经肛全直肠系膜切除术在低位直肠癌中的研究现状  

Current research status of transanal total mesorectal excision in low rectal cancer

作　　者：王振宁 邹敏 王得晨 杨康 归明彬 王雅楠 高峰 Wang Zhenning;Zou Min;Wang Dechen;Yang Kang;Gui Mingbin;Wang Yanan;Gao Feng(Department of Anorectal Surgery,the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou 730030,China;Northwest University for Nationalities,Lanzhou 730030,China;Gansu University of Traditional Chinese Medicine,Lanzhou 730030,China;Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院肛肠科,兰州730030 [2]西北民族大学,兰州730030 [3]甘肃中医药大学,兰州730030 [4]宁夏医科大学,银川750004

出　　处：《中华普通外科学文献(电子版)》2025年第1期55-61,共7页Chinese Archives of General Surgery(Electronic Edition)

基　　金：甘肃省科技计划项目(21JR7RA006);院内科研计划项目(2021yxky018);西北民族大学中央高校基本科研业务费项目(31920200016)。

摘　　要：临床治疗低位直肠癌主要采用根治性手术,其中全直肠系膜切除术(TME)是最常见的术式。由于低位直肠癌病变靠近肛门,传统腹腔镜辅助TME在盆腔及直肠周围的精细操作中难度较大,尤其是对肥胖、骨盆狭窄和男性等“困难骨盆”患者。经肛全直肠系膜切除术(TaTME)通过增强解剖平面的可视化,精准确定远端切缘,降低环周切缘阳性率,从而提高保肛率,并可能提升标本质量和保护器官功能。本文简要论述了TaTME与经自然腔道取标本手术(NOSES)和经自然腔道内镜手术(NOTES)的关联,以及TaTME的微创和功能结局,希望为该领域的研究和实践提供理论依据和经验证据。The primary clinical treatment for low rectal cancer is radical surgery,with total mesorectal excision(TME)being the most commonly used surgical technique.Due to the proximity of low rectal cancer to the anus,traditional laparoscopic-assisted TME presents significant challenges in performing precise operations within the pelvis and around the rectum,especially for patients with“difficult pelvis”conditions,such as obesity,a narrow pelvis,or male anatomy.Transanal total mesorectal excision(TaTME)improves visualization of the anatomical plane,enabling precise identification of the distal margin and reducing the incidence of positive circumferential resection margins(CRM),thereby increasing rates of sphincter preservation.Additionally,TaTME may enhance specimen quality and preserve organ function.This paper briefly explores the relationship between TaTME,natural orifice specimen extraction surgery(NOSES)and natural orifice translumenal endoscopic surgery(NOTES),as well as the minimally invasive and functional outcomes of TaTME,aiming to provide theoretical foundations and empirical evidence for further research and clinical practice in this area.

关 键 词：直肠肿瘤 自然腔道内镜手术 经肛全直肠系膜切除术 微创结局 功能结局 

分 类 号：R735.37[医药卫生—肿瘤]