低位直肠癌功能性保肛：理论与实践的跨越
闻荻豪负责撰写；周乐其负责文献查阅；张卫负责指导与审查。所有作者均阅读并确认最终稿。
收稿日期: 2026-01-20
网络出版日期: 2026-06-23
基金资助
国家自然科学基金(82473439);国家自然科学基金(82503486);上海市2025年度科技产业高质量发展计划“创新药械产品应用示范”项目(25SF1901500);河北省卫生健康委员会医学科学研究课题计划项目(20240577)
Theoretical and practical breakthroughs in functional sphincter preservation for low rectal cancer
Received date: 2026-01-20
Online published: 2026-06-23
低位直肠癌的治疗已从追求根治的“保命”时代到“保肛门”再到“保功能”的新纪元。这一跨越源于外科理念、技术与治疗模式的系统性革新。外科理念上，远切缘安全距离从传统“5 cm原则”过渡为当代“1 cm原则”，推动了保肛术式的发展，并使决策核心从“解剖性保肛”升华为“功能性保肛”。技术上，腹腔镜与机器人手术实现了微创精准操作，吻合器械的进步保障了深部盆腔吻合的可靠性。新辅助治疗模式从传统放化疗演进为全程新辅助治疗(TNT)及免疫治疗，显著提高了病理完全缓解(pCR)率，为“等待观察”策略奠定了科学基础。影像组学则助力于术前精准评估。系统整合最新理论进展，平稳应用于实践，构建标准化诊疗体系，最终在确保肿瘤学安全的前提下，为每位病人定制低位直肠癌治疗个体化方案，实现从“治愈疾病”到“治愈病人”的终极目标。
闻荻豪 , 周乐其 , 张卫 . 低位直肠癌功能性保肛：理论与实践的跨越[J]. 外科理论与实践, 2026 , 31(02) : 114 -120 . DOI: 10.16139/j.1007-9610.2026.02.04
The management of low rectal cancer has evolved from a radical "life-saving" paradigm through an era of sphincter preservation into a new epoch prioritizing function preservation, representing a transformative leap rooted in systematic innovations across surgical philosophy, technological capabilities, and therapeutic procedures. This evolution is epitomized by the revolutionary refinement of safe distal resection margins from the traditional "5-cm principle" to the contemporary "1-cm principle", which has catalyzed the development of sphincter-preserving procedures while fundamentally elevating the decision-making paradigm from "anatomic sphincter preservation" to the more sophisticated concept of "functional sphincter preservation". Technically, laparoscopic and robotic surgeries have achieved minimally invasive and precise operations, and the advancement of surgical instruments has ensured the reliability of deep pelvic anastomosis. The neoadjuvant therapy model has evolved from traditional radiotherapy and chemotherapy to total neoadjuvant therapy (TNT) and immunotherapy, significantly improving the rate of pathological complete response (pCR), laying a scientific foundation for the "watch-and-wait" strategy. Radiomics contribute to the precise preoperative assessment. The ultimate aim is to comprehensively integrate the latest theoretical advancements, smoothly applies them to practice, builds a standardized diagnosis and treatment system. Ultimately, while ensuring the safety of oncology, this initiative will customize individualized treatment plans for each patient of low rectal cancer, shifting the paradigm from merely "curing the disease" to "healing the patient".
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