经肛全直肠系膜切除术的争议和展望  

Controversy and prospect of transanal total mesorectal excision

作　　者：李亮[1] 龙飞 林昌伟[1] 马敏 胡桂[1] 张翼[1] Li Liang;Long Fei;Lin Changwei;Ma Min;Hu Gui;Zhang Yi(Department of Gastrointestinal Surgery,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院胃肠外科,长沙410013

出　　处：《中华胃肠外科杂志》2021年第8期727-734,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：中南大学学位与研究生教育教学改革研究项目(2015JGB53)。

摘　　要：经肛全直肠系膜切除术(taTME)作为一项外科新技术,近年来发展迅速。但taTME在发展过程中,其安全性、有效性和适用性也引起不少争议,具体包括:(1)尿道损伤、CO_(2)栓塞、吻合口漏和盆腔感染等手术并发症的增加,引起了人们对taTME手术安全性的担忧;(2)全直肠系膜切除术(TME)标本质量不良、局部复发率增加、肛门功能受损又使得人们对taTME的有效性产生了质疑;(3)taTME的病例选择、手术操作和成本效益等方面。但不管从理论,还是目前的实践来看,taTME都有着较好的应用前景。尤其是对于低位直肠癌患者,taTME是一种相对安全有效的补充术式。未来我国taTME的发展应重视对初学者的结构化培训和开展高质量的临床研究,以保障taTME的安全实施并获得高级别的循证医学证据,进而规范taTME的临床实践。As a novel surgical technique,taTME has developed rapidly in recent years.TaTME inevitably attracts some skepticism on safety,efficacy,and indication.First,the controversies over taTME are mainly reflected on the safety and effectiveness of taTME.On one hand,the increase of surgical complications,such as urethral injury,CO_(2) embolism,anastomotic leakage and pelvic infection,has raised concerns about the safety of taTME.Second,the poor quality of taTME specimens,the increased local recurrence rate and the impaired anal function after taTME,also make people question the effectiveness of taTME.Third,there are more or less controversies in the selection of taTME cases,surgical procedures and cost-effectiveness.However,it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice.Furthermore,taTME is a relatively safe and effective supplementary surgical procedure,especially for patients with low rectal cancer.We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China,so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence,and then standardize the clinical practice of taTME.

关 键 词：直肠肿瘤 全直肠系膜切除 经肛 

分 类 号：R735.37[医药卫生—肿瘤]