PBS洗涤3次。滴加辣根过氧化物酶(HRP)标记的链霉卵白素,37℃孵育60 min,PBS洗涤3次。DAB显色、苏木精对比染色、脱水、二甲苯透明、中性树胶封片。采用TissueGnostics全景组织扫描仪对染色结果进行扫描,根据染色结果,以所有患者的平均吸光度值的中位表达值为截断值将所有患者分为CENPF高表达组和CENPF低表达组。

    细胞用RIPA裂解液进行裂解,超声后离心取上清液。BCA试剂盒(上海生工公司)测蛋白浓度。SDS-PAGE电泳用5%的浓缩胶与12%的分离胶进行。电泳后将蛋白转至PVDF膜,5%BSA封闭。分别加CENPF(1:1 000)、ACKR3(1:1 000)、E-cadherin(1:1 000)、N-cadherin(1:1 000)及GAPDH(2:1 000)4℃孵育过夜。洗涤,二抗(1:5 000,武汉三鹰公司)室温孵育,洗涤,曝光显色。

    根据人CENPF的mRNA序列设计siRNA慢病毒干扰序列(正义引物: 5’-TAAGAGTCCCATTCTCTTGGG-3’,反义引物: 5’-TAAGAGTCCCATTCTCTTGGG-3’)。参照慢病毒转染说明书感染NCI-H2126细胞,并用嘌呤霉素进行筛选。筛选至第14天时,将筛选细胞进行Western blot鉴定,检测CENPF表达,获得稳定敲除CENPF的单克隆细胞株。

    细胞提取RNA后,按照RNA-seq测序要求制备样品后送第三方测序公司(诺禾致源公司)完成mRNA测序,并对测序结果进行生物信息学分析。

    Transwell小室下室加入500 μl含10% FBS的完全培养基,上室中分别接种1×105个无血清培养基重悬的细胞。37℃、5%CO2培养箱中培养24 h后用湿棉签擦去上室面未迁移的肿瘤细胞,固定1 min,然后结晶紫染色,三蒸水洗2次后在普通光学显微镜下随机选取5个视野计总数,取其平均值。

    按照说明将50 mg/L Matrigel(美国Corning公司)1:8稀释液包被Transwell小室底部膜的上室面,4℃风干。纤维粘蛋白(FN)(美国Sigma公司)均匀涂抹在Transwell小室的下室面,24孔板中加入500 μl含10%FBS的完全培养基,然后将Transwell小室置于孔中,上室中接种1×105个无血清培养基重悬的细胞。37℃、CO2培养箱中培养24 h。取出小室,用湿棉签擦去上室面未侵袭的肿瘤细胞。甲醇固定1 min,结晶紫染色,三蒸水洗2次后在显微镜下随机选取5个视野计总数,取其平均值。

    取对数期细胞做梯度稀释。6孔板每孔种1 000个细胞,约两周后从培养箱中取出,中间可视细胞生长情况给其换新鲜培养基;PBS小心清洗两遍。每孔加入1 ml甲醇固定20 min后弃甲醇,每孔加入1 ml结晶紫染色20 min,PBS洗两遍,晾干后用核酸凝胶成像仪拍照,观察克隆大小,计数超过50个克隆的数量。取对数期细胞接种于96孔板,每孔2 000个细胞。每孔加入10 μl CCK-8溶液,24、48和72 h时在37℃下孵育2 h。酶标仪测量实验孔在450 nm处的吸光度值。

    SPSS22.0和Graph Pad Prism 8.0软件进行数据分析与作图。计数资料用频数和百分比表示,计量资料采用均数±标准差(x±s)表示。Cox生存风险比例模型分析患者年龄、性别、TNM分期、肿瘤大小、病理分期及CENPF表达与患者死亡风险的关系;Kaplan-Meier分析CENPF表达与肺腺癌患者预后的关系;t检验分析独立样本之间差异,χ2检验或Fisher精确检验进行计数资料分析。P < 0.05为差异有统计学意义。

    GEPIA2数据库(http://gepia2.cancer-pku.cn/#index)分析显示,CENPF在LUAD中表达较正常组织显著上调且与临床病理分期正相关,与患者生存及无疾病进展呈负相关,见图 1A~D。免疫组织化学染色进行验证,结果证实,LUAD中CENPF表达显著升高,见图 1E~F,且其表达与患者预后显著相关,低表达患者预后优于高表达患者,见图 1G

    图  1  CENPF在LUAD中的表达及与患者临床预后的关系
    Figure  1  Expression of CENPF in LUAD and correlated with clinical prognosis of patients
    *: P < 0.05, **: P < 0.01; A-D: GEPIA2 database to analyze the expression of CENPF in LUAD and its relationship with the clinical prognosis of patients; E-F: expression of CENPF in normal tissues of LUAD patients and paired tumor tissues was detected by immunohistochemical staining; G: Kaplan-Meier analysis of the relationship between CENPF expression and clinical prognosis of patients with lung adenocarcinoma.

