Review of transanal total mesorectal excision in the treatment of rectal cancer
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摘要: 长久以来，结直肠外科医师一直不断探索直肠癌的治疗方法，尽可能地提升患者的生存质量，不断提高直肠癌的治疗效果。其中低中位的直肠癌常见于中国患者，而关于低中位直肠癌的治疗，目前比较成熟的有经肛门全直肠系膜切除(transanal total mesorectal excision，TaTME)、括约肌间切除术(intersphincteric resection，ISR)、Miles术(腹会阴联合切除术，abdominoperineal resection，APR)、Hartmann术(肿瘤切除远端封闭，近端造口)、经肛门的局部切除、Parks术(结肠-肛管吻合术)、腹会阴柱状切除术(extralevator abdominoperineal excision，ELAPE)、Dixon术(低位直肠癌前切除术)、Bacon术(结肠经肛拖出吻合术)、经骶后入路的局部切除等，不同的术式应用于不同症状的直肠癌。而对于肿瘤巨大、系膜肥大、骨盆狭窄等具有“困难骨盆”的低位直肠癌患者，经肛门全直肠系膜切除术(tTaTME)因为能够精确定位患者病灶切缘、肛管内括约肌和中低位直肠膜间隙，有效降低手术并发症的风险，控制复发率，改善生存率，得到了结直肠外科医师的青睐和认可。但是经肛门全直肠系膜切除术(TaTME)需要医师们有足够的腹腔镜和经肛门手术经验，并受限于目前腹腔镜设备和器械的发展。本文就经肛门全直肠系膜切除术(TaTME)的发展起源、运用，优势和劣势及未来展望方面进行综述，期望为这方面研究和实践提供一点理论依据和经验证据。
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关键词:
- 直肠癌 /
- 经肛门全直肠系膜切除术 /
- 综述
Abstract: For a long time, colorectal surgeons have been continuously exploring the treatment of rectal cancer and improving the quality of life of patients and the therapeutic effect of rectal cancer. Low and median rectal cancer is common in Chinese patients. The current surgical operations used in the treatment of low and median rectal cancer include transanal total mesorectal excision (TaTME), ISR, Miles, APR, Hartmann, Parks, ELAPE and Dixon. Different surgical procedures are used in rectal cancer with different symptoms. For low rectal cancer patients with "difficult pelvis" such as huge tumor, mesangial hypertrophy and pelvic stenosis, TaTME can accurately locate the margin of the lesion, internal sphincter space in the anal canal and middle and low rectal membrane space. It can effectively reduce the risk of surgical complications, control the recurrence rate and improve the survival rate, which has been favoured and recognised by colorectal surgeons. However, TaTME requires doctors to have sufficient experience in laparoscopic and transanal surgery and is limited by the current development of laparoscopic equipment and instruments. In this paper, the developmental origin, application, advantages and disadvantages of TaTME and its future prospects are reviewed to provide some theoretical basis and empirical evidence for this research and practice.-
Key words:
- Rectal cancer /
- Transanal total mesorectal excision /
- Review
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表 1 TaTME的优势和劣势
项目 内容 优势 1.可确保足够的远切缘和环周切缘。
2.无切口，杜绝并发症。
3.可获得足够的可视化空间。
4.减少手术时间并可保护重要的结构。
5.提高解剖平面能力。劣势 1.学习曲线长。
2.完全TaTME不能彻底探查腹腔。
3.不能先处理结扎供血管根部。
4.操作难度大。
5.腹腔镜辅助TaTME存在CO2栓塞的风险。
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