Minimally Laparoscopic Total Mesorectal Excision with Anal Sphincter Preservation for Low Rectal Cancer: Opportunity, Challenge_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

周总光

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Keywords：

直肠癌; 微创外科

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直肠癌的发病率逐年上升，居消化道恶性肿瘤之首；低位直肠癌位于腹膜返折以下，约占直肠癌总数的70%，其中约2/3属低位直肠癌患者需实施切除肛门的改道手术。所以，提高肿瘤切除率、降低局部复发率、提高5年生存率、提高保肛率及改善患者术后的生活质量一直是普外学科努力的方向。全直肠系膜切除术(total mesorectal excision, TME)这一具有划时代意义的创新术式，应用于临床20余年，降低了局部复发率，提高了5年生存率及保肛率，已为越来越多的结、直肠外科医生作为直肠癌治疗的金标准。随着TME理念的深入和腹腔镜技术的发展，腹腔镜全直肠系膜切除术（laparoscopic total mesorectal excision，LTME）及其保肛术式正在兴起，前瞻性临床研究已显示出良好的应用前景。

Citation： 周总光. Minimally Laparoscopic Total Mesorectal Excision with Anal Sphincter Preservation for Low Rectal Cancer: Opportunity, Challenge. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(2): 100-102. doi: Copy

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1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgerythe clue to pelvic recurrence? [J]. Br J Surg， 1982; 69(10)∶613.
2. Heald RJ. Total mesorectal exsicion (TME) [J]. Acta Chir Iugosl， 2000; 47(4 Suppl 1)∶17.
3. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer [J]. N Engl J Med， 2001; 345(9)∶638.
4. Morita T, Suzuki J, Yoshizaki T, et al. Sphincterpreserving surgery for lower rectal cancer aimed at improving postoperative bowel function [J]. Nippon Geka Gakkai Zasshi， 2000; 101(6)∶459.
5. Wagman R, Minsky BD, Cohen AM, et al. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term followup [J]. Int J Radiat Oncol Biol Phys， 1998; 42(1)∶51.
6. Idani H, Narusue M, Kin H, et al. Laparoscopic low anterior resection using a triple stapling technique [J]. Surg Laparosc Endosc Percutan Tech， 1999; 9(6)∶399.
7. Reynolds JV, Joyce WP, Dolan J, et al. Pathological evidence in support of total mesorectal excision in the management of rectal cancer [J]. Br J Surg， 1996; 83(8)∶1112.
8. Hartley JE, Mehigan BJ, Qureshi AE, et al. Total mesorectal excision: assessment of the laparoscopic approach [J]. Dis Colon Rectum， 2001; 44(3)∶315.
9. Chung CC, Ha JP, Tsang WW, et al. Laparoscopicassisted total mesorectal excision and colonic J pouch reconstruction in the treatment of rectal cancer [J]. Surg Endosc， 2001; 15(10)∶1098.
10. Idani H, Narusue M, Kin H, et al. Laparoscopic low anterior resection using a triple stapling technique [J]. Surg Laparosc Endosc Percutan Tech， 1999; 9(6)∶399.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Minimally Laparoscopic Total Mesorectal Excision with Anal Sphincter Preservation for Low Rectal Cancer: Opportunity, Challenge

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