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中华结直肠疾病电子杂志

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:
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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]. 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]. 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。

关键词: 直肠肿瘤, 肛管, 低位直肠癌, 内括约肌切除术, 功能, 预后

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.

Key words: Rectal neoplasms, Anal canal, Low rectal cancer, Intersphincteric resection, Function, Prognosis
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
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