经肛门全直肠系膜切除术的研究进展

Research progress of transanal total mesorectal excision

目的总结经肛门全直肠系膜切除术(transanal total mesorectal excision,TaTME)的研究进展。方法收集国内外的相关研究成果,对TaTME的开展现状、面临问题、应用前景等进行综述。结果 TaTME延续了全直肠系膜切除术(total mesorectal excision,TME)的手术原则,借助腹腔镜的平台,采用"自下而上"的手术人路,可确保足够的肿瘤远切缘、提高直肠系膜标本质量、降低环周切缘阳性率、降低盆腔神经损伤发生率及提高保肛率,但同时也面临新技术带来的新并发症,以及肿瘤学预后和功能学转归不明确问题。结论TaTME节术尚处于起步阶段,其手术的安全性、可行性和短期疗效研究取得了令人满意的结果,但在广泛应用之前,仍需多中心、大样本和长期随访研究进一步验证其远期预后和肿瘤学安全性、

Objective To summarize the research progress oftransanal total mesorectal excision （TaTME） for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision （TME）, by using the ＇bottom-up＇ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.