直肠癌极限保肛手术:经括约肌间切除术

Ultimate sphincter preserving surgery for rectal cancer: intersphincteric resection

近年来,直肠癌发病率正迅猛上升,我国中晚期患者占比高,总体诊治疗效欠佳,其中中低位直肠癌更是治疗难点,许多患者常因无法满足足够的阴性切缘而被迫切除肛门终生造瘘。经括约肌间切除术(ISR)手术是极限保肛手术,有其应用的严格适应证,并对术者操作技巧和经验要求高,国内尚未广泛普及。本文概述ISR手术解剖学基础、适应证以及肿瘤学和生理学结局。

In recent years, the incidence of rectal cancer has been rising rapidly. The proportion of the patients in middle and late stage is rather high, and the prognosis is poor in our country. Among them, the middle and lower rectal cancer is even more difficult to treat. Many patients are forced to remove the anus for life because of insufficient negative margins.Intersphincteric resection(ISR) is the ultimate sphincter preserving surgery for ultra-low rectal cancer. And it has strict indications for its application, and also requires high skill and experience of the operator. But it has not been widely popularized in China.This review aims to discuss the anatomical basis, indications, and oncological and physiological outcomes of ISR surgery.