经肛全直肠系膜切除术会成为腹腔镜低位直肠癌手术的主角还是配角

Transanal total mesorectal excision in laparoscopic surgery for lower rectal cancer: leading actor or supporting actor

经肛全直肠系膜切除术(taTME)已成为当前结直肠外科手术中的一个热点话题。其对于中低位直肠癌,尤其是男性、肥胖和骨盆狭窄患者的直肠系膜间隙术野显露有一定优势,但能达到全直肠系膜切除(TME)根治要求的低位taTME手术,适应证范围非常有限。在管理和规范上,严格掌握手术指征,初期开展时应选择早期、真正存在困难因素的中低位直肠癌病例。在当前情况下,taTME不论是手术技术,还是手术设备平台与器械,均未达到充分成熟的阶段,术中和术后并发症发生率较高。因此,现阶段taTME临床实践的重点应放在适应证的把握、手术技术的规范、设备的改良以及培训体系的完善等方面,切忌为了taTME而taTME。技术开展应仅限于临床研究,并有待高质量循证医学证据的结果加以证实。就目前而言,taTME可作为传统腹腔镜低位直肠癌手术的一项技术补充。相信在规范化的手术开展和高质量的数据积累之后,taTME的价值与地位将会得到一个公允的评价。

Transanal total mesorectal excision (taTME) is a hot topic currently in colorectal surgery. It has several advantages for lower rectal cancer, especially for male obese patients with narrow pelvis. But the indication of taTME which can really achieve the completeness of TME is limited. In terms of management and regulation, it is necessary to strictly control the indications for surgery. In the initial stage of development, patients with lower rectal cancer, with early stage and real difficulties in laparoscopy should be selected. TaTME is still premature in terms of technique, devices and instruments, with relative higher morbidity in its current form. We should pay more attentions to the safety of taTME to avoid the complications. Also, we should pay more attentions to indication and standardization of techniques, the improvement of instruments and training program of the technique. TaTME should be operated in large teaching hospitals for research purpose in the initial stage. Only with the high-quality evidence of clinical trials, can the technique be spread widely. Now, taTME is still a complementary technique to traditional abdominal surgery for lower rectal cancer. With the accumulation of standardized technique and high-quality of clinical evidence, the value of taTME will be assessed fairly.