直肠癌经肛门全直肠系膜切除术的开展现状与注意事项

Present conditions and problems of transanal total mesorectal excision in rectal cancer

经肛门全直肠系膜切除术（taTME）是近年来全世界结直肠外科学界的研究热点之一，目前已有10余个国家进行了该手术。 taTME融合了经自然腔道内镜手术（NOTES）、经肛门微创手术（TAMIS）及全直肠系膜切除（TME）的概念，在保证直肠癌肿瘤根治的基础上达到尽可能微创的无瘢痕手术，代表了目前直肠癌手术的最新进展。中山大学附属第六医院在经过动物实验、尸体实验和伦理认证后顺利开展了该手术，初步结果显示，该手术具备在肥胖和骨盆狭窄患者中更易于保证肿瘤远切缘及环周切缘、更加微创以及吻合口并发症更少等优点。由于该手术尚处于初始阶段，缺乏大量的临床病例和长期生存结果，目前尚无多中心临床随机对照研究的证据支持，需谨慎开展。在完善手术器械和操作平台的研发及经验总结后，该术式有望在未来治疗中低位直肠癌手术中占据越来越重要的地位。

Transanal total mesorectal excision （taTME） is a very innovative approach for the treatment of rectal cancer. This technique comes from some concepts such as natural-orifice transluminal endoscopic surgery （NOTES）, transanal endoscopic microsurgery （TEM）, transanal transabdominal operation （TATA）, transanal minimally invasive surgery （TAMIS） and total mesorectum excision （TME）. It has emerged in a dozen countries throughout the world in recent years. We have performed taTME in patients after a series of animal and human cadaver operations, and the technique approved by Ethics committee of the Six Affiliated Hospital of Sun Yat-sen University. The initial results seem to be advantageous in terms of distal margin and circumferential margins especially in obese and narrow pelvis, minimally invasiveness, reduced complications of anastomosis. There are no results on the long term functional and oncological outcomes by multiple center RCT clinical trials with taTME until now. This novel approach must be governed by skills acquisition and mentorship; it could become a valid alternative for patients with middle and low rectal cancer after experience accumulation and optimized operation equipment.