腹腔镜中低位直肠癌新辅助放化疗联合免疫治疗后根治性保肛术  

Laparoscopic radical anal preservation after neoadjuvant radiotherapy combined with immunotherapy forlowandintermediaterectal cancer

作　　者：姚宏伟[1] 孙丽婷 Yao Hongwei;Sun Liting(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,National Key Laboratory of Digestive Health,Clinical Practice and Research Center for Colorectal Neoplasm,Capital Medical University,Beijing 100032,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床医学研究中心,消化健康全国重点实验室,首都医科大学结直肠肿瘤临床诊疗与研究中心,北京100032

出　　处：《中华普外科手术学杂志(电子版)》2025年第2期132-132,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家重点研发计划资助项目(2017YFC0110904);首都医科大学结直肠肿瘤临床诊疗与研究中心基金项目(1192070313);北京市医院管理中心扬帆计划临床技术创新项目(ZLRK202302)。

摘　　要：通常情况下,TME手术在新辅助放化疗(nCRT)之后进行,以确保肿瘤缩小,使手术更为顺利和彻底。长期以来,低位直肠癌始终是结直肠外科手术治疗的难点,其在根治性切除和功能保护两者之间存在着相互制约和矛盾的问题。近年来,随着经肛内镜显微外科手术等技术的发展,经肛全直肠系膜切除手术(TaTME)也广泛应用于临床。既往研究表明,传统的nCRT联合免疫治疗更是显著提高了病理完全缓解率(pCR),这也使得术中准确识别肿瘤位置成为难点。腹腔镜及经肛内镜的放大效应,使得盆底手术的精细操作得以实现,肛管的外科解剖得以明朗化。低位直肠前壁肿瘤、骨盆狭窄、新辅助放疗引起的组织平面不清晰等“困难骨盆”的直肠癌患者,TaTME可能更具优势。Typically,TME is performed after nCRT to ensure tumour shrinkage and allow for a smoother and more thorough procedure.For a long time,low rectal cancer has always been the difficulty of surgical treatment in colorectal surgery,and there are mutual constraints and contradictions between radical resection and functional protection.In recent years,with the development of transanal endoscopic microsurgery and other surgical techniques,transanal total mesorectal excision(TaTME)surgery is also widely used in clinical practice.Previous studies have shown that traditional nCRT combined with immunotherapy has even significantly increased the pathological complete remission rate(pCR),which also makes it difficult to accurately identify the tumour location intraoperatively.The magnifying effect of laparoscopy and transanal endoscopy allows fine manipulation of the pelvic floor and clarification of the surgical anatomy of the anal canal.TaTME may be more advantageous in rectal cancer patients with'difficult pelvis'such as low anterior rectal wall tumours,pelvic stenosis,and unclear tissue planes due to neoadjuvant radiotherapy.

关 键 词：中低位直肠癌 新辅助放化疗 经肛全直肠系膜切除手术 

分 类 号：R73[医药卫生—肿瘤]