摘要肠道吻合是中低位直肠手术的重点之一,尤其对于男性、肥胖、狭小骨盆腔、或新辅助放化疗后等存在困难因素的患者.经肛全直肠系膜切除术(taTME)进行肠道吻合的原则与经腹全直肠系膜切除术(TME)一致,即以肿瘤的位置为主要考虑因素,来决定是以圆形吻合器还是经肛手工缝合来完成吻合.由于taTME只需使用圆形吻合器完成吻合,与经腹TME手术相比,可降低缝合钉交错区域发生血流供应不良的风险.经肛的荷包缝合部分是影响吻合口成败的关键因素之一,taTME术中进行远端荷包缝合时需注意:(1)缝合前,将待吻合的远端肠管与周围软组织分开,并确保远端荷包缝合的全层缝合;(2)建议初学者在不移除经肛平台的情况下,直视下完成远端荷包缝合;(3)常用的吻合设计包括端对端、边对端、J型储存袋或是结肠成型术等,可根据患者条件和手术医师的偏好而定.根据本中心的临床经验,笔者建议,对于术前接受长期新辅助放化疗、或经肛手工缝合完成肠道吻合的患者,接受taTME保肛手术后应常规做临时肠造口.然而,根据目前国际上现有的研究,taTME在肠道吻合口方面并未展现出明显的安全优势.本文围绕taTME肠道吻合的技术要点和安全性,结合笔者临床经验进行分享,以期为taTME的开展提供参考.

abstractsColorectal anastomosis remains a key aspect in mid?and lower?rectal surgery, particularly in patients who are male, obese, status post neoadjuvant chemoradiation, or possess narrow pelvic anatomy. Transanal total mesorectal excision (taTME) and transabdominal total mesorectal excision (TME) both primarily allow position of the tumor to dictate whether circular stapling or hand?sewing is utilized to achieve anastomosis. Given that taTME only requires a single circular stapler to achieve anastomosis, it consequently decreases the risk of jeopardizing blood supply to the anastomotic site. Should transanal hand?sewing be pursued, numerous points in performing the purse?string suture warrant particular attention: (1) Before suturing, separate the distal rectum to be anastomosed from the surrounding tissues, and ensure the full?layer suture of the distal purse?stitched suture. (2) It is recommended that beginners complete the suturing process under direct visualization without removing the transanal platform. (3) Commonly used anastomosis designs include end?to?end, side?to?end, J?pouch, or coloplasty, depending on patient characteristics and surgeon preferences. Our single?institution clinical experience suggests that taTME patients who underwent neoadjuvant chemoradiation or transanal hand?sewn anastomosis should still have a temporary colostomy created. To date,literature has yet to demonstrate the superiority of taTME anastomosis outcomes. This publication aims to point out anastomosis techniques and safety pointers, as well as clinical experiences.