目的    分析中国经肛全直肠系膜切除（taTME）手术病例登记数据库中登记的taTME术中困难或意外及术后并发症发生情况，为安全实施taTME手术提供数据支持。方法    基于真实世界研究的理念，通过回顾性及前瞻性收集并分析2017-11-15至2022-06-30来自全国43家中心登记录入中国taTME病例登记协作研究数据库（CTRC）的1 926例taTME手术病例，统计分析taTME术中困难或意外及术后并发症发生情况。结果    1 926例taTME手术病例中，男性病人占68.9%，中位年龄61（53～68）岁。34.3%的手术中遇到中困难或意外，其中盆腔术野烟雾发生率为22.3%，不稳定的盆腔CO2灌注压发生率为18.0%。taTME术后并发症总发生率15.4%。术后吻合口漏发生率为5.9%，其中B级发生率2.2%。术后发热82例（4.3%），术后发生肠梗阻41例（2.1%），术后发生尿潴留29例（1.5%），术后发生切口并发症15例（0.8%）。结论    最常见的术中困难是盆腔术野烟雾及不稳定的盆腔CO2灌注压；术后并发症按发生率由高至低依次为吻合口漏（B级最常见）、术后发热、肠梗阻、尿潴留、切口感染等。为进一步降低其发生率，taTME手术的结构化培训不可或缺。

Intraoperative difficulties/accidents and postoperative complications of transanal total mesorectal excision: A nationwide registry study        LI Yang*, REN Ming-yang, ZHANG Hong-yu, et al.*Department of General Surgery,Beijing Friendship Hospital, Capital Medical University;National Clinical Research Center for Digestive Diseases;Clinical Practice and Research Center for Colorectal Neoplasm, Capital Medical University, Beijing 100050, China
Corresponding authors: YAO Hong-wei, E-mail：yaohongwei@ccmu.edu.cn; ZHANG Zhong-tao,E-mail：zhangzht@ccmu.edu.cn
LI Yang, REN Ming-yang, ZHANG Hong-yu, WANG Quan, XU Qing, YU Gang, CHEN Jian-zhi, ZHANG Hong, XIAO Yi, WU Miao are the first authors who contributed equally to the article
LI Yang, REN Ming-yang, ZHANG Hong-yu, WANG Quan, XU Qing, YU Gang, CHEN Jian-zhi, ZHANG Hong, XIAO Yi, WU Miao, LIU Yi-shan, YAO Hong-wei, ZHANG Zhong-tao on behalf of Chinese taTME Registry Collaborative Team
Abstract    Objective    To introduce the intraoperative difficulties/accidents and postoperative complications of transanal total mesorectal excision (taTME) based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods    Between November 15, 2017, and June 30, 2022, clinical data of 1,926 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. The occurrence of difficulties /accidents and postoperative complications in taTME surgery were statistically analyzed. Results    (1) 1926 cases of taTME were included in the analysis of this study. There were 1327 males (68.9%) and 599 females (31.1%) with median age of 61 (53~68) years old; (2) 34.3% of the patients encountered intraoperative difficulties /accidents, among which the most common intraoperative problems were pelvic operation field smoke(22.3%) and unstable pelvic CO2 perfusion pressure(18.0%); (3) The postoperative complications occurred in 296 cases (15.4%). Anastomotic leakage was the most common complication, with an incidence of 5.9%, among which Grade B anastomotic leakage (2.2%) was the most common. The incidence of postoperative fever was 4.3% (82/1,926). Intestinal obstruction occurred in 41 cases (2.1%). Urinary retention occurred in 29 cases (1.5%). 15 cases (0.8%) developed wound complications. Conclusion    The most common intraoperative difficulties were pelvic surgical field smoke and unstable pelvic CO2 perfusion pressure; Postoperative complications, in order of incidence from highest to lowest, were anastomotic leakage (Grade B most common), postoperative fever, ileus, urinary retention, incision infection and etc. To further reduce  problems/accidents and postoperative complications in taTME surgery, structured training on taTME surgery is indispensable.