低位直肠癌经肛全直肠系膜切除手术难点和要点  

Difficulties and key points of transanal total mesorectal excision for lower rectal cancer

作　　者：刘鼎盛[1] 张宏[1] LIU Dingsheng;ZHANG Hong(Department of General Colorectal Surgery,Shengjing Hospital affiliated to China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院结直肠肿瘤外科,辽宁沈阳110004

出　　处：《中国肿瘤外科杂志》2023年第4期336-340,共5页Chinese Journal of Surgical Oncology

基　　金：辽宁省民生科技计划项目(2021JH2/10300053)。

摘　　要：经肛全直肠系膜切除术(taTME)是结直肠外科领域近年来新兴的热门术式。从诞生之日起就争议不断。该手术方式可以很好地解决狭窄骨盆等特殊病例盆底深处游离问题,但经肛自下而上的视野转变使得平时大家很熟悉的解剖结构变得陌生。对于初学者而言上手难度较大,盲目开展可能导致严重的围手术期并发症甚至远期盆腔多点局灶复发。该文结合笔者中心近200例taTME手术经验,探讨该术式在初始荷包缝合、肠壁全层切开、初始层面寻找、神经血管束保护、标本取出技巧、消化道重建等方面的技术细节。通过分享相关的经验和专业知识,提供深入实践taTME的见解,并为该术式的优化做出贡献。Transanal total mesorectal excision(taTME)is a relatively new and controversial surgical technique in the field of colorectal surgery.While it has proven to be effective in managing special cases with difficult pelvic anatomy,such as the narrow pelvis,it poses a challenge to novice surgeons due to the unique transanal approach and the unfamiliarity with the anatomical structures.Blindly performing this procedure without adequate training can lead to serious perioperative complications and even long-term pelvic recurrence.In this mini-review,the author discusses the technical details of taTME based on the experience of nearly 200 cases in Shengjing Hospital affiliated to China Medical University,including initial purse-string suture,full-thickness rectal incision,identification of the correct dissection plane,preservation of nerve and vascular bundles,specimen extraction techniques,and methods for digestive tract reconstruction.By sharing the experience and expertise,this article aims to provide insights into the practical aspects of taTME and contribute to the standardization and optimization of this surgical approach.

关 键 词：直肠癌 腹腔镜手术 经肛全直肠系膜切除 

分 类 号：R735.37[医药卫生—肿瘤]