直肠癌手术时充分、广泛地清除肿瘤近侧之肠管、系膜一般无大困难,但肿瘤远侧肠管、系膜的切除则往往受限。切除过多则无法保留肛门,切除不足则又可能留下日后癌症复发的隐患。传统的直肠癌保肛手术时肿瘤远侧肠管(包括其系膜)至少切除5cm的观点在近十几年来已有争议。认为安全远切缘(远切缘至癌下缘的距离)大于2cm已可的观点正趋风行。又加近十几年来吻合器的改进和推广应用,使盆腔中低位的吻合易于进行。故保肛手术的应用显著增加。但随之而来临床上见到保肛术后局部复发的病人已明显增加。1994年4月杭州召开的全国直肠癌保肛手术专题研讨会上,尽管不少作者报告局部复发率为10%左右,但报告高达25%～37%者也不少见。Malmberg收集的8篇报告中,局部复发率为0～32.4%,其中4篇在 In the operation of rectal cancer, it is generally not difficult to adequately and extensively remove the bowel and mesentery in the proximal part of the tumor, but the resection of the distal bowel and mesentery of the tumor is often limited. Excessive resection can not retain the anus, insufficient resection may leave the risk of cancer recurrence in the future. In traditional rectal cancer surgery, the point that the tumor’s distal bowel (including its mesentery) is excised at least 5 cm during sphincter preservation surgery has been controversial for more than a decade. It is considered that the view that the safety margin (distance from the distal edge to the lower edge of the cancer) is more than 2 cm is becoming popular. In addition, the improvement and popularization of the stapler have been added over the past decade, making the low and middle pelvic anastomosis easy to perform. Therefore, the use of sphincter preservation surgery has increased significantly. However, it has been clinically seen that patients with local recurrence after anal sphincter repair have significantly increased. At the national symposium on rectal cancer surgery held in Hangzhou in April 1994, although many authors reported that the local recurrence rate was about 10%, it was not uncommon for the report to be as high as 25% to 37%. In 8 reports collected by Malmberg, the local recurrence rate was 0 to 32.4%, of which 4 were