探讨近端直肠预离断技术(pre-disconnection technique，PDT)联合3D腹腔镜镜头翻转技术在低位直肠癌经括约肌间切除术(intersphincteric resection，ISR)中的应用可行性及安全性。

回顾分析2022年3月至2025年3月收治的52例困难骨盆低位直肠癌患者的临床资料。记录并分析患者手术情况(手术时间、出血量、预防性造口率等)、术后并发症(吻合口瘘、吻合口出血等)、术后恢复情况(首次肛门排气时间、总住院时间等)及随访数据、术后病理结果(环周切缘情况、脱落细胞检查等)。

所有患者均成功实施腹腔镜手术，均保留肛门，无术中死亡及中转开腹。平均手术时间为(169.0±43.5)min，平均术中出血量为(75.0±37.7)ml，两例预防性造口。术后总体并发症发生率为1.9%，包括吻合口瘘1例，行二次手术治疗。术后恢复情况，首次肛门排气时间为(2.8±0.9)d，总住院时间为(11.2±4.3)d。中位随访12个月，术后1年总体生存率为100%，无瘤生存率为100%，肛门保留率达100%。术后病理检查显示所有切缘(近端、远端及预离断切缘)均为阴性，近端切缘距离为(11.0±1.2)cm，远端切缘距离为(1.5±0.3)cm，腹腔灌洗液细胞学及细菌培养结果均为阴性。

基于52例病例分析，PDT联合3D腹腔镜镜头翻转技术在低位直肠癌ISR术中的应用是一种安全、可行的技术，具有术中视野清晰、操作便利的优点，能在保证肿瘤根治性的同时实现良好的肛门保留，近期肿瘤学结局满意，是一种在ISR手术中值得推广的技术。

Feasibility and safety of proximal rectal pre-disconnection technique (PDT) combined with 3D laparoscopic camera inversion technique in intersphincteric resection for low rectal cancer.

A retrospective analysis was performed on the clinical data of 52 patients with low rectal cancer and a narrow pelvis treated between Mar. 2022 and Mar. 2025. Surgical outcomes (operation time, blood loss, protective stoma rate), postoperative complications (anastomotic leakage, anastomotic bleeding), postoperative recovery (time to first flatus, length of hospital stay), follow-up data, and pathological findings (circumferential resection margin, cytology of peritoneal lavage) were recorded and analyzed.

All patients successfully underwent laparoscopic ISR with anal sphincter preservation, with no intraoperative death or conversion to open surgery. The mean operation time was 169.0 ± 43.5 minutes, and mean intraoperative blood loss was 75.0 ± 37.7 mL. Two patients required a protective stoma. The overall postoperative complication rate was 1.9%, including one case of anastomotic leakage that required reoperation. The mean time to first flatus was 2.8 ± 0.9 days, and the mean length of hospital stay was 11.2 ± 4.3 days. After a median follow-up of 12 months, the 1-year overall survival rate and disease-free survival rate were both 100%, with a 100% sphincter preservation rate. Pathological examination confirmed negative proximal, distal, and pre-disconnection margins. The mean proximal margin was 11.0 ± 1.2 cm, and the distal margin was 1.5 ± 0.3 cm. Cytological and bacteriological examinations of peritoneal lavage fluid were negative.

Based on the analysis of 52 cases, the application of PDT combined with 3D laparoscopic camera inversion technique in ISR for low rectal cancer proves to be a safe and feasible approach. This technique demonstrates advantages of providing clear intraoperative visualization and facilitating surgical manipulation. While ensuring oncological radicality, it achieves satisfactory sphincter preservation with favorable short-term oncological outcomes. This technique represents a valuable and recommendable option for ISR procedures.