中国实用外科杂志

中国实用外科杂志

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中低位直肠癌经肛全直肠系膜切除手术的关键技术

姚宏伟，宋建宁，张忠涛   

  1. 首都医科大学附属北京友谊医院普通外科   国家消化系统疾病临床医学研究中心   消化健康全国重点实验室   首都医科大学结直肠肿瘤临床诊疗与研究中心，北京100050
  • 出版日期:2023-10-01

  • Online:2023-10-01

摘要： 经肛全直肠系膜切除（taTME）手术尚处于发展阶段，在术适应证的选择、规范的手术流程建立、手术质量控制以及手术平台器械的改进等方面，均有提高的空间。taTME的关键技术包括：（1）肿瘤远端肠腔缝合关闭技术。（2）如何进入正确的层面间隙。（3）自下而上的直肠系膜分离技术。（4）吻合口安全性判断及加固缝合技术。鉴于taTME手术操作要求高，学习曲线长，故需要制定结构化培训方案，以快速度过学习曲线，逐步提高手术质量，同时开展高质量的临床研究，回答 taTME实施过程中出现的相关问题，通过临床研究与临床实践的互相推动，提高中低位直肠癌的诊疗水平。

关键词: 直肠癌, 经肛全直肠系膜切除, 手术操作, 关键技术

Abstract: Key techniques in transanal total mesorectal excision surgery for mid-low rectal cancer        YAO Hong-wei, SONG Jian-ning，ZHANG Zhong-tao. Department of General Surgery，Beijing Friendship Hospital, Capital Medical University；National Clinical Medical Research Center for Digestive Diseases；National Key Laboratory for Digestive Health, Beijing 100050，China 
Corresponding authors：ZHANG Zhong-tao，E-mail：zhangzht@ccmu.edu.cn
YAO Hong-wei and SONG Jian-ning are the first authors who contributed equally to the article
Abstract    Transanal total mesorectal excision (taTME) surgery is still in the developmental stage, and there is room for improvement regarding the selection of surgical indications, establishment of standardized surgical procedures, surgical quality control, and surgical platform instruments. taTME's key techniques include: (1) the technique of closing the rectal lumen with sutures distal to the tumor. (2) How to access the correct level gap. (3) Bottom-up rectal mesenteric separation technique. (4) Anastomosis safety judgment and reinforcement suture technique. Regarding the high requirements of taTME surgical operation and the long learning curve, it is necessary to develop a structured training program to quickly pass the learning curve and gradually improve the quality of taTME surgery. It is important to carry out high-quality clinical research to answer the relevant questions that arise during the implementation of taTME. The taTME technique can be gradually improved through the mutual promotion of clinical research and clinical practice. Finally, the level of treatment and care for low and middle rectal cancers can be improved. 

Key words: rectal cancer, transanal total mesorectal excision（taTME）, surgical operation, key techniques