Saito Norio, Ito Masaaki, Kobayashi Akihiro, Nishizawa Yusuke, Sugito Masanori
Colorectal Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Nihon Geka Gakkai Zasshi. 2011 Sep;112(5):318-24.
R0 resection, preservation of the anal sphincter, and local control are considered to be the most important target criteria in rectal cancer surgery. Many efforts have been made in recent years to increase the rate of sphincter preservation by performing pull-through operations, ultra-low anterior resection (U-LAR), and intersphincteric resection (ISR). U-LAR is the standard surgery for patients with lower rectal cancer to preserve anal function. Reconstruction in U-LAR is mainly performed using stapled anastomosis. Although conventional coloanal anastomosis makes it possible to preserve the anal sphincter, the mechanical methods are difficult. In that case, almost all the internal sphincter is preserved. The final options for preserving the sphincter are ISR and external sphincter resection (ESR). Although the internal sphincter is sacrificed partially, subtotally, or totally in ISR, and the external sphincter is resected partially or extensively in ESR, complete or incomplete anal function is maintained. However, the literature is not clear regarding long-term oncologic outcome and anal function after these procedures. The application of these surgical techniques can reduce the rate of abdominoperineal resection in very low rectal cancer. The indications for these procedures must be carefully determined based on tumor site and stage as well as the patient's own preference.
R0切除、保留肛门括约肌和局部控制被认为是直肠癌手术中最重要的目标标准。近年来，人们为提高保肛率做出了诸多努力，包括实施拖出式手术、超低位前切除术（U-LAR）和括约肌间切除术（ISR）。U-LAR是低位直肠癌患者保留肛门功能的标准手术。U-LAR中的重建主要采用吻合器吻合。尽管传统的结肠肛管吻合术能够保留肛门括约肌，但操作难度较大。在这种情况下，几乎保留了所有的内括约肌。保留括约肌的最终选择是ISR和外括约肌切除术（ESR）。尽管在ISR中部分、大部分或全部牺牲了内括约肌，在ESR中部分或广泛切除了外括约肌，但仍能维持完全或不完全的肛门功能。然而，关于这些手术后的长期肿瘤学结局和肛门功能，文献报道并不明确。这些手术技术的应用可以降低极低位直肠癌的腹会阴联合切除术的发生率。必须根据肿瘤部位、分期以及患者自身的偏好仔细确定这些手术的适应证。
