腹腔镜超低位直肠癌保肛手术要点的再认识

Recognition of the gist of iaparoscopic sphincter- preserving surgery in ultra-low rectal cancer

腹腔镜技术的兴起已有20余年，如今融合了3D成像技术后，腹腔镜的微创优势被进一步放大。腹腔镜在直肠癌手术中的应用也得到广泛认可，特别是在超低位直肠癌手术中，高清的视野帮助外科医生充分了解了盆腔内的神经、筋膜等结构，让我们认识到超低位直肠癌保肛手术不仅仅要保留肛门的外形，更要注重功能的保护，这也对外科医生的手术技术提出了更高的要求。笔者结合自身经验及体会，从血管的处理、直肠后方的游离、盆腔植物神经的保护及肛门内外括约肌间沟的处理等方面对腹腔镜超低位直肠癌保肛手术中的一些关键技术要点进行再思考和再认识，以期在推动治疗规范化的同时，可以使更多的超低位直肠癌患者从中获益。

The laparoscopic technique has been applied for over 20 years and its superiority of minimally invasive surgery has been enlarged after combining with 3D technology. Application of this minimally invasive technology is widely acknowledged in rectal cancer surgery, especially in ultra-low rectal cancer. The surgeons can have a good view of the structure such as nerves, fascia in pelvic cavity sufficiently with the help of high definition vision, and recognize that not only the configuration of anus should be preserved but also its function. Therefore, a higher requirement on operative skill is made to the surgeons. In this article, based on our experience and realization, we reconsider and review the key technology of laparoscopic anus-preserving surgery in ultra-low rectal cancer from the aspects of vessel handling, retrorectal space mobilization, pelvic autonomic nerve preservation and intersphincteric groove management, aiming to promote standard treatment, and at the same time, to result in benefits for more patients with ultra-low rectal cancer.