经肛门全直肠系膜切除术研究进展

Research progress of transanal total mesorectal excision

低位直肠癌的治疗方式不仅仅要考虑肿瘤的完整切除,保留肛门生理功能也是一个至关重要的问题。随着对直肠肛管以及盆底肌肉神经局部解剖生理研究的深入,伴随医疗技术的进步,针对低位直肠癌保肛的各种手术方式应运而生,目前较为成熟的手术方式主要有结肠肛管吻合术(Parks术)、经括约肌间切除术(ISR)、经肛门全直肠系膜切除术(TaTME)等。其中,TaTME是体现经自然腔道内镜外科手术(NOTES)的一种理念和手术方式。目前关于TaTME在直肠恶性肿瘤中应用的安全性及有效性在国际上尚存在一定争议,本综述旨在通过查阅国内外现有关于TaTME的相关文献,总结探讨TaTME在低位直肠瘤治疗中的安全性、有效性以及未来的发展趋势。

The treatment of low rectal cancer should not only consider the complete resection of the tumor,but also preserve the physiological function of the anus.With the in-depth research on the local anatomy and physiology of the proctoanal canal and pelvic floor muscles and nerves,along with the progress of medical technology,various surgical methods for preserving anus in low rectal cancer have emerged.At present,the mature surgical methods mainly include colon-anal anastomosis(Parks),transsphincterectomy(ISR),transanal total mesorectal excision(TaTME)and so on.Among them,TaTME represents a concept and surgical method of natural orifice endoscopic surgery(NOTES).At present,there is sill some controversy about the safety and efficacy of TaTME in the treatment of rectal cancer.This review aims to summarize and discuss the safety,efficacy and future development trend of TaTME in the treatment of low rectal cancer by referring to the existing literature on TaTME at home and abroad.