直肠癌保肛手术的规范化实施

Standardized use of sphincter preservation resection forrectal cancer

当前，保肛手术已成为直肠癌的首选术式。究竟有多少是应该选作保肛手术？又有多少不适宜施行保肛手术？笔者旨在阐述在临床上应该如何正确对患者选择实施保肛手术：首先．应在术前作全面评估：然后，根据检查结果严格按照美国国立癌症综合网络（NCCN）直肠癌实践指南规定来决定手术指征：同时．必须按照根治与保功能这两方面的要求来选用手术方式。总之．对直肠癌选作保肛手术必须达到根治性切除和功能良好双满意的目的。这是推行直肠癌保肛手术规范化实施的原因。

Sphincter preservation resection has been the first choice for rectal cancer, not only for high and mid- rectal cancer, but also for low rectal cancer. Were sphincter preservation resection indicated and suitable for all of the patients with rectal cancer？ The aim of this paper is to discuss when sphincter preservation resection should be chosen？ Firstly we should have a thorough preoperative assessment for the patients. After that we should determine the indications of sphincter preservation resection according to the NCCN guideline. Meanwhile, surgical approach should be balanced between long term survival and functional outcomes. As a result, what is most important in sphincter preservation resection is reaching satisfaction both in curative resection and functional outcomes. These are also the reasons for rational utilization of sphincter preservation resection for rectal cancer.