经肛全直肠系膜切除术中的关键技术及解剖标记

The crucial techniques and anatomic markers in transanal total mesorectal excision

经肛全直肠系膜切除术(taTME)是近年来结直肠外科领域的热点技术,由于该技术对低位直肠癌处理上有着明确肿瘤下切缘、先隔离肿瘤病灶等优势,逐渐得到越来越多的结直肠外科医生的关注。然而,由于该技术应用尚不十分广泛,有丰富经验的医生并不多。本文总结中山大学附属第六医院开展taTME的经验,将该手术的关键技术归纳为经肛入路手术和单孔腔镜技术以及"由里往外"、"自下而上"的黏膜外科理念,并分享荷包缝合技术、螺旋式方法游离等操作细节,以及联合纵肌、前后方标记及筋膜下神经血管等解剖学标记,旨在帮助刚开展taTME手术的结直肠外科医生尽快掌握手术要领,使更多的患者获益。

Transanal total mesorectal excision (taTME) for rectal cancer is a hot spot in the field of colorectal surgery in recent years, because this technique has the advantages of clear distal margin, early separation of tumor leision, in the treatment of low rectal cancer. However, this technique is not popularized yet, and there are only a few colorectal surgeons who have enough experience. This article shares the experience of taTME in our hospital, including the details of purse string suture, spiral dissection of rectum, and the anatomic markers of anterior and posterior of rectum, conjoined longitudinal muscle and capillary of pelvic nerves locating in pelvic fascia. We sum up the crucial techniques as transanal operation, single port endoscopic technique and mucosal surgical principle (from inside to outside and from bottom to top), aiming to help colorectal surgeons to grasp the essentials of the techniques with initial cases as soon as possible, and to shorten the learning curve, so that more and more patients can benefit.