引用文本：李聪, 宋望, 李天宇, 等. 适形括约肌间切除技术在低位直肠癌保肛治疗中的应用及要点[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(2): 302-308.

作者：李聪，宋望，李天宇，王胜

单位：复旦大学附属肿瘤医院大肠外科，上海 200032

Authors：Li Cong, Song Wang, Li Tianyu, Wang Sheng

Unit：Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China

摘要：

括约肌间切除术（intersphincteric resection, ISR）是最主要的极限保肛手术之一，因其既能极限保肛又具有和经腹会阴联合切除术相同的肿瘤学效果，近年来越来越受到外科同道的重视。但由于ISR切除了直肠周围最重要的直肠黏膜、感受器及神经等，术后总体肛门功能较差，影响其临床应用。近年来笔者团队开展适形ISR，尽量保留健侧直肠，临床实践证实其具有保肛又保功能的优点。由于此类手术在国内较少开展，因此，本文对适形ISR相关操作步骤、技巧及解剖标志进行阐述，以促进该技术的规范开展。

关键词：直肠癌；超低位直肠癌；适形括约肌间切除术；适形保肛手术；低位前切除综合征

Abstract：

Intersphincteric resection (ISR) represents one of the primary approaches for sphincter-preserving surgery in low rectal cancer, increasingly recognized among colorectal surgeons due to its potential to achieve maximal sphincter preservation and oncological outcomes comparable to abdominoperineal resection. Nevertheless, conventional ISR involves the excision of critical perirectal structures such as rectal mucosa, sensory receptors and associated neural components, leading to compromised postoperative anal function and thereby limiting its broader clinical application. Recently, the authors' group introduced conformal ISR (CISR), a technique aimed at maximal preservation of the unaffected rectal wall. Clinical practice has demonstrated that CISR effectively preserves both sphincter integrity and postoperative anal function. Given the limited application of CISR in China, this article systematically elaborates on the operative procedures, technical considerations and relevant anatomical landmarks, thereby promoting the standardized implementation of this surgical approach.

Key words：Rectal cancer；Ultralow rectal cancer；Conformal intersphincteric resection；Conformal sphincter preservation operation；Low anterior resection syndrome

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