基于解剖学视角的经括约肌间切除术中国与国际专家共识比较与解读

Comparison and interpretation of Chinese and international expert consensuses on intersphincteric resection from an anatomical perspective

摘要:

经括约肌间切除术（ISR）是低位直肠癌重要的极限保肛术式。随着ISR相关解剖学研究及微创技术的发展，国内外相继发布专家共识以规范其临床应用。2023年，经括约肌间切除术国际标准化与优化组织（ISOG-ISR）发布改良德尔菲共识，对ISR的解剖学基础、定义、适应证、手术技术及功能学评估进行了规范化阐述；同年，中华医学会外科学分会结直肠外科学组发布《低位直肠癌经括约肌间切除术中国专家共识（2023版）》，结合我国临床实践经验，对ISR的解剖结构、围手术期管理及远期结局进行了系统总结。本文基于解剖学视角，对中外ISR专家共识进行比较解读，重点围绕ISR定义、括约肌间隙相关解剖、适应证与禁忌证、手术入路与技术细节、切缘评估及术后功能学结局等方面展开分析，并结合近年来关于括约肌间隙复合体等新解剖学概念的研究进展，探讨不同共识之间差异形成的解剖学基础及其临床意义，以期为ISR的规范化实施与精准化发展提供参考。

Abstract:

Intersphincteric resection (ISR) has become an important ultimate sphincter-preserving procedure for low rectal cancer. With advances in anatomical understanding and minimally invasive techniques, several expert consensuses have been published worldwide to standardize ISR. In 2023, the International Standardization and Optimization Group for Intersphincteric Resection (ISOG-ISR) released a modified Delphi consensus that systematically addressed the anatomical basis, definition, indications, surgical techniques, and functional assessment of ISR. In the same year, the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association published the Chinese expert consensus on intersphincteric resection for low rectal cancer (2023 edition), integrating current evidence with Chinese clinical practice to summarize key anatomical concepts, perioperative management, and long-term outcomes. From an anatomical perspective, this article provides a comparative interpretation of the domestic and international consensuses, focusing on the definition of ISR, intersphincteric anatomy, indications and contraindications, surgical approaches and technical details, margin assessment, and postoperative functional outcomes. In addition, recent advances involving novel concepts such as the intersphincteric complex are discussed to further analyze the anatomical basis underlying the differences between the consensuses and their potential surgical implications. This review aims to provide references for the standardized and precision-oriented development of ISR.