中国普外基础与临床杂志

中国普外基础与临床杂志

低位直肠癌保肛手术的研究现状和展望

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目的 了解保肛手术在低位直肠癌中的研究现状。 方法 复习近年来关于保肛手术在低位直肠癌研究进展的相关文献并加以综述。 结果 以往手术治疗低位直肠癌主要以 Miles 术为主。随着解剖认识的深入、手术理念的改进以及微创技术的发展,低位直肠癌的治疗理念逐渐进入到保留肛门和保肛门功能的时代。目前,包括经肛门局部切除术、括约肌间切除术、经肛门全直肠系膜切除术等在内的众多手术方式可适用于低位直肠的保肛治疗,但各个手术方式的优缺点及适用范围却略有差异。 结论 尽管目前能够适用于低位直肠癌患者的手术方式众多,但没有任何一种能够在保留肛门及肛门功能、降低并发症和复发率、改善生存率等方面达到完美。相信随着外科医师们对直肠解剖的不断认识、各种新辅助放化疗和新型器械的出现,以及更多保肛术式乃至于人造肛门术式的发明,对于低位直肠癌的治疗也将更好兼顾保肛、保功能,从而让患者获得更高质量的长期生存机会。

Objective To investigate current status of anal sphincter preservation in low rectal cancer. Method Therecent literatures on the progress of anal sphincter preservation in the low rectal cancer were reviewed. Results In the past, the surgical treatment of the low rectal cancer was mainly based on the Miles. With the deepening of the anatomical understanding, the improvement of surgical concepts, and the development of minimally invasive techniques, the treatment concept of the low rectal cancer had gradually entered the era of retaining anal and anal function. At present, many surgical methods including the transanal local excision, intersphincteric resection, transanal total mesorectal excision, etc. could be applied to the anal sphincter treatment of the lower rectal cancer, but the advantages and disadvantages of each surgical procedure and the scope of application were slightly different. Conclusions Although there are many surgical procedures that can be applied to patients with low rectal cancer, none of them can achieve perfection in terms of retaining anal and anal functions, reducing complications and recurrence rates, and improving survival. It is believed that with continuous understanding of rectal anatomy by surgeons, emergence of various neoadjuvant chemoradiation and new devices, and invention of more anal sphincter and even artificial anal surgery, treatment of low rectal cancer will also be more good care for anal and maintenance functions, so that patients can obtain higher quality long-term survival opportunities.

关键词: 低位直肠癌; 保肛手术; 括约肌间切除术; 经肛门全直肠系膜切除术

Key words: low rectal cancer; anus-preserving; intersphincteric resection; transanal total mesorectal excision

