Abstract:

The advantages and disadvantages of transanal total mesorectal excision        YAO Hong-wei, YANG Ying-chi, ZHANG Zhong-tao. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, ＆ National Clinical Research Center for Digestive Diseases,Beijing 100050, China
Corresponding author: ZHANG Zhong-tao, E-mail：zhangzht@
medmail.com.cn
Abstract    The procedure of transanal total mesorectal excision (TaTME) surgery has been developing but controversial in recent years. The TaTME operation attempts to achieve the unity of minimally invasive and cosmetic effects on the basis of ensuring the radical resection of rectal cancer, and even embodies the concept of natural orifice transluminal endoscopic surgery (NOTES).The procedure of TaTME represents the latest trends in the field of rectal cancer surgery. However, many scholars believe that TaTME will increase the surgical difficulty and risk of rectal cancer, and even leave the distal stump of mesorectum, resulting in increased risk of local recurrence of rectal cancer. Therefore, how to standardize the surgical indications and operation procedures of TaTME surgery, is one of the hot and difficult problems in colorectal surgery in china. In addition, the orderly organization of clinical studies in TaTME surgery, and conducting TaTME surgery related high-level evidence-based medicine evidence, are also one of the relatively urgent task.

Key words: rectal cancer, total mesorectal excision, transanal total mesorectal excision, circumferential resection margin

摘要：

近年来，经肛门全直肠系膜切除（TaTME）手术不断发展但又颇具争议。TaTME手术尝试在保证肿瘤根治的基础上进一步实现微创、美观效果的统一，甚至体现经自然腔道内镜外科手术（NOTES）的理念，代表了当前直肠癌手术的最新动向和发展趋势。然而，很多学者认为TaTME会增加直肠癌手术的难度和手术风险，甚至残留了部分远端直肠的系膜，从而导致病人术后局部复发风险的增加。因此，当前如何规范TaTME手术的适应证以及手术操作流程，是我国结直肠外科面临的热点和难点问题之一。此外，如何有序组织TaTME手术相关的临床研究，获得TaTME手术相关的高级别循证医学证据，也是相对紧迫的任务之一。

关键词: 直肠癌, 全直肠系膜切除, 经肛门全直肠系膜切除, 环周切缘