    Cox风险比例回归模型分析结果显示,LUAD患者N分期及CENPF表达与患者死亡风险相关,而T分期、年龄、性别、病理分型及肿瘤大小则与患者死亡风险无关,见表 1

    表  1  Cox生存风险比例分析与患者死亡相关因素
    Table  1  Cox survival hazard ratio analysis of major factors associated with patient death
    下载: 导出CSV 
    | 显示表格

    Kaplan-Meier生存分析中CENPF表达的截断值将低表达患者定义为阴性,高表达患者定义为阳性,结果表明,除N分期与CENPF表达有关外,性别、年龄、T分期、病理分级及肿瘤大小均与CENPF表达无关,这表明CENPF的表达与患者淋巴结转移密切相关,见表 2

    表  2  CENPF表达与临床病理因素之间的关联
    Table  2  Association between CENPF expression and clinicopathological factors
    下载: 导出CSV 
    | 显示表格

    体外细胞实验表明,下调NCI-H2126细胞CENPF表达后,细胞增殖能力、迁移能力及侵袭能力显著降低,见图 2

    图  2  下调CENPF表达对LUAD细胞增殖、侵袭及迁移的影响
    Figure  2  Effect of down-regulation of CENPF on proliferation, invasion and migration of LUAD cells
    A: CENPF was knocked out in NCI-H2126 cells; B: cell proliferation was detected by CCK-8; C-D: cell colony formation ability was detected by plate clone formation assay; E-H: cell migration and invasion abilities were detected by Transwell. **: P < 0.01, ***: P < 0.001, compared with sh-con group

    NCI-H2126细胞敲除CENPF表达后RNA-seq结果显示,共有132个基因的表达出现显著变化,见图 3A。KEGG富集分析显示细胞趋化因子信号通路富集差异最为显著,见图 3B,其中ACKR3/ CXCR7表达下调最为明显,Western blot验证结果表明,CENPF敲除后,ACKR3/CXCR7表达显著下调。而在聚类差异中分析显示,EMT相关基因CDH1/E-cadherin表达显著上调,而CDH2/N-cadherin表达显著下调,见图 3C,蛋白检测结果显示,敲除CENPF的表达后,E-cadherin显著上调,N-cadherin则显著下调,见图 3D

    图  3  CENPF通过下调ACKR3/ CXCR7抑制NCI-H2126细胞EMT
    Figure  3  CENPF inhibited EMT in NCI-H2126 cells by downregulating ACKR3/CXCR7
    A: RNA-seq was used to analyze the changes in mRNA expression profile and the number of differentially-expressed genes after the expression of CENPF was knocked out in NCI-H2126 cells; B: the KEGG signaling pathway enrichment; C: the cluster differential analysis; D: protein expression of ACKR3/CXCR7, E-cadherin, and N-cadherin were verified by Western blot.

    近年来以表皮生长因子酪氨酸激酶抑制剂为代表的分子靶向及免疫治疗的发展显著延长了NSCLC患者无进展生存期及总生存期[9]。尽管这些治疗方法取得了一定的进展,但由于诊断时多数患者已经是晚期且治疗后易出现复发和耐药性等,导致其治疗前景不甚乐观。因此研究肺癌的发病机制,寻找新的治疗靶点具有重要意义。

    CENPF是FOXM1的已知靶点[6],该蛋白于1993年由Yen和Lee鉴定,约367 kDa。CENPF因其与着丝粒-动粒蛋白复合物的结合特征而得名,但这种结合只是短暂的,CENPF还具备其他功能——通过蛋白质相互作用对有丝分裂和细胞增殖进行调节[10-12]。研究表明,CENPF的表达在乳腺癌及膀胱癌中与患者的预后明显相关[13-14];在胃癌中,hnRNPR通过上调CENPF的表达促进胃癌进展[15],但CENPF在胃癌中的作用机制仍然不清楚。研究表明[8, 16],在前列腺癌中,CENPF可通过与FOXM1协同调节靶基因表达和激活与前列腺癌恶性相关的关键信号通路,协同促进前列腺癌生长。此外,FOXM1和CENPF的联合表达还是前列腺癌预后不良和转移的有力指标[17-18]。尽管以上研究都表明CENPF可能在肿瘤的发生发展中扮演着重要的作用,但CENPF在肿瘤中发挥的功能及其作用机制却仍未被完全阐明。本研究发现,在LUAD中,CENPF的表达显著上调,且与患者N分期及临床预后显著相关,这表明,CENPF在LUAD中发挥着非常重要的作用。

