经肛门直肠全系膜切除术在中低位直肠癌治疗中的应用现状  

Current status of transanal total mesorectal excision for treating mid-low rectal cancer

作　　者：叶景旺[1] 王李[1] 田跃[1] 柯志刚[1] 王祥峰[1] 郑恢超 童卫东[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所普通外科胃结直肠病区,重庆400042

出　　处：《消化肿瘤杂志（电子版）》2017年第3期156-161,共6页Journal of Digestive Oncology(Electronic Version)

基　　金：国家自然科学基金项目(81270461;81570483);重庆市自然科学基金重点项目(cstc2013jjB10025);第三军医大学创新课题(2014YLC04);第三军医大学临床创新课题(2014YLC04);教育部回国留学人员启动基金(2011年)

摘　　要：近30年临床实践证明全直肠系膜切除术(TME)已经成为直肠癌根治的标准术式。在中低位直肠癌行全直肠系膜切除术中,无论是采取传统开腹还是腹腔镜手术方式,直肠肿瘤远端的分离,特别是前侧壁的分离仍然有一定挑战,尤其在肥胖、骨盆狭窄、男性等"困难骨盆"患者。经肛门全直肠系膜切除术(transanal total mesorectal excision,taTME)提出了自下而上操作的手术理念,改变了传统的从上向下分离方式,在克服"困难骨盆"和降低获得远端直肠安全切缘方面具有优势,从而有望提高标本质量、保护器官功能。在保证肿瘤根治与安全性的前提下,taTME也是未来发展经肛门自然腔道手术的起点。本文对taTME术式的背景、操作路线、安全性、肿瘤学效果及对功能性结局的影响进行简要论述。Total mesorectal excision(TME) has been proven to be the standard choice for radical rectal cancer resection through almost 30 years of clinical practice. However, TME for mid-low rectal cancer can be technically challenging, no matter in traditional or laparoscopic surgery. This is due to difficulties in distal dissection and transection, particularly in obese patients, patients with narrow pelvis and male patients. Recently, transanal total mesorectal excision(ta TME) has become a hot topic, for which it has advantages in overcoming difficult pelvis and decreasing the operational difficulty in obtaining safe distal margins to improve the operation quality, reduce iatrogenic injury rate and protect the organ function. In this manuscript, the background, operational route, safety, oncological and functional outcomes of ta TME were discussed.

关 键 词：直肠癌 经肛全直肠系膜切除 手术 

分 类 号：R735.37[医药卫生—肿瘤]