中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

低位直肠癌保肛手术方式选择

韩加刚，王振军   

  1. 首都医科大学附属北京朝阳医院普通外科，北京 100020
  • 出版日期:2019-07-01 发布日期:2019-07-10

  • Online:2019-07-01 Published:2019-07-10

摘要：

随着新辅助治疗的推广、微创技术的进步和新手术技术的开展，低位直肠癌的保肛率逐年增加。在保证肿瘤根治性的前提下，改善病人的术后生活质量成为低位直肠癌治疗的重要目标。目前，低位保肛手术主要有：（1）内括约肌切除术（ISR），如完全ISR、次全ISR、部分ISR和改良的部分ISR。（2）经肛门局部切除术，包括经肛内镜微创手术（TEM）和经肛微创手术（TAMIS）。（3）经前会阴超低位直肠切除术（APPEAR），即经会阴另做切口实施，目前较少应用。（4）经肛全直肠系膜切除（TaTME）手术：初步研究证实可安全、有效用于低位进展期直肠癌的保肛，该技术需要一定的学习曲线，目前已经制定专家共识和操作规范、实施手术系统培训、开展多中心前瞻性研究，有望成为低位直肠癌保肛的重要术式。

关键词: 低位直肠癌, 内括约肌切除术, 经肛局部切除, 经前会阴超低位直肠切除术, 经肛门全直肠系膜切除

Abstract:

Selection of anal preservation surgery of low rectal cancer        HAN Jia-gang，WANG Zhen-jun. Department of General Surgery，Beijing Chaoyang Hosptial，Capital Medical University，Beijing 100020，China
Corresponding author：HAN Jia-gang，E-mail：hjg211@163.com
Abstract    With the promotion of neoadjuvant therapy，the development of minimally invasive techniques and new surgical techniques，the anal preservation rate of low rectal cancer is increasing year by year. To improve postoperative quality of life is an important goal in the treatment of low rectal cancer. At present，the main important low anal preservation surgery is as follows: Intersphincteric resection (ISR)，including complete ISR，subtotal ISR，partial ISR and modified partial ISR; Transanal local resection，including transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS); Anterior perineal plane for ultra-low anterior resection of the rectum (APPEAR)，which is performed through a separate perineal incision，is rarely used at present; Transanal total mesorectal excision (TaTME) proposed in recent years. Preliminary studies have proven safe and effective for low advanced rectal cancer. TaTME require a learning curve. It is now making expert consensus and operation specification，operation training and conducting multi-center prospective study. TaTME is expected to become the important operation for low rectal cancer.

Key words: low rectal cancer, intersphincteric resection, transanal local excision, anterior perineal plane for ultra-low anterior resection of the rectum, transanal total mesorectal excision