    肿瘤细胞要入侵周围的组织并最终形成转移需要上皮细胞经历一个去分化的过程,这一过程称为上皮间质转化(EMT)。在EMT期间,上皮细胞失去其极性和细胞间黏附,并获得具有更高运动性的间充质表型[19]。在EMT过程中,上皮细胞黏附连接的蛋白(E-cadherin)被能提供更大连接灵活性的蛋白(N-cadherin)取代,从而导致细胞分离和细胞运动性增强。E-cadherin介导钙依赖性细胞黏附并在正常组织发育中发挥关键作用。在正常组织和细胞中,E-cadherin的表达是可以检测且表达相对较高的,而N-cadherin则只在心肌、平滑肌及睾丸细胞中表达较高,其他的正常组织细胞表达量则较低或基本检测不到[20]。而在大部分的肿瘤细胞中,癌细胞为发动侵袭转移,N-cadherin则经常被上调,E-cadherin则经常被下调。在本研究中,敲除CENPF的表达后,LUAD细胞中被上调的N-cadherin则被逆转消除,而E-cadherin的表达则被恢复,这表明CENPF能够通过影响LUAD的EMT过程促进其发生转移,结果与患者临床样本组织中CENPF的高表达与患者发生淋巴结转移呈正相关相符合。

    E-cadherin的表达在多个水平上受到调节,如表观遗传、转录和翻译后修饰等。在转录水平上,E-cadherin受到许多转录因子(E-钙黏蛋白转录抑制因子,EcTRs)的抑制,如ZEB1、ZEB2、SNAI1、SNAI2、E12/E47和Twist1/2[9]。EcTRs能够与E-cadherin启动子区域结合从而抑制其表达,在本研究中,RNA-seq测序未发现LUAD细胞在CENPF表达被改变后EcTRs的表达发生改变,这表明,CENPF可能不是通过调控一系列EcTRs的表达,而可能是通过其他途径抑制了EcTRs与E-cadherin启动子区域的结合。研究表明,ACKR3/ CXCR7能够促进TGF-β1介导的EMT发生[16],而本研究中,RNA-seq结果显示,趋化因子富集信号通路改变显著,其中ACKR3/CXCR7表达变化最大,蛋白质表达验证结果进步一证实,在CENPF敲除后,ACKR3/CXCR7的表达被下调,本研究发现CENPF通过调控ACKR3/CXCR7进而促进肺腺癌细胞的EMT,在后续研究中对CENFP调控EMT标志蛋白E-cadherin及N-cadherin的详细机制仍需要进一步深入研究。

    综上所述,CENPF在LUAD中表达上调且与患者预后和淋巴结转移显著相关,它能够通过上调ACKR3/CXCR7进而促进LUAD细胞EMT的进展。本研究也存在一定的局限性,CENPF调控ACKR3/CXCR7的详细机制尚未解释清楚,仍需要进一步的深入研究。

    Competing interests: The authors declare that they have no competing interests.
    作者贡献:
    郑民华:提出文章整体思路、制定写作框架、指导论文写作
    马君俊:论文指导及修改
    赵轩:文献检索及初稿撰写
  • [1]

    Siegel RL, Miller KD, Fuchs HE, et al. Cancer Statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33. doi: 10.3322/caac.21654

    [2]

    Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer[J]. N Engl J Med, 2015, 372(14): 1324-1332. doi: 10.1056/NEJMoa1414882

    [3]

    Park JW, Kang SB, Hao J, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2021, 6(7): 569-577. doi: 10.1016/S2468-1253(21)00094-7

    [4]

    van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR Ⅱ): short-term outcomes of a randomised, phase 3 trial[J]. Lancet Oncol, 2013, 14(3): 210-218. doi: 10.1016/S1470-2045(13)70016-0

    [5]

