直肠癌经肛全直肠系膜切除术的现状与思考

Current status and thoughts of transanal total mesorectal excision for rectal cancer

经肛全直肠系膜切除术(transanal total mesorectal excision,taTME)结合了全直肠系膜切除术(total mesorectal excision,TME)、经自然腔道内镜手术(natural orifice translumenal endoscopic surgery,NOTES)、单孔腹腔镜手术(single-incision laparoscopic surgery,SILS)和经肛微创手术(transanal minimally invasive surgery,TAMIS)等一系列概念,开展至今已有12年,成为近年来结直肠外科领域的热点之一。taTME的优势和缺点都十分明显,在发展的同时伴随着争议。目前在中国,已有许多外科医师开展了taTME。taTME是尝试还是已成为常规,在未来会继续流行,还是有朝一日会过时,对于外科医师而言,除了不断地积累手术经验以外,也应当适时地对其进行反思。在掌握了安全性和肿瘤学的高级别证据以及确立了质量控制标准后,taTME将和外科医师一起走向未来,并确立其在中低位直肠癌治疗中的作用。非预期taTME技术也为保证手术安全提供了一种全新的选项。

Transanl totalmesorectal excision(taTME)combines a series of concepts such as total mesorectal excision(TME),natural orifice transluminal endoscopic surgery(NOTES),single-incision laparoscopic surgery(SILS)and transanal minimally invasive surgery(TAMIS).It has been 12 years since its birth,and it has become one of the highlights in colorectal surgery in the recent decade.Its advantages and disadvantages seem so eye-catching,accompanied by controversy while developing.At present,many surgeons in China have performed the taTME operation.Whether it is experimentation or routine,whether it will be popular or outdated in the future,in addition to non-stop surgery,we should also timely reflect.When we have the high-level expected evidence of safety and oncological results,and establish the quality control standards,taTME will move forward with us.And it will play its role in the treatment of middle and low rectal cancer.Unexpected taTME approach also provides us with a new option to ensure surgical safety.