经肛门全直肠系膜切除术技术平台的建立与面临的问题

Transanal total mesorectal excision：the operative platform and potential issues

20多年来，直肠癌外科最重要的进展是全直肠系膜切除（TME）理念的提出与腹腔镜微创技术的应用。然而，对于骨盆狭小、肿瘤较大、特别是男性肥胖患者，低位直肠的分离显露仍然是个问题。腹腔镜联合经肛门微创手术（TAMIS）或者完全经肛门全直肠系膜切除（taTME）可能是一种潜在的解决途径。直肠癌手术的一个新时代似乎正在来到，但必须重点关注患者的合理选择、手术安全以及长期随访的问题。

In recent 20 years, the most important advancement of rectal cancer surgery is the total mesorectal excision （TME） and laparoscopic minimal invasive surgery. However, visualization of the distal rectum is still troublesome because of narrow pelvic, bulky tumor, and especially obese male patients. A possible solution for this situation is distal rectal mobilization by transanal minimally invasive surgery （TAMIS）, or even pure transanal total mesorectal excision （taTME）. When people applaud a new era of rectal cancer surgery is coming, we must also concern about the patients selection , the long-term follow up results and even the operative safety.