    Fleshman J, Branda M, Sargent DJ, et al. Effect of Laparoscopic-Assisted Resection vs. Open Resection of Stage Ⅱ or Ⅲ Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Rando-mized Clinical Trial[J]. JAMA, 2015, 314(13): 1346-1355. doi: 10.1001/jama.2015.10529

    [6]

    Stevenson ARL, Solomon MJ, Lumley JW, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial[J]. JAMA, 2015, 314(13): 1356-1363. doi: 10.1001/jama.2015.12009

    [7]

    Bulut O, Aslak KK, Levic K, et al. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery[J]. Tech Coloproctol, 2015, 19(1): 11-22. doi: 10.1007/s10151-014-1237-6

    [8]

    Wang Y, Deng H, Mou T, et al. Short-term outcomes of single-incision plus one-port laparoscopic versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial[J]. Surg Endosc, 2019, 33(3): 840-848. doi: 10.1007/s00464-018-6350-6

    [9]

    Zhou ZQ, Wang K, Du T, et al. Transrectal Natural Orifice Specimen Extraction (NOSE) With Oncological Safety: A Prospective and Randomized Trial[J]. J Surg Res, 2020, 254: 16-22. doi: 10.1016/j.jss.2020.03.064

    [10] 王锡山. 结直肠肿瘤NOSES术关键问题的思考与探索[J]. 中华结直肠疾病电子杂志, 2018, 7(4): 315-319. doi: 10.3877/cma.j.issn.2095-3224.2018.04.002

    Wang XS. Consideration and exploration of key issues in NOSES for colorectal cancer[J]. Zhonghua Jie Zhi Chang Ji Bing Dian Zi Za Zhi, 2018, 7(4): 315-319. doi: 10.3877/cma.j.issn.2095-3224.2018.04.002

    [11]

    Jayne D, Pigazzi A, Marshall H, et al. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial[J]. JAMA, 2017, 318(16): 1569-1580. doi: 10.1001/jama.2017.7219

    [12]

    Kim MJ, Park SC, Park JW, et al. Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer: A Phase Ⅱ Open Label Prospective Randomized Controlled Trial[J]. Ann Surg, 2018, 267(2): 243-251. doi: 10.1097/SLA.0000000000002321

    [13]

    Zhao B, Lv W, Mei D, et al. Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-analysis[J]. Langenbecks Arch Surg, 2020, 405(1): 1-12. doi: 10.1007/s00423-020-01853-8

    [14] 洪希周, 马君俊, 余超然, 等. 4K和3D腹腔镜结直肠癌根治术中主观感受调查研究[J]. 中国实用外科杂志, 2019, 39(10): 1077-1080. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201910025.htm

    Hong XZ, Ma JJ, Yu CR, et al. Subjective perception of surgeons with 4K resolution, three-dimensional systems in laparoscopic colorectal surgery: A self-filling questionnaire survey[J]. Zhongguo Shi Yong Wai Ke Za Zhi, 2019, 39(10): 1077-1080. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201910025.htm

    [15]

    De Nardi P, Elmore U, Maggi G, et al. Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial[J]. Surg Endosc, 2020, 34(1): 53-60. doi: 10.1007/s00464-019-06730-0

    [16]

    Blanco-Colino R, Espin-Basany E. Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis[J]. Tech Coloproctol, 2018, 22(1): 15-23. doi: 10.1007/s10151-017-1731-8

    [17]

    Hong HJ, Zhao X, Yu CR, et al. Comparative study of oncologic efficacy of cephalomedial to lateral dissection versus medial to lateral dissection in laparoscopic total mesorectal excision for rectal cancer: An RCT study[J]. J Surg Oncol, 2021, 123 Suppl 1: S65-S75.

    [18] 李心翔, 李清国. 腹腔镜直肠癌术中左结肠动脉保留的意义[J]. 中华胃肠外科杂志, 2018, 21(3): 272-275. doi: 10.3760/cma.j.issn.1671-0274.2018.03.006

    Li X, Li Q. Significance of the preservation of left colic artery in laparoscopic resection of rectal cancer[J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2018, 21(3): 272-275. doi: 10.3760/cma.j.issn.1671-0274.2018.03.006

    [19]

    Zeng Z, Luo S, Chen J, et al. Comparison of pathological outcomes after transanal versus laparoscopic total mesorectal excision: a prospective study using data from randomized control trial[J]. Surg Endosc, 2020, 34(9): 3956-3962. doi: 10.1007/s00464-019-07167-1

    [20]

    Deijen CL, Velthuis S, Tsai A, et al. COLOR Ⅲ: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer[J]. Surg Endosc, 2016, 30(8): 3210-3215. doi: 10.1007/s00464-015-4615-x

    [21]

    Wasmuth HH, Faerden AE, Myklebust TÅ, et al. Transanal total mesorectal excision for rectal cancer has been suspended in Norway[J]. Br J Surg, 2020, 107(1): 121-130.

