低位直肠癌机器人腹腔内直视下切断下切缘行全直肠系膜切除术，探索该术式的疗效及优势。

回顾2020年5～12月江苏省中医院采用机器人腹腔内直视下低位直肠癌根治术保肛治疗3例患者的临床资料，平均年龄65.7岁。术前患者全部确诊为直肠癌，肿瘤下缘距肛缘2.0～3.5 cm，均未累及肛管。

3例手术均顺利完成，术中未中转开腹及增加操作通道。手术时间平均约290 min，术中出血量平均约80 ml。术后2 h，患者麻醉清醒后即可进少量流食。均在术后1 d拔除导尿管，自行排尿顺畅，无尿潴留表现。术后肛门排气时间平均约1.8 d，术后住院时间平均4.8 d。标本下切缘及中低位直肠癌环周切缘均为阴性，下切缘距肿瘤距离平均1.8 cm。术后3个月肛门指检及肠镜检查吻合口愈合良好。所有患者按计划均顺利完成造口还纳。术后患者肛门控便功能良好，无术后局部吻合口周围感染、吻合口出血、吻合口瘘及狭窄等并发症。

低位直肠癌根治行保肛手术，在机器人腹腔内直视下切断下切缘技术行之有效，是低位直肠癌根治保肛手术的一种有益尝试，临床结果良好，值得进一步研究应用。

To explore the curative effect and advantages of the new surgical procedure for low rectal cancer by robotic intraabdominal incision of the lower margin and total mesorectal excision(TME).

3 patients, with an average age of 65.7 years, were treated with robotic laparoscopic radical anal preservation for low rectal cancer in Jiangsu Hospital of Traditional Chinese Medicine from May to Dec. 2020. The clinical data of these patients were reviewed. All the patients were diagnosed with rectal cancer preoperatively, and the lower margin of the tumor was 2.0-3.5 cm from the anal margin, and no anal canal was involved.

The operation of 3 patients was completed successfully, and there was no transfer to laparotomy or increase of operation channel. The average operation time was about 290 min, and the average intraoperative bleeding was about 80 ml. Two hours after the operation, a small amount of fluid diet can be entered after anesthesia awake. All the patients had their catheters removed on the first day after surgery and urinated smoothly without urinary retention. The average postoperative anal exhaust time was about 1.8 days, and the average postoperative hospital stay was 4.8 days. The lower margin and CRM margin of the specimen pathological examination were negative, and the average distance from the lower margin to the tumor was 1.8 cm. The anastomosis healed well by digital anal examination and colonoscopy 3 months after operation. All patients successfully completed stoma closed as planned. The patients had good anal defecation function after operation, and no postoperative complications such as local infection around the anastomotic site, anastomotic bleeding, anastomotic fistula and stenosis occurred.

The technique of cutting off the lower margin under robot′s direct vision in the abdominal cavity is effective for the radical resection of low rectal cancer with anal preserving, which is a beneficial attempt for the operation of low rectal cancer. The clinical results are good, and it is worthy of further study and application.