探讨腹腔镜经括约肌间切除治疗超低位直肠癌的优势及技术要点。

对38例超低位直肠癌患者采用腔镜经括约肌间切除术治疗，记录手术时间、术中出血量、术后并发症、远切缘距离、环周切缘、清扫淋巴结数目及术后肛门功能情况。

38例患者均顺利完成手术，31例行部分内括约肌切除术，6例行次全内括约肌切除术，1例行全内括约肌切除术。术中出血平均168 ml（73~263 ml），手术时间平均260 min（190~330 min），远切缘距肿瘤下缘距离平均1.56 cm（0.93~2.19 cm），切缘均阴性。术后吻合口漏5例，吻合口狭窄6例，经保守治疗后痊愈。无盆腔或吻合口局部复发病例，其中1例患者术后4个月复查发现肝转移行肝转移癌切除术。术后3、6、12个月时分别有73.3%、83.3%和96.7%的患者达到肛门功能良好。

腹腔镜ISR手术增加了超低位直肠癌患者保肛的手术机会，选择合适的病例，严格规范的手术操作是获得良好的远期效果的前提。

The paper is to discuss the advantages and technical essentials of laparoscopic inter-sphincter resection for ultra-low rectal cancer.

A total of 38 patients with ultra-low rectal cancer underwent laparoscopic inter-sphincter resection.

A total of 38 patients completed surgeries successfully, including 31 cases with partial internal sphincter resection, 6 cases with subtotal resection and 1 case with total resection. The average intraoperative bleeding amount was 168 ml (73~263 ml); the average operation time was 260 min (190~330 min); all incisal margins were negative; and the average distance from a incisal margin to tumor inferior margin was 1.56 cm (0.93~2.19 cm). There were 5 cases with postoperative anastomotic leak and 6 cases with anastomotic stenosis, and all the cases were healed with conservative treatment. No case presented pelvic or anastomotic local relapse. At 4-mo review, 1 case showed hepatic metastases and underwent hepatic metastasis resection. At 3-mo, 6-mo and 12-mo after operation, 73.3%, 83.3% and 96.7% patients obtained good functions.

With good radical therapeutic outcomes for tumor and well preserved anus function, Laparoscopic inter-sphincter resection (ISR) increase possibility of anus-preserving operation in ultra-low rectal cancer patients. Selecting proper case and standardizing operational procedures are preconditions to achieve good long-term outcomes.