    [22] 赵轩, 孙晶. 直肠癌和乙状结肠癌根治术中肠系膜下动脉根部淋巴结清扫的相关热点问题及研究进展[J]. 中国肿瘤外科杂志, 2018, 10(5): 278-282. doi: 10.3969/j.issn.1674-4136.2018.05.002

    Zhao X, Sun J. Related questions and research improvements of apical lymph node dissection in rectal and sigmoid cancer surgery[J]. Zhongguo Zhong Liu Wai Ke Za Zhi, 2018, 10(5): 278-282. doi: 10.3969/j.issn.1674-4136.2018.05.002

    [23]

    Matsuda K, Hotta T, Takifuji K, et al. Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery[J]. Br J Surg, 2015, 102(5): 501-508. doi: 10.1002/bjs.9739

    [24]

    Uehara K, Yamamoto S, Fujita S, et al. Impact of Upward Lymph Node Dissection on Survival Rates in Advanced Lower Rectal Carcinoma[J]. Dig Surg, 2007, 24(5): 375-381. doi: 10.1159/000107779

    [25]

    Kawamura YJ, Umetani N, Sunami E, et al. Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement[J]. Eur J Surg, 2000, 166(10): 803-807. doi: 10.1080/110241500447443

    [26]

    Zeng J, Su G. High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage: a meta-analysis[J]. World J Surg Oncol, 2018, 16(1): 157. doi: 10.1186/s12957-018-1458-7

    [27]

    Zhao X, Ma J, Fu Z, et al. Prognostic value of apical lymph node metastasis at the inferior mesenteric artery in sigmoid and rectal cancer patients who undergo laparoscopic surgery[J]. J Surg Oncol, 2021, 123 Suppl 1: S88-S94.

    [28] 中国性学会结直肠肛门功能外科分会, 中国医师协会结直肠肿瘤专业委员会器官功能保护学组, 中国医师协会外科医师分会结直肠外科医师委员会. 直肠癌手术盆腔器官功能保护中国专家共识[J]. 中华胃肠外科杂志, 2021, 24(4): 283-290. doi: 10.3760/cma.j.cn.441530-20200315-00112

    Colorectal and Anal Function Surgeons Committee of China Sexology Association, Organ Function Protection Committee of Chinese College of Colorectal Cancer, Colon and Rectal Surgeons Committee of Chinese College of Surgeons. Chinese expert consensus on the protection of pelvic organ function in the rectal cancer surgery[J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2021, 24(4): 283-290. doi: 10.3760/cma.j.cn.441530-20200315-00112

    [29]

    Wei B, Zheng Z, Fang J, et al. Effect of Denonvilliers' Fascia Preservation Versus Resection During Laparoscopic Total Mesorectal Excision on Postoperative Urogenital Function of Male Rectal Cancer Patients: Initial Results of Chinese PUF-01 Randomized Clinical Trial[J]. Ann Surg, 2021, 274(6): e473-e480. doi: 10.1097/SLA.0000000000004591

    [30]

    You YN, Hardiman KM, Bafford A, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer[J]. Dis Colon Rectum, 2020, 63(9): 1191-1222. doi: 10.1097/DCR.0000000000001762

    [31] 周建平, 刘刚, 董明. 直肠癌侧方淋巴结清扫争议与共识[J]. 中国实用外科杂志, 2019, 39(7): 682-686. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201907011.htm

    Zhou JP, Liu G, Dong M. Controversy and consensus on lateral lymph node dissection for rectal cancer[J]. Zhongguo Shi Yong Wai Ke Za Zhi, 2019, 39(7): 682-686. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201907011.htm

  • 期刊类型引用(0)

    其他类型引用(1)

计量
  • 文章访问数:  1979
  • HTML全文浏览量:  660
  • PDF下载量:  588
  • 被引次数: 1
出版历程
  • 收稿日期:  2021-12-01
  • 修回日期:  2022-02-25
  • 网络出版日期:  2024-01-12
  • 刊出日期:  2022-05-24

目录

/

返回文章
返回
x 关闭 永久关闭