摘要
经肛全直肠系膜切除术（taTME）是当前外科治疗直肠癌的新热点，但如何规范化开展taTME亟待解决。只有具备熟练的腔镜技术和盆腔解剖知识，全面掌握taTME技术细节，并按要求经医疗部门备案批准后才可以谨慎开展，建议选择70岁以下女性，肿瘤下缘位于距肛缘5~ 7 cm，肿瘤〈 3 cm，术前临床分期T3aN0以下的患者开展。该手术所需器械为常规的腹腔镜器械，肛门拉钩，经肛操作通道以及能提供恒定压力的气腹机。手术方式包括完全经肛，联合腹腔镜经肛和序贯方法经肛三种方式，联合腹腔镜经肛方法具备腹腔镜和经肛手术两者的优势，易于开展。taTME手术具备更加微创和术后快速恢复的优点，符合快速康复外科的理念。本文从术前准备，病例选择，器械要求，手术要点，围术期管理，术后康复等方面就该问题进行了阐述，旨在帮助结直肠外科医生更快更好地开展taTME手术，缩短学习曲线，减少并发症的发生，使患者获益。
Transanal total mesorectum excision （taTME） is a novel approach to treat rectal cancer by colorectal surgeons. How to standardize taTME is important for colorectal surgeons, especially at their initial attempt. They can start this approach cautiously only after they master skilled laparoscopic technique and pelvic anatomy, get the knowledge of taTME clearly, and are approved by healthcare department. The female patients with age 〈 70 years old, distance of 5 to 7 cm from tumor inferior margin to anal verge, tumor size 〈 3 cm, cTNM stage〈 T3aN0 are suitable for taTME. The instruments include laparoscopic equipment, anal retractor, anal pathway insufflator with constant pressure. There are three operative approaches, such as pure, combined laparoscopic hybrid and sequential hybrid taTME. The combined approach is easier to perform because it has advantages both of laparoscopic and transanal pathway. TaTME has the advanctages of less invasiveness and fast postoperative recovery, which is in accordance with the concept of enhanced recovery after surgery. This paper discusses the taTME from the following aspects： preoperative preparation, case selection, surgical instruments, surgical skills and perioperative management. We aim to help the colorectal surgeons to initiate taTME earlier, shorten the learning curve, and decrease the complications, resulting in benefits to patients.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第8期862-864,共3页
Chinese Journal of Gastrointestinal Surgery
基金
中山大学医学临床研究5010计划项目（2016005）
中央高校基本科研业务费专项资金资助（16ykjc25）
关键词
直肠肿瘤
经肛全直肠系膜切除
规范化
Transanal total mesorectal excision
Rectal neoplasms
Standadize
