腹腔镜直肠系膜全切除术难点和争议

腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌仍然限于临床研究，其原因是腹腔镜TME难度大、直肠末端裸化困难及难以保证远切端切缘阴性，在肥胖及盆腔小的患者中尤为明显。但越来越多的临床试验证明腹腔镜TME可达到与开腹手术同样的根治效果，并具有创伤小、术后恢复快和并发症少等优点。因此有必要对TME的难点和争议进行探讨，有助于进一步提高对腹腔镜TME的认识。

The difficulties and disputes on laparoscopic total mesorectal excision

Laparoscopic total mesorectal excision(TME) for mid/low rectal carcinoma is still not regularly recommended without clinical research,because of its difficulties in laparoscopic operation,mobilization of the rectal end and attainment of negative distal resection margin,especially in the fatty patient and the patient with small pelvic cavity.Compared to open surgery,laparoscopic TME has the same surgical and oncological outcomes with the advantages of minimal invasion,faster recovery and fewer complications,proved by more and more clinical trials.To further improve the knowledge on laparoscopic TME,the difficulties and disputes on laparoscopic TME are under discussion in this article.