切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 622 -626. doi: 10.3877/cma.j.issn.2095-3224.2019.06.014

所属专题: 文献

综述

内括约肌切除术在低位直肠癌保肛中的应用
刘佳文1, 汤东2, 王道荣2,()   
  1. 1. 116044 大连医科大学研究生院
    2. 225001 扬州大学临床医学院(江苏省苏北人民医院)普通外科、扬州市普通外科研究所
  • 收稿日期:2018-10-23 出版日期:2019-12-25
  • 通信作者: 王道荣
  • 基金资助:
    江苏省重点病种规范化诊疗项目(No.BE2015664)

The application of intersphincteric resection in preserving sphincter function for low rectal cancer

Jiawen Liu1, Dong Tang2, Daorong Wang2,()   

  1. 1. Graduate School, Dalian Medical University, Dalian 116044, China
    2. Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People′s Hospital, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
  • Received:2018-10-23 Published:2019-12-25
  • Corresponding author: Daorong Wang
  • About author:
    Corresponding author: Wang Daorong, Email:
引用本文:

刘佳文, 汤东, 王道荣. 内括约肌切除术在低位直肠癌保肛中的应用[J/OL]. 中华结直肠疾病电子杂志, 2019, 08(06): 622-626.

Jiawen Liu, Dong Tang, Daorong Wang. The application of intersphincteric resection in preserving sphincter function for low rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 622-626.

直肠癌是我国最常见的消化道恶性肿瘤之一,且以中低位多见,对于距肛门低于5 cm的低位直肠癌,过去常规行腹会阴联合切除术(APR),不仅手术创伤大,而且永久性造口也为患者生理和心理带来极大的痛苦。近年来随着对直肠癌特点的深入认识、术前新辅助治疗的开展及手术器械和术者技术的发展,在肿瘤根治的前提下,吻合口的位置也不断地向更低的位置挑战,功能保护和改善术后生活质量已成为低位直肠癌治疗的重要目标。内括约肌切除术(ISR)为低位直肠癌患者带来了更多保肛的机会,并且其根治效果及肛门功能皆令人满意。本文将对ISR的研究现状及进展、肿瘤学和功能预后等作一综述。

Rectal cancer is one of the most common gastrointinal malignant tumors, and mid-low rectal cancer is more common in China. For low rectal cancers from the anus less than 5 cm, conventional abdominoperineal resection (APR) has not only complicated surgical trauma, but also the coloproctia brings great pain to the patient. In recent years, with the deeper understanding of the characteristics of rectal cancer, the application of neoadjuvant and the development of surgical instruments and technic, on the basis of radical tumor resection, the anastomosis has been continuously challenged to a lower position. Functional protection and improved quality of life have become important targets for the treatment of low rectal cancer. The intersphincteric resection (ISR) has brought more opportunities for preserving the sphincter function in some patients with low rectal cancer. Its oncological outcomes and anal function are acceptable. The purpose of this paper was to review the status and progress of ISR, evaluate current evidence regarding oncological and functional outcomes after ISR for low rectal cancer.

