从解剖、功能与肿瘤学平衡角度分析超低位直肠癌适形经括约肌间切除术的价值OA

Conformal Intersphincteric Resection(ISR)repre-sents an evolution in the surgical philosophy for ultralow rectal cancer,shifting from the paradigm of"maximal sphincter pres-ervation"to that of"functional sphincter preservation."At its core,the procedure involves a precise,tumor-conformal exci-sion and reconstruction based on the individualized pattern of tumor invasion into the anal sphincter complex,aiming to bal-ance radical oncological clearance with functional preserva-tion.The surgery achieves this through a conformal incision,three-dimensional dissection within the intersphincteric plane,and a precise"rendezvous"between the abdominal and perineal approaches.This ensures complete tumor removal while maximally protecting the external sphincter-puborectalis complex,which is critical for active continence.The successful implementation of conformal ISR integrates three principal ob-jectives:oncological radicality,anatomical precision,and func-tional preservation.It relies on meticulous preoperative plan-ning,millimeter-accurate intraoperative technique,and func-tion-oriented perioperative management.With advances in minimally invasive and navigation technologies,conformal ISR is progressing toward greater precision,offering more patients the potential to achieve the dual goals of cancer cure and func-tional preservation.