经肛全直肠系膜切除术的器官功能保护  

Transanal total mesorectal excision and organ function preservation

作　　者：申占龙[1] 叶颖江[1] 赵龙[1] 曹键[1] 王杉[1] Shen Zhanlong;Ye Yingjiang;Zhao Long;Cao Jian;Wang Shan(Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Laboratory of General Surgery, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People′s Hospital, Peking 100044, China)

机构地区：[1]北京大学人民医院胃肠外科,北京大学人民医院外科肿瘤研究室,北京大学人民医院普通外科研究室,北京市结直肠癌诊疗研究重点实验室,100044

出　　处：《中华胃肠外科杂志》2019年第3期224-227,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目资助(81672375).

摘　　要：经肛全直肠系膜系膜切除术(taTME)借助经肛内镜和盆气腹的压力效应,可以更好显露远端直肠系膜间隙,在盆神经和器官功能保护方面可能具有一定的应用前景。经肛微创手术平台(TAMIS)可能减少肛门括约肌损伤,有利于肛门功能的保护。目前数据显示,taTME在术后排粪、排尿和性功能方面总体与经腹TME手术相当。taTME术后早期排粪功能较差,可能与taTME手术经肛门操作、放置单孔套筒及学习曲线有关,但随着术后时间的推移,肛门功能可能得到一定程度的改善。在保护排尿功能和性功能方面,对于初学者来说,需要熟悉盆丛神经走行和逆向解剖学标志以及操作要点,尤其需避免taTME手术对盆丛主干和盆腔内脏神经的损伤。taTME手术与经自然腔道内镜手术(NOTES)手术理念不同,后者突出微创理念,而taTME更突出的是在肿瘤学安全性和神经保护等方面的优势。我们需要结合经肛和经腹路径各自优势,取长补短,才能最终达到提高直肠癌手术质量和器官功能保护的目的。Thanks to endoscopic assistance and the pressure effect of pelvic pneumoperitoneum, transanal total mesorectal excision (taTME) can better expose the surgical field of distal mesorectal space, and may have a prospect for the preservation of pelvic nerves and organ function. The transanal minimally invasive surgery (TAMIS) platform may decrease the injury of internal anal sphincter and protect anal function. Current data show that taTME procedure has similar results on postoperative anal function, urinary function and sexual function compared to transabdominal TME procedure. The early impaired anal function after taTME may be related to the transanal approach itself, implement of single port and the learning curve, but the anal function can improve with time. Regarding the protection of urinary and sexual function, the beginners should be familiar with the course of pelvic nerves, the anatomical landmarks and the technical points during the dissection upward, and try to avoid the injury of the pelvic plex trunk and pelvic splanchnic nerves. TaTME is different from natural orifice transluminal endoscopic surgery (NOTES), while the latter focuses on the minimally invasive principle, the former focuses on the oncological safety and nerve protection. We should combine the advantages of transanal and transabdominal approaches to achieve the final goal of surgical quality improvement and organ function preservation.

关 键 词：直肠肿瘤 经肛全直肠系膜切除术 器官功能保护 

分 类 号：R735.37[医药卫生—肿瘤]