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由奥斯陆国际标准化联合会近来提出的治疗直肠癌的新方案在外科医生和肿瘤学家中还未真正达到一致的意见。在1995年由文献引发的有关外科技术的讨论之后,挪威和瑞典已将全直肠系膜切除(TME)作为新的标准手术。这种(标本-定向)手术的精髓是切除肿瘤,包括完整的、表面无撕破的后肠系膜。 日本学者和美国的Enker等对盆腔外科神经解剖学的重要发现是:牺牲一侧的腹下神经丛和其中的副交感神经纤维,很可能发生射精和勃起障碍(分别为90％和80％)。牺牲双侧可发生阳萎,并常危及排尿功能。MacFarlanl指出广泛手术的优点可能是TME成份的结果。日本的外科医生已征明有神经丛周围淋巴结转移的病人即使作切除也不延长存活时间。在手
The recent proposal for treatment of rectal cancer proposed by the Oslo International Consortium for Standardization has not yet reached a consensus among surgeons and oncologists. After the discussion of surgical techniques triggered by the literature in 1995, Norway and Sweden have adopted total mesorectal excision (TME) as the new standard of surgery. The essence of this (specimen-directed) procedure is removal of the tumor, including a complete, non-teared posterior mesentery. Japanese scholars and the American Enker et al. found important findings in the neuroanatomy of pelvic surgery: Sacrifice on one side of the subabdominal plexus and parasympathetic nerve fibers in it, and ejaculation and erectile dysfunction are very likely (90% and 80%, respectively). The impotence can occur on both sides of the sacrifice, and the voiding function is often endangered. MacFarlanl pointed out that the advantages of extensive surgery may be the result of TME ingredients. Japanese surgeons have demonstrated that patients with peripheral plexus lymph node metastases do not prolong survival even if they are removed. In hand