摘要经肛门全直肠系膜切除术(taTME)是经肛门途径在内镜或腔镜下自下而上地游离直肠系膜进而进行全直肠系膜切除(TME)的新术式.该术式的提出是旨在解决既往TME手术对中下段直肠周围间隙的显露、远切缘的判定等问题,同时也是对完全微创手术的贯彻性实施.根据不同手术入路完成程度可分为:经腹腔镜辅助的taTME(hybrid taTME)以及完全经肛入路完成的taTME(pure taTME).目前适用于taTME的经肛门操作设备主要分为两种:经肛门内镜显微外科手术平台(TEM-TME)和经肛门微创手术平台(TAMIS-TME).目前,对于taTME的适应证尚无统一意见,对于解决一些特殊情况带来的手术困难,如中低位直肠癌,男性、肥胖和骨盆狭小患者,肿瘤浸润深度达到周围组织,肿瘤直径>4 cm,由于新辅助治疗导致组织面扭曲者以及难治性良性疾病方面具有潜在优势.禁忌证方面,目前认为梗阻性直肠肿瘤、 急诊手术和晚期肿瘤应视为taTME的禁忌证.近年来各中心已对taTME进行了一定的探索,初步经验表明该术式不仅安全可行,并且能获得满意的标本切除质量,同时减少了副损伤的发生,近年来成为结直肠外科医生关注的热点之一.但是,taTME目前仍处于起步阶段,各方专家对其褒贬不一,其远期效果仍然有待更多病例积累以及循证医学证据来验证.

abstractsTransanal total mesorectal excision (taTME) is a novel operative approach of the radical surgery for rectal cancer, and has been a hot topic in colorectal surgery for years. TaTME aims to solve some problems from previous TME, such as exposure of peripheral mid-lower rectal space, judge of distal cutting margin, and to carry out completely minimal invasive operation. According to the degree of completion of different surgical approach, taTME can be divided into laparoscopic assisted taTME (hybrid taTME) and fully through the anal approach to complete the taTME (pure taTME). At present, the anal operation equipment suitable for taTME is divided into two types: transnasal endoscopic microsurgical platform (TEM-TME) and transnasal minimally invasive surgical platform (TAMIS-TME). Until now, there is no consensus on the indications of taTME. For the treatment of some special circumstances resulting in surgical difficulties , such as low rectal cancer, male, obesity, patients with narrow pelvis, tumor depth of invasion to the surrounding tissue, tumor diameter > 4 cm, tissue distortions by neoadjuvant therapy and refractory benign disease, taTME has potential advantages. As for contraindications, obstructive rectal cancer, emergency surgery and advanced tumors should currently be regarded as contraindications of taTME. It was reported that taTME was safe and feasible, and had a satisfactory short-term outcomes in several centers in China. The operation is characterized by good TME quality, distal margin and circumferential margins, especially in overweight patients with narrow pelvis. The surgical principle is the eternal cornerstone to ensure the radical tumor resection and the safety of patients. The laparoscopic technique is widely used in China and surgeons are going to be skilled with laparoscopic surgeries for low rectal cancers. This situation postpones the development of taTME. It is challenging and disputing to advocate taTME to replace transabdominal laparoscopic surgery for low rectal cancer at recent times. If we have suitable instrument to dissect the root nodes and have the evidence from several ongoing clinical trials, we hope taTME could become a pure transanal approach because of its unique cosmetic superiority , without any abdominal invasive incisions.