低位直肠癌外科治疗的研究进展
Research Progress on Surgical Treatment of Low Rectal Cancer
DOI: 10.12677/acm.2025.1551375, PDF,   
作者: 王祯延：内蒙古医科大学第一临床医学院，内蒙古 呼和浩特；乌新林*：内蒙古医科大学附属医院胃肠外科，内蒙古 呼和浩特
关键词: 低位直肠癌；经肛门内镜显微手术；经自然腔道取标本手术；机器人辅助手术；外科治疗；Low Rectal Cancer； Transanal Endoscopic Microsurgery； Natural Orifice Specimen Extraction Surgery； Robot-Assisted Surgery； Surgical Treatment
摘要: 低位直肠癌因其解剖位置的特殊性和复杂性，在手术根治性切除、保肛及功能保留等方面面临诸多挑战。近年来随着微创技术的进步以及快速康复外科理念的普及，低位直肠癌的外科治疗取得飞跃性的进展。本文对于低位直肠癌外科治疗的现状进行总结，重点介绍了经肛门内镜显微手术(TEM)、经自然腔道取标本手术(NOSES)、精准功能保肛术以及机器人辅助直肠癌根治术等新一代低位直肠癌外科治疗技术，探讨其在提高手术根治性、保留器官功能和改善患者生活质量方面的优势与挑战。
Abstract: Due to its anatomical location and complexity, low rectal cancer presents numerous challenges in radical surgical resection, sphincter preservation, and functional retention. In recent years, with the advancement of minimally invasive techniques and the popularization of rapid rehabilitation surgery concepts, there has been a significant leap in the surgical treatment of low rectal cancer. This article summarizes the current status of surgical treatment for low rectal cancer, with a focus on introducing a new generation of surgical techniques for low rectal cancer, including transanal endoscopic microsurgery (TEM), natural orifice transluminal endoscopy (NOSES), precise sphincter-preserving surgery, and robot-assisted radical resection of rectal cancer. It explores the advantages and challenges of these new techniques in improving surgical radicality, preserving organ function, and enhancing patient quality of life.
文章引用：王祯延, 乌新林. 低位直肠癌外科治疗的研究进展[J]. 临床医学进展, 2025, 15(5): 335-341. https://doi.org/10.12677/acm.2025.1551375

参考文献

[1] Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R.L., Soerjomataram, I., et al. (2024) Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 74, 229-263. [Google Scholar] [CrossRef] [PubMed]
[2] 郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2024, 46(3): 221-231.
[3] Heald, R.J. and Ryall, R.D.H. (1986) Recurrence and Survival after Total Mesorectal Excision for Rectal Cancer. The Lancet, 327, 1479-1482. [Google Scholar] [CrossRef] [PubMed]
[4] 李昀昊, 林国乐. 经肛门内镜显微手术治疗直肠肿瘤的现状及进展[J]. 中华腔镜外科杂志(电子版), 2019, 12(6): 326-329.
[5] Lu, J., Lin, G., Qiu, H., Xiao, Y., Wu, B. and Zhou, J. (2015) Comparison of Transanal Endoscopic Microsurgery and Total Mesorectal Excision in the Treatment of T1 Rectal Cancer: A Meta-Analysis. PLOS ONE, 10, e0141427. [Google Scholar] [CrossRef] [PubMed]
[6] Benson, A.B., Venook, A.P., Al-Hawary, M.M., Azad, N., Chen, Y., Ciombor, K.K., et al. (2022) Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 20, 1139-1167. [Google Scholar] [CrossRef] [PubMed]
[7] Coco, C., Rizzo, G., Mattana, C., Gambacorta, M.A., Verbo, A., Barbaro, B., et al. (2013) Transanal Endoscopic Microsurgery after Neoadjuvant Radiochemotherapy for Locally Advanced Extraperitoneal Rectal Cancer: Short-Term Morbidity and Functional Outcome. Surgical Endoscopy, 27, 2860-2867. [Google Scholar] [CrossRef] [PubMed]
[8] Franklin, M.E., Ramos, R., Rosenthal, D. and Schuessler, W. (1993) Laparoscopic Colonic Procedures. World Journal of Surgery, 17, 51-56. [Google Scholar] [CrossRef] [PubMed]
[9] Palanivelu, C., Rangarajan, M., Jategaonkar, P.A. and Anand, N.V. (2008) An Innovative Technique for Colorectal Specimen Retrieval: A New Era of “Natural Orifice Specimen Extraction” (N.O.S.E). Diseases of the Colon & Rectum, 51, 1120-1124. [Google Scholar] [CrossRef] [PubMed]
[10] Ripollés-Melchor, J., Abad-Motos, A. and Zorrilla-Vaca, A. (2022) Enhanced Recovery after Surgery (ERAS) in Surgical Oncology. Current Oncology Reports, 24, 1177-1187. [Google Scholar] [CrossRef] [PubMed]
[11] Guan, X., Hu, X., Jiang, Z., Wei, Y., Sun, D., Wu, M., et al. (2022) Short-Term and Oncological Outcomes of Natural Orifice Specimen Extraction Surgery (NOSES) for Colorectal Cancer in China: A National Database Study of 5055 Patients. Science Bulletin, 67, 1331-1334. [Google Scholar] [CrossRef] [PubMed]
[12] 王锡山. 中国NOSES面临的挑战与展望[J]. 中华结直肠疾病电子杂志, 2018, 7(1): 2-7.
