直肠癌的外科治疗进展

本文介绍直肠癌外科治疗的进展，探讨直肠癌外科治疗方面的一些重要问题，如保肛、膀胱和性功能的损伤和术后复发三个主要的难点。对于直肠癌手术的切缘问题、全系膜切除的概念、局部切除的手术指征、侧方淋巴结清扫的必要性以及直肠癌切除后结肠袋的重建等保肛手术，应把肿瘤的根治始终放在第一位，在不降低根治原则的前提下最大限度的提高保肛机率，应保证足够的下切缘和环形切缘；保护盆腔自主神经的手术的开展有利于减少膀胱和性功能的损伤；直肠癌的局部复发有很多因素值得考虑；直肠全系膜切除大大减少了直肠手术后的局部复发率；直肠肿瘤的局部切除应注意避免指征的过度扩大和缩小；侧方淋巴结清扫宜选择性开展；直肠癌切除后结肠袋的重建具有一定价值。

Advances in surgery of rectal cancer

To introduce the advances in surgery of rectal cancer and to discuss some of its critical issues. Preserving the anus, diminishing the damage of urinary and sexual function and reducing recurrence are the three major difficulties in surgery of rectal cancer. The surgical margin, the concept of TME, the indication of local surgery, the necessity of pelvic lymphonodectomy and the reconstruction of the colonic sack are important problems in the surgery of rectal cancer.The surgery for preserving the anal function should not go against the fundamental principle of radical surgery. The distal and circumferential margin must be enough. The impairment of urinary and sexual function can be reduced by protecting the pelvic autonomic nerves. There are many factors contributing to the relapse of rectal cancer. TME can reduce markedly recurrence of rectal cancer. The trend of either over-expanding or over-shrinking the indication of local surgery of rectal cancer should be avoided. The extensive dissection of pelvic lymph nodes should be selective. The reconstruction of the colonic sack is valuable to some extent.