低位直肠癌保肛手术术式选择及评价  

Sphincter-preserving surgery for low rectal cancer:Selection and evaluation

作　　者：许剑民[1] 冯青阳[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中国实用外科杂志》2014年第9期827-831,共5页Chinese Journal of Practical Surgery

摘　　要：直肠癌的淋巴引流是低位直肠癌保肛手术的基础。低位直肠癌保肛手术的主要难点在于平衡远端切缘与剩余肠管的长度。针对不同长度的剩余直肠,不同手术方式各有优势。直肠癌前切除术是最常用的保肛术式,但针对切除后剩余直肠不足2 cm的肿瘤,前切除术并不合适。相较传统保肛手术,内括约肌切除术和经前会阴超低位直肠前切除术提供了更低位置肿瘤的保肛可能。随着手术器械的发展,微创技术也逐步应用于保肛手术。相较传统腹腔镜,机器人手术的操作更为简便,也能更好地保护盆腔器官功能。局部切除的手术技术也有了长足进步,但其适用人群仍应当严格评估。The lymphatic drainage of rectal cancer is the basis of sphincter-preserving surgery. The main difficulty of sphincter-preserving surgery for low rectal cancer locates in balancing the distal resection margin and the length of remaining rectum. Different sphincter-preserving surgical approaches have their own advantages. Rectal cancer anteriorresection is the most common surgical approach of sphincter-preserving surgery. But for less than 2cm of remaining rectum after tumor resection,the anterior resectionis not appropriate. Compared with traditional approaches,the intersphincteric resection（ISR） and anterior perineal plane for ultra-low anterior resection（APPEAR） can achieve sphincter preservation for lower position of tumors. With the development of surgical instruments,minimally invasive techniques have been gradually applied in sphincter-preserving surgery. The advantages of robotic surgery mainly focus on more convenient operation and better protection of pelvic organs,compared with conventional laparoscopy. Surgical techniques of local excision have also made great progress. But the indications should be rigorously evaluated.

关 键 词：低位直肠癌 保肛手术 

分 类 号：R6[医药卫生—外科学]