[13] 关旭, 王贵玉, 周主青, 等. 79家医院718例结直肠肿瘤经自然腔道取标本手术回顾性研究[J]. 中华结直肠疾病电子杂志, 2017, 6(6): 469-477.
[14] 中国医师协会结直肠肿瘤专业委员会, 中国医师协会结直肠肿瘤专业委员会, 中国NOSES联盟. 结直肠肿瘤经自然腔道取标本手术指南(2023版) [J]. 中华结直肠疾病电子杂志, 2023, 12(2): 89-99.
[15] Wang, S., Tang, J., Sun, W., Yao, H. and Li, Z. (2022) The Natural Orifice Specimen Extraction Surgery Compared with Conventional Laparoscopy for Colorectal Cancer: A Meta-Analysis of Efficacy and Long-Term Oncological Outcomes. International Journal of Surgery, 97, Article ID: 106196. [Google Scholar] [CrossRef] [PubMed]
[16] Masubuchi, S., Okuda, J., Yamamoto, M., Inoue, Y., Tanaka, K. and Uchiyama, K. (2021) Natural Orifice Specimen Extraction in Laparoscopic Colorectal Cancer Surgery: A Case Series Study. International Journal of Surgery Case Reports, 78, 204-209. [Google Scholar] [CrossRef] [PubMed]
[17] Liu, D., Luo, R., Wan, Z., Zhu, W., He, P., Ye, S., et al. (2020) Clinical Outcomes and Prognostic Factors of Robotic Assisted Rectal Cancer Resection Alone versus Robotic Rectal Cancer Resection with Natural Orifice Extraction: A Matched Analysis. Scientific Reports, 10, Article No. 12848. [Google Scholar] [CrossRef] [PubMed]
[18] Liu, R., Zhang, C., Fan, Y., Pei, J., Zhang, C. and Dai, D. (2019) Safety and Oncological Outcomes of Laparoscopic NOSE Surgery Compared with Conventional Laparoscopic Surgery for Colorectal Diseases: A Meta-Analysis. Frontiers in Oncology, 9, Article 597. [Google Scholar] [CrossRef] [PubMed]
[19] Korai, T., Akizuki, E., Okita, K., Nishidate, T., Okuya, K., Sato, Y., et al. (2021) Defecation Disorder and Anal Function after Surgery for Lower Rectal Cancer in Elderly Patients. Annals of Gastroenterological Surgery, 6, 101-108. [Google Scholar] [CrossRef] [PubMed]
[20] Zhang, J., Li, W., Li, Y., Amin, B., Zhang, N., Sun, Z., et al. (2022) Short-and Long-Term Outcomes as Well as Anal Function of Transanal Natural Orifice Specimen Extraction Surgery versus Conventional Laparoscopic Surgery for Sigmoid Colon or Rectal Cancer Resection: A Retrospective Study with over 5-Year Follow-Up. Videosurgery and Other Miniinvasive Techniques, 17, 344-351. [Google Scholar] [CrossRef] [PubMed]
[21] Costantino, F.A., Diana, M., Wall, J., Leroy, J., Mutter, D. and Marescaux, J. (2011) Prospective Evaluation of Peritoneal Fluid Contamination Following Transabdominal vs. Transanal Specimen Extraction in Laparoscopic Left-Sided Colorectal Resections. Surgical Endoscopy, 26, 1495-1500. [Google Scholar] [CrossRef] [PubMed]
