摘要
超低位直肠癌是指瘤体下缘距离齿状线<2 cm的直肠肿瘤,手术是其主要治疗方法。对于侵犯肛提肌、肛门括约肌的超低位直肠癌患者,腹会阴联合切除术(abdominal-perineal resection,APR)、经肛提肌外腹会阴联合切除术(extralevator abdominoperineal excision,ELAPE)是主要的手术治疗方式。APR存在无法避免的“外科腰”的问题,ELAPE虽然切除了更多的肛提肌组织,减少了术中穿孔率和局部复发率,但面临更加困难的盆底重建工作。近年来,众多学者从手术入路、体位等方面开展了许多ELAPE改良术式,在临床应用中取得了令人满意的效果,但仍无法保肛。随着解剖学研究的深入和腹腔镜技术的不断发展,保肛手术如经括约肌间切除术(intersphincteric resection,ISR)、经肛全直肠系膜切除术(transanal total mesorectal excision,taTME)等不断开展。然而,保肛手术技术要求更高、学习曲线更长,术后并发症、远期肿瘤结局等情况仍需临床论证。为此,本文对超低位直肠癌的手术治疗方式的研究进展进行综述,旨在为临床医师选择合适的手术方式提供参考依据。
Rectal tumors located within 2 cm from the dentate line are classified as ultra-low rectal cancer,with surgery being the primary treatment approach.In patients who have ultra-low rectal cancer invading the levator ani muscle or anal sphincter,abdominoperineal resection(APR)or extralevator abdominoperineal excision(ELAPE)are the most common surgical procedures performed.The“surgical waist”is an unavoidable issue with APR.In spite of ELAPE's ability to remove more levator ani muscle tissue,which reduces intraoperative perforation and local recurrences,it poses the greater challenge of reconstructing the pelvic floor.In recent years,There have been various modifications made to ELAPE in terms of surgical approach and positioning that have achieved satisfactory results in clinical applications,however the anus has not yet been preserved.As anatomical research and laparoscopic technology advance,sphincter-preserving surgeries such as intersphincteric resection(ISR)and transanal total mesorectal excision(taTME)have been increasingly performed.It is important to note,however,that sphincterpreserving surgeries have higher technical demands,a longer learning curve,and postoperative complications as well as long-term oncological outcomes still need to be evaluated clinically.The aim of this article is to review the research progress of surgical treatments for ultra-low rectal cancer,to provide clinical physicians with a reference for selecting appropriate surgical treatments.
作者
孔令琪
郑相云
朱延袤
杨松
潘映雪
张焕虎
Kong Lingqi;Zheng Xiangyun;Zhu Yanmao;Yang Song;Pan Yingxue;Zhang Huanhu(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Department of Colorectal and Anorectal,Weihai Municipal Hospital Affilialed to Shandong University,264200,China;The Second Clinical College of Binzhou Medical College,Yantai 264003,China)
出处
《中华腔镜外科杂志(电子版)》
2024年第6期373-379,共7页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
威海市科技发展计划项目(2015GNS044-3)。
