腹腔镜低位直肠癌保肛手术新进展

Advances in laparoscopic sphincter-preserving surgery for low rectal cancer

低位直肠癌在我国发病率逐年上升,严重威胁着人民的健康。外科手术是低位直肠癌最有效的治疗方法,随着对直肠解剖生理和低位直肠癌生物学特点研究的不断深入,低位直肠癌保肛手术得到越来越广泛的应用,尤其腹腔镜技术的应用已成为当前关注的热点问题之一。腹腔镜低位直肠前切除术、腹腔镜低位直肠前切除术联合经肛门括约肌间切除或经肛门直肠脱出外翻等术式是腹腔镜下低位直肠癌切除保肛手术可选的手术方法。消化道重建可选择双吻合器法、手工经肛结肠肛管吻合以及结肠J型储袋成形吻合等方式。各种术式有其特有的适应范围和优缺点,应以优先保证手术根治同时兼顾生活质量为原则合理选择术式。

The incidence of low rectal cancer, which severely threatens human health, has been increasing annually in China. Surgical operation is the most effective treatment for low rectal cancer. In-depth analyses on the physiology and anatomy of the rectum and the biological characteristics of low rectal cancer have led to the wide application of anus preservation operation as a treatment for this disease. Anus preservation operation is widely used, especially because the application of the laparoscopic technique has recently become a popular topic in colorectal surgery. Alternative laparoscopic sphincter-preserving procedures for this disease include the following： laparoscopic anterior resection; and laparoscopic anterior resection with inter-sphincter resection or with prolapse technique. Colorectal anastomosis with double-stapler technique, hand-sewn coloanal anastomosis, and colonic J-pouch-anal anastomosis are common reconstruction procedures. Each procedure has its own adaptive range, advantages, and disadvantages. Radical surgery must be prioritized, but we should also consider the patients＇ life quality when selecting a mode of surgery.