[22] Zhou, S., Wang, X., Zhao, C., Zhou, H., Pei, W., Liang, J., et al. (2020) Can Transanal Natural Orifice Specimen Extraction after Laparoscopic Anterior Resection for Colorectal Cancer Reduce the Inflammatory Response? Journal of Gastroenterology and Hepatology, 35, 1016-1022. [Google Scholar] [CrossRef] [PubMed]
[23] Sun, G., Zang, Y., Ding, H., Chen, Y., Groothof, D., Gong, H., et al. (2023) Comparison of Anal Function and Quality of Life after Conformal Sphincter Preservation Operation and Intersphincteric Resection of Very Low Rectal Cancer: A Multicenter, Retrospective, Case-Control Analysis. Techniques in Coloproctology, 27, 1275-1287. [Google Scholar] [CrossRef] [PubMed]
[24] 中国医师协会结直肠肿瘤专业委员会, 中国抗癌协会大肠癌专业委员会, 中国NOSES研究协作组. 经自然腔道取标本之超低位直肠癌精准功能保肛(NOSES-PPS)手术操作标准(2024版) [J]. 中华胃肠外科杂志, 2024, 27(11): 1100-1106.
[25] Zhuang, C., Zhang, F., Wang, Z., Jiang, X., Wang, F. and Liu, Z. (2020) Precision Functional Sphincter-Preserving Surgery (PPS) for Ultralow Rectal Cancer: A Natural Orifice Specimen Extraction (NOSE) Surgery Technique. Surgical Endoscopy, 35, 476-485. [Google Scholar] [CrossRef] [PubMed]
[26] 庄成乐, 刘正, 张锋敏, 等. 经自然腔道取标本手术之精准功能保肛术操作要点[J]. 中华胃肠外科杂志, 2020, 23(6): 597-600.
[27] Khajeh, E., Aminizadeh, E., Dooghaie Moghadam, A., Nikbakhsh, R., Goncalves, G., Carvalho, C., et al. (2023) Outcomes of Robot-Assisted Surgery in Rectal Cancer Compared with Open and Laparoscopic Surgery. Cancers, 15, Article 839. [Google Scholar] [CrossRef] [PubMed]
[28] Liu, G., Zhang, S., Zhang, Y., Fu, X. and Liu, X. (2022) Robotic Surgery in Rectal Cancer: Potential, Challenges, and Opportunities. Current Treatment Options in Oncology, 23, 961-979. [Google Scholar] [CrossRef] [PubMed]
[29] Liu, Y., Gao, G., Liang, Y., Li, T. and Li, T. (2023) Safety and Feasibility of Robotic Surgery for Old Rectal Cancer Patients. Updates in Surgery, 75, 1161-1169. [Google Scholar] [CrossRef] [PubMed]
[30] Kojima, T., Hino, H., Shiomi, A., Kagawa, H., Yamaoka, Y., Manabe, S., et al. (2022) Comparison between Robotic‐assisted and Laparoscopic Sphincter‐preserving Operations for Ultra‐Low Rectal Cancer. Annals of Gastroenterological Surgery, 6, 643-650. [Google Scholar] [CrossRef] [PubMed]
[31] Khan, M.H., Tahir, A., Hussain, A., Monis, A., Zahid, S. and Fatima, M. (2024) Outcomes of Robotic versus Laparoscopic-Assisted Surgery in Patients with Rectal Cancer: A Systematic Review and Meta-Analysis. Langenbeck’s Archives of Surgery, 409, Article No. 269. [Google Scholar] [CrossRef] [PubMed]
[32] 唐博, 高庚妹, 邹震, 等. 机器人辅助与腹腔镜辅助中低位直肠癌根治术疗效比较的前瞻性随机对照研究[J]. 中华胃肠外科杂志, 2020, 23(4): 377-383.
[33] 朱家成. 达芬奇机器人结直肠癌根治术的近期疗效分析[D]: [硕士学位论文]. 长春: 吉林大学, 2023.
[34] 谭可. 机器人、经肛微创联合腹腔镜与传统腹腔镜直肠癌根治术疗效比较[D]: [硕士学位论文]. 重庆: 陆军军医大学, 2023.

为你推荐