拖出式二期结-肛吻合在低位直肠癌中的应用及思考

The clinical application and consideration of delay colo-anal anastomosis by pull-through in low rectal cancer

随着微创平台的创新、微创技术的提高及多学科团队协作(MDT)应用,低位直肠癌保肛患者越来越多,与手术相关的并发症(吻合口漏、盆腔慢性感染、直肠阴道瘘等)也相应增多。拖出式二期结-肛吻合近些年来临床应用逐渐增多,由于将近断端肠管拖出肛门外二期进行吻合,与直接一期结-肛吻合比较,并不增加围手术期并发症的发生率,避免了预防性造口,降低了住院费用,提升了生活质量,远期的肛门功能和肿瘤学效果满意,尽管这种手术方式有一定的优点,但也存在一定的争议和质疑,本文结合文献及笔者团队近三年开展的临床病例资料,就此种手术的命名方式、适应证选择、相关并发症、肛门功能及肿瘤学效果进行客观评价,仅供临床读者参考。

With the innovation of minimally invasive platform,the improvement of minimally invasive technology and the application of MDT,the numbers of postoperative anal-preserving surgery patients with low rectal cancer is increasing,and the complications related to surgery(anastomotic leaking,chronic pelvic infections,recto-vaginal fistulae)are also increasing accordingly.The clinical application of delay colo-anal anastomosis by pull-through has been increasing in recent years.Compared with immediate colo-anal anastomosis,delay colo-anal anastomosis does not increase the incidence of perioperative complications,avoids a prophylactic stoma,reduces hospitalization costs,improves quality of life,and has satisfactory long-term anal function and oncology results.Although this method has certain advantages,it also has certain controversies and doubts.Based on the literature and clinical cases carried out by the author's team in the past 3 years,this paper objectively evaluated the nomenclature,indication selection,related complications,anal functional and oncological results for the reference of clinical readers.