图1 ISR手术分型。1A:①部分ISR;②次全ISR;③完全ISR;1B:④保留部分齿状线的改良ISR
图2 低位直肠癌Bordeaux分型[14]。2A:Type I:肛管上型;2B:Type Ⅱ:近肛管型;2C:Type Ⅲ:肛管内型;2D:Type Ⅳ:经肛管型。AR表示肛直肠环;DL表示齿状线;AV表示肛缘
[1]
王磊,刘志华,汪建平. 我国结直肠癌的诊疗现状[J]. 中华实验外科杂志, 2015, 32(4): 677-679.
[2]
Tytherleigh MG, McC Mortensen NJ. Options for sphincter preservation in surgery for low rectal cancer [J]. British Journal of Surgery, 2010, 90(8): 922-933.
[3]
王振军. 直肠癌手术方法的进展[J]. 中华外科杂志, 2010, 48(21): 1610-1612.
[4]
Braun J, Treutner KH, Winkeltau G, et al. Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma [J]. American Journal of Surgery, 1992, 163(4): 407-412.
[5]
Akagi Y, Kinugasa T, Shirouzu K. Intersphincteric resection for very low rectal cancer: a systematic review [J]. Surgery Today, 2013, 43(8): 838-847.
[6]
Kawada K, Hida K, Hasegawa S, et al. A comparison of the long-term anorectal function between laparoscopic intersphincteric resection and low anterior resection for low rectal cancer [J]. Surgery Today, 2018, 48(10): 921-927.
[7]
Matsuhashi N, Takahashi T, Tanahashi T, et al. Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor [J]. Oncology Letters, 2017, 14(4): 4142-4150.
[8]
Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: An active approach to avoid a permanent colostomy [J]. Diseases of the Colon & Rectum, 2004, 47(4): 459-466.
[9]
Chi P, Huang SH, Lin HM, et al. Laparoscopic transabdominal approach partial intersphincteric resection for low rectal cancer: surgical feasibility and intermediate-term outcome [J]. Annals of Surgical Oncology, 2015, 22(3): 1-8.
[10]
Rullier E, Denost Q, Vendrely V, et al. Low rectal cancer: classification and standardization of surgery [J]. Diseases of the Colon & Rectum, 2013, 56(5): 560-567.
[11]
黄颖,池畔. 低位直肠癌行腹腔镜内括约肌切除术技巧与要领[J]. 中国实用外科杂志, 2017, 37(6): 695-698.
[12]
王振军,韩加刚. 内括约肌切除术治疗超低位直肠癌研究进展[J]. 中华普通外科杂志, 2017, 32(1): 1-4.
[13]
Han JG, Wei GH, Gao ZG, et al. Intersphincteric resection with direct coloanal anastomosis for ultralow rectal cancer: the experience of People′s Republic of China [J]. Diseases of the Colon & Rectum, 2009, 52(5): 950-957.
[14]
Denost Q, Rullier E. Intersphincteric resection pushing the envelope for sphincter preservation [J]. Clinics in Colon & Rectal Surgery, 2017, 30(5): 368-376.
[15]
池畔,林惠铭,卢星榕,等. 腹腔镜经盆腔入路括约肌问超低位直肠前切除术治疗直肠癌可行性研究[J]. 中国实用外科杂志, 2010(3): 203-205.
[16]
Fukunaga Y. Superiority of laparoscopic rectal surgery: Towards a new era [J]. World Journal of Gastrointestinal Surgery, 2011, 3(10): 142-146.
[17]
Thompson-Fawcett M, Warren BN. A new look at the anal transitional zone with reference to restorative protocolectomy and the columnar cuff [J]. Br J Surg, 1998, 85(11): 1517-1521.
[18]
黄平. 直肠癌保肛术式的评价[J/CD]. 中华结直肠疾病电子杂志, 2016, 5(3): 204-209.
[19]
Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection[J]. Annals of Surgery, 2009, 249(2): 236-242.
[20]
Akasu T, Takawa M, Yamamoto S, et al. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma [J]. Journal of Gastrointestinal Surgery, 2010, 14(1): 104-111.
[21]
Zhang X, Wu Q, Hu T, et al. Laparoscopic versus conventional open surgery in intersphincteric resection for low rectal cancer: A systematic review and meta-analysis [J]. Journal of Laparoendoscopic & Advanced Surgical Techniques, 2017, 28(2): 189-200.
[22]
Salamone G, Licari L, Agrusa A, et al. Usefulness of ileostomy defunctioning stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis [J]. Annali Italiani Di Chirurgia, 2016, 87(2): 155.
[23]
左志贵,宋华羽,徐昶, 等. 保护性造口在超低位直肠肿瘤内括约肌切除术中的价值[J]. 中华外科杂志, 2010, 48(19): 1479-1483.
[24]
Kim JC, Yu CS, Lim SB, et al. Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients [J]. International Journal of Colorectal Disease, 2015, 30(10): 1-11.
[25]
Molnar C, Vladolimpiu B, Marian B, et al. Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results [J]. Journal of International Medical Research, 2018, 46(4): 1617-1625.
[26]
Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer [J]. British Journal of Surgery, 2012, 99(7): 918-928.
[27]
Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer [J]. Annals of Surgical Oncology, 2014, 21(3): 422-428.
[28]
Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy [J]. Cochrane Database Syst Rev, 2005, 12(12): CD004323.
[1] 陈芬, 葛贝贝, 王小贤, 李明霞, 徐芳, 史坚, 郭冠军, 方爱娟, 史中青, 戚占如, 陈慧, 姚静. 左束支传导阻滞性心肌病心脏电-机械重构的实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 978-985.
[2] 杜祖升, 赵博文, 张帧, 潘美, 彭晓慧, 陈冉, 毛彦恺. 应用二维斑点追踪成像技术评估孕周及心尖方向对中晚孕期正常胎儿左心房应变的影响[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 843-851.
[3] 莫莹, 李文秀, 李刚, 王霄芳, 王强, 丁文虹. 超声心动图在三尖瓣下移畸形中的临床应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 702-708.
[4] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[5] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[6] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[7] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[8] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[9] 张洁, 罗小霞, 余鸿. 系统性免疫炎症指数对急性胰腺炎患者并发器官功能损伤的预测价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 68-71.
[10] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[11] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[12] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[13] 张朝军, 袁新普. 腹腔镜辅助低位直肠癌根治术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 602-602.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 张家珺, 张海涛, 苏菲菲. 径向壁应变分析在冠心病诊疗中的应用[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 687-691.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?