PDF《中国经肛腔镜手术专家共识（2019 版）》

经肛全直肠系膜切除;

经 肛腔镜手术 基金项目: 中央高校基本科研业务费专项资金项目 (16ykjc25) ;

中山大学临床研究5010 项目基金 (2016005) DOI: 10.3760/cma.j.issn.1671?0274.2019.06.001 Chinese consensus on transanal endoscopic surgery(2019 version) Chinese Society of Transanal Total Mesoretal Excision(CSTa) , Chinese Society of Colon and Rectal Surgeons (CSCRS) , Chinese Transanal Endoscopic Surgery College (CTESC) Corresponding author:Wang Jianping,Email:wangjpgz@126. com, Tel: 020?38254020 【Abstract】 With the promotion of transanal total mesorectal excision(taTME)nationwide,transanal endoscopic surgery has become more and more widely used. However, at present, there is still a situation in the domestic colorectal surgery community that is not uniform,in ? depth and not standardized in the understanding of the issues related to transanal endoscopic surgery. In order to clarify the key issues of transanal endoscopic surgery, including definition, indications, contraindications, surgical classification, basic principles of surgery, prevention and treatment of 扫码阅读电子版

501 中华胃肠外科杂志

2019 年6月第

22 卷第

6 期Chin J Gastrointest Surg,June 2019,Vol.22,No.6 complications,the experts of the writing committee based on the existing evidence combined with clinical practice to verify the definition of transanal endoscopic surgery,indications, contraindications and surgical classification, by means of voting for key issues such as intraoperative sterility, no tumor principle,surgical quality control,specimen removal method, digestive tract reconstruction, how to solve intraoperative pressure instability,how to ensure the safety of anastomosis, and prevention and treatment of complications, aiming at providing guidance for transanal endoscopic surgery in China. 【Key words】 Natural orifice translumenal endoscopic surgery;

Transnal total mesorectal excision;

Transanal endoscopic surgery Fund program:Fundamental Research Funds for the Central Universities (16ykjc25);

Project

5010 for Clinical Research of Sun Yat?sen University(2016005) DOI: 10.3760/cma.j.issn.1671?0274.2019.06.001 经肛结直肠手术已有较长的历史.在经肛入路上应用 腔镜器械设备进行手术源于

20 世纪

80 年代, Gerhard Buess 研发了一种起初用于直肠良性病变的经肛手术系统, 即经肛 内镜显微手术 (transanal endoscopic microsurgery, TEM) .该 技术利用特殊的器械置入肛门, 在3D 显微目镜下切除直肠 良性肿瘤和早期癌, 显著提高了直肠病变局部切除手术的质 量[1?2] .随着 TEM 技术的成熟及经自然腔道内镜外科手术 (natural orifice transluminal endoscopic surgery, NOTES) 理念 的推广, Whiteford 等[3] 于2007 年开始尝试采用 TEM 平台进 行直肠癌根治术的动物及尸体实验.由于TEM平台安装较 为复杂, Atallah 等[4] 于2010 年尝试采用单孔腹腔镜装置, 成 功进行了经肛微创手术 (transanal minimally invasive surgery, TAMIS) , 操作简便易行.随后, 各种适用于经肛腔镜手术的 单孔操作平台研发成功.2010年, Sylla等[5] 率先报道了腹腔 镜辅助下应用TEM平台进行直肠癌根治手术的临床应用研 究.同年, 我国陈远光教授开展国内第一例腹腔镜辅助下经 肛直肠癌根治手术[6] ;

2012 年, 张浩教授首先报道完全经肛 直肠癌根治手术[7?8] .随后, 该手术逐渐被称为经肛全直肠 系膜切除术(transanal total mesorectal excision, taTME) [9] . 2014年起, 汪建平教授在国内系统性开展该手术, 随之在国 内逐渐普及[10?11] .目前认为该术式对于经腹操作困难的中 低位直肠癌患者, 由于能充分保证肿瘤下切缘, 且可能具有 手术切除质量高、 环周切缘阳性率低等优势, 被认为是未来 低位直肠癌手术的发展方向之一[12?15] .当前结直肠外科医 生采用各种单孔平台、 应用腔镜技术经肛入路处理各类结直 肠疾病的手术日益广泛, 国际上目前普遍将........