论直肠癌保肛手术前后肛门结构和功能评估的重要性

随着术式的不断改进和术前同步放化疗被广泛接受,直肠癌低位保肛率在增加。放化疗和手术都会对肛门结构、功能造成损伤。术前对肛门结构和功能没有评估,即使保留部分肛门结构,也会出现功能严重损害或无效肛门,达不到“精准保肛”的目的。肛门评估可在术前为采取适当保肛术式,对比手术前后肛门结构、功能差异,术后明确肛门损伤程度和原因提供依据;为医源性损伤造成的肛门功能障碍选择适当的治疗方案。结直肠外科医师应该重视和接受对直肠癌保肛手术前后肛门功能和结构全面评估的理念。随着外科学的发展,直肠癌保肛手术也一定会进入更加精准和个体化的时代。

The importance of anal structure and function evaluation before and after anus preserving surgery for rectal cancer

The rate of low anal sphincter preservation in rectal cancer is increasing with the improvement of surgical technology and the wide acceptance of preoperative concurrent chemoradiotherapy.It is knows that radiotherapy,chemotherapy and operation will damage the structure and function of anus.It would cause severe functional damage or ineffective anus while no evaluation of anal structure and function before operation,even if part of the anal structure is remained It can't achieve the goal of“accurate sphincter preservation”.Anal evaluation can provide the basis for taking appropriate surgical operation,comparing the differences of anal structure and function before and after operation,and clarifying the degree and cause of anal damage after operation;and selecting appropriate treatment for anal dysfunction caused by iatrogenic injury.The concept of comprehensive evaluation of anal function and structure before and after sphincter-preserving surgery for rectal cancer should be focused and accepted by colorectal surgeons.With the development of surgery,sphincter-preserving surgery for rectal cancer will enter a more accurate and individualized era.