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1. Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin, 1971, 21(6): 361-364.
2. Dixon CF. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Trans Meet Am Surg Assoc Am Surg Assoc, 1948, 66(Trans. 68. meeting): 175-192.
3. Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumours. Br J Surg, 1994, 81(9): 1376-1378.
4. Bregendahl S, Emmertsen KJ, Lous J, et al. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis, 2013, 15(9): 1130-1139.
5. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg, 1983, 70(3): 150-154.
6. Emile SH, de Lacy FB, Keller DS, et al. Evolution of transanal total mesorectal excision for rectal cancer: From top to bottom. World J Gastrointest Surg, 2018, 10(3): 28-39.
7. Cheregi CD, Simon I, Fabian O, et al. Mechanical suture in rectal cancer. Clujul Med, 2017, 90(3): 305-312.
8. Moore HG, Riedel E, Minsky BD, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol, 2003, 10(1): 80-85.
9. Martella A, Willett C, Palta M, et al. The selective use of radiation therapy in rectal cancer patients. Curr Oncol Rep, 2018, 20(6): 43.
10. Escal L, Nougaret S, Guiu B, et al. MRI-based score to predict surgical difficulty in patients with rectal cancer. Br J Surg, 2018, 105(1): 140-146.
11. Okafor PN, Swanson K, Shah N, et al. Endoscopic ultrasound for rectal cancer staging: A population-based study of utilization, impact on treatment patterns, and survival. J Gastroenterol Hepatol, 2018, 33(8): 1469-1476.
12. Liu Y, Lu XM, Tao KX, et al. Anatomical basis and clinical research of pelvic autonomic nerve preservation with laparoscopic radical resection for rectal cancer. J Huazhong Univ Sci Technolog Med Sci, 2016, 36(2): 211-214.
13. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
14. Nonaka T, Fukuda A, Maekawa K, et al. The feasibility and efficacy of laparoscopic extended total mesorectal excision for locally advanced lower rectal cancer. In Vivo, 2018, 32(3): 643-648.
15. Chen H, Ma B, Gao P, et al. Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis. World J Surg Oncol, 2017, 15(1): 229.
16. Williams NS, Murphy J, Knowles CH. Anterior perineal plane for ultra-low anterior resection of the rectum (the APPEAR technique): a prospective clinical trial of a new procedure. Ann Surg, 2008, 247(5): 750-758.
17. 刘宝华. 直肠癌局部切除术的国内外进展. 中国普外基础与临床杂志, 2011, 18(11): 1132-1134.
18. Skibber JM. Local excision for rectal cancer. J Natl Compr Canc Netw, 2005, 3(4): 531-539.
19. 夏立建. 直肠肿瘤局部切除技术的现状. 中华肿瘤防治杂志, 2008, 15(13): 961-964.
20. 邱辉忠, 林国乐, 吴斌, 等. Parks手术在低位直肠癌术中的保肛作用. 癌症进展, 2004, 2(6): 420-422.
21. 贾学军, 赵晓伟. 改良式Bacon术作为低位直肠癌器械吻合失败后补救手术的临床应用. 中国肿瘤临床, 2008, 35(4): 227-228.
22. 汪建平. 低位直肠癌术式选择及评价. 中国实用外科杂志, 2017, 37(6): 593-595.
23. 周宗进, 吴安定, 金朝霞, 等. 腹腔镜下低位直肠癌改良Bacon术临床应用分析. 临床外科杂志, 2017, 25(1): 67-69.
24. Kuo LJ, Hung CS, Wu CH, et al. Oncological and functional outcomes of intersphincteric resection for low rectal cancer. J Surg Res, 2011, 170(1): e93-e98.
25. Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol, 2014, 21 Suppl 3: S422-S428.
26. Dumont F, Ayadi M, Goéré D, et al. Comparison of fecal continence and quality of life between intersphincteric resection and abdominoperineal resection plus perineal colostomy for ultra-low rectal cancer. J Surg Oncol, 2013, 108(4): 225-229.
27. Park JS, Choi GS, Jun SH, et al. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg, 2011, 254(6): 941-946.
28. Kim CH, Lee SY, Kim HR, et al. Factors associated with oncologic outcomes following abdominoperineal or intersphincteric resection in patients treated with preoperative chemoradiotherapy: a propensity score analysis. Medicine (Baltimore), 2015, 94(45): e2060.
29. Kim HS, Ko S, Oh NG. Long-term results of extended intersphincteric resection for very low rectal cancer: a retrospective study. BMC Surg, 2016, 16: 21.
30. Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol, 2016, 20(7): 483-494.
31. 杨选华, 田云鸿, 黄斌, 等. 经肛门全直肠系膜切除术的研究进展. 中国普外基础与临床杂志, 2017, 24(11): 1408-1413.
32. Chouillard E, Regnier A, Vitte RL, et al. Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved? Tech Coloproctol, 2016, 20(8): 537-544.
33. Xu W, Xu Z, Cheng H, et al. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: A meta-analysis. Eur J Surg Oncol, 2016, 42(12): 1841-1850.
34. Penna M, Hompes R, Arnold S, et al. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg, 2017, 266(1): 111-117.
35. Tuech JJ, Karoui M, Lelong B, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg, 2015, 261(2): 228-233.
36. Meillat H, de Chaisemartin C, Poizat F, et al. Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study. Tech Coloproctol, 2017, 21(1): 43-51.
37. Al Furajii H, Kennedy N, Cahill RA. Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy. J Minim Access Surg, 2017, 13(1): 7-12.